[Federal Register Volume 77, Number 72 (Friday, April 13, 2012)]
[Notices]
[Pages 22329-22331]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2012-8928]
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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 their Health Professional
Shortage Area (HPSA) scores, that will receive priority for the
assignment of National Health Service Corps (NHSC) scholarship
recipients (Corps Personnel, Corps members) during the period July 1,
2012, through June 30, 2013, is posted on the NHSC Web site at http://datawarehouse.hrsa.gov/HGDWReports/OneClickRptFilter.aspx?rptName=NHSCAppSiteList&rptFormat=HTML3.2. This
searchable database specifies all currently approved NHSC service
sites, by State, and can be utilized to determine which entities are
eligible to receive assignment of Corps members who are participating
in the NHSC Scholarship Program based on the threshold HPSA score set
forth below. Please note that entities on this list may or may not have
current job opportunities for NHSC scholars. Furthermore, not all
vacancies associated with sites on the list described below will be for
Corps members, but could be for NHSC Scholarship Program participants
serving their obligation through the Private Practice Option.
Eligible HPSAs and Entities
To be eligible to receive assignment of Corps personnel, entities
must: (1) Have a current HPSA designation by the Office of Shortage
Designation, Bureau of Health Professions, HRSA; (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; (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 or
arrangements for secondary and tertiary care; (3) have a documented
record of sound fiscal management; and (4) will experience a negative
impact on its capacity to provide primary health services if a
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Corps member is not assigned to the entity. Sites that provide
specialized care, or a limited set of services 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 that receive assignment of Corps personnel 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 Corps member 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 or teaching 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 Sec. 340H of the U.S. Public Health
Service Act, 42 United States Code Sec. 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 (CNMs),
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 or
teaching 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)--defined as a nonprofit facility that is: (a)
Located in a State that has established with the Centers for
Medicare and Medicaid Services (CMS) a Medicare rural hospital
flexibility program; (b) designated by the State as a CAH; (c)
certified by the CMS as a CAH; and (d) in compliance with all
applicable CAH conditions of participation--at least 16 of the
minimum 40 hours per week must be spent providing direct patient
care or teaching 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 (THC) (see Sec. 340H of the
U.S. Public Health Service Act, 42 United States Code Sec. 256h).
Teaching activities in a HRSA-funded THC 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 serving 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 (CNMs),
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 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), at least 8 of the minimum 20 hours per week
must be spent providing direct patient care or teaching 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 service is not an option for scholars serving
their obligation through the Private Practice Option.
In addition to utilizing NHSC assignees in accordance with their
full-time or half-time service obligation (as defined above), sites
receiving assignment of Corps personnel 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 assignees (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 Sec. 330 of the Public Health Service Act. The
Site Survey or UDS report, as applicable, require 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 assigned to 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
[[Page 22331]]
site(s) to which the Corps member is assigned.
Evaluation and Selection Process
In order for a site to be eligible for placement of NHSC personnel,
it must be approved by the NHSC following the site's submission of a
Site Application. The processing of Site Applications from solo or
group practices may 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, 2012, through
June 30, 2013, 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 scholarship
recipients who are primary care physicians, family nurse practitioners
(NPs), physician assistants (PAs) or CNMs; (2) mental health HPSAs with
scores of 16 and above are authorized for the assignment of NHSC
scholarship recipients 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 scholarship recipients who are
dentists. The NHSC has determined that a minimum HPSA score of 16 for
all eligible clinicians 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 2012-2013 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), NP, PA, CNM, 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, and how the additional scholar will
impact retention of other clinicians. Sites wishing to request an
additional scholar must complete an Additional Scholar Request form
available at http:[sol][sol]nhsc.hrsa.gov/scholarship/pdf/
additionalscholarrequestform.pdf.
Sites that do not meet the authorized HPSA score threshold
indicated above may post job openings, however, scholars seeking
placement between July 1, 2012 and June 30, 2013 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 2012-2013, 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 Corps personnel may be updated
periodically. 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. New entities
interested in being added to the high priority list must submit a Site
Application to the National Health Service Corps by visiting
http:[sol][sol]nhsc.hrsa.gov/communities/apply.htm to apply online. A
searchable database of HPSAs and their scores, by State and county, is
posted at http:[sol][sol]hpsafind.hrsa.gov/.
Additional Information
Entities wishing to provide additional data and information in
support of their inclusion on the proposed list of HPSAs and entities
that would receive priority in assignment of scholarship-obligated
Corps members, must do so in writing no later than May 14, 2012. This
information should be submitted to: Sonya Bayone, Chief, Site Branch,
Division of the National Health Service Corps, Bureau of Clinician
Recruitment and Service, 5600 Fishers Lane, Room 8-37, Rockville, MD
20857. This information will be considered in preparing the final list
of HPSAs and 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 9, 2012.
Mary K. Wakefield,
Administrator.
[FR Doc. 2012-8928 Filed 4-12-12; 8:45 am]
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