A.R.S. tit. 36 ch. 21 — Arizona Revised Statutes Title 36 Chapter 21 — Medically Underserved Areas

36-2171. Definitions In this chapter, unless the context otherwise requires: 1. "Advance practice provider" means a physician assistant as defined in section 32-2501 or a registered nurse practitioner as defined in section 32-1601. 2. "Behavioral health provider" means a physician who is a board-certified or board-eligible psychiatrist, a psychologist, a physician assistant or a registered nurse practitioner who is certified to practice as a behavioral health specialist or a person who is licensed pursuant to title 32 as a clinical social worker, professional counselor or marriage and family therapist. 3. "Department" means the department of health services. 4. "Pharmacist" has the same meaning prescribed in section 32-1901. 5. "Rural" means either of the following: (a) A county with a population of less than four hundred thousand persons according to the most recent United States decennial census. (b) A census county division with less than fifty thousand persons in a county with a population of four hundred thousand or more persons according to the most recent United States decennial census. 36-2172. Primary care provider loan repayment program; purpose; eligibility; default; use of monies A. The primary care provider loan repayment program is established in the department to pay off portions of education loans taken out by physicians, dentists, pharmacists, advance practice providers and behavioral health providers. B. The department shall prescribe application and eligibility requirements that are consistent with the requirements of the national health service corps loan repayment program (42 Code of Federal Regulations part 62). To be eligible to participate in the primary care provider loan repayment program, an applicant shall meet all of the following requirements: 1. Have completed the final year of a course of study or program approved by recognized accrediting agencies for higher education in a health profession licensed pursuant to title 32 or hold an active license in a health profession licensed pursuant to title 32. 2. Demonstrate current or prospective employment with a public or nonprofit entity located and providing services in a federally designated health professional shortage area in this state as designated under 42 Code of Federal Regulations part 5. 3. Contract with the department to serve and be qualified to serve in general dentistry, family medicine, pediatrics, obstetrics, internal medicine, geriatrics, psychiatry, pharmacy or behavioral health. C. In addition to the requirements of subsection B of this section, an applicant who is a physician shall meet both of the following requirements: 1. Have completed a professional residency program in family medicine, pediatrics, obstetrics, internal medicine or psychiatry or a fellowship, residency or certification program in geriatrics. 2. Contract with the department to serve for at least two years. D. An advance practice provider, behavioral health provider or dentist who participates in the primary care provider loan repayment program shall initially contract with the department to provide services pursuant to this section for at least two years. E. An applicant who works at an Indian health service facility or tribal or urban Indian health facility is not required to provide a sliding fee scale to be eligible for the program. F. In making recommendations for the primary care provider loan repayment program, the department shall give priority to applicants who: 1. Intend to practice in rural areas most in need of primary care services. 2. Have been assigned to a high-need health professional shortage area pursuant to 42 Code of Federal Regulations part 5. 3. Meet criteria established in rule to determine priority consistent with the national health service corps loan repayment program (42 Code of Federal Regulations part 62, subpart B). G. All loan repayment contract obligations are subject to the availability of monies and legislative appropriation. The department may cancel or suspend a loan repayment contract based on unavailability of monies for the program. The department is not liable for any claims, actual damages or consequential damages arising out of a cancellation or suspension of a contract. H. This section does not prevent the department from encumbering an amount that is sufficient to ensure payment of each primary care provider loan for the services rendered during a contract period. I. The department shall issue program monies to pay primary care provider loans that are limited to the amount of principal, interest and related expenses of educational loans, not to exceed the provider's total student loan indebtedness, according to the following schedule: 1. For physicians and dentists: (a) For the first two years of service, a maximum of $65,000. (b) For subsequent years, a maximum of $35,000. 2. For advance practice providers, pharmacists and behavioral health providers: (a) For the first two years of service, a maximum of $50,000. (b) For subsequent years, a maximum of $25,000. J. A participant in the primary care provider loan repayment program who breaches the loan repayment contract by failing to begin or to complete the obligated services is liable for liquidated damages in an amount equivalent to the amount that would be owed for default as prescribed by the federal grants to states for loan repayment program or as determined and authorized by the department. The department may waive the liquidated damages provisions of this subsection if it determines that death or permanent physical disability accounted for the failure of the participant to fulfill the contract. The department may prescribe additional conditions for default, cancellation, waiver or suspension that are consistent with the national health service corps loan repayment program (42 Code of Federal Regulations sections 62.27 and 62.28). K. Notwithstanding section 41-192, the department may retain legal counsel and commence whatever actions are necessary to collect loan payments and charges if there is a default or a breach of a contract entered into pursuant to this section. L. The director of the department may authorize the program to be implemented independent of the federal grants for state loan repayment program based on the needs of this state. M. The department may use monies to develop programs such as resident-to-service loan repayment and employer recruitment assistance to increase participation in the primary care provider loan repayment program. The department may use private donations, grants and federal monies to implement, support, promote or maintain the program. 36-2173. Obstetrical practitioners; underserved areas; payment of insurance premiums; prioritization A. A physician or an advance practice provider who provides obstetrical services in rural areas of this state may apply for and receive financial assistance to offset medical malpractice premium expenses. B. To be qualified for assistance, a person shall apply to the department on a form and in a manner prescribed by the department and shall meet the following requirements: 1. Have current obstetrical delivery privileges at one or more hospitals that are located in rural areas of this state and that are not operated by the federal government. 2. Have a contract with the Arizona health care cost containment system administration for obstetrical services with one or more of the system's prepaid contractors. 3. Be licensed under title 32, chapter 13, 15, 17 or 25. 4. Personally incur malpractice insurance costs. C. The department shall establish an index that uses indicators to determine a score for each applicant service area. These indicators shall include: 1. The availability of obstetrical services based on a population to provider ratio. 2. The area's geographic accessibility to obstetrical services. 3. The percentage of the area's population that is at or below a designated federal poverty level. D. The department shall identify physicians and advance practice providers who are practicing in medically underserved areas and shall notify them of the eligibility for assistance under this section. A physician or advance practice provider shall submit an application for assistance within thirty days of receiving the notification. The department shall offer assistance to qualified applicants based on the ranking of the area in which the applicant serves as established under subsection C of this section. The applicant shall enter into a contract with the department under which the applicant agrees to remain in practice in the specific area for one year. These contracts are exempt from the requirements of title 41, chapter 23. E. Family physicians and advance practice providers who perform less than fifty-one deliveries per year and who are required to pay an additional premium to perform obstetrical services are eligible to receive an amount of not more than five thousand dollars. Family physicians and obstetricians who perform more than fifty deliveries per year are eligible to receive an amount of not more than ten thousand dollars. F. The health care provider shall submit a report to the department that contains statistical information required by the department and that identifies the number of women to whom the provider has provided medical services during childbirth, the women's ages, the number of prenatal visits each woman received, the number of these women who are enrolled in the Arizona health care cost containment system and the women's insurance status. 36-2174. Rural private primary care provider loan repayment program; private practice; rules A. Subject to the availability of monies, the department shall establish a rural private primary care provider loan repayment program for physicians, dentists, pharmacists, behavioral health providers and advance practice providers with current or prospective rural primary care practices located in federally designated health professional shortage areas or medically underserved areas in this state, as prescribed in section 36-2352. To be eligible to participate in the program, an applicant shall agree to provide organized, discounted, sliding fee scale services for medically uninsured individuals from families with annual incomes below two hundred percent of the federal poverty guidelines as established annually by the United States department of health and human services. An applicant who works at an Indian health service or tribal facility is not required to provide a sliding fee scale to be eligible for the program. The department shall approve the sliding fee scale used by the provider. The provider shall ensure notice to consumers of the availability of these services. The department shall give preference to applicants who agree to serve in rural areas. B. Except as provided in section 36-2172, subsection B, paragraph 2, the program established pursuant to this section and loan repayment contracts made pursuant to this section shall comply with the requirements of section 36-2172. C. The department may apply for and receive private donations and grant monies to implement the rural private primary care provider loan repayment program established pursuant to this section. D. The department shall adopt rules to cancel or suspend a loan repayment contract, impose a penalty for default or find a person in default of a contract. 36-2175. Behavioral health care provider loan repayment program; purpose; eligibility; default; use of monies A. The behavioral health care provider loan repayment program is established in the department to pay off portions of educational loans taken out by behavioral health care providers and nurses, including behavioral health technicians, behavioral health nurse practitioners, psychiatric nurse practitioners and licensed practical nurses, physicians, psychiatrists, and psychologists who serve in behavioral health facilities, including the Arizona state hospital, behavioral health residential facilities and secure behavioral health residential facilities. B. The department shall prescribe application and eligibility requirements. To be eligible to participate in the behavioral health care provider loan repayment program, an applicant shall meet at least the following requirements: 1. Have completed the final year of a course of study or program approved by recognized accrediting agencies for higher education in a health profession licensed pursuant to title 32 or hold an active license in a health profession licensed pursuant to title 32. 2. Demonstrate current employment providing direct patient care with a public or nonprofit entity located and providing services in a behavioral health hospital, a behavioral health residential facility or a secure behavioral health residential facility in this state. 3. Demonstrate that the current employer is contracted with the Arizona health care cost containment system to provide services. 4. Not be participating in any other loan repayment program established by this article. C. In addition to the requirements of subsection B of this section, an applicant who is a physician shall have completed a professional residency or certification program in behavioral health care. D. A behavioral health care provider or nurse who participates in the behavioral health care provider loan repayment program shall initially contract with the department to provide services pursuant to this section for at least two years. E. In making recommendations for the behavioral health care provider loan repayment program, the department shall give priority to applicants who intend to practice in the Arizona state hospital, a behavioral health residential facility or a secure behavioral health residential facility in this state. F. All loan repayment contract obligations are subject to the availability of monies and legislative appropriation. The department may cancel or suspend a loan repayment contract based on unavailability of monies for the program. The department is not liable for any claims, actual damages or consequential damages arising out of a cancellation or suspension of a contract. G. This section does not prevent the department from encumbering an amount that is sufficient to ensure payment of each behavioral health care provider loan for the services rendered during a contract period. H. The department shall issue program monies to pay behavioral health care provider loans that are limited to the amount of principal, interest and related expenses of educational loans, not to exceed the behavioral health care provider's or nurse's total student loan indebtedness, according to the following schedule: 1. For the first two years of service, a maximum of $50,000. 2. For subsequent years, a maximum of $25,000. I. A participant in the behavioral health care provider loan repayment program who breaches the loan repayment contract by failing to begin or to complete the obligated services is liable for liquidated damages in an amount equivalent to the amount that would be owed for default as determined and authorized by the department. The department may waive the liquidated damages provisions of this subsection if it determines that death or permanent physical disability accounted for the failure of the participant to fulfill the contract. The department may prescribe additional conditions for default, cancellation, waiver or suspension. J. Notwithstanding section 41-192, the department may retain legal counsel and commence actions that are necessary to collect loan payments and charges if there is a default or a breach of a contract entered into pursuant to this section. K. The department may use monies to develop programs such as resident-to-service loan repayment and employer recruitment assistance to increase participation in the behavioral health care provider loan repayment program. The department may use private donations, grants and federal monies to implement, support, promote or maintain the program.