[Federal Register Volume 59, Number 95 (Wednesday, May 18, 1994)]
[Unknown Section]
[Page 0]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 94-11994]


[[Page Unknown]]

[Federal Register: May 18, 1994]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES (HHS)
Health Resources and Services Administration
[RIN-0905-ZA50 PN #2222]

 

Availability of Funds for the National Health Service Corps Loan 
Repayment Program and Grants for State Loan Repayment Programs

AGENCY: Health Resources and Services Administration, PHS, HHS.

ACTION: Notice.

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SUMMARY: The Health Resources and Services Administration (HRSA) 
announces that approximately $39 million will be available in fiscal 
year (FY) 1994 for: (1) Awards for educational loan repayment under the 
National Health Service Corps (NHSC) Loan Repayment Program (LRP) 
(section 338B of the Public Health Service (PHS) Act) and (2) grants to 
States to operate loan repayment programs (section 338I of the PHS 
Act).
    The HRSA, through this notice, invites health professionals to 
apply for participation in the NHSC LRP and invites States to apply for 
grants to operate State Loan Repayment Programs (LRPs). The HRSA 
estimates that approximately 460 NHSC Loan Repayment awards totaling 
$32 million will be made to primary care physicians, dentists, nurse 
midwives, nurse practitioners, and physician assistants. Approximately 
$7 million in discretionary grants will be available to States to 
operate LRPs. Approximately $2.3 million will be available to support 9 
competing continuation grants and 3 to 5 new starts. The range for 
these grants is approximately $20,000 to $1 million. Approximately $4.6 
million is available for 18 noncompeting continuation grants. Awards 
will be made for a 1-year budget period and for up to a 3-year project 
period.
    The PHS is committed to achieving the health promotion and disease 
prevention objectives of Healthy People 2000, a PHS-led national 
activity for setting health priority areas. These programs will 
contribute to the Healthy People 2000 objectives by improving access to 
primary health care services through coordinated systems of care for 
medically underserved populations in both rural and urban areas. 
Potential applicants may obtain a copy of Healthy People 2000 (Full 
Report, Stock No. 017-00100474-01) or Healthy People 2000 (Summary 
Report; Stock No. 017001-00473-1) through the Superintendent of 
Documents, Government Printing Office, Washington, DC 20402-9325 
(telephone 202-783-3238).
    The Public Health Service strongly encourages all grant recipients 
to provide a smoke-free workplace and promote the non-use of all 
tobacco products. This is consistent with the PHS mission to protect 
and advance the physical and mental health of the American people.
    Part A of this notice contains specific information concerning the 
NHSC LRP, and part B contains specific information concerning grants 
for State LRPs.

Part A--NHSC Loan Repayment Program

ADDRESSES: Application materials may be obtained by calling or writing, 
and completed applications should be returned to: Mr. Clarke Gordon, 
Chief, Loan Repayment Programs Branch, Division of Scholarships and 
Loan Repayments, Bureau of Primary Health Care, HRSA, 4350 East-West 
Highway, 10th floor, Rockville, Maryland 20857, (301) 594-4400. The 24-
hour toll-free phone number is 1-800-435-6464, and the FAX number is 
(301) 594-4981. Applicants for the NHSC LRP will use HRSA Form 873 
approved under Office of Management and Budget (OMB) Number 0915-0127.

DATES: To receive consideration for funding, health professionals must 
submit their applications by August 15, 1994. To assure early 
processing of the application and approval for site matching, 
individuals are encouraged to submit applications well ahead of the 
August 15 deadline.
    Applications will be considered to be on time if they are either: 
(1) Received on or before the deadline date; or (2) postmarked on or 
before the established deadline date and received in time for orderly 
processing. Applicants should request a legibly dated U.S. Postal 
Service postmark or obtain a legibly dated receipt from a commercial 
carrier or U.S. Postal Service. Private metered postmarks are not 
acceptable as proof of timely mailing. Applications received after the 
announced closing date will not be considered for funding.

FOR FURTHER INFORMATION CONTACT: For further program information and 
technical assistance, please contact Mr. Gordon at the above address, 
phone or FAX number.

SUPPLEMENTARY INFORMATION: Section 338B of the Public Health Service 
Act (42 U.S.C. 2541-1) authorizes the Secretary to establish the NHSC 
LRP to help in assuring, with respect to the provision of primary 
health services, an adequate supply of trained primary care health 
professionals for the NHSC. The NHSC is used by the Secretary to 
provide primary health services in federally designated health 
professional shortage areas (HPSAs). Primary health services are 
services regarding family medicine, internal medicine, pediatrics, 
obstetrics and gynecology, dentistry, or mental health, that are 
provided by physicians or other health professionals.
    Under the NHSC LRP, the Secretary will repay graduate and 
undergraduate educational loans incurred by primary care health 
professionals. For the first 2 years of full-time service at an 
approved site in a designated HPSA, the Secretary will repay up to 
$25,000 per year of the educational loans of such individual. (There is 
a minimum 2-year service obligation.) For subsequent years of full-time 
service, if the NHSC LRP contract is extended, the Secretary will repay 
up to $35,000 per year. Payments may be made to participants on an 
advanced quarterly basis (one quarter in advance of service for the 
entire service obligation), on an advanced annual basis (one year in 
advance of service for each year of service or on an advanced biennial 
basis (2 years in advance of service but only for the first 2 years of 
a contract). The Secretary shall, in addition to such payments, make 
payments to the individual in an amount equal to 39 percent of the 
total amount of loan repayments made for the taxable year involved. In 
addition to these amounts, NHSC LRP participants will receive a salary 
from a private nonprofit or public entity or, in some cases, the 
Federal Government during the term of their service.
    The Secretary will identify and make available annually a list of 
those HPSA sites which will be available for service repayment under 
the NHSC LRP. The Secretary will select applicants for consideration 
for participation in the NHSC LRP according to the following criteria:

    (1) The extent to which an individual's training in a health 
profession or specialty is determined by the Secretary to be needed 
by the NHSC in providing primary health services. From time to time, 
the Secretary will publish a notice detailing the professions and 
specialties most needed by the NHSC. Current professional and 
specialty priorities are outlined in this notice at the end of part 
A.
    (2) The extent to which an individual is determined by the 
Secretary to be committed to serve in a HPSA.
    (3) The extent of an individual's demonstrated interest in 
providing primary health services.
    (4) The immediacy of an individual's availability for service. 
Individuals who have a degree, have completed all necessary 
postgraduate training in their professions and specialities (i.e., 
in the case of physicians, are certified or eligible to sit for the 
certifying examinations of a specialty board), have a current and 
unrestricted license to practice their profession in a State, will 
receive highest consideration.
    (5) The academic standing, prior professional experience in a 
HPSA, board certification, residency achievements, peer 
recommendations, and other criteria related to professional 
competence or conduct will also be considered.

    In providing contracts under the NHSC LRP, priority will be given 
to those applicants:

     Whose health profession or specialty is most needed by 
the NHSC;
     Who have and whose spouses, if any, have 
characteristics that increase the probability of their continuing to 
serve in a HPSA upon completion of their service obligations;
     Who are from disadvantaged backgrounds, subject to the 
preceding paragraph.

Eligible Participants

    To be eligible to participate in the NHSC LRP, an individual must:

    (1)(a) Have a degree in allopathic or osteopathic medicine, 
dentistry, or other health profession, or be certified as a nurse 
midwife, nurse practitioner, or physician assistant;
    (B) Be enrolled in an approved graduate training program in 
allopathic or osteopathic medicine, dentistry, or other health 
profession; or
    (c) Be enrolled as a full-time student at an accredited school 
in a State and in the final year of a course of study or program 
leading to a degree in allopathic or osteopathic medicine, 
dentistry, or other health profession;
    (2) Be eligible for appointment as a commissioned officer in the 
Regular or Reserve Corps of the PHS or be eligible for selection for 
civilian service in the NHSC; and
    (3) Submit an application for a contract to participate in the 
NHSC LRP which contract describes the repayment of educational loans 
in return for the individual serving for an obligated period.

    Any individual who previously incurred an obligation for health 
professional service to the Federal Government, a State Government, or 
other entity is ineligible to participate in the NHSC LRP unless such 
obligation will be completely satisfied prior to the beginning of 
service under this Program. Any individual who has breached an 
obligation for health professional service to the Federal Government, a 
State Government or other entity is ineligible to participate in the 
NHSC LRP. Any individual who has a judgment lien against his or her 
property for a debt to the United States is ineligible to participate 
in the NHSC LRP until the judgment is paid in full or otherwise 
satisfied.
    No loan repayments will be made for any professional practice prior 
to the effective date of the NHSC LRP contract. All individuals must 
have a current and unrestricted license to practice their profession in 
a State prior to beginning service under this Program.

Professions and Specialties Needed by the NHSC

    At this time, the Secretary has determined that priority will be 
given to physicians who are certified or eligible to sit for the 
certifying examination in the specialty boards of family practice, 
osteopathic general practice, obstetrics/gynecology, internal medicine, 
and pediatrics.

Other Award Information

    This program is not subject to the provisions of Executive Order 
12372, Intergovernmental Review of Federal Programs, since Executive 
Order 12372 does not cover payments to individuals. In addition, this 
program is not subject to the Public Health System Reporting 
Requirements, since the requirements do not cover payment to 
individuals.

    The OMB Catalog of Federal Domestic Assistance number for this 
program is 93.162.

Part B--Grants for State Loan Repayment Programs

ADDRESSES: Application materials for State Loan Repayment Programs may 
be obtained from, and completed applications returned to: Alice H. 
Thomas, Grants management Officer, HRSA/BPHC/GMB, 4350 East-West 
Highway, room 11-1C3, Rockville, Maryland 20857, (301) 594-4242. The 
Grants Management staff is available to provide assistance on business 
management issues.

    Application for these grants will be made on PHS form 5161-1 
(revised in July 1992) with revised face sheet DHHS Form 424, as 
approved by the OMB under control number 0937-0189. Specific 
instructions for completing the application form for this program will 
be sent to any State requesting an application package.

DATES: Applications are due June 17, 1994. Applications will be 
considered to have met the deadline if they are: (1) Received on or 
before the deadline date; or (2) postmarked on or before the deadline 
date and received in time for orderly processing. Applicants should 
request a legibly dated U.S. Postal Service postmark or obtain a 
legibly dated receipt from a commercial carrier or the U.S. Postal 
Service. Private metered postmarks will not be accepted as proof of 
timely mailing. Late applications will not be considered for funding 
and will be returned to the applicant.

FOR FURTHER INFORMATION CONTACT: For general program information and 
technical assistance, please contact Betty DeBerry-Sumner, D.D.S., 
M.P.H., Chief, Site Development and Placement Branch, HRSA/BPHC/NHSC, 
4350 East-West Highway, room 8-7A2, Rockville, MD 20857, (301) 594-
4165, FAX number (301) 594-4076.

SUPPLEMENTARY INFORMATION: Section 338I of the PHS Act (42 U.S.C. 254q-
1) authorizes the Secretary, acting through the Administrator, HRSA, to 
make grants to States for the purpose of assisting the States in 
operating programs as described in this notice for the repayment of 
educational loans of health professionals in return for their practice 
in federally designated health professional shortage areas (HPSAs) to 
increase the availability of primary health service in federal 
designated HPSAs.

Eligibility Requirements

    State Loan Repayment Programs (LRPs) eligible for funding under 
this announcement must meet the following requirements:

    (1) Direct administration by a State agency;
    (2) Payment of all or part of the qualifying educational loans 
(including principal, interest, and related educational loan 
expenses) of health professionals agreeing to provide primary health 
services in federally designated HPSAs. ``Qualifying educational 
loans'' are Government and commercial loans for actual costs paid 
for tuition, reasonable educational expenses, and reasonable living 
expenses relating to the graduate or undergraduate education of a 
health professional;
    (3) Assignment of participating health professionals only to 
public and nonprofit private entities located in and providing 
primary health services in federally designated MPSAs; and
    (4) Participant contracts which provide remedies for any breach 
of contract by participating health professionals.

Contract Requirements

    Contracts provided by a State are not to be on terms that are more 
favorable to health professionals than the most favorable terms the 
Secretary is authorized to provide for contracts under Federal NHSC 
Loan Repayment Programs under section 338B of the PHS Act, including 
terms regarding:

    (a) The annual amount of payments provided on behalf of the 
professionals regarding educational loans; and
    (b) The availability of remedies for any breach of the contracts 
by the health professionals involved.

    States are required to develop contracts that reflect a minimum of 
2 years of obligated full-time service. The annual amount of payments 
under a contract will not exceed the maximum amount of $35,000 
authorized in section 338B(g)(2)(A) of the PHS Act unless (1) this 
excess amount is paid solely from non-Federal contributions, and (2) 
the contract provides that the health professional involved will 
satisfy the requirement of obligated service under the contract solely 
through the provision of primary health services in a federally 
designated HPSA that is receiving priority for the purposes of section 
333A(a)(1), and is authorized to receive assignments of individuals who 
are participating in the NHSC Scholarship Program.
    No loan repayments will be made for any professional practice 
performed prior to the effective date of the health professional's 
State Loan Repayment Program contract, and no credit will be given for 
any practice done while the provider is in a professional school or 
graduate training program. Any individual who previously incurred an 
obligation for health professional service to the Federal Government, a 
State Government, or other entity is ineligible to participate in the 
State LRP unless such obligation will be completely satisfied prior to 
the beginning of service under this Program. Any individual who has 
breached an obligation for health professional service to the Federal 
Government, a State Government or other entity is ineligible to 
participate in the State LRP. Any individual who has a judgment lien 
against his or her property for a debt to the United States is 
ineligible to participate in the State NHSC LRP until the judgment is 
paid in full or otherwise satisfied.

Program Requirements

    States seeking support under this notice for the cost of State LRPs 
must provide adequate assurances that:

    (1) With respect to the costs of making loan repayments under 
contracts with health professionals, the State will make available 
(directly or through donations from public or private entities) non-
Federal contributions in cash in an amount equal to not less than $1 
for each $1 of Federal funds provided in the grant. The Federal 
grant funds and the State matching funds will be used only for loan 
repayments to health professionals who have entered into contracts 
with States. In determining the amount of non-Federal contributions 
in cash that a State has to provide, no other Federal funds may be 
used.
    (2) The State will assign health professionals participating in 
the program only to public and nonprofit private entities located in 
and providing primary health services in federally designated HPSAs.
    (3) Applications must identify the State entity and key 
personnel who will administer the grant.

Future Support

    The Secretary must determine that the State has complied with each 
of the agreements of the grant in order for funding to continue. Before 
making a grant for a subsequent year of State LRP support, the 
Secretary will, in the case of a State with one or more initial 
breaches by health professionals of the repayment contracts, reduce the 
amount of a grant to the State for the fiscal year involved. The grant 
will be reduced by an amount equal to the sum of the expenditures of 
Federal funds made regarding the State LRP contracts involved, 
including interest on the amount of such expenditures, determined on 
the basis of the maximum legal rate prevailing for loans made during 
the time amounts were paid under the contract, as determined by the 
Treasurer of the United States. The Secretary may waive the reduction 
in the subsequent grant award if the Secretary determines that a health 
professional's breach was attributable solely to the professional 
having a serious illness or has died.

Evaluation Criteria

    For new and competing continuation grants the following criteria 
will be used to evaluate State applications to determine which States 
are to be supported under this notice: (a) The extent of State's need 
for health professionals consistent with the health professions and 
specialties identified later in this notice; (b) the extent to which 
special consideration will be extended to federally designated HPSA's 
with large minority populations; (c) the number and type of providers 
the State proposes to support through this program; (d) the 
appropriateness of the proposed placements of State LRP recipients 
(e.g., consistency and coordination with State-based plans to improve 
access to primary health services for the underserved communities and 
individuals); (e) the appropriateness of the qualifications, the 
administrative and managerial ability of the staff to implement the 
proposed project; (f) the suitability of the State's approach and the 
degree to which the plan of a State is coordinated with Federal, State, 
and other programs for meeting the State's health professional needs 
and resources, including mechanisms for ongoing evaluation of the 
program's activities; (g) the source and plans for the use of the State 
match (the degree to which the State match exceeds the minimum 
requirements or has increased over time, and the amount of the match 
relative to the needs and resources of the State).
    For competing continuation applicants only, the following criteria 
will be used: (a) The grantee's progress in achieving stated goals and 
objectives for the previous year's grant including the impact the State 
LRP placements have had on the State's short-term and long-term 
professional needs; (b) an assessment of the number of and the reasons 
for initial breaches by health professionals of repayment contracts; 
and, (c) the grantee's history of compliance with reporting 
requirements including goals, objectives, evaluation plans, 
organizational structure, financial management, and personnel changes.
    Noncompeting continuation applications will be evaluated on the 
following criteria: (a) The grantee's progress in achieving stated 
goals and objectives for the previous year's grant including the impact 
the State LRP placements have had on the State's short-term and long-
term professional needs; (b) an assessment of the number of and the 
reasons for initial breaches by health professionals of repayment 
contracts; (c) the grantee's history of compliance with reporting 
activities including goals, objectives, evaluation plans, 
organizational structure, financial management, and personnel changes; 
and (d) the adequacy and appropriateness of the proposed budget.

Professions and Specialties Needed

    To be supported under this program, the State Program must 
establish State priorities for the selection of health professionals 
consistent with the NHSC LRP. At this time, the Secretary has 
determined that priority will be given to physicians who are certified 
or eligible to sit for the certifying examination in the specialty 
boards of family practice, osteopathic general practice, obstetrics/
gynecology, internal medicine and pediatrics.

Other Award Information

    This program is not subject to the Public Health System Reporting 
Requirements.
    This program is subject to the provisions of Executive Order 12372 
concerning intergovernmental review of Federal programs as implemented 
by 45 CFR part 100. Executive Order 12372 allows States the option of 
setting up a system to review applications from within their States 
under certain Federal programs. The application kit, to be made 
available under this notice, will contain a listing of States which 
have chosen to set up a review system and will provide a single point 
of contact (SPOC) in the States for that review. Applicants (other than 
federally recognized Indian tribal governments) should contact their 
State SPOC as early as possible to alert them to the prospective 
applications and receive any necessary instructions on the State 
process. For proposed projects serving more than one State, the 
applicant is advised to contact the SPOC of each affected State. The 
due date for State process recommendations is 60 days after the 
appropriate application deadline date. The BPHC does not guarantee that 
it will accommodate or explain its response to State process 
recommendations received after the due date.

    The OMB Catalog of Federal Domestic Assistance number for this 
program is 93.165.

    Dated: March 18, 1994.
Ciro V. Sumaya,
Administrator.
[FR Doc. 94-11994 Filed 5-17-94; 8:45 am]
BILLING CODE 4160-15-P-M