[Federal Register Volume 77, Number 18 (Friday, January 27, 2012)]
[Notices]
[Pages 4332-4334]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2012-1844]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Health Resources and Services Administration


Recruitment of Sites for Assignment of National Health Service 
Corps Loan Repayors (FY 2012)

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 proposed list of the Health Professional Shortage 
Areas (HPSAs) and entities that would receive priority in applying for 
the assignment of National Health Service Corps (NHSC) Loan Repayors 
(Corps personnel, Corps members) during the period November 1, 2011, 
through September 30, 2012 is posted on the NHSC Web site at http://datawarehouse.hrsa.gov/HGDWReports/OneClickRptFilter.aspx?rptName=NHSCAppSiteList&rptFormat=HTML3.2. This 
database can be searched by State and will show the entities that have 
been approved by the NHSC for the assignment of NHSC Loan Repayment 
Program (LRP) participants serving as Corps members (i.e. Federal 
employees or Private Practice Assignees), as well as NHSC LRP 
participants wishing to exercise the Private Practice Option (PPO).

Eligible HPSAs and Entities

    To be eligible to receive assignment of Corps personnel, entities 
must: (1) Have a current HPSA status of ``designated'' 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, and use and post a discounted fee plan (including fee waivers 
as appropriate); 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 health care providers; (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. Sites 
that provide specialized care, or a limited set of services, will 
receive greater scrutiny and may not receive approval as NHSC service 
sites. This may include clinics that focus on one disease or disorder 
or offer limited services, such as a clinic that only provides 
immunizations or a substance abuse clinic. In order for a site to be 
eligible for placement of NHSC personnel, it must submit a Site 
Application and the Site Application must be approved by the NHSC. The 
NHSC site approval is good for a period of 3 years from the date of 
approval.
    Entities that receive assignment of Corps personnel must ensure 
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, except 
to the extent the provider is directly serving patients during that 
period.
    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

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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 
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-
funded Teaching Health Center (see Sec. 340H of the U.S. Public Health 
Service Act, 42 United States Code Sec. 256h). Teaching activities in a 
HRSA-funded 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-funded Teaching Health Center. 
Teaching activities in a HRSA-funded Teaching Health Center shall not 
exceed 20 hours of the minimum 40 hours per week.
    For health professionals serving in a Critical Access Hospital 
(CAH), defined as a nonprofit facility that is (a) located in a State 
that has established with the Centers for Medicare and Medicaid 
Services (CMS) a Medicare rural hospital flexibility program; (b) 
designated by the State as a CAH; (c) certified by the CMS as a CAH; 
and (d) in compliance with all applicable CAH conditions of 
participation, at least 16 of the minimum 40 hours per week must be 
spent providing direct patient care or teaching in the CAH-affiliated 
outpatient ambulatory care setting(s) specified in the Customer Service 
Portal, during normally scheduled office hours. The remaining 24 hours 
of the minimum 40 hours per week must be spent providing direct patient 
care for patients or teaching at the CAH(s) or the CAH-affiliated 
outpatient ambulatory care setting specified in the Practice Agreement, 
providing direct patient care in the CAH's skilled nursing facility or 
swing bed unit, or performing practice-related administrative 
activities. No more than 8 hours per week can be spent on practice-
related administrative activities. Teaching activities at the approved 
service site(s) shall not exceed 8 hours of the minimum 40 hours per 
week, unless the teaching takes place in a HRSA-funded Teaching Health 
Center (THC) (see Definitions). Teaching activities in a HRSA-funded 
THC 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, except to the extent the 
provider is directly serving patients during that period.
    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.
    For health professionals serving in a Critical Access Hospital 
(CAH), at least 8 of the minimum 20 hours per week must be spent 
providing direct patient care or teaching in the CAH-affiliated 
outpatient ambulatory care setting(s) specified in the Customer Service 
Portal, during normally scheduled office hours. The remaining 12 hours 
of the minimum 20 hours per week must be spent providing direct patient 
care for patients or teaching at the CAH(s) or the CAH-affiliated 
outpatient ambulatory care setting specified in the Practice Agreement, 
providing direct patient care in the CAH's skilled nursing facility or 
swing bed unit, 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 35 full-time days per service year in the case of 
full-time service and up to 35 half-time days per service year in the 
case of half-time service), but only to the extent the absences result 
in the clinician falling below the NHSC minimum service level; (2) 
report to the NHSC any change in the status of an NHSC clinician at the 
site; (3) provide the leave records, work 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 an NHSC Site Survey, or a Uniform Data System (UDS) 
report in the case of entities receiving HRSA grant support under Sec. 
330 of the Public Health Service Act. The Site Survey and UDS report 
require the site to assess the age, sex, race/ethnicity of, and 
provider encounter records for its user population and are site 
specific. Providers fulfilling NHSC commitments are assigned to a 
specific site or, in some cases, more than one site.

Evaluation and Selection Process

    In approving applications for the assignment of Corps members, the 
Secretary shall give priority to any application that is made regarding 
the provision of primary health services to

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a HPSA with the greatest shortage. For determination of priority 
assignments for NHSC LRP awards made using FY 2012 funding from 
November 1, 2011, to September 30, 2012, HPSAs of greatest shortage 
will be defined as follows: HPSAs (appropriate to each discipline) with 
scores of 14 and above are authorized for priority assignment of Corps 
members who are participating in the LRP. HPSAs with scores between 13 
and 10 will be given second priority for the assignment of Corps 
personnel participating in the LRP. HPSAs with scores of 9 and below 
will be eligible to receive assignment of Corps personnel participating 
in the LRP only after assignments are made of Corps members matching to 
HPSAs scoring 10 or above. Placement made through the NHSC LRP in HPSAs 
with scores of 9 or below 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 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 
distribution of NHSC resources, the number of new NHSC LRP placements 
(full-time or half-time) allowed at any one site during FY 2012 is 
limited to the following:
    HPSA Score: 0-9.

Primary Medical Care

    No more than 9 allopathic (MD) or osteopathic (DO) physicians; and 
no more than a combined total of 9 nurse practitioners (NPs), physician 
assistants (PAs), or certified nurse-midwives (CNMs).

Dental

    No more than 9 dentists and 9 dental hygienists.

Mental Health

    No more than 9 psychiatrists (MD or DO); and no more than a 
combined total of 9 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 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 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 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.

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 proposed for withdrawal or withdrawn, will be 
removed from the priority listing. New entities interested in being 
added to the high priority list must submit an online Site Application. 
The online application can be accessed at http://nhsc.hrsa.gov/sites/becomenhscapprovedsite/index.html. In order to qualify for placement of 
an NHSC loan repayor in the FY 2012 application cycle, Site 
Applications must be submitted and approved on or before March 30, 
2012. Clinicians applying for LRP funding must be employed, or be 
starting employment within 60 days of the submission of their NHSC LRP 
application, at an entity with a currently approved Site Application. 
Therefore, we strongly encourage all sites to have current NHSC-
approved Site Applications and vacancies on file. Site applications 
submitted after March 30, 2012, or under review as of March 30, 2012 
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/sites/becomenhscapprovedsite/index.html.

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: Sonya Bayone, Chief, Site Branch, 
Division of National Health Service Corps, Bureau of Clinician 
Recruitment and Service, 5600 Fishers Lane, Room 8-37, 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 January 31, 2014.
    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: January 20, 2012.
Mary K. Wakefield,
Administrator.
[FR Doc. 2012-1844 Filed 1-26-12; 8:45 am]
BILLING CODE 4165-15-P