Delaware Health Care Commission

Delaware Institute of Dental Education and Research (DIDER)

Board of Directors

Tuesday, May 17, 2011

3:00 p.m.

Herman Holloway Health & Social Services Campus

MainAdministrationBuilding

First Floor Conference Room 198

New Castle

Meeting Minutes

Board Members Present: Louis Rafetto, DMD, Chair;Ryan C. Barnhart, DDS; Lisa Goss, RDH, BS;John J. Lenz, DDS; Brian S. McAllister, DDS; Gregory B. McClure, DMD, MPH; Ray S. Rafetto, DMD; and Wanda Gardiner Smith, DDS.

Staff Attending: Stuart Drowos, Deputy Attorney General; Maureen Laffey, Higher Education Commission;Marlyn Marvel, Community Relations Officer; and Paula Roy, Executive Director.

Call to Order

Chairman Louis Rafetto, DMD called the meeting to order at 3:00 p.m.

Approval of February 15, 2011 Meeting Minutes

Dr. Ryan Barnhartmade a motion that the February 15, 2011meeting minutesbe approved. Dr. Brian McAllister seconded the motion. There was a voice vote. Motion carried.

Action: State Loan Repayment Program

This Loan Repayment Committee met on May 10, 2011.

Funding Updates

The Loan Repayment Program has the following funds available for distribution:

 $ 67,214 available in State DIDER funds through June 30, 2011

Note: Gloria Wu chose not to sign her contract at this time because she did not want to

make thecommitment. She returned the un-executed contract with a letter declining the

award. $25,000.00 reverted back to DIDER funds.

 $ 54,771 available in FY 10 federal matching funds through August 31, 2011

 $ 17,500 available in FY 11 federal matching funds through August 31, 2011

 $100,000 available in ARRA federal matching funds through Sept. 29, 2011

Review of DIDER Applications

The Loan Repayment Committee reviewed the following applications and made the following recommendations.

1. Site: Mercer Dental Associates, 77 Saulsbury Road, Dover, Delaware

19904

 located in a Federally designated dental HPSA

Application: Adam Sydell, DMD / continuation contract

The State Loan Repayment Program awarded Dr. Sydell $70,000.00 for a two year contract which ends July 31, 2011. His debt burden is approximately $267,110.00 (verified)

After receiving a degree in Biology from the University of Charleston (SC) in 2004 and TempleUniversity with a Doctor of Medical Dentistry in 2008, Dr. Sydell completed his residency at Christiana Care in 2009. After obtaining his Delaware license to practice, Dr. Sydell joined the practice of brother-in-law, Sean Mercer, at Mercer Dental Associates in Dover.

 State funds only

Recommendation

The Loan Repayment Committee recommended that Dr. Adam Sydell be awarded loan repayment in the amount of $20,000 for an additional one year extension of his contract to practice at Mercer Dental Associates in Dover.

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Revisiting Applications Placed on ‘HOLD’
(Previous Considerations)

1. Site: Crescent Dental, 129 South West Street, Wilmington, DE

19801

 located in a Federally designated dental HPSA

 applying for loan repayment and capital loanexpenditure reimbursement

 current debt burden is approximately $520,750.00 (verified)

($131,626.84 education loan and $389,122.00 construction and equipment)

Applicant: Syamack Ganjavian, DDS / previously placed on HOLD

Dr. Ganjavian, the son of doctors, was born and raised in Iran. His family came to the U.S. in 1997 and he speaks English, Farsi, and Turkish. Dr. Ganjavian graduated from the University of Maryland-Baltimore College of Dental Surgery in May 2003, and entered the General Practice Residency program at Christiana Care Health System in Wilmington. He has practiced general dentistry in various locations throughout the state, including Delaware correctional facilities, since he completed his residency in July of 2004. In July 2008, he and his wife/business partner, Dr. Zahara Ashrafi, established Crescent Dental in downtown Wilmington incurring more than $470,000 in construction and equipment purchase loans. They have since treated over 1,700 patients, 80 percent of who were Medicaid recipients. In 2009 he applied for SLRP but was declined because he was not working full time at a dental HPSA site.

 Funding:State funds only

Recommendation

The Loan Repayment Committee recommended that Dr. Syamack Ganjavian be awarded loan repayment in the amount of $27,214 for a two year contract to practice at Crescent Dental in Wilmington.

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2. Site: DiamondState Dentistry (practice name changed-formerly

Lucinda Bunting {LKB-C}) 615 N. DuPont Highway, Milford, DE

19963

 located in a Federally designated dental HPSA

 treated 576 Medicaid or S-CHIP patients in the previous calendar year

Applicant: Andrea Hunter, DMD / continuation contract-previously placed on HOLD

Dr. Hunter graduated in 2008 from NovaSoutheasternUniversityCollege of

Dental Medicine in Fort Lauderdale, FL, and completed her residency at

Christiana Care in Wilmington.

She was awarded a loan repayment of $70,000.00 for the period August 1,

2009 to July 31, 2011 and is asking for a one year continuation contract. Her

current debt burden is approximately $71,830.00 (verified)

 Funding:State funds only

Recommendation

The Loan Repayment Committee recommended that Dr. Andrea Hunter be awarded loan repayment in the amount of $20,000 for an additional one year extension of her contract to practice at Diamond State Dentistry in Milford.

State Loan Repayment Program Policy Discussion

Subsequent to the Loan Repayment Committee meeting, Dr. Sydell emailed the Commission office that he is interested in providing dental services for the inmate population at the James T. Vaughn Correctional Center (JTVCC) in Smyrna one day per week.

One of the requirements of the State Loan Repayment Program is that the practice site be located in a Health Professional Shortage Area (HPSA). The State follows the Federal guidelines for HPSAs, which are designated by the U.S. Health and Human Services, Health Resources and Services Administration (HRSA). The JTVCC at 1181 Paddock Road, Smyrna, Delaware19977 is not in a dental HPSA.

As the requirements are now, Dr. Sydell would not be eligible for loan repayment if he provides services at the JTVCC one day per week.

One option would be to change the program requirements for State funded loan repayment awards to permit services to be provided at State facilities, whether or not those sites are located in a designated HPSA.

The members of the Loan Repayment Committee were asked to share their thoughts by email.

Three members were in favor of changing the program requirements to allow Dr. Sydell to participate in the Loan Repayment Program while providing services one day per week at the JTVCC.

One member was under the impression that state facilities, such as the Division of Public Health dental clinics, were qualified sites. If that is not correct, then allowing Dr. Sydell to practice at the JTVCC would be a violation of the program rules. If it is not a violation of the program rules, he would support the loan repayment award.

One member was opposed to providing loan repayment to Dr. Sydell to work at the prison because it is not allowed by current rules. Allowing this would set a precedent that has been avoided in the past: allowing loan repayment recipients to practice outside a HPSA. She suggested that this be considered as part of a general policy change, particularly if it would allow loan repayment recipients to work at public health medical, mental health and dental clinics that fall outside of federally designated HPSAs. The program guidance would need to be very specific about what types of facilities are allowed.

It was one member’s understanding that the prison health system is supposed to provide dental services and they receive state funding to do so. If Dr. Sydell provides services at the prison he will be getting paid by them while he is receiving loan repayment funds. He will be receiving two forms of payment for the same job and they are both state funds. In a sense, this is double dipping. The member said he was cautiously against allowing this if everything he understands is true.

Recommendation

Upon deliberation, the DIDER Board agreed that state operated facilities, by their very nature, serve underserved populations, regardless of where the facility is physically located. By only considering geographic location, some facilities might be eligible to have loan repayment recipients practicing within their walls, while others would not.

The Board believed that providing dental services to residents in state owned or operated facilities is in fact meeting the spirit of the program, and recommended amending the program guidance to permit this.

The recommendation will be presented to the DIMER Board for consideration, recognizing that, at some point in the future, a similar situation could arise for health professionals eligible to receive loan repayment awards made under DIMER.

If the DIMER Board agrees, the recommendation that the existing program guidance be amended to allow state loan repayment recipients to provide services for patients in state owned or operated facilities will be presented to the Health Care Commission for consideration.

Since this recommendation falls outside of federal definitions, state only dollars would be awarded in the cases where the geographic location of the facility falls outside of a federally designated Health Professional Shortage Area (HPSA)

Action

Dr. Ryan Barnhardt made a motion that Dr. Sydell be awarded loan repayment in the amount of $10,000 for an additional one year extension of his contract to practice at Mercer Dental Associates in Dover; that Dr. Ganjavian be awarded $47,214 for a two year contract atCresent Dental in Wilmington; and that Dr. Hunter be awarded $10,000 for an additional one year extension of her contract to practice at Diamond State Dentistry in Milford.

The motion was not seconded and failed.

Action

Dr. Ryan Barnhardt made a motion that Dr. Sydell be awarded loan repayment in the amount of $15,000 for an additional one year extension of his contract to practice at Mercer Dental Associates in Dover; that Dr. Ganjavian be awarded $37,214 for a two year contract at Cresent Dental in Wilmington; and that Dr. Hunter be awarded $15,000 for an additional one year extension of her contract to practice at Diamond State Dentistry in Milford. Dr. John Lenz seconded the motion. There was a voice vote. Motion carried.

Action

Dr. Ray Rafetto made a motion to support drafting a change in the State Loan Repayment Program Requirements to allow recipients to provide services in any state affiliated institution or facility. Lisa Goss seconded the motion. There was a voice vote. Motion carried.

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Update:

Special Award For Pediatric Dentists in Lower Kent and SussexCounties

Delaware State Dental Director, Dr. Greg McClure, applied for and was awarded a two year, $200,000.00 ($100,000.00 each year) federal grant to fund a pediatric dentist in an underserved area of Delaware (Kent or SussexCounty). A proviso of the award is that the State disburses $40,000.00 in the DIDER program in each of the grant years (2011 and 2012). One hundred thousand dollars must be spent by August 31, 2011.

Faxes and e-mails were sent to regional pediatric dental programs and Delaware pediatric dentists that included information, program guidance and application forms. To date, one inquiry has been received from the Virginia Commonwealth University Education Program in Pediatric Dentistry

Dr. McClure said there is currently little interest in the pediatric dentist award. An intensive recruitment effort will take place over the summer.

DIDER SLRP awards to date (FY11):

DIDER has awarded more than the required State match of $40,000.00 in accordance with the Federal grant of the Special Award For Pediatric Dentists in Lower Kent and SussexCounties. Dr. Gloria Wu was awarded $25,000 for a two year contract but later notified staff that she was declining the award because she did not want to commit to a two year obligation at this time.

Myochul Kwon, DMD (final payment) $12,500.00

Karen Rose, DDS $17,500.00

James Forshey, DMD (final payment) $14,000.00

Rama Yerneni, DMD $ 7,500.00

Yuri Majul, DMD $ 3,000.00

Total DIDER disbursements as of February 9, 2011 $ 54,500.00

State Dental Director’s Report

Dr. McClure reported that this year the Division of Public Health decided to present a reward to a dentist with outstanding achievement in the contribution of dental public health efforts. He presented the award to Dr. Lou Rafetto.

Dr. McClure said that the Pew Foundation gave Delaware an F last year in the oral health of the state. This year Delaware was upgraded to a B. Last year the Pew Foundation had incorrect data in three categories. Rather than improving, Delaware has been recognized for everything it has been doing in the past three years to improve oral health in Delaware. There was also a flaw in the data released by Medicaid.

La RedHealthCenter began operations in February. Dr. Sharon Welsh is operating from the Division of Public Health dental van on a temporary basis. La RedHealthCenter broke ground in February for a complete new facility which will have eight dental clinics. It is projected that the facility will open in December.

Ms. Roy reported that DelmarvaRuralMinistriesKentCommunityHealthCenter will close in June. It has had a series of challenges and has lost federal funding. Plans are to give at least three operatories to La Red Health Center.

Dr. McClure said that HenriettaJohnsonMedicalCenter just broke ground on a new facility on May 16, 2011 and will have ten operatories. A May2012 opening is anticipated.

Other Business

Christiana Care Health System report required by DIDER Memorandum of Understanding

The DIDER Board reviewed the Christiana Care Health System report required by the DIDER Memorandum of Understanding. The oral surgery program at the hospital is expanding from one to two people and will also accept advanced standing people. As a result, there will be an increased amount of care provided in the clinic by residents of that specialty. In oral surgery there will be eight residents plus one intern. Next year there will be seven general dentists plus one oral surgeon intern.

TempleUniversityKornbegSchool of Dentistry report required by DIDER Memorandum of Understanding

The DIDER Board reviewed the Temple University Kornberg School of Dentistry report required by the DIDER Memorandum of Understanding. Dr. Rafetto said that they received 4,127 applicants, but there were only 14 from Delaware, 8 of whom were accepted and only 2 are expected to matriculate. It appears that, since the tuition assistance has been reduced, Delawareans are choosing other schools. There were only 3 Delawareans matriculated at Temple for the current year.

Dr. Rafetto reviewed the GPA of Delaware students versus the students who got accepted overall and it was a significantly lower threshold for Delaware residents.

There is financial incentive for Temple to fill its seats with Delawareans. It receives $12,500 per student matriculated. In the past, the strategy has been to do everything possible to preserve the slots and reduce the tuition offset. Perhaps that was not correct thinking. If the slots are not filled, there will be unspent seat money. Perhaps the unspent seat money may be redirected toward tuition assistance. The Board asked the staff to pursue the feasibility of redirecting unspent seat money toward tuition assistance in Fiscal Year 2012.

Report to the Director of the Office of Management and Budget and Controller General on expenditure of DIDER funds

The DIDER Board reviewed the report to the Director of the Office of Management and Budget and Controller General on the expenditure of DIDER funds for support of the general practice residency program at Christiana Care Health Services.

Update: Federal Health Reform

Ms. Roy reported that currently most of the activity in Delaware is focused on the design issues surrounding Health Benefit Exchanges. Exchanges are where small business, their employees and individuals can shop for insurance. The only dental related issue in exchanges is that there will be federal guidelines on what kind of benefits plans have to offer. Dental coverage is not required in those health plans, but Exchanges may offer stand alone dental plans.

Dr. McClure explained that every child will have a dental plan once the Federal Affordable Care Act is enacted. Currently nearly 70 percent of children in Delaware have dental insurance and nearly 50 percent of Delaware children are eligible for traditional Medicaid and SCHIP Medicaid.

Next Meeting

The next meeting is scheduled for Tuesday, September 13, 2011, at 3:00 p.m. in Conference Room Number 198 on the first floor of the MainAdministrationBuilding at the Herman Holloway Campus in New Castle.

Adjourn

The meeting adjourned at 4:30p.m.

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Minutes/DIDER Minutes/DIDER Board Minutes February 15, 2011