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  1. Fiscal Year 2009 Senate Appropriations Bill Health and Human Services Dental Provisions Background: The Senate Appropriations Committee approved a Labor-Health and Human Services (Labor-HHS) allocation of $153.139 billion, which is a $7.991 billion (5.5 percent) increase above the fiscal year 2008 allocation, and nearly $7.8 billion more than the President’s budget request. The committee allocated $195.537 million for Title VII, a $1.58 million (0.8 percent) increase above fiscal year 2008, including a slight increase for the Primary Care Medicine and Dentistry programs ($48.851 million, up from $47.998 million in fiscal year 2008) and an increase for the Public Health, Preventive Medicine and Dental Public Health programs ($9 million, up from $8.273 million in fiscal year 2008). The House Appropriations Committee abruptly cut short consideration of its Labor-HHS bill after Republicans tried to force votes on amendments related to the expansion of domestic oil production. Efforts by Republicans to force consideration of the Interior bill to address rising fuel prices caused chaos, and Democrats opted to vote to adjourn. The bill, which the Subcommittee previously had approved, provided a $1.2 billion increase to last year’s budget (the largest in six years). Further, the panel rejected the Administration’s proposal to eliminate funding for Title VII health professions education and provides $244.1 million for these programs, a $50.2 million (25.9 percent) increase from last year. Below are excerpts from the Senate Committee report and the draft House bill. Senate Committee Report Health Resources and Services Administration (HRSA) The Committee provides a program level of $6.968 billion for the HRSA. The fiscal year 2008 comparable program level is $6.881 billion, and the budget request for fiscal year 2009 was $5.889 million. Community Health Centers (CHC) The Committee provides $2.215 billion for the CHC program. The fiscal year 2008 comparable program level is $2.065 billion, and the budget request for fiscal year 2009 is $2.091 million. Title VII Health Professions Program The Committee provides $363.189 million for all HRSA health professions programs. The fiscal year 2008 comparable level was $350.003 million, and the budget request for fiscal year 2009 was $109.853 million. Training in Primary Care Medicine and Dentistry Within the Title VII program funding, the Committee provides $48.851 million for training in primary care medicine and dentistry programs. The fiscal year 2008 comparable level is $47.998 million. The budget for fiscal year 2009 did not request funding for this program. The Committee has included bill language funding family medicine activities, general dentistry, and the pediatric dentistry program at no less than last year’s level. Pediatric dentistry residency programs provide both treatments for underprivileged children and training opportunities to address the national shortage of pediatric dentists. Even though it is easily preventable, dental decay is the most common chronic childhood disease in the United States. Children with dental pain fail to function properly in school and their everyday lives, thus impacting their development for years to come. When oral infections go untreated, the proximity to the brain can lead to fatal conditions. August 2008
  2. The Committee has included bill language allowing funds to be used for faculty loan repayment. The Committee encourages HRSA to communicate clearly to applicants that grant funds can be utilized for faculty development and curriculum enhancement, as well as program creation or expansion. Public Health, Preventive Medicine, and Dental Public Health Programs The Committee provides $9 million for these programs. The fiscal year 2008 comparable level was $8.273 million, and the budget request for fiscal year 2009 did not include any funds for this program. This program supports awards to schools of medicine, osteopathic medicine, public health, and dentistry for support of residency training programs in preventive medicine and dental public health, and for financial assistance to trainees enrolled in such programs. Maternal and Child Health Bureau (MCHB) The Committee retains funding for oral health within the MCHB at $4.718 million. The Committee recognizes the critical role that MCHB Centers for Leadership in Pediatric Dentistry Education provide in preparing dentists with dual training in pediatric dentistry and dental public health. Dentists in the three currently funded programs concentrate on working with federal, state, and local programs that provide services for vulnerable populations including low-income children and women and children with special health care needs. Dentists trained through these centers provide state and community leadership in maternal and child oral health programs, and become future faculty and policy leaders specializing in pediatric dentistry and maternal and child health. The Committee encourages the HRSA to explore mechanisms to augment center support with foundation and corporate funds. The Committee continues to encourage the HRSA to expand support of state oral health programs that increase access to oral health services for women and children through sustainable, well integrated statewide programs. The Committee also recognizes the importance of building partnerships between the public and private sectors to assure an adequate workforce to meet the needs of those children and their families most vulnerable to oral disease. The Committee intends that funds provided within the MCHB program be used to support integration of health systems in states and partnerships with national organizations and foundations that focus on early intervention to prevent oral disease. The HRSA is encouraged to utilize grants to accomplish this and formalize relationships with other federal agencies to prevent childhood caries to avoid the need for more costly care. AIDS Dental Services The Committee provides $12.857 million for AIDS dental services, the same as the fiscal year 2008 comparable level and the budget request for fiscal year 2009. This program provides grants to dental schools, dental hygiene schools, and postdoctoral dental education programs to assist with the cost of providing unreimbursed oral health care to patients with HIV disease. Chronic Disease Prevention, Health Promotion, and Genomics The Committee provides $12.422 million for oral health, the same level as fiscal year 2008. The Committee recognizes that to reduce disparities in oral disease will require additional and more effective efforts at the federal, state and local levels. The Committee has provided sufficient funding to continue grants to states that strengthen their capacities to assess the prevalence of oral diseases and the associated health burden; to target resources and interventions—including proven preventive strategies like school-linked sealant programs—to the underserved; and to evaluate changes in policies and programs. The Committee encourages the Centers for Disease Control (CDC) to advance efforts to reduce the health disparities and burden from oral diseases, including those that are linked to chronic diseases. National Institute of Dental and Craniofacial Research (NIDCR) The Committee recommendation includes $401.405 million for the NIDCR. The fiscal year 2008 appropriation was $390.158 million and the budget request is $390.535 million. The Committee supports the Institute’s planned research into developing complex models of behavior and oral health. August 2008
  3. The Committee notes the urgent need to eradicate early childhood caries among American Indian/Alaska Native populations. The Committee urges the NIDCR, in collaboration with the Indian Health Service, to increase support for clinical research to find effective anti-caries preventions, including new education and intervention modalities. The Committee encourages the NIDCR to put a higher priority on using noninvasive imaging technologies to establish, validate and standardize clinical diagnostic criteria for TMJDs and to better understand the etiology and mechanisms underlying the symptoms of biomechanical pain and dysfunction. The Committee also calls on the NIDCR to initiate interdisciplinary partnerships within the NIH on chronic pain that is associated not only with TMJDs, but other conditions as well. To address these collaborations extramurally, the Committee urges the NIDCR to follow the recommendation of the Fourth Scientific Meeting of the TMJ Association calling for the establishment of regional centers of excellence. Finally, the Committee calls upon the TMJ Interagency Working Group to increase its level of activities and work more effectively to assess the state of science of TMJDs and their co-morbidities and to develop short- and long-range research plans. Health Care-Related Facilities and Activities The following dental and oral health care projects were included in the Senate bill: Iowa Dental Foundation, Johnston, Iowa, for portable dental equipment: $250,000 La Clinica de Familia, Inc., Las Cruces, N.M., for construction of the Chaparral Dental Center: $775,000 Marquette University, Milwaukee, Wis., for a dental health outreach program: $250,000 Sedgwick County Government, Kansas, to establish an advanced education in general dentistry residency program: $500,000 State of New Mexico, Santa Fe, N.M., to collect and analyze data about the need and potential locations for a dental school within the state: $100,000 University of Louisiana at Monroe, Monroe, La., to purchase a mobile dental unit for use in rural Louisiana: $400,000 Draft House Bill Because the full Appropriations Committee has not taken any formal action on this bill, we do not have a Committee report. However, we did obtain a list of projects included in the Subcommittee bill, as well as some funding levels for certain programs of importance to general dentists. National Institute of Dental and Craniofacial Research (NIDCR) This program was provided $403.958 million—$2 million more than the Senate version. Of this amount, $5 million shall be for general dentistry programs, and not less than $5 million shall be for pediatric dentistry programs. Maternal and Child Health Bureau (MCHB) The bill provides $15 million within the Maternal and Child Health block grant and the allied health program. These grants will expand access to oral health services by encouraging more dentists to practice in shortage areas, expanding or establishing dental health services in community-based facilities, expanding dental residency programs, and creating integrated statewide dental programs. August 2008
  4. Health Care-Related Facilities and Activities The following dental and oral health care projects were included in the draft House bill: American Prosthodontic Society Foundation, Oseceola Mills, Pa., for scholarships and program costs related to prosthetic dentistry and clinical prosthodontics: $100,000 Central Pennsylvania Institute of Science and Technology, Pleasant Gap, Pa., for a dental assistant training program: $400,000 Christus St. Francis Cabrini Hospital, Alexandria, La., for a school dental hygiene program: $200,000 E.A. Hawse Health Center, Baker, W.V., for an oral health care initiative, including facilities and equipment: $200,000 Idaho Caring Foundation for Children, Boise, Idaho, for dental services for low-income children: $300,000 Idaho Oral Health Institute, to provide a center for oral health education, research, and clinical practice: $350,000 Iowa Dental Foundation, Johnston, Iowa, for portable dental equipment: $250,000 Lorain County Health & Dentistry, Lorain, Ohio, for facilities and equipment: $200,000 Marquette University, Milwaukee, Wis., for a dental health outreach program: $250,000 New Mexico Dental Foundation, Albuquerque, N.M., for rural outreach: $200,000 Prince George’s County, Upper Marlboro, Md., for dental equipment: $500,000 Sedgwick Country Government, Kansas, to establish an advanced education in general dentistry residency program: $500,000 University of Louisiana at Monroe, Monroe, La., to purchase a mobile dental unit for use in rural Louisiana: $400,000 Winton Hills Medical and Health Center, Cincinnati, Ohio, for an electronic medical and dental records initiative and dental imaging system: $270,000 August 2008

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