Anna Gonzales, MPH Regional Supervisor Bureau of Clinician Recruitment & Service

1. 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 Supervisor Bureau of Clinician Recruitment & Service Health Resources & Services Administration U.S. Department of Health and Human Services National Tribal Health Reform Training Prior Lake, MN April 18, 2012

2. 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

3. NHSC Field Strength Projections

4. NHSC Scholarship Program Eligible Disciplines • Certified Nurse-Midwife • Dentist (DMD and DDS) • Family Nurse Practitioner • Physician Assistant (Primary Care) • Primary Care Physician (MD and DO)

5. NHSC Scholarship Program • 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

6. 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 NHSC Loan Repayment Program(LRP) Eligible Clinicians

7. NHSC Loan Repayment Program (LRP) 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

8. 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

9. 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.

10. 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

11. NHSC Approved SitesTypes of Practice Setting • Indian Health Programs* • Federal (IHS), tribal, and urban • Public or private entity • Community Health Centers • Rural Health Clinics • Critical Access Hospitals • Private Practices • Prisons – State and Federal • Community Mental Health Centers • Does not have to be nonprofit * Includes all Indian Health Service, 638, dually funded, and Urban Indian health care facilities

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

13. New policy for Critical Access Hospitals (CAHs)* • 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 * under 3-year pilot

14. CAH Eligibility Requirements for NHSC site Approval • 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

15. NHSC Clinician Recruitment at CAHs • 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

16. NHSC Service Requirements at CAHs • 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

17. 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

18. HRSA NELRP/NSPCritical Shortage Facility • 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.

19. HRSA NELRPEligible Sites • Participants are required to work at a CSF that must be a public or private nonprofit entity • Health 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 * Includes all Indian Health Service, 638, dually funded, and Urban Indian health care facilities

20. HRSA NELRPIneligible 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

21. 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 support • Participants may satisfy their service obligations on either a full-time or part-time basis • Preference to applicants with the greatest financial need * taxable

22. HRSA NSPEligible 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

23. Contact Information • NHSC 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”

24. 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