C. ELIGIBILITY REQUIREMENTS, QUALIFICATION FACTORS AND FUNDING PREFERENCES

1.  Eligibility Requirements to Participate

a. Citizenship

Applicants for the NHSC LRP must be citizens of the United States (either U.S. born or naturalized).  All applicants must submit documentation to verify U.S. citizenship or status as a U.S. national (e.g., a copy of a birth certificate, a certificate of citizenship, passport or naturalization certificate) with the application material.  Permanent residents of the U.S. are not eligible to apply.

b.Training and Licensure Requirements for Clinicians

Applicants must meet discipline and specialty-specific education and training requirements as described below.  In addition, applicants must possess and maintain a current, full, permanent, unencumbered health professional license (or, if applicable, a current full, permanent, unencumbered certificate or registration) to practice in the State in which they intend to practice to fulfill their NHSC LRP service obligation.

Primary Care

• Allopathic (MD) or Osteopathic (DO) physicians must have:

1. certification in a primary care specialty from a specialty board approved by the American Board of Medical Specialties or the American Osteopathic Association, OR
2. completed a residency program in a primary care specialty, approved by the Accreditation Council for Graduate Medical Education or the American Osteopathic Association, AND
3. a current, full, permanent, unencumbered health professional license (or, if applicable, a current full, permanent, unencumbered certificate or registration) which is from the State in which the applicant intends to practice to fulfill his/her NHSC LRP service obligation.

**Residents who will complete their residency training by June 30, 2009, must submit a letter of verification from their current Residency Director that certifies their 1) enrollment in the residency training program; 2) academic standing, and 3) projected residency completion date.  The letter must be received by January 31, 2009 (postmark date).  A letter verifying the completion of the residency or a completion certificate must be submitted by July 7, 2009 (postmark date).  Residents who will complete their residency training by June 30, 2009 must be licensed, and mail or fax a copy of the license to Discovery Logic at 240-912-1978, in the State in which they intend to practice by August 15, 2009 or they will not be considered for loan repayment.

Per statute, the primary care specialties for physicians are family medicine, obstetrics/gynecology, general internal medicine, general pediatrics, or general psychiatry.  Although general psychiatrists must meet the above qualifications for physicians, this specialty is placed exclusively in mental health HPSAs.

• Primary Care Certified Nurse Practitioners (NPs) must have:

1. a master's degree, post-master’s certificate, or doctoral degree from a school accredited by the National League for Nursing Accrediting Commission or the Commission on Collegiate Nursing Education, in one of the primary care nurse practitioner specialties listed below, AND
2. national certification by the American Nurses Credentialing Center (ANCC), the American Academy of Nurse Practitioners (AANP), the Pediatric Nursing Certification Board (formerly the National Certification Board of Pediatric Nurse Practitioners and Nurses), or the National Certification Corporation, AND
3. a current, full, permanent, unencumbered health professional license (or, if applicable, a current, unencumbered certificate or registration) which is from the State in which the applicant intends to practice to fulfill his/her NHSC LRP service obligation.

The primary care specialties for nurse practitioners are adult, family, pediatric, psychiatry/mental health, gerontology, or women’s health. 

• Certified Nurse-Midwives (NMs) must have:

1. a master's degree or post-baccalaureate certificate, from a school accredited by the American College of Nurse-Midwives (ACNM), AND
2. national certification by the American Midwifery Certification Board (formerly know as the ACNM Certification Council) AND
3. a current, full, permanent, unencumbered health professional license (or, if applicable, a current, unencumbered certificate or registration) which is from the State in which the applicant intends to practice to fulfill his/her NHSC LRP service obligation.

• Primary Care Physician Assistants (PAs) must have:

1. a certificate of completion or an associate, bachelor’s or master's degree from a physician assistant educational program accredited by the Accreditation Review Commission on Education for the Physician Assistant at a college, university or educational institution that is accredited by a U.S. Department of Education nationally recognized regional or State institutional accrediting agency, AND
2. national certification by the National Commission on Certification of Physician Assistants, AND
3. a current, full, permanent, unencumbered health professional license (or, if applicable, a current, unencumbered certificate or registration) which is from the State in which the applicant intends to practice to fulfill his/her NHSC LRP service obligation.

   Dental Health

• General Practice Dentists must have:

1. a D.D.S. or D.M.D. degree, from a program accredited by the American Dental Association (ADA), Commission on Dental Accreditation, AND
2. a current, full, permanent, unencumbered health professional license which is from the State in which the applicant intends to practice to fulfill his/her NHSC LRP service obligation.

Note: The following four paragraphs were added December 23, 2008

** Dental students who will complete their last year of education by June 30, 2009, must submit, with their application package, a letter of verification from their Program Director by January 31, 2009 (postmark date).  The letter of verification must certify
1) enrollment in the academic program,
2) academic standing, and
3) projected graduation date.

Dental students must provide a letter from their State Licensing Board, stating that all of the state’s requirements for licensure have been met, by August 15, 2009 (postmark date).  Dental students must provide a copy of a current, full, permanent, unencumbered health professional license from the State in which the applicant intends to practice immediately upon receipt.

Dental students must begin their service obligation for the NHSC LRP at the NHSC-approved site(s) no later than September 1, 2009 to be eligible for the Fiscal Year 2009 NHSC LRP award cycle.

All required documents are to be mailed to the
NHSC LRP,
c/o Discovery Logic,
1375 Piccard Drive, Suite 350,
Rockville, MD 20850
or faxed to Discovery Logic at 240-912-1978. ** (end of December 23 addition)

• Pediatric Dentists must have:

1. a D.D.S. or D.M.D. degree, from a program accredited by the American Dental Association (ADA) Commission on Dental Accreditation, AND
2. have completed a 2-year training program in the specialty of pediatric dentistry that is accredited by the ADA Commission on Dental Accreditation, AND
3. a current, full, permanent, unencumbered health professional license which is from the State in which the applicant intends to practice to fulfill his/her NHSC LRP service obligation.

 ** Residents who will complete pediatric or general dentistry training by June 30, 2009, must submit a letter of verification from their current Residency Program Director that certifies their 1) enrollment in the residency training program, 2) academic standing, and 3) projected residency completion date.  The letter must be submitted by January 31, 2009 (postmark date).  A letter verifying the completion of the residency or a completion certificate is due July 7, 2009 (postmark date).  Residents not licensed in the State in which they intend to practice by August 15, 2009 will not be considered for loan repayment.  A copy of the license must be mailed or faxed to Discovery Logic at 240-912-1978 by August 15, 2009, or the applicant will not be considered for loan repayment.

• Registered Clinical Dental Hygienists (DHs) must have:

1. graduated from a 4-year program with a bachelor's degree in dental hygiene, OR
2. graduated from a 2-year dental hygiene training program with a diploma, certificate or associate degree and have at least one year of experience as a licensed clinical dental hygienist, AND
3. successfully passed the National Board Dental Hygiene Examination, AND
4. a current, full, permanent, unencumbered health professional license (or if applicable, a current unrestricted, unencumbered certificate or registration) to practice in the State in which they intend practice to fulfill his/her NHSC LRP service obligation.

The programs must be accredited by the American Dental Association, Commission on Dental Accreditation.

Behavioral and Mental Health

The NHSC recognizes that States have varying educational, experience and testing requirements for the licensing of behavioral and mental health clinicians.  It is important to note that the purpose of the NHSC LRP is to ensure an adequate supply of health professionals to provide primary health services to populations located in health professional shortage areas (HPSAs) throughout the United States.  Consequently, the NHSC adheres to national certification and licensing standards detailed below to assure that its clinicians have the ability to obtain licensure in multiple States throughout the country as community needs dictate or arise.

• Health Service Psychologists (HSP) (formerly Clinical and Counseling Psychologists) must have:

1. a doctoral degree (Ph.D. or equivalent) directly related to full professional work in clinical or counseling psychology from a school accredited by the American Psychological Association, Committee on Accreditation, AND
2. a minimum of one year of post-graduate supervised clinical experience, AND
3. successfully passed the Examination for Professional Practice of Psychology (EPPP), AND
4. the ability to practice independently and unsupervised as a health service psychologist, AND
5. a current, full, permanent, unencumbered health professional license (or if applicable, a current, unencumbered certificate or registration) to engage in the independent and unsupervised practice of clinical or counseling psychology in the State in which they intend to practice to fulfill their NHSC LRP service obligation.

Individuals practicing as school psychologists are not eligible to participate in the NHSC LRP.

• Licensed Clinical Social Workers (LCSWs) must have:

1. a master’s degree or doctoral degree in social work from a school accredited by the Council on Social Work Education and a U.S. Department of Education nationally recognized regional or State institutional accrediting agency, AND
2. two years post-graduate supervised clinical experience, AND
3. successfully passed the Association of Social Work Boards (ASWB) Clinical or Advanced licensing exam prior to July 1,1998, or the ASWB Clinical exam on or after July 1,1998, AND
4. the ability to practice independently and unsupervised as a licensed clinical social worker, AND
5. a current, full, permanent, unencumbered health professional license (or, if applicable, a current, unencumbered certificate or registration) to practice, at the level of licensure that allows them to practice independently and unsupervised as a Clinical Social Worker, in the State in which they intend to practice to fulfill their NHSC LRP service obligation.

• Psychiatric Nurse Specialists (PNSs) must be registered nurses, AND

1. have a master's degree or higher degree in nursing from an accredited program with a specialization in psychiatric/mental health and 2 years of post-graduate supervised clinical experience in psychiatric/mental health nursing, OR
2. have a baccalaureate or higher degree in nursing from an accredited program, AND
3. be certified by the American Nurses Credentialing Center as a Psychiatric and Mental Health Nurse, Clinical Specialist in Adult Psychiatric and Mental Health Nursing, or Clinical Specialist in Child and Adolescent Psychiatric and Mental Health Nursing, AND
4. must be licensed as a registered nurse (or a PNS if applicable) in the State in which they intend to practice, AND
5. have a current, full, permanent, unencumbered health professional license (or if applicable, a current, unencumbered certificate or registration) to practice in the State in which they intend to practice to fulfill their NHSC LRP service obligation.

Nursing programs must be accredited by the National League for Nursing Accrediting Commission or the Commission on Collegiate Nursing Education

• Marriage and Family Therapists (MFTs) must:

1. have completed a master's or doctoral program in marriage and family therapy from a program accredited by the American Association for Marriage and Family Therapy, Commission on Accreditation for Marriage and Family Therapy Education (COAMFTE) or earned a graduate degree in another mental health field (psychiatry, psychology, clinical social work, psychiatric nursing, etc.) and completed a COAMFTE accredited post-graduate degree clinical training program in marriage and family therapy, AND
2. have at least 2 years of post-graduate supervised clinical experience in practice as a marital and family therapist, OR
3. be clinical members of the American Association for Marriage and Family Therapy (AAMFT), AND
4. have a current, full, permanent, unencumbered health professional license (or if applicable, a current, unencumbered certificate or registration) to practice independently and unsupervised as a MFT in the State in which they intend to practice to fulfill their NHSC LRP service obligation, OR
5. if such licensure is not available in the State of intended practice, have a current, full, permanent, unencumbered health professional license (or if applicable, a current, unencumbered certificate or registration) to practice independently and unsupervised as a MFT in a State.

• Licensed Professional Counselors (LPCs) must:

1. have a master’s degree or higher degree with a major study in counseling from a school accredited by a U.S. Department of Education nationally recognized regional or State institutional accrediting agency, AND
2. have at least 2 years of post-graduate supervised counseling experience, AND
3. be certified as a National Certified Counselor (NCC) or a Certified Clinical Mental Health Counselor (CCMHC) by the National Board for Certified Counselors, AND
4. have a current, full, permanent, unencumbered health professional license (or if applicable, a current, unencumbered certificate or registration) to practice independently and unsupervised as an LPC in the State in which they intend to practice to fulfill their NHSC LRP service obligation, OR
5. if such licensure is not available in the State of intended practice, have a current, full, permanent, unencumbered health professional license (or if applicable, a current, unencumbered certificate or registration) to practice independently and unsupervised as an LPC in a State.

NOTE:  School and Career LPCs are not eligible to participate in the NHSC LRP.

c. Medicare/Medicaid/State Children’s Health Insurance Program Participation

Applicants to the NHSC LRP must participate in or be eligible to participate as a provider in the Medicare, Medicaid and State Children’s Health Insurance Programs.  All NHSC community sites and clinicians must accept assignment under the Medicare Program and enter into appropriate agreements with the State Medicaid and Children’s Health Insurance Programs.  Therefore, all NHSC community sites and their clinicians (NHSC and non-NHSC) must be eligible to receive Medicare/Medicaid/State Children’ s Health Insurance Program payment for any items or services they furnish, order or prescribe.

d. No Other Service Obligations

All applicants who have an outstanding contractual obligation for health professional service to the Federal Government (e.g., an active military obligation or a Nursing Education Loan Repayment Program obligation), a State (e.g., State Loan Repayment Program or Scholarship Program obligation) or other entity are ineligible to participate in the NHSC LRP, unless that service obligation will be satisfied completely before June 30, 2009.  Beware that certain bonus clauses in employment contracts may impose a service obligation.  The applicant is required to submit a letter, on business letterhead, indicating the date the service obligation will be completed.

Note: The following paragraph was added December 23, 2008

** Current NHSC Scholars who will complete their Scholarship Program (SP) service obligation no later than August 31, 2009, may be considered for an FY 2009 NHSC LRP award.  The applicant must
1) remain at the site where they are currently fulfilling their NHSC SP service obligation and,
2) begin the NHSC LRP service obligation by September 1, 2009 (no break in service permitted). ** (end of December 23 addition)

Exception:  Members of a Reserve Component of the Armed Forces.  Individuals in a Reserve component of the Armed Forces or National Guard are eligible to participate in the NHSC LRP.  However, reservists should understand the following:

• Placement opportunities for reservists may be limited by the NHSC in order to minimize the negative impact that a deployment would have on the vulnerable populations served by the reservist.
• Military training or service performed by reservists will not satisfy the NHSC service commitment.  If a participant's military training and/or service, in combination with the participant's other absences from the service site, will exceed 7 weeks (35 workdays) per service year, the participant should request a suspension.  See Sections H (full-time clinical practice) and K (suspension of the obligation for military duty) of this Bulletin for more information.  The NHSC service obligation end date will be extended to compensate for the break in NHSC service. 
• If the approved NHSC community site where the reservist is serving at the time of his/her deployment is unable to reemploy that reservist, the NHSC will reassign the participant to another NHSC-approved community site to complete his or her remaining NHSC service commitment.  Because it is sometimes difficult to identify short-term assignments, a participant may be asked by the community site to sign an employment contract which extends beyond the completion date of his or her NHSC service commitment.

e. No Breach of a Prior Service Obligation

Applicants in breach of a prior service obligation for health professions service to the Federal government or a State or local government are not eligible to participate in the NHSC LRP.

f. No Judgment Lien for a Federal Debt

An applicant must be free of any judgment liens against his/her property arising from a debt owed to the United States.  Debtors with judgment liens for Federal debts are ineligible to receive Federal financial assistance.  Please be advised that a credit check will be conducted as part of the application process.

g. Not Excluded, Debarred, Suspended, or Disqualified By a Federal Agency

The receipt of funding under the NHSC LRP is a “covered transaction” pursuant to Title 2 of the Code of Federal Regulations (CFR) Part 180, as adopted by HHS pursuant to 2 CFR Part 376.  Before entering into a LRP contract, the applicant is required, under Subpart C of Part 180, to report certain information which is described in the “Certification Regarding Debarment, Suspension, Disqualification and Related Matters.” The applicant should sign the Certification that is applicable to his/her situation.

Individuals who are currently excluded (suspended or debarred) or disqualified by a Federal Agency from participating in covered transactions are ineligible to receive an award under the NHSC LRP.  (Individuals with reportable problems other than exclusion or disqualification may, or may not, be selected to participate in the NHSC LRP, based on the Program’s consideration and evaluation of the applicant’s circumstances.)

As a condition of participating in the NHSC LRP, a participant must agree to comply with the requirements of Subpart C of Part 180, which include providing immediate written notice to BCRS if the applicant learns that he/she failed to make a required disclosure or that a disclosure is now required due to changes or circumstances.

h. Submission of Complete Application 

The Checklist and the Summary of Important Dates describe the application, forms and supporting documentation that must be submitted by January 31, 2009 (postmark date).  If the application, other forms, and supporting documentation required to be submitted by the January 31, 2009 are incomplete, the application will not be reviewed or considered for funding

2.  Qualification Factors

Applications from eligible applicants will also be evaluated based on the following factors relevant to selecting qualified applicants to participate in the NHSC LRP.

a.  Professional Competence and Conduct

Applicants must demonstrate satisfactory professional competence and conduct and, therefore, must submit the following:

• Letters of recommendation from at least two individuals in a position to evaluate the applicant’s current clinical skills.  At least one letter of reference must be from the applicant’s current employer unless the applicant is self-employed.  If the applicant is self-employed, one of the reference letters must be from the Chief of the medical staff or the credentials committee at the hospital where the applicant has admitting privileges (if he/she is a physician), or from an objective source such as a hospital or clinic credentials committee, a physician with whom the applicant has a collaborative practice agreement, or the Director of the applicant’s training program (if he/she is not a physician).  If the applicant is a student or in a residency program (with a graduation date of June 30, 2009), one reference letter can be from the Director of the applicant’s training program.  Reference letters must be current.  If the applicant has been working in his/her present position less than 1 year, then two additional reference letters must be from the applicant’s previous position.  Program assessments and evaluations are not acceptable forms of reference;  AND  
• A copy of the entire response the applicant receives from a self-query of both the National Practitioner Data Bank (NPDB) and the Healthcare Integrity and Protection Data Bank (HIPDB) (and if necessary, information from State licensing and/or professional review boards, etc.).  To submit the NPDB and HIPDB self-query, applicants must complete an “Individual Self-Query” form which is available only on the NPDB-HIPDB web site or by calling 1-800-767-6732.  Each data bank self-query form request is assessed an $8.00 fee for each Data Bank, for a total of $16.00.  The fee must be paid by credit card (VISA, MasterCard, or Discover); AND
• A current resume/curriculum vitae; AND
• Biographical Statements.  Biographical statements must be typed, dated and signed and must provide, at a minimum, information regarding:

1. Student or work experience with medically underserved populations (e.g., community or migrant health centers, free clinics, public health departments, and rural health clinics) during or after the applicant’s health professions training. The Statement should include:
   • Location
   • Start and end dates for each student/work experience
   • Number of hours per week spent on the student/work experience
   • Brief description of the experience
   • The knowledge, skills, or abilities gained from the experience
   • Community effort which lead to improved delivery of health services to underserved populations
   • Total number of years/months as a clinician providing primary care to underserved populations
   • Published primary care articles
   • Awards for primary care community efforts
2. Language skills (including level of proficiency), if any, that the applicant uses or will use to provide services to the patient population of the NHSC community site.
3. Awareness of the values, beliefs, and practices as they relate to the health of the population served by the NHSC community site. Include any knowledge, skills, and abilities that will be incorporated into practice to improve the delivery of health services to the population of the community site. 
4. A description of the applicant’s current duties and responsibilities and, if different, a description of the applicant’s duties and responsibilities at the community site(s) identified in the applicant’s Community Site Information Form.

b. Full-time Clinical Employment at an NHSC-Approved Community Site

The NHSC LRP is seeking clinicians able to commence service prior to the end of this Fiscal Year.   Consequently, before applying to the NHSC LRP, a clinician must have successfully completed negotiations for employment at a one or more community site(s), as evidenced by 1) a signed job offer from the site and acceptance letter signed by the applicant or 2) a signed contract for employment with the community site.  The employment status of the clinician at the NHSC-approved site(s) will be verified.

The community site(s) must be located in a designated health professional shortage area (HPSA) and have a current and approved NHSC Recruitment and Retention Assistance (R&R) Application.  All NHSC sites must be approved every three (3) years through the submission and approval of an R&R Application.  If an applicant’s site does not have a current and approved R&R Application at the time of the application submission (on or before January 31, 2009), the site must submit an R&R Application no later than March 27, 2009.  For more information about eligible NHSC-approved community sites, see Section G of this Bulletin.

An applicant’s employment must meet NHSC LRP full-time clinical practice requirements (e.g., work a minimum of 40 hours per week, providing direct patient care, in an outpatient setting, etc.). 

An applicant may work at a maximum of 4 approved NHSC sites (a primary site and 3 satellites) to meet the NHSC full-time clinical practice requirement described in this Bulletin.  However, the majority of the applicant’s time must be spent at the approved NHSC community site with the highest HPSA score.

The applicant’s employment at the approved-NHSC site(s) must begin no later than July 1, 2009.  Physician and dental residents who will complete a residency program by June 30, 2009 must begin service at the NHSC-approved site(s) no later than August 15, 2009.

If the applicant leaves or loses his/her job at the community site identified in the application/Community Site Information Form, the applicant must notify the NHSC LRP immediately.

c.  History of Honoring Prior Obligations

The NHSC LRP will not select eligible applicants who have a history of not honoring prior legal obligations, as evidenced by one or more of the following factors:

• Default on any Federal payment obligations (e.g., Health Education Assistance Loans, Nursing Student Loans, FHA Loans, Federal income tax liabilities, etc.) or non-Federal payment obligations (e.g., court-ordered child support payments), even if the applicants are currently considered to be in good standing by that creditor;
• Default on a prior service obligation to the Federal government or a State or local government, even if the applicants subsequently satisfied that obligation through service, monetary payment or other means;
• Write off of any Federal or non-Federal debt as uncollectible or waiver of any Federal service or payment obligation; or
• Failure to apply all NHSC LRP funds previously received toward the applicants’ qualifying educational loans.

Please be advised that a credit check will be performed as part of the application process.

3. Funding Preferences

Among applicants who have been determined to be eligible and qualified, the following funding preferences apply:

1. Applicants with documented disadvantaged background and/or EFN status will be funded regardless of HPSA score.
2. Applicants proposing to serve in an approved NHSC site with a HPSA score of 17 or above (HPSAs of greatest need) will be funded second.  Awards will be made on an ongoing basis to applicants who propose to serve in an approved NHSC site with a HPSA score of 17 or above. 
3. To the extent funds remain available, applicants who propose to serve in an approved NHSC site with a HPSA score of less than 17 will be funded third, in order of decreasing HPSA score until funds are exhausted.
4. In order to distribute the number of NHSC LRP clinicians across many NHSC community sites, the number of new NHSC placements through the Loan Repayment Program allowed at any one site (parent sites as well as satellite sites) is limited to the following:

• Primary Health Care: no more than 2 allopathic (MD) or osteopathic (DO) physicians, and no more than a combined total of 2 Nurse Practitioners, Physician Assistants, or Certified Nurse Midwives.  (Mental health clinicians in these disciplines are not included.)
  
  
• Dental Care: no more than 2 Dentists and 2 Dental Hygienists.
  
  
• Behavioral and Mental Health: no more than 2 Psychiatrists (MD or DO), and no more than a combined total of 2 Clinical or Counseling Psychologists, Licensed Clinical Social Workers, Licensed Professional Counselors, Marriage and Family Therapists, or Psychiatric Nurse Specialists.  (Psychiatrists – see C.1.b. Eligibility – Primary Care)

5. If funding is available after applying the above criteria, the NHSC LRP may allow up to four 2-year contract awards per discipline category for each community site.  Eligible applicants are funded by decreasing HPSA score.
6. If the number of eligible clinician applicants at the community sites exceeds the number of awards allowed per site, the loan repayment awards will be offered to clinicians in the order in which the clinicians are determined to be eligible based on their completed applications. 
7. Community demand for each discipline category may be considered, in the event funding is insufficient to fund all eligible applicants at sites which have the same HPSA score.
8. All FY 2009 NHSC LRP 2-year contracts will be awarded no later than September 30, 2009.
9. Applicants who are not selected to participate in the NHSC LRP will receive notice of their non-selection by September 30, 2009.

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