Ana Lyn M. Roscetti, MPH

1. Workforce Programs Arizona Department of Health ServicesDivision of Public Health ServicesBureau of Health Systems Development Ana Lyn M. Roscetti, MPH

2. Arizona Department of Health Services Division of Behavioral Health Services Division of Public Health Services Division of Licensing Public Health Prevention Public Health Preparedness Tobacco and Chronic Disease Epidemiology and Disease Control Women’s and Children’s Health State Laboratory Services Emergency Medical Services and Trauma Health Systems Development Emergency Preparedness Nutrition and Physical Activity Vital Statistics

3. Bureau of Health Systems Development

4. Designations • Health Professional Shortage Area (HPSA) - defined as an area designated as having a shortage of primary medical, dental or mental health providers. They may be urban or rural areas, population groups or medical or other public facilities. • Medically Underserved Areas (MUA) - defined as areas in which residents have a shortage of personal health services. • i.e.whole county, group of contiguous counties, group of county or civil divisions , group of urban census tracts   • Medically Underserved Populations (MUPs) - defined as groups of people who face economic, cultural or linguistic barriers to health care. • To find out if a service site is located in a designated HPSA, MUA or MUP: http://hpsafind.hrsa.gov/

5. Shortage Designation Criteria Designation of HPSA can be either Geographic, Population, or Facility. Geographic • The geographic area must be rational for the delivery of health services, • Population-to- provider ratio of 3500:1 or 3000:1 but have unusually high needs for primary care services, and • Resources in contiguous areas must be shown to be over utilized (2000:1), excessively distant (>30 minutes travel time), or otherwise inaccessible (majority non-English speaking . Population • Population live in an area that is rational for the delivery of health services, • Have access barriers preventing use of health services in the area • economically-related – % of population in poverty, ratio of the Medicaid-eligible population to providers accepting Medicaid • non-economically related – culture, language, minority status • Population-to- provider ratio of 3000:1

6. Shortage Designation Criteria Facility Federal and/or State correctional facilities • Ratio of inmate population per year to the number of FT physicians serving the institution (1000:1) Public or non-profit medical facilities • Provide primary care service in a designated primary care HPSA and have insufficient capacity to meet the health care needs of the area /population MUA/P HRSA uses the Index of Medical Underservice (IMU) for designating areas as MUA/P. • Ratio of primary medical care physicians per 1,000 population • Infant mortality rate • Percentage of the population in poverty, and • Percentage of the population age 65 or over.

7. Designated HPSAs in Arizona • *132 PC HPSAs • * 74 Dental HPSAs • *68 Mental HPSAs • * 34 MUA • * 9 MUP • *includes facility designations • 29 PC Native American Tribal Population HPSAs • 16 IHS facilities

8. Arizona Loan Repayment Programs (ALRP) Public, non-profit Rural, private practice National Health Service Corps (NHSC) Loan Repayment Program Workforce Programs • J-1 Visa Waiver Program • National Interest Waiver Program • First Things First Early Childhood Therapist Incentives Programs • Loan Repayment • Stipend

9. Workforce Programs Objectives • To improve accessibility of health care for underserved areas and populations in Arizona • To provide incentives for primary care providers and dentists in exchange for services • To encourage retention of healthcare professionals

10. Provider US Citizen Current AZ license Valid Employment contract 2 year minimum obligation Full time employment at 40 hrs/week Provide outpatient primary care services at the approved site Accept Medicare and Medicaid (AHCCCS) Sliding Fee Scale No unsatisfied obligations Arizona Loan Repayment Programs (ALRP) Eligibility Requirements Eligible disciplines: MD/DO, Dentists, Physicians Assistants, Nurse Practitioners, Certified Nurse Midwives • Service Site • Public, non-profit or rural private practice are eligible • Located in a designated HPSA • Accept Medicare and Medicaid (AHCCCS) • Sliding Fee Scale and policy in place

11. Arizona Loan Repayment Programs (ASLRP)Application Deadline • Only complete applications are considered for review. • Applications must be postmarked no later than the last date of the application cycle.

12. Arizona Loan Repayment Programs (ASLRP)Award Amounts Award amounts are based upon the type of health professional, the priority ranking of the site, and the recipient’s total student loan indebtedness. Physicians Pas, NPs, Midwives Award amounts are subject to the availability of funding.

13. For more details about the ALRP, please visit the program website at http://www.azdhs.gov/hsd/az_loan_repayment.htm.

14. National Health Service Corps (NHSC) Loan Repayment • Administered by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS). • Recruits fully-trained health professionals to provide culturally competent, interdisciplinary primary health care services to underserved populations located in selected Health Professional Shortage Areas (HPSAs) • Assists clinicians in repayment of qualifying educational loans that are still owed • Make loan repayment for up to $50,000 tax-free for the initial 2-year service commitment • Up to $145,000 tax-free for extended service commitments through 5 years • Annual application cycles

15. National Health Service Corps (NHSC) Loan RepaymentProvider Eligibility Eligible disciplines: • MD/DO • Dentists • Psychiatrists • Physicians Assistants • Nurse Practitioners • Certified Nurse Midwives • Dental Hygienists • Psychologists • Social Workers • Professional Counselors • Marriage & Family Therapists • Psychiatric Nurse Specialists • Must meet the following requirements: • US Citizen • Current AZ license • Participate or eligible to participate in Medicare, Medicaid, and SCHIP • No outstanding service obligation • No breach of prior service obligation • Has not been suspended, debarred, or excluded by the federal agency • Demonstrate satisfactory professional competence and conduct • Be free of judgment liens arising from federal debt

16. National Health Service Corps (NHSC) Loan Repayment Site Eligibility • Eligible Sites • Federally Qualified Health Center • Center or Look-Alike (FQHC) • Certified Rural Health Clinic (RHC) • Indian Health Service Site (Federal or Tribal) • Solo or Group Partnership or Practice • Hospital-Affiliated Primary Care Practice • Managed Care Network • State or Federal Prison • U.S. Immigration, Customs and Enforcement Site • Public Health Department • Service Site • Located in a designated HPSA • Accept Medicare and Medicaid • Sliding Fee Scale • Public and Private are eligible • Can document sound fiscal management • Has capacity to maintain a competitive salary, benefits, and malpractice coverage package for clinicians

17. For more details about the NHSC LRP, please visit the program website at http://nhsc.hrsa.gov/loanrepayment/applicantbulletin/default.htmFor general information about the NHSC including how to become an approved NHSC service site, please visit http://nhsc.hrsa.gov.

18. J-1 Visa Waiver Program • For foreign medical graduates who came to the United States with J-1 visas to pursue graduate medical studies (“J-1 physicians”). • Improves the accessibility of health care in underserved areas by supporting J-1 visa waiver requests on behalf of J-1 physicians willing to practice in medically underserved areas. • Thirty (30) slots are available per year (22 primary care, 7 specialist, 1 discretionary). Preference points are used if more applications are received than slots available. • Annual application cycle is from October 1 through November 30. • ADHS’ application review takes about 6 to 8 weeks. • Department of State’s estimated processing time for a waiver is is 4 to 6 weeks.

19. Provider Have an offer of FT employment at 40 hours per week at an eligible service site 3 year minimum obligation Provide primary care or specialty services in an approved site AZ license or eligible for an AZ license J-1 Visa Waiver Program Eligible disciplines: MDs with primary care discipline (internal medicine, family or general practice, pediatrics, OB/GYN or psychiatry) or specialists • Service Site • Located in a designated HPSA, MUA or MUP • Accept Medicare and Medicaid • Accept all patients regardless of ability to pay • Sliding Fee Scale • Demonstrate unsuccessful recruitment efforts of a US citizen physician • Operational and providing care for at least six months as of the date of the request

20. For more information about the J1 Visa Waiver Program, please visit the program website at http://www.azdhs.gov/hsd/visa_waiver.htm • List of primary care HPSAs, MUAs, and MUPs, and mental health HPSAs: • http://nhscjobs.hrsa.gov/Search_HPOL.aspx • List of service sites that offer a sliding discount-to-fee scale: • http://www.azdhs.gov/hsd/sfs_provider.htm • For additional information on the federal program: • http://www.globalhealth.gov/exchangevisitor.shtml • http://www/travel.state.gov/jvw.html • Other sources for job search are: • The Arizona Association of Community Health Centers: http://www.aachc.org • The University of Arizona Rural Health Office: http://www.rho.arizona.edu/ • Rural Recruitment and Retention Network (3Rnet):https://www.3rnet.org/default.aspx

21. Arizona National Interest Waiver Program (NIW) • The federal National Interest Waiver (NIW) program allows certain foreign workers including foreign physicians (MDs) with advanced degrees or exceptional abilities to work in the United States. • The federal guidelines allow states to recommend a national interest waiver to foreign physicians. • ADHS will ONLY consider requests for ADHS NIW support from J1 physicians meeting the following conditions: • Obtained a J1 waiver from USCIS based on ADHS recommendation • Practiced in a primary care outpatient setting full-time at an eligible service site (within designated HPSA/MUA) for at least one year immediately preceding the request for an ADHS NIW support and will continue to practice in the same or similar setting to a total aggregate of 5 years (including J1 obligation) • Complied with the ADHS J-1 Visa Waive r Program's policies.

22. For more information about the AZ National interest Waiver Program, please visit the program website at http://www.azdhs.gov/hsd/nationalinterestwaiver.htm

23. Sliding Fee Scale (SFS) Requirements • Agree to see all patients regardless of ability to pay • Have a policy of non-discrimination, in the provision of health care services • Must match current Federal Poverty Level (FPL) guidelines • Offer discounted services to people at or below 200% FPL • Patients below 100% poverty are charged a nominal fee or not charged at all • Signage posted to notify patients of available SFS resource • Apply to all providers providing services at site

24. Sliding Fee Scale (SFS) Sample

25. Arizona First Things First Early Childhood Therapist Incentives Programs Eligible disciplines: Physical Therapist, Speech/Language Pathologist, Occupational Therapist, Child Psychologist, Mental Health Specialist Provider • AZ licensed • United States citizen • Valid offer of employment at an eligible service site • Provide developmentally appropriate services at an approved site • Work at least 30 hours per week Service Site • Provide services in an acceptable regional council census tract • Accept DES/AzEIP, DES/DDD, AHCCCS, or Local Education Agency caseload assignments and rates • Have a non-discrimination policy in the provision of health services • Offer an employment contract with the provider applicant that covers the period of obligation applied for • Has financial means to support the provider applicant, including salary, benefits, and malpractice insurance for a minimum of 24 months.

26. Arizona First Things First Early Childhood Therapist Incentives Programs Two components: 1) Loan Repayment 2) Stipend

27. For more information about the First Things First Early Childhood Therapist Incentives Programs, please visit the program website at http://www.azdhs.gov/hsd/ftf_therapist_incentive.htm

28. Ana Roscetti, MPH CONTACT INFORMATION: Workforce Programs Section Manager Email: Ana.Lyn.Roscetti@azdhs.gov Phone: (602) 542-1066 ADHS website:www.azdhs.gov/hsd

29. Any Questions?