[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
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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]
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