[Federal Register Volume 61, Number 61 (Thursday, March 28, 1996)]
[Notices]
[Pages 13861-13864]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 96-7459]



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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Health Resources and Services Administration


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.

ACTION: Notice.

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SUMMARY: The Health Resources and Services Administration (HRSA) 
announces that applications will be accepted for fiscal year (FY) 1996 
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).
    This program announcement is subject to the final action on the 
appropriation of funds. At this time, given the continuing resolutions 
and the absence of a final FY 1996 appropriation for these programs, 
the specific amount available is not known.
    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). Awards will be 
made for a 1-year budget period and for up to a 5-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. 017-001-00474-01) or Healthy People 2000 (Summary 
Report; Stock No. 017-001-00473-1) through the Superintendent of 
Documents, Government Printing Office, Washington, D.C. 20402-9325 
(telephone 202-783-3238).
    PHS strongly encourages all grant recipients to provide a smoke-
free workplace and promote the non-use of all tobacco products. In 
addition, Public Law 103-227, the Pro-Children Act of 1994, prohibits 
smoking in certain facilities (or in some cases, any portion of a 
facility) in which regular or routine education, library, day care, 
health care or early childhood development services are provided to 
children.
    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 
to: National Health Service Corps Loan Repayment Program, 2070 Chain 
Bridge Road, Suite 450, Vienna, Virginia 22182-2536, 1-800-221-9393 or 
(703) 734-6855. Completed applications must be returned to: Loan 
Repayment Programs Branch, Division of Scholarships and Loan 
Repayments, Bureau of Primary Health Care, HRSA, 4350 East-West 
Highway, 10th Floor, Bethesda, Maryland 20814, (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: The deadline for applications is April 30, 1996, or until all 
appropriated funds have been obligated, whichever occurs first. Due to 
limited funding, it is anticipated that all appropriated funds will be 
obligated prior to April 30, 1996. The volume of applications is 
historically three times greater than the number of contracts that can 
be awarded, therefore, to receive consideration for funding, health 
professionals must submit an application and proof of a job offer at an 
eligible NHSC LRP Service Site.
    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 Sharley L. Chen, Chief, Loan 
Repayment Programs Branch, HRSA/BPHC/DSLR, at the above address, phone 
or FAX number.

SUPPLEMENTARY INFORMATION: Section 338B of the PHS Act (42 U.S.C. 254l-
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, general internal medicine, general 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 federally 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

[[Page 13862]]
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 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 specialties (i.e., in 
the case of physicians, are certified or eligible to sit for the 
certifying examinations of a specialty board, and in the case of other 
health professions, are certified in their specialty), and have a 
current and unrestricted license to practice their profession in the 
State in which they intend to serve, 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 an applicant:
     Whose health profession or specialty is most needed by the 
NHSC;
     Who has and whose spouse, if any, has characteristics that 
increase the probability of continuing to serve in a HPSA upon 
completion of his or her service obligation;
     Who is from a disadvantaged background, 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, or in 
accordance with State licensure requirements, as a nurse midwife, nurse 
practitioner, or physician assistant. Other health professions include 
clinical psychology, clinical social work, and dental hygiene;
    (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 (e.g., must be a citizen or national of 
the United States); 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 is 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 
performed prior to the effective date of the NHSC LRP contract. All 
individuals must have a current and unrestricted license to practice 
their profession in the State of practice prior to beginning service 
under this Program.

Professions and Specialties Needed by the NHSC

    At this time, the Secretary has determined, based on community 
demand, that priority will be given to: physicians (M.D.s and D.O.s) 
who are certified or eligible to sit for the certifying examination in 
the specialty boards of family 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: Grants Management Officer, HRSA/BPHC/GMB, 4350 East-
West Highway, Room 11-1C3, Bethesda, Maryland 20814, (301) 594-4260, 
FAX (301) 594-4073. Completed new and competing applications must be 
returned to: Bureau of Primary Health Care, Grants Management Officer, 
c/o Houston Associates, Inc., 1010 Wayne Avenue, Suite 240, Silver 
Spring, Maryland 20910. Completed applications for budget period 
renewals (i.e., non-competing continuations) must be returned to: 
Grants Management Officer, HRSA/BPHC/GMB, 4350 East-West Highway, Room 
11-1C3, Bethesda, Maryland 20814, (301) 594-4260 and FAX (301) 594-
4073. 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 May 1, 1996. 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

[[Page 13863]]
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 Sharley L. Chen, Chief, Loan 
Repayment Programs Branch, HRSA/BPHC/DSLR, 4350 East-West Highway, 10th 
Floor, Bethesda, Maryland 20814, (301) 594-4400. The 24-hour toll-free 
phone number is 1-800-435-6464, and the FAX number is (301) 594-4981.

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 services in federally 
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 HPSAs; 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 the Federal NHSC 
Loan Repayment Program under Section 338B of the PHS Act, including 
terms regarding:
    (1) The annual amount of payments provided on behalf of the 
professionals regarding educational loans; and
    (2) 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 clinical service. The annual amount of 
payments under a contract may not exceed $35,000, 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 full-time clinical 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 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:
    (1) Provide adequate assurance that, 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) Provide adequate assurance that 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, and identify each site available for 
placement.
    (3) Identify the State entity and key personnel who will administer 
the grant.
    (4) Provide an assurance that, with respect to contracts between 
the State and the health professional, all contract breaches, by either 
party, will be reported regularly.

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 serious illness or 
death of that professional.

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 HPSAs

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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, the amount of the match 
relative to the needs and resources of the State); and (h) the adequacy 
and appropriateness of the proposed budget.
    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 health 
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.

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 the following health professionals: 
Physicians (M.D.s and D.O.s) who are certified or eligible to sit for 
the certifying examination in the specialty boards of family 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 21, 1996.
Ciro V. Sumaya,
Administrator.
[FR Doc. 96-7459 Filed 3-27-96; 8:45 am]
BILLING CODE 4160-15-P