Summary of the House Committee Version of the Bill


SPONSOR:  Bentley (Barry)

COMMITTEE ACTION:  Voted "do pass" by the Committee on Children,
Families and Health by a vote of 15 to 0.

This substitute contains various provisions pertaining to dental


The substitute allows physicians to administer the appropriate
fluoride treatment to children when they receive their

In addition to exemptions based on religious and medical
contraindications, the substitute allows children to be exempted
from required immunizations if one parent or guardian objects in
writing to the school administrator because of philosophical


The substitute removes language prohibiting the use of general
revenue funds for certain health care programs and initiatives
and allows any other funds to be used for these health care
programs and initiatives.

The substitute also requires the Director of the Department of
Health to include dentists in the development and implementation
of a plan to provide a system of coordinated health care
services accessible to all persons in rural and urban areas of
Missouri, particularly areas designated as health resource
shortage areas.


The substitute renames the Medical School Loan Repayment Program
as the Health Professional Student Loan Repayment Program and
expands its scope to include dentists.  The criteria for areas
of defined need are revised.  Patient ratios, poverty and age
percentages, and distance requirements to hospitals are removed
and replaced with a designation as a shortage area by the U.S.
Department of Health and Human Services or a determination of
extraordinary need by the Director of the Department of Health.
The maximum amount of repayment assistance is revised from its
current level of $20,000 per year of obligated service to an
amount not exceeding the maximum allowed under the National
Health Service Corps Repayment Program.  For students who breach
their service obligation contracts, the penalty of $500 per
month of service not completed is deleted.  Students will be
responsible for damages incurred by the Department of Health
resulting from the breach and legal fees and costs incurred in
the collection of damages.


The substitute allows the Department of Health to provide
literature on the importance of routine dental care for children.

Dentists and dental hygienists who are licensed in another state
can practice in Missouri without an examination or payment of
required fees for a period not exceeding 14 days when providing
gratuitous dental or dental hygienist services.  The requirement
that the services be provided for summer camp is deleted.

The substitute establishes a 5-member Advisory Commission for
Dental Hygienists.  The duties of the commission include
recommending educational requirements for dental hygienist
registration; annually reviewing the practice act of dental
hygienists; providing recommendations to the Missouri Dental
Board concerning the practice, licensure, examination, and
discipline of dental hygienists; and assisting the board in
implementing the dental hygienist provisions of Chapter 332,

Members of the commission will be appointed by the Governor and
approved with the advice and consent of the Senate.  The
requirements, composition, lengths of service, selection of
commission members, and times of commission meetings are stated
in the substitute.  Members of the initial commission are
required to be appointed by April 1, 2002.

Registered and currently licensed dental hygienists who have
been practicing for at least 3 years and who practice in a
public health setting can without the supervision of a licensed
dentist provide fluoride treatments, teeth cleaning, and
sealants, if appropriate, to children who are eligible for
medical assistance under Chapter 208.

By Fiscal Year 2004, the Medicaid program is prohibited from
reimbursing eligible providers who provide fluoride treatments,
teeth cleaning, and sealants to eligible children at a rate less
than 75% of the usual and customary charge as established by the
Division of Medical Services.

Public health settings where a dental hygienist can practice
without the supervision of a licensed dentist will be
established jointly by the Department of Health and the Missouri
Dental Board by rule.  This provision will expire on August 28,

The substitute allows the Department of Health to contract with
the Missouri Dental Board to establish a Donated Dental Services
Program in conjunction with the provisions of Section 332.323.

Licensed volunteer dentists will provide comprehensive dental
care for the needy, disabled, elderly, and medically compromised
persons.  Dental care can be provided to these persons in a
licensed volunteer dentist's office.  Eligible persons are
required to pay for dental laboratory costs.

The department may contract with the Missouri Dental Board, its
designee, or other qualified organizations to administer the
program.  The substitute also contains provisions specifying the
contractual responsibilities of the organization administering
the program.


The substitute allows the Director of the Department of Social
Services, or a designee, to contract with and to provide funding
support to federally qualified health centers in Missouri.
Funding support is subject to appropriations.

The funding is required to be used to assist the health centers
in ensuring the provision of health care and dental care to
needy persons.  The funds can also be used by the health centers
for capital expansion, infrastructure redesign, or other similar
uses if federal funding is not available for these purposes.

The substitute contains an emergency clause pertaining to the
following:  fluoride treatments and immunizations; dental
awareness for children; gratuitous dental services and dental
hygienists services; dental hygienists services without the
supervision of a licensed dentist; the establishment of an
Advisory Commission for Dental Hygienists; the Donated Dental
Services Program; and funding for federally qualified health

FISCAL NOTE:  Estimated Net Cost to General Revenue Fund could
exceed $391,000 in FY 2002, $393,400 to in excess of $5,393,400
in FY 2003, and $395,872 to in excess of $5,395,872 in FY 2004.
Estimated Net Cost to Dental Board Fund of $10,748 in FY 2002,
$11,052 in FY 2003, and $11,365 in FY 2004.  Estimated Net
Transfer to Healthy Families Trust Fund - Health Care Account of
$0 in FY 2002, $0 to $5,000,000 in FY 2003, and $0 to $5,000,000
in FY 2004.  Estimated Net Cost to Health Initiatives Fund of
Unknown in FY 2002, FY 2003, and FY 2004.  Estimated Net Effect
on Health Access Initiative Fund of $0 in FY 2002, FY 2003, and
FY 2004.  Estimated Net Effect on Medical School Loan and Loan
Repayment Fund of $0 in FY 2002, FY 2003, and FY 2004.

PROPONENTS:  Supporters say that there is an oral health care
crisis in Missouri as a declining number of licensed dentists
practice in Missouri and the number of health care and dental
care shortage areas increases.  The shortage of dentists in
Missouri affects the provision of dental care for private pay
individuals and individuals who receive Medicaid.

Testifying for the bill were Senator Bentley; Missouri Primary
Care Association; Missouri Coalition for Oral Health Access;
Missouri Dental Board; and Missouri Dental Hygienists'

OPPONENTS:  There was no opposition voiced to the committee.

Joseph Deering, Legislative Analyst

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Missouri House of Representatives
Last Updated November 26, 2001 at 11:47 am