Building a Stronger Health Workforce

Report
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
1
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
2
NHSC Field Strength Projections
12,000
10,279
10,000
7,530
8,000
6,000
4,000
9,193
4,808
3,601
2,000
2008
2009
2010
2011
2012
3
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)
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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
5
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
6
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
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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
8
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
10
NHSC Approved Sites
Types 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
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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
[email protected]; 301-443-4242
with cc to Albert Perrine: [email protected]
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
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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 fulltime practice
 12 hrs. in the case of half-time practice
* under 3-year pilot
13
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
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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
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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
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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
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HRSA NELRP/NSP
Critical 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.
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HRSA NELRP
Eligible 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
19
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 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
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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
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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
– [email protected]; 301-443-4242
– with copy to [email protected]
– NHSC Approved Sites List
– Web site:
http://datawarehouse.hrsa.gov/HGDWReports/OneClickRptFilter.aspx?rptName=
NHSCAppSiteList&rptFormat=HTML3.2
– OR search “NHSC Approved Sites”
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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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