SECTION I.  APPLICANT INFORMATION BULLETIN

INTRODUCTION

Program Purpose
The United States Congress has charged the NHSC (administered by the Bureau of Clinician Recruitment and Service (BCRS) with the responsibility for alleviating the geographic maldistribution of primary care physicians and other health practitioners in the United States.

The NHSC Scholarship Program is mandated by Congress to supply the NHSC with health care professionals trained in those disciplines and specialties most needed to deliver quality primary health care services in health professional shortage areas (HPSAs) throughout the United States as designated by the Secretary of Health and Human Services.

The NHSC Scholarship Program is not a general financial assistance program for students of health-related disciplines; rather, it provides the NHSC with the committed health professionals it needs to carry out its mission of providing primary health care to populations in areas of greatest need in health professional shortage areas (HPSA).

National Health Service Corps Scholarship Program Profile

The National Health Service Corps (NHSC) Scholarship Program is a competitive Federal program that awards scholarships to students pursuing primary care health professions training in return for a service commitment.

The scholarship consists of payment for tuition, fees, other reasonable educational costs, and a monthly support stipend. In return, the students agree to provide one (1) year of service in the HPSA of greatest need to which they are assigned for each school year or partial school year of scholarship support received, with a minimum 2-year service commitment and a maximum 4-year commitment.

For the 2008-2009 academic year, scholarships will be available for students pursuing primary health care training leading to a degree in allopathic medicine, osteopathic medicine, or dentistry, and education leading to a degree as a family nurse practitioner, nurse-midwife or physician assistant.

The scholarship recipient's NHSC service commitment will be fulfilled as a non-Federal employee, as a commissioned officer of the Regular or Reserve Corps of the U.S. Public Health Service (PHS), or as a civilian employee of the U.S. Government.  It should be noted that approximately 92% of scholars fulfill their commitments as non-Federal employees of public or private entities such as community and migrant health centers, State or local health departments, and other non-Federal entities.  The remaining 8% of scholars serve as Federal employees at HPSA sites served by the Indian Health Service, the Department of Justice's Federal Bureau of Prisons, or the Department of Homeland Security's Immigration and Customs Enforcement.

Students uncertain of a commitment to primary health care practice in HPSAs throughout the United States or who are unable to relocate based on the needs of the NHSC are not advised  to participate in this program.  Students (e.g., osteopathic and nurse practitioners) unsure about their future specialty interests are not advised to apply for the NHSC scholarship.

Health Professional Shortage Areas (HPSAs)
A HPSA is a geographic area, a facility, or a population group, which has been determined by the Secretary of Health and Human Services to have a shortage of health professionals. HPSAs are identified on the basis of agency or individual requests for designation. Information considered when ­designating a primary care HPSA includes health practitioner-to-population ratios, rates of poverty, and access to available primary health services. Service commitments to the NHSC may be satisfied only in those HPSAs with the greatest need at the time of service assignment, as determined by the Bureau of Clinician Recruitment and Service (BCRS).

Program Administration
The Bureau of Clinician Recruitment and Service (BCRS), Health Resources and Services Administration (HRSA), administers the NHSC Scholarship Program. The Division of Application and Awards (DAA) awards the scholarships. The Division of Scholar and Clinician Support (DSCS) monitors scholars while in school and in deferment for advanced training, assists scholars in securing employment at eligible service sites at the completion of their training, reviews and approves requests for service transfers, and monitors scholars' service until they have completed their service commitment.  In addition, the Division of Site and Clinician Recruitment (DSCR) identifies appropriate service sites. The Legal and Compliance Office (LCO) reviews scholar and clinician compliance referrals, handles default determinations, and reviews requests for suspensions and waivers.

1. A school of allopathic medicine or osteopathic medicine, pursuing the M.D. or D.O. degree, accredited by the Liaison Committee on Medical Education (sponsored by the American Medical Association and the Association of American Medical Colleges) or the American Osteopathic Association, Commission on Osteopathic College Accreditation.
   
   
2. A school of dentistry, pursuing the D.D.S. or D.M.D. degree, accredited by the American Dental Association, Commission on Dental Accreditation.
   
   
3. A school or program of family nurse practitioner (FNP) education pursuing a master's degree, or post-master's certificate, accredited by the National League for Nursing Accrediting Commission or the Commission on Collegiate Nursing Education, and leading to national certification as a family nurse practitioner by either the American Nurses Credentialing Center or the American Academy of Nurse Practitioners.
   
   
4. A school or program of nurse-midwifery (NM) education pursuing a master's degree, or post-master's certificate, accredited by the American College of Nurse-Midwives, Division of Accreditation and leading to national certification by the American Midwifery Certification Board.
   
   NURSING STUDENTS PLEASE NOTE: The NHSC Scholarship Program will not provide scholarship support for students who are enrolled in a nursing Bridge Program (e.g. RN-MSN, BSN-MSN, Direct Entry, Graduate Entry Pre-specialty or Entry to Practice Programs) or who are pursuing a doctoral degree in nursing. 
   
   
5. A school or program of primary care physician assistant (PA) education where the applicant will: 1) graduate from a full 4-year baccalaureate PA training program with a bachelor's degree; or 2) graduate from a certificate, post-baccalaureate certificate, associate or master's degree PA training program of at least 12 months, and demonstrate a broad background knowledge of the medical environment, practices, and procedures, e.g., as would be acquired by having, prior to enrollment in the PA training program, a) a bachelor's degree in a health care occupation such as nursing, medical technology, or physical therapy, or
   b) 3 years of responsible and progressive health care experience as a medical corpsman, nursing assistant or medical technician.
   
   Physician Assistant applicants pursuing an associate, master's degree, or certificate but who do not have a bachelor's degree in nursing, medical technology or physical therapy must submit by July 11, 2008, a resume outlining related health care education and work experience (including periods of employment and number of hours worked per week).
   
   The PA training program must be accredited by the Accreditation Review Commission on Education for the Physician Assistant and the affiliated school must be accredited by a U.S. Department of Education nationally recognized regional or State institutional accrediting agency.  The PA training program must lead to national certification by the National Commission on Certification of Physician Assistants.
   
   PLEASE NOTE: Students in the "pre-professional" phase (e.g., taking undergraduate course work as a prerequisite for admission to the PA training program) or in PA programs specializing in areas other than primary care (e.g., PA programs with a surgical or emergency room focus) ARE NOT eligible for NHSC scholarship funding.

First, the placement opportunities for reservists may be more limited, in order to minimize the negative impact that a deployment would have on continuity of patient care for the vulnerable populations served by the NHSC.  For example, placement of a reservist as the sole provider at a clinic, that would be forced to close if the reservist were deployed, would not be approved.

Second, 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 NHSC service site, exceeds 7 weeks (49 calendar days) per service year, the NHSC service commitment end date will be extended to compensate for the break in service.  See discussion of Full-Time Clinical Practice located under the "Fulfilling the Service Commitment" section of this Bulletin.

Third, if the site where the reservist was serving at the time of his/her deployment is unable to re-employ that reservist, the participant will be reassigned to another service site to complete his/her remaining NHSC service commitment.  In some cases, a participant may be asked to sign an employment contract that extends beyond the completion date of his/her NHSC service commitment.

• Application.  Please be advised, beginning this year, all applications must be completed and submitted on-line July 11, 2008.  The Assurances, Certification, and the entire on-line application must be printed, signed and submitted with a hard copy of all the supporting documents and be received in the BCRS by July 11, 2008.  Any applicant that fails to submit a complete application by the deadline will be considered non-responsive and will not be considered for funding under this announcement.
• Supporting Documentation.  All supporting documents must be submitted via hard copy and received by the July 11, 2008 deadline.  Supporting documentation includes, but is not limited to, the following items:
  • Verification of Acceptance/Verification of Good Standing (discussed below)
  • Authorization to Release Information Letter (discussed below)
  • Essay Questions (discussed below)
  • Transcript (discussed below)
  • Dean/Faculty Advisor Evaluation Letter (discussed below)
  • Standard Form 1199A (EG) Direct Deposit Sign Up Form
  • A Signed and Dated Contract

Applicants who have not been accepted for enrollment at the time of submitting the application must indicate on the application only one school or program they anticipate attending, and the Verification of Acceptance Report must be received by July 11, 2008. ONCE THE APPLICATION DEADLINE HAS PASSED, NO CHANGES WILL BE ACCEPTED IN THE APPLICANT'S CHOICE OF SCHOOL OR DISCIPLINE PRIOR TO AWARD. The school identified in the Verification of Acceptance/Verification of Good Standing Report submitted by the July 11, 2008 deadline will be the applicant's "initial school of record."

If the Verification of Acceptance/Verification of Good Standing Report states that there are conditions (not yet fulfilled) for acceptance into the school and/or program, other than standard contingencies that apply to all admitted applicants, applicants will not be eligible for consideration for an award for the 2008-2009 school year, unless all contingencies or conditions for acceptance are removed and documented in writing by the school and received by BCRS on or before July 11, 2008. 

Essay Questions -- New Requirement
Applicants will be required to respond to the following five essay-style questions:

1. Why do you want to be a National Health Service Corps Scholar
2. When did you realize you wanted to serve underserved populations and how did you arrive at this decision?
3. What experiences have you had or activities have you participated in that have prepared you for working with underserved populations?
4. If you were selected, how do you envision your service as a provider/employee at a health clinic in a medically underserved community?
5. What are your long-term professional plans after fulfilling your scholarship service obligations?

Transcript -- New Requirement
Each applicant must include an official transcript from his/her last complete year of academic training.  If the applicant is currently enrolled in the program that he/she is seeking a scholarship for, a transcript must be provided that includes the last complete semester or term.

Dean/Faculty Advisor Evaluation Letter - New Requirement
Applicants are required to submit one Dean/Faculty Advisor Evaluation Letter.  If the applicant is currently enrolled in the health professions training program, then the letter should be from the Dean of that academic program.  If the applicant has not begun the training associated with the scholarship, the letter should be from the Dean or academic advisor of the applicant's most recent academic program.  The letter should be based on the Dean/academic advisor's observations or knowledge of your education/work achievement, relationships with other people, and your overall potential for the practice of primary health care, especially in a health professions shortage area.  Included with the Supplemental Forms, is a sample letter which you may want to provide to the Dean or academic advisor for their use in responding to this requirement.  The letter should be on the institution's letterhead, included with the other supporting documents and must be submitted in a sealed envelope with the evaluator's signature across the seal.

Students Must Use the Current Application Packet
Students who have submitted applications to the NHSC Scholarship Program in past years, and who did not receive or accept an award, must complete a new application and compete with all other applicants.  Prior year applications will not be considered.

The NHSC Scholarship Program for the 2008-2009 school year is very competitive; the Program anticipates more applicants for scholarship awards than available funds.  Due to the competitiveness of the NHSC Scholarship Program, students are advised to apply for other funding sources.

1. Former NHSC Scholarship Program Recipients
   Former NHSC Scholarship Program recipients who are seeking support for the 2008-2009 academic year, or through their date of graduation;
   
   
2. Recipients of Federal Scholarship Program for Students of Exceptional Financial Need (EFN) (Medical Students Only)
   
   Applicants who have received a Scholarship for Students of Exceptional Financial Need under former section 758 of the Public Health Service Act (42 U.S.C. 294z) qualify for a funding priority. Applicants claiming EFN status must submit (to be received by July 11, 2008) written documentation from their school's financial aid official of former participation in the EFN Program.

1. For Medical and Dental Students: Applicants' schools must certify that the applicants participated in, or would have been eligible for participation in, Federal programs such as Scholarships for Disadvantaged Students, and Loans to Disadvantaged Students.
   
   
2. For Family Nurse Practitioners, Nurse Midwifery, and Physician Assistant Students: Their schools must certify that the applicants participated in, or would have been eligible for participation in, Federal programs such as "Scholarships for Disadvantaged Students" or the benefits of the "Nursing Workforce Diversity Grant Program." 

For information about programs for disadvantaged students, visit the Web site.

The documentation of "disadvantaged background" must be received by the July 11, 2008,deadline.

Notification of Selection/Acceptance of Award
Individuals selected for awards will be notified by email, as early as August 2008.  To accept the award, the selectees must respond by the deadline in the notice of award email.  If you do not respond to the NHSC Scholarship Program by the deadline date in the notice of award email, the offer of award expires and the award will be offered to an alternate.

Individuals selected for an award must attend full-time classes during the 2008-2009 school year and class attendance must begin on or before September 30, 2008.  Individuals whose class attendance during the 2008-2009 school year will begin after September 30, 2008, MUST decline the award, but may reapply next year.  Please note that the ranking of selectees will not be disclosed.

Notification of Alternate Status
Individuals selected as alternates will be notified by email, as early as September 2008.  Alternates will be notified of selection for an award as selectees decline their awards.  Please note that the ranking of alternates will not be disclosed.

Notification of Non-Selection
Individuals whose application did not fall within the competitive range to be considered as an NHSC scholarship selectee or alternate will be notified no later than October 2008.

New Scholars' Conference
Individuals awarded a NHSC scholarship will be expected to attend the "Enhancing Your Scholarship Today: Maximizing Your Service Tomorrow" Conference planned for Fall 2008 (specific date and location to be determined).

Child Support Obligation
In keeping with the President's Executive Orders concerning compliance with child support orders, the NHSC Scholarship Program is stressing the importance of honoring any child support obligation an applicant may have.

Discontinuation of Benefits
The NHSC Scholarship Program will discontinue the payment of all benefits under the following circumstances:

1. While the recipient is on a leave of absence (for personal or medical reasons) which has been approved by the school;
   
   
2. While the recipient is repeating course work which delays the recipient's graduation date. The NHSC Scholarship Program will pay tuition only for courses taken the first time. (This does not include courses taken prior to the receipt of the NHSC Scholarship Program award.)  If a student repeats a course which is taken in addition to a standard full-time course load and the repeat course work does not delay the graduation date, payment of the monthly stipend will continue, but the NHSC Scholarship Program will not pay for the course work being repeated;
   
   
3. While the recipient is enrolled in school as a less than full-time student; and
   
   
4. If the recipient withdraws or is dismissed from school.  Moreover, the recipients' withdrawal or dismissal from school is a breach of the scholarship contract, and the recipient will be liable to repay the amount described in the "A Failure to Complete Academic Training" section of this Bulletin.   

A recipient is required to notify the Scholarship Support Branch of the Division of Scholar and Clinician Support immediately, in writing, whenever any of the following events are anticipated or expected:

1) an approved leave of absence;
2) repeat course work;
3) a decrease in credit hours in any academic term; or 
4) withdrawal or dismissal from school. 

The NHSC Scholarship Program needs to know, in advance, that the above events may occur, so that timely action can be taken to discontinue payments and avoid overpayments.  The recipient must also submit a letter, to the Scholarship Support Branch from the school verifying that one of these events has occurred.  Please be advised that if the NHSC Scholarship Program has any questions concerning a participant's eligibility for continued support, the NHSC Scholarship Program may delay the payment of all benefits to that participant pending clarification of the participant's eligibility status.

Termination of Contract
The Secretary of Health and Human Services may terminate an NHSC Scholarship Program Contract for a school year if the recipient, on or before June 1 of the school year: 1) submits a written request to terminate his or her contract for that school year to the Scholarship Support Branch, DSCS, and 2) repays all amounts paid to, or on behalf of that recipient for that school year.  If a scholarship recipient does not meet these requirements, he or she will incur a service commitment for the full or partial year of support received, as set forth in the "Fulfilling the Service Commitment"section of this Bulletin.

A scholar who begins receiving support under a school year contract and subsequently has that support discontinued for the remainder of the same school year (due to a leave of absence, repeat course work or less than full-time enrollment) may wish to submit a request to terminate that school year contract.  The potential benefit of such a request is two-fold.  First, the student would not incur a service obligation for that school year.  Second, that school year would not count against the student's maximum of 4 school years of support.

For example, a medical student signs a contract for 4 school years of scholarship support, through his date of graduation.  During the third school year, this student goes on a leave of absence from October 1 through June 30.  If the student submits a written request to terminate his/her third year contract and repays any scholarship support received for that year by June 1 of the third school year, the Secretary will terminate his/her third year contract (eliminating his service obligation for the third school year of support and making him/her eligible to receive scholarship support for 2 more years (subject to the availability of funds).  If this medical student elects to retain the scholarship support received from July 1 through October 1, he/she would owe a year of service for the partial third year of support received and would be eligible to receive only one additional year of scholarship support.

Resumption of Benefits for Contracts That Have Not Been Terminated
To resume benefits under existing scholarship contracts (contracts that have not been terminated), the recipient must submit documentation from a school official confirming that he/she is: 1) enrolled as a full-time student in courses leading to the degree for which the scholarship was awarded and 2) not repeating course work.  Requests for the resumption of scholarship benefits will be considered on a case-by-case basis by the Associate Administrator, BCRS, to determine the recipient's eligibility to receive continuing funds.  For recipients who have not repaid overpayments received, the resumption of scholarship benefits will be subject to the administrative offset described in the below "Collection of Benefit Overpayments"section of this Bulletin.  For recipients whose benefits were discontinued due to their withdrawal or dismissal from school, benefits will not be resumed.  See "Failure to Complete Academic Training."

Collection of Benefit Overpayments
Scholarship Program payment(s) received by a recipient, including payment(s) made to a school on the recipient's behalf, during periods while the recipient is on an approved leave of absence, is repeating course work, or is enrolled as a part-time student, are overpayments. Overpayments may also occur due to administrative error.  A participant receiving an overpayment should immediately telephone the Scholarship Support Branch, DSCS,  and follow-up in writing to make arrangements to promptly return all overpayment(s) to avoid interest accrual and debt collection procedures.

• family practice (3 years),
• general internal medicine (3 years),
• general pediatrics (3 years),
• obstetrics-gynecology (4 years),
• general psychiatry (4 years),
• internal medicine/pediatrics (4 years),
• internal medicine/family practice (4 years),
• geriatrics, and
• rotating internship with a request to complete one of the above specialties (D.O. only)

1. A 1-year Child Psychiatry Fellowship which may follow the completion of residency training in Psychiatry;
2. A 1-year Obstetrics/Gynecology Fellowship which may follow the completion of residency training in Family Practice; and
3. A 1-year Geriatrics Fellowship which may follow the completion of residency training in Family Practice or General Internal Medicine.

For dental students entering the NHSC Scholarship Program in the 2008-2009 school year, the approved specialties for which training deferments may be granted are:

• General Dentistry Residency (up to 2 years)
• Advanced Education in General Dentistry (1 year)
• Pediatric Dentistry (2 years)
• Public Health Dentistry (2 years)

NOTE:  When selecting a residency program, it is the responsibility of the scholarship recipient to research the residency programs to assure that the program selected will provide adequate training to enable the scholarship recipient to sit for the appropriate boards.

Training for Which Deferments Are Not Granted
Deferments will not be approved by the BCRS for non-primary health care programs (e.g., emergency medicine, surgery, radiology, neurology, anesthesiology, ophthalmology, pathology, oral surgery, endodontics, etc.) or programs which the BCRS determines are not consistent with the needs of the NHSC to provide primary health services in HPSAs.

• Deferments will not be approved by the BCRS for postgraduate health professions education conducted by a branch of the Armed Forces of the United States. Participants in such programs incur military service obligations which conflict with the service commitment required under the NHSC Scholarship Program.
• Deferments will not be approved by the BCRS for part-time residency training.
• Deferments will not be approved by the BCRS for transitional residency training.

Please write to the Division of Scholar and Clinician Support or call 1-800-221-9393 if you have any questions about the service deferments the NHSC Scholarship Program will grant for postgraduate medical education.

No Scholarship Payments, Service Obligation or Service Credit
During residency and other advanced training, recipients do not receive NHSC Scholarship Program financial support nor do they incur additional NHSC Scholarship Program service commitments.

Periods of advanced training (including residencies) are not creditable toward satisfying the scholarship service commitment, even though the training may occur in a facility located in a HPSA.

Conditions of Deferment
The terms and conditions of deferment require participants:

1. To pursue training which is approved for deferment by the BCRS, and which does not incur a conflicting service commitment;
   
   
2. To complete and return the annual Deferment Request Form, or provide equivalent evidence of approvable training, by the deadline stated in the Deferment Information Bulletin;
   
   
3. To make no change in the type or period of training without prior written approval of the NHSC Scholarship Program; and
   
   
4. To notify the NHSC Scholarship Program in writing, within 30 days, of his/her new mailing address and/or any changes that affect their training status.

Ending Date of Obligated Service
The last day of the service commitment is determined in whole years from the start date. For example, the last day of service for a recipient with a 3-year service commitment who began service on July 15, 2008, would be July 14, 2011.  Adjustments in the ending date will be made by the BCRS if the scholar takes more than the allowable 35 work days away from the site in a service year (see "Full-Time Clinical Practice" section).

NOTE:  Please be advised that NHSC scholarship recipients are eligible for NHSC Loan Repayment Program after they have completed their scholarship service commitment.  While they are not given preference based on their scholar status, the NHSC Loan Repayment Program does give preference to clinicians working at the highest need HPSA sites.

Service Assignment Process

NHSC Scholarship Program recipients must fulfill their service commitments at approved sites in federally-designated HPSAs with the greatest need at the time of assignment, as determined by the Secretary (or his/her designee).  These may include assignments to the Indian Health Service (IHS), the medical facilities of the Federal Bureau of Prisons (BOP), or the medical facilities of the U.S. Department of Homeland Security, Immigration and Customs Enforcement (ICE).

NHSC scholarship recipients cannot fulfill their NHSC Scholarship Program service commitments by serving in one of the Armed Forces of the United States or the Veterans Administration.

Physicians and dentists will receive information about the NHSC placement process approximately 6 months prior to the scheduled start of service.  Family nurse practitioners, certified nurse midwives and physician assistants will be sent information about the placement process approximately 4 months prior to the scheduled start of service.  The packet will include the Approved Practice List containing job vacancies for which scholars in each discipline and specialty can compete.

The BCRS reserves the right to make final decisions on all placements, in order to comply with statutory requirements for the placement of scholarship recipients.  There is no guarantee that HPSAs or sites which are currently approved for NHSC scholar placements will still be approved at the time applicants are available to serve.

Recipients who fail to obtain a placement in one of the approved practices by the deadlines announced by the BCRS will be scheduled for an interview at a service site identified by the BCRS.

Recipients who, for any reason, fail to begin or complete service at their assigned service location breach the NHSC Scholarship Program contract and incur the damages described in section "Failure to Begin or Complete the Service Commitment or Meet the Terms and Conditions of Deferment" of this Bulletin.

Types of Placements
The following types of NHSC scholar placements may appear on the Approved Practice List:

Non-Federal Placements:
Private Practice Assignment (PPA)
A PPA is an assignment to a public or private entity that operates a community-based system of care where a scholar may serve his/her commitment. These entities may be supported by local communities or may be supported in part by Federal grant funds. Under the PPA, scholars are considered non-Federal members of the NHSC and are paid by and work under the personnel system of the entity to which they are assigned.  The salary and benefits paid by the entity must be at least equal to the salary and benefits that the scholar would have received as a Federal civil service employee.  Malpractice insurance should be agreed upon by the employer and the scholar and detailed in their written employment contract.  The BCRS requires that each entity make provisions for malpractice insurance, including tail coverage, for scholars under the PPA.  Employment contract negotiations are solely the responsibility of the scholar.

Private Practice Option (PPO)
A PPO is a release (from having to serve as a member of the NHSC) to serve in a private practice that operates as fee-for-service, or a salaried position at a public, private non-profit, or for-profit site.  There is no minimum provider salary and benefit package requirement for a PPO.  By statute, scholars wishing to exercise the PPO must submit a written application to the BCRS.  If a PPO placement is approved by the BCRS, the scholar must sign an agreement to, among other things, comply with the section "Charges for Services"; requirements set forth in this Bulletin.  The scholar must also prepare and submit a Uniform Data System report to the BCRS on the conduct of his/her practice.   NOTE: PPO providers must make arrangements to obtain their own malpractice and medical insurance.  Scholars are not eligible for solo private practice options.

Federal Placements:
Indian Health Service (IHS)
This agency of the Department of Health and Human Services offers a variety of placement opportunities at hospitals and other health care facilities serving
Native American/Alaskan Native populations (usually on Indian reservations).  An IHS placement may require a security clearance.

Federal Bureau of Prisons (BOP)
This agency of the Department of Justice employs health professionals in Federal prison facilities ranging from infirmary-size units to 500-bed tertiary care hospitals throughout the United States.  A BOP placement requires a security clearance.

U.S. Immigration and Customs Enforcement (ICE)
This agency of the Department of Homeland Security provides primary health care for the detainees remanded to the custody of the ICE. Within each Service Processing Center throughout the country, there is a fully accredited outpatient clinic.  An ICE placement requires a security clearance.

Charges for Services
Federal and PPA entities, as well as PPO providers, must not discriminate in the provision of services to an individual because that individual is unable to pay or because payment would be made under Medicare, Medicaid or the State Children's Health Insurance Program.  A schedule of discounts (including, in appropriate cases, waiver) must be utilized for patients unable to pay.  Finally, Federal and PPA entities and PPO providers must accept assignment under Medicare and enter into appropriate agreements with State agencies to participate in the Medicaid and State Children's Health Insurance Programs.

Scholarship recipients serving under a PPO or PPA Agreement are required to have a license in the State where the service site is located. Scholarship recipients serving as Federal employees are required to be licensed in a State (i.e., any State).  Responsibility for obtaining the required State license prior to the service start date rests with the scholarship recipient.  Given that scholars will be required to serve in the areas of greatest need throughout the country, each scholar is responsible for ensuring that his or her professional program will provide broad eligibility to obtain a license in multiple States.  In addition, each scholar is responsible for meeting the applicable board and licensure requirements outlined below.

Physicians
All physicians must have successfully completed Steps 1, 2 (clinical skills and clinical knowledge components) and 3 of the United States Medical Licensing Examination (USMLE) or Levels 1, 2 (cognitive evaluation and performance evaluation components), and 3 of the Comprehensive Osteopathic Medical Licensing Examination (COMLEX) by the time they complete their primary care residency training program.  To assure that physician scholars are able to fulfill their commitment wherever the need is greatest upon completion of their primary care residency, the BCRS expects all MD/DO scholars to take and pass:

• Step 1 of the USMLE or Level 1 of the COMLEX by the end of the 2^nd year of their MD/DO program.
• Step 2 (both components) of the USMLE or Level 2 of the COMLEX (both components) by the end of the 4^th year of their MD/DO program.
• Step 3 of the USMLE or Level 3 of the COMLEX by the end of the 1^st year of their post-graduate (residency) training program.

MD/DO scholars unable to pass all parts of the licensing examination and obtain a license to practice medicine by the time the service is scheduled to begin will not be routinely eligible for a suspension of their service obligation and may be placed in default.

Dentists
All dentists must have successfully completed the National Board Dental Examination Parts 1 and 2 prior to beginning their NHSC Scholarship service.  To assure that dentists will have licensure in States with the greatest dental needs, the BCRS reserves the right to determine which Regional or State clinical exam the dental scholar should take and pass.  Dental scholars are expected to take the appropriate exams at the earliest possible date.  If the recipient is unsuccessful in passing the exams and obtaining a license, the recipient should immediately contact the Division of Scholar and Clinician Support, (DSCS) in writing, to request a suspension.  Please see the "Waiver, Suspension or Cancellation of the Commitment" section in this Bulletin.

Nurse Midwives, Family Nurse Practitioners and Physician Assistants
All nurse midwives, family nurse practitioners and physician assistants must have successfully passed discipline specific national certification exams prior to beginning their service commitments.  Students are expected to take the appropriate certification exam at the earliest possible date.  No service credit will be given to any NHSC scholar for practice at an NHSC scholar site prior to passing the national certification exams.  If the recipient is unsuccessful in passing the national certification exam, the recipient should immediately contact the DSCS, in writing, to request a suspension.  Please see the "Waiver, Suspension or Cancellation of the Commitment" section in this Bulletin.

Full-Time Clinical Practice
Every participant is required to engage in the full-time outpatient clinical practice of the profession for which he or she was awarded an NHSC Scholarship contract.

A full-time practice is defined as a minimum of 40 hours per week.  The 40 hours per week may be compressed into no less than 4 days per week, with no more than 12 hours of work to be performed in any 24-hour period.  Time spent in "on-call" status will not count toward the 40-hour week.  Hours worked over the required 40 hours per week will not be applied to any other workweek.

No more than 7 weeks (35 workdays) per service year can be spent away from the practice for vacation, holidays, continuing professional education, illness, or any other reason.  For absences of greater than 7 weeks in a service year, the participant must request a suspension.  A break in service will extend the service commitment end date.

A full-time clinical practice is defined as follows:

For all health professionals, except obstetrician/gynecologist (OB/GYN) physicians, family medicine physicians who practice obstetrics on a regular basis, certified nurse midwives, and psychiatrists, at least 32 of the minimum 40 hours per week must be spent providing direct outpatient care. These services must be conducted during normally scheduled clinic hours in an ambulatory care setting in the office(s) specified in the PPA or PPO Agreement.  The remaining hours must be spent providing inpatient care to patients of that clinic (as appropriate to meet the needs of the patients and to assure continuity of care) and/or in practice-related administrative activities.

For OB/GYN physicians, family medicine physicians who practice obstetrics on a regular basis, and certified nurse midwives, at least 21 of the minimum 40 hours per week must be spent providing direct outpatient care.  These services must be conducted during normally scheduled clinic hours in an ambulatory outpatient care setting in the office(s) specified in the PPA or PPO Agreement.  Eleven of the remaining hours must be spent providing inpatient care to patients of that clinic.  The remaining 8 hours per week may be spent providing additional patient care and/or performing practice-related administrative activities, with administrative activities not to exceed 8 hours per week.

For psychiatrists, at least 21 of the minimum 40 hours per week must be spent providing direct outpatient care.  These services must be conducted during normally scheduled clinic hours in an ambulatory outpatient care setting in the office(s) specified in the PPA or PPO Agreement.  Eleven of the remaining hours must be spent providing direct clinical services to patients of the assigned site either at the site, an inpatient facility or in an alternative setting.  The remaining 8 hours per week may be spent providing additional patient care and/ or performing practice-related administrative activities, with administrative activities.

Practice-related administrative activities include teaching, attending staff meetings, supervision of other clinicians, court appearances, and other non-treatment related activities pertaining to the clinician's approved NHSC practice. Supervision of other clinicians is defined as an administrative activity if the clinician being supervised is treating the patient and billing for such treatment in his or her name.  If the supervising clinician is treating the patient and billing for such treatment under his or her name, this activity would be counted as direct clinical services for the supervising clinician.

Work schedules at Federal facilities may be significantly different than community-based systems of care.  Scholars who are interested in practice positions at Federal facilities need to discuss the details with these facilities directly.

Failure to Begin or Complete the Service Commitment or Failure to Meet the Terms and Conditions of Deferment
Scholarship recipients who, for any reason, fail to comply with the terms and conditions of deferment (including physicians who fail to complete an approved residency in a BCRS-approved specialty) or who, for any reason, fail to begin or complete their service commitments after completion of training, will be in breach of their scholarship commitments.  When recipients default on their contracts for these reasons, the United States shall be entitled to recover damages equal to three times the scholarship award plus interest, in accordance with the formula:

   A = 3Ø(­­t-s)
t

In which:

"A"= is the amount the United States is entitled to recover,

"Ø"= is the sum of the amounts paid to or made on behalf of the participant and the interest on such amounts which would be payable if, at the time the amounts were paid, they were loans bearing interest at the maximum legal prevailing rate, as determined by  the Treasurer of the United States,

"t"= is the total number of months in the par­participant's period of obligated service, and

"s"= is the number of months of the period of obligated service served by the participant.

The damages which the United States is entitled to recover shall be paid within 1 year of the date of default.

Delinquent Debt
If the default debt is not repaid within 1 year or 3 years (as applicable), and subsequent collection efforts are unsuccessful, the case may be referred to the Department of Justice for enforced collection. The recipient will be liable for the debt incurred plus administrative costs and court costs associated with collection of the debt.  All delinquent debts will be reported to a commercial credit reporting agency and to the Treasury Department for the Treasury Offset Program.  Also recovery through Administrative Wage Garnishment may be enforced to repay a delinquent default debt.

IRS Tax Refund Offsets and Medicare/Medicaid Exclusion
Through the Treasury Offset Program, the government may offset Federal and/or State payments due to the participant (e.g., an IRS income tax refund) and apply those payments to repay delinquent NHSC Scholarship Program debts. In addition, a delinquent defaulter who is unwilling to enter into, or stay in compliance with, an agreement to repay his/her default debt can be excluded from participation in Medicare, Medicaid, and other Federal health care programs.  See section 1128 of the Social Security Act.

Licensure Sanctions
In several States, a health professional license can be suspended or revoked for non-payment of an NHSC scholarship debt.

The Secretary of Health and Human Services may suspend or waive, in whole or in part, a service or payment obligation.  Requests for suspensions and waivers are processed and reviewed by the Legal and Compliance Office (LCO). 

Scholarship recipients seeking a waiver or suspension of the service or payment obligation must submit a written request stating the underlying circumstances to the Bureau of Clinician Recruitment and Service, Division of Scholar and Clinician Support, 5600 Fishers Lane, Room 8-15, Rockville, Maryland 20857.  Upon receipt of the request, the LCO will mail the recipient instructions for additional documentation necessary to process the request. 

A waiver may be granted if the recipient documents a permanent situation that makes compliance with the service or financial obligation impossible or an extreme hardship, such that enforcement would be against equity and good conscience.  A suspension is granted if the recipient documents a temporary situation that makes compliance with the service or financial obligation impossible or an extreme hardship, such that enforcement would be against equity and good conscience.

Compliance would be considered "impossible" if the Secretary's designee determines that the participant suffers from a physical or mental disability resulting in his/her inability to perform the obligation incurred.

To determine whether performance of the obligation would impose an "extreme hardship" and be "against equity and good conscience," the Secretary's designee, will consider: (1) the recipient's present financial resources and obligations; (2) the recipient's estimated future financial resources and obligations; and (3) the extent to which the recipient has problems of a personal nature, such as physical or mental disability, or terminal illness in the immediate family, which so intrudes on the recipient's present and future ability to perform as to raise a presumption that the individual would be unable to perform the obligation incurred.

Maternity leave is limited to 12 weeks.  A suspension for maternity over 12 weeks can only be extended upon a showing of medical complications requiring additional time away from the service site.  A request for medically necessary additional time for maternity leave is submitted as a suspension request as described above.

In the unfortunate event of a scholarship recipient's death, any commitment to the NHSC Scholarship Program is canceled.

1. Application. Be sure to print two copies of the application (one for your records and the other copy to mail with your supplemental documentation).  Sign and date the application in ink and mail in the application and the supplemental information by July 11, 2008.
   
   
2. Scholarship contract (see sample), signed in ink, and dated. Sign on each line for each school year you are requesting support. 
   
   
3. Authorization to Release Information Letter (in forms packet downloaded from on-line application).  Be sure to complete and sign the authorization letter.
   
   
4. Verification of "Disadvantaged Background"status, if claimed. Obtain from financial aid official of your health professions school.
   
   
5. Verification by school of your previous participation in the "Scholarship Program for Students of Exceptional Financial Need" (EFN), if this priority status is claimed (Medical and Dental students only).
   
   
6. Verification of Acceptance or Verification of Good Standing Report (in forms packet downloaded from on-line application).
   
   
7. A copy of your program's curriculum.
   
   
8. Verification of any undergraduate degrees/diplomas for applicants who are pursuing training as Family Nurse Practitioners, Nurse-Midwives, or Physician Assistants. A copy of an official transcript or copy of your degree/diploma is acceptable.
   
   
9. Physician Assistants ONLY. If you are pursuing a Master's degree, an Associate degree or a Certificate and you do not have a bachelor's degree in nursing, medical technology, or physical therapy, you MUST submit a detailed resume outlining all health care related education and work experience (including periods of employment and number of hours worked per week). See Applicant Eligibility.
   
   
10. Essay Questions - New Requirement.  Each applicant must respond to five essay-style questions.  Each response should be limited to 2,500 characters or less (approximately one-half typed page).
    
    
11. Transcript - New Requirement.   Each applicant must include a transcript from his/her last complete year of academic training.  If the applicant is currently enrolled in the program from which he/she is seeking a scholarship, a transcript must be provided that includes the last complete semester or term.
    
    
12. Dean/Faculty Advisor Evaluation Letter - New Requirement (sample in forms packet downloaded from on-line application). Each applicant is required to submit one letter.  If the applicant is currently enrolled in the health professions training program, then the letter should be from the Dean of that academic program.  If the applicant has not begun the training associated with the scholarship, the letter should be from the Dean or academic advisor of applicant's most recent academic program.  The letter should focus on why the applicant is a good fit for the National Health Service Corps Scholarship.
    
    
13. Proof of Citizenship.  Each applicant is required to submit evidence of your 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).
    
    
14. Direct Deposit form.  Each applicant must submit a direct deposit form.  Without this form, awards cannot be made.
    
    
15. Power-of-Attorney. This document must be submitted if you are submitting an application on behalf of another person.
    
    
16. Documentation that there is no conflicting service commitment, applicable to individuals with an existing service obligation. See section "No Conflicting Service Commitment".
    
    
17. Documentation that all contingencies regarding the student's acceptance have been or will be met by the start of the Fall 2008-2009 term.