II 

108TH CONGRESS 

2D SESSION S. 2740

To improve dental services in underserved areas by amending the Public 

Health Service Act, and for other purposes. 

IN THE SENATE OF THE UNITED STATES 

JULY 22, 2004

Mr. DASCHLE (for himself and Ms. COLLINS) introduced the following bill; 

which was read twice and referred to the Committee on Health, Education, Labor, and Pensions 

A BILL

To improve dental services in underserved areas by amending 

the Public Health Service Act, and for other purposes.

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 

3 SECTION 1. SHORT TITLE; TABLE OF CONTENTS. 

4 (a) SHORT TITLE.—This Act may be cited as the 

5 ‘‘Dental Health Provider Shortage Act’’. 

6 (b) TABLE OF CONTENTS.—The table of contents for 

7 this Act is as follows:

Sec. 1. Short title; table of contents. 

TITLE I—EXPANDED DELIVERY OF DENTAL SERVICES 

Sec. 101. Expansion of dental services offered in underserved areas. 
2

•S 2740 IS 

Sec. 102. Grants for capital expenditures for dental care practices in dental 

health professional shortage areas. 

Sec. 103. Grants for administrative simplification for medicaid providers. 

TITLE II—EXPANSION OF DENTAL TRAINING PROGRAMS 

Sec. 201. Flexible use of training funds for general and pediatric dentistry. 

Sec. 202. Loan repayment for faculty of dental educational programs. 

TITLE III—IMPROVING DELIVERY OF DENTAL SERVICES 

THROUGH THE INDIAN HEALTH SERVICE AND THE NATIONAL 

HEALTH SERVICE CORPS 

Sec. 301. Indian Health Service dental officer multiyear retention bonus. 

Sec. 302. Increase in National Health Service Corps dental training positions. 

Sec. 303. Availability of scholarship and loan repayment programs for National 

Health Service Corps dental hygienists.

1 TITLE I—EXPANDED DELIVERY 

2 OF DENTAL SERVICES 

3 SEC. 101. EXPANSION OF DENTAL SERVICES OFFERED IN 

4 UNDERSERVED AREAS. 

5 Section 330 of the Public Health Service Act (42 

6 U.S.C. 254b) is amended by adding at the end the fol7 lowing: 

8 ‘‘(s) HEALTH CENTER DENTAL ACCESS GRANTS.— 

9 ‘‘(1) GRANT PROGRAM AUTHORIZED.—The Sec10 retary, acting through the Administrator of the 

11 Health Resources and Services Administration, is 

12 authorized to award grants and enter into coopera13 tive agreements, for a period not to exceed 3 years, 

14 to health centers for the purpose of increasing the 

15 number of dental providers associated with the 

16 health centers. 
3

•S 2740 IS 

1 ‘‘(2) AUTHORIZED ACTIVITIES.—A health cen2 ter shall use amounts received under a grant under 

3 this subsection in any fiscal year— 

4 ‘‘(A) for recruitment or retention efforts 

5 targeting the dental health care staff of a 

6 health center; 

7 ‘‘(B) to contract for technical assistance 

8 for the purpose of recruiting or retaining dental 

9 health care staff; or 

10 ‘‘(C) to contract for technical assistance in 

11 preparing contracts with local providers of den12 tal health care to provide dental services for 

13 medically underserved populations. 

14 ‘‘(3) APPLICATION.—Each health center desir15 ing a grant under this subsection shall submit an 

16 application to the Secretary at such time, in such 

17 manner, and containing such information as the Sec18 retary may reasonably require. 

19 ‘‘(t) GRANTS FOR DENTAL CARE FACILITY CAPITAL

20 EXPENDITURES.— 

21 ‘‘(1) GRANT PROGRAM AUTHORIZED.—The Sec22 retary, acting through the Administrator of the 

23 Health Resources and Services Administration, is 

24 authorized to award 1-year grants to health centers 

25 for the purpose of increasing dental health care ca-
4

•S 2740 IS 

1 pabilities by constructing or renovating building 

2 space to provide for dental health care. 

3 ‘‘(2) AUTHORIZED ACTIVITIES.—A health cen4 ter shall use amounts received under a grant under 

5 this subsection in any fiscal year for the construc6 tion or expansion of dental care facilities, includ7 ing— 

8 ‘‘(A) the costs of acquiring or leasing fa9 cilities; 

10 ‘‘(B) the costs of constructing new facili11 ties; 

12 ‘‘(C) the costs of repairing or modernizing 

13 existing facilities; or 

14 ‘‘(D) the purchase or lease of equipment. 

15 ‘‘(3) APPLICATION.—Each health center desir16 ing a grant under this subsection shall submit an 

17 application to the Secretary at such time, in such 

18 manner, and containing such information as the Sec19 retary may reasonably require. 

20 ‘‘(u) GRANTS FOR DENTAL RESIDENCY PRO21 GRAMS.—

22 ‘‘(1) GRANTS AUTHORIZED.—The Secretary is 

23 authorized to award grants to health centers for the 

24 purpose of establishing, at the health centers, new or 

25 alternative-campus accredited dental residency train-
5

•S 2740 IS 

1 ing programs affiliated with accredited dental pro2 grams. 

3 ‘‘(2) AUTHORIZED ACTIVITIES.—A health cen4 ter shall use amounts received under a grant under 

5 this subsection for the costs of establishing a new or 

6 alternative-campus accredited dental residency train7 ing program affiliated with an accredited dental pro8 gram at the health center, including the costs of cur9 riculum development, equipment, and recruitment, 

10 training, and retention of residents and faculty for 

11 such training program. 

12 ‘‘(3) PRIORITY.—The Secretary shall give pri13 ority in awarding grants under this subsection to 

14 health centers in rural areas. 

15 ‘‘(4) APPLICATION.—Each health center desir16 ing a grant under this subsection shall submit an 

17 application to the Secretary at such time, in such 

18 manner, and containing such information as the Sec19 retary may reasonably require. 

20 ‘‘(5) DEFINITION OF ACCREDITED.—

21 ‘‘(A) IN GENERAL.—In this subsection, the 

22 term ‘accredited’, when applied to a dental 

23 training program or a new or alternative-cam24 pus dental residency training program, means a 

25 program that is accredited by a recognized body
6

•S 2740 IS 

1 or bodies approved for such purpose by the Sec2 retary of Education. 

3 ‘‘(B) SPECIAL RULE.—A new dental resi4 dency training program that, by reason of an 

5 insufficient period of operation, is not, at the 

6 time of application for a grant under this sub7 section, eligible for accreditation by such a rec8 ognized body or bodies, shall be deemed accred9 ited for purposes of this subsection, if the Sec10 retary of Education finds, after consultation 

11 with the appropriate accreditation body or bod12 ies, that there is reasonable assurance that the 

13 new dental residency training program will 

14 meet the accreditation standards of such body 

15 or bodies prior to the graduation date of the 

16 first entering class in such program. 

17 ‘‘(C) RULE OF CONSTRUCTION.—The spe18 cial rule for accreditation described in subpara19 graph (B) shall not apply to an alternative-cam20 pus dental residency training program.’’. 
7

•S 2740 IS 

1 SEC. 102. GRANTS FOR CAPITAL EXPENDITURES FOR DEN2 TAL CARE PRACTICES IN DENTAL HEALTH 

3 PROFESSIONAL SHORTAGE AREAS. 

4 Subpart V of part D of title III of the Public Health 

5 Service Act (20 U.S.C. 256 et seq.) is amended by adding 

6 at the end the following: 

7 ‘‘SEC. 340A. GRANTS FOR CAPITAL EXPENDITURES FOR 

8 DENTAL CARE PRACTICES IN DENTAL 

9 HEALTH PROFESSIONAL SHORTAGE AREAS. 

10 ‘‘(a) GRANT PROGRAM AUTHORIZED.—The Sec11 retary, acting through the Administrator of the Health 

12 Resources and Services Administration, is authorized to 

13 award 1-year grants to eligible individuals for the purpose 

14 of increasing dental health care capabilities in dental 

15 health professional shortage areas by constructing or ren16 ovating building space to provide for dental health care. 

17 ‘‘(b) AUTHORIZED ACTIVITIES.—An eligible indi18 vidual shall use amounts received under a grant under this 

19 section in any fiscal year for the construction or expansion 

20 of dental care facilities in dental health professional short21 age areas, including— 

22 ‘‘(1) the costs of acquiring or leasing facilities; 

23 ‘‘(2) the costs of constructing new facilities; 

24 ‘‘(3) the costs of repairing or modernizing exist25 ing facilities; or 

26 ‘‘(4) the purchase or lease of equipment. 
8

•S 2740 IS 

1 ‘‘(c) APPLICATION.—Each eligible individual desiring 

2 a grant under this section shall submit an application to 

3 the Secretary at such time, in such manner, and con4 taining such information as the Secretary may reasonably 

5 require. 

6 ‘‘(d) ELIGIBLE INDIVIDUAL.—To be eligible to re7 ceive a grant under this section, an individual shall be a 

8 dental health professional who is licensed or certified in 

9 accordance with the laws of the State in which such indi10 vidual provides dental services. 

11 ‘‘(e) ELIGIBLE INDIVIDUAL GRANT AGREEMENT.—

12 Each eligible individual who receives a grant under this 

13 section shall enter into an agreement with the Secretary 

14 under which the eligible individual agrees— 

15 ‘‘(1) to practice for 5 years in a dental health 

16 professional shortage area, as determined by the 

17 Secretary; 

18 ‘‘(2) that during the period under paragraph 

19 (1), not less than 25 percent of the patients of such 

20 individual receive assistance— 

21 ‘‘(A) under a State plan under title XIX of 

22 the Social Security Act (42 U.S.C. 1396 et 

23 seq.); or 
9

•S 2740 IS 

1 ‘‘(B) under a State plan under title XXI of 

2 the Social Security Act (42 U.S.C. 1397aa et 

3 seq.); 

4 ‘‘(3) to provide services to patients regardless of 

5 such patients’ ability to pay; 

6 ‘‘(4) to use a sliding payment scale for patients 

7 who are unable to pay the total cost of services; and 

8 ‘‘(5) to repay a pro rata portion of the grant 

9 funds received if the eligible individual fails to prac10 tice in accordance with paragraphs (1) through (4). 

11 ‘‘(f) AUTHORIZATION OF APPROPRIATIONS.—There 

12 is authorized to be appropriated to carry out this section 

13 such sums as may be necessary for each of fiscal years 

14 2005 through 2009.’’. 

15 SEC. 103. GRANTS FOR ADMINISTRATIVE SIMPLIFICATION 

16 FOR MEDICAID PROVIDERS. 

17 (a) AUTHORITY TO AWARD PROVIDER ADMINISTRA18 TIVE SIMPLIFICATION GRANTS.— 

19 (1) IN GENERAL.—The Secretary of Health and 

20 Human Services shall award grants to State agen21 cies responsible for the administration of the State 

22 medicaid program under title XIX of the Social Se23 curity Act (42 U.S.C. 1396 et seq.) for the purpose 

24 of simplifying and automating the procedures appli25 cable to providers of medical assistance under the 
10

•S 2740 IS 

1 State medicaid program in order to encourage pro2 viders to participate in the dental component of such 

3 program. 

4 (2) USE OF FUNDS.—A grant awarded under 

5 this subsection may be used to simplify— 

6 (A) provider enrollment contracts and 

7 processes through such means as providing for 

8 online provider enrollment forms; 

9 (B) preauthorization procedures; 

10 (C) claims remittance and processing; and 

11 (D) any other procedures or requirements 

12 that would reduce the time and expenses nec13 essary for providers to participate in the med14 icaid program. 

15 (3) AUTHORIZATION OF APPROPRIATIONS.—

16 There is authorized to be appropriated to the Sec17 retary of Health and Human Services to award 

18 grants under this subsection such sums as are nec19 essary for fiscal year 2005. 

20 (b) MODEL CONTRACT FOR THE ENROLLMENT OF

21 DENTISTS AS MEDICAID PARTICIPATING PROVIDERS.— 

22 (1) IN GENERAL.—The Secretary of Health and 

23 Human Services shall award grants to eligible enti24 ties to develop, disseminate, and assist with the im25 plementation of a model contract for States to use
11

•S 2740 IS 

1 to enroll dentists as participating providers under 

2 the State medicaid program under title XIX of the 

3 Social Security Act (42 U.S.C. 1396 et seq.). 

4 (2) ELIGIBLE ENTITIES DEFINED.—In this sub5 section, the term ‘‘eligible entities’’ means entities 

6 with expertise in the administration of State med7 icaid programs, which may include the National As8 sociation of State Medicaid Directors. 

9 (3) AUTHORIZATION OF APPROPRIATIONS.—

10 There is authorized to be appropriated to the Sec11 retary of Health and Human Services to award 

12 grants under this subsection such sums as are nec13 essary for fiscal year 2005. 

14 TITLE II—EXPANSION OF 

15 DENTAL TRAINING PROGRAMS 

16 SEC. 201. FLEXIBLE USE OF TRAINING FUNDS FOR GEN17 ERAL AND PEDIATRIC DENTISTRY. 

18 Section 747(a)(6) of the Public Health Service Act 

19 (42 U.S.C. 293k(a)(6)) is amended to read as follows: 

20 ‘‘(6) to plan, develop, or operate a program of 

21 general dentistry or pediatric dentistry, including the 

22 costs of faculty development, curriculum develop23 ment, program administration, financial assistance 

24 to residents in such program, and other functions 

25 critical to building a competent dental workforce.’’. 
12

•S 2740 IS 

1 SEC. 202. LOAN REPAYMENT FOR FACULTY OF DENTAL 

2 EDUCATIONAL PROGRAMS. 

3 Part C of title VII of the Public Health Service Act 

4 (42 U.S.C. 293k et seq.) is amended by inserting after 

5 section 748 the following: 

6 ‘‘SEC. 749. LOAN REPAYMENT FOR FACULTY OF DENTAL 

7 EDUCATIONAL PROGRAMS. 

8 ‘‘(a) ESTABLISHMENT.—The Secretary, acting 

9 through the Administrator of the Health Resources and 

10 Services Administration, shall carry out a program to 

11 repay (by direct payment on behalf of the individual) any 

12 outstanding student loan of an individual who is employed 

13 as a full-time faculty member of a school of dentistry or 

14 an accredited dental education program. 

15 ‘‘(b) LOAN REPAYMENT.—The payments described in 

16 subsection (a) shall be made by the Secretary as follows: 

17 ‘‘(1) Upon completion by the individual for 

18 whom the payments are to be made of the first year 

19 of employment described under subsection (a), the 

20 Secretary shall pay 25 percent of the principal of, 

21 and the interest on, each outstanding student loan. 

22 ‘‘(2) Upon completion by such individual of the 

23 second consecutive year of such employment, the 

24 Secretary shall pay an additional 25 percent of the 

25 principal of, and the interest on, each such loan. 
13

•S 2740 IS 

1 ‘‘(3) Upon completion by such individual of the 

2 third consecutive year of such employment, the Sec3 retary shall pay an additional 35 percent of the prin4 cipal of, and the interest on, each such loan. 

5 ‘‘(c) PRIORITY.—In entering into agreements to 

6 repay outstanding student loans under subsection (a), the 

7 Secretary shall give priority to qualified applicants—

8 ‘‘(1) with the greatest financial need; or 

9 ‘‘(2) who are full-time faculty for an accredited 

10 program of general or pediatric dentistry. 

11 ‘‘(d) REGULATIONS.—The Secretary shall promul12 gate such regulations as may be necessary to carry out 

13 the program under this section. 

14 ‘‘(e) REPORTS.—Not later than 18 months after the 

15 date of enactment of this section, and annually thereafter, 

16 the Secretary shall prepare and submit to Congress a re17 port describing the program carried out under this section, 

18 including—

19 ‘‘(1) the number and amount of loan repay20 ments made; 

21 ‘‘(2) the number of individuals who receive loan 

22 repayment under subsection (a) at each school of 

23 dentistry or accredited dental education program 

24 that employs individuals who receive such loan re25 payment; 
14

•S 2740 IS 

1 ‘‘(3) the demographics of the individuals par2 ticipating in the loan repayment program; and 

3 ‘‘(4) an evaluation of the overall costs and bene4 fits of the loan repayment program. 

5 ‘‘(f) AUTHORIZATION OF APPROPRIATIONS.—There 

6 are authorized to be appropriated to carry out this section 

7 such sums as may be necessary for each of fiscal years 

8 2005 through 2009.’’. 

9 TITLE III—IMPROVING DELIV10 ERY OF DENTAL SERVICES 

11 THROUGH THE INDIAN 

12 HEALTH SERVICE AND THE 

13 NATIONAL HEALTH SERVICE 

14 CORPS 

15 SEC. 301. INDIAN HEALTH SERVICE DENTAL OFFICER 

16 MULTIYEAR RETENTION BONUS. 

17 (a) TERMS AND DEFINITIONS.—In this section: 

18 (1) CREDITABLE SERVICE.—The term ‘‘cred19 itable service’’ includes all periods that a dental offi20 cer spent in graduate dental educational training 

21 programs while not on active duty in the Indian 

22 Health Service and all periods of active duty in the 

23 Indian Health Service as a dental officer. 
15

•S 2740 IS 

1 (2) DENTAL OFFICER.—The term ‘‘dental offi2 cer’’ means an individual in the dental health profes3 sion who is an officer of the Indian Health Service. 

4 (3) DIRECTOR.—The term ‘‘Director’’ means 

5 the Director of the Indian Health Service. 

6 (4) RESIDENCY.—The term ‘‘residency’’ means 

7 a graduate dental educational training program of at 

8 least 12 months leading to a specialty, including 

9 general practice residency or an advanced education 

10 general dentistry. 

11 (5) SPECIALTY.—The term ‘‘specialty’’ means a 

12 dental specialty for which there is an Indian Health 

13 Service specialty code number. 

14 (b) GENERAL AUTHORITY.—The Director may au15 thorize a multiyear retention bonus under this section for 

16 a dental officer of the Indian Health Service who meets 

17 the eligibility requirements of subsection (c) and who exe18 cutes a written agreement to remain on active duty for 

19 2, 3, or 4 years after the completion of any other active 

20 duty service commitment to the Indian Health Service. 

21 (c) ELIGIBILITY REQUIREMENTS.—In addition to the 

22 requirements described under subsection (b), an eligible 

23 dental officer shall—

24 (1) if trained as a dentist—
16

•S 2740 IS 

1 (A) be at or below such grade as the Di2 rector shall determine; 

3 (B) hold the degree of doctor of dentistry 

4 or an equivalent degree; 

5 (C) have completed any active duty service 

6 commitment of the Indian Health Service in7 curred for dental education and training or 

8 have 8 years of creditable service; and 

9 (D) have completed initial residency train10 ing, or be scheduled to complete initial resi11 dency training before September 30 of the fiscal 

12 year in which the dental officer enters into a 

13 multiyear retention bonus service agreement 

14 under this section; or 

15 (2) if trained as a dental hygienist—

16 (A) have graduated from a dental hygiene 

17 educational or training program accredited by 

18 the American Dental Association Commission 

19 on Dental Accreditation (ADA CDA); 

20 (B) hold a certification of successful com21 pletion of the National Board Dental Hygiene 

22 Examination; and 

23 (C) hold an active and current dental hy24 giene license. 

25 (d) MAXIMUM BONUS AMOUNTS.—
17

•S 2740 IS 

1 (1) MAXIMUM BONUS AMOUNTS FOR DEN2 TISTS.—A multiyear retention bonus authorized for 

3 a dental officer who meets the requirements of sub4 section (c)(1) shall not exceed— 

5 (A) $14,000 for a 4-year written agree6 ment; 

7 (B) $8,000 for a 3-year written agreement; 

8 or 

9 (C) $4,000 for a 2-year written agreement. 

10 (2) MAXIMUM BONUS AMOUNTS FOR DENTAL

11 HYGIENISTS.—A multiyear retention bonus author12 ized for a dental officer who meets the requirements 

13 of subsection (c)(2) shall not exceed—

14 (A) $4,000 for a 4-year written agreement; 

15 (B) $2,000 for a 3-year written agreement; 

16 or 

17 (C) $1,000 for a 2-year written agreement. 

18 (e) DISCRETION IN SELECTION PROCESS.—The Di19 rector may, based on the requirements of the Indian 

20 Health Service, decline to offer a multi-year retention 

21 bonus to any specialty that is otherwise eligible, or to re22 strict the length of such a retention bonus contract for 

23 a specialty to less than 4 years. 

24 (f) TERMINATION OF ENTITLEMENT TO MULTIYEAR

25 RETENTION BONUS.— 
18

•S 2740 IS 

1 (1) IN GENERAL.—The Director may terminate, 

2 with cause, a dental officer multiyear retention 

3 bonus agreement with a dental officer under this 

4 section at any time. 

5 (2) PRO RATA RECOUPMENT.—If a dental offi6 cer multiyear retention bonus agreement is termi7 nated under paragraph (1), the unserved portion of 

8 the retention bonus agreement shall be recouped on 

9 a pro rata basis. 

10 (3) REGULATIONS.—The Director shall estab11 lish regulations that— 

12 (A) specify the conditions and procedures 

13 under which termination may take place; and 

14 (B) shall be included in the dental officer 

15 multiyear retention bonus agreement under sub16 section (b). 

17 (g) REFUNDS.— 

18 (1) IN GENERAL.—Prorated refunds shall be re19 quired for sums paid under a retention bonus con20 tract under this section if a dental officer who has 

21 received the retention bonus fails to complete the 

22 total period of service specified in the dental officer 

23 multiyear retention bonus agreement, as conditions 

24 and circumstances warrant. 
19

•S 2740 IS 

1 (2) DEBT TO UNITED STATES.—An obligation 

2 to reimburse the United States imposed under para3 graph (1) is a debt owed to the United States. 

4 (3) NO DISCHARGE IN BANKRUPTCY.—Notwith5 standing any other provision of law, a discharge in 

6 bankruptcy under title 11, United States Code, that 

7 is entered less than 5 years after the termination of 

8 a dental officer multiyear retention bonus agreement 

9 under this section does not discharge the dental offi10 cer who signed such a contract from a debt arising 

11 under the contract or under paragraph (1). 

12 (h) AUTHORIZATION OF APPROPRIATIONS.—There 

13 are authorized to be appropriated to carry out this section 

14 such sums as may be necessary for each of fiscal years 

15 2005 through 2009. 

16 SEC. 302. INCREASE IN NATIONAL HEALTH SERVICE CORPS 

17 DENTAL TRAINING POSITIONS. 

18 (a) IN GENERAL.—The Secretary of Health and 

19 Human Services (referred to in this section as the ‘‘Sec20 retary’’) shall increase the number of dentists in the Na21 tional Health Service Corps (referred to in this section as 

22 the ‘‘Corps’’), as designated in subpart II of part D of 

23 title III of the Public Health Service Act (42 U.S.C. 254d 

24 et seq.), by not less than 100 in each of fiscal years 2005, 

25 2006, and 2007. 
20

•S 2740 IS 

1 (b) AVAILABILITY OF LOAN REPAYMENT AND

2 SCHOLARSHIP PROGRAMS FOR DENTISTS.—The Sec3 retary shall increase the number of Corps dentists selected 

4 for the loan repayment and scholarship programs under 

5 subpart III of part D of title III of the Public Health Serv6 ice Act (42 U.S.C. 254l et seq.) in a sufficient number 

7 to address the demand for such programs by qualified in8 dividuals. 

9 (c) REPORT ON CORPS.—The Secretary shall annu10 ally report to Congress concerning how the Corps is meet11 ing the oral health needs in underserved areas, including 

12 rural, frontier, and border areas. 

13 SEC. 303. AVAILABILITY OF SCHOLARSHIP AND LOAN RE14 PAYMENT PROGRAMS FOR NATIONAL 

15 HEALTH SERVICE CORPS DENTAL HYGIEN16 ISTS. 

17 Section 338A of the Public Health Service Act (42 

18 U.S.C. 254l) is amended—

19 (1) by redesignating subsection (h) as sub20 section (i); and 

21 (2) by inserting after subsection (g) the fol22 lowing: 

23 ‘‘(h) Of the total number of contracts under this sec24 tion and section 338B for each school year that are dedi25 cated to dental hygienists, not less than 20 percent of such 
21

•S 2740 IS 

1 contracts for each such school year shall be entered into 

2 under this section.’’.

Æ