Funding Opportunity Number: HRSA-18-011
Program Administrative Management
Participant Contract Terms and Conditions
The State Loan Repayment Program (SLRP) is part of the National Health Service Corps (NHSC) that provides cost-sharing grants to states to operate their own loan repayment programs. These state programs offer loan repayment to primary care, mental and behavioral health, and dental providers working in Health Professional Shortage Areas (HPSAs) for a minimum of two years full- or four years half-time.
The NHSC SLRP is funded by a grant received from the Bureau of Health Workforce (BHW) in the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS). These funds support the loan repayment awards distributed by the program. States must also agree to provide (directly or through donations from public or private entities) non-federal contributions towards NHSC SLRP contracts in an amount not less than one dollar for each dollar of federal funds provided in the grant.
Do clinicians have to be a U.S. citizen to apply for the NHSC SLRP?
Clinicians applying to the NHSC SLRP must be a U.S. citizen (either U.S. born or naturalized) or U.S. national.
Can clinicians still apply for the NHSC SLRP if they currently owe an existing service obligation?
Clinicians must not have an outstanding contractual obligation for health professional service to the federal government, or to a state or other entity, unless that service obligation will be completely satisfied before the NHSC SLRP contract has been signed. Please note that certain provisions in employment contracts can create a service obligation (e.g., an employer offers a physician a recruitment bonus in return for the physician’s agreement to work at that facility for a certain period of time or pay back the bonus).
Do clinicians have to be licensed in order to apply for NHSC SLRP?
Clinicians who intend to apply for and practice under the NHSC SLRP must have a current, full, permanent, unencumbered, unrestricted health professional license, certificate or registration (whichever is applicable) in a state where their NHSC SLRP-approved service site is located.
What disciplines qualify for the NHSC SLRP?
Qualified disciplines for the NHSC SLRP include the following:
Abbreviation Discipline MD Allopathic Medicine DO Osteopathic Medicine DDS/DMD General and Pediatric Dentistry NP Nurse Practitioner CNM Certified Nurse-Midwife PA Physician Assistant RDH Registered Dental Hygienist HSP Health Service Psychologist (Clinical and Counseling) LCSW Licensed Clinical Social Worker PNS Psychiatric Nurse Specialist LPC Licensed Professional Counselor MFT Marriage and Family Therapist RN Registered Nurse Pharm Pharmacist
Is preventive medicine an approved discipline in the NHSC SLRP?
Preventative medicine is a covered discipline within Allopathic and Osteopathic Medicine.
Are U.S. Public Health Service (USPHS) Commissioned Corps (CC) Officers eligible to participate in SLRP?
Applicants are able to apply for both programs as long as eligibility requirements are met and applicants are able to provide appropriate resources to both programs.
Can clinicians apply for more than one scholarship or loan repayment program at a time?
Clinicians are encouraged to apply, if qualified, for as many scholarship or loan repayment programs as available. However, clinicians may not accept more than one award for or sign a contract for more than one service obligation simultaneously. Clinicians must complete one service obligation at a time.
Do all applicants of the NHSC SLRP receive a loan repayment award?
The NHSC SLRP is a competitive program. The number of awards will depend on the amount of funding available and number of applications received by each individual state program. Applicants may contact the NHSC SLRP Administrator within their respective state to determine the current amount of funding available for the upcoming cycle. Find your NHSC SLRP state program office.
How many clinicians are awarded each cycle for the NHSC SLRP?
Each NHSC SLRP application cycle is unique, and the number of applicants awarded depends on the number of applications received as well as the availability of funding.
Program Administrative Management
Would the Public Service Loan Forgiveness Program be considered a service obligation thus making the provider ineligible for NHSC SLRP?
The Public Loan Forgiveness Program is not considered a service obligation thus providers participating in it are eligible for the NHSC SLRP.
Are consolidated and/or refinanced loans eligible for NHSC SLRP loan repayment?
Consolidated Loans may also be eligible within the following guidelines:
- If loans are consolidated, the consolidated/refinanced loan must be from a government (federal, state, or local) or commercial lender and must include only the applicant’s qualifying educational loans.
- If an eligible educational loan is consolidated/refinanced with ineligible (non-qualifying) debt, no portion of the consolidated/refinanced loan will be eligible for loan repayment.
- If an eligible educational loan is consolidated/refinanced with loans owed by any other person, such as a spouse or child, no portion of the consolidated/refinanced loan will be eligible for loan repayment.
What if the loans are in forbearance?
If loans are in forbearance, the clinician is required to fill out any paperwork required by the state to verify the status of the loan at the time of application and must include a recent copy of the corresponding lender statements.
What if the loans are in default?
Loans that are currently in default are not eligible for the NHSC SLRP.
What is a “service obligation?”
In the context of NHSC SLRP, a “service obligation” means the contractual commitment in which a clinician legally agrees to practice for a specified period of time in a particular area or facility, or for a specific entity or type of entity. Entities may include federal, state or local agencies, as well as private organizations.
What types of loans are eligible for the NHSC SLRP?
Government (federal, state, or local) and commercial (i.e., private student loans) loans incurred to obtain a health profession education qualify for the program. The educational loans must be obtained prior to the date the participant submits his/her online application to the respective state program.
What types of loans are NOT eligible for the NHSC SLRP?
The following loans do not qualify for the NHSC SLRP:
- Loans for which the applicant incurred a service obligation which will not be fulfilled before the deadline for submission of the NHSC SLRP application. All applicants should contact their individual state program for the current application deadline
- Loans for which the associated documentation cannot identify that the loan was solely applicable to the undergraduate or graduate education of the applicant
- Loans not obtained from a government entity or private student loan lending institution. Most loans made by private foundations to individuals are not eligible for repayment
- Loans that have been repaid in full
- Primary care loans
- Parent PLUS loans (made to parents)
- Personal lines of credit
- Loans subject to cancellation
- Residency loans
- Credit card debt
Documentation of loans will be required. Qualifying educational loans must have documentation to establish that they were contemporaneous with the education received. Loan documentation will be verified by contacting lenders/holders and reviewing the applicant’s credit report at each state’s program.
What requirements must clinicians meet in order to apply for NHSC SLRP?
To qualify for the NHSC SLRP, clinicians must meet the following criteria:
- Be a U.S. citizen (either U.S. born or naturalized) or U.S. national with a valid, unrestricted health care license or certificate for the state in which he or she practices
- Have no other existing service obligations/commitments (e.g. primary care loans)
- Be free of judgments arising from federal debt
- Cannot have:
- Defaulted on any federal payment obligations
- Breached a prior service obligation to the federal/state/local government or other entity, even if he or she subsequently satisfied the obligation
- Had any federal or non-federal debt written off as uncollectible or received a waiver of any federal service or payment obligation
- Must be currently employed or have accepted full-time (minimum of 40 hours per week) / half-time (a minimum of 20 hours per week) providing direct patient care in an eligible discipline, at an approve site located in a designated HPSA
- Must agree to use the NHSC SLRP funds only to repay qualifying educational loans
When is the application filing period for the NHSC SLRP?
Individual state applications cycles vary from state to state. Each state is permitted to have its own application cycle, and it is not required to coincide with the NHSC competitive or continuation application cycles. View state application cycles and click on the states “Organization Name” to be redirected to the states’ website.
What documents must a clinician submit in order to make his or her NHSC SLRP application complete?
Required documents for the NHSC SLRP are based on each state’s individual application. In general, states may require documents including an application form, proof of educational debt (such as lender statements), personal statements or letters of recommendation, and proof of employment at an eligible site. Interested applicants should contact the state program coordinator to ensure compliance with all application requirements. Usually, the following information may be requested:
- Application: Clinicians must sign and date the application and have enclosed all required documentation.
- Educational Debt Reporting Form: Clinicians should refer to his or her lender statements when filling out this form.
- Lender Statements: These must be current and dated within 30 days of application submission. They must also include the clinician’s name, the name and payment address of the lender, account number, and the current principal balance.
- Personal Statement: Clinicians should refer to the application for these predetermined questions. Personal statements should be typed in a question and answer format.
- Letter of Recommendation: This should come from the clinician’s supervisor and explain why he or she feels that the applicant is a good candidate for the program. The letter should be on letterhead and include an original signature.
- Certification of Practice Site Form: This form verifies the applicant’s employer’s agreement to participate in the program.
If the state receives its non-federal matching funds from entities besides the clinician’s employer, are those dollars tax exempt as well?
Federal funds and matching state funds, used to support the State Loan Repayment funds are exempt from federal income and employment taxes.
Can funds be used to enhance internship programs and field placements?
Funds may be used to enhance or expand field placements and internships with the focus of the program.
Participant Contract Terms and Conditions
What are the terms of a NHSC SLRP contractual obligation?
The following highlights some of the NHSC SLRP contractual obligations:
NHSC SLRP award recipients are required to serve at a public and non-profit private entity in a designated HPSA for a minimum of two years full-time (a minimum of 40 hours per week, 32 hours of which must be spent providing direct patient care) or four years for half-time (a minimum of 20 hours per week (not to exceed 39 hours per week), 16 hours of which must be spent providing direct patient care). Additionally, provider contracts have more specific terms and conditions that are derived from state and federal statues; as well as program and grant policies. If a clinician chooses to apply for a contract extension, he or she must continue to meet the same program requirements for the duration of the contract.
What happens if a clinician is unable to fulfill the terms of his or her contractual obligation and complete his or her service obligation?
If a clinician breaches his or her NHSC SLRP obligation, he or she will be responsible for repaying an amount equal to the sum of the following:
(A) The amounts paid to the participant for any period not served
(B) The # of months not served, multiplied by $7,500
(C) Interest on (A) and (B)
Practice Site Eligibility
How does a facility get a HPSA designation?
To be designated as a HPSA, communities, or facilities must directly contact their respective State Primary Care Offices (PCO). HPSA applications are submitted to HRSA for review and approval via the state PCO contacts.
To verify if a site or community is located in a designated HPSA, search by state, county and address. Federally Qualified Health Centers (FQHCs), FQHC Look-Alikes, and Indian Health Service (IHS) sites are automatically designated as being a facility HPSA, and some Rural Health Clinics that meet additional criteria may be automatically designated as a facility HPSA.
There are three HPSA categories – primary, dental, and mental health. To recruit an NHSC SLRP clinician, NHSC SLRP -approved sites must have a designated HPSA for the specific category under which an NHSC SLRP clinician would serve. For example, to recruit for an internal medicine physician, an NHSC SLRP-approved site must have a designated primary care HPSA. To recruit a psychiatrist, the site must be in a designated mental health HPSA.
How many hours are considered “full-time & half-time” for the SLRP?
Full-time service – Full-time clinical practice is defined, for the purposes of the NHSC SLRP, as a minimum of 40 hours/week, for a minimum of 45 weeks each service year.
Half-time service – Half-time clinical practice is defined, for the purposes of NHSC SLRP, as a minimum of 20 hours per week (not to exceed 39 hours per week), for a minimum of 45 weeks per service year.
What HPSA designation status is accepted for clinician placement at a NHSC SLRP site?
NHSC SLRP providers can only be placed at sites that are in HPSAs with a “Designated” status.
The NHSC SLRP guidance does not include emergency medicine as an approved discipline, but if a physician is providing primary care in the ER and rounding on patients admitted by the primary care physicians would this individual be eligible for the NHSC SLRP?
Emergency medicine is not an approved discipline.
If a site has a charity care program that is not structured like a sliding fee scale, would it be allowed to participate in NHSC SLRP?
Eligible practice sites must provide discounts for individuals with limited incomes (i.e., use a sliding fee scale). For information about Visit the HHS Poverty Guidelines for more information. Sliding fee scale requirements include:
- For individuals with annual incomes at or below 100 percent of the HHS Poverty Guidelines, states must ensure that practice sites provide services at no charge or at a nominal charge.
- For individuals between 100 and 200 percent of the HHS Poverty Guidelines, states must ensure that practice sites provide a schedule of discounts, which should reflect a nominal charge covered by a third party (either public or private). A state may allow practice sites to charge for services to the extent that payment will be made by a third party which is authorized or under legal obligation to pay the charges. See p. 8 of the FY 2014 FOA.