[Federal Register Volume 75, Number 214 (Friday, November 5, 2010)]
[Notices]
[Pages 68368-68370]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2010-28083]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Health Resources and Services Administration


Recruitment of Sites for Assignment of Corps Personnel Obligated 
Under the National Health Service Corps Loan Repayment Program (FY 
2011)

AGENCY: Health Resources and Services Administration, HHS.

ACTION: General notice.

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SUMMARY: The Health Resources and Services Administration (HRSA) 
announces that the listing of entities, and their Health Professional 
Shortage Area (HPSA) scores, that will receive priority for the 
assignment of National Health Service Corps (NHSC) Loan Repayors (Corps 
Personnel, Corps members) during the period October 1, 2010, through 
September 30, 2011, is posted on the HRSA Web site at http://datawarehouse.hrsa.gov/HGDWReports/OneClickRptFilter.aspx?rptName=NHSCAppSiteList&rptFormat=HTML3.2. This 
list specifies which entities are eligible to receive assignment of 
Corps members who are participating in the NHSC Loan Repayment Program 
(LRP), and Corps members who have become Corps members other than 
pursuant to contractual obligations under the LRP. Please note that not 
all vacancies associated with sites on this list will be for Corps 
members, but could be for individuals serving an obligation to the NHSC 
LRP through the Private Practice Option.

Eligible HPSAs and Entities

    To be eligible to receive assignment of Corps personnel, entities 
must: (1) Have a current HPSA designation by the Office of Shortage 
Designation, Bureau of Health Professions, HRSA; (2) not deny requested 
health care services, or discriminate in the provision of services to 
an individual because the individual is unable to pay for the services 
or because payment for the services would be made under Medicare, 
Medicaid, or the Children's Health Insurance Program; (3) enter into an 
agreement with the State agency that administers Medicaid and the 
Children's Health Insurance Program, accept assignment under Medicare, 
see all patients regardless of their ability to pay, and use and post a 
discounted fee plan; and (4) be determined by the Secretary to have (a) 
A need and demand for health manpower in the area; (b) appropriately 
and efficiently used Corps members assigned to the entity in the past; 
(c) general community support for the assignment of Corps members; (d) 
made unsuccessful efforts to recruit; (e) a reasonable prospect for 
sound fiscal management by the entity with respect to Corps members 
assigned there; and (f) demonstrated a willingness to support and 
facilitate mentorship, professional development and training 
opportunities for Corps members. Priority in approving applications for 
assignment of Corps members goes to sites that (1) provide primary 
medical care, mental health, or oral health services to a primary 
medical care, mental health, or dental HPSA of greatest shortage, 
respectively; (2) are part of a system of care that provides a 
continuum of services, including comprehensive primary health care and 
appropriate referrals or arrangements for secondary and tertiary care; 
(3) have a documented record of sound fiscal management; and (4) will 
experience a negative impact on its capacity to provide primary health 
services if a Corps member is not assigned to the entity. In order for 
a site to be eligible for placement of NHSC personnel, it must be 
approved by the NHSC through the successful submission of a Site 
Application. The Site Application approval is good for a period of 3 
years from the date of approval.
    Entities that receive assignment of Corps personnel must assure 
that (1) the position will permit the full scope of practice and that 
the clinician meets the credentialing requirements of the State and 
site; and (2) the Corps member assigned to the entity is engaged in the 
requisite amount of clinical service, as defined below, to meet his or 
her service obligation:

Full-time clinical practice

    ``Full-time clinical practice'' is defined as a minimum of 40 
hours per week for at least 45 weeks per service year. The 40 hours 
per week may be compressed into no less than 4 work days per week, 
with no more than 12 hours of work to be performed in any 24-hour 
period. Time spent on-call does not count toward the full-time 
service obligation.
    For all health professionals, except as noted below, at least 32 
of the minimum 40 hours per week must be spent providing direct 
patient care or teaching in the outpatient ambulatory care 
setting(s) at the NHSC-approved service site(s) during normally 
scheduled office hours. The remaining 8 hours per week must be spent 
providing clinical services for patients or teaching in the approved 
practice site(s),

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providing clinical services in alternative settings as directed by 
the approved practice site(s), or performing practice-related 
administrative activities. Teaching activities at the approved 
service site shall not exceed 8 hours of the minimum 40 hours per 
week, unless the teaching takes place in a HRSA-approved Teaching 
Health Center. Teaching activities in a Teaching Health Center shall 
not exceed 20 hours of the minimum 40 hours per week.
    For obstetrician/gynecologists, certified nurse midwives (CNMs), 
family medicine physicians who practice obstetrics on a regular 
basis, providers of geriatric services, pediatric dentists, and 
behavioral/mental health providers, at least 21 of the minimum 40 
hours per week must be spent providing direct patient care or 
teaching in the outpatient ambulatory care setting(s) at the NHSC-
approved service site(s), during normally scheduled office hours. 
The remaining 19 hours per week must be spent providing clinical 
services for patients or teaching in the approved practice site(s), 
providing clinical services in alternative settings as directed by 
the approved practice site(s), or performing practice-related 
administrative activities. No more than 8 hours per week can be 
spent performing practice-related administrative activities. 
Teaching activities at the approved service site shall not exceed 8 
hours of the minimum 40 hours per week, unless the teaching takes 
place in a HRSA-approved Teaching Health Center. Teaching activities 
in a Teaching Health Center shall not exceed 20 hours of the minimum 
40 hours per week.

Half-Time Clinical Practice

    ``Half-time clinical practice'' is defined as a minimum of 20 
hours per week (not to exceed 39 hours per week), for at least 45 
weeks per service year. The 20 hours per week may be compressed into 
no less than 2 work days per week, with no more than 12 hours of 
work to be performed in any 24-hour period. Time spent on-call does 
not count toward the half-time service obligation.
    For all health professionals, except as noted below, at least 16 
of the minimum 20 hours per week must be spent providing direct 
patient care in the outpatient ambulatory care setting(s) at the 
NHSC-approved service site(s), during normally scheduled office 
hours. The remaining 4 hours per week must be spent providing 
clinical services for patients or teaching in the approved practice 
site(s), providing clinical services in alternative settings as 
directed by the approved practice site(s), or performing practice-
related administrative activities. Teaching and practice-related 
administrative activities shall not exceed a total of 4 hours of the 
minimum 20 hours per week.
    For obstetrician/gynecologists, certified nurse midwives (CNMs), 
family medicine physicians who practice obstetrics on a regular 
basis, providers of geriatric services, pediatric dentists, and 
behavioral/mental health providers, at least 11 of the minimum 20 
hours per week must be spent providing direct patient care in the 
outpatient ambulatory care setting(s) at the NHSC-approved service 
site(s), during normally scheduled office hours. The remaining 9 
hours per week must be spent providing clinical services for 
patients or teaching in the approved practice site(s), providing 
clinical services in alternative settings as directed by the 
approved practice site(s), or performing practice-related 
administrative activities. Teaching and practice-related 
administrative activities shall not exceed 4 hours of the minimum 20 
hours per week.

    In addition to utilizing NHSC assignees in accordance with their 
full-time or half-time service obligation (as defined above), sites 
receiving assignment of Corps personnel are expected to (1) Report 
to the NHSC all absences, including those in excess of the 
authorized number of days (up to 285 work hours per service year in 
the case of full-time service and up to 142 hours per service year 
in the case of half-time service); (2) report to the NHSC any change 
in the status of an NHSC clinician at the site; (3) provide the time 
and leave records, schedules, and any related personnel documents 
for the NHSC assignees (including documentation, if applicable, of 
the reason(s) for the termination of an NHSC clinician's employment 
at the site prior to his or her obligated service end date); and (4) 
submit a Uniform Data System (UDS) report. The UDS allows the site 
to assess the age, sex, race/ethnicity of, and provider encounter 
records for its user population. The UDS reports are site specific. 
Providers fulfilling NHSC commitments are assigned to a specific 
site or, in some cases, more than one site. The scope of activity to 
be reported in UDS includes all activity at the site(s) to which the 
Corps member is assigned.

Evaluation and Selection Process

    In approving applications for the assignment of Corps members, 
the Secretary shall give priority to any such application that is 
made regarding the provision of primary health services to a HPSA 
with the greatest shortage. For assignments made under the NHSC LRP 
resulting from loan repayment awards made using FY 2011 funding from 
October 1, 2010, to September 30, 2011, HPSAs of greatest shortage 
for determination of priority for assignment of Corps personnel will 
be defined as follows: HPSAs (appropriate to each discipline) with 
scores of 10 and above are authorized for priority assignment of 
Corps members who are participating in the LRP. HPSAs with scores 
below 10 will be eligible to receive assignment of Corps personnel 
participating in the LRP only after assignments are made of those 
Corps members matching to HPSAs receiving priority for placement of 
Corps members through the LRP (i.e., HPSAs scoring 10 or above). 
Placement made through the Loan Repayment Program in HPSAs with 
scores below 10 will be made by decreasing HPSA score, and only to 
the extent that funding remains available. All sites on the list are 
eligible sites for ``volunteers''--i.e., individuals wishing to 
serve in an underserved area but who are not contractually obligated 
under the NHSC Scholarship or Loan Repayment Programs. A listing of 
HPSAs and their scores is posted at http://hpsafind.hrsa.gov/.
    In order to implement the statutory directive to place NHSC 
clinicians in the highest need areas and to assure appropriate 
geographic distribution of NHSC resources, the number of new NHSC 
LRP placements (full-time or half-time) allowed at any one site 
during FY 2011 is limited to the following:

HPSA Score: 0-9

Primary Medical Care

    No more than 12 allopathic (MD) or osteopathic (DO) physicians; 
and no more than a combined total of 12 nurse practitioners (NPs), 
physician assistants (PAs), or CNMs.

Dental

    No more than 12 dentists and 12 dental hygienists.

Mental Health

    No more than 12 psychiatrists (MD or DO); and no more than a 
combined total of 12 health service psychologists (clinical or 
counseling psychologists), licensed clinical social workers, 
licensed professional counselors, marriage and family therapists, or 
psychiatric nurse specialists.

HPSA Score: 10-13

Primary Medical Care

    No more than 15 allopathic (MD) or osteopathic (DO) physicians; 
and no more than a combined total of 15 NPs, PAs, or CNMs.

Dental

    No more than 15 dentists and 15 dental hygienists.

Mental Health

    No more than 15 psychiatrists (MD or DO); and no more than a 
combined total of 15 health service psychologists (clinical or 
counseling psychologists), licensed clinical social workers, 
licensed professional counselors, marriage and family therapists, or 
psychiatric nurse specialists.

HPSA Score: 14-26

Primary Medical Care

    No more than 18 allopathic (MD) or osteopathic (DO) physicians; 
and no more than a combined total of 18 NPs, PAs, or CNMs.

Dental

    No more than 18 dentists and 18 dental hygienists.

Mental Health

    No more than 18 psychiatrists (MD or DO); and no more than a 
combined total of 18 health service psychologists (clinical or 
counseling psychologists), licensed clinical social workers, 
licensed professional counselors, marriage and family therapists, or 
psychiatric nurse specialists.

Application Requests, Dates, and Address

    The list of HPSAs and entities that are eligible to receive 
priority for the placement of Corps personnel may be updated 
periodically. Entities that no longer meet eligibility criteria, 
including those sites whose NHSC 3-year approval has lapsed or whose 
HPSA designation is withdrawn, will be removed from the priority 
listing. New entities interested in being added to the high

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priority list must submit a Site Application to: National Health 
Service Corps, 5600 Fishers Lane, Room 8A-30, Rockville, MD 20857, 
fax 301-594-2721. These applications must be postmarked on or before 
the submission deadline date of June 30, 2011. Applications 
submitted by clinicians for loan repayment will be processed as they 
are received. Applicants must be employed, or be starting employment 
within 30 days of their NHSC LRP application, at an entity with a 
currently approved Site Application, in order to be selected for an 
LRP award. Therefore, we strongly encourage all sites to have 
current NHSC-approved Site Applications and vacancies on file. Site 
applications submitted after June 30, 2011 will be considered for 
placement on the priority list in the following application cycle.
    Entities interested in receiving application materials may do so 
by calling the HRSA call center at 1-800-221-9393. They may also get 
information and download application materials from: http://nhsc.hrsa.gov/communities/apply.htm.

Additional Information

    Entities wishing to provide additional data and information in 
support of their inclusion on the proposed list of HPSAs and 
entities that would receive priority in assignment of Corps members, 
must do so in writing no later than [30 days after FRN publish 
date]. This information should be submitted to: Marty Bond, Chief, 
Site and Community Development Branch, Division of Site and 
Clinician Recruitment, Bureau of Clinician Recruitment and Service, 
5600 Fishers Lane, Room 8A-55, Rockville, MD 20857. This information 
will be considered in preparing the final list of HPSAs and entities 
that are receiving priority for the assignment of Corps personnel.
    Paperwork Reduction Act: The Site Application has been approved 
by the Office of Management and Budget under the Paperwork Reduction 
Act. The OMB clearance number is 0915-0230 and expires September 30, 
2011.
    The program is not subject to the provisions of Executive order 
12372, Intergovernmental Review of Federal Programs (as implemented 
through 45 CFR part 100).

    Dated: October 25, 2010.
Mary K. Wakefield,
Administrator.

[FR Doc. 2010-28083 Filed 11-4-10; 8:45 am]
BILLING CODE 4165-15-P