NEBRASKA’s Rural Health Incentive
Programs
Presentation by: Marlene A. JanssenHealth Program Manager
Nebraska Office of Rural Health For UNMC COD
August 20, 2015
The ACT:
Created Rural Health Advisory Commission
Established a forgivable medical STUDENT LOAN program
Established the LOAN REPAYMENT program for certain licensed health professionals
http://nebraskalegislature.gov/laws/laws.phpSections 71-5650 to 71-5670 Nebraska Revised Statutes
Nebraska’sRural Health Systems and Professional
Incentive Act (THE ACT)
Thirteen (13) members appointed by the Governor for 3-year terms and include:
Two Representatives from DHHS - DHHS Director of Public Health and Another DHHS Representative; One Representative from each Nebraska medical school; One physician in family practice residency training; and From rural areas (counties under 15, 000 population), physician, hospital administrator, nursing home
administrator, nurse, physician assistant, mental health practitioner or psychologist, dentist, and consumer.
NebraskaRural Health Advisory Commission
“The purpose of the commission shall be to advise the department (DHHS), the Legislature, the Governor, the University of Nebraska, and the citizens of Nebraska regarding all aspects of rural health care and to advise the office (Office of Rural Health) regarding the administration of the Rural Health Systems and Professional Incentive Act.” §71-5655 Ne Rev Statutes
Rural Health Advisory CommissionPurpose
Some of the statutory powers and duties of the commission include:
Prepare recommendations to the appropriate bodies to alleviate identified problems
Designate state-designated shortage areas in Nebraska
Select recipients of financial incentives available under the ACT
Rural Health Advisory CommissionPowers and Duties
Nebraska Rural Health Student Loan Program for certain health professional students
Nebraska Loan Repayment Program for eligible licensed health professionals
Nebraska’sRural Incentive Programs
Nebraska Rural HealthStudent Loan Program
Eligibility Requirements
Must be a Nebraska resident and
Enrolled or Accepted for enrollment in a Nebraska medical, dental, physician assistant, or graduate-level mental health training program
Nebraska Rural Health Student Loan Program
Obligation
Medical and PA students agree to practice one of the following specialties: family practice general internal medicine general pediatrics obstetrics/gynecology
general surgery psychiatry
Dental students agree to practice: general dentistry pediatric dentistryoral surgery
Nebraska Rural HealthStudent Loan Program
Obligation (continued)
Graduate-level mental health students agree to practice the scope of practice of a Licensed Mental Health Practitioner or Psychologist
All student loan recipients agree to practice, in a state-designated shortage area, the equivalent of one year of full-time practice for each year a student loan is received
Nebraska Rural HealthStudent Loan Program
Application Process
Application period April 1 – June 1 each year
Interviewed by members of the Rural Health Advisory Commission
Rural Health Advisory Commission awards student loans
Nebraska Rural HealthStudent Loan Program
Awards
The maximum amount of student loan awards is up to:
$30,000 for medical, dental, and doctorate-level mental health student loan recipients
$15,000 to full-time masters level mental health and physician assistant student loan recipients
(Legislation passed in 2015 (effective August 29, 2015) increases maximum amount to $30,000/$15,000)
Rural Health Advisory Commission awards approximately 6 new student loans and 10 continuation student loans each year. The amount of student loan awards is based on the total appropriation for the rural incentive programs.
Nebraska Rural HealthStudent Loan Program
Forgiveness
Student Loans are forgiven if recipient practices the equivalent of full-time (40 hours/week) in a state-designated shortage area the equivalent of one year for each year a loan was awarded.
A student loan recipient may practice part-time (minimum 20 hours/week) which will extend the forgiveness period.
What if I decide to pursue a non-primary care field or practice in a non-shortage area?
What happens to my Nebraska rural health student loan?
Nebraska Rural HealthStudent Loan Program
Contract Buyouts and Defaults
Contract Buyout Provisions –
Doctorate-level before end of second year:
◦ Must notify Office of Rural Health, in writing, of intent to buyout
◦ Repay principal plus 6 percent simple interest from date loan was granted
◦ Must be repaid before graduation
Nebraska Rural HealthStudent Loan Program
Contract Buyouts and Defaults
Contract Buyout Provision for Doctorate-level after end of second year and master’s level
◦ 150% of principal plus 8 percent interest from the date of default
◦ Double the number of years loans granted to repay
For eligible licensed health professionals (do not have to be a Nebraska resident or graduate of a Nebraska college)
Nebraska Loan Repayment Program
Eligible Health Professionals –
Physicians, Nurse Practitioners, Physician Assistants practicing one of the following specialties◦ Family Practice◦ General Internal Medicine◦ General Pediatrics◦ OB/GYN◦ General Surgery◦ Psychiatry
Nebraska Loan Repayment ProgramEligibility Requirements
Eligible Health Professionals -
Dentists practicing one of the following specialties:◦ General Dentistry◦ Pediatric Dentistry◦ Oral Surgery
Nebraska Loan Repayment ProgramEligibility Requirements
(continued)
Eligible Health Professionals –
Clinical Psychologists Master’s Level Mental Health (LMHP) Pharmacists Occupational Therapists Physical Therapists
Nebraska Loan Repayment ProgramEligibility Requirements
(continued)
Government or Commercial educational loans- only educational loans to student in student’s name are eligible
- loans to parents, consumer loans (ex: credit card), mortgage loans, and private loans are not eligible
Local entity must agree to provide local match and verify practice
Nebraska Loan Repayment Program
Other Requirements
3-year practice obligation in a state-designated shortage area
Part-time practice (minimum 20 hours/week) reduces benefit
Rural Health Advisory Commission approves loan repayment applications
Nebraska Loan Repayment ProgramOther Requirements
(continued)
Maximum of $60,000 per year in loan repayment (state and local match) for physicians, dentists, and psychologists
Maximum of $30,000 per year in loan repayment (state and local match) for all other eligible professions
(Legislative changes effective August 29, 2015, changes maximum
amounts $60,000/$30,000 per year (state and local match).)
Nebraska Loan Repayment Program
Benefits
Applications are accepted year roundThe only “deadlines” are for the Rural Health Advisory Commission’s agenda items prior to each meeting.
Rural Health Advisory Commission awards loan repayment
May apply up to 18 months prior to being eligible to practice
Loan repayment no longer taxable income(effective January 1, 2009 as per P.L. 111-148, 3/23/10)
Nebraska Loan Repayment Program
Application Process
Cannot serve practice obligation under Student Loan and Loan Repayment programs simultaneously
Cannot receive loan repayment during residency training or under provisional license
Nebraska Loan Repayment Program
Other Considerations
Contract Buyout Provisions –(Legislative changes effective August 29, 2015, changed the buyout provisions)
150% of all funds received 8% interest from the date of default Same number of months to repay as received loan
repayment
FACT: 483 loan repayment participants (1994-2014)FACT: 91 in practice under obligationFACT: 92 percent complete the practice obligationDecember 2014 Annual Report
Nebraska Loan Repayment Program
Contract Buyout/Default
Guidelines are established by the Rural Health Advisory Commission
Statutory authorization and guidance for defining shortage areas
Statewide review of all shortage areas every 3 years
State-Designated Shortage Areas
State-Designated Family Practice Shortage Area Criteria
Service area: county, partial county, identified population group within a defined area
Designation based on ratio of service area (county) population to full-time equivalency (FTE) of family practice physicians
State-Designated Family Practice Shortage Area Criteria
Population to FTE FP Physician >= 2000:1or no physician in service area
OR population to FTE FP Physician is between 1500:1 – 1999:1 AND service area (county) has one of the following high need indicators
State-Designated Family Practice Shortage Area Criteria
High Need Indicators:
Population 65+ in the highest quartile for the state
Poverty level ranks in the highest quartile for the state
Frontier Area (< 6 people per square mile)
State-Designated Family Practice Shortage Area Criteria
High Need Indicators (continued):
Infant Mortality Rate ranks in the highest quartile for the state
Low Birth Weight Rate ranks in the highest quartile for the state
More than 50% of physicians are over 60 years old
State-Designated Family Practice Shortage Area Criteria
Counties with population >= 15,000 will not be designated
Areas within a 25-mile radius of Lincoln and Omaha will not be designated
State employees are not eligible for the Nebraska rural incentive programs
State-Designated Family Practice Shortage Area Criteria
Federally designated (HPSA), primary care shortage areas may be designated as “State-Designated”
◦ If requested by the community or clinic◦ And approved by the Rural Health Advisory
Commission◦ Example: Community Health Centers –
Panhandle, One World, Charles Drew, Good Neighbor
Summary of Nebraska’sRural Health Systems and Professional Incentive Act
Created:
1. Rural Health Advisory Commission (RHAC)2. Forgivable Student Loan Program for
certain health professional students3. Loan Repayment Program for certain
licensed health professionals
Nebraska Office of Rural Health(402) 471-2337
www.dhhs.ne.gov/orh
State-Funded Programs & Shortage Areas:Marlene [email protected]
Contact Information