{ "id": "R43920", "type": "CRS Report", "typeId": "REPORTS", "number": "R43920", "active": true, "source": "EveryCRSReport.com", "versions": [ { "source": "EveryCRSReport.com", "id": 460603, "date": "2017-04-18", "retrieved": "2017-04-25T17:13:15.819347", "title": "National Health Service Corps: Background, Funding, and Programs", "summary": "The National Health Service Corps (NHSC) is a pipeline for clinician recruitment and training. Its program objective is to increase the availability of primary care services to populations in Health Professional Shortage Areas (HPSAs). It aims to increase clinician availability by making loan repayments and awarding scholarships to individuals in exchange for their agreement to serve as NHSC clinicians (or providers) at approved sites. NHSC providers are mainly physicians, physician assistants, nurse practitioners, and behavioral/mental health professionals who must serve for a minimum of two years at an approved facility. An approved facility, for example, may be a Federally Qualified Health Center (FQHC) and FQHC Look-Alike, American Indian and Native Alaska Health Clinic, Rural Health Clinic, Critical Access Hospital, School-Based Clinic, Mobile Unit, Free Clinic, or Community Mental Health Center, and must be located in a federally designated HPSA. All NHSC providers must fulfill a minimum of two-year service commitment at an NHSC-approved site. The NHSC is administered by the Health Resources and Services Administration (HRSA), within the Department of Health and Human Services (HHS). Congress created the NHSC in the Emergency Health Personnel Act of 1970 (P.L. 91-623), and since then has reauthorized and amended its programs several times. The Patient Protection and Affordable Care Act of 2010 (ACA; P.L. 111-148) permanently reauthorized the NHSC.\nLegislation to potentially repeal or replace all or parts of the ACA, depending on its scope, may impact NHSC authorization and funding. In 2010, Congress implemented major revisions in the NHSC through the ACA. Most notably, the ACA permanently authorized the NHSC and created the Community Health Center Fund (CHCF), a source of mandatory funding for the NHSC from FY2011 through FY2015. This funding was subsequently extended in the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA, P.L. 114-10). MACRA provided $310 million to support the NHSC in FY2016 and FY2017 through the CHCF. MACRA is the sole source of NHSC funds in FY2017. (Because this fund is subject to the mandatory spending sequester, the FY2017 funding level is $289 million.) In addition, the ACA amended statutory authorities pertaining to the NHSC\u2019s requirements for part-time service, teaching credits toward service obligations, and exclusions from an individual\u2019s gross income for those payments from state loan repayment or loan forgiveness programs that seek to increase health care access in federally designated HPSAs. \nIn FY2015, the most recent annual data available, the NHSC awarded 2,934 new loan repayment agreements; 1,841 continuing loan repayment agreements; 96 student-to-service loan repayments; 620 state loan repayments; 196 new scholarships; and 11 continuing scholarships. In FY2014, the NHSC issued the largest number of awards, 5,620, in a single year. Mental health providers, physicians, and nurse practitioners represented the largest number of NHSC clinicians in recent years. Also, in recent years, congressional appropriators have expressed concerns about updating the methodology for designating areas where NHSC providers are placed, and interest in the possibility of authorizing pharmacists as NHSC clinicians. The 21st Century Cures Act (P.L. 114-255) expanded the list of NHSC providers to include child and adolescent psychiatrists. This report summarizes the NHSC\u2019s recruitment and retention programs, and the NHSC\u2019s funding trends from FY2010 through FY2017.", "type": "CRS Report", "typeId": "REPORTS", "active": true, "formats": [ { "format": "HTML", "encoding": "utf-8", "url": "http://www.crs.gov/Reports/R43920", "sha1": "7cd8baf3c5e4d013af0c6e8fbb78b78dc7ac4592", "filename": "files/20170418_R43920_7cd8baf3c5e4d013af0c6e8fbb78b78dc7ac4592.html", "images": null }, { "format": "PDF", "encoding": null, "url": "http://www.crs.gov/Reports/pdf/R43920", "sha1": "f2093270a82a391c900b35535c4aaf0d7e43f53c", "filename": "files/20170418_R43920_f2093270a82a391c900b35535c4aaf0d7e43f53c.pdf", "images": null } ], "topics": [ { "source": "IBCList", "id": 4788, "name": "Health Care Delivery" }, { "source": "IBCList", "id": 4921, "name": "Labor, HHS, & Education Appropriations" } ] }, { "source": "EveryCRSReport.com", "id": 452613, "date": "2016-05-17", "retrieved": "2016-11-28T22:12:58.424696", "title": "National Health Service Corps: Background and Trends in Funding and Recruitment", "summary": "The National Health Service Corps (NHSC) is a pipeline for clinician recruitment and training. Its program objective is to increase the availability of primary care services to populations in Health Professional Shortage Areas (HPSAs). It aims to increase clinician availability by making loan repayment and scholarship awards to individuals in exchange for their agreement to serve as clinicians at approved sites. NHSC clinicians are mainly physicians, physician assistants, nurse practitioners, and behavioral/mental health professionals who must serve for a minimum of two years at an approved facility. An approved facility, for example, may be a Federally Qualified Health Center (FQHC) and FQHC Look-Alike, American Indian and Native Alaska Health Clinic, Rural Health Clinic, Critical Access Hospital, School-Based Clinic, Mobile Unit, Free Clinic, or Community Mental Health Center, and must be located in a federally designated health professional shortage area. All NHSC clinicians must fulfill a minimum of two years of NHSC service. The NHSC is administered by the Health Resources and Services Administration (HRSA), within the Department of Health and Human Services (HHS). \nCongress established the NHSC in the Emergency Health Personnel Act of 1970 (P.L. 91-623) and has amended and reauthorized the program several times since its inception. In 2010, Congress implemented major revisions in the NHSC in the Patient Protection and Affordable Care Act of 2010 (ACA; P.L. 111-148). Most notably, the ACA permanently authorized the NHSC and created the Community Health Centers Fund (CHCF), a source of mandatory funding for the NHSC from FY2011 through FY2015. Additionally, the ACA amended statutory authorities pertaining to the NHSC\u2019s requirements for part-time service, teaching credits toward service obligations, and exclusions from an individual\u2019s gross income for those payments from state loan repayment or loan forgiveness programs that seek to increase health care access in designated HPSAs.\nIn FY2016, an estimated 9,100 NHSC clinicians are providing medical, dental, and other health care services to approximately 9.2 million individuals in rural and urban HPSAs. In addition, in FY2016, the NHSC is planning to award an estimated 2,654 new loan repayment agreements; 1,732 continuing loan repayment agreements; 117 student-to-service loan repayments; 433 state loan repayments; 165 new scholarships; and 16 continuing scholarships. During the five-year period from FY2011 through FY2016, the number of new NHSC awards averaged 5,595. In FY2014, the NHSC issued the largest number of awards, 5,620, in a single year. In FY2016, mental health providers, physicians, and nurse practitioners represent the largest number of NHSC clinicians. In recent years, congressional appropriators have expressed concerns about updating the methodology for designating areas where NHSC providers are placed, and interest in the possibility of authorizing pharmacists as NHSC clinicians.\nFor FY2016, the CHCF funded 100% of the NHSC budget. Funding for the CHCF was extended in the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA, P.L. 114-10). MACRA provided $310 million to support the NHSC in each of FY2015 through FY2017. The President\u2019s FY2017 budget request contains a request of $380 million, which includes $20 million in discretionary funds for behavioral/mental health initiatives, and $50 million in new mandatory funding for two treatment initiatives associated with opioid disorders (in addition to the extant $310 million in mandatory funding appropriated through MACRA). \nThis report summarizes the NHSC\u2019s recruitment and retention programs, and the NHSC\u2019s funding history from FY2010 through FY2016, and the FY2017 President\u2019s budget request.", "type": "CRS Report", "typeId": "REPORTS", "active": true, "formats": [ { "format": "HTML", "encoding": "utf-8", "url": "http://www.crs.gov/Reports/R43920", "sha1": "4ec1fa2f5c9112ba6a6ebc894814ad95667048b7", "filename": "files/20160517_R43920_4ec1fa2f5c9112ba6a6ebc894814ad95667048b7.html", "images": null }, { "format": "PDF", "encoding": null, "url": "http://www.crs.gov/Reports/pdf/R43920", "sha1": "7055a9e9fb437c0b39ff70834951107c5b8d91bc", "filename": "files/20160517_R43920_7055a9e9fb437c0b39ff70834951107c5b8d91bc.pdf", "images": null } ], "topics": [ { "source": "IBCList", "id": 4788, "name": "Health Care Delivery" }, { "source": "IBCList", "id": 4921, "name": "Labor, HHS, & Education Appropriations" } ] }, { "source": "EveryCRSReport.com", "id": 440648, "date": "2015-04-22", "retrieved": "2016-04-06T19:10:37.314514", "title": "National Health Service Corps: Changes in Funding and Impact on Recruitment", "summary": "The National Health Service Corps (NHSC) recruits and places trained individuals in underserved communities to provide health care services at approved sites. In exchange for a two-year service commitment in federally designated health professional shortage areas (HPSAs), individuals receive scholarships or loan repayments. NHSC clinicians may fulfill their service commitment at approved Federally Qualified Health Centers (FQHCs), FQHC Look-Alikes, Rural Health Clinics, Critical Access Hospitals, and other approved sites.\nThe primary objective of the NHSC is to increase the availability of primary care services to underserved populations. The NHSC offers scholarships, loan repayments, and loan forgiveness to individuals in selected health professions. In FY2015, an estimated 8,495 NHSC clinicians will provide medical, dental, and other health care services to 8.9 million individuals in underserved communities. Also, in FY2015, the NHSC will award an estimated 2,272 new loan repayment agreements; 1,629 continuing loan repayment agreements; 100 student to service loan repayments; 464 state loan repayments; 163 new scholarships; and 14 continuing scholarships to individuals in various health professions. \nThe NHSC was established in the Emergency Health Personnel Act of 1970 (P.L. 91-623), and it has been amended and reauthorized several times since its inception. Most recently, Congress revised the NHSC in the Patient Protection and Affordable Care Act of 2010 (ACA; P.L. 111-148) by amending statutory authorities associated with part-time service, teaching credits toward service obligations, and exclusions from an individual\u2019s gross income for those payments from state loan repayment or loan forgiveness programs that seek to increase health care access in HPSAs or other designated underserved areas. The NHSC is based within the Health Resources and Services Administration (HRSA), an agency in the Department of Health and Human Services (HHS).\nThe ACA created a new Community Health Center Fund (CHCF) and required that a total of $1.5 billion in mandatory CHCF appropriations be transferred to the NHSC over the course of FY2011 through FY2015. Prior to the ACA, Congress had appropriated funds for the NHSC solely through the discretionary appropriations process for the Departments of Labor, Health and Human Services, and Education, and Related Agencies (Labor-HHS-ED). Since FY2012, in the absence of discretionary funding, the CHCF has been the NHSC\u2019s only funding source. On April 16, 2015, the President signed P.L. 114-10, Medicare Access and CHIP Reauthorization Act (MACRA), which amends the ACA to extend mandatory funding for the NHSC from FY2015 through FY2017. Total NHSC funding, regardless of the source, affects the size of the NHSC health workforce that is available to provide health services in underserved areas. This report briefly summarizes the NHSC programs, describes recent trends in clinician service, reviews funding trends for FY2009 through FY2015, and includes data from the President\u2019s FY2016 budget.", "type": "CRS Report", "typeId": "REPORTS", "active": true, "formats": [ { "format": "HTML", "encoding": "utf-8", "url": "http://www.crs.gov/Reports/R43920", "sha1": "2cd0b586ca50f9e2a3993de5056bcc75bfca1606", "filename": "files/20150422_R43920_2cd0b586ca50f9e2a3993de5056bcc75bfca1606.html", "images": null }, { "format": "PDF", "encoding": null, "url": "http://www.crs.gov/Reports/pdf/R43920", "sha1": "e533ab09913fc0eb8ec32462ff0833a245401c30", "filename": "files/20150422_R43920_e533ab09913fc0eb8ec32462ff0833a245401c30.pdf", "images": null } ], "topics": [ { "source": "IBCList", "id": 2347, "name": "Labor, HHS, and Education Appropriations" } ] } ], "topics": [] }