Health Resources and Services Administration (HRSA)

The National Health Service Corps and Other Federal Scholarship and

Loan Repayment Opportunities for Primary Care Clinicians

Anna Gonzales, MPH

Regional SupervisorBureau of Clinician Recruitment & Service

Health Resources & Services AdministrationU.S. Department of Health and Human Services

National Tribal Health Reform TrainingPrior Lake, MN

April 18, 2012

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HRSA Update

National Health Service Corps (NHSC) scholarship, loan repayment, and S2S programs

New provisions for Indian Health Programs and Critical Access Hospitals

HRSA nursing scholarship and loan repayment programs

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NHSC Field Strength Projections

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3,601

4,808

7,530

10,279 9,193

-

2,000

4,000

6,000

8,000

10,000

12,000

2008 2009 2010 2011 2012

Certified Nurse-Midwife

Dentist (DMD and DDS)

Family Nurse Practitioner

Physician Assistant (Primary Care)

Primary Care Physician (MD and DO)

NHSC Scholarship Program

Eligible Disciplines

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Scholarships to students who commit to practicing primary care in HPSAs of greatest need (HPSA score >16*) upon graduation, training and licensure. Payment for tuition, required fees, and other reasonable

educational costs Monthly support stipend of $1,289 (taxable) Assistance in finding a practice site

Period of service is 2-4 years, based on number of years of scholarship support

* HPSA threshold re-calculated annually, beginning July 1

NHSC Scholarship Program

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NHSC Loan Repayment Program (LRP) Eligible Clinicians

Primary Care Physicians (MD and DO)

Primary Care Nurse Practitioners

Physician Assistants

Certified Nurse Midwives

Dentists (DMD and DDS)

Dental Hygienists

Psychiatrists

Health Service Psychologists

Clinical Social Workers

Licensed Professional Counselors

Marriage and Family Therapists

Psychiatric Nurse Specialists

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Repayment of educational loans for full-time primary care clinicians

Two-year initial service commitment with optional 1-year contract extensions

Maximum repayment during the required initial two-year contract is up to $60,000 tax-free (up to

$40,000 if HPSA is equal to or below 13)

Site/vacancy must be approved and clinician must also make a separate application to the NHSC

NHSC Loan Repayment Program (LRP)

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LRP Option for Half-Time Service (20 to 39 hours each week, at least 45 weeks each year)

Four year initial service commitment for up to $60,000 ( up to $40,000 if HPSA <13), or 2-year commitment for $30,000 ($20,000 if HPSA <13)

Potential for additional years of support with 1-year contract extensions

Same eligible disciplines as full-time Loan Repayment Program

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NHSC Students to Service LRP

Full-time medical students (MD or DO) in the last year of school– Disadvantaged background*– Likely to remain in an underserved area**

Up to $120,000 for an initial 3 years of full-time clinical service at sites with HPSA of 14 and above (Internal Medicine, Family Practice, Pediatrics, OB/GYN, or Geriatrics)

* School certifies that he/she: (i) was identified as having a “disadvantaged background” based on environmental and/or economic factors or (ii) received a Federal Exceptional Financial Need Scholarship.

** as outlined in the application essay and letters of recommendation.9

NHSC Practice Site Requirements

Located in a Health Professional Shortage Area (HPSA)

Comprehensive primary care

Outpatient setting

Services provided regardless of patient’s ability to pay

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NHSC Approved Sites

Types of Practice Setting

Indian Health Programs*Federal (IHS), tribal, and urban

Public or private entity Community Health CentersRural Health ClinicsCritical Access Hospitals Private PracticesPrisons – State and FederalCommunity Mental Health CentersDoes not have to be nonprofit

* Includes all Indian Health Service, 638, dually funded, and Urban Indian health care facilities 11

Important changes to Indian Health Program NHSC sites

All eligible Indian Health Service/Tribal Clinic/Urban Indian Health Clinic (I/T/U) facilities are pre-approved by the NHSC* – I/T/U sites may post vacancies on the NHSC Job

Opportunities List

Pre-approval does not include HPSA designation– Contact Michael Berryhill (IHS) for HPSA designation

Michael.Berryhill@ihs.gov; 301-443-4242

with cc to Albert Perrine: APerrine@hrsa.gov

I/T/U sites may limit NHSC clinician services to tribal members only, with the exception of emergency care 

I/T/U site clinicians may hold a license from any state

12* Includes all Indian Health Service, 638, dually funded, and Urban Indian health care facilities

• NHSC will approve entire CAH as a service site

Including the ER, swing bed unit, skilled nursing facility (SNF)

• Clinician’s time in the inpatient setting will now count towards service obligation

In general, 24 hrs. of the minimum 40 hrs. of full-time practice

12 hrs. in the case of half-time practice

New policy for Critical Access Hospitals (CAHs)*

* under 3-year pilot 13

• Located in a designated Health Professional Shortage Area (HPSA) appropriate for disciplines site is recruiting

• Contact State Primary Care Office for HPSA designation

• Outpatient, ambulatory care clinic

• Comprehensive primary care and related inpatient services

• Accept Medicare, Medicaid & Children’s Health Insurance Program beneficiaries

• See all patients, regardless of ability to pay

• Utilize a sliding fee scale or “charity care policy” for low-income patients

Full discount or nominal charge for those below 100% of poverty

Schedule of discounts for those between 100% and 200% of poverty

CAH Eligibility Requirements for NHSC site Approval

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• May only recruit the following disciplines:

Physicians

Physician Assistants

Nurse Practitioners

Certified Nurse-Midwives

• Specialties may include: family practice, general internal medicine, pediatrics, geriatrics, obstetrics/gynecology, and psychiatry

• Maximum of 10 NHSC providers per CAH over the 3-year pilot period

NHSC Clinician Recruitment at CAHs

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• Full-time providers (40 hrs/wk) Minimum of 16 hrs/wk must be spent in outpatient clinic

24 hrs/wk can be spent in the inpatient setting, including the swing bed unit, ER or SNF, teaching, or doing administrative tasks

No more than 8 hrs/wk spent teaching AND

No more than 8 hrs/wk spent on administrative tasks

• Half-time providers (20-39 hrs/wk) Minimum of 8 hrs/wk must be spent in outpatient clinic

12 hrs/wk can be spent in the inpatient setting, teaching, or doing administrative tasks

No more than 4 hrs/wk spent teaching OR on administrative tasks

NHSC Service Requirements at CAHs

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HRSA Nursing Education

Loan Repayment Program (NELRP)Repayment* of educational loans for full-time licensed nurses (diploma, associate, baccalaureate or graduate) employed at non-profit health care facilities with a critical shortage of nurses (Critical Shortage Facility or CSF)

Two-year initial service commitment

Maximum repayment during the initial two-year contract is 60 percent of the total qualifying nursing education loan balance

For an optional third year of service, participants may receive 25 percent of their original total qualifying nursing education loan balance

* taxable 17

NELRP and NSP participants must serve at a health care facility with a critical shortage of nurses (Critical Shortage Facility or CSF).

A CSF is a health care facility located in, designated as, or serving a primary medical care or mental health HPSA.

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HRSA NELRP/NSP

Critical Shortage Facility

HRSA NELRP

Eligible SitesParticipants are required to work at a CSF that must be a public or private nonprofit entityHealth care facilities include:– Indian Health Service Center*– Critical Access Hospital– Disproportionate Share Hospital– Public Hospital– Federally Qualified Health Center– Native Hawaiian Health Center– Rural Health Clinic– Skilled Nursing Facility– State or Local Public Health or Human Services Department– Ambulatory Surgical Center– Home Health Agency– Hospice Program– Nonprofit, Non-Disproportionate Share Hospital– Nursing Home

19* Includes all Indian Health Service, 638, dually funded, and Urban Indian health care facilities

HRSA NELRP

Ineligible Sites Those ineligible facilities include but are not limited to:– Free-standing clinics that do not qualify as facility mentioned

prior– Renal dialysis centers– Private practice offices– Assisted living facilities– Clinics in prisons and correctional facilities; and– Private, for-profit facilities

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HRSA Nursing Scholarship Program (NSP)

For full-time students in baccalaureate, graduate, associate degree, or diploma nursing programs The Nursing Scholarship Program pays: – tuition – required fees – other reasonable costs, including required books, clinical

supplies, laboratory expenses, etc. – monthly stipend of $1,289 *

Period of service is 2-4 years based on number of years of scholarship supportParticipants may satisfy their service obligations on either a full-time or part-time basis Preference to applicants with the greatest financial need

* taxable 21

HRSA NSP

Eligible Sites

NSP participants will be expected to serve in a CSF with a primary care or mental health HPSA score of 14 or above at the following health care facilities:  – Indian Health Service Health Center*– Critical Access Hospital– Disproportionate Share Hospital– Federally Qualified Health Center– Native Hawaiian Health Center– Public Hospital– Rural Health Clinic– Skilled Nursing Facility– State or Local Public Health or Human Services Department

* Includes all Indian Health Service, 638, dually funded, and Urban Indian health care facilities 22

Contact InformationNHSC Scholarship and Loan Repayment

– Toll-free helpline: (800) 221-9393 – Web site: http://www.nhsc.hrsa.gov

HRSA Nursing Scholarship – Web site: http://www.hrsa.gov/loanscholarships/scholarships/nursing/

HRSA Nursing Education Loan Repayment – Web site: http://www.hrsa.gov/loanscholarships/repayment/nursing/

HPSA designation for I/T/U sites– Michael.Berryhill@ihs.gov; 301-443-4242

– with copy to APerrine@hrsa.gov

– NHSC Approved Sites List– Web site:

http://datawarehouse.hrsa.gov/HGDWReports/OneClickRptFilter.aspx?rptName=NHSCAppSiteList&rptFormat=HTML3.2

– OR search “NHSC Approved Sites” 23

Follow up

Take-home message– Federal scholarship and loan repayment

programs provide new opportunities to improve recruitment and retention of clinicians at Indian Health Programs and other medically underserved sites

Action items– Visit http://www.nhsc.hrsa.gov for program

details– Check NHSC Approved Sites List– Contact IHS for HPSA designation

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