[Federal Register Volume 85, Number 146 (Wednesday, July 29, 2020)]
[Rules and Regulations]
[Pages 45532-45537]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2020-15411]


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DEPARTMENT OF VETERANS AFFAIRS

38 CFR Part 17

RIN 2900-AQ63


Specialty Education Loan Repayment Program

AGENCY: Department of Veterans Affairs.

ACTION: Final rule.

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SUMMARY: The Department of Veterans Affairs (VA) is amending its 
regulations that govern scholarship programs to certain health care 
professionals. This rulemaking implements the mandates of the VA 
MISSION Act of 2018 by establishing a Specialty Education Loan 
Repayment Program, which will assist VA in meeting the staffing needs 
of VA physicians in medical specialties for which VA has determined 
that recruitment or retention of qualified personnel is difficult.

DATES: This rule is effective August 28, 2020.

FOR FURTHER INFORMATION CONTACT: Teresa Culpepper, Manager, Education 
Loan Repayment Services, 810 Vermont Avenue NW, Washington, DC 20420, 
(501) 687-4064. (This is not a toll-free number.)

SUPPLEMENTARY INFORMATION: On December 26, 2019, VA published a 
proposed rule in the Federal Register (84 FR 70908) that called for the 
establishment of a new student loan repayment program, the Specialty 
Education Loan Repayment Program (SELRP). VA provided a 60-day comment 
period, which ended on February 24, 2020. We received 4 comments on the 
proposed rule.
    On June 6, 2018, section 303 of Public Law 115-182, the John S. 
McCain III, Daniel K. Akaka, and Samuel R. Johnson VA Maintaining 
Internal Systems and Strengthening Integrated Outside Networks Act of 
2018, or the VA MISSION Act of 2018, amended title 38 of the United 
States Code (U.S.C.) by establishing new sections 7691 through 7697 and 
created the SELRP. The SELRP serves as an incentive for physicians 
starting or currently in residency programs in medical specialties, for 
which VA has determined that recruitment and retention of qualified 
personnel is difficult, to work at VA facilities that need more 
physicians within that medical specialty after the individual completes 
their residency program. VA will determine the anticipated needs for 
medical specialties during a period of two to six years in the future. 
In taking this proactive approach, VA will commence recruitment for 
physicians in these specialties before the projected need to help 
ensure adequate health care coverage for VA beneficiaries. This final 
rule will establish the requirements for the SELRP in new 38 CFR 17.525 
through 17.531.
    One commenter requested that VA expand the individuals who qualify 
for the SELRP to include certified registered nurse anesthetists 
(CRNAs). The commenter stated that they understand there is 
underutilization and staffing shortages of other types of providers, 
including certified registered nurse anesthetists (CRNAs), and the 
commenter asked that this loan

[[Page 45533]]

repayment program be broadened to include incentives for recruitment 
and retention of advanced practice registered nurses (APRNs) in VA 
medical facilities. Another commenter similarly stated that to 
alleviate the primary care gap, a report recommends expanding the 
Primary Care Services Corps, which repays loans of nurse practitioners 
and physician assistants willing to work in underserved areas, and 
creating more Medicare-funded or state-funded residency slots for 
primary care doctors willing to work in upstate areas that need more 
physicians. Another commenter recommended that VA provide flexibility 
in the eligibility requirements to allow for fellows to be eligible. 
Fellows could also benefit from the program and may only have one year 
left of training. The current requirement for this program, however, 
limits participation to physicians currently in training who have more 
than two years remaining to complete such training. The commenter 
further added that fellows could deepen the applicant pool for the 
program, helping to facilitate participation by more psychiatrists 
during this time of critical need.
    We agree with the commenters in that VA's shortage of health care 
professionals is not limited to physicians. However, 38 U.S.C. 7693 
establishes the eligibility criteria for individuals who wish to 
participate in the SELRP. This criteria states that eligible 
individuals must be recently graduated from an accredited medical or 
osteopathic school and matched to an accredited residency program in a 
medical specialty described in section 7692 of this title; or a 
physician in training in a medical specialty described in section 7692 
of this title with more than 2 years remaining in such training. As 
such, VA cannot extend the eligibility criteria to include individuals 
who are not otherwise listed in section 7692. We are not making any 
changes based on these comments.
    A commenter requested that CRNAs be granted the ability to practice 
to the full scope of their education, training, licensure, and 
certification in VA medical facilities to allow veterans to receive 
access to safe and timely anesthesia services. The commenter stated 
that this step would make an anesthesia position within the VA more 
attractive in its own right to prior active duty and civilian CRNAs. 
The commenter's request that VA grant CRNAs full practice authority is 
beyond the scope of the proposed rule. We are not making any changes 
based on this comment.
    Another commenter recommended expanding the Doctors Across New 
York, or DANY, program that, as one of its features, forgives up to 
$150,000 of student loan debt for young physicians who commit to 
practicing medicine in certain parts of the state for at least five 
years. The commenter stated that medical school graduates from the 
class of 2012 left school with an average student loan debt of 
$166,750, according to the Association of American Medical Colleges. 
The commenter added that in the most recent round of the DANY program, 
26 young doctors in 2013 received the full, five-year awards. The SELRP 
is not a loan forgiveness program. Section 7494(c)(1) of 38 U.S.C. 
states that the amount of payments made for a participant under the 
SELRP may not exceed $160,000 over a total of four years of 
participation in the Program, of which not more than $40,000 of such 
payments may be made in each year of participation in the Program. If 
an individual participates in the SELRP for four years, the total 
amount of repayment of the individual's educational loan would be more 
than the $150,000 that the commenter stated that is repaid under the 
DANY. Also, VA does not have the statutory authority to adopt any 
provision of the DANY and any such adoption is beyond the scope of the 
proposed rule. We are not making any changes based on this comment.
    Several comments proposed opening new physician or medical schools, 
with some comments offering a specific number of schools to be opened, 
and some comments offering specific reasons why such schools should be 
opened or current failings to open such schools. The opening of new 
physician or medical schools is beyond the scope of the proposed rule 
and is not within VA's authority to do under section 303 of Public Law 
115-182. We are not making any changes based on these comments.
    A commenter referred to a HANYS survey and stated that they agree 
with this survey in that the survey recommends greater use of 
telemedicine to allow certain specialists to remotely provide a 
consultation or other medical service to patients in underserved areas 
of the state. The commenter did not provide more details on the source 
of the survey or the date of the study, so we are not clear what this 
survey might refer or relate to. Although the provision of telehealth 
services is beyond the scope of the proposed rule, we generally respond 
that VA has regulations in place that grant VA health care 
professionals the ability to provide telehealth services, within their 
scope of practice, functional statement, and/or in accordance with 
privileges granted to them by VA, irrespective of the State or location 
within a State where the health care provider or the beneficiary is 
physically located. See 38 CFR 17.417. VA also has statutory authority 
under 38 U.S.C. 1730C for the provision of telehealth services by VA 
health care professionals. We are not making any changes based on this 
comment.
    A commenter stated that incentives for medical students to pursue a 
career in primary care by helping with student loans is not enough to 
change what the commenter stated was a trend in which less than 10 
percent of medical students are going into primary care. The commenter 
added that Medicare needs to restructure the reimbursement system now 
so current family practitioners, internists and pediatricians will have 
higher pay. The restructuring of Medicare's reimbursement system is 
beyond the scope of the proposed rulemaking. We are not making any 
changes based on this comment.
    Another commenter indicated that they have long advocated for 
better recruitment of psychiatrists in the VA through the Clay Hunt 
Suicide Prevention for American Veterans Act, which included a pilot 
project encouraging more psychiatrists to choose a career with the VA 
by offering medical school loan repayments on par with those offered by 
other government agencies and private practices. The commenter added 
that the program was never implemented, but they are encouraged by the 
release of the SELRP and its potential to incentivize more 
psychiatrists to pursue careers with the VA. VA established into 
regulations the Program for the Repayment of Educational Loans for 
Certain VA Psychiatrists (PREL), which was established by Public Law 
114-2, section 4, the Clay Hunt Suicide Prevention for American 
Veterans Act (Clay Hunt SAV Act). See 81 FR 66820, Sept. 29, 2016. VA 
is planning to implement the PREL in the near future and agrees with 
the commenter that the PREL will help alleviate the shortage of VA 
psychiatrists and increase veterans' access to needed mental health 
care. We are not making any changes based on this comment.
    A commenter recommended that the SELRP be portable to sites where 
specialty is needed instead of the recipient being placed in one 
location. We believe the commenter intended to recommend that the SELRP 
be portable to VA facilities where a resident's specialty is needed, to 
enable rotations or other multiple assignments of such residents. As 
previously stated in this rulemaking, the SELRP serves as an

[[Page 45534]]

incentive for physicians starting or currently in residency programs in 
medical specialties for which VA has determined that recruitment and 
retention of qualified personnel is difficult, to work for VA at VA 
facilities that need more physicians with that medical specialty after 
the individual completes their residency program. VA will continuously 
monitor locations where there is the greatest need for physician 
specialties and appoint qualified individuals to these locations. To 
the extent the commenter recommends that VA enable rotations of 
residents in the SELRP, such administrative matters could be addressed 
outside of regulation and do not relate to the aspects of the SELRP 
that were proposed. We are not making any changes based on this 
comment.
    A commenter stated that special protections or a continuation of 
eligibility should also be included for parental leave to encourage 
women to participate. The commenter added that given that this is early 
career, such protections are necessary to support applicants. The 
commenter also stated that Federal guidelines on parental leave should 
be followed as a minimum. VA agrees with the commenter. Because the 
participants of the SELRP are appointed VA employees, all Federal rules 
regarding parental leave apply. We are not making any changes based on 
this comment.
    A commenter recommended that VA ensure that they coordinate with 
local VAs to announce and connect potential loan repayment recipients 
with local vacancies. The proposed rule stated in Sec.  17.527(a)(1) 
that in determining staffing needs, VA will consider the anticipated 
needs of VA for a period of two to six years in the future. VA will 
publish these vacancies in a notice in the Federal Register on an 
annual basis until vacancies are filled. Also, under Sec.  
17.530(b)(2), VA will provide SELRP participants a list of qualifying 
medical facility locations from which a participant may select a 
service location. However, VA reserves the right to make final 
decisions on the location and position of the obligated service. All 
placements will be coordinated and verified with local VA medical 
centers, including preliminary identification position need and medical 
center participation through selection and placement of eligible 
candidates. We are not making any changes based on this comment.
    A commenter also recommended that VA develop a process to 
comprehensively evaluate and track the application and placement 
process for accountable and equitable disbursement among the 
applicants, to ensure that psychiatrists are receiving equivalent 
consideration for this program among the specialties. The commenter 
added that this process could also include a mechanism to ensure the 
application process is not too burdensome for prospective candidates, 
thus streamlining the process overall. VA is leveraging existing 
programs and technologies to meet the lengthy application requirements 
while minimizing redundant requests for information. For example, VA 
will utilize approved VA forms to collect personnel and job application 
information instead of creating new program forms. We are not making 
any changes based on this comment.
    We are making technical edits to Sec.  17.529(c)(2)(i) for clarity. 
Proposed Sec.  17.528(c)(2)(i) stated that a summary of the applicant's 
educational debt, which includes the total debt amount and when the 
debt was acquired, would be one piece of information that must be 
provided to VA. Proposed Sec.  17.528(c)(2)(i) further stated that the 
health professional debt covered the loan must be specific to education 
that was required, used, and qualified the applicant for appointment as 
a physician. We have amended this paragraph to now state a summary of 
the applicant's educational loan, which includes the total loan amount 
and when the loan was acquired. The educational loan must be specific 
to the education that was required and used to qualify the applicant 
for appointment as a physician. VA always intended the meaning of the 
educational loan in this paragraph to clearly state that the eligible 
loan would only be that which was required and used to qualify an 
applicant for the SELRP. This change does not result in any substantive 
change in meaning and is only intended to be a technical change.
    Based on the rationale set forth in the Supplementary Information 
to the proposed rule and in this final rule, VA is adopting the 
proposed rule with the edits discussed in this rule.

Paperwork Reduction Act

    The Paperwork Reduction Act of 1995 (at 44 U.S.C. 3507) requires 
that VA consider the impact of paperwork and other information 
collection burdens imposed on the public. According to the 1995 
amendments to the Paperwork Reduction Act (5 CFR 1320.8(b)(2)(vi)), an 
agency may not collect or sponsor the collection of information, nor 
may it impose an information collection requirement unless it displays 
a currently valid Office of Management and Budget (OMB) control number. 
This rule includes provisions constituting new collections of 
information under the Paperwork Reduction Act of 1995 that require 
approval by the OMB. Accordingly, under 44 U.S.C. 3507(d), VA has 
submitted a copy of this rulemaking action to OMB for review.
    38 CFR 17.528 contains collections of information under the 
Paperwork Reduction Act of 1995. If OMB does not approve the 
collections of information as requested, VA will immediately remove the 
provisions containing a collection of information or take such other 
action as is directed by the OMB.
    The collections of information contained in 38 CFR 17.528 are 
described immediately following this paragraph.
    Title: Specialty Education Loan Repayment Program.
    Summary of collection of information: The information required 
determines the eligibility or suitability of an applicant desiring to 
participate in the SELRP under the provisions of 38 U.S.C. 7691 through 
7697. The purpose of the SELRP would be to repay educational loans to 
individuals who pursued a program of study leading to a degree in 
medicine and who are seeking employment in VA. VA considers this 
program as a hiring incentive to meet the staffing needs for physicians 
in medical specialties for which VA determines that recruitment and 
retention of qualified personnel is difficult.
    Description of the need for information and proposed use of 
information: The information is needed to apply for the SELRP. VA will 
use this information to select qualified candidates to participate in 
this program.
    Description of likely respondents: Potential participants of the 
SELRP.
    Estimated number of respondents per month/year: 200 per year.
    Estimated frequency of responses per month/year: 1 time per year.
    Estimated average burden per response: 90 minutes.
    Estimated total annual reporting and recordkeeping burden: 80 
hours.
    Estimated cost to respondents per year: VA estimates the total cost 
to all respondents to be $8,130 per year.

Regulatory Flexibility Act

    The Secretary hereby certifies that this final rule will not have a 
significant economic impact on a substantial number of small entities 
as they are defined in the Regulatory Flexibility Act, 5 U.S.C. 601-
612. The provisions associated with this rulemaking are not processed 
by any other entities outside of VA. Therefore, pursuant to 5 U.S.C.

[[Page 45535]]

605(b), the initial and final regulatory flexibility analysis 
requirements of 5 U.S.C. 603 and 604 do not apply.

Executive Orders 12866, 13563 and 13771

    Executive Orders 12866 and 13563 direct agencies to assess the 
costs and benefits of available regulatory alternatives and, when 
regulation is necessary, to select regulatory approaches that maximize 
net benefits (including potential economic, environmental, public 
health and safety effects, and other advantages; distributive impacts; 
and equity). Executive Order 13563 (Improving Regulation and Regulatory 
Review) emphasizes the importance of quantifying both costs and 
benefits, reducing costs, harmonizing rules, and promoting flexibility. 
The Office of Information and Regulatory Affairs has determined that 
this rule is not a significant regulatory action under Executive Order 
12866.
    VA's impact analysis can be found as a supporting document at 
http://www.regulations.gov, usually within 48 hours after the 
rulemaking document is published. Additionally, a copy of the 
rulemaking and its impact analysis are available on VA's website at 
http://www.va.gov/orpm/, by following the link for ``VA Regulations 
Published From FY 2004 Through Fiscal Year to Date.''
    This final rule is not expected to be an E.O. 13771 regulatory 
action because this final rule is not significant under E.O. 12866.

Unfunded Mandates

    The Unfunded Mandates Reform Act of 1995 requires, at 2 U.S.C. 
1532, that agencies prepare an assessment of anticipated costs and 
benefits before issuing any rule that may result in the expenditure by 
State, local, and tribal governments, in the aggregate, or by the 
private sector, of $100 million or more (adjusted annually for 
inflation) in any one year. This final rule will have no such effect on 
State, local, and tribal governments, or on the private sector.

Congressional Review Act

    Pursuant to the Congressional Review Act (5 U.S.C. 801 et seq.), 
the Office of Information and Regulatory Affairs designated this rule 
as not a major rule, as defined by 5 U.S.C. 804(2).

Catalog of Federal Domestic Assistance

    There are no Catalog of Federal Domestic Assistance numbers and 
titles for this rule.

List of Subjects in 38 CFR Part 17

    Administrative practice and procedure, Health care, Health 
facilities, Health professions, Health records, Medical and dental 
schools, Scholarships and fellowships, Veterans.

Signing Authority

    The Secretary of Veterans Affairs, or designee, approved this 
document and authorized the undersigned to sign and submit the document 
to the Office of the Federal Register for publication electronically as 
an official document of the Department of Veterans Affairs. Brooks D. 
Tucker, Acting Chief of Staff, Department of Veterans Affairs, approved 
this document on July 13, 2020, for publication.

Consuela Benjamin,
Regulations Development Coordinator, Office of Regulation Policy & 
Management, Office of the Secretary, Department of Veterans Affairs.

    For the reasons stated in the preamble, the Department of Veterans 
Affairs amends 38 CFR part 17 as follows:

PART 17--MEDICAL

0
1. The authority citation for part 17 is amended as follows:

    Authority:  38 U.S.C. 501, and as noted in specific sections.
* * * * *
    Sections 17.525 through 17.531 are also issued under 38 U.S.C. 
7691 through 7697.
* * * * *

0
2. Adding an undesignated center heading immediately following Sec.  
17.511 and new Sec. Sec.  17.525 through 17.531 to read as follows.
Specialty Education Loan Repayment Program
Sec.
17.525 Purpose.
17.526 Definitions.
17.527 Eligibility.
17.528 Application.
17.529 Award procedures.
17.530 Agreement and obligated service.
17.531 Failure to comply with terms and conditions of agreement.


Sec.  17.525  Purpose.

    The purpose of Sec. Sec.  17.525 through 17.531 is to establish the 
Specialty Education Loan Repayment Program (SELRP). The SELRP is an 
incentive program for certain individuals to meet VA's need for 
physicians in medical specialties for which VA determines that 
recruitment and retention of qualified personnel is difficult. 
Assistance under the SELRP may be in addition to other assistance 
available to individuals under the Educational Assistance Program under 
38 U.S.C. 7601.


Sec.  17.526   Definitions.

    The following definitions apply to Sec. Sec.  17.525 through 
17.530:
    Educational loan means a loan, government or commercial, made for 
educational purposes by institutions that are subject to examination 
and supervision in their capacity as lending institutions by an agency 
of the United States or of the state in which the lender has its 
principal place of business. Loans must be for the actual costs paid 
for tuition, and other reasonable educational expenses such as living 
expenses, fees, books, supplies, educational equipment and materials, 
and laboratory expenses. Loans must be obtained from a government 
entity, a private financial institution, a school, or any other 
authorized entity stated in this definition. The following loans do not 
qualify for the SELRP:
    (1) Loans obtained from family members, relatives, or friends;
    (2) Loans made prior to, or after, the individual's qualifying 
education;
    (3) Any portion of a consolidated loan that is not specifically 
identified with the education and purposes for which the SELRP may be 
authorized, such as home or auto loans merged with educational loans;
    (4) Loans for which an individual incurred a service obligation for 
repayment or agreed to service for future cancellation;
    (5) Credit card debt;
    (6) Parent Plus Loans;
    (7) Loans that have been paid in full;
    (8) Loans that are in default, delinquent, not in a current payment 
status, or have been assumed by a collection agency;
    (9) Loans not obtained from a bank, credit union, savings and loan 
association, not-for-profit organization, insurance company, school, 
and other financial or credit institution which is subject to 
examination and supervision in its capacity as a lending institution by 
an agency of the United States or of the state in which the lender has 
its principal place of business;
    (10) Loans for which supporting documentation is not available;
    (11) Loans that have been consolidated with loans of other 
individuals, such as spouses, children, friends, or other family 
member; or
    (12) Home equity loans or other noneducational loans.
    SELRP means the Specialty Education Loan Repayment Program 
established in Sec. Sec.  17.525 through 17.530.
    State means a State as defined in 38 U.S.C. 101(20), or a political 
subdivision of such a State.

[[Page 45536]]

    VA means the Department of Veterans Affairs.


Sec.  17.527  Eligibility.

    (a) General. An individual must meet the following requirements to 
be eligible to participate in the SELRP:
    (1) Will be eligible for appointment under 38 U.S.C. 7401 to work 
as a physician in a medical specialty for which VA determines that 
recruitment or retention of qualified personnel is difficult. In 
determining staffing needs, VA will consider the anticipated needs of 
VA for a period of two to six years in the future. VA will publish 
these vacancies in a notice in the Federal Register on a yearly basis 
until vacancies are filled.
    (2) Owes any amount of principal or interest for an educational 
loan where the proceeds were used by or on behalf of the individual to 
pay costs relating to a course of medical education or training that 
leads to employment as a physician and;
    (3) Is:
    (i) Recently graduated from an accredited medical or osteopathic 
school and matched to an accredited residency program in a medical 
specialty designated by VA; or
    (ii) A physician in training with more than 2 years remaining in 
such training.
    (b) Applicants without a residency match. An applicant may apply 
for the SELRP before receiving a residency match during the applicant's 
senior year of medical or osteopathic school. Once the applicant is 
matched with a residency specialty stated in Sec.  17.525 and upon 
selection of the SELRP, VA must offer the applicant participation in 
the SELRP no later than 28 days after:
    (1) The applicant is matched with the residency; and
    (2) VA has published the residency in a Notice in the Federal 
Register. Such notices are published on a yearly basis until vacancies 
are filled.
    (c) Preferences. VA will give preference to eligible participants 
who:
    (1) Are, or will be, participating in residency programs in health 
care facilities that are:
    (i) Located in rural areas;
    (ii) Operated by Indian tribes, tribal organizations, or the Indian 
Health Services; or
    (iii) Are affiliated with underserved health care facilities of VA; 
or
    (2) Veterans.


Sec.  17.528   Application.

    (a) General. A complete application for the SELRP consists of a 
completed application form, letters of reference, and personal 
statement.
    (b) References. The applicant must provide the following letters of 
reference and sign a release of information form for VA to contact such 
references:
    (1) One letter of reference from the Program Director of the core 
program in which the applicant is training, which indicates that the 
applicant is in good to excellent standing, or, for individuals who 
have yet to initiate training, a letter of reference from a faculty 
member or dean;
    (2) One or more letters of reference from faculty members under 
which the applicant trained; and
    (3) One letter of reference from a peer colleague who is familiar 
with the practice and character of the applicant.
    (c) Personal statement. The personal statement must include the 
following documentation:
    (1) A cover letter that provides the following information:
    (i) Why the applicant is interested in VA employment;
    (ii) The applicant's interest in working at a particular medical 
specialty and underserved area;
    (iii) Likely career goals, including career goals in VA; and
    (iv) A brief summary of past employment or training and 
accomplishments, including any particular clinical areas of interest 
(e.g., substance abuse).
    (2) The following information must be provided on a VA form or 
online collection system and is subject to VA verification:
    (i) A summary of the applicant's educational loan, which includes 
the total loan amount and when the loan was acquired. The educational 
loan must be specific to the education that was required and used to 
qualify the applicant for appointment as a physician.
    (ii) The name of the lending agency that provided the educational 
loan.
    (3) A full curriculum vitae.


(The Office of Management and Budget has approved the information 
collection requirements in this section under control number XXXX-
XXXX.)


Sec.  17.529   Award procedures.

    (a) Repayment amount. (1) VA may pay no more than $40,000 in 
educational loan repayment for each year of obligated service for a 
period not to exceed four years for a total payment of $160,000.00.
    (2) An educational loan repayment may not exceed the actual amount 
of principal and interest on an educational loan or loans.
    (b) Payment. VA will pay the participant, or the lending 
institution on behalf of the participant, directly for the principal 
and interest on the participant's educational loans. Payments will be 
made monthly or annually for each applicable service period, depending 
on the terms of the agreement. Participants must provide VA 
documentation that shows the amounts that were credited or posted by 
the lending institution to a participant's educational loan during an 
obligated service period. VA will issue payments after the participant 
commences the period of obligated service. Payments are exempt from 
Federal taxation.
    (c) Waiver of maximum amount of payment. VA may waive the 
limitations under paragraph (a)(1) of this section to participants of 
the SELRP if VA determines that there is a shortage of qualified 
employees due to either the location of where the participant will 
serve the period of obligated service or the requirements of the 
position that the participant will hold in VA. However, the waiver may 
not exceed the actual amount of the principal and the interest on the 
participant's loans payable to or for that participant.


Sec.  17.530   Agreement and obligated service.

    (a) General. In addition to any requirements under section 5379(c) 
of title 5, a participant in the SELRP must agree, in writing, to the 
following:
    (1) Obtain a license to practice medicine in a State;
    (2) Successfully complete postgraduate training leading to 
eligibility for board certification in a medical specialty;
    (3) Serve as a full-time clinical practice employee of VA for 12 
months for every $40,000.00 that the participant receives payment 
through the SELRP, however, the participant must serve for a period of 
no fewer than 24 months; and
    (4) Except as provided in paragraph (b) of this section, begin 
obligated service as a full-time VA employee no later than 60 days 
after completing residency in the medical specialty described in Sec.  
17.527(a)(1).
    (b) Obligated service. (1) General provision. A participant's 
obligated service will begin on the date on which the participant 
begins full-time permanent employment with VA in the qualifying field 
of medicine in a location determined by VA. Obligated service must be 
full-time permanent employment and does not include any period of 
temporary or contractual employment.
    (2) Location and position of obligated service. VA will provide 
SELRP participants a list of qualifying medical facility locations. A 
participant may select a service location from that list.

[[Page 45537]]

However, VA reserves the right to make final decisions on the location 
and position of the obligated service.
    (c) Exception to commencement of obligated service. If a 
participant receives an accredited fellowship in a medical specialty 
other than the specialty described in Sec.  17.27(a)(1), the 
participant may request, in writing, a delayed commencement of the 
period of obligated service until after the participant completes the 
fellowship. However, the period of obligated service will begin no 
later than 60 days after completion of such fellowship in the medical 
specialty described in Sec.  17.527(a)(1).


Sec.  17.531   Failure to comply with terms and conditions of 
agreement.

    A participant of the SELRP who fails to satisfy the period of 
obligated service will owe the United States government an amount 
determined by the formula A = B x ((T-S) / T)), where:
    (a) ``A'' is the amount the participant owes the United States 
government.
    (b) ``B'' is the sum of all payments to or for the participant 
under the SELRP.
    (c) ``T'' is the number of months in the period of obligated 
service of the participant.
    (d) ``S'' is the number of whole months of such period of obligated 
service served by the participant.

[FR Doc. 2020-15411 Filed 7-28-20; 8:45 am]
BILLING CODE 8320-01-P