1. Federal Loan Repayment Programs
MARYLAND DEPARTMENT OF HEALTH
Federal Loan Repayment Programs
Elizabeth Vaidya, Director, Primary Care Office (PCO)
Office of Population Health Improvement, PHS
June 7, 2018

2. Office of Population Health Improvement
Vision
In pursuit of a healthy, thriving Maryland, the Office of Population Health Improvement (OPHI) envisions a health system that is stakeholder-driven, data-informed, and financially aligned with health in all policies. 
Mission
We seek to transform public health through stewardship of data, partnerships, and funding initiatives to develop innovative health policy and improve the health infrastructure of Maryland.
Core Goals: SUD, Chronic Disease Management, Chronic Condition Health, Senior Health
Process measures: Screening, counseling and care planning, treatment
Outcomes: Senior Health and QoL
School Health is a mandated interagency program with MSDE and LSS/LHDs

3. Office of Population Health Improvement
Coordinates the integration of Maryland’s high-performing public health system with value-based health care to:
Improve Maryland’s population health and Reduce Maryland’s health care spending
Quality Improvement
Public Health Accreditation, Public Health Services Training Needs
School Health
Naloxone / Opioids & SUD, Disaster Preparedness, Immunization, School Telehealth, Health Services, Guidelines, TA and professional development
State Health Improvement Plan (SHIP)
DHMH Dashboard for 39 health measures by jurisdiction
Local Health-Core Funding, Local Health Improvement Coalitions
Public Health Workforce Development
Health Care Transformation
State Innovation Model, Primary Care Model, Population Health Quality Measurement: Health Equity & Social Determinants
Workforce Development for Healthcare Professionals
Maryland and State Loan Assistance Repayment Program, J-1 Visa Waiver, Preceptor Tax Credit, National Health Service Corps
Primary Care Improvement
Health Professional Shortage Area designations
Rural Health Improvement
Maryland’s Rural Health Plan
$53.0
Core Funding For
Million Budget* + 24
Local Health Departments and the Baltimore City Health Department 12
Employees**
*FY19 allowance, $51.8M GF, $1.1M FF
+ Reduction of FF due to removal of Title V MCH $ from Core funding Mechanism
**7 pin allowance, with other contractual employees

4. Office of Population Health Improvement: Accomplishments
Quality Improvement
Public Health Accreditation: 7 Local Health Departments are accredited; 7 are applying.
PHS Quality Improvement Plan: designed, executed, and progressing on to version 2.
MDH Public Health Services Quality Improvement Council established and sustained.
Project management and technical assistance in quality improvement offered to all PHS staff.
Quality improvement orientation attended by 227 staff.
Quality improvement basics (2-day exercise) attended by 25 staff.
School Health
Diabetes management: Provided access to online diabetes training by the National Association of School Nurses (NASN) to 100 school nurses.
Naloxone: Technical assistance and guidance to local programs for school nurses on administration of naloxone. Distributed 175 reusable Narcan nasal spray trainers to the 24 jurisdictions.
SBIRT: Partnered to implement SBIRT in 15 school based health centers
Healthy School Dashboard: Collaborate with Garrett County Public Schools and the University of Maryland to correlate student health and academic outcomes
Rural Health
Maryland’s Rural Health Plan: SORH in collaboration with rural health stakeholders to update the Maryland Rural Health Plan published in January 2018.
Rural Prosperity Investment Fund: grant awarded for rural healthcare program totaling $520,
Maryland Agricultural Education and Rural Development Assistance Fund : Grant awarded for rural healthcare program a total of $138,766
Maryland Rural Health Day: proclamation from Governor Hogan to declare November 17, 2017 Maryland Rural Health Day.

5. Office of Population Health Improvement: Accomplishments
Primary Care Office
Technical Assistance: Recommended four FQHC applications for funding ($2.5 million) for the Maryland Capital Program. There are 21 FQHC organizations totaling 136 service delivery sites serving 301,322 patients.
Shortage Designations: Analyzed 89 HPSA designations (53 continued designation, 18 new areas met eligibility, and 18 were recommended with changes). 1 MUP recommended for update.
Health Professions Workforce Programs
State Loan Repayment Program (SLRP) & Maryland Loan Repayment Program (MLRP): Awarded 64 recipients $387,890.2 in Federal funds and $752,890.2 in State funds
J-1 Visa Waiver: All 30 slots allocated & updated waiver policy
Income Tax Credit Preceptor Program:
National Health Service Corps: 172 NHSC loan repayment awards were approved for Maryland clinicians (53% behavioral health for non-physicians, 12% physicians, 20% nurses, 5% nurse midwives, 4% PAs, 4% dentists, 2% dental hygienists). The PCO attended and participated with HRSA staff in 11 NHSC site visits in 2017.
Public Health Accreditation
National public health accreditation awarded through Public Health Accreditation Board (PHAB)
PHS Strategic Plan developed and implemented.
Performance management of strategic plan tracked through development and maintenance of dashboard.

6. Office of Population Health Improvement: Accomplishments
Public Health Workforce Development
PHS Training Needs Assessment: developed and disseminated as part of Workforce Development Collaborative
Workforce Development Plan featured at national conference, American Public Health Association (APHA).
National Recognition of Workforce Development Plan at meeting of Association of State and Territorial Health Officials (ASTHO), Public Health Workforce Interests and Needs Survey (PHWINS).
National Workforce Development Collaborative: participation through ASTHO PHWINS.
Population Health and Healthcare Transformation
State Health Improvement Process (SHIP): Maintenance of 39 health targets implemented through Local Health Improvement Coalitions.
Ongoing collaboration with Medicaid, hospitals, and other MDH units related to primary care transformation, population health measurement definition, and advanced payment model development.
not sure how to update this due to the TCOC delay and the resulting PCP implementation delay. The highlighted part is last year’s info in here now.

7. Primary Care Office Overview
Federal Loan Repayment Programs
Primary Care Office Overview

8. Funding & Mission
Primary Care Office (PCO) Overview
Maryland Primary Care Office (PCO) – Mission is to improve access to dental, mental and primary health care services for all Maryland residents through shortage designation, workforce programs, community interaction, and technical assistance to stakeholders.
Federally funded by the Health Resources & Services Administration’s (HRSA’s) Bureau of Health Workforce and housed within MDH’s Office of Health Population Improvement (OPHI).

9. How Do We Improve Access to Healthcare?
Primary Care Office (PCO) Overview
Recruiting, Retaining, Communicating with Providers
Collaboration & Partnering with Stakeholders
LHDs
LHICs
Hospitals
Practitioners
FQHCs
Capital Bond Funding
Determining needs for your community
Shortage Designations

10. Benefits of Shortage Designations
Primary Care Office (PCO) Overview
Component for Eligibility for certain HRSA Grants like:
Federally Qualified Health Center or Look-Alike applications
Rural Health Center applications
Area Health Education Centers
CMS Physician Bonus Payments
Workforce Programs
National Health Service Corps’ Loan Repayment and Scholarship Programs
Nurse Corps and Scholarship Programs
Maryland State Loan Repayment Program
Preceptor Tax Credit Program
J-1 Visa Waiver & National Interest Waiver Programs
Appalachian Regional Commission (ARC)
Department of Health and Human Services (HHS)

11. Federal Loan Repayment Programs
National Health Service Corps (NHSC)

12. 3 STEP PROCESS
National Health Service Corps
PCO determines HPSA in MD. Each HPSA receives a score for NHSC to utilize for funding priority. (only sites with scores of 15 and higher were awarded in 2017) for MD.
NHSC Site Review – PCO Review site applications from April-June each year.
NHSC Scholars & Loan Repayment Awardees – Eligible NHSC sites (scores 17 and higher) can recruit for Scholars or utilize the NHSC loan repayment program for recruitment of new employees or retention of current employees.

13. NHSC SITE REVIEW
National Health Service Corps
PCO reviews each site to make sure they meet NHSC requirements:
Policies on Non-Discrimination
Sliding Fee Schedule Documents & Policy
Required NHSC Signage
Proof of Access to Ancillary, Inpatient and Specialty Care
NHSC Site Data Tables

14. NHSC SCHOLARSHIP PROGRAM
National Health Service Corps
NHSC SCHOLARSHIP PROGRAM
Disciplines:
Physicians (MD or DO)
Dentists
Nurse Practitioners
Certified Nurse-Midwives
Physician Assistants
Scholarship pays tuition, fees, other educational costs, and provides a living stipend in return for a commitment to work at least 2 years at an NHSC-approved site with a HPSA score of 17 or higher.

15. TOTAL LOAN REPAYMENT PARTICIPANTS IN MARYLAND*
National Health Service Corps
TOTAL LOAN REPAYMENT PARTICIPANTS IN MARYLAND*

16. NHSC LOAN REPAYMENT AWARD
National Health Service Corps
The NHSC Loan Repayment Program offers priority funding to applicants who work at NHSC- approved sites in high-need areas, as defined by a Health Professional Shortage Area (HPSA) score.
AWARD AMOUNTS
UP TO $50,000 FOR 2 YEARS Full-time
UP TO $25,000 FOR 2 YEARS Half-time
In FY17, awards were given to Maryland applicants working at sites with HPSA scores between

17. NHSC ELIGIBILITY National Health Service Corps
U.S. citizen or national
Currently work, or applying to work, at an NHSC-approved site
Have unpaid government or commercial loans for school tuition, reasonable educational expenses, and reasonable living expenses, segregated from all other debts
Licensed to practice in state where employer site is located
Must be licensed in one of the following eligible disciplines:
Physician (MD or DO)
Dentist (general or pediatric)
Licensed clinical social worker
Nurse practitioner (primary care)
Dental hygienist
Psychiatric nurse specialist
Certified nurse-midwife
Psychiatrist
Marriage and family therapist
Physician assistant
Psychologist (health service)
Licensed professional counselor

18. APPLICATIONS Loan Repayment
National Health Service Corps
Loan Repayment
Site Approval
To see if your site(s) are located in a Health Professional Shortage Area (HPSA), please visit:

19. Federal Loan Repayment Programs
NURSE Corps

20. What is NURSE Corps?
NURSE Corps
NURSE Corps is a federally funded program that awards scholarships and loan repayment to nurses, nursing students, and nurse faculty.
The program helps to support nurses by paying for qualifying educational loans.
It also aides in building healthier communities in areas of greatest need.

21. 2 STEP PROCESS
NURSE Corps
PCO determines primary care and mental Health Professional Shortage Areas (HPSAs) in MD.
Qualified nurses apply to the program and if accepted, must serve two years at a CSF*.
*A Critical Shortage Facility (CSF) is a nonprofit health care facility located in, designated as, or serving an area designated as a HPSA.

22. ELIGIBILITY REQUIREMENTS
NURSE Corps
ELIGIBILITY REQUIREMENTS
Be a U.S. citizen (either U.S. born or naturalized), U.S. National, or Lawful Permanent Resident
Have one of the following degrees: associates, bachelor’s, master’s, doctoral, or a diploma in nursing
Have a current, full, permanent, unencumbered, unrestricted and valid Maryland RN license
Have outstanding, qualified nursing education loans

23. DISCIPLINES Registered Nurse Nurse Practitioner
NURSE Corps
Registered Nurse
Nurse Practitioner
Certified Nurse-Midwife
Clinical Nurse Specialist
Nurse Anesthetist
Nurse Faculty

24. TYPES OF AWARDS
NURSE Corps
Initial 2-year Award: NURSE Corps participants receive an Award equal to 60% of their current, outstanding, qualifying loan balances incurred while pursuing education in nursing; in return for a 2-year service commitment at a Critical Shortage Facility (CSF)
Continuation Award: After the completion of the initial 2-years of service qualifying NURSE Corps Loan Repayment Program participants may receive an additional 25% of their original loan balance for a third year of service
All awards are subject to Federal Taxes

25. TYPES OF CSF Eligible Facilities:
NURSE Corps
Eligible Facilities:
Hospitals:
Critical Access Hospital (CAH)
Disproportionate Share Hospital (DSH)
Public Hospital
Private Hospital
Outpatient Clinics:
Federally Qualified Health Center
Indian Health Service Health Center
Native Hawaiian Health Center
Rural Health Clinic
State or Local Public Health or Human Services Department
Nurse Managed Health Clinic/Center
Outpatient Clinics (Continued):
Urgent Care Center
Certified Community Behavioral Health Clinic
End Stage Renal Disease Dialysis
Ambulatory Surgical Center
Residential Nursing Home
Home Health Agency
Hospice Program
Ineligible Facilities include, but are not limited to:
Private practice offices
Clinics in prisons and correctional facilities

26. NURSE Corps
SERVICE REQUIREMENTS
Registered Nurses (RN) must provide full-time service, defined as working at least 32 hours per week for a minimum of 45 weeks per year, at a Critical Shortage Facility
Nurse Faculty (NF) must provide full-time service by teaching pre-licensure students, RNs or Advanced Practice Nurses, in an eligible public or private nonprofit school of nursing, at least 9 months out of the year.
Scholars – Must work at an eligible CSF upon graduation.

27. FUNDING PRIORITY NURSE Corps Debt to Salary Ratio
Qualified applicants will be grouped into one of the funding preference tiers based on the factors described in the table below.
Debt to Salary Ratio
Funding Preference Tiers
100% or Above
Tier 1
99.99% or Less
Tier 2

28. NURSE Corps
ADDITIONAL RESOURCES
Nurse Corps Loan Repayment Program Web Site:
To see if your site(s) are located in a Health Professional Shortage Area (HPSA), please visit:

29. CONTACT http://pophealth.dhmh.maryland.gov/Pages/Primary-Care.aspx
Federal Loan Repayment Programs
Elizabeth Vaidya, Director
Primary Care Office (PCO),
Shortage Designation, Federal Workforce Programs (NHSC & Nurse Corps)
(410) office
Office of Population Health Improvement (OPHI), PHS, MDH
201 West Preston Street
Baltimore, MD 21201
Website: