Transcript Federal and State Programs to Assist with Primary Care

Workforce Recruitment and
Retention Programs
Robert Stiles
Barbara Huske
Primary Care Office, KDHE
Our Vision - Healthy Kansans living in safe and sustainable environments
Kansas Primary Care Office
Program Focus
• Access to primary care services for all
Kansans.
• Attention to larger health care delivery
system.
• Facilitate and participate in
public/private partnerships to meet the
health care needs of Kansans.
Our Vision - Healthy Kansans living in safe and sustainable environments
Program Areas
• Recruitment and Retention—National
Health Service Corps, State Loan
Repayment, J-1 Visa Waiver Program.
• Underserved Areas Designation—
HPSA and MUA/P.
• Access—Community-Based Primary
Care Clinic Program, Charitable Health
Care Provider Program, Unused
Medications Program/Repository,
Technical Assistance to Communities.
Our Vision - Healthy Kansans living in safe and sustainable environments
State Loan Repayment
Program
(SLRP)
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About the Program
• PCO receives funding from HRSA
through the National Health Service
Corps to administer program.
• $300,000 is available annually (50
percent federal/50 percent state) to
assist health professionals in the
repayment of eligible educational loans.
• Continuous application cycle beginning
July 1 of each year for awards
beginning October 1.
– Priority in order applications received.
Our Vision - Healthy Kansans living in safe and sustainable environments
Providers
• Eligible professions include primary care
physicians, nurse practitioners, physician
assistants, nurse mid-wives, dentists, dental
hygienists, clinical psychologists, clinical
social workers, clinical professional
counselors and clinical marriage and family
therapists.
• Up to $25,000 per year is available to PAs,
ARNPS, dental hygienists, and clinical mental
health.
• Up to $30,000 to primary care doctors (MD or
DO) and dentists.
Our Vision - Healthy Kansans living in safe and sustainable environments
Providers
• Must be U.S. Citizen or National.
• Completed appropriate level of education and
licensed/certified in Kansas.
• No prior, unfulfilled practice obligations.
• Employed at an eligible practice site. Not
discriminate in providing health care services
to Medicare and Medicaid beneficiaries and
those unable to pay for health care services.
• Contract to practice in an eligible
underserved area for a minimum of 2 years.
Our Vision - Healthy Kansans living in safe and sustainable environments
Providers
• Must work a minimum of 40 hours per week,
for a minimum of 45 weeks per service year
providing primary health services.
– No more than 8 hours of the minimum 40 may be
devoted to practice-related administrative
activities.
– Research and teaching are not clinical practice.
– Services must be conducted during normally
scheduled hours in the ambulatory care setting.
– Absences greater than 7 weeks per year will
extend the service commitment end date.
Our Vision - Healthy Kansans living in safe and sustainable environments
Sites
• Public or nonprofit private entity in
Kansas.
• Provide care in a federally designated
HPSA.
• May not discriminate in care to Medicaid
and Medicare beneficiaries and those
unable to pay for services.
• Charge at the usual and customary rate,
using a reduced rate for those unable to
pay.
Our Vision - Healthy Kansans living in safe and sustainable environments
Sites
• Written nondiscrimination policy and
provide services in a culturally and
linguistically appropriate responsive to
needs of area.
• May not use SLRP funding as salary
offset.
• Cooperate with communication or site
visits to monitor compliance.
Our Vision - Healthy Kansans living in safe and sustainable environments
Our Vision - Healthy Kansans living in safe and sustainable environments
National Health Service
Corps Loan Repayment
Program
(NHSC)
Our Vision - Healthy Kansans living in safe and sustainable environments
Kansas Primary Care Office
• Evaluates all Recruitment and Retention
Application requests from entities in Kansas and
recommend approval or disapproval of
applications.
• Collaborates with state agencies and partners in
integrating NHSC activities into the state’s
strategy to increase health professionals in
underserved areas.
• Assists communities in recruiting and retaining
NHSC providers.
• Provides information to and participate in
recruitment activities for potential student loan
repayors in the state.
Our Vision - Healthy Kansans living in safe and sustainable environments
2010-2011 Loan Repayment Cycle
• Opened November 22, 2010.
• Increase in Financial Support.
– Up to $60,000 for two years of service.
• More Flexible Options.
– Three options—a two-year full-time contract, a
four-year half-time contract, and a two-year halftime contract.
• Increased Credit for Teaching.
– 20 percent credit for teaching.
– 50 percent credit for teaching at a Teaching
Health Center.
Our Vision - Healthy Kansans living in safe and sustainable environments
Provider Requirements
• Provides $60,000 in exchange for a two year
commitment to practice at an eligible site.
• Full-time clinical care (40 hours per week in the
approved ambulatory care setting with at least 32
hours of direct patient care at the approved site).
– Half-time 20 hours per week, 16 hours patient care is
allowed.
• Either $30,000 for two years or $60,000 for four
years of service.
– Eight hours of teaching allowed.
• No reduction in salary or benefits because
receiving NHSC loan repayment.
• May only practice at approved site to meet
obligation.
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Applicant Requirements
• Applicant must be U.S. Citizen or national.
• Must be employed at site or within 30 days of
approval of application.
• Eligible disciplines: Primary Care MD or DO,
Primary Care Nurse Practitioners, NurseMidwife, Primary Care PA, Dentist, Dental
Hygienist, Clinical Psychologist (doctorallevel), Licensed Clinical Social Worker,
Psychiatric Nurse Specialist, Licensed
Marriage and Family Therapist, Licensed
Clinical Professional Counselor.
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Site Requirements
• Care must be provided in the ambulatory setting
(inpatient not eligible).
• Ensure access to ancillary, inpatient, and
specialty referrals for patients.
• Provide comprehensive care in the area in which
the NHSC Loan Repayor practices (primary
medical, dental, or mental health).
• Ensure that patients receive care regardless of
ability to pay or method of payment.
– Information on a discounted fee schedule available is at
http://nhsc.bhpr.hrsa.gov/communities/discountfee.htm.
Our Vision - Healthy Kansans living in safe and sustainable environments
Site Requirements
Charges for Services:
• Full charge for care must be consistent with
prevailing rates in the site’s area.
• Care should be provided for a nominal fee or no
charge for individuals at or below 200 percent of
the federal poverty level.
• Must accept assignment for Medicare
beneficiaries and have entered into agreement
with Medicaid/CHIP (HealthWave).
• Prominently post a statement that explicitly
communicates the fact that no one will be denied
care based on ability to pay in languages
appropriate to the service area’s population.
Our Vision - Healthy Kansans living in safe and sustainable environments
Site Eligibility
• Must be in compliance with requirements at
time of application and remain so throughout
period of clinician service.
• The entire site must meet the NHSC site
requirements, not just the area in which the
clinician receiving loan repayment is
practicing.
• After approval as a site may list eligible job
vacancies on NHSC job opportunities site
and hire clinicians applying for NHSC loan
repayment or, with a high enough HPSA
score, NHSC scholars.
Our Vision - Healthy Kansans living in safe and sustainable environments
Site Requirements
• Must be approved by NHSC as an eligible
site through submitting the Recruitment and
Retention Assistance application.
– Must renew site application every three years
for continued participation.
• Must be sited in a current and appropriate
Health Professional Shortage Area (medical,
dental, mental).
Our Vision - Healthy Kansans living in safe and sustainable environments
NHSC Scholars Program
• Scholarship pays tuition, fees, some other
educational expenses, and a living stipend ($1,289
for 2010-11)for up to four years.
• Must serve for one year for each year of support
(minimum of two years).
• Eligible professions: Physician (MD or DO), family
nurse practitioner, certified nurse mid-wife, PA, or
dentist.
• Must serve in an approved site with an appropriate
HPSA score (17 or higher for 2010-11 depending on
specialty).
– Required score updated each year in Federal Register each
May or June.
• Minimum of 40 hours per week (32 hours of direct
patient care).
Our Vision - Healthy Kansans living in safe and sustainable environments
J-1 Visa Waiver
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J-1 Visa Waiver Overview
• Physicians admitted to the U.S. with J-1 Visas
must return to their home country for at least
two years.
– A state government department of public health may request
that this requirement be set aside in the public interest.
• The Conrad 30 program allows each state to
recommend up to 30 visa waivers per federal
fiscal year for physicians recruited to sites in
primary care or mental health HPSAs
(psychiatrists).
– Based on the state’s recommendation, the Waiver Review
Division of the U.S. Department of State then makes
recommendations to US CIS, the agency authorized to issue
the waiver.
Our Vision - Healthy Kansans living in safe and sustainable environments
J-1 Visa Waiver Overview
• Federal law allows up to ten physicians in
each state to work in regions not specifically
designated as underserved at the state
department of public health’s discretion.
– Kansas uses this flexibility to recommend waivers if the
need for services can be demonstrated and if patients
from designated shortage designation areas will be
served by the physician.
• Kansas’ participation in the waiver program is
intended to assist local communities to
ensure access to physician services.
– Specialists as well as primary care providers are
eligible.
– Primary Care providers will be given priority.
Our Vision - Healthy Kansans living in safe and sustainable environments
J-1 Visa Waiver Overview
Requirements
• Complete Data Sheet obtained through U.S. Dept. of
State.
• Request submitted by legal entity employing the
provider.
– Facilities, institutions, rural health clinics, FQHCs, primary
care clinics, medical centers, hospitals, private practices.
• Must show evidence of a signed physician contract.
• Must show evidence of open recruitment and that
hiring a J-1 physician is a last resort.
– A physician not encumbered by the J-1 home residence
requirement who is qualified for and applies for the job must
be offered the position.
Our Vision - Healthy Kansans living in safe and sustainable environments
J-1 Visa Waiver Overview
Requirements
• Must be eligible for a medical license from the
Kansas Board of Healing Arts.
• Contract must be for a minimum of three years to
provide care at least 40 hours per week at least 4
days per week in the appropriate specialty.
• Must commence practice within 90 days of receiving
a waiver.
National Interest Waiver
KDHE will provide a letter of support at its
discretion for J-1Physicians with waivers in
good standing.
Our Vision - Healthy Kansans living in safe and sustainable environments
Negotiated Rule for Underserved
Areas Designation
• The Accountable Care Act requires a
negotiated process for reviewing the
designation of HPSAs and MUA/Ps.
– HPSAs are used to determine eligibility for NHSC,
Conrad 30, and Medicare bonus payment to
primary care physicians working in whole-county
geographic HPSAs.
– MUA/Ps are used in awarding FQHC funding.
• 28 stakeholder members representing
programs most affected by designation.
– Includes FQHCs, rural health clinics and rural
providers, special populations, and technical
experts.
Our Vision - Healthy Kansans living in safe and sustainable environments
HRSA Workforce Planning Grant
• Partnership led by KS Dept. of Commerce.
• One-year planning grant with potential for 2 to
3 year implementation grant.
• Plan and implement programs aimed at
increasing the supply of primary health care
professionals (medical, dental, mental
health).
• Goal: Increase number of primary health care
professionals in Kansas by 10-25% over the
next ten years.
Our Vision - Healthy Kansans living in safe and sustainable environments
Contact Information
Barbara Huske
Workforce Coordinator
785-296-2742
[email protected]
Our Vision - Healthy Kansans living in safe and sustainable environments