Health Professional Student Loan Repayment Program

PURPOSE: This rule establishes guidelines for implementing the Health Professional Student Loan Repayment Program that will reduce the burden of educational debt among selected health professionals in return for providing professional clinical services in areas of defined need. (1) The following definitions shall be used in interpretation and enforcement of this rule: (A) Approved practice site means the practice location for which the department agreed to provide support; (B) Area of defined need means a geographic area or population designated by the Missouri Department of Health and Senior Services as experiencing a shortage of accessible primary and preventive health care services; (C) Department means the Missouri Department of Health and Senior Services; (D) Director means the director of the Missouri Department of Health and Senior Services; (E) Health care professional means a general dentist or primary care physician as defined in 191.600, RSMo; (F) Hospital means a facility licensed in the state of Missouri pursuant to Chapter 197, RSMo; (G) Licensing board means the Board of Registration for the Healing Arts and the Missouri State Dental Board within the Missouri Department of Economic Development; (H) Primary care means the services provided by a general dentist or a physician engaged in general or family practice, internal medicine, pediatrics, or obstetrics and gynecology as his/her primary specialty; (I) Qualifying loans means government and commercial loans for actual costs paid for tuition and educational costs and associated living expenses for the health professional; (J) Sliding scale fee means a fee structure that provides adjustment to charges for all individuals under two hundred percent (200%) of the federal poverty limit, based upon family income and size. (2) The department may contract with selected health care professionals to repay in total or in part, qualifying loans in exchange for an agreement to provide primary health care services to populations in need within the state. (3) Applicants must submit a written request that contains all of the following information and documentation presented in the order they are listed in subsections (3)(A)–(J). Applications for participation that do not comply with these requirements will not be considered. Each request shall contain: (A) A written request from the applicant for participation in the program; (B) A detailed written description of the proposed practice site, including the facility in which the applicant will be working and the health care services currently provided at that site; (C) Official notification from the applicable Missouri licensing board that the applicant is licensed in good standing; (D) For physicians, a letter from the medical director of all hospitals at which the physician has or will have privileges delineating the status of the privileges. This should include when the privileges began or will begin, how they may have changed over time and an explanation for any changes; (E) A written statement from the applicant’s malpractice insurance carrier setting forth any claims that have been made against the applicant and the disposition of those claims; (F) A written statement from the local public health agency, whose jurisdiction includes the applicant’s proposed practice site, that the applicant’s services are required by and are in the interest of the community; (G) A copy of the applicant’s employment contract for the proposed practice site for a period of no less than two (2) years; (H) Documentation of agreement to provide care to the populations in the area of defined need, including: 1. Acceptance as a provider by the Missouri Medicaid agency; and 2. A copy of the sliding scale fee; (I) Documentation of qualifying loans for which repayment is requested; and (J) A signed release of information document to allow the department to obtain current information on qualifying loans from the appropriate institutions. (4) Selection for participation in the Health Professional Student Loan Repayment Program will be prioritized utilizing the following criteria: (A) The degree of need for health professional services (areas with a lack of access for the entire population will be given priority over those areas without access for specific populations); (B) Recruitment of health professionals into an area will be given priority over retention of existing providers; (C) Those employed by an organization with a history of service to the underserved may be given priority over other employment types including self-employed applicants; and (D) Those approved practice sites participating with the department in the financing of the loan repayments. (5) Participation in the Health Professional Student Loan Repayment Program shall consist of payments to individual health professionals under a written contract. (A) The contract period shall be, at a minimum, two (2) years in length. (B) Contract amounts shall not exceed the maximum amounts allowed under the National Health Service Corps Loan Repayment Program, 42 U.S.C. section 2541-1, P.L. 106-213. (C) Payment for the contract shall be due the final quarter of the last year of the contract period. (D) Prepayment of the contract amount may be made to facilitate placement in areas of need within the state. (E) The department may approve contract extensions up to three (3) additional years beyond the original contract, not to exceed five (5) years in total. (6) Participants shall supply the following to the department by July 1 of each year: (A) Participant’s name; (B) Address of the participant’s approved practice site(s); (C) The number and characteristics of the patients served including: 1. Gender; 2. Race/ethnicity; 3. Age distributions; and 4. Payor source (Medicaid, Medicare, commercial insurance or sliding scale fee); (D) Letter from the applicable licensing board stating that the participant is licensed in good standing in Missouri; and (E) Documentation of remaining educational debt. (7) If an individual violates the written contract the state shall be entitled to recover from the individual an amount equal to the sum of: (A) The total of the amounts prepaid by the state on behalf of the individual and the interest on those amounts which would be payable if at the time the amounts were paid they were loans bearing interest at the maximum prevailing rate as determined by the Treasurer of the United States; (B) An amount equal to any damages incurred by the department as a result of the breach; (C) Any legal fees or associated costs incurred by the department or the state of Missouri in the collection of damages. AND SENIOR SERVICES AUTHORITY: section 191.607, RSMo Supp. 2001. This rule was previously filed as 19 CSR 50-1.030. Original rule filed Nov. 14, 1988, effective April 28, 1989. Changed to 19 CSR 10-3.030 July 30, 1998. Rescinded and readopted: Filed April 15, 2002, effective Oct. 30, 2002. *Original authority: 191.607, RSMo 1988, amended 2001.