[Federal Register Volume 77, Number 72 (Friday, April 13, 2012)]
[Notices]
[Pages 22329-22331]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2012-8928]


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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 Scholarship Program

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) scholarship 
recipients (Corps Personnel, Corps members) during the period July 1, 
2012, through June 30, 2013, is posted on the NHSC Web site at http://datawarehouse.hrsa.gov/HGDWReports/OneClickRptFilter.aspx?rptName=NHSCAppSiteList&rptFormat=HTML3.2. This 
searchable database specifies all currently approved NHSC service 
sites, by State, and can be utilized to determine which entities are 
eligible to receive assignment of Corps members who are participating 
in the NHSC Scholarship Program based on the threshold HPSA score set 
forth below. Please note that entities on this list may or may not have 
current job opportunities for NHSC scholars. Furthermore, not all 
vacancies associated with sites on the list described below will be for 
Corps members, but could be for NHSC Scholarship Program participants 
serving their obligation 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 (CHIP); (3) enter 
into an agreement with the State agency that administers Medicaid and 
CHIP, accept assignment under Medicare, see all patients regardless of 
their ability to pay and post such policy, 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

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Corps member is not assigned to the entity. Sites that provide 
specialized care, or a limited set of services 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.
    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 practice, 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 
treating 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 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 physicians (including psychiatrists), physician assistants, 
nurse practitioners (including those specializing in psychiatry or 
mental health), and certified nurse midwives 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 NHSC's 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 Customer Service 
Portal, 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 Sec. 340H of the 
U.S. Public Health Service Act, 42 United States Code Sec. 256h). 
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 physicians (including psychiatrists), physician assistants, 
nurse practitioners (including those specializing in psychiatry or 
mental health), and certified nurse midwives 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.
    Half-time clinical service is not an option for scholars serving 
their obligation through the Private Practice Option.
    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); (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 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 or UDS report, as applicable, 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. The scope of activity to be reported in the survey 
includes all activity at the

[[Page 22331]]

site(s) to which the Corps member is assigned.

Evaluation and Selection Process

    In order for a site to be eligible for placement of NHSC personnel, 
it must be approved by the NHSC following the site's submission of a 
Site Application. The processing of Site Applications from solo or 
group practices may involve additional screening, including a site 
visit by NHSC representatives. The Site Application approval is good 
for a period of 3 years from the date of approval.
    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 the program year July 1, 2012, through
    June 30, 2013, HPSAs of greatest shortage for determination of 
priority for assignment of NHSC scholarship-obligated Corps personnel 
will be defined as follows: (1) Primary medical care HPSAs with scores 
of 16 and above are authorized for the assignment of NHSC scholarship 
recipients who are primary care physicians, family nurse practitioners 
(NPs), physician assistants (PAs) or CNMs; (2) mental health HPSAs with 
scores of 16 and above are authorized for the assignment of NHSC 
scholarship recipients who are psychiatrists or mental health nurse 
practitioners; and (3) dental HPSAs with scores of 16 and above are 
authorized for the assignment of NHSC scholarship recipients who are 
dentists. The NHSC has determined that a minimum HPSA score of 16 for 
all eligible clinicians will enable it to meet its statutory obligation 
to identify a number of entities eligible for placement at least equal 
to, but not greater than, twice the number of NHSC scholars available 
to serve in the 2012-2013 placement cycle.
    The number of new NHSC placements through the Scholarship Program 
allowed at any one site is limited to one (1) of the following provider 
types: Physician (MD/DO), NP, PA, CNM, or dentist. The NHSC will 
consider requests for up to two (2) scholar placements at any one site 
on a case-by-case basis. Factors that are taken into consideration 
include community need, as measured by demand for services, patient 
outcomes and other similar factors, and how the additional scholar will 
impact retention of other clinicians. Sites wishing to request an 
additional scholar must complete an Additional Scholar Request form 
available at http:[sol][sol]nhsc.hrsa.gov/scholarship/pdf/
additionalscholarrequestform.pdf.
    Sites that do not meet the authorized HPSA score threshold 
indicated above may post job openings, however, scholars seeking 
placement between July 1, 2012 and June 30, 2013 will be advised that 
they can only compete for open positions at sites that meet the 
threshold placement HPSA score of 16. While not eligible for scholar 
placements in 2012-2013, vacancies in HPSAs scoring less than 16 will 
be used by the NHSC in evaluating the HPSA threshold score for the next 
scholarship placement cycle.

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 3-year approval as an NHSC service site has 
lapsed or whose HPSA designation has been withdrawn or proposed for 
withdrawal, will be removed from the priority listing. New entities 
interested in being added to the high priority list must submit a Site 
Application to the National Health Service Corps by visiting 
http:[sol][sol]nhsc.hrsa.gov/communities/apply.htm to apply online. A 
searchable database of HPSAs and their scores, by State and county, is 
posted at http:[sol][sol]hpsafind.hrsa.gov/.

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 scholarship-obligated 
Corps members, must do so in writing no later than May 14, 2012. This 
information should be submitted to: Sonya Bayone, Chief, Site Branch, 
Division of the 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 
scholarship-obligated Corps personnel.
    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: April 9, 2012.
Mary K. Wakefield,
Administrator.
[FR Doc. 2012-8928 Filed 4-12-12; 8:45 am]
BILLING CODE 4165-15-P