State Loan Repayment Program Service Requirements for Clinician Awardees

A service obligation is a contractual commitment. National Health Service Corps (NHSC) State Loan Repayment Program (SLRP) non-federal entities (NFEs)/grantees award eligible clinicians, who then must adhere to a set of requirements.

What is a clinician’s length of service?

Full-time service*

• A minimum of two years full-time
• 40 hours per week, of which 32 hours is spend providing direct patient care
• A minimum of 45 weeks each service year

Half-time service*

• Two years half-time
• Between 20 and 39 hours per week, of which 16 hours is spent providing direct patient care
• A minimum of 45 weeks each service year

State and federal statutes and program and grant policies may require clinicians to follow more specific terms and conditions.

*Review the NHSC LRP APG, pages 31-38 for more information (PDF - 696 KB).

Can clinicians extend their service?

If a clinician chooses to apply for a contract extension, s/he must continue to meet the same program requirements for the duration of the contract.

What happens if a clinician is unable to complete their service?

If a clinician breaches their NHSC SLRP obligation, they will be responsible for repaying an amount equal to the sum of the following:

1. The amounts paid to the participant for any period not served;
2. The number of months not served, multiplied by $7,500; and
3. Interest on (A) and (B).

If the amount resulting from the above formula is less than $31,000, then the clinician owes $31,000. The clinician must pay the amount owed within one year of breach.

Where must clinicians complete their service?

States receiving SLRP grants assign clinicians to public and nonprofit sites in federally designated Health Professional Shortage Areas (HPSAs).

There are three HPSA categories:

• Primary medical care
• Dental health
• Mental health

All clinicians must work in a HPSA that corresponds with their training (e.g., a dentist must work in a dental HPSA).

How does a facility get a HPSA designation?

Communities or facilities must directly contact their respective State Primary Care Offices (PCO).

The PCO submits HPSA applications to HRSA for review and approval.

Eligible Site Types

• Federally-Qualified Health Centers (FQHCs)*
  • Community health center
  • Migrant health
  • Homeless program
  • Public housing program
  • School-based program
  • Mobile clinic
• FQHC Look-Alikes*
• American Indian Health Facilities: Indian Health Service Facilities, Tribally Operated 638 Health Programs, and Urban Indian Health Programs (ITUs)
  • Indian Health Service (IHS) American Indian/Alaskan Native Health Facilities
  • Tribal/638 health facility
  • Dual-funded (Tribal Health Clinic and FQHC-funded)
  • Urban Indian Health Program
  • IHS hospitals
• Correctional or Detention Facilities
  • Federal prison*
  • State prison
    *Note: Not all prisons are eligible. A prison must meet certain criteria and qualify for a designated HPSA.
  • Immigration and Customs Enforcement (ICE) Health Service Corps*
• Centers for Medicare & Medicaid Services Certified Rural Health Clinics (RHC)
  • Provider-based
  • Independent
• Critical Assess Hospitals (CAH)
• Community Mental Health Centers (CMHC)
• State or Local Health Departments
• Community Outpatient Facilities
  • Hospital-affiliated
  • Non-hospital-affiliated
• Private Practices (Solo or Group)
• School-based Clinics
• Mobile Units
• Free Clinics

*This site type may be an eligible auto-approved site.

Sliding Fee Requirements

Eligible practice sites must provide discounts—via a sliding fee schedule—for individuals with limited incomes.

• For individuals with annual incomes at or below 100% of the HHS Poverty Guidelines:
  • Sites must provide services at no charge, or at a nominal charge.
• For individuals with annual incomes between 100% and 200% of the HHS Poverty Guidelines:
  • Sites must provide a schedule of discounts, which should reflect a nominal charge covered by a third party (either public or private), which is authorized or under legal obligation to pay the charges.