[Federal Register Volume 78, Number 122 (Tuesday, June 25, 2013)]
[Notices]
[Pages 38061-38063]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2013-15112]
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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, that will receive priority
for the assignment of National Health Service Corps (NHSC) scholarship
recipients serving as Corps members, as well as those serving under the
Private Practice Option (``NHSC scholars'' collectively), during the
period July 1, 2013, through June 30, 2014, is posted on the NHSC Web
site at http://nhscjobs.hrsa.gov. The NHSC Jobs Center includes all
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.
[[Page 38062]]
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 Clinician Recruitment and
Service, HRSA, as of January 1, 2013, for placements July 1, 2013,
through December 31, 2013, or January 1, 2014, for placements January
1, 2014, through June 30, 2014; (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 Corps
member is not assigned to the entity. 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 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 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, 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 CMS as a CAH; and (d) in compliance with all applicable
CAH conditions of participation, 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 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
(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 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, 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
[[Page 38063]]
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), 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 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 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,
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 an NHSC Site Survey,
or 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 Site Survey or 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 site specific. Providers fulfilling
NHSC commitments are approved to serve at 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 site(s) at which the NHSC scholar
is serving.
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 to a HPSA with the
greatest shortage. For the program year July 1, 2013, through June 30,
2014, 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 2013-2014
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 July 1, 2013, and June 30, 2014,
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 2013-2014, 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 scholarship-obligated Corps members,
or in support of a higher priority determination, must do so in writing
no later than July 25, 2013. This information should be submitted to:
Beth Dillon, Director, Division of Regional Operations, Bureau of
Clinician Recruitment and Service, 999 18th Street, Denver, CO 80202.
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: June 19, 2013.
Mary K. Wakefield,
Administrator.
[FR Doc. 2013-15112 Filed 6-24-13; 8:45 am]
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