FIRST REGULAR SESSION
SENATE BILL NO. 46
91ST GENERAL ASSEMBLY
INTRODUCED BY SENATOR BENTLEY.
Pre-filed December 1, 2000, and 1,000 copies ordered printed.
TERRY L. SPIELER, Secretary.
0418S.01I
AN ACT
To repeal sections 191.600, 191.603, 191.605, 191.607, 191.609 and 191.614, RSMo 2000, relating to health services in underserved areas, and to enact in lieu thereof seven new sections relating to the same subject.
Be it enacted by the General Assembly of the State of Missouri, as follows:
Section A. Sections 191.600, 191.603, 191.605, 191.607, 191.609 and 191.614, RSMo 2000, are repealed and seven new sections enacted in lieu thereof, to be known as sections 191.600, 191.603, 191.605, 191.607, 191.609, 191.614 and 332.324, to read as follows:
191.600. 1. Sections 191.600 to 191.615 establish a loan repayment program for graduates of approved medical schools, schools of osteopathic medicine [and], accredited chiropractic colleges, and dental schools who practice in areas of defined need and shall be known as the "Medical School Loan Repayment Program".
2. The "Medical School Loan and Loan Repayment Program Fund" is hereby created in the state treasury. All funds recovered from an individual pursuant to section 191.614 and all funds generated by loan repayments and penalties received pursuant to section 191.540 shall be credited to the fund. The moneys in the fund shall be used by the department of health to provide loan repayments pursuant to section 191.611 in accordance with sections 191.600 to 191.614 and to provide loans pursuant to sections 191.500 to 191.550.
191.603. As used in sections 191.600 to 191.615, the following terms shall mean: (1) "Areas of defined need", areas designated by the department pursuant to section 191.605, when services of a physician, chiropractor or dentist are needed to improve the patient-doctor ratio in the area, to contribute professional physician, chiropractic or dental services to an area of economic impact, or to contribute professional physician, chiropractic or dental services to an area suffering from the effects of a natural disaster;
(2) "Chiropractor", a person licensed and registered pursuant to chapter 331, RSMo;
(3) "Dentist", a person licensed and registered pursuant to chapter 332, RSMo;
(4) "Department", the department of health;
[(3)] (5) "Primary care physician", physicians licensed and registered pursuant to chapter 334, RSMo, engaged in general or family practice, internal medicine, pediatrics or obstetrics and gynecology as their primary specialties, and who are providing such primary care services to the general population.
191.605. The department shall designate counties, communities, or sections of urban areas as areas of defined need for medical, chiropractic or dental services when such county, community or section of an urban area has, but is not limited to, the following:
(1) A population to primary care physician, chiropractor or dentist ratio of three thousand five hundred to one or more; or
(2) A population to primary care physician, chiropractor or dentist ratio of less than three thousand five hundred to one, but greater than two thousand five hundred to one; and
(a) Has a twenty percent or greater population fifty-five years of age or over; or
(b) Twenty percent of the population or households are below the poverty level; or
(c) If the largest hospital in the area is approximately thirty miles or more from a comparable or larger facility or if the central community in the area is approximately fifteen miles or more from a hospital having more than four thousand discharges a year or more than four hundred deliveries annually; and
(d) Has a community or city of six thousand or more population plus the surrounding area up to a radius of approximately fifteen miles that serves as the central community or an urban or metropolitan neighborhood located within the central city or cities of a standard metropolitan statistical area having limited interaction with contiguous areas and a minimum population of approximately twenty thousand;
(3) Any other community or section of an urban area with unusual circumstances can be evaluated on a case-by-case basis for designation by the department as an area of defined need.
191.607. The department shall adopt and promulgate regulations establishing standards for determining eligible persons for loan repayment under sections 191.600 to 191.615. These standards shall include, but are not limited to the following:
(1) Citizenship or permanent residency in the United States;
(2) Residence in the state of Missouri;
(3) Enrollment as a full-time medical student, chiropractic student or dental student in the final year of a course of study offered by an approved educational institution or licensed to practice medicine or osteopathy pursuant to chapter 334, RSMo, or licensed to practice chiropractic medicine pursuant to chapter 331, RSMo, or licensed to practice dentistry pursuant to chapter 332, RSMo;
(4) Application for loan repayment.
191.609. 1. The department shall enter into a contract with each individual qualifying for repayment of educational loans. The written contract between the department and an individual shall contain, but not be limited to, the following:
(1) An agreement that the state agrees to pay on behalf of the individual loans in accordance with section 191.611 and the individual agrees to serve for a time period equal to two years, or such longer period as the individual may agree to, in an area of defined need, such service period to begin within one year of the signed contract;
(2) A provision that any financial obligations arising out of a contract entered into and any obligation of the individual which is conditioned thereon is contingent upon funds being appropriated for loan repayments;
(3) The area of defined need where the person will practice;
(4) A statement of the damages to which the state is entitled for the individual's breach of the contract;
(5) Such other statements of the rights and liabilities of the department and of the individual not inconsistent with sections 191.600 to 191.615.
2. The department may stipulate specific practice sites contingent upon department generated physician, chiropractor or dentist need priorities where applicants shall agree to practice for the duration of their participation in the program.
191.614. 1. An individual who has entered into a written contract with the department; and in the case of an individual who is enrolled in the final year of a course of study and fails to maintain an acceptable level of academic standing in the educational institution in which such individual is enrolled or voluntarily terminates such enrollment or is dismissed from such educational institution before completion of such course of study or fails to become licensed pursuant to [chapter 334] chapter 331, 332 or 334, RSMo, within one year shall be liable to the state for the amount which has been paid on his or her behalf under the contract.
2. If an individual breaches the written contract of the individual by failing either to begin such individual's service obligation or to complete such service obligation, the state shall be entitled to recover from the individual an amount equal to the sum of:
(1) The total of the amounts prepaid by the state on behalf of the individual;
(2) The interest on the amounts which would be payable if at the time the amounts were paid they were loans bearing interest at the maximum prevailing rate as determined by the Treasurer of the United States;
(3) An amount equal to the unserved obligation penalty, the amount equal to the product number of months of obligated service which were not completed by an individual, multiplied by five hundred dollars.
3. The department may act on behalf of a qualified community to recover from an individual described in subsections 1 and 2 of this section the portion of a loan repayment paid by such community for such individual.
332.324. 1. The department of health may contract with the Missouri dental board to establish a donated dental services program, in conjunction with the provisions of section 332.323, through which volunteer dentists, licensed by the state pursuant to this chapter, will provide comprehensive dental care for needy, disabled, elderly and medically-compromised individuals. Eligible individuals may be treated by the volunteer dentists in their private offices. Eligible individuals may not be required to pay any fees or costs, except for dental laboratory costs.
2. The department of health shall contract with the Missouri dental board, its designee or other qualified organizations experienced in providing similar services or programs, to administer the program.
3. The contract shall specify the responsibilities of the administering organization which may include:
(1) The establishment of a network of volunteer dentists including dental specialists, volunteer dental laboratories and other appropriate volunteer professionals to donate dental services to eligible individuals;
(2) The establishment of a system to refer eligible individuals to appropriate volunteers;
(3) The development and implementation of a public awareness campaign to educate eligible individuals about the availability of the program;
(4) Providing appropriate administrative and technical support to the program;
(5) Submitting an annual report to the department that:
(a) Accounts for all program funds;
(b) Reports the number of individuals served by the program and the number of dentists and dental laboratories participating as providers in the program; and
(c) Reports any other information required by the department;
(6) Performing, as required by the department, any other duty relating to the program.
4. The department shall promulgate rules, pursuant to chapter 536, RSMo, for the implementation of this program and for the determination of eligible individuals. Any rule or portion of a rule, as that term is defined in section 536.010, RSMo, that is created under the authority delegated in this section shall become effective only if it complies with and is subject to all of the provisions of chapter 536, RSMo, and, if applicable, section 536.028, RSMo. This section and chapter 536, RSMo, are nonseverable and if any of the powers vested with the general assembly pursuant to chapter 536, RSMo, to review, to delay the effective date or to disapprove and annul a rule are subsequently held unconstitutional, then the grant of rulemaking authority and any rule proposed or adopted after August 28, 2001, shall be invalid and void.