Chapter 3701-6 Physician Loan Repayment Program

3701-6-01 Definitions.

As used in this chapter:

(A) "Department" means the Ohio department of health.

(B) "Director" means the director of the department or the director's designee.

(C) "Educational expenses" mean all or part of the principal and interest of a government or commercial educational loan which has been taken by a primary care physician and which meets the following criteria:

(1) The expenses were incurred while the physician was enrolled in, for up to a maximum of four years:

(a) A medical institution or a school or college of osteopathy in the United States accredited by the liaison committee on medical education or the American osteopathic association; or

(b) A medical school located outside the United States that was acknowledged by the world health organization while the physician was enrolled; and

(2) The expenses were incurred for:

(a) Tuition;

(b) Other educational expenses, such as fees, books, and laboratory expenses, for specific purposes and in amounts determined to be reasonable by the director; and

(c) Loans that have not already been paid by or on behalf of the physician.

(D) "Health resource shortage area" means an area which has been determined by the director to meet the criteria outlined in rule 3701-6-04 of the Administrative Code.

(E) "Primary care physician" means a physician who is licensed to practice medicine and surgery or osteopathic medicine and surgery under section 4731.14 of the Revised Code and is board certified or board eligible in a primary care specialty.

(F) "Primary care specialty" means general internal medicine, general pediatrics, obstetrics and gynecology, psychiatry, child and adolescent psychiatry, geriatric psychiatry, combined internal medicine/pediatrics, adolescent health, geriatrics or family practice.

Effective: 11/30/2017
Five Year Review (FYR) Dates: 9/15/2017 and 11/15/2022
Promulgated Under: 119.03
Statutory Authority: 3702.79
Rule Amplifies: 3702.71, 3702.75
Prior Effective Dates: 10/15/1994, 12/28/01, 8/2/07, 9/6/12

3701-6-02 Eligibility and application process.

(A) A primary care physician will not have an outstanding obligation for medical service to the federal government, a state, or other entity at the time of participation in the physician loan repayment program and meets one of the following requirements may apply for participation in the physician loan repayment program if:

(1) The primary care physician is enrolled in the final year of an accredited program required for board certification in a primary care specialty; or

(2) The primary care physician is enrolled in the final year of a fellowship program in a primary care specialty; or

(3) The primary care physician holds a valid license to practice medicine and surgery or osteopathic medicine and surgery issued under Chapter 4731. of the Revised Code.

(B) The application shall be submitted by a date and on a form prescribed by the department.

The form shall require an applicant to set forth the following information:

(1) Name;

(2) Current and permanent mailing address;

(3) Telephone number;

(4) Primary care specialty;

(5) The medical school or institution or school or college of osteopathy attended, dates attended and verification of attendance;

(6) The facility or institution where medical residency and fellowship training was completed or is being performed, and if completed, the date(s) of completion;

(7) A summary of the educational expenses for which reimbursement is sought under the physician loan repayment program and verification of expenses;

(8) Verification of United States citizenship or legal alien status;

(9) Verification of an active license to practice medicine and surgery or osteopathic medicine under Chapter 4731. of the Revised Code; and

(10) Any other information requested by the department .

(C) The director shall grant an application for placement in a health resource shortage area and participation in the physician loan repayment program if all of the following apply:

(1) Funds are available in the physician loan repayment fund;

(2) The general assembly has appropriated adequate funds for the physician loan repayment program; and

(3) The director finds that the applicant is eligible for placement and participation and that, in accordance with the priorities established under rule 3701-6-04 of the Administrative Code, the applicant's primary care specialty is needed in a health resource shortage area.

(D) Upon granting an application, the director shall notify and enter into discussions with the applicant. The object of the discussions is the placement of the applicant in a health resource shortage area in which, according to the priorities established under rule 3701-6-04 of the Administrative Code his or her primary care specialty is most needed.

(E) If the health resource shortage area site, the director and applicant agree on the applicant's placement in a particular health resource shortage area and the amount of the applicant's educational expenses to be repaid, the applicant shall prepare, sign, and deliver to the director a letter of intent agreeing to that placement.

(F) In the event that it is necessary to establish priorities among applicants, the director shall consider the following factors:

(1) The applicant's background and career goals;

(2) The applicant's primary care specialty;

(3) The length of time the applicant is willing to provide primary care services in a health care resource shortage area;

(4) The applicant's expressed interest in working and staying in an underserved area and whose family members are interested in the lifestyle associated with areas of underservice;

(5) The extent to which the applicant has sought or undertaken culturally or economically diverse experiences;

(6) The amount of the loan balance for which the applicant is requesting repayment assistance;

(7) Physicians being recruited to a health resource shortage area and not yet practicing in an eligible area will be given preference over physicians already practicing in the eligible area;

(8) To ensure an equitable distribution of physicians desiring to practice in a health resource shortage area, preference will be given to applicants desiring to practice in a health resource shortage area which has not had a physician placed in the preceding four years in the area either through the Ohio physician loan repayment program or through the federal national health service corps scholarship and loan repayment programs.

(G) Each applicant will be evaluated against the factors listed in this rule. A score will be given to an applicant's response to each factor and each applicant will be given a total score. In addition, the director may instruct staff to interview applicants to gather responses not easily evaluated from the applicant's written application. The applicants with the highest scores will be recommended for funding provided that funds are authorized and available.

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Effective: 11/30/2017
Five Year Review (FYR) Dates: 9/15/2017 and 11/15/2022
Promulgated Under: 119.03
Statutory Authority: 3702.79
Rule Amplifies: 3702.72, 3702.73, 3702.75, 3702.77
Prior Effective Dates: 10/15/1994, 12/2/95, 12/28/01, 8/2/07, 9/6/12

3701-6-03 Requirements for contract.

(A) As used in this rule:

(1) "Full-time practice" means working a minimum of forty hours per week for a minimum of forty-five weeks each service year. Practice related administrative duties may not exceed eight hours per week.

(2) "Part-time practice" means working a minimum of twenty hours and a maximum of thirty-nine hours per week for a minimum of forty-five weeks each service year. Practice related administrative activities may not exceed four hours per week.

(3) "Teaching activities" means providing clinical education to health professions students and residents regarding the normal course of practice and expertise at the practice site(s) specified in the contract. Full-time practitioners may spend up to eight hours per week conducting both practice related administrative activities and teaching in the clinical setting at the approved practice site(s). Part-time practitioners may spend up to four hours per week conducting both practice related administrative duties and teaching in the clinical setting at the approved practice site(s).

In order to qualify as teaching, the physician must be providing clinical education and supervision of students or clinicians in the approved practice site(s) as part of an accredited clinical training program.

All teaching must be conducted at the practice site(s) specified in the physician's contract. If the supervising physician provides primary care services while the student or clinician observes, the activity should be treated as direct patient care rather than teaching.

(4) "Telemedicine activities" means providing primary care services using an interactive telecommunications system, defined as multimedia communication equipment that includes, at a minimum, audio and video equipment permitting two-way real time interactive communication between the patient at the originating site(s) and the physician at the practice site(s) approved by the department and agreed upon by the physician and the director. Full-time practitioners may count up to eight hours per week in telemedicine activities as patient care at the approved practice site(s). Part-time practitioners may count up to four hours per week in telemedicine activities as patient care at the approved practice site(s).

In order to qualify as telemedicine activities, both the originating site(s) (location of the patient) and the approved practice site(s) must be located in health resource shortage areas.

All telemedicine activities must be conducted at the practice site(s) specified in the physician's contract.

(B) A primary care physician who has signed a letter of intent under paragraph (E) of rule 3701-6-02 of the Administrative Code and the director may enter into a contract providing for the physician's participation in the physician loan repayment program. The physician's employer or another funder may also be a party to the contract.

(C) The contract shall include all of the following obligations:

(1) Agreement by the primary care physician to provide primary care services in the health resource shortage area(s) and practice site(s) approved by the department and agreed upon by the physician and director for the duration specified in the contract.

(2) Agreement by the primary care physician that, in providing primary care services in the health resource shortage area(s), he or she will do all of the following:

(a) Provide primary care services in full-time practice or part-time practice as specified in the contract;

(b) Provide primary care 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 medicaid for participation in the medicaid program established under Chapter 5160. of the Revised Code and enter into a contract with the Ohio department of medicaid and its contracting managed care plans to provide primary care services to recipients of the medicaid program.

(d) Accept into his or her practice a percentage of individuals determined eligible for the medicaid program described in paragraph (C)(2)(c) of this rule at least equal to the percentage of the general population in that health resource shortage area(s) which has been determined eligible for the medicaid program.

(3) Agreement by the department, as provided in section 3702.75 of the Revised Code, to repay, so long as the primary care physician performs the service obligation to which he or she has agreed under paragraph (C)(1) of this rule, all or part of the primary care physician's educational expenses, as defined in paragraph (C) of rule 3701-6-01 of the Administrative Code.

(4) Agreement by the primary care physician to pay the department the following as damages if he or she fails to complete the service obligation to which he or she has agreed under paragraph (C)(1) of this rule:

(a) Three times the amount the department has agreed to repay under paragraph (C)(3) of this rule; or

(b) If funds from another source are used to repay a portion of the physician's loan, damages owed if the physician fails to complete the obligation will be the damages specified by the other source of the funds, or as outlined in paragraph (C)(4)(a) of this rule, whichever is greater.

(5) If the department assumes the physician's duty to pay a portion of the loan, the contract shall set forth the amount of each payment.

(D) The contract shall include the following terms as agreed upon by the parties:

(1) The physician's required length of service in the health resource shortage area(s) which must be at least two years for an initial contract. Contracts may be renewed for no more than two additional one year periods;

(2) The physicians commitment to full-time practice or part-time practice;

(3) The maximum amount that the department will repay on behalf of the physician;

(4) The extent to which the physician's teaching activities as defined under paragraph (A)(3) of this rule will be counted toward the physician's full-time or part-time practice hours under the contract; and

(5) The extent to which the physician's telemedicine activities as defined under paragraph (A)(4) of this rule will be counted toward the physician's full-time or part-time practice hours under the contract.

(E) In addition to the terms required under paragraph (C) of this rule, the contract may contain other terms agreed upon by the parties.

Replaces: 3701-6-03

Effective: 11/30/2017
Five Year Review (FYR) Dates: 11/15/2022
Promulgated Under: 119.03
Statutory Authority: 3702.79
Rule Amplifies: 3702.74, 3702.75
Prior Effective Dates: 10/15/1994, 1/20/00, 12/28/01, 8/2/07, 9/6/12

3701-6-04 Health resource shortage areas.

(A) Health resource shortage areas shall include the following:

(1) A geographical area, facility, or population group in this state that is designated by the United States secretary of health and human services as a health professional shortage area for primary care or mental health under 42 CFR in accordance with Appendix A or Appendix C to 42 CFR Part 5, dated October 1, 2007.

(2) A geographical area, facility or population group in this state which:

(a) Has previously been designated as a health professional shortage area as described in paragraph (A)(1) of this rule; and

(b) Has a population to primary care physician ratio exceeding two thousand to one or a population to psychiatrist ratio exceeding twenty thousand to one.

(3) A free clinic, as defined in section 3701.071 of the Revised Code, regardless of whether a clinic is located in a geographic area that is designated as a health resource shortage area.

(4) Other areas or population groups which the director has determined to have unmet needs for primary care physicians.

(B) In determining priorities among health resource shortage areas, the director shall consider:

(1) Population groups that experience special health problems; and

(2) Physician practice patterns that limit access to primary care.

Replaces: 3701-6-04

Effective: 11/30/2017
Five Year Review (FYR) Dates: 11/15/2022
Promulgated Under: 119.03
Statutory Authority: 3702.79
Rule Amplifies: 3702.75, 3702.76, 3702.77
Prior Effective Dates: 10/15/1994, 12/28/01, 8/2/07, 9/6/12