Title of Regulation: 12VAC5-525. Regulations for Physician Assistant Scholarships (adding 12VAC5-525-10 through 12VAC5-525-140).

Statutory Authority: § 32.1-122.6:03 of the Code of Virginia.

Effective Date: February 17, 2022.

Agency Contact: Olivette Burroughs, Statewide Health Workforce Manager, Virginia Department of Health, 109 Governor Street, Richmond, VA 23219, telephone (804) 864-7431, FAX (804) 864-7440, or email olivette.buroughs@vdh.virginia.gov.

Summary:

The action creates a new regulation to comply with § 32.1-122.6:03 of the Code of Virginia, which requires the establishment of an annual physician assistant scholarship program for students who intend to enter an accredited physician assistant program. The substantive elements are modeled after similar scholarship incentive programs and include definitions; eligibility and selection criteria; conditions of participation; processes for applying, selecting a practice site, deferring or waiving scholarship, and repayment in cases of default; number of scholarships one student may have and amount of scholarships available to each student; reporting requirements; contract contents; and what constitutes a breach of contract.

Changes since the proposed include (i) changing the term "participant" to "recipient"; (ii) clarifying that the cumulative grade point average to be eligible for the scholarship must be at least 3.0; (iii) defining the maximum number of scholarships that each applicant is eligible to receive; (iv) clarifying the award amount, the number of scholarships available, and how awards are determined; (v) including websites where the scholarship eligibility guidelines are located and where maps of the Health Professional Shortage Areas can be found to assist recipients in fulfilling their obligation; (vi) clarifying the obligation of the start date, that failure to transfer to an eligible practice site is a breach of contract, that leaving the Commonwealth prior to completing training or service obligation also constitutes a breach of contract and the associated penalties if such scholarship obligations are not completed; and (vii) clarifying what events are eligible for deferment, waivers, and variances and how to submit a request.

Summary of Public Comments and Agency's Response: No public comments were received by the promulgating agency.

Chapter 525

Regulations for Physician Assistant Scholarships

12VAC5-525-10. Definitions.

The following words and terms when used in this chapter shall have the following meanings:

"Approved physician assistant program" means a fully accredited physician assistant school in Virginia as approved by the board.

"Board" or "Board of Health" means the State Board of Health.

"Commissioner" means the State Health Commissioner.

"Department" means Virginia Department of Health.

"Full-time" means at least 32 hours per week for 45 weeks per year.

"Health professional shortage area" or "HPSA" means an area in Virginia designated by the U.S. Secretary of Health and Human Services as having a shortage of health professionals in accordance with the procedures of the Public Health Service Act (42 USC § 254e) and implementing regulations (42 CFR Part 5).

"Interest" means the legal rate of interest pursuant to § 6.2-302 of the Code of Virginia.

[ Participant"" or "recipient" means an eligible registered physician assistant student of an approved physician assistant program who enters into a contract with the commissioner and participates in the scholarship program. ]

"Penalty" means twice the amount of all monetary payments to the scholarship [ participant award recipient ], less any service obligation completed.

"Physician assistant" or "PA" means an individual who has met the requirements of the Board of Medicine for licensure and who works under the supervision of a licensed doctor of medicine, osteopathy, or podiatry as defined in § 54.1-2900 of the Code of Virginia.

"Practice" means the practice of medicine by a recipient in one of the defined primary care specialties in a location within Virginia that is designated as a health professional shortage area or a Virginia medically underserved area to fulfill the recipient's service obligation.

"Primary care" means the specialties of family practice medicine, general internal medicine, pediatric medicine, and obstetrics and gynecology.

[ "Recipient" means an eligible registered physician assistant student of an approved physician assistant program who enters into a contract with the commissioner and participates in the scholarship program. ]

"Virginia medically underserved area" or "VMUA" means an area in Virginia designated by the State Board of Health in accordance with the Rules and Regulations for the Identification of Medically Underserved Areas in Virginia (12VAC5-540) or § 32.1-122.5 of the Code of Virginia.

12VAC5-525-20. Physician assistant scholarship committee.

All scholarship awards shall be made by the physician assistant scholarship committee appointed by the board. The physician assistant scholarship committee shall consist of eight members: four deans or directors of physician assistant programs or their designees, two former scholarship [ award ] recipients, and two members with experience in the administration of student financial aid programs. Committee appointments shall be for two-year terms, and members shall not serve for more than two successive terms.

12VAC5-525-30. Eligibility for scholarships.

In order to be considered for a scholarship [ award ], an applicant shall:

1. Be a United States citizen, national, or a qualified alien pursuant to 8 USC § 1621;

2. Be accepted for enrollment or enrolled in an approved PA program in the Commonwealth of Virginia preparing him for examination for licensure as a PA in the Commonwealth of Virginia;

3. If already enrolled in an approved PA program in the Commonwealth, the student must have a cumulative grade point average of [ at least ] 3.0;

4. Submit a completed application form and appropriate grade transcript prior to the established deadline dates;

5. Demonstrate financial need, which is verified by the school's financial aid officer or authorized person, as part of the application process; and

6. Not have an active military obligation.

An applicant who fails to meet all of these requirements shall be ineligible for a scholarship.

12VAC5-525-40. Conditions of scholarships.

A. Prior to becoming a [ participant recipient ] in the PA scholarship program, the applicant shall enter into a contract with the commissioner agreeing to the terms and conditions upon which the scholarship is granted.

B. For each $5000 of scholarship money received, the [ participant recipient ] agrees to engage in the equivalent of one year of full-time primary care medical practice in a HPSA or VMUA within the Commonwealth. The recipient shall notify the department, within 180 days of being awarded a PA degree, of the type of practice to be performed and give the name and address of the employer for approval. Voluntary military service, even if stationed in Virginia, cannot be used to repay the service obligation required when a scholarship is awarded.

C. If a [ participant recipient ] fails to complete his studies, the full amount of the scholarship or scholarships received, plus the applicable interest charge, shall be repaid.

D. If upon graduation a [ participant recipient ] leaves the Commonwealth or fails to engage or ceases to engage in primary care medical practice in Virginia before all employment conditions of the scholarship award are fulfilled, the [ participant recipient ] shall repay the award amount reduced by the proportion of obligated years served plus the applicable interest and penalty. [ The penalty is twice the amount of the scholarship award received plus interest, less any service obligation completed. ]

E. If the [ participant recipient ] is in default due to death or permanent disability so as not to be able to engage in medical practice, the [ participant recipient ] or his personal representative [ , upon repayment of the total amount of scholarship funds received plus applicable interest, may be relieved of his obligation under the contract to engage in medical practice. For participants completing part of the PA obligation prior to becoming permanently disabled or in the event of death, the total amount of scholarship funds owed shall be reduced by the proportion of obligated years served. The obligation to make restitution may be waived by the board upon application of the participant or the participant's personal representative to the board may request the board waive his obligation under the contract as described in 12VAC5-525-130 ].

F. All default payments shall be made payable to the Commonwealth of Virginia.

12VAC5-525-50. Number of applications per student.

Scholarships are awarded for single academic years. However, the same student may, after demonstrating satisfactory progress in his studies, which is demonstrated by a cumulative grade point average of [ at least ] 3.0, apply for and receive scholarship awards for a succeeding academic year or years. No student shall receive scholarships for more than a total of [ four three ] years.

12VAC5-525-60. Amounts of scholarships.

The [ amount and ] number of [ scholarships awarded shall be dependent upon the amount of money appropriated by the General Assembly, the amount of funds available within the Physician Assistant Scholarship Fund administered by the board, scholarship awards shall be determined annually as provided in the Appropriation Act ] and [ based on ] the number of qualified applicants. Each [ participant recipient ] shall receive an award of $5,000 per year [ , based upon the availability of funds ].

12VAC5-525-70. How to apply.

Eligible applicants shall submit a complete application made available by the department on the department's website [ at http://www.vdh.virginia.gov ]. A complete application shall include documentation of all eligibility requirements. The deadline for submission of the application shall be announced by the department on the department's website.

12VAC5-525-80. Selection criteria.

Applicants shall be competitively reviewed and selected for participation in the Physician Assistant Scholarship Program based upon the following criteria pursuant to § 32.1-122.6:03 of the Code of Virginia:

1. Qualifications. All of an individual's professional qualifications and competency to practice in an underserved area will be considered, including eligibility for Virginia licensure, professional achievements, and other indicators of competency received from supervisors, program directors, or other individuals who have previously entered into an employment contract with the individual.

2. Virginia residents. Preferential consideration shall be given to individuals who are or have been Virginia residents (verification will be obtained by the Virginia Physician Assistant Scholarship Program).

3. Residents of medically underserved areas. Preferential consideration shall be given to individuals who reside in rural, Virginia medically underserved areas, or health professional shortage areas (verification shall be obtained by the Virginia Physician Assistant Scholarship Program).

12VAC5-525-90. Scholarship contract.

Applicants selected to receive scholarship awards by the physician assistant scholarship committee shall sign and return a written contract to the department by the specified deadline date. Failure to return the contract by the specified deadline date may result in the award being rescinded. At minimum, the scholarship contract shall include the following elements:

1. The total amount of the award and the award period;

2. Agreement to pursue a degree at an accredited PA program in the Commonwealth of Virginia that is approved by the board;

3. Agreement to begin continuous full-time employment within 180 days of the recipient's [ graduation completion of training ];

4. Agreement to comply with all reporting requirements;

5. Agreement to the terms of service requiring continuous full-time primary care medical practice in the Commonwealth for a specified period of time and the terms and conditions associated with a breach of contract;

6. Signature of the applicant; and

7. Signature of the commissioner or his designee.

A recipient may terminate a contract while enrolled in school after notice to the board and upon repayment within 90 days of the entire amount of the scholarship [ award ] plus interest.

12VAC5-525-100. Practice site selection.

Each recipient shall perform his service obligation at a practice site in either a health professional shortage area or a Virginia medically underserved area. The [ participant recipient ] shall agree to provide health services without discrimination, regardless of a patient's ability to pay. Maps of health professional shortage areas and Virginia medically underserved areas shall be available on the department's website [ at http://www.vdh.virginia.gov ].

12VAC5-525-105. Change of practice site.

Should any [ participant recipient ] find that he is unable to fulfill the service commitment at the practice site to which he has committed to practice, he may request approval of a change of practice site. Such requests shall be made in writing. The department in its discretion may approve such a request. All practice sites, including changes of practice sites, shall be selected with the approval of the commissioner.

[ Failure of the recipient to transfer to another site shall be deemed to be a breach of the contract.

In the event of a breach of contract and in accordance with the terms of the contract, the recipient shall make default payments as described in 12VAC5-510-30. ]

In the event of a dispute between the [ participant recipient ] and the practice site, every effort shall be made to resolve the dispute before reassignment will be permitted.

12VAC5-525-110. Reporting requirements.

A. Each [ participant recipient ] shall provide information as required by the department to verify compliance with the practice requirements of the PA scholarship program (e.g., verification of employment in a primary care setting form once every [ six months) 180 days) ].

B. Each [ participant recipient ] shall promptly notify the department in writing within 30 days if any of the following events occur:

1. [ Participant Recipient ] changes name;

2. [ Participant Recipient ] changes address;

3. [ Participant Recipient ] changes practice site. [ Participant Recipient ] is required to request in writing and obtain prior approval of changes in practice site;

4. [ Participant Recipient ] no longer intends or is able to fulfill service obligation as a PA in the Commonwealth;

5. [ Participant Recipient ] ceases to practice as a PA; or

6. [ Participant Recipient ] ceases or no longer intends to complete his PA academic program.

12VAC5-525-120. Breach of contract.

The following shall constitute a breach of contract:

1. The recipient fails to complete his PA studies;

2. [ The recipient leaves the Commonwealth of Virginia prior to completing studies or service obligation;

3. ] The recipient fails to begin or complete the term of obligated service under the terms and conditions of the scholarship contract;

[ 3. 4. ] The recipient falsifies or misrepresents information on the program application, the verification of employment forms, or other required documents; and

[ 4. 5. ] The recipient's employment is terminated for good cause as determined by the employer and confirmed by the department. If employment is terminated for reasons beyond the [ participant's recipient's ] control (e.g., closure of site), the [ participant recipient ] shall transfer to another site approved by the board in the Commonwealth within [ six months 180 days ] of termination. Failure of [ participant recipient ] to transfer to another site shall be deemed to be a breach of the contract.

In the event of a breach of contract and in accordance with the terms of the contract, the recipient shall make default payments as described in 12VAC5-525-40. In the event of a breach of contract where the recipient has partially fulfilled his obligation, the total amount of reimbursement shall be prorated by the proportion of obligation completed.

12VAC5-525-130. [ Deferment and Deferments, ] waivers [ , and variances ].

A. [ In the event that a recipient is unable to find employment at an approved practice site or complete physician assistant school, a recipient may request a deferment of service obligation to secure employment at an approved practice site or to complete physician assistant school in Virginia. ]

If the [ participant recipient ] is in default due to death or permanent disability so as not to be able to engage in primary care practice in a region designated as a HPSA or VMUA in the Commonwealth, the [ participant recipient ] or his personal representative may be relieved of his obligation under the contract to engage in practice, upon repayment of the total amount of scholarship [ award ] received plus applicable interest. For [ participants recipients ] completing part of the obligation prior to becoming permanently disabled or in the event of death, the total amount of scholarship funds owed shall be reduced by the proportion of obligated years served. The obligation to make restitution may be waived by the board upon application of the [ participant recipient ] or the [ participant's recipient's ] personal representative to the board.

B. Individual cases of undue hardship may be considered for a variance by the board of payment or service pursuant to § 32.1-12 of the Code of Virginia.

C. [ All requests for deferments, waivers, or variances must be submitted in writing to the department for consideration and final disposition by the board A variance, waiver, or deferment request must be submitted in writing to the department and be approved by the board. These requests shall be submitted on a Variance/Hardship Form ].

12VAC5-525-140. Fulfillment after default payments.

In the event that a recipient, in accordance with the terms of the contract, fully repays the Commonwealth for part or all of any scholarship [ award ] because of breach of contract and later fulfills the terms of the contract after repayment, the Commonwealth shall reimburse the award amount repaid by the recipient minus applicable interest and fees.

FORMS (12VAC5-525)

[ Verification of Employment form (rev. 6/2016)

Physician Assistant Scholarship Program Application (includes Application Checklist and Requirements) (rev. 11/2016)

Verification of Employment form (rev. 1/2022)

Physician Assistant Scholarship Program Application (includes Application Checklist and Requirements) (rev. 1/2022)

Variance/Hardship Form (rev. 1/2022) ]