Nurse Loan and Nurse Loan Repayment Programs

PURPOSE: This rule establishes the requirements for implementing the professional and practical nursing student loan and loan repayment programs. (1) The following definitions shall be used in the interpretation and enforcement of this rule: (A) Academic year for a practical nursing program means a calendar year. Academic year for a professional nursing program means the period of time from the beginning of the fall semester to the final day of the spring semester and may include a summer session; (B) Advisory panel means the advisory group of nurses appointed by the director of the Missouri Department of Health to advise the department regarding the rules, funding and guidelines for implementing and administration of the nurse loan and nurse loan repayment programs; (C) Application contract means the form provided by the Missouri Department of Health for the purpose of applying for a nurse loan; (D) Area of defined need means a geographic area or a type of practice specialization designated by the Missouri Department of Health as experiencing nursing shortages and published annually by rule; (E) Board means the State Board of Nursing; (F) Department means the Missouri Department of Health; (G) Director means the director of the Missouri Department of Health; (H) Educational loan means the financial assistance provided by the department under the authority of the nurse loan program; or commercial loans made by banks, credit unions, savings and loan associations, insurance companies, schools and other financial institutions for nurse education purposes; or loans made by federal, state, county or city agencies authorized by law to make loans for nurse education purposes; (I) Eligible applicant for the nurse loan repayment program means a current Missouri licensed professional nurse who has attained either an associate degree, a diploma, a bachelor of science degree or a graduate degree in nursing from an accredited institution; or a student nurse in the final full year as a fulltime student in a school of nursing leading to a bachelor of science degree or a graduate nursing program leading to a master’s degree in nursing; (J) Eligible student means a resident who has made application to be a full-time student in a formal course of instruction leading to an associate degree, a diploma, a bachelor of science degree, or a master of science degree in nursing, or leading to the completion of educational requirements for a licensed practical nurse; (K) Participating school means an institution within Missouri which is approved by the board for participation in the nurse loan program; (L) Practical nurse means a person licensed under the provisions of sections 335.011—335.096, RSMo 1986 to engage in the practice of practical nursing; (M) Professional nurse means a nurse licensed under the provisions of sections 335.011—335.096, RSMo 1986 to engage in the practice of professional nursing; (N) Qualified applicant for the nurse loan program means a student matriculating in a participating school; (O) Qualified employment means employment on a full- or part-time basis in Missouri in a position requiring a licensed practical nurse or registered professional nurse in any public or nonprofit agency, institution or organization in an area of defined need; (P) Reasonable educational costs means tuition, books, fees, supplies, equipment and materials required by the program of the school in which the financial aid recipient was or is enrolled to obtain a professional diploma or degree or practical nurse certification; (Q) Reasonable living expenses means the cost of room, board, transportation and miscellaneous costs based on individual program costs as published annually by the department; (R) Repayment application means the form provided by the department for the purpose of applying for participation in the nurse loan repayment program; and (S) Repayment contract means the form signed by a professional nurse loan repayment applicant and the director of the department or an authorized agent in which the applicant agrees to accept responsibility for repayment of educational loans through qualified employment or by cash. (2) Members of the advisory panel shall serve for three (3) years from the date of appointment by the director and may be reappointed for consecutive three (3)-year terms. Resignations from the panel may be accepted by the director at any time. Appointments to fill vacated panel positions shall be for three (3) years. Nonattendance by a panel member at two (2) consecutive scheduled panel meetings shall constitute a resignation from the panel unless a written explanation of the absences with a written request to continue service on the panel is received by the director within thirty (30) days after the second absence of a panel member from a scheduled panel meeting. Nonattendance at more than four (4) scheduled panel meetings in any two (2) consecutive years may constitute, at the discretion of the director, a resignation from the panel. (3) Recipients of professional and practical nurse loans shall verify to the department their enrollment, their program eligibility, their academic standing following the completion of each semester and summer session, and their expected program completion date. (A) Interest on funds loaned by the nurse loan program shall accrue at a rate of nine and one-half percent (9 1/2%) per year from the issue date of the department check. (B) When a recipient of financial assistance ceases his/her study prior to the successful completion of the course of instruction required for graduation from a participating school, repayment of the principal and interest shall begin within ninety (90) days after the date the recipient ceases to be an eligible student, in accordance with the repayment contract. The department shall be notified by the loan recipient within thirty (30) days of the date the recipient ceases to be an eligible student. Payment shall be completed no more than twelve (12) months from that date. (C) The department may grant a limited deferral of repayment of the principal and interest on the basis of hardship such as critical illness of the participant or an immediate family member, or death in the immediate family, or severe handicapping condition of the participant when the hardship has been adequately documented such as attending physician statement, death certificate or Social Security disability determination. (D) The department may grant a limited deferral of the repayment of the principal and interest when the deferral would best serve the interest of the state and the nurse loan program. (E) The status of each deferral may be reviewed as often as necessary by the department but shall be reviewed annually to insure compliance with the intent of the deferral. (F) Interest accrued during a deferral period by a financial assistance recipient shall be forgiven on the same basis as the original loan and interest. (G) Forgiveness of interest and principal for a financial assistance recipient engaged in qualified employment on a less than full-time basis may be prorated. Partial year forgiveness of the loan and accrued interest for employment in an area of defined need may be authorized by the director. (H) Once a financial assistance recipient has started to practice in an area of defined need, the principal and interest shall continue to be forgiven even if the designation of the area of defined need changes. If the recipient terminates that employment, reemployment in an area of defined need shall be required to reestablish forgiveness status. (I) Recipients found to be in default of their contracts shall be allowed a repayment period up to twenty-four (24) months. The repayment period begins on the date the recipient is out of compliance. (4) To qualify for a nurse student loan, the applicant shall have no conflicting service obligation that would prevent the state from benefitting from the applicant’s services after graduation, with the exception of service in the National Guard or military reserve. (5) Application contracts shall be completed, signed by the applicant and received by the department at least eight (8) weeks prior to the beginning of classes. (A) Application contracts shall be accompanied by proof of Missouri residency, such as a copy of the Missouri individual income tax return for the previous year of the applicant or of the applicant’s parents or legal guardian, or current Missouri driver’s license. (B) Loan recipients shall apply annually. (C) Completed application contracts on file in the department shall be prioritized for funding based on each applicant’s financial need, willingness to serve in an area of defined need, and the total amount estimated to be needed by the applicant to complete the applicant’s program. (D) Application contract forms for the nurse loan program shall be made available through the financial aid offices of the participating schools and the department for distribution to eligible students. (E) Upon approval for funding, the application contract shall be signed by the department director or an authorized agent and shall become the agreement of the applicant to accept responsibility for repayment either by cash or by service in an area of defined need. (F) A copy of an applicant’s financial aid award notice from the participating school and of the applicant’s notice of acceptance by the participating school shall be on file in the department prior to funding by the nurse loan program. (6) Selection criteria for the nurse loan repayment program are willingness to serve in an area of defined need, professional references and appropriate work history. (7) Repayment applications for the nurse loan repayment program shall be made on forms available through the department. (A) To qualify for a nurse loan repayment the applicant shall have no conflicting service obligation that would prevent the state from benefitting from the applicant’s professional services with the exception of service in the National Guard or military reserve. (B) Repayment applications shall be completed, signed by the applicant and accompanied by proof of professional licensure. (8) Subject to availability of federal, state or community funds for the nurse loan repayment program, the department shall enter into a minimum two (2)-year contract with each individual qualifying for repayment of educational loans. No loan repayment shall be made for any professional practice performed prior to the effective date of the health professional’s nurse loan repayment contract. (A) Participants shall practice in an approved area of defined need. (B) Final approval of a nurse loan repayment contract is contingent upon approval by the director and a signed service agreement from an approved site, agreed upon by the site authority and the applicant. (9) Participants who default on their written repayment contracts shall be subject to monetary repayment of the contracted amount and interest. Cash repayment periods may be authorized up to a maximum of twenty-four (24) consecutive months. (A) The department may grant a deferral of payment of the loan repayment amount and interest at the discretion of the director on the basis of hardship such as critical illness of participant or an immediate family member, or death in the immediate family, or severe handicapping condition of the participant when that hardship has been adequately documented such as statement of the attending physician, death certificate or Social Security disability determination. (B) The status of each deferral may be reviewed as often as necessary by the department but shall be reviewed annually to insure compliance with the intent of the deferral. (C) Once a loan repayment participant has begun qualified employment, loan repayment shall continue, even if the designation of the area of defined need of qualified employment changes as long as the loan repayment participant does not terminate employment. (D) If circumstances beyond the control of a loan repayment participant result in the termination of qualified employment, deferral status may be granted for a period up to ninety (90) days to allow the participant to gain employment in an area of defined need. AUTHORITY: section 173.030(3) and (6), RSMo Supp. 1990.* This rule previously filed as 19 CSR 50-2.010 and 19 CSR 10-5.010. Original rule filed Feb. 4, 1991, effective July 8, 1991. Changed to 19 CSR 10-5.010 July 30, 1998. Changed to 19 CSR 10-6.010 August 30, 1998. ** *Original authority 1963, amended 1988, 1990. **Pursuant to Executive Order 21-07, 19 CSR 10-6.010, subsection (3)(A) and section 335.233, RSMo was suspended from March 25, 2020 through August 31, 2021.