G.  Community Site Employment

1. General Information
   
   In exchange for NHSC LRP benefits, NHSC LRP participants must be engaged in the full-time clinical practice (see Section H.) of their professions at community sites on the NHSC Opportunities List.  The NHSC Opportunities List includes specific primary health care employment opportunities in federally designated HPSAs that have been identified by the NHSC as significantly lacking certain health professionals.  The NHSC community sites provide outpatient primary health services to populations residing in HPSAs throughout the Nation.  Hospital day treatment centers and inpatient facilities do not qualify as NHSC service sites.
   
   School or home-based health programs serving HPSA populations may appear on the NHSC Opportunities List if the program/site position meets the full-time clinical practice requirements (see Section H of the Bulletin). Please note that if a school-based program only provides clinical services to students during the school year, a clinician will need an additional service site in the approved HPSA during the summer months in order to participate in the NHSC LRP and remain in compliance with NHSC full-time clinical practice requirements.
   
   The NHSC Opportunities List is prepared each year by the Division of Applications and Awards.  This list reflects approved NHSC vacancies. See the NHSC Opportunities List for FY 2008. Only those vacancies posted on the NHSC Opportunities List on or before the application deadline will be considered for FY 2008 NHSC LRP two-year contract awards. 
   
   Community sites may have several vacancies per discipline category posted on the NHSC Opportunities List.  Please see section C. 2.c. of this Bulletin for further information on funding levels per discipline category per site.   If funding remains available, the NHSC LRP may fund beyond two two-year contract awards per discipline category for each community site. 
   
   At the time the application is submitted, the applicant must have accepted an offer of employment or be in the final stages of negotiating an employment contract with an NHSC community site and must begin employment on or before September 30, 2008.  See Section C. of the Bulletin for the definition of “accepted an offer of employment.” The NHSC LRP Community Site Information Form (CSIF) (see Section P of this Bulletin), documents the applicant's employment status. This form must be submitted with the application by the application deadline, April 2, 2008.  The applicant must include a separate CSIF for each location or employment site.
   
   An applicant’s acceptance of an offer of employment to fill a vacancy on the NHSC Opportunities List does not guarantee that the applicant will subsequently receive an NHSC LRP contract award. See Section C of this Bulletin describing the eligibility requirements and funding preferences used by the NHSC LRP to determine which applicants will receive NHSC LRP contract awards. In addition, eligible sites could have certain positions that do not meet NHSC service requirements.  It is important for an NHSC LRP applicant to determine that the site has requested a vacancy for the applicant’s position and that the position is in compliance with NHSC full-time service requirements.
   
   Applicants become participants in the NHSC LRP (i.e., the contract becomes effective) on the date the Secretary of Health and Human Services or his/her designee countersigns the NHSC LRP contract.  The applicant's signature alone on this contract does not constitute a contractual agreement.
   
   When the employment start date precedes the effective date of the NHSC LRP contract, no NHSC LRP service credit will be approved for employment prior to the effective date of the contract and no loan repayments will be made for any professional practice performed before the effective date of the contract.
   
   Please contact your state Primary Care Organization (PCO) or Primary Care Association (PCA) representative for further assistance regarding site or HPSA questions.
   
2. Serving Under a Private Practice Assignment (PPA) Agreement
   
   Under the PPA, an individual employed by a public or private entity on the NHSC Opportunities List is subject to the personnel system of the entity to which he or she is assigned and must receive an income at least equal to the income he or she would have received as a civilian employee of the U.S. Government.  Entities employing Private Practice Assignees are required to accept assignment under the Medicare Program, to enter into appropriate agreements with the Medicaid and State Children’s Health Insurance Programs, and to utilize a schedule of discounts (including, as appropriate, waivers) of fees based on a patient’s ability to pay.  Failure of a site to comply with the above will result in NHSC providers being unable to serve at the site.
   
   Serving Under a Private Practice Option (PPO) Agreement
   
   Under the PPO, an individual is self-employed or is a salaried employee of a public or private entity.  The PPO Agreement requires that a participant:  accept Medicare assignment; enter into appropriate agreements under the Medicaid and State Children’s Health Insurance Programs; utilize a schedule of discounts (including, as appropriate, waivers) of fees based on a patient’s ability to pay, and submit reports and documents, as required, relating to the conduct of his or her practice

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