National Health Service CorpsDedication, Caring, Commitment: A Call to Service

for Primary Care Clinicians

HRSA Office of Regional OperationsNHSC

May 27, 2010

Clark ConoverKansas City Regional Division

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National Health Service Corps (NHSC)National Health Service Corps (NHSC)

About the NHSCAbout the NHSC NHSC Site Eligibility RequirementsNHSC Site Eligibility Requirements NHSC Site and Clinician DataNHSC Site and Clinician Data NHSC Recruitment Programs NHSC Recruitment Programs American Recovery and Reinvestment ActAmerican Recovery and Reinvestment Act State-based Programs and ResourcesState-based Programs and Resources

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National Health Service Corps (NHSC)National Health Service Corps (NHSC)

NHSCNHSC is administered by the Health Resources is administered by the Health Resources and Services Administration (HRSA), the U.S. and Services Administration (HRSA), the U.S. Government agency that provides access to Government agency that provides access to health care for the underserved.health care for the underserved.

NHSC NHSC clinicians are a unique group of dedicated clinicians are a unique group of dedicated and caring primary care providers who care for and caring primary care providers who care for millions of people who live in communities where millions of people who live in communities where health care is scarce.health care is scarce.

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Must be located in and providing service to a federally Must be located in and providing service to a federally designated Health Professional Shortage Area (HPSA) designated Health Professional Shortage Area (HPSA)

Must be continuously approved by NHSC as an eligible Must be continuously approved by NHSC as an eligible site (Rsite (Recruitmentecruitment & R & Retention etention Application)Application)

HPSAs are designated by the Office of Shortage HPSAs are designated by the Office of Shortage Designation in HRSA’s Bureau of Health Professions Designation in HRSA’s Bureau of Health Professions (BHPr)(BHPr)

Site Eligibility: Health Professional Shortage Area (HPSA)

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HPSAs can be:HPSAs can be:

• Primary care – shortage of primary care Primary care – shortage of primary care providersproviders• Mental health – shortage of mental health Mental health – shortage of mental health providersproviders• Dental – shortage of oral health providersDental – shortage of oral health providers

NHSC clinicians must work in a HPSA appropriate for their NHSC clinicians must work in a HPSA appropriate for their disciplinediscipline

Site Eligibility-Health Professional Shortage Area (HPSA)

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HPSA Score – the higher the score, the greater the HPSA Score – the higher the score, the greater the needneed

NHSC uses HPSA score to determine which NHSC uses HPSA score to determine which communities have the greatest needcommunities have the greatest need

Other programs, such as the Centers for Medicare and Other programs, such as the Centers for Medicare and Medicaid Services (CMS), also use HPSA designation Medicaid Services (CMS), also use HPSA designation as an eligibility criteriaas an eligibility criteria

Site Eligibility-Health Professional Shortage Area (HPSA)

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http://datawarehouse.hrsa.gov/GeoAdvisor/ShortageDesignationAdvisor.aspx

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All Federally Qualified Health Centers (FQHCs) and All Federally Qualified Health Centers (FQHCs) and FQHC Look-Alikes have an Automatic HPSA designationFQHC Look-Alikes have an Automatic HPSA designation

Certified Rural Health Clinics are eligible for Automatic Certified Rural Health Clinics are eligible for Automatic HPSA but must apply and meet NHSC Charges for HPSA but must apply and meet NHSC Charges for Services RequirementsServices Requirements

Native American populations and sites also have Native American populations and sites also have Automatic HPSA opportunitiesAutomatic HPSA opportunities

Site Eligibility-Health Professional Shortage Area (HPSA)

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Provide comprehensive primary care, mental Provide comprehensive primary care, mental and behavioral health and/or dental servicesand behavioral health and/or dental services

Ambulatory (no inpatient sites) Ambulatory (no inpatient sites)

Ensure access to ancillary, inpatient and Ensure access to ancillary, inpatient and specialty referralsspecialty referrals

Site Eligibility-Services Provided

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Ensure no financial barriers to care existEnsure no financial barriers to care exist

• Fees for service consistent with prevailing rates in Fees for service consistent with prevailing rates in areaarea

• Discounts or waives fees for individuals at or Discounts or waives fees for individuals at or below 200% of the Federal poverty levelbelow 200% of the Federal poverty level• Accepts assignments for Medicare beneficiaries; Accepts assignments for Medicare beneficiaries;

and enters into agreements with Medicaid and and enters into agreements with Medicaid and State State Children’s Health Insurance programsChildren’s Health Insurance programs

• Prominently posts signage Prominently posts signage

Site Eligibility-Charges for Services

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When hiring NHSC Clinicians sites agreeWhen hiring NHSC Clinicians sites agree::• Full-time clinicalFull-time clinical• No reduction in salary because of NHSCNo reduction in salary because of NHSC• Communicate changes in employmentCommunicate changes in employment• Only allow practice at approved site(s) Only allow practice at approved site(s) • Make available personnel/practice recordsMake available personnel/practice records• Not restrict communication between clinician Not restrict communication between clinician

and NHSCand NHSC

Site Eligibility-Hiring NHSC Clinicians

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Must be in compliance at time of applicationMust be in compliance at time of application

Must agree to maintain compliance throughout term of Must agree to maintain compliance throughout term of NHSC clinician’s service commitmentNHSC clinician’s service commitment

Requirements pertain to entire site, not just NHSC Requirements pertain to entire site, not just NHSC clinicianclinician

Each location must apply and be approvedEach location must apply and be approved

Site Eligibility-Compliance

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NHSC Opportunities List

http://nhscjobs.hrsa.gov

Only unfilled vacancies will be listed on the NHSC opportunities Only unfilled vacancies will be listed on the NHSC opportunities listlist

Sites are also being encouraged to develop a site profile to Sites are also being encouraged to develop a site profile to assist in marketing themselvesassist in marketing themselves

Changes/updates can be made by contacting the Recruitment Changes/updates can be made by contacting the Recruitment Training and Support Center (RTSC) 1-877-313-1823Training and Support Center (RTSC) 1-877-313-1823

NHSC Clinician Data

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Scholarships to students who commit to practicing primary care in HPSAs of greatest need upon completion of education or training.

Period of service is 2-4 years based on number of years of scholarship support

Students choose their practice site from a list of approved sites located in areas of greatest need across the country.

NHSC Scholarship Program

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Scholars Available:

Certified Nurse MidwivesCertified Nurse Midwives DentistsDentists Family Nurse PractitionersFamily Nurse Practitioners Physician AssistantsPhysician Assistants PsychiatristsPsychiatrists Primary Care Physicians Primary Care Physicians (FP, IM, PEDS, & OB/GYN)(FP, IM, PEDS, & OB/GYN)

NHSC Scholarship Program

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Repayment of educational loans for clinicians who are Repayment of educational loans for clinicians who are

providing full-time clinical services providing full-time clinical services

2-year service commitment with options for additional 2-year service commitment with options for additional

yearsyears

Maximum repayment during the required initial 2-year Maximum repayment during the required initial 2-year

contract is $50,000contract is $50,000

Site/vacancy must be approved and clinician must also Site/vacancy must be approved and clinician must also

make a separate application to the NHSCmake a separate application to the NHSC

NHSC Loan Repayment Program (LRP)

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Recruit These Disciplines

Primary Care Physicians (FP, IM, PED, & OB/GYN)Primary Care Physicians (FP, IM, PED, & OB/GYN) Primary Care Nurse PractitionersPrimary Care Nurse Practitioners Physician AssistantsPhysician Assistants Certified Nurse MidwivesCertified Nurse Midwives DentistsDentists Dental HygienistsDental Hygienists

NHSC Loan Repayment Program (LRP)

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Recruit These Disciplines for Mental and Mental and

Behavioral Health ProfessionalsBehavioral Health Professionals

Health Service PsychologistsHealth Service Psychologists Clinical Social WorkersClinical Social Workers Licensed Professional CounselorsLicensed Professional Counselors Marriage and Family TherapistsMarriage and Family Therapists Psychiatric Nurse SpecialistsPsychiatric Nurse Specialists

PsychiatristsPsychiatrists

NHSC Loan Repayment Program (LRP)

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Learn more or sign up to be an Ambassador Learn more or sign up to be an Ambassador on the NHSC Web siteon the NHSC Web site

http://nhsc.hrsa.gov/ambassadorshttp://nhsc.hrsa.gov/ambassadors//

NHSC Ambassador Program

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NHSC Appropriations for Recruitment = $240 millionNHSC Appropriations for Recruitment = $240 million

Recruitment Line (in millions)Recruitment Line (in millions)

NHSC SP (10% statutory requirement) NHSC SP (10% statutory requirement) $ 24$ 24

NHSC LRPNHSC LRP $196$196

SLRP (Administered by BHPr)SLRP (Administered by BHPr) $ 20$ 20

NHSC ARRA Budget for RecruitmentNHSC ARRA Budget for Recruitment

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Strong heath care workforce is the lynchpin to an effective health care Strong heath care workforce is the lynchpin to an effective health care systemsystem

Primary care clinicians are the first line of defense to prevent disease Primary care clinicians are the first line of defense to prevent disease and disability; the base of the health care system and disability; the base of the health care system

Facilitate work opportunities and provide incentives to primary care Facilitate work opportunities and provide incentives to primary care clinicians to work in the Nation’s underserved communities clinicians to work in the Nation’s underserved communities

Educate and train the next generation of cliniciansEducate and train the next generation of clinicians One-time investment will:One-time investment will:

•Stimulate creation of primary care clinician and other jobsStimulate creation of primary care clinician and other jobs•Increase health care services to the Nation’s underserved populationsIncrease health care services to the Nation’s underserved populations

NHSC Principles under ARRANHSC Principles under ARRA

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Expend $Millions to Save $BillionExpend $Millions to Save $Billion

Challenge:Challenge:

Recruit an additional 4,200 primary care clinicians Recruit an additional 4,200 primary care clinicians

Result:Result: 8,722 years of service8,722 years of service 4,519,200 patients with access to primary care 4,519,200 patients with access to primary care

servicesservices 18,076,800 patient visits18,076,800 patient visits

ARRA NHSC Recruitment ChallengeARRA NHSC Recruitment Challenge

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NHSC ARRA – New FeaturesNHSC ARRA – New Features

More Application FlexibilityMore Application Flexibility

For the first time, primary health care clinicians For the first time, primary health care clinicians interested in NHSC’s loan repayment program interested in NHSC’s loan repayment program do not need to be employed at the site at the do not need to be employed at the site at the time of applicationtime of application

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NHSC ARRA – New FeaturesNHSC ARRA – New Features

More Efficient Application ProcessMore Efficient Application Process

Most applications will be processed within 8 Most applications will be processed within 8 weeks of receipt of a complete application (i.e., weeks of receipt of a complete application (i.e., all application supporting documentation all application supporting documentation received)received)

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State Primary Care Offices (PCOs)State Primary Care Offices (PCOs)

Grants from HRSA to States. PCOs by State: Grants from HRSA to States. PCOs by State: http://bhpr.hrsa.gov/shortage/pcos.htmhttp://bhpr.hrsa.gov/shortage/pcos.htm

HRSA coordinates resources from within the HRSA coordinates resources from within the Agency to work with the PCOs in order to Agency to work with the PCOs in order to improve primary care service delivery and improve primary care service delivery and workforce availability to meet the needs of workforce availability to meet the needs of underserved populationsunderserved populations

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State Primary Care Associations (PCAs)State Primary Care Associations (PCAs)

Member based organizationsMember based organizations

Members include Federally Qualified Health Centers Members include Federally Qualified Health Centers (FQHCs)(FQHCs)

Many organizations also have non-FQHC membersMany organizations also have non-FQHC members

Provide advocacy, technical assistance and other Provide advocacy, technical assistance and other support to their memberssupport to their members

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Area Health Education CentersArea Health Education Centers

Academic-community partnerships that train Academic-community partnerships that train health care providers in sites and programs that health care providers in sites and programs that are responsive to State and local needsare responsive to State and local needs

Health career enhancement and recruitment Health career enhancement and recruitment programs for K-12 students are emphasizedprograms for K-12 students are emphasized

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Rural Recruitment & Retention NetworkRural Recruitment & Retention Network

3R Net members are not-for-profit organizations made 3R Net members are not-for-profit organizations made up of State Offices of Rural Health, AHECs, PCOs, up of State Offices of Rural Health, AHECs, PCOs, PCAs, etc. that assist health professionals locate PCAs, etc. that assist health professionals locate practice opportunities in rural areas through the countrypractice opportunities in rural areas through the country

Some charge sites a fee to assist them in their Some charge sites a fee to assist them in their recruitment efforts, but not for recruitment of NHSC recruitment efforts, but not for recruitment of NHSC cliniciansclinicians

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State Loan Repayment Programs

The NHSC provides grants to states to operate their The NHSC provides grants to states to operate their own State Loan Repayment Programsown State Loan Repayment Programs

Some States also have non-NHSC funded State Some States also have non-NHSC funded State Loan Repayment ProgramsLoan Repayment Programs

Cannot participate in both Federal and State LRPsCannot participate in both Federal and State LRPs

Benefits and requirements vary state-to-stateBenefits and requirements vary state-to-state

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How to Contact NHSC

Call the toll-free helpline at Call the toll-free helpline at 1-800-221-9393 1-800-221-9393

Visit the Web site at Visit the Web site at http://www.nhsc.hrsa.govhttp://www.nhsc.hrsa.gov