Chapter 508. Regulations Governing the Virginia Physician Loan Repayment Program
Part I
Definitions
12VAC5-508-10. Definitions.
The following words and terms when used in this chapter shall have the following meanings unless the context clearly indicates otherwise:
"Approved residency" means a graduate medical education program in family practice medicine, general internal medicine, pediatric medicine, or obstetrics and gynecology approved by the board. In determining whether a course of study is acceptable, the board may consider the reputation of the program and whether it is approved or accredited by (i) a regional or national educational or professional association, including such organizations as the Accreditation Council for Graduate Medical Education, Liaison Committee on Medical Education, Council on Postgraduate Training of the American Osteopathic Association, Council on Osteopathic College Accreditation, College of Family Physicians of Canada, Committee for the Accreditation of Canadian Medical Schools, Education Commission on Foreign Medical Graduates, or Royal College of Physicians and Surgeons of Canada, or their appropriate subsidiary agencies; (ii) any appropriate agency of the United States government; or (iii) any other organization approved by the board.
"Board" or "Board of Health" means the State Board of Health.
"Commercial loans" means loans made by banks, credit unions, savings and loan associations, insurance companies, schools, and either financial or credit institutions that are subject to examination and supervision in their capacity as lenders by an agency of the United States or of the state in which the lender has its principal place of business.
"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.
"Geriatrics fellowship" means a geriatrics subspecialty training program following residency approved by the board. In determining whether a course of study is acceptable, the board may consider the reputation of the program and whether it is approved or accredited by (i) a regional or national educational or professional association, including such organizations as the Accreditation Council for Graduate Medical Education, Liaison Committee on Medical Education, Council on Postgraduate Training of the American Osteopathic Association, Council on Osteopathic College Accreditation, College of Family Physicians of Canada, Committee for the Accreditation of Canadian Medical Schools, Education Commission on Foreign Medical Graduates, or Royal College of Physicians and Surgeons of Canada, or their appropriate subsidiary agencies; (ii) any appropriate agency of the United States government; or (iii) any other organization approved by the board.
"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).
"Participant" means an eligible primary care physician or a physician currently employed in a geriatrics fellowship who enters into a contract with the commissioner and participates in the loan repayment program.
"Penalty" means twice the amount of all monetary payments paid to the participant, less any service obligation completed.
"Practice" means the practice of medicine by a participant in a geriatrics fellowship or in one of the designated primary care specialties in a specific area determined to fulfill the participant's loan repayment obligation.
"Primary care" means the specialties of family practice medicine, general internal medicine, pediatric medicine, and obstetrics and gynecology.
"Reasonable educational expenses" means the costs of education, exclusive of tuition, that are considered to be required by the school's degree program or an eligible program of study, such as fees for room, board, transportation and commuting costs, books, supplies, educational equipment and materials, and travel that was a part of the estimated student budget of the school in which the participant was enrolled.
"State or local institution" means any Virginia state agency or local government agency that may require services of a primary care practitioner. This includes, but is not limited to, the Department of Health, the Department of Behavioral Health and Developmental Services, the Department of Corrections, the Department of Juvenile Justice, and local community services boards.
"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) and § 32.1-122.5 of the Code of Virginia.
Statutory Authority
§§ 32.1-12 and 32.1-122.6:1 of the Code of Virginia.
Historical Notes
Derived from Virginia Register Volume 26, Issue 11, eff. March 3, 2010; amended, Virginia Register Volume 32, Issue 20, eff. July 15, 2016.
12VAC5-508-20. (Repealed.)
Historical Notes
Derived from Virginia Register Volume 26, Issue 11, eff. March 3, 2010; repealed, Virginia Register Volume 32, Issue 20, eff. July 15, 2016.
12VAC5-508-30. (Repealed.)
Historical Notes
Derived from Virginia Register Volume 26, Issue 11, eff. March 3, 2010; repealed, Virginia Register Volume 32, Issue 20, eff. July 15, 2016.
Part II
Administration of the Virginia Physician Loan Repayment Program
12VAC5-508-40. (Repealed.)
Historical Notes
Derived from Virginia Register Volume 26, Issue 11, eff. March 3, 2010; repealed, Virginia Register Volume 32, Issue 20, eff. July 15, 2016.
12VAC5-508-50. Eligible applicants.
Eligible applicants for the Virginia Physician Loan Repayment Program shall:
1. Be a United States citizen, national, or a qualified alien pursuant to 8 USC § 1621;
2. Have graduated from an accredited medical school;
3. Be an allopathic (M.D.) or osteopathic (D.O.) physician who is enrolled in the final year of an approved residency program in allopathic medicine or osteopathic medicine, or already in practice, and who will have completed post-graduate training in an approved residency or be employed or accepted in a geriatrics fellowship when the period of obligated service begins;
4. Have a valid unrestricted Virginia license to practice medicine, a copy of which shall be furnished to the Virginia Physician Loan Repayment Program;
5. Have submitted a completed application to participate in the Virginia Physician Loan Repayment Program;
6. Have no other contractual service obligation unless completely satisfied before the physician loan repayment program contract has been signed;
7. Not have an active military obligation;
8. Be employed or have a contract for employment in an HPSA, a VMUA, an approved geriatrics fellowship, or a state or local institution within a month of the completion of the approved residency program or within a month of the application date, whichever is later;
9. Not have a history of failing to comply with, or inability to comply with, service or payment obligations;
10. Not have a history of noncompliance within any other state or federal scholarship or loan repayment program; and
11. Have an educational loan balance that can be verified.
Statutory Authority
§§ 32.1-12 and 32.1-122.6:1 of the Code of Virginia.
Historical Notes
Derived from Virginia Register Volume 26, Issue 11, eff. March 3, 2010; amended, Virginia Register Volume 32, Issue 20, eff. July 15, 2016.
12VAC5-508-60. Application requirement.
The applicant shall submit a completed application for loan repayment, including documentation of eligibility requirements, to the Virginia Physician Loan Repayment Program, and the application shall be received in the department by July 31. The application form shall be available on the department's website.
Statutory Authority
§§ 32.1-12 and 32.1-122.6:1 of the Code of Virginia.
Historical Notes
Derived from Virginia Register Volume 26, Issue 11, eff. March 3, 2010; amended, Virginia Register Volume 32, Issue 20, eff. July 15, 2016.
12VAC5-508-70. Selection criteria.
Applicants shall be competitively reviewed and selected for participation in the Virginia Physician Loan Repayment Program based upon the following criteria:
1. Commitment to serve. The individual's stated commitment to serve in an HPSA, a VMUA, an approved geriatrics fellowship, or a state or local institution.
2. Virginia residents or Virginia graduates. Preferential consideration shall be given to individuals who are or have been Virginia residents or graduates of Virginia medical schools (verification shall be obtained by the Virginia Physician Loan Repayment Program).
3. Residents of HPSAs or VMUAs. Preferential consideration shall be given to individuals who reside in HPSAs or VMUAs (verification shall be obtained by the Virginia Physician Loan Repayment Program).
4. Availability for service. Individuals who are immediately eligible and available for service shall be given higher consideration.
5. Length of proposed commitment. Preferential consideration shall be given to individuals who commit to longer periods of service.
6. Selection for participation. All of an individual's professional qualifications and competency to practice in an underserved area shall be considered, including board eligibility or specialty certification, professional achievements, and other indicators of competency received from supervisors, program directors, or other individuals who have agreed to enter into an employment contract with the individual.
Statutory Authority
§§ 32.1-12 and 32.1-122.6:1 of the Code of Virginia.
Historical Notes
Derived from Virginia Register Volume 26, Issue 11, eff. March 3, 2010; amended Virginia Register Volume 32, Issue 20, eff. July 15, 2016.
12VAC5-508-75. Loans qualifying for repayment.
A. Based on the availability of funds, the loan repayment program shall pay for the cost of education necessary to obtain a medical degree. The program shall pay toward the outstanding principal, interest, and related expense of verifiable federal, state, or local government loans and commercial loans obtained by the participant for:
1. Tuition expenses; and
2. Other reasonable educational expenses.
B. All loan repayment awards shall be applied only to outstanding educational loans secured while attending an accredited medical school. Qualifying outstanding educational loans shall:
1. Have sufficient documentation verifying the educational use of the loans;
2. Not exceed the "reasonable" levels as determined by the school's standard budget in the year the loan was made; and
3. Not include loans from friends and relatives.
C. The department shall be the final authority in determining qualifying educational loans.
Statutory Authority
§§ 32.1-12 and 32.1-122.6:1 of the Code of Virginia.
Historical Notes
Derived from Virginia Register Volume 32, Issue 20, eff. July 15, 2016.
12VAC5-508-80. Loan repayment terms.
A. Repayment of loans shall begin after the commissioner has received notification that the participant has officially accepted placement and has begun the required service obligation.
B. The applicant shall agree to serve a minimum of two years for a loan repayment amount of up to $60,000 with an option for a renewal in the third and fourth years. Renewals shall only be granted if the applicant can show a reduction in his educational loan balances. The loan repayment amount shall depend upon availability of funds and the applicant's indebtedness. In no event shall the amount of the loan repayment exceed the total indebtedness.
C. Payment shall be a lump-sum payment. Payment shall be made to the participant. A participant shall be paid one lump sum payment of up to $60,000 the first year for the minimum two-year commitment. If a participant commits to a service obligation greater than two years, he shall be paid a lump sum payment of up to $40,000 each following year depending on the availability of funds.
D. The maximum number of years of participation in the loan repayment program to which a participant may commit is four years. Verification of payment made to the lender shall be required and submitted to the department. It shall be the responsibility of the participant to negotiate with each lending institution the terms of the educational loan repayments.
Statutory Authority
§§ 32.1-12 and 32.1-122.6:1 of the Code of Virginia.
Historical Notes
Derived from Virginia Register Volume 26, Issue 11, eff. March 3, 2010; amended, Virginia Register Volume 32, Issue 20, eff. July 15, 2016.
12VAC5-508-90. (Repealed.)
Historical Notes
Derived from Virginia Register Volume 26, Issue 11, eff. March 3, 2010; repealed, Virginia Register Volume 32, Issue 20, eff. July 15, 2016.
12VAC5-508-100. (Repealed.)
Historical Notes
Derived from Virginia Register Volume 26, Issue 11, eff. March 3, 2010; repealed, Virginia Register Volume 32, Issue 20, eff. July 15, 2016.
12VAC5-508-110. Release of information.
A. Applicants shall agree to execute a release of information to allow the department access to loan records, credit information, and information from lenders necessary to verify eligibility and to determine loan repayments. To facilitate the process, applicants shall submit payment statements from each lending institution.
B. Participants who have consolidated qualifying loans with other loans shall submit upon request other documentation, such as copies of original loan applications, to verify the portion of the loan that qualifies for repayment.
C. The applicant shall submit all requested loan documentation prior to approval by the department.
Statutory Authority
§§ 32.1-12 and 32.1-122.6:1 of the Code of Virginia.
Historical Notes
Derived from Virginia Register Volume 26, Issue 11, eff. March 3, 2010; amended, Virginia Register Volume 32, Issue 20, eff. July 15, 2016.
12VAC5-508-120. Practice site.
All sites eligible for a participant's loan repayment service obligation shall be located in an HPSA, a VMUA, an approved geriatrics fellowship, or a state or local institution. The department shall publish a list of preapproved areas on the department's website.
Statutory Authority
§§ 32.1-12 and 32.1-122.6:1 of the Code of Virginia.
Historical Notes
Derived from Virginia Register Volume 26, Issue 11, eff. March 3, 2010; amended, Virginia Register Volume 32, Issue 20, eff. July 15, 2016.
12VAC5-508-130. Effective date for start of service.
Applicants shall become participants in the loan repayment program only when the applicant and the commissioner or his designee have signed the loan repayment program contract. The effective start date of the obligated service under the contract is the date of employment or the date of the commissioner's signature on the contract, whichever is later.
Statutory Authority
§§ 32.1-12 and 32.1-122.6:1 of the Code of Virginia.
Historical Notes
Derived from Virginia Register Volume 26, Issue 11, eff. March 3, 2010; amended, Virginia Register Volume 32, Issue 20, eff. July 15, 2016.
12VAC5-508-135. Terms of service.
The following are the terms of service for the loan repayment program:
1. The participant shall contract to provide a minimum of two years of the required service with a maximum of four years in whole year increments. Additional service beyond the two-year commitment is dependent upon the availability of state funds for the Virginia Physician Loan Repayment Program. An existing contract may be renewed for one year at a time up to a maximum of four years, as funds become available.
2. The participant shall provide full-time service.
3. No period of internship, residency, or other advanced clinical training, except an approved geriatrics fellowship, may count toward satisfying a period of obligated service under this loan repayment program.
Statutory Authority
§§ 32.1-12 and 32.1-122.6:1 of the Code of Virginia.
Historical Notes
Derived from Virginia Register Volume 32, Issue 20, eff. July 15, 2016.
12VAC5-508-140. (Repealed.)
Historical Notes
Derived from Virginia Register Volume 26, Issue 11, eff. March 3, 2010; repealed, Virginia Register Volume 32, Issue 20, eff. July 15, 2016.
12VAC5-508-150. (Repealed.)
Historical Notes
Derived from Virginia Register Volume 26, Issue 11, eff. March 3, 2010; repealed, Virginia Register Volume 32, Issue 20, eff. July 15, 2016.
12VAC5-508-160. Compensation during service.
Each participant shall be responsible for negotiating his own compensation package directly with the site where he will provide primary health care services.
Statutory Authority
§§ 32.1-12 and 32.1-122.6:1 of the Code of Virginia.
Historical Notes
Derived from Virginia Register Volume 26, Issue 11, eff. March 3, 2010; amended, Virginia Register Volume 32, Issue 20, eff. July 15, 2016.
12VAC5-508-165. Conditions of practice.
A. The participant shall agree to provide health services without discrimination, regardless of a patient's ability to pay. Payments from Medicare and Medicaid shall be accepted by the designated practice site.
B. The participant shall agree to comply with all policies, rules, and regulations of the designated practice site.
Statutory Authority
§§ 32.1-12 and 32.1-122.6:1 of the Code of Virginia.
Historical Notes
Derived from Virginia Register Volume 32, Issue 20, eff. July 15, 2016.
12VAC5-508-170. (Repealed.)
Historical Notes
Derived from Virginia Register Volume 26, Issue 11, eff. March 3, 2010; repealed, Virginia Register Volume 32, Issue 20, eff. July 15, 2016.
12VAC5-508-175. Change of practice site.
Should any participant find that he is unable to fulfill the required 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 commissioner in his 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.
Statutory Authority
§§ 32.1-12 and 32.1-122.6:1 of the Code of Virginia.
Historical Notes
Derived from Virginia Register Volume 32, Issue 20, eff. July 15, 2016.
12VAC5-508-180. Monitoring during service.
Monitoring of the participant's service obligation shall be conducted on an ongoing basis by department staff. Service verification forms shall be submitted by the participant to the department semi-annually (every six months) and countersigned by a representative of the service site (e.g., the medical director, human resource coordinator, or chief executive officer), certifying continuous full-time service by the participant.
The participant shall maintain practice records in a manner that will allow the department to readily determine if the individual has complied with or is complying with the terms and conditions of the contract. Department staff reserves the right to conduct a regular survey to ensure that all participants are maintaining practices that accept Medicare and Medicaid assignment and do not discriminate based on the patient's ability to pay.
Statutory Authority
§§ 32.1-12 and 32.1-122.6:1 of the Code of Virginia.
Historical Notes
Derived from Virginia Register Volume 26, Issue 11, eff. March 3, 2010; amended, Virginia Register Volume 32, Issue 20, eff. July 15, 2016.
12VAC5-508-190. (Repealed.)
Historical Notes
Derived from Virginia Register Volume 26, Issue 11, eff. March 3, 2010; repealed, Virginia Register Volume 32, Issue 20, eff. July 15, 2016.
12VAC5-508-200. (Repealed.)
Historical Notes
Derived from Virginia Register Volume 26, Issue 11, eff. March 3, 2010; repealed, Virginia Register Volume 32, Issue 20, eff. July 15, 2016.
12VAC5-508-210. (Repealed.)
Historical Notes
Derived from Virginia Register Volume 26, Issue 11, eff. March 3, 2010; repealed, Virginia Register Volume 32, Issue 20, eff. July 15, 2016.
Part III
Contract
12VAC5-508-220. Loan repayment contract.
Prior to becoming a participant in the Virginia Physician Loan Repayment Program, the applicant shall enter into a contract with the commissioner agreeing to the terms and conditions upon which the loan repayment is granted. The contract shall:
1. Include the terms and conditions to carry out the purposes and intent of this program;
2. Provide that the participant shall be required to (i) provide primary health care services at an approved site in an HPSA, a VMUA, or a state or local institution for a minimum period of two years or (ii) be employed in an approved geriatrics fellowship for a minimum of two years. All loan repayment program participation shall be contingent upon continuous, full-time practice in an HPSA, a VMUA, an approved geriatrics fellowship, or a state or local institution;
3. Provide for repayment of all amounts paid, plus interest and penalties, less any service time in the event of breach of the contract;
4. Be signed by the applicant; and
5. Be signed by the commissioner or his designee.
Statutory Authority
§§ 32.1-12 and 32.1-122.6:1 of the Code of Virginia.
Historical Notes
Derived from Virginia Register Volume 26, Issue 11, eff. March 3, 2010; amended, Virginia Register Volume 32, Issue 20, eff. July 15, 2016.
12VAC5-508-230. Breach of contract.
A. The following may constitute breach of contract:
1. Participant's failure to begin or complete his term of obligated service under the terms and conditions of the Virginia Physician Loan Repayment Program contract, regardless of the length of the agreed period of obligated service;
2. Participant's falsification or misrepresentation of information on the program application or verification forms or other required documents; or
3. Termination of participant's employment 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 approved site in an HPSA, a VMUA, an approved geriatrics fellowship, or a state or local institution within six months of termination. Failure of the participant to find a transfer site within this time limit shall be deemed to be a breach of the contract.
B. In the event of a breach of contract, the participant shall make default payments as described in 12VAC5-508-260 and in accordance with the terms of the contract. In the event of a breach of contract where the participant has partially fulfilled his obligation, the total amount of reimbursement shall be prorated by the proportion of obligation completed.
Statutory Authority
§§ 32.1-12 and 32.1-122.6:1 of the Code of Virginia.
Historical Notes
Derived from Virginia Register Volume 26, Issue 11, eff. March 3, 2010; amended, Virginia Register Volume 32, Issue 20, eff. July 15, 2016.
12VAC5-508-240. (Repealed.)
Historical Notes
Derived from Virginia Register Volume 26, Issue 11, eff. March 3, 2010; repealed, Virginia Register Volume 32, Issue 20, eff. July 15, 2016.
12VAC5-508-250. Deferment or waiver of service.
A. Participants have the obligation to complete full-time continuous service for the period of their commitment. Under unusual circumstances as described in subsection B of this section, a participant may request that the board agree to a deferment of the service obligation. This deferment, if granted, shall not relieve the participant of the responsibility to complete the remaining portion of the obligation. Such deferment shall not be permitted as a matter of course, but may be allowed in the most compelling cases.
B. Individual cases may be considered by the board for a variance of payment or service, pursuant to § 32.1-12 of the Code of Virginia, if it finds compliance with the applicable service requirements or default repayment would pose an undue hardship on the participant.
C. If the participant is in default due to death or disability so as not to be able to engage in medical practice in an HPSA, a VMUA, an approved geriatrics fellowship, or a state or local institution in the Commonwealth, the participant or his personal representative may be relieved of his obligation under the contract to engage in medical practice, upon repayment to the Commonwealth of the total amount of loan repayment received plus interest and penalty as stated in the contract. For participants completing part of the required service obligation prior to becoming permanently disabled or in the event of death, the total amount of loan repayment 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 representative to the board.
D. All requests for deferments, waivers, or variances must be submitted in writing to the department for consideration and final disposition by the board.
Statutory Authority
§§ 32.1-12 and 32.1-122.6:1 of the Code of Virginia.
Historical Notes
Derived from Virginia Register Volume 26, Issue 11, eff. March 3, 2010; amended, Virginia Register Volume 32, Issue 20, eff. July 15, 2016.
12VAC5-508-260. Cash reimbursement and penalty.
Participants who serve less than their obligated service shall be liable for repayment, including interest and penalty, to the Commonwealth as stated in the contract, reduced by the proportion of obligated years served.
Statutory Authority
§§ 32.1-12 and 32.1-122.6:1 of the Code of Virginia.
Historical Notes
Derived from Virginia Register Volume 26, Issue 11, eff. March 3, 2010; amended, Virginia Register Volume 32, Issue 20, eff. July 15, 2016.
Part IV
Records and Reporting
12VAC5-508-270. Reporting requirements.
Reporting requirements of the participant are as follows:
1. Each participant shall at any time provide information as required by the department to verify compliance with the practice requirements of the Virginia Physician Loan Repayment Program.
2. Each participant shall promptly notify the department, in writing, within 30 days of any of the following events:
a. Participant changes name;
b. Participant changes address;
c. Participant changes practice site;
d. Participant no longer intends or is no longer able to fulfill service obligation as a primary care health care provider in an HPSA, a VMUA, an approved geriatrics fellowship, or a state or local institution; or
e. Participant ceases to practice as a physician.
Statutory Authority
§§ 32.1-12 and 32.1-122.6:1 of the Code of Virginia.
Historical Notes
Derived from Virginia Register Volume 26, Issue 11, eff. March 3, 2010; amended, Virginia Register Volume 32, Issue 20, eff. July 15, 2016.
Forms (12VAC5-508)
2009‑2010 Application Form (rev. 1/10).