Workforce Recruitment and Retention Programs

1. Workforce Recruitment and Retention Programs Robert Stiles Barbara Huske Primary Care Office, KDHE Our Vision - Healthy Kansans living in safe and sustainable environments

2. Kansas Primary Care Office Program Focus • Access to primary care services for all Kansans. • Attention to larger health care delivery system. • Facilitate and participate in public/private partnerships to meet the health care needs of Kansans. Our Vision - Healthy Kansans living in safe and sustainable environments

3. Program Areas • Recruitment and Retention—National Health Service Corps, State Loan Repayment,J-1 Visa Waiver Program. • Underserved Areas Designation—HPSA and MUA/P. • Access—Community-Based Primary Care Clinic Program, Charitable Health Care Provider Program, Unused Medications Program/Repository, Technical Assistance to Communities. Our Vision - Healthy Kansans living in safe and sustainable environments

4. State Loan Repayment Program (SLRP) Our Vision - Healthy Kansans living in safe and sustainable environments

5. About the Program PCO receives funding from HRSA through the National Health Service Corps to administer program. $300,000 is available annually (50 percent federal/50 percent state) to assist health professionals in the repayment of eligible educational loans. Continuous application cycle beginning July 1 of each year for awards beginning October 1. Priority in order applications received. Our Vision - Healthy Kansans living in safe and sustainable environments

6. Providers Eligible professions include primary care physicians, nurse practitioners, physician assistants, nurse mid-wives, dentists, dental hygienists, clinical psychologists, clinical social workers, clinical professional counselors and clinical marriage and family therapists. Up to $25,000 per year is available to PAs, ARNPS, dental hygienists, and clinical mental health. Up to $30,000 to primary care doctors (MD or DO) and dentists. Our Vision - Healthy Kansans living in safe and sustainable environments

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

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

9. Sites Public or nonprofit private entity in Kansas. Provide care in a federally designated HPSA. May not discriminate in care to Medicaid and Medicare beneficiaries and those unable to pay for services. Charge at the usual and customary rate, using a reduced rate for those unable to pay. Our Vision - Healthy Kansans living in safe and sustainable environments

10. Sites Written nondiscrimination policy and provide services in a culturally and linguistically appropriate responsive to needs of area. May not use SLRP funding as salary offset. Cooperate with communication or site visits to monitor compliance. Our Vision - Healthy Kansans living in safe and sustainable environments

11. Our Vision - Healthy Kansans living in safe and sustainable environments

12. National Health Service Corps Loan Repayment Program (NHSC) Our Vision - Healthy Kansans living in safe and sustainable environments

13. Kansas Primary Care Office • Evaluates all Recruitment and Retention Application requests from entities in Kansas and recommend approval or disapproval of applications. • Collaborates with state agencies and partners in integrating NHSC activities into the state’s strategy to increase health professionals in underserved areas. • Assists communities in recruiting and retaining NHSC providers. • Provides information to and participate in recruitment activities for potential student loan repayors in the state. Our Vision - Healthy Kansans living in safe and sustainable environments

14. 2010-2011 Loan Repayment Cycle • Opened November 22, 2010. • Increase in Financial Support. • Up to $60,000 for two years of service. • More Flexible Options. • Three options—a two-year full-time contract, a four-year half-time contract, and a two-year half-time contract. • Increased Credit for Teaching. • 20 percent credit for teaching. • 50 percent credit for teaching at a Teaching Health Center. Our Vision - Healthy Kansans living in safe and sustainable environments

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

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

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

18. Site Requirements Charges for Services: • Full charge for care must be consistent with prevailing rates in the site’s area. • Care should be provided for a nominal fee or no charge for individuals at or below 200 percent of the federal poverty level. • Must accept assignment for Medicare beneficiaries and have entered into agreement with Medicaid/CHIP (HealthWave). • Prominently post a statement that explicitly communicates the fact that no one will be denied care based on ability to pay in languages appropriate to the service area’s population. Our Vision - Healthy Kansans living in safe and sustainable environments

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

20. Site Requirements • Must be approved by NHSC as an eligible site through submitting the Recruitment and Retention Assistance application. • Must renew site application every three years for continued participation. • Must be sited in a current and appropriate Health Professional Shortage Area (medical, dental, mental). Our Vision - Healthy Kansans living in safe and sustainable environments

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

22. J-1 Visa Waiver Our Vision - Healthy Kansans living in safe and sustainable environments

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

24. J-1 Visa Waiver Overview • Federal law allows up to ten physicians in each state to work in regions not specifically designated as underserved at the state department of public health’s discretion. • Kansas uses this flexibility to recommend waivers if the need for services can be demonstrated and if patients from designated shortage designation areas will be served by the physician. • Kansas’ participation in the waiver program is intended to assist local communities to ensure access to physician services. • Specialists as well as primary care providers are eligible. • Primary Care providers will be given priority. Our Vision - Healthy Kansans living in safe and sustainable environments

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

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

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

28. HRSA Workforce Planning Grant • Partnership led by KS Dept. of Commerce. • One-year planning grant with potential for 2 to 3 year implementation grant. • Plan and implement programs aimed at increasing the supply of primary health care professionals (medical, dental, mental health). • Goal: Increase number of primary health care professionals in Kansas by 10-25% over the next ten years. Our Vision - Healthy Kansans living in safe and sustainable environments

29. Contact Information Barbara Huske Workforce Coordinator 785-296-2742 bhuske@kdheks.gov Our Vision - Healthy Kansans living in safe and sustainable environments