[Federal Register Volume 81, Number 87 (Thursday, May 5, 2016)]
[Notices]
[Pages 27143-27145]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2016-10527]


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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 (HRSA), HHS.

ACTION: General notice.

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SUMMARY: 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 available for service during the period October 
1, 2016, through September 30, 2017, is posted on the NHSC Jobs Center 
Web site at http://nhscjobs.hrsa.gov. The NHSC Jobs Center includes 
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 Health Workforce, HRSA, 
as of January 1, 2016, for placements October 1, 2016, through December 
31, 2016, or as of January 1, 2017, for placements January 1, 2017, 
through September 30, 2017; (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, because payment for 
the services would be made under Medicare, Medicaid, or the Children's 
Health Insurance Program (CHIP), or based upon the individual's race, 
color, sex, national origin, disability, religion, age, or sexual 
orientation; (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

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secondary and tertiary care; (3) have a documented record of sound 
fiscal management; (4) will experience a negative impact on its 
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 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 patient care for patients at the 
approved practice site(s), providing patient care in alternative 
settings as directed by the approved practice site(s), or performing 
clinical-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, and pediatric dentists, at least 21 of 
the minimum 40 hours per week must be spent providing 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 patient care for patients at the 
approved practice site(s), providing patient care in alternative 
settings as directed by the approved practice site(s), or performing 
clinical-related administrative activities. Of the remaining 19 hours 
per week, no more than 8 hours can be spent performing clinical-related 
administrative activities. Teaching activities at the approved service 
site shall not exceed 8 of the minimum 21 hours per week providing 
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 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 
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 patient care for patients at 
the CAH(s) or the CAH-affiliated outpatient ambulatory care setting 
specified in the Customer Service Portal, providing patient care in the 
CAH's skilled nursing facility or swing bed unit, or performing 
clinical-related administrative activities. Of the remaining 24 hours 
per week, no more than 8 hours can be spent on clinical-related 
administrative activities. Teaching activities at the approved service 
site(s) shall not exceed 8 of the minimum 16 hours per week providing 
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 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 patient care for patients at the 
approved practice site(s), providing patient care in alternative 
settings as directed by the approved practice site(s), or performing 
clinical-related administrative activities. Teaching and clinical-
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, and pediatric dentists, at least 11 of 
the minimum 20 hours per week must be spent providing 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 patient care for patients at the 
approved practice site(s), providing patient care in alternative 
settings as directed by the approved practice site(s), or performing 
clinical-related administrative activities. Teaching and clinical-
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 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 patient care for patients at the 
CAH(s) or the CAH-affiliated outpatient

[[Page 27145]]

ambulatory care setting specified in the Practice Agreement, providing 
patient care in the CAH's skilled nursing facility or swing bed unit, 
or performing clinical-related administrative activities. Teaching and 
clinical-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 six 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 the NHSC Site Data Tables, which 
replace the former Uniform Data System (UDS)/Site Survey reporting 
tool. The NHSC collects the Site Data Tables from sites at the time of 
application, recertification, and NHSC site visits. Providers 
fulfilling NHSC commitments are approved to serve at a specific site 
or, in some cases, more than one site.

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 in a HPSA with the 
greatest shortage. For the program year October 1, 2016, through 
September 30, 2017, 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 17 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 17 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 17 and above are authorized for the 
assignment of NHSC scholars who are dentists. The NHSC has determined 
that a minimum HPSA score of 17 for all service-ready NHSC scholars 
will enable it to meet its statutory obligation to identify a number of 
entities eligible for NHSC scholar placement that is at least equal to, 
but not greater than, twice the number of NHSC scholars available to 
serve in the 2016-2017 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 17 may post job openings on the NHSC Jobs Center; however, 
scholars seeking placement between October 1, 2016, and September 30, 
2017, will be advised that they can only compete for open positions at 
sites that meet the threshold placement HPSA score of 17. While not 
eligible for scholar placements in the 2016-2017 cycle, vacancies in 
HPSAs scoring less than 17 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 
6, 2016. This information should be submitted to: Beth Dillon, 
Director, Division of Regional Operations, Bureau of Health Workforce, 
1961 Stout Street, Denver, Colorado 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 28, 2016.
James Macrae,
Acting Administrator.
[FR Doc. 2016-10527 Filed 5-4-16; 8:45 am]
 BILLING CODE 4165-15-P