[Federal Register Volume 79, Number 71 (Monday, April 14, 2014)]
[Notices]
[Pages 20890-20893]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2014-08264]


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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 associated Health 
Professional Shortage Area (HPSA) scores that will receive priority for 
the assignment of National Health Service Corps (NHSC) scholarship 
recipients serving as Corps members, as well as those serving under the 
Private Practice Option (``NHSC scholars'' collectively), during the 
period July 1, 2014, through September 30, 2015, is posted on the NHSC 
Web site at http://nhscjobs.hrsa.gov. The NHSC Jobs Center includes all 
sites that are approved for performance of service by NHSC scholars; 
however, note that entities on this list may or may not have current 
job vacancies.

Eligible HPSAs and Entities

    To be eligible to receive assignment of Corps members, entities 
must: (1) Have a current HPSA status of ``designated'' by the Division 
of Policy and Shortage Designation, Bureau of Clinician Recruitment and 
Service, HRSA, as of January 1, 2014, for placements July 1, 2014, 
through December 31, 2014, or January 1, 2015, for placements January 
1, 2015, through September 30, 2015; (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

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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 (e.g. 
ancillary, inpatient, and specialty referrals) or arrangements for 
secondary and tertiary care; (3) have a documented record of sound 
fiscal management; (4) will experience a negative impact on their 
capacity to provide primary health services if a Corps member is not 
assigned to the entity, and (5) are a nonprofit or public entity to 
which Corps members may be assigned. 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.
    Entities at which NHSC scholars are performing their service 
obligations 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 NHSC scholar 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 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 Section 340H of the Public 
Health Service Act, 42 U.S.C. Section 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, 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 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) that is certified by the Centers for Medicare and 
Medicaid Services (CMS) as a CAH under section 1820 of the Social 
Security Act, the full-time service requirements are as follows: At 
least 16 of the minimum 40 hours per week must be spent providing 
direct patient care 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 (see Section 340H of the Public Health Service Act, 42 U.S.C 
Section 256h). Teaching activities in a HRSA-funded Teaching Health 
Center 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 treating 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, 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

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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), the half-time service requirements are as 
follows: At least 8 of the minimum 20 hours per week must be spent 
providing direct patient care 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 practice is not an option for scholars serving 
their obligation through the Private Practice Option.
    In addition to utilizing NHSC scholars in accordance with their 
full-time or half-time service obligation (as defined above), NHSC 
service sites 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 scholars 
(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 Section 330 of the Public Health Service Act. 
The Site Survey or UDS report, as applicable, requires 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 approved to serve at 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 site(s) at which the NHSC scholar 
is serving.

Evaluation and Selection Process

    In order for a site to be eligible for placement of NHSC scholars, 
it must be approved by the NHSC following the site's submission of a 
Site Application. Processing of site applications from solo or group 
practices will 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, 2014, through September 
30, 2015, 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 14 
and above are authorized for the assignment of NHSC scholars who are 
primary care physicians, family nurse practitioners, physician 
assistants, or certified nurse midwives; (2) mental health HPSAs with 
scores of 14 and above are authorized for the assignment of NHSC 
scholars who are psychiatrists or mental health nurse practitioners; 
and (3) dental HPSAs with scores of 14 and above are authorized for the 
assignment of NHSC scholars who are dentists. The NHSC has determined 
that a minimum HPSA score of 14 for all service-ready NHSC scholars 
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 2014-2015 
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), nurse practitioner, physician assistant, 
certified nurse midwife, 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. Sites wishing to request an additional scholar must 
complete an Additional Scholar Request form available at http://nhsc.hrsa.gov/downloads/additionalrequestform.pdf.
    NHSC-approved sites that do not meet the authorized threshold HPSA 
score of 14 may post job openings on the NHSC Jobs Center; however, 
scholars seeking placement between July 1, 2014 and September 30, 2015, 
will be advised that they can only compete for open positions at sites 
that meet the threshold placement HPSA score of 14. While not eligible 
for scholar placements in 2014-2015, vacancies in HPSAs scoring less 
than 14 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 NHSC scholars may be updated 
periodically. New entities may be added to the NHSC Jobs Center during 
a Site Application competition. Likewise, 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.

Additional Information

    Entities wishing to provide additional data and information in 
support of their inclusion on the proposed list of entities that would 
receive priority in assignment of scholarship-obligated Corps members, 
or in support of a higher priority determination, must do so in writing 
no later than May 14, 2014. This information should be submitted to: 
Beth Dillon, Director, Division of Regional Operations, Bureau of 
Clinician Recruitment and Service, 999 18th Street, Denver, Colorado 
80202. This information will be considered in preparing the final list 
of 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).


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    Dated: April 4, 2014.
Mary K. Wakefield,
Administrator.
[FR Doc. 2014-08264 Filed 4-11-14; 8:45 am]
BILLING CODE 4165-15-P