Chapter 3701-58 Dental Hygienist Loan Repayment Program
As used in this chapter:
(A) "Dental practice site" means nonprofit dental clinics or privately owned dental practices that provide services for medicaid recipients and offer sliding fee schedules based on the patient's family income, significantly reduced fees or free care to clients who otherwise could not afford private dental care.
(B) "Dental health resource shortage area" means an area in Ohio that experiences special dental health problems and dentist practice patterns that limit access to dental care as set forth by the director in accordance with rule 3701-58-04 of the Administrative Code.
(C) "Dental hygiene services" means the provision of preventive services provided by licensed dental hygienists under the supervision of a licensed dentist. The provision of dental hygiene services includes a reasonable amount of time for performing administrative tasks related to the services as defined under paragraph (A) of rule 3701-58-03 of the Administrative Code.
(D) "Dental hygienist" means a person who is licensed under Chapter 4715. of the Revised Code to practice dental hygiene.
(E) "Department" means the Ohio department of health.
(F) "Director" means the director of the Ohio department of health or the director's designee.
(G) "Educational expenses" means all or part of the principal and interest of a government or commercial loan which has been taken by an individual and which meets the following criteria:
(1) The expenses were incurred while an individual was enrolled in, for up to a maximum of four years, a college of dental hygiene in the United States accredited by the American dental association commission on dental education to accredit dental hygiene education programs; and
(2) The expenses were incurred for:
(b) Other educational expenses such as fees, books and laboratory expenses, for specific purposes and in amounts determined as reasonable by the director;
(c) Room and board in an amount determined reasonable by the director; and
(d) Loans incurred for educational or education-related expenses that have not already been paid for by the individual or a member of his or her family.
(A) An individual who will not have an outstanding obligation for dental hygiene services to the federal government, a state or other entity at the time of participation in the dental hygienist loan repayment program and meets one of the following requirements may apply for participation in the dental hygienist loan repayment program:
(1) A dental hygiene student enrolled in the final year of dental hygiene school; or
(2) A person who is licensed under Chapter 4715. of the Revised Code to practice dental hygiene in the state of Ohio.
(B) The application shall be submitted by a date and on a form prescribed by the department. The form shall require an applicant to set forth the following information:
(2) Current and permanent mailing address;
(3) Telephone number;
(4) The dental hygiene college the applicant attended, dates attended and verification of attendance;
(5) A summary and verification of the educational expenses for which reimbursement is sought under the dental hygienist loan repayment program;
(6) Verification of United States citizenship or legal alien status;
(7) Verification of license to practice dental hygiene under Chapter 4715. of the Revised Code and proof of good standing; and
(8) Any other information requested by the department.
(C) The director of health shall grant an application for placement in a dental health resource shortage area and participation in the dental hygienist loan repayment program if both of the following apply:
(1) The general assembly has appropriated adequate funds for the dental hygienist loan repayment program; and
(2) The director finds that the applicant is eligible for placement and participation, and that, in accordance with priorities established under rule 3701-58-04 of the Administrative Code, the applicant is needed in a dental health resource shortage area.
(D) Upon granting an application, the director shall notify and enter into discussions with the applicant. The object of the discussions is the placement of the applicant in the dental health resource shortage area which, according to the priorities established under rule 3701-58-04 of the Administrative Code, the applicant is most needed. The department may also refer the applicant to the Ohio dental hygienist's association for assistance in being recruited to a dental practice site within a dental health resource shortage area at which the applicant will agree to be placed.
(E) In the event it is necessary to establish priorities among applicants, the director shall consider the following factors:
(1) The applicant's background and career goals;
(2) The extent to which the applicant's background is similar to the population in the dental health resource shortage area;
(3) The length of time the applicant is willing to provide dental hygiene services in a dental health resource shortage area;
(4) The applicant's expressed interest in staying and working in an underserved area and whose family members are interested in the lifestyle associated with areas of underservice;
(5) The extent to which the applicant has sought or undertaken culturally or economically diverse experiences;
(6) The amount of the loan balance for which the applicant is requesting repayment assistance;
(7) The type of dental practice site as defined in paragraph (A) of rule 3701-58-01 of the Administrative Code;
(8) The location of the dental practice site as defined under paragraph (A) of rule 3701-58-04 of the Administrative Code:
(9) The percentage of individuals served by the dental practice site who participate in the medicaid program established under Chapter 5613. of the Revised Code, and the percentage of individuals who pay sliding fee payments or reduced fees based on the individual's family income;
(10) To ensure an equitable distribution of dental hygienists desiring to practice in a dental health resource shortage area, preference will be given to applicants desiring to practice in a dental health resource shortage area which does not have a dental hygienist placed in the area, either through the Ohio dental hygienist loan reapayment program or through the federal national health service corps scholarship and loan repayment programs.
(F) Each factor listed in paragraph (E) of this rule shall be used by the department to develop scoring criteria which shall be made available to loan repayment applicants as part of the dental hygienist loan repayment program application. Each applicant will be evaluated against the criteria and a score will be given for the applicant's responses to each criterion.
Each applicant will be given a total score. In addition, the department staff may interview applicants to gather responses not easily evaluated from the applicant's written application. The applicants with the highest scores will be recommended for funding provided that funds are authorized and available. The Ohio dentist loan repayment program advisory board shall determine the amounts that will be paid as loan repayments on behalf of participants in the dental hygienist loan repayment program.
If the dental practice site, the director and the applicant agree on the applicant's placement in a particular dental health resource shortage area and the amount of the applicant's educational expenses to be repaid, the applicant shall prepare, sign and deliver to the director a letter of intent agreeing to that placement.
(A) As used in this rule:
(1) "Full-time practice" means working a minimum of forty hours per week for a minimum of forty-five weeks each service year. Practice-related administrative activities may not exceed eight hours per week.
(2) "Part-time practice" means working a minimum of twenty hours and a maximum of thirty-nine hours per week for a minimum of forty-five weeks each service year. Practice-related administrative hours may not exceed four hours per week.
(3) "Provide dental hygiene services without regard to a patient's ability to pay" means that patients with incomes below one hundred per cent of the federal poverty guidelines may not be denied dental services by the dental practice site due to the inability to pay for such services, assuring that any payments or fees for such services will be reduced or waived.
(4) "Teaching activities" means providing clinical education to dental hygiene students regarding the normal course of practice and expertise at the dental practice site specified in the contract. Full-time practitioners may spend up to eight hours per week teaching in the clinical setting at the approved dental practice site. Part-time practitioners may spend up to four hours per week conducting both practice-related administrative activities and teaching in the clinical setting at the approved dental practice site.
In order to qualify as teaching, the dental hygienist must be providing clinical education and supervision of dental hygiene students or clinicians in the approved dental practice site as part of an accredited clinical training program.
All teaching must be conducted in the dental practice site specified in the dental hygienist's contract. If the supervising dental hygienist provides dental hygiene services while the student or clinician observes, the activity should be counted as direct clinical care rather than teaching.
(B) A dental hygienist who has a signed letter of intent under paragraph (F) of the rule 3701-58-02 of the Administrative Code and the department may enter into a contract providing for the dental hygienist's participation in the dental hygienist loan repayment program. The dental hygienist's employer or other funder may also be party to the contract.
(C) The contract shall include all of the following obligations:
(1) Agreement by the dental hygienist to provide dental hygiene services in the dental health resource shortage area identified in a letter of intent for the number of hours and duration specified in the contract;
(2) Agreement by the dental hygienist that, in providing dental hygiene services in the dental health resource shortage area, he or she will do all of the following:
(a) Provide dental hygiene services in a dental practice site approved by the Ohio department of health and agreed upon by the dental hygienist and the director;
(b) Provide dental hygiene services in a dental practice site wherein the supervising dentist or dental practice site meets the conditions prescribed by the "Social Security Act," 49 Stat. 620 (1935), 42 U.S.C.A. as amended (1981) and the Ohio department of medicaid for participation in the medicaid program established under Chapter 5163. of the Revised Code and has entered into a contract with the Ohio department of medicaid and it's contracting managed care plans and provides comprehensive dental services to a percentage of recipients of the medicaid program at the approved dental practice site as defined in paragraph (C)(2)(c) of this rule;
(c) Provide dental hygiene services to a percentage of individuals determined eligible for the medicaid program as defined in paragraph (C)(2)(b) of this rule;
(d) Provide dental hygiene services without regard to a patient's ability to pay as defined under paragraph (A)(3) of this rule.
(3) Agreement by the department as provided in section 3702.965 of the Revised Code, to repay, so long as the dental hygienist performs the service obligation to which he or she has agreed under paragraph (C)(1) of this rule, all or part of the dental hygienist's educational expenses as defined in paragraph (G) of rule 3701-58-01 of the Administrative Code.
(4) Agreement by the dental hygienist to pay the department the following as damages if he or she fails to complete the service obligation to which he or she agreed under paragraph (C)(1) of this rule:
(a) Three times the amount the department has agreed to repay under paragraph (C)(3) of this rule; or
(b) If funds from another source are used to repay a portion of the dental hyginist's loans, damages owed if the dental hygienist fails to complete the service obligation will be the damages specified by the other source of funds, or as outlined in paragraph (C)(4)(a) of this rule, whichever is greater.
(5) If the department assumes the dental hygienist's duty to pay a portion of the loan, the contract shall set forth the amount of each payment.
(D) The contract shall include the following terms as agreed upon by the parties:
(1) The dental hygienist's required length of service in the dental health resource shortage area which must be at least two years for an initial contract. Contracts may be renewed for no more than two additional one-year periods;
(2) The number of hours per week the dental hygienist will be in full-time or part-time practice;
(3) The maximum amount the department will repay on behalf of the dental hygienist; and
(4) The extent to which the dental hygienist's teaching activities as defined under paragraph (A)(4) of this rule will be counted toward the dental hygienist's full-time or part-time practice hours under the contract.
(E) In addition to the terms required under paragraphs (C) and (D) of this rule, the contract may contain other terms agreed upon by the parties.
(A) Dental health resource shortage areas shall include all of the following:
(1) A geographic area, facility (including federally qualified health centers), or population group in this state that has been designated by the United States secretary of health and human services as a dental health professional shortage area under 42 C.F.R. in accordance with Appendix B to 42 C.F.R. Part 5 (1993).
(2) A geographic area, one or more facilities within a particular area, or a population group within a particular area which:
(a) Has a population to dentist ratio exceeding four thousand to one and is in an appalachian county; or
(b) Has a population to dentist ratio exceeding four thousand to one and a minority population which exceeds seventy per cent; or
(c) Has a low-income population (less than or equal to two hundred per cent of federal poverty level) to dentist serving the low-income population (adjusted to full-time equivalent) ratio exceeding four thousand to one; or
(d) Has insufficient capacity, such as unusually long wait time for new patient appointments (more than six weeks for routine dental services) or two-thirds of dentists do not accept new patients; or
(e) Demonstrates the population in the area experiences significant barriers to obtaining dental care.
(3) A free clinic as defined in section 3701.071 of the Revised Code, regardless of whether a clinic is located in a geographic area that is designated as a dental health resource shortage area.
(B) In determining whether to approve an area, facility or population as a dental health resource shortage area, the director shall consider:
(1) Population groups that experience special oral health problems, such as low-income, medicaid, minority, migrant, homeless, nursing home residents and other population groups as determined by the director to have special oral health problems;
(2) Dentist practice patterns that limit access to dental care.
(C) The director shall give priority to the dental health resource shortage areas, based on the following factors, with the population to dentist ratio receiving the highest priority:
(1) Population to dentist ratio in the dental health resource shortage area;
(2) Per cent of the population with incomes below the poverty level or other oral health status indicators of the target population such as community water fluoridation; and
(3) Travel time or distance to the nearest source of care outside of the dental health resource shortage area.