Chapter 3701-6 Physician Loan Repayment Program

As used in this chapter:

(A) “Department” means the department of health.

(B) “Director” means the director of the Ohio department of health.

(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 the physician or a member of his family.

(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 has received a certificate 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, or family practice.

Effective: 08/02/2007

R.C. 119.032 review dates: 05/16/2007 and 08/01/2012

Promulgated Under: 119.03

Statutory Authority: 3702.79

Rule Amplifies: 3702.71

Prior Effective Dates: 10/15/1994, 12/28/01

(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 certificate topractice of 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 was completed and the date 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 certification to practice medicine and surgery or osteopathic medicine under Chapter 4731. of the Revised Code; and

(10) Any other information requested by the department of health.

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

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

(2) 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 factor will be weighted using the criteria scoring sheet attached to this rule. 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. When necessary due to limited funds from the general assembly, repayments of less than twenty thousand dollars per year may be made in order to maximize the number of physicians granted applications in health resource shortage areas.

APPENDIX A

Prioritization of loan repayment candidates criteria scoring sheet.

Criteria Scores High Score

1. Background

a) Geographic background 4

Rural or Inner City

(Applicant will be practicing in the same county where raised) = 4

Rural or Inner City background = 2

Other = 0

b) Experiential background 4

Applicant has undertaken culturally or economically diverse experiences

Extensive experience, beyond formal education requirements = 4

Limited experience, including required educational opportunities = 2

Minimal or no experience = 0

2. Goals

a) Goals reflect interest in practicing in an underserved area 4

Clearly expressed = 4

Minimally expressed = 2

No goals expressed = 0

b) Goals reflect desire to remain in primary care 4

Clearly expressed = 4

Minimally expressed = 2

No goals expressed = 0

3. Length of employment contract 4

greater than 3 years = 4

2 years = 2

1 year = 0

4. Amount of Loan Balance

Score is related to obligation period. For example, if the physician owes $40,000 or less, he/she must fulfill a minimum obligation to practice at least 2 years in the HRSA. Therefore, in this case, a score of 0 will be given to an application with a $0 – $40,000 loan balance.

Loan Balance: 4

greater than $60,000 = 4

$40,001 – $60,000 = 2

$0 – $40,000 = 0

Physicians receiving highest total scores will be recommended.

Effective: 08/02/2007

R.C. 119.032 review dates: 05/16/2007 and 08/01/2012

Promulgated Under: 119.03

Statutory Authority: 3702.79

Rule Amplifies: 3702.74

Prior Effective Dates: 10/15/1994, 12/2/95, 12/28/01

(A) A primary care physician who has signed a letter of intent under paragraph (E) of rule 3701-6-02 of the Administrative Code, the director, and the Ohio board of regents may enter into a contract providing for the physician’s participation in the physician loan repayment program. A lending institution, the physician’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 primary care physician to provide primary care services in the health resource shortage area identified in his or her letter of intent for a period of time which is the greater of:

(a) Two years; or

(b) One year for each twenty thousand dollar increment or portion thereof of repayment agreed to under paragraph (B)(3) of this rule.

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

(a) Provide primary care services for a minimum of forty hours per week;

(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.A. 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 to provide primary care 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 health resource shortage area which has been determined eligible for the medical assistance program.

(3) Agreement by the Ohio board of regents, 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 (B)(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 Ohio board of regents the following as damages if he or she fails to complete the service obligation to which he or she has 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 Ohio board of regents 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 Ohio board of regents 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 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 (B)(4) of this rule, whichever is greater.

(5) If the Ohio board of regents assumes the physician’s duty to repay 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 increased tax liability if a repayment results in an increase in the primary care physician’s federal, state, or local income liability.

Effective: 08/02/2007

R.C. 119.032 review dates: 05/16/2007 and 08/01/2012

Promulgated Under: 119.03

Statutory Authority: 3701.79

Rule Amplifies: 3701.74

Prior Effective Dates: 10/15/94, 1/20/00, 12/28/01

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

(1) A geographical area, facility, or population group in this state that has been designated by the United States secretary of health and human services as a health manpower shortage area under Title III of the “Public Health Services Act,” 58 Stat. 682 (1944), 42 U.S.C.A. 201, as amended (1981).

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

(a) Has a population to primary care physician ratio exceeding two thousand to one; and

(b) Has previously been designated to be a health manpower shortage area as described in paragraph (A)(1) of this rule but upon regular redetermination by the director, no longer meets the criteria of paragraph (A)(1) of this rule.

(B) In determining whether to approve an area facility or population as a health resource shortage area, the director shall consider:

(1) Population groups that experience special health problems;

(2) Physician practice patterns.

(C) To determine priorities among health resource shortage areas for assignment of primary care physicians the director shall use the methodology used by the United States secretary of health and human services to determine priorities among designated health professional shortage areas. This methodology is codified at 42 CFR part 5 and the ranking of the eligible health resource shortage areas is provided to the department on an annual basis by the national health service corps. The factors considered in this methodology as follows:

(1) Population to primary care physician ratio;

(2) Percent of the population with incomes below the poverty level;

(3) Infant health index (infant mortality or low birth weight babies); and

(4) Average travel time or distance to nearest source of care outside the health resource shortage area.

Effective: 08/02/2007

R.C. 119.032 review dates: 05/16/2007 and 08/01/2012

Promulgated Under: 119.03

Statutory Authority: 3702.77

Rule Amplifies: 3702.76

Prior Effective Dates: 10/15/1994, 12/28/01