Re963port Title:

Hawaii Health Corps

Description:

Establishes the Hawaii Health Corps Program to provide health care to underserved areas of the state.

HOUSE OF REPRESENTATIVES

H.B. NO.

963

TWENTY-THIRD LEGISLATURE, 2005

 

STATE OF HAWAII

 


 

A BILL FOR AN ACT

 

relating to rural health care.

 

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF HAWAII:

SECTION 1. The legislature finds that changes in demographics, the delivery of health care services, and an escalation in the cost of educating health care professionals have resulted in shortages of health care professionals. A poor distribution of health care professionals has resulted in a surplus of some professionals in some areas of the state and a shortage of others in other parts of the state, such as in the more rural areas. Health professional shortage areas are often areas that have troubled economies and lower per capita incomes. These areas often require more services because the health care needs are greater due to poverty or because the areas are difficult to service due to geographic circumstances.

The legislature further finds that the high cost of health professional education requires that health care practitioners command higher incomes to repay the financial obligations incurred in obtaining the required training. The salary potentials for shortage areas are often not as favorable when compared to nonshortage areas and practitioners are unable to serve. Encouraging health professionals to serve in shortage areas is essential to assure continued access to health care for persons living in these parts of the state.

The purpose of this Act is to establish the Hawaii health corps that will provide mechanisms to encourage health care professionals to accept positions in shortage areas.

SECTION 2. The Hawaii Revised Statutes is amended by adding a new chapter to be appropriately designated and to read as follows:

"Chapter

HAWAII HEALTH CORPS

§ -1 Definitions. As used in this chapter:

"Department" means the department of health.

"Eligible education and training programs" means education and training programs approved by the department for purposes of this chapter that lead to eligibility for a license as a licensed health care professional.

"Eligible expenses" means reasonable expenses associated with the costs of acquiring an education such as tuition, books, equipment, fees, room and board, and other expenses determined by the department.

"Eligible student" means a student who has been accepted into an eligible education or training program and has a declared intention to serve in a health professional shortage area upon completion of the education or training program.

"Forgiven" or "to forgive" or "forgiveness" means to render health care services in a health professional shortage area in the state in lieu of monetary repayment.

"Health professional shortage areas" means those areas where licensed health care professionals are in short supply as a result of geographic maldistribution or as the result of a short supply of licensed health care professionals in specialty health care areas and where vacancies exist in serious numbers that jeopardize patient care and pose a threat to the public health and safety.

"Licensed health care professional" means a person regulated by chapter 453 or 457.

"Loan repayment" means a loan that is paid in full or in part if the participant renders health care services in a health professional shortage area as defined by the department.

"Nonshortage rural area" means a nonurban area that has not been designated as a rural physician shortage area. The department shall identify the nonshortage rural areas of the state.

"Participant" means a licensed health care professional who has received a loan repayment award and has commenced practice as a licensed health care provider in a designated health professional shortage area, or an eligible student who has received a scholarship under this program.

"Program" means the Hawaii health corps program.

"Required service obligation" means an obligation by the participant to provide health care services in a health professional shortage area for a period to be established as provided for in this chapter.

"Rural physician shortage area" means rural geographic areas where primary care physicians are in short supply as a result of geographic maldistributions and where their limited numbers jeopardize patient care and pose a threat to public health and safety. The department shall designate rural physician shortage areas.

"Satisfied" means paid-in-full.

"Scholarship" means a loan that is forgiven in whole or in part if the recipient renders health care services in a health professional shortage area.

"Sponsoring community" means a hospital or county government.

§ -2 Hawaii health corps program. The Hawaii health corps program is established for licensed health care professionals serving in health professional shortage areas. The program shall be administered by the department. In administrating this program, the department shall:

(1) Select licensed health care professionals to participate in the loan repayment portion of the loan repayment and scholarship program and select eligible students to participate in the scholarship portion of the loan repayment and scholarship program;

(2) Adopt rules and develop guidelines to administer the program;

(3) Collect and manage repayments from participants who do not meet their service obligations under this chapter;

(4) Publicize the program, particularly to maximize participation among individuals in shortage areas and among populations expected to experience the greatest growth in the work force;

(5) Solicit and accept grants and donations from public and private sources for the program; and

(6) Develop criteria for a contract for service in lieu of the service obligation, where appropriate, that may be a combination of service and payment.

§ -3 Technical assistance for rural communities. The department may provide technical assistance to rural communities:

(1) Desiring to become sponsoring communities for the purposes of identification of prospective students for the program;

(2) Assisting prospective students to apply to an eligible education and training program;

(3) Making formal agreements with prospective students to provide licensed health care services in the community;

(4) Forming agreements between rural communities in a service area to share licensed health care professionals; and

(5) Fulfilling any matching requirements.

§ -4 Criteria for selecting participants. The department shall establish a planning committee to assist the department in developing criteria for the selection of participants. The department shall include on the planning committee representatives of the department, John A. Burns School of Medicine of the University of Hawaii, health care facilities, provider groups, consumers, community and technical colleges, and other appropriate public and private agencies and organizations.

§ -5 Required service obligations. The department shall:

(1) Establish loan repayments for persons licensed to practice medicine or surgery pursuant to chapter 453 or nursing pursuant to chapter 457. The amount of the loan repayments shall not exceed:

(A) $10,000 per year served for physicians;

(B) $5,000 per year served for physician assistants and advanced practice registered nurses; or

(C) $2,500 per year served for nurses other than advance practice registered nurses; and

(2) Establish a scholarship program for eligible students who have been accepted into an eligible education or training program leading to a license pursuant to chapter 453 or 457. The amount of the scholarship shall not exceed:

(A) $10,000 per year served for programs for medicine or surgery;

(B) $5,000 per year served for programs for physician assistants and advanced practice registered nurses; or

(C) $2,500 per year served for programs for nursing other than programs for advanced practice registered nurses,

and shall be awarded for a maximum of five years. In determining scholarship awards for prospective physicians, the selection criteria shall include requirements that recipients declare an interest in serving in rural areas of the state. Preference for scholarships shall be given to students who reside in a rural physician shortage area or a nonshortage rural area of the state prior to admission to the eligible education and training program in medicine. Highest preference shall be given to students seeking admission who are recommended by sponsoring communities and who declare the intent to serve as a physician in a rural area. The department may require the sponsoring community located in a nonshortage rural area to financially contribute to the eligible expenses of a medical student if the student will serve in the nonshortage rural area.

§ -6 Health professional shortage areas. The department shall:

(1) Determine eligible licensed health care professions for the purposes of the loan repayment and scholarship program authorized by this chapter. Eligibility shall be based upon an assessment that determines that there is a shortage or insufficient availability of a licensed profession so as to jeopardize patient care and pose a threat to the public health and safety. The department shall consider the relative degree of shortages among professions when determining eligibility. The department may add or remove professions from eligibility based upon the determination that a profession is no longer in shortage. Should a profession no longer be eligible, participants or eligible students who have received scholarships shall be eligible to continue to receive scholarships or loan repayments until they are no longer eligible or until their service obligation has been completed; and

(2) Determine health professional shortage areas for each of the eligible licensed health care professions. In making health professional shortage area designations, the department may be guided by applicable federal standards for "health manpower shortage areas," "medically underserved areas," and "medically underserved populations."

§ -7 Annual award amount; scholarship preferences; required service obligations. The department shall:

(1) Establish the annual award amount for each licensed health care profession, which shall be based upon an assessment of reasonable annual eligible expenses involved in training and educating each licensed health care profession. The annual award amount may be established at a level less than annual eligible expenses. The annual award amount shall be established by the department for each eligible health care profession. The awards shall not be paid for more than a maximum of ten years per individual;

(2) Determine any scholarship awards for prospective physicians in such a manner to require the recipients to declare an interest in serving in rural areas of the state. Preference for scholarships shall be given to students who reside in a rural physician shortage area or a nonshortage rural area of the state prior to admission to the eligible education and training program in medicine. Highest preference shall be given to students seeking admission who are recommended by sponsoring communities and who declare the intent of serving as a physician in a rural area. The department may require the sponsoring community located in a nonshortage rural area to financially contribute to the eligible expenses of a medical student if the student will serve in the nonshortage rural area;

(3) Establish the required service obligation for each licensed health care profession, which shall be no fewer than three years or no more than five years. The required service obligation may be based upon the amount of the scholarship or loan repayment award such that higher awards involve longer service obligations on behalf of the participant; and

(4) Determine eligible education and training programs for purposes of the scholarship portion of the program.

§ -8 Loan repayment and scholarship awards. (a) The department may grant loan repayment and scholarship awards to eligible participants from the funds appropriated for this purpose, or from any private or public funds given to the department for this purpose. Participants are ineligible to receive loan repayments if they have received or are ineligible to receive a scholarship from programs authorized under this chapter.

(b) Funds appropriated for the program, including reasonable administrative costs, may be used by the department for:

(1) Loan repayments or scholarships. The department shall annually establish the total amount of funding to be awarded for loan repayments and scholarships, and such allocations shall be established based upon the best use of funding for that year; and

(2) As a recruitment incentive for activities in state-operated institutions, county public health departments and districts, county human service agencies, federal and state contracted community health clinics, and other health care facilities identified by the department as providing substantial amounts of charity care or publicly subsidized health care.

§ -9 Discrimination by participants prohibited; violation. In providing health care services, the participant:

(1) Shall not discriminate against a person on the basis of the person's ability to pay for such services or because payment for the health care services provided to such persons will be made under the insurance program established under Part A or B of Title XVIII of the federal Social Security Act or under a state plan for medical assistance including Title XIX of the federal Social Security Act; and

(2) Agrees to accept assignment under Section 18.42(b)(3)(B)(ii) of the federal Social Security Act for all services for which payment may be made under Part B of Title XVIII of the federal Social Security Act and enters into an appropriate agreement with the department for medical assistance under Title XIX of the federal Social Security Act to provide services to individuals entitled to medical assistance under the plan and enters into appropriate agreements with the department for medical care services. Participants found by the department in violation of this section shall be declared ineligible for receiving assistance under the program authorized by this chapter.

§ -10 Participant obligation; repayment obligation. (a) Participants in the program who are awarded loan repayments shall receive payment from the program for the purpose of repaying educational loans secured while attending a program of health care professional training which led to a license as a licensed health care professional in the state.

(b) Participants shall agree to meet the required service obligation in a designated health care professional shortage area.

(c) Repayment shall be limited to eligible expenses as determined by the department and shall include principal and interest.

(d) Loans from both government and private sources may be repaid by the program. Participants shall agree to allow the department access to loan records and to acquire information from lenders necessary to verify eligibility and to determine payments. Loans may not be renegotiated with lenders to accelerate repayment.

(e) Repayment of loans established pursuant to this program shall begin no later than ninety days after the individual has become a participant. Payments to the participant shall be made quarterly or more frequently if deemed appropriate by the department until:

(1) The loan is repaid;

(2) The participant becomes ineligible due to discontinued service in a health professional shortage area; or

(3) After the required service obligation when eligibility discontinues,

whichever comes first.

(f) Should the participant discontinue service in a health professional shortage area, payments against the loans of the participants shall cease to be effective on the date that the participant discontinues service.

(g) Except for circumstances beyond their control, participants who serve less than the required service obligation shall be obligated to repay to the program an amount equal to twice the total amount paid by the program on their behalf, in addition to any payments on the unsatisfied portion of the principal and interest. The department shall determine the applicability of this subsection.

(h) The department is responsible for the collection of payments made on behalf of participants from the participants who discontinue service before completion of the required service obligation. The department shall exercise due diligence in such collection, maintaining all necessary records to ensure that the maximum amount of payment made on behalf of the participant is recovered. Collection under this section shall be pursued using the full extent of the law, including wage garnishment if necessary.

(i) The department shall not be held responsible for any outstanding payments on principal and interest to any lenders once a participant's eligibility expires.

§ -11 Participant obligation; scholarships. (a) Participants in the health professional loan repayment and scholarship program who are awarded scholarships incur an obligation to repay the scholarship, with interest, unless they serve the required service obligation in a health professional shortage area in the state.

(b) The interest rate shall be eight per cent for the first four years of repayment and ten per cent beginning with the fifth year of repayment.

(c) The period for repayment shall coincide with the required service obligation, with payments of principal and interest accruing quarterly commencing no later than nine months from the date the participant completes or discontinues the course of study or completes or discontinues the required residency. Provisions for deferral of payment shall be determined by the department.

(d) The entire principal and interest of each payment shall be forgiven for each payment period in which the participant serves in a health professional shortage area until the entire repayment obligation is satisfied or the borrower ceases to so serve. Should the participant cease to serve in a health professional shortage area of this state before the participant's repayment obligation is completed, payments on the unsatisfied portion of the principal and interest shall begin the next payment period and continue until the remainder of the participant's repayment obligation is satisfied. Except for circumstances beyond their control, participants who serve less than the required service obligation shall be obliged to repay to the program an amount equal to twice the total amount paid by the program on their behalf.

(e) The department is responsible for the collection of repayments made under this section and shall exercise due diligence in such collection, maintaining all necessary records to ensure that maximum repayments are made. Collection and servicing of repayments under this section shall be pursued using the full extent of the law, including wage garnishment if necessary. The department is responsible to forgive all or parts of such repayments under the criteria established in this section and shall maintain all necessary records of forgiven payments.

(f) Receipts from the payment of principal, interest, or any other subsidies to which the department as administrator is entitled, which are paid by or on behalf of participants under this section, shall be deposited in the Hawaii health corps fund and shall be used to cover the costs of granting the scholarships, maintaining necessary records, and making collections under subsection (e). The department shall maintain accurate records of these costs, and all receipts beyond those necessary to pay such costs shall be used to grant scholarships to eligible students.

(g) Sponsoring communities who financially contribute to the eligible expenses of eligible medical students may enter into agreements with the student to require repayment should the student not serve the required service obligation in the community as a primary care physician. The department may develop criteria for the content of such agreements with respect to reasonable provisions and obligations between communities and eligible students.

(h) The department may make exceptions to the conditions for participation and repayment obligations should circumstances beyond the control of individual participants warrant such exceptions.

§ -12 Hawaii health corps fund. (a) There is established the Hawaii health corps fund to be administered by the department. Any funds appropriated by the legislature for the program or any other public or private funds intended for loan repayments or scholarships under this program shall be placed in the Hawaii health care fund.

(b) All receipts from the program shall be deposited into the fund. The department may authorize expenditures from the fund for purposes of this chapter."

SECTION 3. There is appropriated out of the general revenues of the State of Hawaii the sum of $1,000,000 or so much thereof as may be necessary for fiscal year 2005-2006 for purposes of the Hawaii health corps program.

The sum appropriated shall be expended by the department of health for the purposes of this Act.

SECTION 4. This Act shall take effect on July 1, 2005.

INTRODUCED BY:

_____________________________