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.

Public Hearing Information: No public hearings are scheduled.

Public Comment Deadline: January 27, 2017.

Agency Contact: Adrienne McFadden, Director, Minority Health and Health Equity, Department of Health, 109 Governor Street, Richmond, VA 23219, telephone (804) 864-7425, FAX (804) 864-7440, or email adrienne.mcfadden@vdh.virginia.gov.

Basis: The regulation is promulgated under the authority of § 32.1-122.6:03 of the Code of Virginia, which requires the board to establish an annual physician assistant scholarship program and mandates that the board promulgate regulations to administer the program.

Purpose: Chapter 806 of the 1997 Acts of Assembly created § 32.1-122.6:03 of the Code of Virginia to require the establishment of an annual physician assistant scholarship program for students who intend to enter an accredited physician assistant program. Regulations are necessary to support the implementation of § 32.1-122.6:03. The intent of this regulatory action is to implement the regulatory action required by § 32.1-122.6:03 and address the shortage of trained medical professionals in the Commonwealth. The regulation establishes administrative guidance for increasing the availability of health care providers in medically underserved areas in the Commonwealth.

Substance: This regulatory action will promulgate a new regulation, establishing a physician assistant scholarship program. The substantive elements of this program will be modeled after similar scholarship programs administered by the agency. Substantive elements include:

12VAC5-525-10 (Definitions) provides clarification on key or frequently use terms in the regulation.

12VAC5-525-20 (Physician assistant scholarship committee) establishes that a physician assistant scholarship committee as appointed by the State Board of Health shall make all scholarship recommendations.

12VAC5-525-10 (Eligibility for scholarships) provides eligibility requirements, including acceptance in or enrollment in an approved education program, a 3.0 cumulative GPA if already enrolled in a program, application, financial need, and no active military obligation.

12VAC5-525-40 (Conditions of scholarships) provides guidance and provisions on the contract requirements, calculations of the service obligation, employment requirements, transfer of practice site, default, waiver, partial, hardship, and default payments.

12VAC5-525-50 (Number of applications per student), 12VAC5-525-60 (Amounts of scholarships), and 12VAC5-525-70 (How to apply). These sections provide information and provisions regarding applicant renewals, minimum and maximum award amounts, location of application form, and deadline dates for submission of applications.

12VAC5-525-80 (Selection criteria) provides for preferential consideration of applications, including applications from Virginia residents, residents of medically underserved areas, and minority students.

12VAC5-525-90 (Scholarship contract) provides the required elements of the scholarship contract.

12VAC5-525-100 (Practice site selection) provides where a participant in the program will be able to perform his service obligation.

12VAC5-525-110 through 12VAC5-525-140 provide program reporting requirements, breach of contract, and deferments and waivers.

Issues: The primary advantage of the proposed regulatory action to the public will be an increase in the availability of primary care providers in medically underserved communities should this program be funded by the Commonwealth. Additionally, these medically underserved communities will be better positioned to retain qualified primary care providers because of the obligation created by accepting the scholarship funds. The Virginia Department of Health sees no disadvantage to the public, the agency, or the Commonwealth associated with the proposed regulatory action.

Department of Planning and Budget's Economic Impact Analysis:

Summary of the Proposed Amendments to Regulation. Pursuant to § 32.1-122.6:03 of the Code of Virginia, the Board of Health (Board) proposes to promulgate a new regulation to establish rules and requirements for a physician assistant scholarship program. Consistent with the statute, under the proposed regulation scholarship recipients must commit to practicing as physician assistants in underserved areas of the Commonwealth in exchange for the scholarship funding.

Result of Analysis. The benefits likely exceed the costs.

Estimated Economic Impact. Chapter 806 of the 1997 Virginia Acts of Assembly amended and reenacted § 32.1-122.6:03 of the Code of Virginia to require the establishment of an annual physician assistant scholarship program for students who intend to enter an accredited physician assistant program, and mandated the Board to adopt regulations governing the implementation of such a scholarship program within 280 days of its enactment. Up until now no action has been taken to adopt such regulations. Also, no physician assistant scholarships have been awarded pursuant to § 32.1-122.6:03.¹

There are no funds currently budgeted for the physician assistant scholarship program. Thus, the promulgation of this regulation will not likely have an immediate impact. Nevertheless, the promulgation of this regulation will be beneficial in that a framework will be prepared concerning scholarship: committee appointments, eligibility, conditions, dollar amount to be awarded,² applications, selection criteria, contracts, practice sites, reporting requirements, breach of contract,³ deferment and waivers, and other information. When and if funds are appropriated for the physician assistant scholarship program, having an existing regulation would be beneficial in that it would reduce delays in implementing the program and reduce uncertainty for potential scholarship candidates.

Businesses and Entities Affected. The proposed regulation would particularly affect medical facilities that employ physician assistants located in underserved areas of the Commonwealth.

Localities Particularly Affected. The proposed regulation specifies that each scholarship recipient agrees to engage in the equivalent of one year of full-time primary care medical practice in a health professional shortage area (HPSA) or Virginia medically underserved area (VMUA) within the Commonwealth. HPSA is defined as "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)." VMUA is defined as "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 (12VAC5-540) or § 32.1-122.5 of the Code of Virginia." Thus, localities most in need of additional health services are more likely to be affected by having additional care provided by a physician assistant.

Projected Impact on Employment. Depending upon future funding of the physician assistant scholarship program, the proposed regulation may help moderately increase the number of practicing physician assistants in the Commonwealth.

Effects on the Use and Value of Private Property. The proposed regulation does not significantly affect the use and value of private property.

Real Estate Development Costs. The proposed regulation does not affect real estate development costs.

Small Businesses:

Definition. Pursuant to § 2.2-4007.04 of the Code of Virginia, small business is defined as "a business entity, including its affiliates, that (i) is independently owned and operated and (ii) employs fewer than 500 full-time employees or has gross annual sales of less than $6 million."

Costs and Other Effects. The proposed regulation does not affect costs for small businesses.

Alternative Method that Minimizes Adverse Impact. The proposed regulation does not adversely affect small businesses.

Adverse Impacts:

Businesses. The proposed regulation does not adversely affect businesses.

Localities. The proposed regulation does not adversely affect localities.

Other Entities. The proposed regulation does not adversely affect other entities.

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¹ Source: Virginia Department of Health

² The proposed regulation states that "Each participant shall receive an award of $5,000 per year." § 32.1-122.6:03.A states that "The amounts and numbers of such scholarships shall be determined annually as provided in the appropriation act." Presuming that if and when funds are provided in the appropriation act for the physician assistant scholarship program that the amounts of the scholarships are specified, then the amounts in the appropriation act would be awarded rather than the $5,000 specified in the regulation.

³ Under the proposed regulation it is a breach of contract to not begin continuous full-time employment within 180 days of graduation. There is no proviso for a graduate who actively seeks but is unable to find employment. Such an individual is required to repay the scholarship award amount plus interest and penalty. The penalty is "twice the amount of all monetary payments to the scholarship participant." This may be considered excessive; and an unemployed individual would likely be unable to pay. It may be beneficial to include a proviso to account for an unemployed scholarship recipient who can demonstrate their active seeking of physician assistant employment in an underserved area.

Agency's Response to Economic Impact Analysis: The Department of Health concurs with the economic impact analysis submitted by the Department of Planning and Budget.

Summary:

The proposed 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.

CHAPTER 525
REGULATIONS FOR PHYSICIAN ASSISTANT SCHOLARSHIP PROGRAM

Part I
General Information

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, 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.

"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 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.

Part II
Administration of Physician Assistant Scholarship Program

12VAC5-525-30. Eligibility for scholarships.

In order to be considered for a scholarship, 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 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 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 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 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 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 shall repay the award amount reduced by the proportion of obligated years served plus the applicable interest and penalty.

E. If the participant is in default due to death or permanent disability so as not to be able to engage in medical practice, the participant 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.

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 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 years.

12VAC5-525-60. Amounts of scholarships.

The 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, and the number of qualified applicants. Each participant shall receive an award of $5,000 per year.

12VAC5-525-70. How to apply.

Eligible applicants shall submit a complete application made available by the department on the department's website. 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;

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 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 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.

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

Should any participant 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.

In the event of a dispute between the participant 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 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).

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

1. Participant changes name;

2. Participant changes address;

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

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

5. Participant ceases to practice as a PA; or

6. Participant 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 fails to begin or complete the term of obligated service under the terms and conditions of the scholarship contract;

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

4. 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 control (e.g., closure of site), the participant shall transfer to another site approved by the board in the Commonwealth within six months of termination. Failure of participant 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 waivers.

A. If the participant 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 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 received plus applicable interest. For participants 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 or the participant'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.

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 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)