The National Health Service Corps (NHSC) is committed to increasing access to primary care services and reducing health disparities for people in health professional shortage areas (HPSAs) by assisting communities through recruitment and retention, site development, practice management, and quality assurance activities.

Sites may apply for assistance from the NHSC in recruiting and retaining community-responsive, culturally competent primary care clinicians. To begin the application process for NHSC assistance, sites must complete the NHSC Multi-Year Recruitment and Retention (R&R) Assistance Application.  Once approved, as long as your site remains in a HPSA (and the HPSA score does not change) and continues to meet NHSC requirements, your site can continue to list vacancies on the NHSC On-Line Opportunities List for a period of three years.  The R&R Application is good for three years of the approval date and the vacancies remain approved through the entire third placement cycle which normally goes through June of the third year.  All sites must re-apply for NHSC eligibility every three years by submitting a new R&R Application.  If your site's HPSA score changes, you must re-apply for NHSC eligibility at that time.

Please note that in order to be considered, sites must meet several criteria, including:

• Located in a federally designated HPSA. You may check your HPSA status by searching the HPSA database, or you may read more information about the HPSA designation process.
• Documentation of sound fiscal management
• Use a sliding-fee schedule or other documented methods to reduce fees that ensure no financial barriers to care exist, accept assignment of Medicare, and enter into an agreement with the State agency that administers Medicaid
• Proof of the capacity to maintain a competitive salary, benefits, and malpractice coverage package
• Submit a completed application no later than the last Friday in March of the application year. (Example: Those applying to be an NHSC site in 2009 must submit the R&R Application by March 27, 2009).

NHSC sites must provide requested health care services regardless of the individual's ability or method of payment. NHSC sites must not discriminate in the provision of services to an individual because of (1) the individual's ability to pay for the services; or (2) because payment for the services would be made under the Medicare, Medicaid or State Children's Health Insurance Programs. To meet this requirement entities must:

• Provide health care services at no charge, or at a nominal charge, to patients whose incomes are at or below 200% of the federal poverty guidelines, which are revised annually in March. For example, the poverty level for a family of four is $19,350 (100%); thus, a 200% poverty level for this family would be $38,700. NHSC sites utilize different practices to ensure that no barriers to care exist, including establishing a schedule of discounts based on patients' ability to pay. Information on developing a discount fee policy
• Accept assignments under the Medicare program.
• Enter into an appropriate agreement with the State agency administering the Medicaid program;
• Enter into an appropriate agreement with the State agency administering the State Children's Health Insurance Program.
• Prominently advertise a statement that explicitly communicates the fact that no one will be denied access to services due to inability to pay. In accordance with the breadth and scope of the NHSC service area, when applicable, this signage should be translated into the appropriate language/dialect.

The entity shall take reasonable and appropriate steps to collect all payments due for health care services provided by the entity, including payments from any third party (including a Federal, State or local government agency and any other third party) that is responsible for part or all of the charge for such services.

Practices employing NHSC clinicians enjoy flexibility in designing a discount fee schedule that meets the above requirement. However specific guidelines are provided in the view of the Office of Inspector General (OIG) (PDF - 365 KB) on the discounts provided for uninsured patients who cannot afford to pay their bills and reductions or waiver of Medicare cost-sharing amounts for patients experiencing financial hardship.

The NHSC prioritizes resource assistance based upon need, as determined by HPSA scoring criteria. You will receive official notification by mail regarding the status of your site's application. If approved as an NHSC site, your open vacancies will be published on the NHSC Opportunities List and viewed by hundreds of clinicians, including NHSC Scholars and those interested in the Loan Repayment Program. If your application is submitted in order to retain a clinician already hired by your site who would like to participate in the NHSC Loan Repayment Program, your vacancy will not be posted on the Opportunities List since it is not an "open" vacancy. It is important to keep the NHSC informed as to the status of your vacancies so that we can ensure the accuracy of our Opportunities List.

The NHSC has an annual limit on the number of vacancies that can be approved and posted for the NHSC Scholarship and Loan Repayment Programs. This limit is published annually in the Federal Register (view this year's Federal Register Notice). Once a site has met the maximum number allowed in the placement cycle, all remaining vacancies will be categorized as VL for volunteer.

Please fax the completed R&R application to the NHSC at 301-594-2721 or mail to:

U.S. Department of Health and Human Services
Health Resources and Services Administration
Bureau of Clinician Recruitment and Service
Division of Site and Clinician Recruitment
Site and Community Development Branch
5600 Fishers Lane, Room 8A-30
Rockville, MD 20857