HPSAs are defined service areas that demonstrate a critical shortage of primary care physicians, dentists, or mental health providers.  A HPSA can be a distinct geographic area such as a parish or grouping of census tracts, a specific population group within a defined geographic area (such as a population under 200% poverty), or a specific public or non-profit facility such a state hospital.  Maps of each of these types of HPSAs in Louisiana can be accessed on the Bureau of Primary Care and Rural Health’s website on the Data and Maps page.

No.  If an area is designated as a HPSA it does not mean it is a rural area.  There are several HPSAs in our state that are in metropolitan areas. 

MUAs identify areas or populations with a shortage of health care services.  Documentation of shortage for MUAs includes several indicators in addition to the availability of health care providers.  These factors include infant mortality rate, poverty rate, and percentage of population aged 65 or over.

Louisiana’s MUA designations are currently being used for various grants including Section 330 grants but cannot be used for the National Health Service Corps or Louisiana’s State Loan Repayment Program or J-1 visa waiver placements.

Under the provisions of Public law 99-280, enacted in 1986, a population group which does not meet the established criteria of an IMU less than 62.0 can nevertheless be considered for designation if "unusual local conditions which are a barrier to access to or the availability of personal health services" exist and are documented, and if such a designation is recommended by the chief executive officer and local officials of the State where the requested population resides. These areas are not eligible for RHC certification.

Requests for designation under these exceptional procedures should describe in detail the unusual local conditions/access barriers/availability indicators which led to the recommendation for exceptional designation and include any supporting data.

Such requests must also include a written recommendation for designation from the Governor or other chief executive officer of the State (or State-equivalent) and local health official.

This designation of Governor's Certified Shortage Area, authorized under the Rural Health Clinic legislation, is only used for eligibility for RHC certification.  It is not used like a Health Professional Shortage Area for National Health Service Corps placements or a Medically Underserved Area/Medically Underserved Population for 330 funding.

All HPSA designation requests are evaluated and approved or disapproved by the federal Shortage Designation Branch (SDB) in the Health Resources and Services Administration (HRSA) based on the shortage/underserved criteria established by regulation. 

There is a 30-day mandatory comment period for all applications.  After 30 days, if the application is complete and has all the required information, the process takes an average of 120 working days.  The review schedule for Louisiana’s HPSAs can be viewed on the Health Professional Shortage Area page.

HPSA designations must be updated every three years.  The update procedure is exactly the same as the procedure for the original request.  At the time of the update review, changes in the type of HPSA may occur including a loss of HPSA designation due to the successful recruitment and retention efforts of the community.

A J-1 visa, also called an exchange visitor visa, is a visa used by foreign nationals who come to the U.S. for the purpose of teaching, training, studying, research, etc.  It is often referred to as a student visa.  Foreign nationals are required to physically return to their home country or the country of last residence for at least two years before they are eligible to apply for any other non-immigrant visa or Lawful Permanent Residence.

The J-1 visa waiver, issued from the State Conrad Program or other federal programs, makes a foreign national exempt from the return home requirement.  J-1 visa waiver holders are allowed to stay in the United States.

Yes, J-1 visa waiver physicians may work for private, for-profit entities, as well as public or nonprofit entities.

Yes.  However, it is imperative that the site can show evidence of the ability to pay the prevailing wage as defined in the H-1B petition (see question below).  Also, the site must be ready to open immediately upon the arrival of the J-1 visa waiver physician.

Yes.  An H-1B petition should be filed about six months prior to the time the H-1B worker will commence employment.  However, the application for change of status may not be filed until the Department of State (DOS) issues its waiver recommendation to Bureau of Citizenship and Immigration Services (BCIS).  For specific advice, seek legal counsel.

No. You are not required to hire a J-1 visa waiver physician even though you applied and were approved for a slot.  NOTE: DHH requests that you notify the BPCRH when you decide not to use a J-1 visa waiver physician so that another site can utilize the available slot.

Yes. Replacing a J-1 visa waiver physician that is leaving your site with another J-1 visa waiver physician is not automatic. A new site application must be submitted and approved before an offer can be made to the new physician who needs a J-1 visa waiver. 

A site should advertise for all qualified physicians and not just J-1 visa waiver physicians. 

For the J-1 visa waiver application, either the employer or physician may pay the filing fees.  According to Department of Labor's regulations, the sponsoring employer is required to pay the filing fees for the H-1B portion of the case.

The executed contract should include at least a three-year commitment for outpatient preventative and primary care or an approved specialty.  The contract should also include:

• The address of each practice site;
• The normal office hours for outpatient care for each practice site. The physician’s 40 hours should not be performed in less than four days a week;
• No non-compete clause;
• A $250,000 damages clause.  This amount must be paid to the provider if the J-1 visa waiver physician does not satisfactorily complete service under the employment contract;
• Any other restrictions on the J-1 visa waiver applicant negotiated in the contract and agreed to by the employer and the J-1 visa waiver applicant.

Additional contract information can be found in the J-1 Visa Waiver Program Policy, which can be accessed under Recruitment Services.

If the contract is not fulfilled, the physician may become subject to the two-year foreign residence requirement again.  Both the physician and the sponsoring employer should notify DHH as soon as any problem arises.  All parties should obtain the advice of legal counsel.

If the employing facility closes or extenuating circumstances beyond the control of the physician arise, the waiver will not be revoked, provided the three years of service in H-1B status can be completed at another eligible facility.  A subsequent H-1B petition must be filed with BCIS and DHH, accompanied by evidence of the closure of the facility or extenuating circumstances, an employment contract the balance of the three year period, evidence that the proposed new employment is in a HPSA in Louisiana, and the original signed copy of the Criteria for J-1 visa waiver Support by the State of Louisiana.

The physician will probably have to leave the United States to obtain a new H-1B visa if a new petition for new employment is not filed within ten days of the termination of the last employment.

The minimum requirements are:

• Submitter’s cover letter and G-28, if applicable
• Letter of need from medical facility
• Department of State Data Sheet (2 copies)
• Readable copies of J-1's IAP-66 forms for each year in J-1 status
• CV, including Social Security number
• Notarized Department of State attestation forms
• CRITERIA FOR J-1 VISA WAIVER SUPPORT BY THE STATE OF LOUISIANA
• Copy of notarized, dated, executed contract plus documentation of site visit
• Evidence of employer’s regional and national recruitment efforts
• Proof of health professional service area and documentation of site approval received from DHH
• Letters of support from within the community.  NO FORM LETTERS WILL BE ACCEPTED
• Letters of recommendation from those who know the J-1 physician's qualifications
• Qualifications (diplomas, licenses) and Medicaid Identification Number
• Proof of facility’s existence
• Names of all U.S. citizens or permanent resident physicians applying for and/or interviewed and reason not hired
• Proof of physician’s visit to site of employment

With an approved site application, usually about 8 months from the time DHH receives the J-1 visa waiver request packet to the time the physician begins work.  However, delays related to recruitment efforts, contract negotiations, and J-1 visa waiver processing at BCIS, may prolong the process.   Therefore, DHH cannot guarantee when the J-1 visa waiver physician will actually be able to begin practicing.  If you are in immediate need of a physician, this program may not be the appropriate choice for your site.

The most commonly reported problem from physicians is the lack of other physicians to share call in rural areas and isolation from others who share their culture and background.

The most commonly reported problem from employers is that physicians do not integrate into the community, do not market themselves in the community, and are not committed to working the long hours necessary to build a practice.

Yes, if the sponsoring employer is in agreement and the moonlighting site is in a Health Professional Shortage Area (HPSA).  An employment agreement for the moonlighting site should be provided to DHH’s BPCRH.  For more information, see pages 9-12 of the Louisiana J-1 Visa Waiver Program Policy under Recruitment Services.  The physician should be sure that the BCIS has authorized the participation in moonlighting activities as the H-1B petition only authorizes a worker to work for a specific employer.  Please seek legal advice prior to engaging in moonlighting.

Yes, but only after the move has been approved by DHH’s BPCRH and BCIS.  To protect the physician’s waiver, the employer must provide a contract amendment or new contract.  DHH’s BPCRH will issue its decision to the employer and the physician.  BCIS approval has to be received before the physician may change work places. See pages 9-12 of the Louisiana J-1 Visa Waiver Program Policy.

If the entire facility has moved, documentation of the change of address, such as a lease or public announcement or documentation of purchase, should be submitted to DHH’s BPCRH.  The sponsoring employer must submit several documents and forms to BCIS.  If the change satisfies BCIS’s regulatory and policy requirements, it will approve the change.  Legal advice should be obtained prior to changing the physician’s work location.

The National Health Service Corps (NHSC) is a federally funded program that is part of the U.S. Department of Health and Human Services and is housed in the Health Resources and Services Administration’s Bureau of Health Professions. The NHSC is composed of a unique group of clinicians providing primary health care to adults and children in the communities of greatest need across the Nation, bringing quality primary health care professionals to communities in need, as well as supporting their efforts to build a better system of care.

NHSC clinicians practice in a broad range of community-based systems of care operating in rural and urban federally designated health professional shortage areas (HPSA).  NHSC clinicians serve in communities in every state, the District of Columbia, Puerto Rico, the Pacific Basin, and the U.S. Virgin Islands.

The NHSC Loan Repayment Program (LRP) is one way the NHSC works with communities to recruit health care professionals committed to serving the needs of underserved populations.  This competitive program makes contract awards to clinicians that agree to serve full time at approved sites in designated health professional shortage areas (HPSAs) of greatest need.  In return for this service, NHSC LRP participants receive money to repay qualifying educational loans that are still owed, plus a 39% tax assistance payment.  For the first 2 years of service in a federally designated health professional shortage area, the NHSC LRP will pay up to $25,000 for each year of service, based on the participant's outstanding balance of qualifying educational loans. If the total amount of the participant's qualifying educational loans is less than $50,000, the NHSC LRP will pay one-half of the total qualifying educational loans annually. Opportunities to participate in the program beyond 2 years may be available.  All loan repayments paid to the participant must be used by the participant to repay the approved qualifying educational loans. 

• Fully-trained Allopathic (MD) and Osteopathic (DO) physicians with specialties in Family Medicine, General Pediatrics, General Internal Medicine, General Obstetrics/Gynecology, General Dentistry, and General Psychiatry
•  Primary Care Nurse Practitioners and Certified Nurse-Midwives
• Primary Care Physician Assistants
• Dentists and General Hygienists
• Clinical Psychologists, Clinical Social Workers, Psychiatric Nurse Specialists, and Marriage and Family Therapists

Loans qualifying for repayment include government (federal, state or local) and commercial loans obtained by the participant to pay for school tuition, required fees, and other reasonable educational and living expenses incurred by the participant for undergraduate or graduate education leading to a health professional degree.

Consolidated loans are eligible as long as the consolidation is with a commercial lender and includes only the applicant’s student loans.  For more information, call the NHSC at 1-800-221-9393.

An eligible application must be complete, postmarked by the current deadline, and from a clinician who meets all eligibility criteria outlined in the NHSC LRP Application Bulletin.  An applicant must have accepted employment or be in the final stages of negotiating an employment contract with an eligible NHSC LRP community site to be eligible for funding.

NHSC LRP awards will be made on an ongoing basis for eligible applicants whose applications are complete and who are working at an approved NHSC LRP site with a qualifying HPSA score.  Complete applications from applicants working at a site with a HPSA score below the qualifying score will be awarded after the deadline, if funding is still available.  The qualifying HPSA score is set annually with the intention of reaching as many underserved sites as possible in the first round of placements.  The following criteria will be used to determine which clinicians receive an NSHC LRP contract award:

1. The participant’s commitment to serving underserved populations and disadvantaged background status

2.  The site’s HPSA Score

3.  The date of receipt of a complete application

The scoring guidelines for HPSAs are included in 42 CFR, Chapter 1, Part 5.  HRSA’s Shortage Designation Branch assigns this score when the HPSA designation is approved.  See the Health Professional Shortage Area’s section for other HPSA questions.

No.  NHSC Scholars must follow the same application procedures and are subject to the same funding priorities as any other NHSC LRP applicant.

All obligations for service must be completed on or before the annual deadline for an applicant to be considered eligible for the NHSC LRP for that fiscal year.

Applicants who have defaulted on any federal payment obligation will not be selected to participate in the NHSC LRP, even if they are considered to be in good standing by that creditor.

No. The NHSC LRP is a competitive program.  However, due to a proposed increase in funding, the NHSC LRP hopes to fund more awards in the future.

An eligible NHSC LRP community site is a public, nonprofit or private health facility that provides a continuum of services, including comprehensive primary health care and appropriate referrals or arrangements for specialty and inpatient care to individuals in a health professional shortage area (HPSA) regardless of the patient’s ability to pay for the services.  To be considered, the site must submit an NHSC Recruitment and Retention Assistance Application to the LA Bureau of Primary Care and Rural Health who will in turn submit the application to the NHSC for approval.

Section 338 of the Public Health Service Act (42 USC 254-1) authorizes the Secretary of Health and Human Services, through the Health Resources and Services Administration to administer the State Loan Repayment Program (SLRP) which is funded with 50% state dollars and 50% federal dollars.  The state Department of Health and Hospitals (DHH) through the Bureau of Primary Care and Rural Health (BPCRH) administers the SLRP for Louisiana.

The purpose of the SLRP is to recruit and retain primary care practitioners to difficult-to-fill shortage areas by reducing their educational debt.  The mission of the program is to alleviate the state’s problem of a substantial maldistribution of primary care health professionals in rural and inner city areas designated as health professional shortage areas (HPSAs).

Eligible primary care practitioners include those who are board certified or have completed a residency in family practice, osteopathic general practice, obstetrics/gynecology, general internal medicine, pediatrics, psychiatry or dentistry.  Eligible mid-levels include physician assistants, advanced nurse practitioners and nurse midwives.

• Work in a federally designated HPSA
• Work for a public or nonprofit private entity
• Work at least 32 hours per week in an outpatient capacity
• Accept assignment of Medicare and Medicaid
• Accept low-income, uninsured patients on a sliding scale
• Be a United States citizen
•  Have an unrestricted license to practice in Louisiana
• Have no other obligation for health professional services
• Have medical education debt at least equal to the total loan repayment contract amount
• Have not defaulted on educational loans
• Have not breached a health professional services contract

Physicians, psychiatrists and dentists can receive up to $13,333 per year for a two-year commitment or up to $20,000 per year for a three-year commitment.

Mid-levels can receive up to $3,333 per year for a two-year commitment or up to $5,000 per year for a three-year commitment.

Should a primary care physician work in one of the priority parishes, he/she can receive up to $30,000 per year for a three-year commitment.  Dentists will be eligible for up to $30,000per year if he/she accepts referrals for HIV infected patients from the Department of Health and Hospitals, Office of Public Health and/or the Louisiana State University Health Science Center’s outpatient sites.

• Persons who are not citizens or nationals of the United States, including permanent resident aliens and other aliens
• Persons who have breached an obligation for health professional services to the Federal Government, a State Government, local government body or other entity.  Any person with a similar obligation is ineligible for the SLRP unless such obligation is completely satisfied.
• Persons who are obligated under another loan or scholarship payback program, regardless of source. Once a person has fulfilled other obligations, that person may apply for loan repayment.
• Students or residents who will not be licensed and ready to work at the approved health professional shortage site by the end of the current fiscal year.
• Licensed Registered Nurses and Practical Nurses are not eligible.
• Persons who have a judgment lien against their property for a debt to the United States.
• Persons with loans in a default status.

Present SLRP policy requires the SLRP contractors submit a monthly service report form by mail or fax to DHH’s BPRRH.  The form documents the number of primary care encounters (face-to-face contacts), the total number of patients attended for each month, hours worked in outpatient care, and the total number of hours worked including inpatient and on-call.  Submitting the monthly service report after the 15^th of the month may delay the issuance of a participant’s check. 

A copy of the current monthly service report can now be downloaded from the Recruitment Services page on the BPCRH website at www.dhh.la.us.state/pcrh. 

Usually, the contract process is completed in 6-8 weeks, including approval by the Department of Administration’s (DOA’s) Office of Contractual Review.

Yes, loan repayment benefits are taxable.  Each provider will be issued a Form 1099 each January.

All loan repayment monies must be used to repay only approved qualifying educational loans.

No more than 20% of loan repayment funds can be set aside to defray tax liability.

The program will repay governmental or commercial educational loans for tuition expenses, other reasonable education expenses required by the health professional school including books, laboratory expenses and other fees, and reasonable living expenses as determined by published university standards.  For more information, see page five of the Louisiana State Loan Repayment Program Policy.

• To serve a minimum of two years or a maximum of three year
• To provide primary health care services within the officially designated HPSA(s)
•  To agree to accept Medicare, Medicaid, Sliding Fee Scale patients, as well as, provide free care for those who are unable to pay
•  To provide health care encounters/services
•  To provide DHH with a signed monthly service report which totals the number of encounters rendered
• To provide DHH with documentation of practice in a HPSA or a copy of an employment contract with a public or nonprofit facility located in a HPSA

·        Primary health care services rendered full-time in a public or non-profit private outpatient setting and are defined as a minimum 40 hour work week to be performed in no less than four days per week with no more than 12 hours of work to be performed in a 24 hour period.  Time spent in an "on-call" status will not count toward the 40 hours per week.

·        Physicians must provide 4,200 primary care encounters per 12 month period beginning on the effective date of the contract.  A primary health care encounter is a face-to-face contact between the contracting physician and a patient for the purpose of preventive care, diagnosis, and/or treatment.  Exception:  Obstetricians, gynecologists, and psychiatrists must provide 3,600 health care encounters, and dentists must provide 2,000 health care encounters per 12-month period.

·       Contacts with more than one health professional and/or multiple contacts with the same contracting physician that takes place on the same day constitutes a single encounter unless the patient, subsequent to the first visit, suffers illness or injury requiring additional diagnosis or treatment.

For mid-levels, health care services are defined as:

Waivers on SLRP obligations may be granted by the Secretary of DHH in the event of death, physical or mental disability resulting in the permanent inability of the participant to perform the service, bankruptcy, or at the request of the placement agency for a justifiable cause.

Suspensions of the SLRP contract obligations may be made for up to six months in the event of temporary physical or mental disability or for other justifiable causes.