Overview

The NHSC is committed to improving the health of the Nation's underserved - uniting communities in need with caring health professionals and supporting communities' efforts to build better systems of care. The Corps assists in the recruitment and retention of community-responsive, culturally competent primary care clinicians to serve people in health professional shortage areas (HPSAs). For a brief overview of the NHSC, its mission, and role in providing over 30 years of service to the underserved, refer to the fact sheet at ftp://ftp.hrsa.gov/nhsc/factsheets/General-Info-NHSC.pdf.

This first chapter of the manual provides a discussion of the NHSC and its programs. It also contains information on criteria for securing NHSC clinicians and policies for community placement. As you review this chapter, you will see that a number of acronyms are used. We are citing some of them here for your quick reference and better understanding of the program:

(A more comprehensive list of acronyms and abbreviations can be found here (link)

The NHSC
Commitment

The NHSC is committed to serving underserved communities by assuring that high quality health care services are available and accessible to everyone. To accomplish this goal, the NHSC works to do the following.

1. Meet the needs of underserved people by:
   • empowering individuals to identify and address their own health needs;
   • removing the many barriers to obtaining quality health care including barriers related to language and culture, economics, geography, and transportation; and
   • providing primary health care that is accessible, culturally competent, linguistically correct, community- based, and efficient.
2. Ensure that the community has:
   • community-responsive care - which means practicing in a way that is in harmony with the area and its needs and empowering individuals and communities to improve their health status;
   • culturally competent care(which means inclusion of language or terms easily understood by the patient as well as recognizing the role of traditional beliefs in the healing process; and
   • an interdisciplinary team approach to health care delivery--where physicians, physician assistants, nurse practitioners, certified nurse-midwives, dentists, dental hygienists, and mental health professionals apply the full scope of their skills in direct patient care and all have an important and integral role to play in meeting the health care needs of the community.
3. Develop practice sites for health care professionals that are professionally challenging, personally satisfying and where patients appreciate the provider's role and the services provided. NHSC sites are also expected to:
   • adapt to the changing health care environment to benefit the people we serve; and
   • ensure that the programs and providers we support are well researched, achieve desired outcomes, and efficiently utilize available resources.

Strategies for
the Future

The NHSC estimates that a significant number of health professionals will be needed within the next decade to provide health care in underserved frontier, rural and urban areas. This includes primary care physicians, physician assistants, nurse practitioners, certified nurse-midwives, dentists, dental hygienists, and mental health professionals including health service psychologists, clinical social workers, licensed professional counselors, marriage and family therapists, psychiatrists and psychiatric nurse specialists.

The NHSC has begun a campaign to attract the needed primary care professionals over the next decade through a six-point strategy. This strategy, which requires expanding the number of practice sites and building partnerships with entities which are interested in assuring access to primary health care services to all members of society will include:

• increasing access to primary and preventive care delivery systems;
• enhancing recruitment of professionals;
• expanding partnerships with key stakeholders;
• supporting and retaining primary health care providers;
• continuing to prioritize health professional shortage areas of greatest need; and
• continuing to focus on the interdisciplinary team approach to primary care.

NHSC
Programs

The NHSC has a number of programs which support the goal of recruiting and retaining health care professionals to serve in sites/communities that lack adequate primary health care services:

• NHSC Scholarship Program - in return for a commitment to serve in a federally-designated HPSA of greatest need upon completion of training, the NHSC provides payment of tuition, fees, and monthly stipends to students pursuing primary care careers as allopathic/osteopathic physicians, family nurse practitioners, physician assistants, certified nurse-midwives and dentists.
• NHSC Loan Repayment Program - in exchange for a commitment to serve in a federally-designated HPSA the NHSC assists in the repayment of educational loans for primary care allopathic/osteopathic physicians, nurse practitioners, physician assistants, certified nurse-midwives, dentists, dental hygienists, and mental health professionals including psychiatrists, health service psychologists, clinical social workers, licensed professional counselors, marriage and family therapists, psychiatrists and psychiatric nurse specialists.
• State Loan Repayment Program - States receive grants to sponsor repayment agreements with primary care practitioners in federally designated HPSAs.
• The NHSC On-line Opportunity List - assists in the recruitment of dedicated clinicians who wish to work in HPSAs regardless of their interest or participation in the NHSC Scholarship and/or Loan Repayment Programs.
• Student Experiences And Rotation in Community Health (SEARCH) Program - provides opportunities for primary health care students to:
  • gain experience in the delivery of primary care in under served communities
  • train on interdisciplinary teams
  • link with primary care mentors
  • complete health promotion and disease prevention projects in selected communities.

Where NHSC
Clinicians
Serve

NHSC clinicians serve in public and private primary health care delivery systems working to establish or improve health care services to all members of the community. Examples of such clinical and program settings where NHSC Clinicians serve include:

• Community and Migrant Health Centers (C/MHC);
• Health Care for the Homeless programs;
• Public Housing clinics;
• Indian Health Service (IHS) Federal and Tribal sites;
• Bureau of Prisons (BOP) facilities;
• State/local health department clinics within a HPSA; and
• Private fee-for-service practices.

Health Professional
Shortage Areas
(HPSAs)

The community/site is not eligible to receive a NHSC clinician or other assistance from the NHSC until the area, population or facility has been designated as a primary care, dental, or mental health HPSA. The Shortage Designation Branch (SDB) in the BHPr's National Center for Health Workforce Analysis considers the following factors in the Federal primary care HPSA designation process:

• the ratio of available health professionals to the number of individuals in the area, population group or facility involved or served by the medical facility or other public facility involved;
• indicators of a high need and insufficient capacity; and
• specific indicators of need such as:
  • the rate of low weight births,
  • the rate of infant mortality,
  • the rate of poverty, and
  • access to primary care health services, taking into account the travel time or distance to such services.

To find out if your area is designated as a federal HPSA, you may either query the HPSA database at http://bhpr.hrsa.gov/shortage, or contact your state Primary Care Office (PCO). The national roster of state PCOs may be accessed on the Web at http://nhsc.bhpr.hrsa.gov/resources/info/pco.asp. If your area has not been designated as a HPSA, the PCO staff can tell you how to request a designation.

Securing an
NHSC Clinician

Data for each currently designated HPSA is collected, analyzed, and scored by the SDB in order to determine HPSAs of greatest shortage. Vacancies in HPSAs of greatest shortage are then prioritized for NHSC recruitment and retention assistance.

To meet the expectations for consideration of NHSC recruitment and retention assistance, an entity must:

• Be a part of a system of care which provides a service continuum that includes comprehensive primary care and appropriate referral arrangements for secondary and tertiary care;
• Be located in a federally-designated primary care, dental, or mental health HPSA of greatest shortage;
• Have a documented record of sound fiscal management;
• Verify that the requesting site has made appropriate and efficient use of current and former NHSC clinicians (if applicable);
• Be accessible to individuals regardless of their ability to pay;
  • Accept Medicaid, Medicare and State Children's Health Insurance beneficiaries;
  • Maintain a discount fee schedule that ensures there is no financial barrier to care for those below 200 percent of the federal poverty level;
• Verify that NHSC clinicians will be employed full- time (here I'd like to do a pop up box of the definition of NHSC full-time, which is attached)
• Maintain a credentialing program to check references and to verify licensure and/or certification of clinicians;
• Maintain a retention component in place to encourage the retention of all health professionals including NHSC providers;
• Maintain a salary and benefits package that is competitive in the marketplace (applicable to Private Practice Assignment (PPA) entities only--see Placement Options section below for definition of PPA and Private Practice Options PPO); and
• Maintain malpractice coverage that includes full payment for any tail coverage that may be required (applicable to PPA entities only--see Placement Options section below for definition of PPA and Private Practice Options PPO); and/or assurance that the sponsoring entity is "deemed" under the Federal Tort Claims Act.

A number of groups play a role in the identification of sites eligible for NHSC clinicians. Various community-based organizations, the IHS, the BOP, State/regional primary care associations, community and migrant health centers, and State/local health departments work collaboratively to review the staffing needs of their areas to determine those vacancies appropriate for the placement of an NHSC scholarship recipient or potential loan repayment program participant.

An application for NHSC Recruitment and Retention may be downloaded from our web site at http://nhsc.bhpr.hrsa.gov/applications/rraa.asp. It is particularly helpful for applicants to work with their state PCO to determine if an NHSC placement is appropriate and to verify the accuracy of data requirements prior to submitting the application. Completed applications should be forwarded to the following address:

U.S. Department of Health and Human Services
Health Resources and Services Administration
Bureau of Health Professions
Division of the National Health Service Corps
5600 Fishers Lane, Room 8A-55
Rockville, Maryland 20857
FAX 301-594-2721

The application may be submitted throughout the year. Specific deadlines for the loan repayment program will be posted on the NHSC web site.

Placement
Guidelines

NHSC clinicians must serve in ambulatory settings requiring full-time clinical practice (pop up box for definition of full-time).

In placing NHSC clinicians, the following guidelines apply:

Family physicians will be placed primarily where they will address the health needs of both pediatrics and adult medicine, as well as provide routine obstetrical/gynecological services.

Obstetricians/gynecologists will be placed in systems of care with appropriate cross coverage. Inpatient delivery arrangements must be made in advance of the placement request.

Dentists will be placed in primary dental care practices.

Mental health professionals will be placed at entities which are in catchment areas with current mental health shortage designations and which are part of an organized system of outpatient mental health services.

Placement
Options

NHSC scholarship recipients and loan repayment program participants may fulfill the service obligation through one of the following types of placement:

Private Practice Assignment (PPA) - Under the PPA, an individual serves at 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, including malpractice liability insurance with tail coverage.

Private Practice Option (PPO) - Under the PPO, an individual is self-employed or is a salaried employee of a public or private entity. Such service must be at a community site identified on the NHSC Opportunities List as a PPO site. PPO sites may or may not provide an income and benefits package equal to that of a civilian employee of the U.S. government.

Federal Salaried Position (FED) - A limited number of NHSC clinicians may fulfill their service obligation as members of the PHS commissioned corps or in civil service positions. Vacancies at the IHS and the BOP are usually Federal salaried positions. Community-based Federal positions are only available through the Ready Responder program.