National Health Service Corps Dedication, Caring, Commitment: A Call to Service U.S. Department of Health and Human Services Health Resources and Services Administration Bureau of Clinician Recruitment and Service July 2009 Raymond F. Lala, D.D.S. Chief Dental Officer National Health Service Corps

National Health Service Corps (NHSC)  About the NHSC  NHSC Site Eligibility Requirements  NHSC Site and Clinician Data  NHSC Recruitment Programs  American Recovery and Reinvestment Act

National Health Service Corps (NHSC) Site Eligibility Requirements

 Must be located in and providing service to a federally designated Health Professional Shortage Area (HPSA)  Must be continuously approved by NHSC as an eligible site (R ecruitment & R etention Application)  HPSAs are designated by the Office of Shortage Designation in HRSA’s Bureau of Health Professions (BHPr) Site Eligibility: Health Professional Shortage Area (HPSA)

 HPSA Score – the higher the score, the greater the need  NHSC uses HPSA score to determine which communities have the greatest need  Other programs, such as the Centers for Medicare and Medicaid Services (CMS), also use HPSA designation as an eligibility criteria Site Eligibility-Health Professional Shortage Area (HPSA)

 All Federally Qualified Health Centers (FQHCs) and FQHC Look-Alikes have an Automatic HPSA designation  Certified Rural Health Clinics are eligible for Automatic HPSA but must apply and meet NHSC Charges for Services Requirements  Native American populations and sites also have Automatic HPSA opportunities Site Eligibility-Health Professional Shortage Area (HPSA)

 Public or private entity  Community/Migrant Health Centers  Rural Health Clinics  Private practices  Indian Health Service/Tribal Health Centers  Prisons – State and Federal  Community Mental Health Centers Site Eligibility-Type of Sites

 Provide comprehensive primary medical care, primary dental services, and/or primary mental and behavioral health services  Ambulatory sites  Ensure access to ancillary, inpatient and specialty referrals Site Eligibility-Services Provided

 Ensure no financial barriers to care exist Fees for service consistent with prevailing rates in area Fees for service consistent with prevailing rates in area Discounts or waives fees for individuals at or below 200% of the Federal poverty level Discounts or waives fees for individuals at or below 200% of the Federal poverty level Provide care to patients of the HPSA without regard for ability to pay Provide care to patients of the HPSA without regard for ability to pay Accepts assignments for Medicare beneficiaries; and enters into agreements with Medicaid and State Children’s Health Insurance programs Accepts assignments for Medicare beneficiaries; and enters into agreements with Medicaid and State Children’s Health Insurance programs Prominently posts signage Prominently posts signage Site Eligibility-Charges for Services

 When hiring NHSC Clinicians sites agree: Full-time clinical practice (40 hours per week) Full-time clinical practice (40 hours per week) No reduction in salary because of NHSC No reduction in salary because of NHSC Communicate changes in employment Communicate changes in employment Only allow practice at approved site(s) Only allow practice at approved site(s) Make available personnel/credential/practice records Make available personnel/credential/practice records Not restrict communication between clinician and NHSC Not restrict communication between clinician and NHSC Site Eligibility-Hiring NHSC Clinicians

 Must be in compliance at time of application  Must maintain compliance throughout term of NHSC clinician’s service  Requirements pertain to entire site, not just NHSC clinician  Each location must apply and be approved Site Eligibility-Compliance

National Health Service Corps (NHSC) NHSC Site and Clinician Data

NHSC Site Data _______________________________ Total NHSC approved sites: 7,213 (as of July 7, 2009) States with most sites: California, Florida, Illinois,States with most sites: California, Florida, Illinois, Missouri, New York and Texas Missouri, New York and Texas Approved sites with vacancies: 3,285Approved sites with vacancies: 3,285 Approved sites with clinicians working: 2,475Approved sites with clinicians working: 2,475

NHSC Opportunities Data __________________________________ NHSC Opportunities List ( as October 6, 2009) Total vacancies: 8,154Total vacancies: 8,154 Dentist Vacancies: 758Dentist Vacancies: Rural / 327 Urban 575 in CHCs Dental Hygiene Vacancies: 233Dental Hygiene Vacancies: Rural / 108 Urban 195 in CHCs

NHSC Clinician Data __________________________________ NHSC Field Strength (10/06/2009) Dentists: 450 (in 46 States)Dentists: 450 (in 46 States) Dental Hygienists: 36 (in 20 States)Dental Hygienists: 36 (in 20 States)

NHSC Opportunities List  Once a site R & R application is approved, they can post vacancies on the NHSC on-line Job Opportunities list as needs arise  Site approvals are good for 3 years or until HPSA changes or the site becomes out of compliance NHSC Site Application

NHSC Opportunities List  Only unfilled vacancies will be listed on the NHSC opportunities list  Sites are also being encouraged to develop a site profile to assist in marketing themselves  Changes/updates can be made by contacting the Recruitment Training and Support Center (RTSC) NHSC Opportunities List

National Health Service Corps (NHSC) NHSC Recruitment Programs

 NHSC Scholarship Program  NHSC Loan Repayment Program (LRP)  NHSC Ambassador Program  NHSC Ready Responder Program

 Scholarships to students who commit to practicing primary care medicine, primary care dentistry or psychiatry 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

Scholars Available:  Certified Nurse Midwives  Primary Care Dentists  Family Nurse Practitioners  Physician Assistants  Psychiatrists  Primary Care Physicians (FP, IM, PEDS, & OB/GYN) NHSC Scholarship Program

 Repayment of educational loans for clinicians who are providing full-time clinical services  2-year service commitment with options for additional years  Maximum repayment during the required initial 2-year contract is $50,000  Clinician must make a separate application to the NHSC and the Site and Vacancy must also be approved NHSC Loan Repayment Program (LRP)

Recruit These Disciplines  Primary Care Physicians (FP, IM, PED, & OB/GYN)  Primary Care Nurse Practitioners  Physician Assistants  Certified Nurse Midwives  Primary Care Dentists  Dental Hygienists NHSC Loan Repayment Program (LRP)

Mental and Recruit These Disciplines for Mental and Behavioral Health Professions  Health Service Psychologists  Clinical Social Workers  Licensed Professional Counselors  Marriage and Family Therapists  Psychiatric Nurse Specialists  Psychiatrists NHSC Loan Repayment Program (LRP)

Sites can be eligible for:  Scholars (received support while in school)  Loan Repayors (agree to serve in exchange for repayment of educational loans)  If a site is eligible for a Scholar, it’s eligible for a loan repayor NHSC Scholarship and Loan Repayment Programs Site Eligibility

Serve in areas of greatest need determined by HPSA score  July 1, 2009 – June 30, 2010 Primary Care Physicians –Physician Assistants/ Nurse Practitioners – Certified Nurse Midwives -Primary Care HPSA Score 17 abovePrimary Care Physicians –Physician Assistants/ Nurse Practitioners – Certified Nurse Midwives -Primary Care HPSA Score 17 above Primary Care Dentists – Dental HPSA Score 17 and abovePrimary Care Dentists – Dental HPSA Score 17 and above Psychiatrists – Mental Health HPSA 17 and abovePsychiatrists – Mental Health HPSA 17 and above NHSC Scholar Placement

Maximum number of new scholars per site  Primary Care Physicians - no more than 1  Physician Assistants, Family Nurse  Practitioners, Certified Nurse Midwives - no more than 1  Psychiatrists - no more than 1  Primary Care Dentists - no more than 1 Eligible Service Sites for NHSC Scholars

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

 Dedicated group of volunteers on campuses and in communities across the Nation  Work in partnership with the NHSC to improve the health of the Nation’s underserved.  Ambassadors can be Campus-based, Community-based, or both.  Together provide a “Continuum of Support” for students and clinicians who are dedicated to providing uncompromised healthcare services to areas across the country that lack an adequate number of healthcare providers NHSC Ambassador Program

NHSC Ready Responders  Commissioned Officers in the U.S. Public Health Service  This uniformed service cadre of health care professionals consists of dentists, clinical psychologists, physicians, nurses, social workers, and physician assistants  Serve in NHSC approved underserved communities with the greatest needs

National Health Service Corps (NHSC) American Recovery and Reinvestment Act (ARRA)

THE ACT $500,000,000 to address health professions workforce shortages, of which $75,000,000 for the National Health Service Corps shall remain available through September 30, 2011: Provided, that funds may be used to provide scholarships, loan repayment, and grants to training programs for equipment as authorized in the PHS Act, and grants authorized in sections 330L, 747, 767, and 768 of the PHS Act: Provided further, that 20 percent of the funds allocated to the National Health Service Corps shall be used for field operations. ARRA Statutory and Conference Report

THE CONFERENCE REPORT Conference agreement provides $500,000,000 for health profession training programs instead of $600,000,000 as proposed by the House. Within this total, $300,000,000 is allocated for National Health Service Corps (NHSC) recruitment and field activities, within $75,000,000 available through September 30, 2011 for extending service contracts and the recapture and reallocation of funds in the event that a participant fails to fulfill his or her term of service. ARRA Statutory and Conference Report

THE CONFERENCE REPORT (cont.) Twenty percent of the NHSC funding shall be used for field operations. The remaining $200,000,000 is allocated for all the disciplines trained through the primary care medicine and dentistry program, the public health and preventive medicine program, the scholarship and loan repayment programs authorized in Title VII (Health Professions) and Title VIII (Nurse Training) of the PHS Act, and grants to training programs for equipment. Funds may also be used to foster cross-State licensing agreements for healthcare specialists. ARRA Statutory and Conference Report

NHSC Appropriations for Recruitment = $240 million Recruitment Line (in millions) NHSC SP (10% statutory requirement) $ 24 NHSC LRP$196 SLRP (Administered by BHPr)$ 20 NHSC ARRA Budget for Recruitment

 Strong heath care workforce is the lynchpin to an effective health care system  Primary care clinicians are the first line of defense to prevent disease and disability; the base of the health care system  Facilitate work opportunities and provide incentives to primary care clinicians to work in the Nation’s underserved communities  Educate and train the next generation of clinicians  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 ARRA

ARRA: Sites Eligible for NHSC Loan Repayment Program (LRP)  All sites in HPSA are eligible for LRP  Sites in a HPSA with a score of 10 or higher receive priority (funded first and early as soon as clinician application determined to be complete and eligible)

ARRA: Sites Eligible for NHSC LRP Maximum number of new LRP awards per site: HPSA Score 0-9  Primary Care Physicians - Up to 10  Psychiatrists - Up to 10  Other mental & Behavioral Health - Up to 10  Primary Care Dentists - Up to 10  Dental Hygienists - Up to 10  Physician Assistants, Primary Care Nurse Practitioners, Certified Nurse Midwives - Up to a total of 10 Certified Nurse Midwives - Up to a total of 10

ARRA: Sites Eligible for NHSC LRP Maximum number of new LRP awards per site: HPSA Score  Primary Care Physicians - Up to 15  Psychiatrists - Up to 15  Other mental & Behavioral Health - Up to 15  Primary Care Dentists - Up to 15  Dental Hygienists - Up to 15  Physician Assistants, Primary Care Nurse Practitioners, Certified Nurse Midwives - Up to a total of 15 Certified Nurse Midwives - Up to a total of 15

ARRA: Sites Eligible for NHSC LRP Maximum number of new LRP awards per site: HPSA Score  Primary Care Physicians - Up to 12  Psychiatrists - Up to 12  Other mental & Behavioral Health - Up to 12  Primary Care Dentists - Up to 12  Dental Hygienists - Up to 12  Physician Assistants, Primary Care Nurse Practitioners Certified Nurse Midwives - Up to a total of 12 Certified Nurse Midwives - Up to a total of 12

Expend $Millions to Save $Billion Challenge: Recruit an additional 4,200 primary care clinicians Result:  8,722 years of service  4,519,200 patients with access to primary care services  18,076,800 patient visits ARRA NHSC Recruitment Challenge

 More Choices of Sites and Vacancies Eligible for Loan Repayment More than 7,000 already eligible service sites will be able to post significantly more new vacancies and increase the number of clinicians eligible for loan repayment awards at these sites. Additionally, more sites are being approved by the NHSC every day NHSC ARRA – New Features

 First-come, First-served Loan repayment awards to primary health care clinician applicants who are interested in loan repayment will be made on a first-come, first-served basis, opening new opportunities for areas in high-need sites located in Health Professional Shortage Areas with lower HPSA scores Applications will be accepted on an open, continuous basis until all Recovery Act funds are expended.

NHSC ARRA – New Features  More Application Flexibility For the first time, primary health care clinicians interested in NHSC’s loan repayment program do not need to be employed at the site at the time of application

How to Contact NHSC  Call the toll-free helpline at  Visit the Web site at

Contact Information  Raymond F. Lala, DDS  5600 Fishers Lane, Room 8-15 Rockville, MD  (301)  Visit the Web site at