NEBRASKA’s Rural Health Incentive

Programs

Presentation by: Marlene A. JanssenHealth Program Manager

Nebraska Office of Rural Health For UNMC COD

August 20, 2015

The ACT:

Created Rural Health Advisory Commission

Established a forgivable medical STUDENT LOAN program

Established the LOAN REPAYMENT program for certain licensed health professionals

http://nebraskalegislature.gov/laws/laws.phpSections 71-5650 to 71-5670 Nebraska Revised Statutes

Nebraska’sRural Health Systems and Professional

Incentive Act (THE ACT)

Thirteen (13) members appointed by the Governor for 3-year terms and include:

Two Representatives from DHHS - DHHS Director of Public Health and Another DHHS Representative; One Representative from each Nebraska medical school; One physician in family practice residency training; and From rural areas (counties under 15, 000 population), physician, hospital administrator, nursing home

administrator, nurse, physician assistant, mental health practitioner or psychologist, dentist, and consumer.

NebraskaRural Health Advisory Commission

“The purpose of the commission shall be to advise the department (DHHS), the Legislature, the Governor, the University of Nebraska, and the citizens of Nebraska regarding all aspects of rural health care and to advise the office (Office of Rural Health) regarding the administration of the Rural Health Systems and Professional Incentive Act.” §71-5655 Ne Rev Statutes

Rural Health Advisory CommissionPurpose

Some of the statutory powers and duties of the commission include:

Prepare recommendations to the appropriate bodies to alleviate identified problems

Designate state-designated shortage areas in Nebraska

Select recipients of financial incentives available under the ACT

Rural Health Advisory CommissionPowers and Duties

Nebraska Rural Health Student Loan Program for certain health professional students

Nebraska Loan Repayment Program for eligible licensed health professionals

Nebraska’sRural Incentive Programs

Nebraska Rural HealthStudent Loan Program

Eligibility Requirements

Must be a Nebraska resident and

Enrolled or Accepted for enrollment in a Nebraska medical, dental, physician assistant, or graduate-level mental health training program

Nebraska Rural Health Student Loan Program

Obligation

Medical and PA students agree to practice one of the following specialties: family practice general internal medicine general pediatrics obstetrics/gynecology

general surgery psychiatry

Dental students agree to practice: general dentistry pediatric dentistryoral surgery

Nebraska Rural HealthStudent Loan Program

Obligation (continued)

Graduate-level mental health students agree to practice the scope of practice of a Licensed Mental Health Practitioner or Psychologist

All student loan recipients agree to practice, in a state-designated shortage area, the equivalent of one year of full-time practice for each year a student loan is received

Nebraska Rural HealthStudent Loan Program

Application Process

Application period April 1 – June 1 each year

Interviewed by members of the Rural Health Advisory Commission

Rural Health Advisory Commission awards student loans

Nebraska Rural HealthStudent Loan Program

Awards

The maximum amount of student loan awards is up to:

$30,000 for medical, dental, and doctorate-level mental health student loan recipients

$15,000 to full-time masters level mental health and physician assistant student loan recipients

(Legislation passed in 2015 (effective August 29, 2015) increases maximum amount to $30,000/$15,000)

Rural Health Advisory Commission awards approximately 6 new student loans and 10 continuation student loans each year. The amount of student loan awards is based on the total appropriation for the rural incentive programs.

Nebraska Rural HealthStudent Loan Program

Forgiveness

Student Loans are forgiven if recipient practices the equivalent of full-time (40 hours/week) in a state-designated shortage area the equivalent of one year for each year a loan was awarded.

A student loan recipient may practice part-time (minimum 20 hours/week) which will extend the forgiveness period.

What if I decide to pursue a non-primary care field or practice in a non-shortage area?

What happens to my Nebraska rural health student loan?

Nebraska Rural HealthStudent Loan Program

Contract Buyouts and Defaults

Contract Buyout Provisions –

Doctorate-level before end of second year:

◦ Must notify Office of Rural Health, in writing, of intent to buyout

◦ Repay principal plus 6 percent simple interest from date loan was granted

◦ Must be repaid before graduation

Nebraska Rural HealthStudent Loan Program

Contract Buyouts and Defaults

Contract Buyout Provision for Doctorate-level after end of second year and master’s level

◦ 150% of principal plus 8 percent interest from the date of default

◦ Double the number of years loans granted to repay

For eligible licensed health professionals (do not have to be a Nebraska resident or graduate of a Nebraska college)

Nebraska Loan Repayment Program

Eligible Health Professionals –

Physicians, Nurse Practitioners, Physician Assistants practicing one of the following specialties◦ Family Practice◦ General Internal Medicine◦ General Pediatrics◦ OB/GYN◦ General Surgery◦ Psychiatry

Nebraska Loan Repayment ProgramEligibility Requirements

Eligible Health Professionals -

Dentists practicing one of the following specialties:◦ General Dentistry◦ Pediatric Dentistry◦ Oral Surgery

Nebraska Loan Repayment ProgramEligibility Requirements

(continued)

Eligible Health Professionals –

Clinical Psychologists Master’s Level Mental Health (LMHP) Pharmacists Occupational Therapists Physical Therapists

Nebraska Loan Repayment ProgramEligibility Requirements

(continued)

Government or Commercial educational loans- only educational loans to student in student’s name are eligible

- loans to parents, consumer loans (ex: credit card), mortgage loans, and private loans are not eligible

Local entity must agree to provide local match and verify practice

Nebraska Loan Repayment Program

Other Requirements

3-year practice obligation in a state-designated shortage area

Part-time practice (minimum 20 hours/week) reduces benefit

Rural Health Advisory Commission approves loan repayment applications

Nebraska Loan Repayment ProgramOther Requirements

(continued)

Maximum of $60,000 per year in loan repayment (state and local match) for physicians, dentists, and psychologists

Maximum of $30,000 per year in loan repayment (state and local match) for all other eligible professions

(Legislative changes effective August 29, 2015, changes maximum

amounts $60,000/$30,000 per year (state and local match).)

Nebraska Loan Repayment Program

Benefits

Applications are accepted year roundThe only “deadlines” are for the Rural Health Advisory Commission’s agenda items prior to each meeting.

Rural Health Advisory Commission awards loan repayment

May apply up to 18 months prior to being eligible to practice

Loan repayment no longer taxable income(effective January 1, 2009 as per P.L. 111-148, 3/23/10)

Nebraska Loan Repayment Program

Application Process

Cannot serve practice obligation under Student Loan and Loan Repayment programs simultaneously

Cannot receive loan repayment during residency training or under provisional license

Nebraska Loan Repayment Program

Other Considerations

Contract Buyout Provisions –(Legislative changes effective August 29, 2015, changed the buyout provisions)

150% of all funds received 8% interest from the date of default Same number of months to repay as received loan

repayment

FACT: 483 loan repayment participants (1994-2014)FACT: 91 in practice under obligationFACT: 92 percent complete the practice obligationDecember 2014 Annual Report

Nebraska Loan Repayment Program

Contract Buyout/Default

Guidelines are established by the Rural Health Advisory Commission

Statutory authorization and guidance for defining shortage areas

Statewide review of all shortage areas every 3 years

State-Designated Shortage Areas

State-Designated Family Practice Shortage Area Criteria

Service area: county, partial county, identified population group within a defined area

Designation based on ratio of service area (county) population to full-time equivalency (FTE) of family practice physicians

State-Designated Family Practice Shortage Area Criteria

Population to FTE FP Physician >= 2000:1or no physician in service area

OR population to FTE FP Physician is between 1500:1 – 1999:1 AND service area (county) has one of the following high need indicators

State-Designated Family Practice Shortage Area Criteria

High Need Indicators:

Population 65+ in the highest quartile for the state

Poverty level ranks in the highest quartile for the state

Frontier Area (< 6 people per square mile)

State-Designated Family Practice Shortage Area Criteria

High Need Indicators (continued):

Infant Mortality Rate ranks in the highest quartile for the state

Low Birth Weight Rate ranks in the highest quartile for the state

More than 50% of physicians are over 60 years old

State-Designated Family Practice Shortage Area Criteria

Counties with population >= 15,000 will not be designated

Areas within a 25-mile radius of Lincoln and Omaha will not be designated

State employees are not eligible for the Nebraska rural incentive programs

State-Designated Family Practice Shortage Area Criteria

Federally designated (HPSA), primary care shortage areas may be designated as “State-Designated”

◦ If requested by the community or clinic◦ And approved by the Rural Health Advisory

Commission◦ Example: Community Health Centers –

Panhandle, One World, Charles Drew, Good Neighbor

Summary of Nebraska’sRural Health Systems and Professional Incentive Act

Created:

1. Rural Health Advisory Commission (RHAC)2. Forgivable Student Loan Program for

certain health professional students3. Loan Repayment Program for certain

licensed health professionals

Nebraska Office of Rural Health(402) 471-2337

www.dhhs.ne.gov/orh

State-Funded Programs & Shortage Areas:Marlene Janssenmarlene.janssen@nebraska.gov

Contact Information