(A) An individual who has signed a letter of intent under paragraph (E) of the rule 3701-56-02 of the Administrative Code and the director may enter into a contract providing for the dentist's participation in the dentist loan repayment program. A lending institution, the dentist's employer or another funder may also be a party to the contract.
(B) The contract shall include all of the following obligations:
(1) Agreement by the individual to provide dental services in the dental health resource shortage area identified in the letter of intent for at least two years.
(2) Agreement by the dentist that, in providing dental services in the dental health resource shortage area, he or she will do all of the following:
(a) Provide dental services for a minimum of forty hours per week;
(b) Provide dental services without regard to a patient's ability to pay;
(c) Meet the conditions prescribed by the "Social Security Act," 49 Stat. 620 (1935), 42 U.S.C. 301 as amended (1981), and the Ohio department of job and family services for participation in the medical assistance program established under Chapter 5111. of the Revised Code and enter into a contract with the Ohio department of job and family services and its contracting managed care plans to provide dental services to recipients of the medical assistance program;
(d) Accept into his or her practice a percentage of individuals determined eligible for the medical assistance program described in paragraph (B)(2)(c) of this rule at least equal to the percentage of the general population in that dental health resource shortage area which has been determined eligible for the medical assistance program;
(3) Agreement by the department as provided in section 3702.91 of the Revised Code to repay, so long as the dentist performs the service obljgation to which he or she has agreed under paragraph (B)(1) of this rule, all or part of the dentist's educational expenses as defined in paragraph (H) of rule 3701-56-01 of the Administrative Code.
(4) Agreement by the dentist to pay the department the following as damages if he or she fails to complete the service obligation to which he or she agreed under paragraph (B)(1) of this rule;
(a) If the failure occurs during the first two years of the service obligation, three times the amount the department has agreed to repay under paragraph (B)(3) of this rule;
(b) If the failure occurs after the first two years of the service obligation, three times the amount the department is still obligated to repay under paragraph (B)(3) of this rule;
(c) If funds from another source are used to repay a portion of the dentist's loan, damages owed if the dentist fails to complete the obligation will be the damages specified by the other source of the funds, or as outlined in paragraph (B)(4) of this rule, whichever is greater.
(5) Agreement by the department, as provided in section 3702.85 of the Revised Code, to pay, so long as the individual performs the service obligation to which he or she has agreed under paragraph (B)(1) of this rule, all or part of the individual's educational expenses, but not to exceed twenty-five thousand in the first and second years, or thirty-five thousand in the third and fourth years of service.
(6) If the department assumes the individual's duty to pay a portion of the loan, the contract shall set forth the amount of each payment.
(C) In addition to the terms required under paragraph (B) of this rule, the contract may contain other terms agreed upon by the parties, including reimbursement for some or all of the increased tax liability at the director's discretion, if a repayment results in an increase in the dentist's federal, state or local income tax liability.