25 U.S.C. § 1616a — Indian Health Service Loan Repayment Program
submitted 38 years ago by Pub. L. 94-437 to r/title-25-INDIANS · 2,825 words · no verdicts yet
The Secretary must run a loan-repayment program to secure trained health professionals for Indian health programs. Eligible participants receive payments on qualifying education loans in exchange for obligated service, with rules for breaches, waivers, reports, and tax reimbursements.
(a) Establishment. The Secretary*, through the Service*, must establish the “Indian Health Service Loan Repayment Program” to maintain enough trained health professionals to keep Indian health programs accredited and provide care to Indians. “Indian health program” means a Service-funded health program or facility benefiting Indians and run directly by the Service; by a tribe or tribal or Indian organization under an Indian Self-Determination Act or Buy-Indian Act contract; or by an urban Indian organization* under this chapter’s subchapter IV. This section does not define “State”; it says that term has the meaning in 42 U.S.C. § 254d(i)(4).
(b) Eligibility. A person must either (1)(A) be enrolled in a Secretary-approved program at an accredited institution in a State and scheduled to finish that year, or in an approved graduate health-profession program, or (B) have a health-profession degree and a State license; (2) be eligible for or hold a Public Health Service commissioned-officer appointment, be eligible for civilian Service selection, meet Indian Health Service civil-service standards, or work in an Indian health program without a service obligation; and (3) apply to the Secretary for the subsection (f) contract.
(c) Forms. The Secretary must give applicants a fair summary of the approved participant’s rights and liabilities, including a clear explanation of breach damages under subsection (l). The Secretary must explain enough about commissioned and civilian Service careers for an informed decision. Forms and information must be understandable to the average applicant and available early enough for careful review.
(d) Vacancies and priority. Each year, consistently with paragraph (3) and subsection (k), the Secretary must identify and rank needed or vacant positions in each Indian health program. When choosing applications and contracts, the Secretary must give priority to Indians and to people recruited through tribes or tribal or Indian organizations. For fiscal years 1993–1995, at least 25% of appropriated contract money must go to nurses, nurse practitioners, or nurse midwives, and at least 10% to mental-health professionals other than those nurses. These percentages do not apply if there are not enough applications to meet them.
(e) Approval. A person becomes a participant only when the Secretary and person sign the subsection (f) contract. The Secretary must promptly give written notice of approval, including an extension making total obligated service exceed four years, or of disapproval.
(f) Contract. The written contract must say that the Secretary will, subject to paragraph (3), pay qualifying loans and, if appropriated money is available, accept the person into the Service or place the person with a tribe or Indian organization. The person must accept the payments; if enrolled under subsection (b)(1), remain enrolled until completing the study or training and maintain the academic level required by the school’s rules; and serve full time in clinical practice in an assigned Indian health program for two years or a longer agreed period. The contract may extend that service period by additional agreed periods. United States payment and the person’s conditioned obligation depend on appropriations. The contract must state the subsection (l) damages and other consistent rights and liabilities.
(g) Loans and payments. Payments may cover principal, interest, and related expenses on government or commercial undergraduate or graduate education loans used for tuition, other reasonable education costs including fees, books, and laboratories, and reasonable living costs set by the Secretary. For each obligated-service year, the Secretary may pay up to $35,000 or the amount in 42 U.S.C. § 254l–1(g)(2)(A). The Secretary must consider maximizing contracts, encouraging service where shortages are greatest, and encouraging continued primary care after the obligation. Payments for a service year must be made by the end of that fiscal year. To reimburse resulting tax liability, the Secretary may pay an additional 20% to 39% of that year’s repayments and other appropriate amounts. The Secretary may schedule payments with a loan holder.
(h) Employment ceiling. A contract participant in academic training is not counted against a Department of Health and Human Services employment ceiling.
(i) Recruitment. The Secretary must recruit for this and other Service health-professional programs at schools training the professionals identified in subsection (a).
(j) Assignment. 42 U.S.C. § 215 does not apply during the participant’s obligated service.
(k) Tribal program needs. When assigning people, the Secretary must treat staffing needs of tribally administered programs equally with directly administered programs and must prioritize programs needing professionals because other participants breached contracts.
(l) Breach and damages. A final-year student who fails academic standards, voluntarily leaves, or is dismissed before finishing, or a graduate trainee who does not finish and receives no waiver, owes the United States all amounts paid on the person’s behalf instead of service. For another breach that prevents beginning or completing service, damages are A = 3Z(t−s/t): A is the recovery; Z is payments plus interest calculated as if they were loans at the maximum legal prevailing rate set by the U.S. Treasurer; t is total obligated-service months; and s is months served. Unpaid amounts may be collected from Medicare payments under 42 U.S.C. § 1395ccc. Damages are due within one year after breach or a longer period the Secretary sets. If three months delinquent, the Secretary must use General Services Administration collection agencies or contract with agencies selected by the Secretary. Each contract must require a status report at least every six months, and 31 U.S.C. § 3718 applies unless inconsistent.
(m) Cancellation and waiver. Service and damage obligations end when the participant dies. By rule, the Secretary must partly or fully waive or suspend an obligation when compliance is impossible or extremely hard and enforcement would be unconscionable. The Secretary may waive recovery for extreme hardship or other good cause. Bankruptcy can discharge damages only after five years from the first required payment and only if the bankruptcy court finds nondischarge unconscionable.
(n) Annual report. For the prior fiscal year, the Secretary must report for inclusion in the report under 25 U.S.C. § 1671: hard-to-recruit or retain positions; applications and contracts by profession; loan payments total and by profession; scholarship grants under 25 U.S.C. § 1613a total and by profession; providers needed by place and profession during the next three fiscal years; and planned measures to fill difficult positions.
The Secretary*, acting through the Service*, shall establish a program to be known as the Indian Health Service Loan Repayment Program (hereinafter referred to as the “Loan Repayment Program”) in order to assure an adequate supply of trained health professionals necessary to maintain accreditation of, and provide health care services to Indians through, Indian health programs.
For the purposes of this section—
the term “Indian health program” means any health program or facility funded, in whole or part, by the Service for the benefit of Indians and administered—
directly by the Service;
by any Indian tribe* or tribal or Indian organization pursuant to a contract under—
the Indian Self-Determination Act [25 U.S.C. 5321 et seq.], or
section 23 of the Act of April 30, 19081 (25 U.S.C. 47), popularly known as the “Buy-Indian” Act; or
by an urban Indian organization* pursuant to subchapter IV of this chapter; and
the term “State” has the same meaning given such term in section 254d(i)(4) 1 of title 42.
To be eligible to participate in the Loan Repayment Program, an individual must—
be enrolled—
in a course of study or program in an accredited institution, as determined by the Secretary, within any State and be scheduled to complete such course of study in the same year such individual applies to participate in such program; or
in an approved graduate training program in a health profession*; or
have—
a degree in a health profession; and
a license to practice a health profession in a State;
be eligible for, or hold, an appointment as a commissioned officer in the Regular or Reserve Corps 2 of the Public Health Service;
be eligible for selection for civilian service in the Regular or Reserve Corps 2 of the Public Health Service;
meet the professional standards for civil service employment in the Indian Health Service; or
be employed in an Indian health program without a service obligation; and
submit to the Secretary an application for a contract described in subsection (f).
In disseminating application forms and contract forms to individuals desiring to participate in the Loan Repayment Program, the Secretary shall include with such forms a fair summary of the rights and liabilities of an individual whose application is approved (and whose contract is accepted) by the Secretary, including in the summary a clear explanation of the damages to which the United States is entitled under subsection (l) in the case of the individual’s breach of the contract. The Secretary shall provide such individuals with sufficient information regarding the advantages and disadvantages of service as a commissioned officer in the Regular or Reserve Corps 2 of the Public Health Service or a civilian employee of the Indian Health Service to enable the individual to make a decision on an informed basis.
The application form, contract form, and all other information furnished by the Secretary under this section shall be written in a manner calculated to be understood by the average individual applying to participate in the Loan Repayment Program.
The Secretary shall make such application forms, contract forms, and other information available to individuals desiring to participate in the Loan Repayment Program on a date sufficiently early to ensure that such individuals have adequate time to carefully review and evaluate such forms and information.
Consistent with paragraph (3), the Secretary, acting through the Service and in accordance with subsection (k), shall annually—
identify the positions in each Indian health program for which there is a need or a vacancy, and
rank those positions in order of priority.
Consistent with the priority determined under paragraph (1), the Secretary, in determining which applications under the Loan Repayment Program to approve (and which contracts to accept), shall give priority to applications made by—
Indians; and
individuals recruited through the efforts of Indian tribes or tribal or Indian organizations.
Subject to subparagraph (B), of the total amounts appropriated for each of the fiscal years 1993, 1994, and 1995 for loan repayment contracts under this section, the Secretary shall provide that—
not less than 25 percent be provided to applicants who are nurses, nurse practitioners, or nurse midwives; and
not less than 10 percent be provided to applicants who are mental health professionals (other than applicants described in clause (i)).
The requirements specified in clause (i) or clause (ii) of subparagraph (A) shall not apply if the Secretary does not receive the number of applications from the individuals described in clause (i) or clause (ii), respectively, necessary to meet such requirements.
An individual becomes a participant in the Loan Repayment Program only upon the Secretary and the individual entering into a written contract described in subsection (f).
The Secretary shall provide written notice to an individual promptly on—
the Secretary’s approving, under paragraph (1), of the individual’s participation in the Loan Repayment Program, including extensions resulting in an aggregate period of obligated service in excess of 4 years; or
the Secretary’s disapproving an individual’s participation in such Program.
The written contract referred to in this section between the Secretary and an individual shall contain—
an agreement under which—
subject to paragraph (3), the Secretary agrees—
to pay loans on behalf of the individual in accordance with the provisions of this section, and
to accept (subject to the availability of appropriated funds for carrying out this section) the individual into the Service or place the individual with a tribe or Indian organization as provided in subparagraph (B)(iii), and
subject to paragraph (3), the individual agrees—
to accept loan payments on behalf of the individual;
in the case of an individual described in subsection (b)(1)—
to maintain enrollment in a course of study or training described in subsection (b)(1)(A) until the individual completes the course of study or training, and
while enrolled in such course of study or training, to maintain an acceptable level of academic standing (as determined under regulations of the Secretary by the educational institution offering such course of study or training);
to serve for a time period (hereinafter in this section referred to as the “period of obligated service”) equal to 2 years or such longer period as the individual may agree to serve in the full-time clinical practice of such individual’s profession in an Indian health program to which the individual may be assigned by the Secretary;
a provision permitting the Secretary to extend for such longer additional periods, as the individual may agree to, the period of obligated service agreed to by the individual under paragraph (1)(B)(iii);
a provision that any financial obligation of the United States arising out of a contract entered into under this section and any obligation of the individual which is conditioned thereon is contingent upon funds being appropriated for loan repayments under this section;
a statement of the damages to which the United States is entitled under subsection (l) for the individual’s breach of the contract; and
such other statements of the rights and liabilities of the Secretary and of the individual, not inconsistent with this section.
A loan repayment provided for an individual under a written contract under the Loan Repayment Program shall consist of payment, in accordance with paragraph (2), on behalf of the individual of the principal, interest, and related expenses on government and commercial loans received by the individual regarding the undergraduate or graduate education of the individual (or both), which loans were made for—
tuition expenses;
all other reasonable educational expenses, including fees, books, and laboratory expenses, incurred by the individual; and
reasonable living expenses as determined by the Secretary.
For each year of obligated service that an individual contracts to serve under subsection (f) the Secretary may pay up to $35,000 (or an amount equal to the amount specified in section 254l–1(g)(2)(A) of title 42) on behalf of the individual for loans described in paragraph (1). In making a determination of the amount to pay for a year of such service by an individual, the Secretary shall consider the extent to which each such determination—
affects the ability of the Secretary to maximize the number of contracts that can be provided under the Loan Repayment Program from the amounts appropriated for such contracts;
provides an incentive to serve in Indian health programs with the greatest shortages of health professionals; and
provides an incentive with respect to the health professional involved remaining in an Indian health program with such a health professional shortage, and continuing to provide primary health services, after the completion of the period of obligated service under the Loan Repayment Program.
Any arrangement made by the Secretary for the making of loan repayments in accordance with this subsection shall provide that any repayments for a year of obligated service shall be made no later than the end of the fiscal year in which the individual completes such year of service.
For the purpose of providing reimbursements for tax liability resulting from payments under paragraph (2) on behalf of an individual, the Secretary—
in addition to such payments, may make payments to the individual in an amount not less than 20 percent and not more than 39 percent of the total amount of loan repayments made for the taxable year involved; and
may make such additional payments as the Secretary determines to be appropriate with respect to such purpose.
The Secretary may enter into an agreement with the holder of any loan for which payments are made under the Loan Repayment Program to establish a schedule for the making of such payments.
Notwithstanding any other provision of law, individuals who have entered into written contracts with the Secretary under this section, while undergoing academic training, shall not be counted against any employment ceiling affecting the Department of Health and Human Services.
The Secretary shall conduct recruiting programs for the Loan Repayment Program and other health professional programs of the Service at educational institutions training health professionals or specialists identified in subsection (a).
Section 215 of title 42 shall not apply to individuals during their period of obligated service under the Loan Repayment Program.
The Secretary, in assigning individuals to serve in Indian health programs pursuant to contracts entered into under this section, shall—
ensure that the staffing needs of Indian health programs administered by an Indian tribe or tribal or health organization receive consideration on an equal basis with programs that are administered directly by the Service; and
give priority to assigning individuals to Indian health programs that have a need for health professionals to provide health care services as a result of individuals having breached contracts entered into under this section.
An individual who has entered into a written contract with the Secretary under this section and who—
is enrolled in the final year of a course of study and who—
fails to maintain an acceptable level of academic standing in the educational institution in which he is enrolled (such level determined by the educational institution under regulations of the Secretary);
voluntarily terminates such enrollment; or
is dismissed from such educational institution before completion of such course of study; or
is enrolled in a graduate training program, fails to complete such training program, and does not receive a waiver from the Secretary under subsection (b)(1)(B)(ii),
shall be liable, in lieu of any service obligation arising under such contract, to the United States for the amount which has been paid on such individual’s behalf under the contract.
If, for any reason not specified in paragraph (1), an individual breaches his written contract under this section by failing either to begin, or complete, such individual’s period of obligated service in accordance with subsection (f), the United States shall be entitled to recover from such individual an amount to be determined in accordance with the following formula:
A=3Z(t-s/t)
in which—
“A” is the amount the United States is entitled to recover;
“Z” is the sum of the amounts paid under this section to, or on behalf of, the individual and the interest on such amounts which would be payable if, at the time the amounts were paid, they were loans bearing interest at the maximum legal prevailing rate, as determined by the Treasurer of the United States;
“t” is the total number of months in the individual’s period of obligated service in accordance with subsection (f); and
“s” is the number of months of such period served by such individual in accordance with this section.
Amounts not paid within such period shall be subject to collection through deductions in Medicare payments pursuant to section 1395ccc of title 42.
Any amount of damages which the United States is entitled to recover under this subsection shall be paid to the United States within the 1-year period beginning on the date of the breach or such longer period beginning on such date as shall be specified by the Secretary.
If damages described in subparagraph (A) are delinquent for 3 months, the Secretary shall, for the purpose of recovering such damages—
utilize collection agencies contracted with by the Administrator of the General Services Administration; or
enter into contracts for the recovery of such damages with collection agencies selected by the Secretary.
Each contract for recovering damages pursuant to this subsection shall provide that the contractor will, not less than once each 6 months, submit to the Secretary a status report on the success of the contractor in collecting such damages. Section 3718 of title 31 shall apply to any such contract to the extent not inconsistent with this subsection.
Any obligation of an individual under the Loan Repayment Program for service or payment of damages shall be canceled upon the death of the individual.
The Secretary shall by regulation provide for the partial or total waiver or suspension of any obligation of service or payment by an individual under the Loan Repayment Program whenever compliance by the individual is impossible or would involve extreme hardship to the individual and if enforcement of such obligation with respect to any individual would be unconscionable.
The Secretary may waive, in whole or in part, the rights of the United States to recover amounts under this section in any case of extreme hardship or other good cause shown, as determined by the Secretary.
Any obligation of an individual under the Loan Repayment Program for payment of damages may be released by a discharge in bankruptcy under title 11 only if such discharge is granted after the expiration of the 5-year period beginning on the first date that payment of such damages is required, and only if the bankruptcy court finds that nondischarge of the obligation would be unconscionable.
The Secretary shall submit to the President, for inclusion in each report required to be submitted to the Congress under section 1671 of this title, a report concerning the previous fiscal year which sets forth—
the health professional positions maintained by the Service or by tribal or Indian organizations for which recruitment or retention is difficult;
the number of Loan Repayment Program applications filed with respect to each type of health profession;
the number of contracts described in subsection (f) that are entered into with respect to each health profession;
the amount of loan payments made under this section, in total and by health profession;
the number of scholarship grants that are provided under section 1613a of this title with respect to each health profession;
the amount of scholarship grants provided under section 1613a of this title, in total and by health profession;
the number of providers of health care that will be needed by Indian health programs, by location and profession, during the three fiscal years beginning after the date the report is filed; and
the measures the Secretary plans to take to fill the health professional positions maintained by the Service or by tribes or tribal or Indian organizations for which recruitment or retention is difficult.
Source credit: (Pub. L. 94–437, title I, § 108, as added Pub. L. 100–713, title I, § 108, Nov. 23, 1988, 102 Stat. 4789; amended Pub. L. 102–573, title I, §§ 106(a)–(g)(1), (h), (i), 117(b)(3), title IX, § 902(2)(C), (D), Oct. 29, 1992, 106 Stat. 4535–4537, 4544, 4591.)
- 1988Enacted · Pub. L. 94-437 · 102 Stat. 4789
- 1992Amended · Pub. L. 102-573 · 106 Stat. 4535
A history note hasn’t been published yet. The record shows enactment by Pub. L. 94-437 on 1988-11-23.
all 0 arguments · sorted by: best
no arguments yet — make the first case