Healthcare Workforce. Provider Loan Repayment Programs

Transcription

1 Healthcare Workforce Provider Loan Repayment Programs Presented by Ken Miller and Bob Esdale Michigan Department of Community Health January 23, 2007

2 We are here to provide information about Michigan State Loan Repayment Program (MSLRP) National Health Service Corps (NHSC) Government programs designed to increase the supply of health providers These programs can complement provider recruitment incentives 2

3 Encourage Providers to Apply to for Both Programs Providers can apply for both the NHSC and MSLRP at the same time. Providers cannot participate in both programs at the same time. MSLRP is especially advantageous for providers in HPSAs with low HPSA Scores NHSC awards contracts to providers in HPSA with highest scores MSLRP doesn t consider HPSA score Consecutive Participation Allowed Best to participate in NHSC first, then in MSLRP One-day contract overlap 3

4 MSLRP Objective Provide Loan Repayment Assistance to: Medical, Dental & Mental Health Care Professionals Committed to Providing Full-Time (40/32 hours per week) Primary Health Care Services At a Not-For Profit Clinic In a Health Professional Shortage Area (HPSA) For 2 or More Years 4

5 How Can MSLRP Assist in Your Recruitment and Retention Efforts? Maximum Contract Amounts: Primary Providers = $50,000 Initial 2-Year Contract Physicians, Dentists, PH.D MHC Providers Mid-Level Providers = $30,000 Initial 2-Year Contract PAs, NPs, CNM, MSWs & other Masters-Level MHC Providers 5

6 A Closer Look at Eligible Provider Types Primary Providers ($50,000 Initial 2 Years) Dentists: DDS or DMD Physicians: MD/DO Family Practice, Internal Medicine, OB/GYN, Pediatrics Psychiatrists Clinical or Counseling Psychologists (Ph.D) Licensed Professional Counselors (Ph.D.) Marriage and Family Therapists (Ph.D.) 6

7 A Closer Look at Eligible Provider Types Mid-Level Providers: ($30,000 Initial 2 Years) Physician Assistants (Primary Care) Nurse Practitioners Certified Nurse Midwives Clinical Social Workers (Masters) Licensed Professional Counselors (Masters) Marriage & Family Therapists (Masters) Mental Health Counselors (Masters) Psychiatric Nurse Specialists (Masters) 7

8 MSLRP Selection Criteria and Process Priority Providers Priority Practice Sites Non-Priority Status Single Priority Status Double Priority Status Triple Priority Status Lottery Numbers Waiting Lists 8

9 Priority Providers Participants Applying to Re-Contract with MSLRP Dentists Psychiatrists Other Mental Health Care Providers 9

10 Priority Practice Sites Local Health Departments State Funded Institutions State Psychiatric Hospitals Forensic Medicine Centers CMH Agencies State Correctional Facilities State-Funded Primary Care Clinics Federally Qualified Health Centers (FQHCs) and FQHC Look-Alikes Critical Access Hospital (CAH)-Administered Primary Care Clinics Certified Rural Health Clinics (RHCs) Designated as Facility HPSAs 10

11 Applicant Priority Status Non-Priority Status Non-Priority Provider/Non-Priority Practice Site Single Priority Status Priority Provider/Non-Priority Practice Site Non-Priority Provider/Priority Practice Site Double Priority Status Priority Provider/Priority Practice Site Triple Priority Status Participant Applying to Re-Contract with MSLRP 11

12 Rank-Ordered MSLRP Applicant List Triple Priority (Re-Contracting for Third Year) PA, L= 201 MD, L=456 Dentist, L=623 Double Priority (Initial Applications) Dentist, L= 198 Psychiatrist, L=376 Dentist, L=805 Single Priority DO, L=389 NP, L=662 PA, L=940 Non-Priority PA, L=143 DO, L=492 PA, L=725 Withdrawn and Ineligible 12

13 Rank-Ordered MSLRP Applicant List Withdrawn and Ineligible Withdrawn, Accepted into NHSC- Good! Ineligible Bad!! HPSA Status Not Confirmed Medical, Dental, Mental Health, Facility HPSA Not Providing Primary Care ER, Trauma Center, Orthopedics, Hospitalist Incomplete/Illegible Application Package Ugly!!! Provider Application, Part A Provider Application, Part B Practice Site Application & Declaration of Intent W9 (Provider s Address/Signature) Payee Registration Form (Provider s Address/Signature) Faxed Application Package 13

14 Waiting Lists Applicants Not Initially Selected Remain on Rank-Ordered List. Offered Contracts as Candidates Already Selected Withdraw their Application, or are Determined Ineligible. 14

15 MSLRP Contract Provisions Qualifying Educational Loans MSLRP Payments Tax Treatment of MSLRP Payments Contract Start Dates Service Obligation Default Provisions 15

16 MSLRP Contract Provisions Qualifying Educational Loans Undergraduate and Graduate Loans through Government Agencies and Commercial Lenders Private Loans from Individuals Ineligible Loans Must Have Been: Used for Education Leading to a Degree in the Health Profession in which the Participant will Satisfy their Service Obligation Provider Application, Part B Long Lead Time (start 1 month before begin of application period) Provider (fax) Lender(s) (fax) Provider Include in Application Package w/required Postmark Mail to MSLRP Office (no faxes) 16

17 MSLRP Contract Provisions MSLRP Payments: Start 6 Months after Contract Start Date Each 6 Months during Contract Provider Initiates Each Payment Cycle Work Verification Form: Provider Employer MSLRP Office Check Provider s Home Address (W9/Payee Registration Form) Example: Physician, $50,000 Contract, 4/1/08 3/31/10 17

18 Physician Contract $50,000 4/1/08 3/31/10 WVF Payment Amount 9/08 10/08 $12,500 3/09 4/09 $12,500 9/09 10/09 $12,500 3/10 4/10 $12,500 18

19 MSLRP Contract Provisions Tax Treatment of MSLRP Payments Information for Providers Tax Professionals Public Law All NHSC and State Loan Repayment Program Funds Received on or after January 1, 2004 are: Exempt from Gross Income and Employment Taxes Excluded from Wages in Determining Benefits under the Social Security Act. State of Michigan has Exempted NHSC and MSLRP Payments from State and Local Taxes 19

20 MSLRP Contract Provisions Service Obligation Each Provider Entering into a MSLRP Contract Agrees to Complete a Service Obligation, which Runs the Length of their Contract Legal Responsibility Shouldn t be taken Lightly Providers: Read Carefully Before Signing Providers Who Fail to Complete Service Obligation, or Meet any Contractual Service Obligation, Face Significant Default Provision included in their Contracts 20

21 MSLRP Contract Provisions Default Provisions Severe Federal Penalties Mandated by the Federal State Loan Repayment Program Apply to all Providers who default on their MSLRP Contract: Don t Complete Service Obligation Fail to Meet any Contractual Service Requirements 21

22 A Provider Who Breaches the MSLRP Contract: Receives no future MSLRP payments, and owes the Department an amount equal to the sum of: 1. The total of the amounts paid by the Department to the Contractor for loan repayment for any period of obligated service not served; and, 2. An amount equal to the number of months of obligated service not completed, multiplied by $7,500; except that: 3. The amount the Department is entitled to recover shall not be less than $31,000 22

23 Limited Flexibility in Dealing with Provider Issues Informed Employer and Provider Reading/understanding MSLRP Contract Frank pre-contract provider/mslrp Office discussion Good Employer/Provider/MSLRP Office Communications Notify MSLRP Office and discuss changes in employment situation that affects contract Suspension Transfer to New Practice Site 23

24 Dealing with Provider Issues: Suspension Stops the clock on provider s service obligation Allows time away from practice site in excess of 7 week/35 workday limit per contract year for: Personal health issues Caregiving for child, spouse or relative MSLRP Contract is amended Contract end date is extended to recapture period of unfulfilled service obligation Completion of service obligation can be postponed, but not cancelled 24

25 Dealing with Provider Issues: Transfer to New Practice Site Allows provider to complete service obligation and avoid breach of contract, when: Current practice site is closed Irreconcilable problems in employer/provider relationship Provider s responsibility to find new practice site of a different employer New practice site must be located in a HPSA corresponding to provider s discipline MSLRP Office assists, but resources limited 25

26 Recent MSLRP Developments & Current Opportunities Expansion of Mental Health Care Provider Policy Notification of Current MSLRP Opportunities Development of Marketing Partners First Come, First-Served Application Period, Started January 1, 2008 Looking to the Future 26

27 Expansion of Mental Health Care Provider Policy Attempt to increase participation of MHC providers in MSLRP Old Policy: Eligible Practice Sites: State Psychiatric Hospitals Forensic Medicine Centers CMH Agencies State Correctional Facilities 27

28 Expansion of Mental Health Care Provider Policy New Policy: Eligible Practice Sites: Local Health Departments State Funded Institutions State Psychiatric Hospitals Forensic Medicine Centers CMH Agencies State Correctional Facilities State-Funded Primary Care Clinics Federally Qualified Health Centers (FQHCs) and FQHC Look-Alikes Critical Access Hospital (CAH)- Administered Primary Care Clinics Certified Rural Health Clinics (RHCs) Designated as Facility HPSAs 28

29 Expansion of Mental Health Care Provider Policy Old Policy: Employer/Community Matching Contributions had to be from: Community Mental Health funds, or Department of Corrections funds New Policy: Employer/Community Matching Contributions May be from: Any verifiable non-federal source 29

30 Notification of Current MSLRP Opportunities MSRLP Opportunity Notification List Current and future MSLRP employers Organizations concerned about access to primary care MSLRP Opportunity Notification s Upcoming application periods Changes in MSLRP policy MSLRP Marketing Partners Organizations representing segments of our target markets Forward opportunities to their constituencies Provide opportunities for MSLRP staff speak to their members about the program 30

31 Getting on the List Interested in: Receiving MSLRP Opportunity Notifications? Becoming a MSLRP Marketing Partner? To get on the list: Give me your card today Mail me your card, or Send me an with your contact information Feel free to call me about MSLRP opportunities any time 31

32 Contact Information Ken Miller MSLRP Analyst Health Planning and Access to Care Section Michigan Department of Community Health Capitol View Building, 7 th Floor 201 Townsend Lansing, MI MillerK3@michigan.gov 32

33 First Come, First Served MSLRP Application Period Current MSLRP Opportunity Started January 1, 2008 First come, first served, regardless of priority status Will continue until all funds are committed Close will be posted on the MSLRP Website Employer/Community Contribution Contracts: Allow employers and communities to double the impact of their recruitment and retention funds Each employer/community contribution dollar is matched with available federal dollars to fund loan repayment contracts for needed medical, dental and MHC providers. 33

34 Looking to the Future Objectives: Increase application volume Expand employer/community contribution (local match) contract segment of program Increase number of providers serving in Health Professional Shortage Areas. Increase federal funding and sustain state funding Employer/Community Contribution Segment is Growing Current competitive grant allows for increases in federal funding over the next two years Use it, or lose it. Means we need additional employers, communities and organizations to sponsor medical, dental or mental health care providers 34

35 Employer, Community, Organizational Sponsorship Do you know a provider committed to working in a HPSA worthy of your sponsorship? Do you know of employers, organizations or community-based funding sources wanting to double the impact of their recruitment and retention dollars? If so, call me to discuss how we can bring another provider to an underserved area. 35

36 MSLRP Questions? 36

37 Addressing the Shortage of Health Care Providers The National Health Service Corps Started in 1972 as a scholarship program The NHSC is committed to: - Uniting communities in need with caring health professionals - Supporting communities' efforts to build better systems of health care 37

38 National Health Service Corps: Recruitment Programs NHSC Scholarship Program NHSC Loan Repayment Program (LRP) NHSC Campus Based Ambassador Program NHSC Ready Responder Program NHSC SEARCH (Student/Resident Experiences And Rotations in Community Health) Program NHSC State Loan Repayment Program 38

39 NHSC Scholarship Program Scholarships to students who commit to practicing primary care in Health Professional Shortage Areas (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. 39

40 NHSC Loan Repayment Program: Clinician Incentive 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 obtains employment at eligible/approved site and then applies for NHSC-LRP 40

41 Recruit These Disciplines for NHSC Loan Repayment Primary Health Care Primary Care Physicians (FP, IM, PED, & OB/GYN) Primary Care Nurse Practitioners Physician Assistants Certified Nurse Midwives Mental Health Psychiatrists Psychiatric Nurse Practitioners Clinical Psychologists Clinical Social Workers Licensed Professional Counselors Marriage and Family Therapists Oral Health Care Dentists Dental Hygienists 41

42 Site Eligibility-Type of Sites Public or private entity Community Health Centers Rural Health Clinics Hospital affiliated practices Private practices Indian Health Service Prisons - State and Federal Community Mental Health Centers 42

43 What Can You Do to Maximize Your Opportunities with the NHSC? Apply to NHSC to be included on the NHSC Opportunity List Market your site Recruit potential loan repayors If eligible, recruit scholars 43

44 Site Eligibility-Type of Sites Provide comprehensive primary care, primary mental health/substance abuse or dental services in an ambulatory setting Ensure access to ancillary, inpatient and specialty referrals Requirements pertain to entire site, not just NHSC clinician Must be in compliance at time of application and maintain compliance throughout term of NHSC clinician's service commitment Each location must apply and be approved by State and by NHSC-SIAB 44

45 Site Eligibility-Health Professional Shortage Area (HPSA) Must be located in and providing service to a federally designated Health Professional Shortage Area (HPSA) HPSAs Primary care - shortage of primary care providers Mental health - shortage of mental health providers Dental - shortage of oral health providers Contact the Primary Care Office (PCO) at (517)

46 Primary Care HPSAs Updated: December 2007 Contact the Primary Care Office (PCO) at (517)

47 Dental Health HPSAs Updated: December 2007 Contact the Primary Care Office (PCO) at (517)

48 Mental Health HPSAs Contact the Primary Care Office (PCO) at (517)

49 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 eligible for Automatic HPSA but must apply and meet NHSC Charges for Services Requirements Native American populations and sites also have Automatic HPSA opportunities 49

50 Sites Eligible for NHSC LRP All approved sites in HPSAs eligible for LRP Sites in a HPSA with a score of 17 or higher receive priority (funded first and early - as soon as clinician application determined to be complete and eligible) Sites in a HPSA with a score of 16 or below will be funded after deadline (last Friday in March) by decreasing HPSA score, as funds are available FY Primary Care LRP applications funded with scores as low as 6 50

51 Site Eligibility- Charges for Services Ensure no financial barriers to care exist Fees for service consistent with prevailing rates in area Discounts or waives fees for individuals at or below 200% of the Federal poverty level Accepts assignments for Medicare beneficiaries; and enters into agreements with Medicaid and State Children's Health Insurance programs Prominently posts signage 51

52 Site Eligibility - Hiring NHSC Clinicians When hiring NHSC Clinicians, sites agree: Full-time clinical No reduction in salary because of NHSC Communicate changes in employment Only allow practice at approved site(s) Make available personnel/practice records Not restrict communication between clinician and NHSC 52

53 Monitoring Site Compliance Information from State Partners The State Primary Care Office involved and often are aware of issues sooner than the NHSC Required to pass along information regarding site or NHSC clinician s compliance NHSC also involved in site/clinician monitoring and are doing 6-month service verifications 53

54 NHSC Assistance to Communities In addition to the programs the NHSC offers to students and clinicians, the NHSC works with communities to recruit and retain primary care clinicians by: Providing technical assistance to become an NHSC Site. Developing academic and community partnerships for student experiences and rotations in underserved areas. 54

55 Technical Assistance Site development Planning and development; type of services Development of fee schedules; practice management Retain NHSC clinicians Recruitment of NHSC clinicians 55

56 What Happens When... HPSA is withdrawn or No New Data No new NHSC clinicians can be placed at the site All vacancies are removed NHSC Clinicians currently serving can continue to serve, but no loan repayors can amend their LRP contracts at that site If eligible for auto HPSA, site can switch vacancies to that HPSA and NHSC Loan Repayors can amend under that auto HPSA 56

57 What Happens When... HPSA Score Changes If the vacancy was on the NHSC list in the discipline and specialty for that Scholar, and the Scholar visited the site (and was approved for the site visit by NHSC) we would honor the original score If however, the vacancy was on the list but the Scholar had not interviewed and was now asking to visit/interview or match, it would not be approved. 57

58 What Happens When... Site Visit Reveals Site Non-Compliance Depends on areas of non-compliance If of a serious nature (i.e., does not use a discount fee policy; does not provide full-time clinical hours; site moved to non-hpsa) and site is unwilling to resolve, current NHSC clinicians serving may be moved If the area of non-compliance is not as serious and can be resolved, NHSC clinicians currently serving would be allowed to stay, however no new NHSC clinicians would be approved until the site is brought back into compliance 58

59 What Happens When... Site Terminates a NHSC Provider All vacancies are removed from the list Site visit scheduled unless CHC If CHC, phone TA may be provided Determination made if site should continue to be eligible for NHSC Would not affect current NHSC clinicians who continue to serve at the site 59

60 To Learn More For more information on NHSC and its programs: Call HHS toll-free helpline at Visit the NHSC Web site at: Call the Primary Care Office in Michigan at (517) or 60

61 Program Comparison NHSC LRP Open to: primary care MDs & DOs, primary care nurse practitioners, nurse-midwives, physician assistants, Dentists, dental hygienists, clinical psychologists, clinical social workers, licensed professional counselors, family therapists, psychiatric NP Requires: Minimum two year commitment, practice in shortage area Provides: Up to $50,000 for two years MSLRP Open to: primary care MDs & DOs, primary care nurse practitioners, nurse-midwives, physician assistants, Dentists, clinical psychologists, clinical social workers, licensed professional counselors, family therapists, psychiatric NP Requires: Minimum two year commitment, practice in shortage area Provides: Up to $25,000 a year, up to three years Still have loans? Complete one program and apply for the other 61