[Federal Register Volume 80, Number 89 (Friday, May 8, 2015)]
[Notices]
[Pages 26569-26571]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2015-11049]


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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, which will receive priority 
for the assignment of National Health Service Corps (NHSC) scholarship 
recipients available for service during the period October 1, 2015, 
through September 30, 2016, is posted on the NHSC Jobs Center Web site 
at http://nhscjobs.hrsa.gov. The NHSC Jobs Center includes sites that 
are approved for service by NHSC scholars; however, 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 Health Workforce, HRSA as 
of January 1, 2015, for placements October 1, 2015, through December 
31, 2015, or as of January 1, 2016, for placements January 1, 2016, 
through September 30, 2016; (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 health professionals; (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 that matches the discipline 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 the 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 direct patient care for patients 
at the approved practice site(s), providing direct patient care 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.

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    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 direct patient care for patients at the approved 
practice site(s), providing direct patient care in alternative settings 
as directed by the approved practice site(s), or performing practice-
related administrative activities. Of the remaining 19 hours per week, 
no more than 8 hours can be spent performing practice-related 
administrative activities. Teaching activities at the approved service 
site shall not exceed 8 hours of the minimum 21 hours per week 
providing direct patient care, unless the teaching takes place in a 
HRSA-funded Teaching Health Center, as noted above.
    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 & 
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 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. Of the 
remaining 24 hours per week, no more than 8 hours can be spent on 
practice-related administrative activities and teaching activities at 
the approved service site(s) shall not exceed 8 of the minimum 16 hours 
per week providing direct patient care, 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 direct patient care for 
patients at the approved practice site(s), providing direct patient 
care 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 
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 direct patient care for patients at the approved 
practice site(s), providing direct patient care 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 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 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 
through clinician in-service verifications every 6 months, 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 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 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 aggregated at the 
organization level. Providers fulfilling NHSC commitments are approved 
to serve at a specific site or, in some cases, more than one site.

Evaluation and Selection Process

    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

[[Page 26571]]

provision of primary health services in a HPSA with the greatest 
shortage. For the program year October 1, 2015, through September 30, 
2016, 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 scholars who are 
primary care physicians, family nurse practitioners, physician 
assistants, or certified nurse midwives; (2) mental health HPSAs with 
scores of 16 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 16 and above are authorized for the 
assignment of NHSC scholars who are dentists. The NHSC has determined 
that a minimum HPSA score of 16 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 2015-
2016 placement cycle.
    The number of new NHSC placements through the Scholarship Program 
allowed at any one site is limited to one 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 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 16 may post job openings on the NHSC Jobs Center; however, 
scholars seeking placement between October 1, 2015, and September 30, 
2016, 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 2015-2016, 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 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 NHSC Scholars, or in support of a 
higher priority determination, must do so in writing no later than June 
8, 2015. This information should be submitted to: Beth Dillon, 
Director, Division of Regional Operations, Bureau of Health Workforce, 
1961 Stout Street, Denver, CO 80294. 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).

    Dated: April 30, 2015.
James Macrae,
Acting Administrator.
[FR Doc. 2015-11049 Filed 5-7-15; 8:45 am]
 BILLING CODE 4165-15-P