[Federal Register Volume 59, Number 95 (Wednesday, May 18, 1994)]
[Unknown Section]
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From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 94-11994]
[[Page Unknown]]
[Federal Register: May 18, 1994]
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DEPARTMENT OF HEALTH AND HUMAN SERVICES (HHS)
Health Resources and Services Administration
[RIN-0905-ZA50 PN #2222]
Availability of Funds for the National Health Service Corps Loan
Repayment Program and Grants for State Loan Repayment Programs
AGENCY: Health Resources and Services Administration, PHS, HHS.
ACTION: Notice.
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SUMMARY: The Health Resources and Services Administration (HRSA)
announces that approximately $39 million will be available in fiscal
year (FY) 1994 for: (1) Awards for educational loan repayment under the
National Health Service Corps (NHSC) Loan Repayment Program (LRP)
(section 338B of the Public Health Service (PHS) Act) and (2) grants to
States to operate loan repayment programs (section 338I of the PHS
Act).
The HRSA, through this notice, invites health professionals to
apply for participation in the NHSC LRP and invites States to apply for
grants to operate State Loan Repayment Programs (LRPs). The HRSA
estimates that approximately 460 NHSC Loan Repayment awards totaling
$32 million will be made to primary care physicians, dentists, nurse
midwives, nurse practitioners, and physician assistants. Approximately
$7 million in discretionary grants will be available to States to
operate LRPs. Approximately $2.3 million will be available to support 9
competing continuation grants and 3 to 5 new starts. The range for
these grants is approximately $20,000 to $1 million. Approximately $4.6
million is available for 18 noncompeting continuation grants. Awards
will be made for a 1-year budget period and for up to a 3-year project
period.
The PHS is committed to achieving the health promotion and disease
prevention objectives of Healthy People 2000, a PHS-led national
activity for setting health priority areas. These programs will
contribute to the Healthy People 2000 objectives by improving access to
primary health care services through coordinated systems of care for
medically underserved populations in both rural and urban areas.
Potential applicants may obtain a copy of Healthy People 2000 (Full
Report, Stock No. 017-00100474-01) or Healthy People 2000 (Summary
Report; Stock No. 017001-00473-1) through the Superintendent of
Documents, Government Printing Office, Washington, DC 20402-9325
(telephone 202-783-3238).
The Public Health Service strongly encourages all grant recipients
to provide a smoke-free workplace and promote the non-use of all
tobacco products. This is consistent with the PHS mission to protect
and advance the physical and mental health of the American people.
Part A of this notice contains specific information concerning the
NHSC LRP, and part B contains specific information concerning grants
for State LRPs.
Part A--NHSC Loan Repayment Program
ADDRESSES: Application materials may be obtained by calling or writing,
and completed applications should be returned to: Mr. Clarke Gordon,
Chief, Loan Repayment Programs Branch, Division of Scholarships and
Loan Repayments, Bureau of Primary Health Care, HRSA, 4350 East-West
Highway, 10th floor, Rockville, Maryland 20857, (301) 594-4400. The 24-
hour toll-free phone number is 1-800-435-6464, and the FAX number is
(301) 594-4981. Applicants for the NHSC LRP will use HRSA Form 873
approved under Office of Management and Budget (OMB) Number 0915-0127.
DATES: To receive consideration for funding, health professionals must
submit their applications by August 15, 1994. To assure early
processing of the application and approval for site matching,
individuals are encouraged to submit applications well ahead of the
August 15 deadline.
Applications will be considered to be on time if they are either:
(1) Received on or before the deadline date; or (2) postmarked on or
before the established deadline date and received in time for orderly
processing. Applicants should request a legibly dated U.S. Postal
Service postmark or obtain a legibly dated receipt from a commercial
carrier or U.S. Postal Service. Private metered postmarks are not
acceptable as proof of timely mailing. Applications received after the
announced closing date will not be considered for funding.
FOR FURTHER INFORMATION CONTACT: For further program information and
technical assistance, please contact Mr. Gordon at the above address,
phone or FAX number.
SUPPLEMENTARY INFORMATION: Section 338B of the Public Health Service
Act (42 U.S.C. 2541-1) authorizes the Secretary to establish the NHSC
LRP to help in assuring, with respect to the provision of primary
health services, an adequate supply of trained primary care health
professionals for the NHSC. The NHSC is used by the Secretary to
provide primary health services in federally designated health
professional shortage areas (HPSAs). Primary health services are
services regarding family medicine, internal medicine, pediatrics,
obstetrics and gynecology, dentistry, or mental health, that are
provided by physicians or other health professionals.
Under the NHSC LRP, the Secretary will repay graduate and
undergraduate educational loans incurred by primary care health
professionals. For the first 2 years of full-time service at an
approved site in a designated HPSA, the Secretary will repay up to
$25,000 per year of the educational loans of such individual. (There is
a minimum 2-year service obligation.) For subsequent years of full-time
service, if the NHSC LRP contract is extended, the Secretary will repay
up to $35,000 per year. Payments may be made to participants on an
advanced quarterly basis (one quarter in advance of service for the
entire service obligation), on an advanced annual basis (one year in
advance of service for each year of service or on an advanced biennial
basis (2 years in advance of service but only for the first 2 years of
a contract). The Secretary shall, in addition to such payments, make
payments to the individual in an amount equal to 39 percent of the
total amount of loan repayments made for the taxable year involved. In
addition to these amounts, NHSC LRP participants will receive a salary
from a private nonprofit or public entity or, in some cases, the
Federal Government during the term of their service.
The Secretary will identify and make available annually a list of
those HPSA sites which will be available for service repayment under
the NHSC LRP. The Secretary will select applicants for consideration
for participation in the NHSC LRP according to the following criteria:
(1) The extent to which an individual's training in a health
profession or specialty is determined by the Secretary to be needed
by the NHSC in providing primary health services. From time to time,
the Secretary will publish a notice detailing the professions and
specialties most needed by the NHSC. Current professional and
specialty priorities are outlined in this notice at the end of part
A.
(2) The extent to which an individual is determined by the
Secretary to be committed to serve in a HPSA.
(3) The extent of an individual's demonstrated interest in
providing primary health services.
(4) The immediacy of an individual's availability for service.
Individuals who have a degree, have completed all necessary
postgraduate training in their professions and specialities (i.e.,
in the case of physicians, are certified or eligible to sit for the
certifying examinations of a specialty board), have a current and
unrestricted license to practice their profession in a State, will
receive highest consideration.
(5) The academic standing, prior professional experience in a
HPSA, board certification, residency achievements, peer
recommendations, and other criteria related to professional
competence or conduct will also be considered.
In providing contracts under the NHSC LRP, priority will be given
to those applicants:
Whose health profession or specialty is most needed by
the NHSC;
Who have and whose spouses, if any, have
characteristics that increase the probability of their continuing to
serve in a HPSA upon completion of their service obligations;
Who are from disadvantaged backgrounds, subject to the
preceding paragraph.
Eligible Participants
To be eligible to participate in the NHSC LRP, an individual must:
(1)(a) Have a degree in allopathic or osteopathic medicine,
dentistry, or other health profession, or be certified as a nurse
midwife, nurse practitioner, or physician assistant;
(B) Be enrolled in an approved graduate training program in
allopathic or osteopathic medicine, dentistry, or other health
profession; or
(c) Be enrolled as a full-time student at an accredited school
in a State and in the final year of a course of study or program
leading to a degree in allopathic or osteopathic medicine,
dentistry, or other health profession;
(2) Be eligible for appointment as a commissioned officer in the
Regular or Reserve Corps of the PHS or be eligible for selection for
civilian service in the NHSC; and
(3) Submit an application for a contract to participate in the
NHSC LRP which contract describes the repayment of educational loans
in return for the individual serving for an obligated period.
Any individual who previously incurred an obligation for health
professional service to the Federal Government, a State Government, or
other entity is ineligible to participate in the NHSC LRP unless such
obligation will be completely satisfied prior to the beginning of
service under this Program. Any individual who has breached an
obligation for health professional service to the Federal Government, a
State Government or other entity is ineligible to participate in the
NHSC LRP. Any individual who has a judgment lien against his or her
property for a debt to the United States is ineligible to participate
in the NHSC LRP until the judgment is paid in full or otherwise
satisfied.
No loan repayments will be made for any professional practice prior
to the effective date of the NHSC LRP contract. All individuals must
have a current and unrestricted license to practice their profession in
a State prior to beginning service under this Program.
Professions and Specialties Needed by the NHSC
At this time, the Secretary has determined that priority will be
given to physicians who are certified or eligible to sit for the
certifying examination in the specialty boards of family practice,
osteopathic general practice, obstetrics/gynecology, internal medicine,
and pediatrics.
Other Award Information
This program is not subject to the provisions of Executive Order
12372, Intergovernmental Review of Federal Programs, since Executive
Order 12372 does not cover payments to individuals. In addition, this
program is not subject to the Public Health System Reporting
Requirements, since the requirements do not cover payment to
individuals.
The OMB Catalog of Federal Domestic Assistance number for this
program is 93.162.
Part B--Grants for State Loan Repayment Programs
ADDRESSES: Application materials for State Loan Repayment Programs may
be obtained from, and completed applications returned to: Alice H.
Thomas, Grants management Officer, HRSA/BPHC/GMB, 4350 East-West
Highway, room 11-1C3, Rockville, Maryland 20857, (301) 594-4242. The
Grants Management staff is available to provide assistance on business
management issues.
Application for these grants will be made on PHS form 5161-1
(revised in July 1992) with revised face sheet DHHS Form 424, as
approved by the OMB under control number 0937-0189. Specific
instructions for completing the application form for this program will
be sent to any State requesting an application package.
DATES: Applications are due June 17, 1994. Applications will be
considered to have met the deadline if they are: (1) Received on or
before the deadline date; or (2) postmarked on or before the deadline
date and received in time for orderly processing. Applicants should
request a legibly dated U.S. Postal Service postmark or obtain a
legibly dated receipt from a commercial carrier or the U.S. Postal
Service. Private metered postmarks will not be accepted as proof of
timely mailing. Late applications will not be considered for funding
and will be returned to the applicant.
FOR FURTHER INFORMATION CONTACT: For general program information and
technical assistance, please contact Betty DeBerry-Sumner, D.D.S.,
M.P.H., Chief, Site Development and Placement Branch, HRSA/BPHC/NHSC,
4350 East-West Highway, room 8-7A2, Rockville, MD 20857, (301) 594-
4165, FAX number (301) 594-4076.
SUPPLEMENTARY INFORMATION: Section 338I of the PHS Act (42 U.S.C. 254q-
1) authorizes the Secretary, acting through the Administrator, HRSA, to
make grants to States for the purpose of assisting the States in
operating programs as described in this notice for the repayment of
educational loans of health professionals in return for their practice
in federally designated health professional shortage areas (HPSAs) to
increase the availability of primary health service in federal
designated HPSAs.
Eligibility Requirements
State Loan Repayment Programs (LRPs) eligible for funding under
this announcement must meet the following requirements:
(1) Direct administration by a State agency;
(2) Payment of all or part of the qualifying educational loans
(including principal, interest, and related educational loan
expenses) of health professionals agreeing to provide primary health
services in federally designated HPSAs. ``Qualifying educational
loans'' are Government and commercial loans for actual costs paid
for tuition, reasonable educational expenses, and reasonable living
expenses relating to the graduate or undergraduate education of a
health professional;
(3) Assignment of participating health professionals only to
public and nonprofit private entities located in and providing
primary health services in federally designated MPSAs; and
(4) Participant contracts which provide remedies for any breach
of contract by participating health professionals.
Contract Requirements
Contracts provided by a State are not to be on terms that are more
favorable to health professionals than the most favorable terms the
Secretary is authorized to provide for contracts under Federal NHSC
Loan Repayment Programs under section 338B of the PHS Act, including
terms regarding:
(a) The annual amount of payments provided on behalf of the
professionals regarding educational loans; and
(b) The availability of remedies for any breach of the contracts
by the health professionals involved.
States are required to develop contracts that reflect a minimum of
2 years of obligated full-time service. The annual amount of payments
under a contract will not exceed the maximum amount of $35,000
authorized in section 338B(g)(2)(A) of the PHS Act unless (1) this
excess amount is paid solely from non-Federal contributions, and (2)
the contract provides that the health professional involved will
satisfy the requirement of obligated service under the contract solely
through the provision of primary health services in a federally
designated HPSA that is receiving priority for the purposes of section
333A(a)(1), and is authorized to receive assignments of individuals who
are participating in the NHSC Scholarship Program.
No loan repayments will be made for any professional practice
performed prior to the effective date of the health professional's
State Loan Repayment Program contract, and no credit will be given for
any practice done while the provider is in a professional school or
graduate training program. Any individual who previously incurred an
obligation for health professional service to the Federal Government, a
State Government, or other entity is ineligible to participate in the
State LRP unless such obligation will be completely satisfied prior to
the beginning of service under this Program. Any individual who has
breached an obligation for health professional service to the Federal
Government, a State Government or other entity is ineligible to
participate in the State LRP. Any individual who has a judgment lien
against his or her property for a debt to the United States is
ineligible to participate in the State NHSC LRP until the judgment is
paid in full or otherwise satisfied.
Program Requirements
States seeking support under this notice for the cost of State LRPs
must provide adequate assurances that:
(1) With respect to the costs of making loan repayments under
contracts with health professionals, the State will make available
(directly or through donations from public or private entities) non-
Federal contributions in cash in an amount equal to not less than $1
for each $1 of Federal funds provided in the grant. The Federal
grant funds and the State matching funds will be used only for loan
repayments to health professionals who have entered into contracts
with States. In determining the amount of non-Federal contributions
in cash that a State has to provide, no other Federal funds may be
used.
(2) The State will assign health professionals participating in
the program only to public and nonprofit private entities located in
and providing primary health services in federally designated HPSAs.
(3) Applications must identify the State entity and key
personnel who will administer the grant.
Future Support
The Secretary must determine that the State has complied with each
of the agreements of the grant in order for funding to continue. Before
making a grant for a subsequent year of State LRP support, the
Secretary will, in the case of a State with one or more initial
breaches by health professionals of the repayment contracts, reduce the
amount of a grant to the State for the fiscal year involved. The grant
will be reduced by an amount equal to the sum of the expenditures of
Federal funds made regarding the State LRP contracts involved,
including interest on the amount of such expenditures, determined on
the basis of the maximum legal rate prevailing for loans made during
the time amounts were paid under the contract, as determined by the
Treasurer of the United States. The Secretary may waive the reduction
in the subsequent grant award if the Secretary determines that a health
professional's breach was attributable solely to the professional
having a serious illness or has died.
Evaluation Criteria
For new and competing continuation grants the following criteria
will be used to evaluate State applications to determine which States
are to be supported under this notice: (a) The extent of State's need
for health professionals consistent with the health professions and
specialties identified later in this notice; (b) the extent to which
special consideration will be extended to federally designated HPSA's
with large minority populations; (c) the number and type of providers
the State proposes to support through this program; (d) the
appropriateness of the proposed placements of State LRP recipients
(e.g., consistency and coordination with State-based plans to improve
access to primary health services for the underserved communities and
individuals); (e) the appropriateness of the qualifications, the
administrative and managerial ability of the staff to implement the
proposed project; (f) the suitability of the State's approach and the
degree to which the plan of a State is coordinated with Federal, State,
and other programs for meeting the State's health professional needs
and resources, including mechanisms for ongoing evaluation of the
program's activities; (g) the source and plans for the use of the State
match (the degree to which the State match exceeds the minimum
requirements or has increased over time, and the amount of the match
relative to the needs and resources of the State).
For competing continuation applicants only, the following criteria
will be used: (a) The grantee's progress in achieving stated goals and
objectives for the previous year's grant including the impact the State
LRP placements have had on the State's short-term and long-term
professional needs; (b) an assessment of the number of and the reasons
for initial breaches by health professionals of repayment contracts;
and, (c) the grantee's history of compliance with reporting
requirements including goals, objectives, evaluation plans,
organizational structure, financial management, and personnel changes.
Noncompeting continuation applications will be evaluated on the
following criteria: (a) The grantee's progress in achieving stated
goals and objectives for the previous year's grant including the impact
the State LRP placements have had on the State's short-term and long-
term professional needs; (b) an assessment of the number of and the
reasons for initial breaches by health professionals of repayment
contracts; (c) the grantee's history of compliance with reporting
activities including goals, objectives, evaluation plans,
organizational structure, financial management, and personnel changes;
and (d) the adequacy and appropriateness of the proposed budget.
Professions and Specialties Needed
To be supported under this program, the State Program must
establish State priorities for the selection of health professionals
consistent with the NHSC LRP. At this time, the Secretary has
determined that priority will be given to physicians who are certified
or eligible to sit for the certifying examination in the specialty
boards of family practice, osteopathic general practice, obstetrics/
gynecology, internal medicine and pediatrics.
Other Award Information
This program is not subject to the Public Health System Reporting
Requirements.
This program is subject to the provisions of Executive Order 12372
concerning intergovernmental review of Federal programs as implemented
by 45 CFR part 100. Executive Order 12372 allows States the option of
setting up a system to review applications from within their States
under certain Federal programs. The application kit, to be made
available under this notice, will contain a listing of States which
have chosen to set up a review system and will provide a single point
of contact (SPOC) in the States for that review. Applicants (other than
federally recognized Indian tribal governments) should contact their
State SPOC as early as possible to alert them to the prospective
applications and receive any necessary instructions on the State
process. For proposed projects serving more than one State, the
applicant is advised to contact the SPOC of each affected State. The
due date for State process recommendations is 60 days after the
appropriate application deadline date. The BPHC does not guarantee that
it will accommodate or explain its response to State process
recommendations received after the due date.
The OMB Catalog of Federal Domestic Assistance number for this
program is 93.165.
Dated: March 18, 1994.
Ciro V. Sumaya,
Administrator.
[FR Doc. 94-11994 Filed 5-17-94; 8:45 am]
BILLING CODE 4160-15-P-M
