MARYLAND DEPARTMENT OF HEALTH Federal Loan Repayment Programs

MARYLAND DEPARTMENT OF HEALTH Federal Loan Repayment Programs Elizabeth Vaidya, Director, Primary Care Office (PCO) Office of Population Health Improvement, PHS June 7, 2018

Office of Population Health Improvement Vision In pursuit of a healthy, thriving Maryland, the Office of Population Health Improvement (OPHI) envisions a health system that is stakeholder-driven, datainformed, and financially aligned with health in all policies. Mission We seek to transform public health through stewardship of data, partnerships, and funding initiatives to develop innovative health policy and improve the health infrastructure of Maryland. 2

Office of Population Health Improvement Coordinates the integration of Maryland’s high-performing public health system with value-based health care to: Improve Maryland’s population health and Reduce Maryland’s health care spending Health Care Transformation State Innovation Model, Primary Care Model, Population Health Quality Measurement: Health Equity & Social Determinants Workforce Development for Healthcare Professionals Maryland State Loan Assistance Repayment Program, J-1 Visa Waiver, Preceptor Tax Credit, National Health Service Corps Primary Care Improvement Health Professional Shortage Area designations Rural Health Improvement Maryland’s Rural Health Plan $53. 0 Million Budget* 12 Employees** + *FY 19 allowance, $51. 8 M GF, $1. 1 M FF + Reduction of FF due to removal of Title V MCH $ from Core funding Mechanism **7 pin allowance, with other contractual employees 3 Quality Improvement Public Health Accreditation, Public Health Services Training Needs School Health Naloxone / Opioids & SUD, Disaster Preparedness, Immunization, School Telehealth, Health Services, Guidelines, TA and professional development State Health Improvement Plan (SHIP) DHMH Dashboard for 39 health measures by jurisdiction Local Health-Core Funding, Local Health Improvement Coalitions Public Health Workforce Development Core Funding For 24 Local Health Departments and the Baltimore City Health Department

Office of Population Health Improvement: Accomplishments Quality Improvement • Public Health Accreditation: 7 Local Health Departments are accredited; 7 are applying. • PHS Quality Improvement Plan: designed, executed, and progressing on to version 2. • MDH Public Health Services Quality Improvement Council established and sustained. • Project management and technical assistance in quality improvement offered to all PHS staff. • Quality improvement orientation attended by 227 staff. • Quality improvement basics (2 -day exercise) attended by 25 staff. School Health • Diabetes management: Provided access to online diabetes training by the National Association of School Nurses (NASN) to 100 school nurses. • Naloxone: Technical assistance and guidance to local programs for school nurses on administration of naloxone. Distributed 175 reusable Narcan nasal spray trainers to the 24 jurisdictions. • SBIRT: Partnered to implement SBIRT in 15 school based health centers • Healthy School Dashboard: Collaborate with Garrett County Public Schools and the University of Maryland to correlate student health and academic outcomes 4 Rural Health • Maryland’s Rural Health Plan: SORH in collaboration with rural health stakeholders to update the Maryland Rural Health Plan published in January 2018. • Rural Prosperity Investment Fund: grant awarded for rural healthcare program totaling $520, 680. 00. • Maryland Agricultural Education and Rural Development Assistance Fund : Grant awarded for rural healthcare program a total of $138, 766 • Maryland Rural Health Day: proclamation from Governor Hogan to declare November 17, 2017 Maryland Rural Health Day.

Office of Population Health Improvement: Accomplishments Primary Care Office • Technical Assistance: Recommended four FQHC applications for funding ($2. 5 million) for the Maryland Capital Program. There are 21 FQHC organizations totaling 136 service delivery sites serving 301, 322 patients. • Shortage Designations: Analyzed 89 HPSA designations (53 continued designation, 18 new areas met eligibility, and 18 were recommended with changes). 1 MUP recommended for update. Health Professions Workforce Programs • State Loan Repayment Program (SLRP) & Maryland Loan Repayment Program (MLRP): Awarded 64 recipients $387, 890. 2 in Federal funds and $752, 890. 2 in State funds • J-1 Visa Waiver: All 30 slots allocated & updated waiver policy • Income Tax Credit Preceptor Program: • National Health Service Corps: 172 NHSC loan repayment awards were approved for Maryland clinicians (53% behavioral health for non-physicians, 12% physicians, 20% nurses, 5% nurse midwives, 4% PAs, 4% dentists, 2% dental hygienists). The PCO attended and participated with HRSA staff in 11 NHSC site visits in 2017. Public Health Accreditation • National public health accreditation awarded through Public Health Accreditation Board (PHAB) • PHS Strategic Plan developed and implemented. • Performance management of strategic plan tracked through development and maintenance of dashboard. 5

Office of Population Health Improvement: Accomplishments Public Health Workforce Development • • PHS Training Needs Assessment: developed and disseminated as part of Workforce Development Collaborative Workforce Development Plan featured at national conference, American Public Health Association (APHA). National Recognition of Workforce Development Plan at meeting of Association of State and Territorial Health Officials (ASTHO), Public Health Workforce Interests and Needs Survey (PHWINS). National Workforce Development Collaborative: participation through ASTHO PHWINS. Population Health and Healthcare Transformation ● ● 6 State Health Improvement Process (SHIP): Maintenance of 39 health targets implemented through Local Health Improvement Coalitions. Ongoing collaboration with Medicaid, hospitals, and other MDH units related to primary care transformation, population health measurement definition, and advanced payment model development.

Federal Loan Repayment Programs Primary Care Office Overview

Primary Care Office (PCO) Overview Funding & Mission 8 • Maryland Primary Care Office (PCO) – Mission is to improve access to dental, mental and primary health care services for all Maryland residents through shortage designation, workforce programs, community interaction, and technical assistance to stakeholders. • Federally funded by the Health Resources & Services Administration’s (HRSA’s) Bureau of Health Workforce and housed within MDH’s Office of Health Population Improvement (OPHI).

Primary Care Office (PCO) Overview How Do We Improve Access to Healthcare? • Recruiting, Retaining, Communicating with Providers • Collaboration & Partnering with Stakeholders • • • LHDs LHICs Hospitals Practitioners FQHCs • Capital Bond Funding • Determining needs for your community • Shortage Designations 9

Primary Care Office (PCO) Overview Benefits of Shortage Designations § Component for Eligibility for certain HRSA Grants like: • Federally Qualified Health Center or Look-Alike applications • Rural Health Center applications • Area Health Education Centers § CMS Physician Bonus Payments § Workforce Programs • National Health Service Corps’ Loan Repayment and Scholarship Programs • Nurse Corps and Scholarship Programs • Maryland State Loan Repayment Program • Preceptor Tax Credit Program • J-1 Visa Waiver & National Interest Waiver Programs • Appalachian Regional Commission (ARC) • Department of Health and Human Services (HHS) 10

Federal Loan Repayment Programs National Health Service Corps (NHSC)

National Health Service Corps 3 STEP PROCESS 1. PCO determines HPSA in MD. Each HPSA receives a score for NHSC to utilize for funding priority. (only sites with scores of 15 and higher were awarded in 2017) for MD. 2. NHSC Site Review – PCO Review site applications from April-June each year. 3. NHSC Scholars & Loan Repayment Awardees – Eligible NHSC sites (scores 17 and higher) can recruit for Scholars or utilize the NHSC loan repayment program for recruitment of new employees or retention of current employees. 12

National Health Service Corps NHSC SITE REVIEW • PCO reviews each site to make sure they meet NHSC requirements: • • Policies on Non-Discrimination Sliding Fee Schedule Documents & Policy Required NHSC Signage Proof of Access to Ancillary, Inpatient and Specialty Care • NHSC Site Data Tables 13

National Health Service Corps NHSC SCHOLARSHIP PROGRAM • Disciplines: • Physicians (MD or DO) • Dentists • Nurse Practitioners • Certified Nurse-Midwives • Physician Assistants • Scholarship pays tuition, fees, other educational costs, and provides a living stipend in return for a commitment to work at least 2 years at an NHSC-approved site with a HPSA score of 17 or higher. 14

National Health Service Corps TOTAL LOAN REPAYMENT PARTICIPANTS IN MARYLAND* 2% Dental Hygienists 4% Dentists 4% 53% 12% PHYSICIANS Mental Health (Non-Physician) Nurse Practitioners Providers 20% 15 Physician Assistants 5% Nurse Mid-wives

National Health Service Corps NHSC LOAN REPAYMENT AWARD The NHSC Loan Repayment Program offers priority funding to applicants who work at NHSCapproved sites in high-need areas, as defined by a Health Professional Shortage Area (HPSA) score. AWARD AMOUNTS UP TO $50, 000 FOR 2 YEARS Full-time UP TO $25, 000 FOR 2 YEARS Half-time In FY 17, awards were given to Maryland applicants working at sites with HPSA scores between 15 - 22. 16

National Health Service Corps NHSC ELIGIBILITY U. S. citizen or national Currently work, or applying to work, at an NHSC-approved site Have unpaid government or commercial loans for school tuition, reasonable educational expenses, and reasonable living expenses, segregated from all other debts Licensed to practice in state where employer site is located Must be licensed in one of the following eligible disciplines: • • Physician (MD or DO) Nurse practitioner (primary care) Certified nurse-midwife Physician assistant 17 • • Dentist (general or pediatric) Dental hygienist Psychiatrist Psychologist (health service) • • Licensed clinical social worker Psychiatric nurse specialist Marriage and family therapist Licensed professional counselor

National Health Service Corps APPLICATIONS • Loan Repayment https: //nhsc. hrsa. gov/loanrepayment/index. html • Site Approval https: //nhsc. hrsa. gov/sites/index. html To see if your site(s) are located in a Health Professional Shortage Area (HPSA), please visit: http: //hpsafind. hrsa. gov/ 18

Federal Loan Repayment Programs NURSE Corps

NURSE Corps What is NURSE Corps? NURSE Corps is a federally funded program that awards scholarships and loan repayment to nurses, nursing students, and nurse faculty. • The program helps to support nurses by paying for qualifying educational loans. • It also aides in building healthier communities in areas of greatest need. 20

NURSE Corps 2 STEP PROCESS 1. PCO determines primary care and mental Health Professional Shortage Areas (HPSAs) in MD. 2. Qualified nurses apply to the program and if accepted, must serve two years at a CSF*. *A Critical Shortage Facility (CSF) is a nonprofit health care facility located in, designated as, or serving an area designated as a HPSA. 21

NURSE Corps ELIGIBILITY REQUIREMENTS • Be a U. S. citizen (either U. S. born or naturalized), U. S. National, or Lawful Permanent Resident • Have one of the following degrees: associates, bachelor’s, master’s, doctoral, or a diploma in nursing • Have a current, full, permanent, unencumbered, unrestricted and valid Maryland RN license • Have outstanding, qualified nursing education loans 22

NURSE Corps DISCIPLINES • • • 23 Registered Nurse Practitioner Certified Nurse-Midwife Clinical Nurse Specialist Nurse Anesthetist Nurse Faculty

NURSE Corps TYPES OF AWARDS • Initial 2 -year Award: NURSE Corps participants receive an Award equal to 60% of their current, outstanding, qualifying loan balances incurred while pursuing education in nursing; in return for a 2 -year service commitment at a Critical Shortage Facility (CSF) • Continuation Award: After the completion of the initial 2 -years of service qualifying NURSE Corps Loan Repayment Program participants may receive an additional 25% of their original loan balance for a third year of service • All awards are subject to Federal Taxes 24

NURSE Corps TYPES OF CSF Eligible Facilities: Hospitals: • Critical Access Hospital (CAH) • Disproportionate Share Hospital (DSH) • Public Hospital • Private Hospital Outpatient Clinics: • Federally Qualified Health Center • Indian Health Service Health Center • Native Hawaiian Health Center • Rural Health Clinic • State or Local Public Health or Human Services Department • Nurse Managed Health Clinic/Center 25 Outpatient Clinics (Continued): • Urgent Care Center • Certified Community Behavioral Health Clinic • End Stage Renal Disease Dialysis • Ambulatory Surgical Center • Residential Nursing Home • Home Health Agency • Hospice Program Ineligible Facilities include, but are not limited to: • Private practice offices • Clinics in prisons and correctional facilities

NURSE Corps SERVICE REQUIREMENTS • Registered Nurses (RN) must provide full-time service, defined as working at least 32 hours per week for a minimum of 45 weeks per year, at a Critical Shortage Facility • Nurse Faculty (NF) must provide full-time service by teaching pre-licensure students, RNs or Advanced Practice Nurses, in an eligible public or private nonprofit school of nursing, at least 9 months out of the year. • Scholars – Must work at an eligible CSF upon graduation. 26

NURSE Corps FUNDING PRIORITY Qualified applicants will be grouped into one of the funding preference tiers based on the factors described in the table below. Debt to Salary Ratio 27 Funding Preference Tiers 100% or Above Tier 1 99. 99% or Less Tier 2

NURSE Corps ADDITIONAL RESOURCES • Nurse Corps Loan Repayment Program Web Site: https: //bhw. hrsa. gov/loansscholarships/nursecorps/lrp To see if your site(s) are located in a Health Professional Shortage Area (HPSA), please visit: http: //hpsafind. hrsa. gov/ 28

Federal Loan Repayment Programs CONTACT Elizabeth Vaidya, Director Primary Care Office (PCO), Shortage Designation, Federal Workforce Programs (NHSC & Nurse Corps) (410) 767 -5695 office Elizabeth. vaidya@maryland. gov Office of Population Health Improvement (OPHI), PHS, MDH 201 West Preston Street Baltimore, MD 21201 Website: http: //pophealth. dhmh. maryland. gov/Pages/Primary-Care. aspx 29