I
107TH CONGRESS
2D SESSION
H. R. 4476
To expand the availability of oral health services by strengthening the dental
workforce in designated underserved areas.
IN THE HOUSE OF REPRESENTATIVES
APRIL 17, 2002
Mr. SANDERS introduced the following bill; which was referred to the
Committee on Energy and Commerce
A BILL
To expand the availability of oral health services by strength-
ening the dental workforce in designated underserved
areas.
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the ‘‘Dental Health Im-
provement Act’’.
SEC. 2. FINDINGS.
Congress finds the following:
(1) Oral and general health are inseparable,
and good dental care is critical to our overall phys-
ical health and well-being.
(2) Although oral health in America has im-
proved dramatically over the last 50 years, these im-
provements have not occurred evenly across all sec-
tors of our population, particularly among low-in-
come individuals and families and people living in
underserved areas.
(3) According to the United States Surgeon
General, an estimated 25,000,000 Americans live in
areas lacking adequate dental care services, and as
many as 11 percent of our Nation’s rural population
has never been to a dentist.
(4) This access problem is exacerbated by the
fact that our dental workforce is aging: more than
20 percent of dentists will retire in the next 10
years, and the number of dental graduates by 2015
may not be enough to replace these retirees. Al-
though dentists have significantly increased their
productivity, there are still distribution problems in
specific geographic areas.
(5) Our Nation’s dental school faculty is also
aging. With retirement being the leading indicator,
faculty shortage issues face United States dental
schools with approximately 400 current vacancies for
unfilled, budgeted positions. United States dental
schools play an important role in improving access
to care to underserved populations.
(6) While the National Health Service Corps
has placed more than 20,000 health care providers
in some of America’s most difficult-to-place inner
city, rural, and frontier communities, the current
funding levels for this program do not begin to meet
the need in these underserved communities for phys-
ical, oral, and mental and behavioral health care
services and should be substantially increased.
(7) According to the United States Surgeon
General, the number of dentists and dental hygien-
ists with obligations to serve in the National Health
Service Corps falls far short of meeting the total
identified need: only about 6 percent of the dental
need in designated underserved areas is currently
being met by this program, and outreach and devel-
opment are critical to future opportunities for
strengthening the dental workforce in designated
dental health professional shortage areas.
SEC. 3. EXPANDING AVAILABILITY OF DENTAL SERVICES.
Part D of title III of the Public Health Service Act
(42 U.S.C. 254b et seq.) is amended by adding at the end
the following:
‘‘Subpart X—Primary Dental Programs
‘‘SEC. 340F. DESIGNATED DENTAL HEALTH PROFESSIONAL
SHORTAGE AREA.
‘‘In this subpart, the term ‘designated dental health
professional shortage area’ means an area, population
group, or facility that is designated by the Secretary as
a dental health professional shortage area under section
332 or designated by the applicable State as having a den-
tal health manpower shortage.
‘‘SEC. 340G. GRANTS FOR INNOVATIVE PROGRAMS.
‘‘(a) GRANT
PROGRAM
AUTHORIZED.—The Sec-
retary, acting through the Administrator of the Health
Resources and Services Administration, is authorized to
award grants to States for the purpose of helping States
develop and implement innovative programs to address the
dental workforce needs of designated dental health profes-
sional shortage areas in a manner that is appropriate to
the State’s individual needs.
‘‘(b) STATE ACTIVITIES.—A State receiving a grant
under subsection (a) may use funds received under the
grant for—
‘‘(1) loan forgiveness and repayment programs
for dentists who—
‘‘(A) practice in designated dental health
professional shortage areas; and
‘‘(B) agree to—
‘‘(i) provide services to patients re-
gardless of such patients’ ability to pay;
and
‘‘(ii) provide a sliding payment scale
for patients who are unable to pay the
total cost of services;
‘‘(2) recruitment and retention efforts;
‘‘(3) grants and low-interest or no-interest loans
to help practitioners who participate in the medicaid
program under title XIX of the Social Security Act
(42 U.S.C. 1396 et seq.) to establish or expand
practices in designated dental health professional
shortage areas by equipping dental offices or sharing
in the overhead costs of such operations;
‘‘(4) the establishment or expansion of dental
residency programs in coordination with accredited
dental training facilities in States without dental
schools;
‘‘(5) programs developed in consultation with
State and local dental societies to expand or estab-
lish oral health services in designated dental health
professional shortage areas, such as—
‘‘(A) the expansion or establishment of a
community-based dental facility, free-standing
dental clinic, consolidated health center dental
facility, school-linked dental facility, or United
States dental school-based facility;
‘‘(B) the establishment of a mobile or port-
able dental clinic; and
‘‘(C) the establishment or expansion of pri-
vate dental services to enhance capacity through
additional equipment or additional hours of op-
eration;
‘‘(6) placement and support of dental students,
residents, and advanced dentistry trainees;
‘‘(7) continuing dental education, including dis-
tance-based education;
‘‘(8) practice support through teledentistry con-
ducted in accordance with existing State laws;
‘‘(9) community-based prevention services such
as water fluoridation and dental sealant programs;
‘‘(10) coordination with local education systems
within the State to foster programs that promote
children going into oral health or science professions;
‘‘(11) the establishment of faculty recruitment
programs at accredited dental training institutions
whose mission includes community outreach and
service and that have a demonstrated record of serv-
ing underserved States;
ing from State or local sources or from community or
other organizations.
‘‘(e) REPORT.—Not later than 5 years after the date
of enactment of the Dental Health Improvement Act, the
Secretary shall prepare and submit to the appropriate
committees of Congress a report containing data relating
to whether grants provided under this section have in-
creased access to dental services in designated dental
health professional shortage areas.
‘‘(f) AUTHORIZATION OF APPROPRIATIONS.—There
is authorized to be appropriated to carry out this section,
$50,000,000 for the 5-fiscal year period beginning with
fiscal year 2003.’’.
SEC. 4. NATIONAL HEALTH SERVICE CORPS.
(a) SCHOLARSHIP
AND LOAN REPAYMENT PRO-
GRAMS.—The Secretary of Health and Human Services,
in consultation with the American Dental Association, the
American Dental Education Association, the American
Dental Hygienists Association, the American Academy of
Pediatric Dentistry, the Association of State and Terri-
torial Dental Directors, and the National Association of
Community Health Centers, shall develop and implement
a plan for increasing the participation of dentists and den-
tal hygienists in the National Health Service Corps’ schol-
arship program under section 338A of the Public Health
Service Act (42 U.S.C. 254l) and the loan repayment pro-
gram under section 338B of such Act (42 U.S.C. 254l–
1).
(b) LOAN REPAYMENT PLAN.—Section 338C of the
Public Health Service Act (42 U.S.C. 254m) is amended
by adding at the end the following:
‘‘(f) Notwithstanding any other provision of this title,
periods of obligated service may be served and fulfilled on
a part time basis if—
‘‘(1) such part time service is agreed to by both
the placement site or sites and the recipient of the
scholarship or loan repayment; and
‘‘(2) the recipient’s total obligation is fulfilled.’’.
(c) SCHOLARSHIP PROGRAMS.—Any scholarship pro-
gram for dental students administered through the Na-
tional Health Service Corps shall meet the following re-
quirements:
(1) AVAILABILITY.—The scholarship program
shall be open to students attending any accredited
dental school or dental hygiene program in the
United States.
(2) PLACEMENT.—The placement of an oral
health provider participating in the scholarship pro-
gram shall be solely based upon community need for
dental services.
(d) SITE DESIGNATION PROCESS.—
(1) IMPROVEMENT
OF
DESIGNATION
PROC-
ESS.—The Administrator of the Health Resources
and Services Administration, in consultation with
the Association of State and Territorial Dental Di-
rectors, dental societies, and other interested parties,
shall—
(A) design and implement procedures to
simplify the process of designating areas, popu-
lation groups, and facilities as dental health
professional shortage areas under section 332
of the Public Health Service Act (42 U.S.C.
254e); and
(B) revise the criteria upon which such
designations are based so that such criteria pro-
vide a more accurate reflection of oral health
care need, particularly in rural areas.
(2) PUBLIC
HEALTH
SERVICE
ACT.—Section
332 of the Public Health Service Act (42 U.S.C.
254e) is amended by adding at the end the fol-
lowing:
‘‘(i) The Administrator of the Health Resources and
Services Administration shall disseminate information
concerning the designation criteria described in subsection
(b) to—
‘‘(1) the Governor of each State;
‘‘(2) the representative of any area, population
group, or facility selected by any such Governor to
receive such information;
‘‘(3) the representative of any area, population
group, or facility that requests such information;
and
‘‘(4) the representative of any area, population
group, or facility determined by the Administrator to
be likely to meet the criteria described in subsection
(b).
‘‘(j) The Administrator of the Health Resources and
Services Administration shall provide technical assistance
to any area, population group, or facility that dem-
onstrates an interest in applying for dental health profes-
sional shortage area designation.’’.
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