Workforce Recruitment and Retention Programs

1
Workforce Recruitment and Retention Programs

• Robert Stiles
• Barbara Huske
• Primary Care Office, KDHE

2
Kansas Primary Care Office Program Focus

• Access to primary care services for all Kansans.
• Attention to larger health care delivery system.
• Facilitate and participate in public/private
  partnerships to meet the health care needs of
  Kansans.

3
Program Areas

• Recruitment and RetentionNational Health Service
  Corps, State Loan Repayment, J-1 Visa Waiver
  Program.
• Underserved Areas DesignationHPSA and MUA/P.
• AccessCommunity-Based Primary Care Clinic
  Program, Charitable Health Care Provider Program,
  Unused Medications Program/Repository, Technical
  Assistance to Communities.

4

State Loan Repayment Program (SLRP)
5
About the Program

• PCO receives funding from HRSA through the
  National Health Service Corps to administer
  program.
• 300,000 is available annually (50 percent
  federal/50 percent state) to assist health
  professionals in the repayment of eligible
  educational loans.
• Continuous application cycle beginning July 1 of
  each year for awards beginning October 1.
• Priority in order applications received.

6
Providers

• Eligible professions include primary care
  physicians, nurse practitioners, physician
  assistants, nurse mid-wives, dentists, dental
  hygienists, clinical psychologists, clinical
  social workers, clinical professional counselors
  and clinical marriage and family therapists.
• Up to 25,000 per year is available to PAs,
  ARNPS, dental hygienists, and clinical mental
  health.
• Up to 30,000 to primary care doctors (MD or DO)
  and dentists.

7
Providers

• Must be U.S. Citizen or National.
• Completed appropriate level of education and
  licensed/certified in Kansas.
• No prior, unfulfilled practice obligations.
• Employed at an eligible practice site. Not
  discriminate in providing health care services to
  Medicare and Medicaid beneficiaries and those
  unable to pay for health care services.
• Contract to practice in an eligible underserved
  area for a minimum of 2 years.

8
Providers

• Must work a minimum of 40 hours per week, for a
  minimum of 45 weeks per service year providing
  primary health services.
• No more than 8 hours of the minimum 40 may be
  devoted to practice-related administrative
  activities.
• Research and teaching are not clinical practice.
• Services must be conducted during normally
  scheduled hours in the ambulatory care setting.
• Absences greater than 7 weeks per year will
  extend the service commitment end date.

9
Sites

• Public or nonprofit private entity in Kansas.
• Provide care in a federally designated HPSA.
• May not discriminate in care to Medicaid and
  Medicare beneficiaries and those unable to pay
  for services.
• Charge at the usual and customary rate, using a
  reduced rate for those unable to pay.

10
Sites

• Written nondiscrimination policy and provide
  services in a culturally and linguistically
  appropriate responsive to needs of area.
• May not use SLRP funding as salary offset.
• Cooperate with communication or site visits to
  monitor compliance.

11
(No Transcript)
12

National Health Service Corps Loan Repayment
Program (NHSC)
13
Kansas Primary Care Office

• Evaluates all Recruitment and Retention
  Application requests from entities in Kansas and
  recommend approval or disapproval of
  applications.
• Collaborates with state agencies and partners in
  integrating NHSC activities into the states
  strategy to increase health professionals in
  underserved areas.
• Assists communities in recruiting and retaining
  NHSC providers.
• Provides information to and participate in
  recruitment activities for potential student loan
  repayors in the state.

14
2010-2011 Loan Repayment Cycle

• Opened November 22, 2010.
• Increase in Financial Support.
• Up to 60,000 for two years of service.
• More Flexible Options.
• Three optionsa two-year full-time contract, a
  four-year half-time contract, and a two-year
  half-time contract.
• Increased Credit for Teaching.
• 20 percent credit for teaching.
• 50 percent credit for teaching at a Teaching
  Health Center.

15
Provider Requirements

• Provides 60,000 in exchange for a two year
  commitment to practice at an eligible site.
• Full-time clinical care (40 hours per week in the
  approved ambulatory care setting with at least 32
  hours of direct patient care at the approved
  site).
• Half-time 20 hours per week, 16 hours patient
  care is allowed.
• Either 30,000 for two years or 60,000 for four
  years of service.
• Eight hours of teaching allowed.
• No reduction in salary or benefits because
  receiving NHSC loan repayment.
• May only practice at approved site to meet
  obligation.

16
Applicant Requirements

• Applicant must be U.S. Citizen or national.
• Must be employed at site or within 30 days of
  approval of application.
• Eligible disciplines Primary Care MD or DO,
  Primary Care Nurse Practitioners, Nurse-Midwife,
  Primary Care PA, Dentist, Dental Hygienist,
  Clinical Psychologist (doctoral-level), Licensed
  Clinical Social Worker, Psychiatric Nurse
  Specialist, Licensed Marriage and Family
  Therapist, Licensed Clinical Professional
  Counselor.

17
Site Requirements

• Care must be provided in the ambulatory setting
  (inpatient not eligible).
• Ensure access to ancillary, inpatient, and
  specialty referrals for patients.
• Provide comprehensive care in the area in which
  the NHSC Loan Repayor practices (primary medical,
  dental, or mental health).
• Ensure that patients receive care regardless of
  ability to pay or method of payment.
• Information on a discounted fee schedule
  available is at http//nhsc.bhpr.hrsa.gov/communit
  ies/discountfee.htm.

18
Site Requirements

• Charges for Services
• Full charge for care must be consistent with
  prevailing rates in the sites area.
• Care should be provided for a nominal fee or no
  charge for individuals at or below 200 percent of
  the federal poverty level.
• Must accept assignment for Medicare beneficiaries
  and have entered into agreement with
  Medicaid/CHIP (HealthWave).
• Prominently post a statement that explicitly
  communicates the fact that no one will be denied
  care based on ability to pay in languages
  appropriate to the service areas population.

19
Site Eligibility

• Must be in compliance with requirements at time
  of application and remain so throughout period of
  clinician service.
• The entire site must meet the NHSC site
  requirements, not just the area in which the
  clinician receiving loan repayment is practicing.
• After approval as a site may list eligible job
  vacancies on NHSC job opportunities site and hire
  clinicians applying for NHSC loan repayment or,
  with a high enough HPSA score, NHSC scholars.

20
Site Requirements

• Must be approved by NHSC as an eligible site
  through submitting the Recruitment and Retention
  Assistance application.
• Must renew site application every three years for
  continued participation.
• Must be sited in a current and appropriate Health
  Professional Shortage Area (medical, dental,
  mental).

21
NHSC Scholars Program

• Scholarship pays tuition, fees, some other
  educational expenses, and a living stipend
  (1,289 for 2010-11)for up to four years.
• Must serve for one year for each year of support
  (minimum of two years).
• Eligible professions Physician (MD or DO),
  family nurse practitioner, certified nurse
  mid-wife, PA, or dentist.
• Must serve in an approved site with an
  appropriate HPSA score (17 or higher for 2010-11
  depending on specialty).
• Required score updated each year in Federal
  Register each May or June.
• Minimum of 40 hours per week (32 hours of direct
  patient care).

22
J-1 Visa Waiver

23
J-1 Visa Waiver Overview

• Physicians admitted to the U.S. with J-1 Visas
  must return to their home country for at least
  two years.
• A state government department of public health
  may request that this requirement be set aside in
  the public interest.
• The Conrad 30 program allows each state to
  recommend up to 30 visa waivers per federal
  fiscal year for physicians recruited to sites in
  primary care or mental health HPSAs
  (psychiatrists).
• Based on the states recommendation, the Waiver
  Review Division of the U.S. Department of State
  then makes recommendations to US CIS, the agency
  authorized to issue the waiver.

24
J-1 Visa Waiver Overview

• Federal law allows up to ten physicians in each
  state to work in regions not specifically
  designated as underserved at the state department
  of public healths discretion.
• Kansas uses this flexibility to recommend waivers
  if the need for services can be demonstrated and
  if patients from designated shortage designation
  areas will be served by the physician.
• Kansas participation in the waiver program is
  intended to assist local communities to ensure
  access to physician services.
• Specialists as well as primary care providers are
  eligible.
• Primary Care providers will be given priority.

25
J-1 Visa Waiver Overview

• Requirements
• Complete Data Sheet obtained through U.S. Dept.
  of State.
• Request submitted by legal entity employing the
  provider.
• Facilities, institutions, rural health clinics,
  FQHCs, primary care clinics, medical centers,
  hospitals, private practices.
• Must show evidence of a signed physician
  contract.
• Must show evidence of open recruitment and that
  hiring a J-1 physician is a last resort.
• A physician not encumbered by the J-1 home
  residence requirement who is qualified for and
  applies for the job must be offered the position.

26
J-1 Visa Waiver Overview

• Requirements
• Must be eligible for a medical license from the
  Kansas Board of Healing Arts.
• Contract must be for a minimum of three years to
  provide care at least 40 hours per week at least
  4 days per week in the appropriate specialty.
• Must commence practice within 90 days of
  receiving a waiver.
• National Interest Waiver
• KDHE will provide a letter of support at its
• discretion for J-1Physicians with waivers in
• good standing.

27
Negotiated Rule for Underserved Areas Designation

• The Accountable Care Act requires a negotiated
  process for reviewing the designation of HPSAs
  and MUA/Ps.
• HPSAs are used to determine eligibility for NHSC,
  Conrad 30, and Medicare bonus payment to primary
  care physicians working in whole-county
  geographic HPSAs.
• MUA/Ps are used in awarding FQHC funding.
• 28 stakeholder members representing programs most
  affected by designation.
• Includes FQHCs, rural health clinics and rural
  providers, special populations, and technical
  experts.

28
HRSA Workforce Planning Grant

• Partnership led by KS Dept. of Commerce.
• One-year planning grant with potential for 2 to 3
  year implementation grant.
• Plan and implement programs aimed at increasing
  the supply of primary health care professionals
  (medical, dental, mental health).
• Goal Increase number of primary health care
  professionals in Kansas by 10-25 over the next
  ten years.

29
Contact Information

• Barbara Huske
• Workforce Coordinator
• 785-296-2742
• bhuske_at_kdheks.gov