[Federal Register Volume 74, Number 101 (Thursday, May 28, 2009)]
[Notices]
[Pages 25568-25570]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: E9-12531]


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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 (ARRA 
and FY 2010)

AGENCY: Health Resources and Services Administration (HRSA), HHS.

ACTION: General notice.

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SUMMARY: Under the American Recovery and Reinvestment Act of 2009 
(ARRA), additional funds are available to expand the National Health 
Service Corps (NHSC) through its programs to provide access to, and 
improve quality of, primary health care for millions of underserved 
Americans. The HRSA is

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therefore announcing an approximate 16-month funding cycle for new NHSC 
Loan Repayment applications and awards. During this 16-month cycle, the 
NHSC Loan Repayment Program will accept applications for loan repayment 
awards until all funds are expended. The policies described in this 
notice will be effective for all NHSC loan repayment awards made using 
ARRA funding from June 2009, to September 30, 2010, and all NHSC loan 
repayment awards made using fiscal year (FY) 2010 funding (if funding 
is appropriated) from October 1, 2009, to September 30, 2010. 
Provisions regarding assignment of NHSC Scholarship Program 
participants for the upcoming program year will be announced through a 
subsequent Notice.
    The listing of entities, and their Health Professional Shortage 
Area (HPSA) scores, that will receive priority for the assignment of 
NHSC Loan Repayors (Corps Personnel, Corps members) for this period is 
posted on the NHSC Web site at http://nhscjobs.hrsa.gov/. This list 
specifies which entities are eligible to receive assignment of Corps 
members who are participating in the NHSC Loan Repayment Program, and 
Corps members who have become Corps members other than pursuant to 
contractual obligations under the Loan Repayment Programs. 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 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, and/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 Multi-Year 
Recruitment and Retention (R&R) Assistance Application. The R&R 
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 
full-time clinical practice at the approved service location for a 
minimum of 40 hours per week with at least 32 hours per week in the 
ambulatory care setting. Obstetricians/gynecologists, certified nurse 
midwives (CNMs), and family practitioners who practice obstetrics on a 
regular basis are required to engage in a minimum of 21 hours per week 
of outpatient clinical practice. The remaining hours, making up the 
minimum 40-hour per week total, include delivery and other clinical 
hospital-based duties. For behavioral and mental health providers, at 
least 32 hours of the minimum 40 hours per week must be spent providing 
direct clinical services. At least 21 hours of the 32 clinical hours 
per week must be spent providing direct patient counseling during 
normally scheduled office hours in an ambulatory outpatient care 
setting. For all Corps personnel, (1) time spent on-call does not count 
toward the 40 hours per week and (2) no more than 8 hours per week can 
be spent performing practice-related administrative activities. In 
addition, 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 35 work days or 280 hours per service 
year); (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 NHSC assignees 
(including documentation, if applicable, of the reason(s) for the 
termination of a 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 Loan Repayment 
Program resulting from loan repayment awards made using ARRA funding 
from June 2009, through September 30, 2010, and loan repayment awards 
made using FY 2010 funding (if funding is appropriated) from October 1, 
2009, to September 30, 2010, 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 Loan Repayment Program. HPSAs with scores 
below 10 will be eligible to receive assignment of Corps personnel 
participating in the Loan Repayment Program only after assignments are 
made of those Corps members matching to those HPSAs receiving priority 
for placement of Corps members through the Loan Repayment Program 
(i.e., HPSAs scoring 10 or above). Placements 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

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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 
placements through the Loan Repayment Program allowed at any one site 
for the assignments/awards covered by this notice is limited to the 
following:

HPSA Score: 0-9

Primary Medical Care
    No more than 10 allopathic (MD) or osteopathic (DO) physicians; and 
no more than a combined total of 10 nurse practitioners (NPs), 
physician assistants (PAs), or CNMs.
Dental
    No more than 10 dentists and 10 dental hygienists.
Mental Health
    No more than 10 psychiatrists (MD or DO); and no more than a 
combined total of 10 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 12 allopathic (MD) or osteopathic (DO) physicians; and 
no more than a combined total of 12 NPs, 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 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 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 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 priority 
list must submit a Multi-Year Recruitment and Retention (R&R) 
Assistance 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 March 26, 2010. Due to the availability of additional funds 
through ARRA, applications submitted by clinicians for loan repayment 
will be processed as they are received. Therefore, we strongly 
encourage all sites to have current NHSC-approved R&R applications and 
vacancies on file. Site applications submitted after this deadline date 
will be considered for placement on the priority placement 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/applications/rraa.asp.

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 June 29, 2009. This information should be 
submitted to: Mark Pincus, Director, 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 Multi-Year R&R Assistance 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: May 22, 2009.
Mary K. Wakefield,
Administrator.
[FR Doc. E9-12531 Filed 5-26-09; 4:15 pm]
BILLING CODE 4165-15-P