Section 594.10  Applicability

 

a)         This Part implements Section 10 of the Family Practice Residency Act [110 ILCS 935/10] and Sections 2310-200 and 2310-205 of the Department of Public Health Powers and Duties Law of the Civil Administrative Code [20 ILCS 2310/2310-200 and 2310-205].  These statutory provisions are designed to increase the availability of health care professionals to meet health care needs of citizens living in underserved areas.  Monies made available are to be used to expand access to primary care services.  The provisions of this Part are organized into five Subparts. Subpart A includes general provisions, such as definitions and administrative hearing rules, that apply to all Sections of the Part.

 

b)         Subpart B includes provisions for creation of resource enhancement funds in cooperation with entities such as the Illinois Development Finance Authority or any others to be authorized.  These provisions set forth the proposed amount of funds to be transferred to the Illinois Development Finance Authority, and establishes performance requirements for both the Authority and the Department.

 

c)         Subpart C includes provisions for distribution of funds to create a health professional education loan repayment program, including the modifications necessary when federal grant funds are available.

 

d)         Subpart D includes provisions for distribution of monies in the Community Health Center Care Fund to support activities detailed in Subparts B and D of the Illinois Rural Health Code (77 Ill. Adm. Code 596) and to support educational enhancement activities to increase the numbers and abilities of family physicians able to meet the primary health care needs in Illinois' underserved areas.

 

e)         Subpart E establishes program requirements to award grants for activities that will increase access to primary health care for underserved populations and will enhance educational opportunities for family physicians.

 

(Source:  Amended at 25 Ill. Reg. 14507, effective November 1, 2001)

 

Section 594.20  Definitions

 

"Act" means the Illinois Family Practice Residency Act [110 ILCS 935].

 

"Advanced practice nurse" means a nurse licensed under Title 15 of the Nursing and Advanced Practice Nursing Act [225 ILCS 65].

 

"Authority" means the Illinois Development Finance Authority.

 

"Community Based Organization" means a locally organized and recognized group of individuals whose goals include efforts to maintain or increase the availability or accessibility of necessary health care for the citizens of the community.

 

"Community health center" means community/migrant health centers or health care for the homeless projects supported under Section 254b, 254c or 256 of the federal Public Health Service Act (42 USC 254b, 254c and 256) or federally qualified health center look-alikes, as designated by the U.S. Public Health Service.

 

"Center" means the Center for Rural Health of the Illinois Department of Public Health.

 

"Dentist" means a person licensed to practice dentistry under the Illinois Dental Practice Act [225 ILCS 25].

 

"Department" means the Illinois Department of Public Health.

 

"Downstate" means those Illinois counties other than Cook, Lake, McHenry, DuPage, Will and Kane.

 

"Family practice residency program" means a training program meeting the requirements of the Accreditation Council for Graduate Medical Education of the American Medical Association or the Committee on Postdoctoral Training of the American Osteopathic Association.

 

"Full time practice" means maintaining office hours for patient care that equal or exceed the mean number of office hours per week reported by physicians, by specialty, and published in the American Medical Association's "Socioeconomic Characteristics of Medical Practice, 1992."  Physician assistants and advanced practice nurses will meet the same minimum time requirements as their supervising or collaborating physician.

 

"Fund" means the Community Health Center Care Fund.

 

"Local health department" means a county, multi-county, municipal or district public health agency recognized by the Department.

 

"Medically underserved population" means individuals who reside in a U.S. Department of Health and Human Services designated health professional shortage area or medically underserved area; or who are designated a medically underserved population by the U.S. Department of Health and Human Services; or who reside in an area designated by the Department as underserved.

 

"Physician assistant" means an individual licensed under the Physician Assistant Practice Act of 1987 [225 ILCS 95].

 

"Primary care" means health care that encompasses prevention services, basic diagnostic and treatment services, and support services such as laboratory, radiologic, transportation, and pharmacy.  Primary care is comprehensive in nature and not organ or problem specific; is oriented toward the longitudinal care of the patient; and includes responsibility for coordination of other health and social services as they relate to the patients' needs.

 

"Primary care physician"  means a person licensed to practice medicine in all its branches under the Medical Practice Act of 1987 [225 ILCS 60] with a specialty in family practice, general internal medicine, obstetrics/gynecology, general pediatrics, or combined internal medicine/pediatrics and as defined by recognized standards for professional medical practices.

 

"Psychiatrist" means a physician licensed to practice medicine in all its branches under the Medical Practice Act of 1987 [225 ILCS 60] who has successfully completed an accredited residency program in psychiatry.

 

"Rural" means any geographic area not located in a U.S. Bureau of the Census Metropolitan Statistical Area or a county located within a Metropolitan Statistical Area but having a population of 60,000 or less.

 

(Source:  Amended at 25 Ill. Reg. 14507, effective November 1, 2001)

 

Section 594.30  Incorporated or Referenced Materials

 

The following materials are incorporated or referenced in this Part:

 

a)         Illinois Statutes and Rules Referenced

 

1)         Family Practice Residency Act [110 ILCS 935].

 

2)         Illinois Rural/Downstate Health Act [410 ILCS 65].

 

3)         Sections 2310-200 and 2310-205 of the Department of Public Health Powers and Duties Law of the Civil Administrative Code of Illinois [20 ILCS 2310/2310-200 and 2310-205].

 

4)         Public Act 88-0535, effective January 26, 1994 (see Section 10 of the Family Practice Residency Act).

 

5)         Rules of Practice and Procedure in Administrative Hearings (77 Ill. Adm. Code 100).

 

6)         Family Practice Residency Code (77 Ill. Adm. Code 590).

 

7)         Illinois Rural Health Code (77 Ill. Adm. Code 596).

 

b)         Federal Statutes Referenced

 

1)         Designation of Health Professional Shortage Areas, Section 332 of the Public Health Service Act (42 USC 254e).

 

2)         Designation of Medically Underserved Areas, Section 330 (b)(3) of the Public Health Service Act (42 USC 254c (b)(3)).

 

c)         All incorporations by reference of standards of nationally recognized organizations refer to standards on the date specified and do not include any additions or deletions subsequent to the date specified.

 

(Source:  Amended at 25 Ill. Reg. 14507, effective November 1, 2001)

 

Section 594.40  Administrative Hearings

 

All administrative hearings conducted by the Department concerning the provisions of this Part shall be governed by the Department's Rules of Practice and Procedure in Administrative Hearings (See 77 Ill. Adm. Code 100).

 

Section 594.100  Availability of Funds

 

From monies deposited into the Community Health Center Care Fund since January 1, 1992, a sum not to exceed $300,000 will be transferred to the Authority, pursuant to Public Act 88-0535, effective January 26, 1994 (see Section 10 of the Family Practice Residency Act).  The transfer will be a one-time, lump sum payment.

 

(Source:  Amended at 25 Ill. Reg. 14507, effective November 1, 2001)

 

Section 594.110  Responsibilities of the Illinois Development Finance Authority

 

a)         The Authority will be responsible for management of the monies transferred to it by the Department from the Fund.  It will use the transferred monies to establish bond reserve or credit enhancement escrow accounts, loan program reserves, or other escrow accounts.

 

b)         The Authority will be responsible for completion of all reports as required by the Department and agreed to by the Authority in an interagency agreement.

 

c)         The Authority will be responsible for all loan monitoring and collection of loan repayments from the community health centers which have borrowed from the fund created.

 

Section 594.120  Responsibilities of the Department and the Center for Rural Health

 

a)         The Department will be responsible for management of the Community Health Center Care Fund and the transfer of the agreed upon payment to the Authority.

 

b)         The Center will assist the Authority in identifying the eligible recipients to participate in the capital development projects to be funded with the monies leveraged by the Authority.

 

Section 594.130  Eligibility to Receive Loans From the Capital Funds

 

Community health centers in Illinois are eligible to apply for loans from the Illinois Development Finance Authority-managed capital fund.

 

Section 594.140  Application for Loans

 

a)         Applications for loans will be in a format determined by the Authority.

 

b)         Applications will be submitted to the Authority through the Center prior to the Authority's determination of the type of financing option it will pursue.

 

Section 594.150  Selection of Loan Recipients

 

Applications submitted to the Center will be reviewed by staff of the Center, the Authority, and the Illinois Primary Health Care Association.  Final selection decisions will be at the discretion of the Authority.

 

Section 594.200  Availability of Loan Repayment Funds

 

a)         From monies deposited into the Fund, an annual sum of at least $150,000 shall be used for a health professional educational loan repayment program beginning in State Fiscal Year 1995.

 

b)         These monies shall be used by the Center to match federal dollars awarded through the National Health Service Corps State Loan Repayment Program Grant, when available.

 

c)         If the federal grant dollars are not available, the monies made available from the Fund shall continue to be used to support an educational loan repayment program for health professionals.

 

d)         Funds used to repay a health professionals' educational loans shall consist of at most 75 percent State and/or federal funds and at least 25 percent local funds from nonstate and nonfederal sources.

 

1)         When National Health Service Corps State Loan Repayment Grant Program funds are available and used, the local payment will be made into the Rural/Downstate Health Access Fund.

 

2)         When only State and Community Health Center Care Fund monies are used, the local contribution may be made directly to the health care provider recruited through this program.  The local entity assuming responsibility for at least 25 percent of the payment shall enter into a written agreement with the Department. The agreement contains additional terms and conditions that ensure compliance with this Part, the laws of the State of Illinois, and enforcement of the agreement.

 

(Source:  Amended at 25 Ill. Reg. 14507, effective November 1, 2001)

 

Section 594.210  Limitations on Use of Loan Repayment Funds

 

a)         Funds shall be used for the repayment of educational loans of primary care physicians, dentists, psychiatrists, physician assistants, and advanced practice nurses who agree to serve in designated shortage areas.

 

b)         Payments may be used for the principal, interest and related expenses of government and commercial loans received by the individual and used for tuition expenses, and all other reasonable educational expenses incurred by the individual.  The loans must have been incurred in pursuit of the recipient's professional education and may include undergraduate and graduate educational programs.

 

c)         Applicants who agree to practice at a Department approved site in an underserved area for 2 years are eligible for up to $25,000 annually; however, if the total amount of the applicant's qualifying educational loans is less than $50,000, the applicant will receive one-half of the total qualifying educational loan amount annually.

 

d)         Applicants who agree to practice in an underserved area for 3 years are eligible for up to $25,000 for each of the first 2 years and up to $35,000 for the third year of service; if the balance of the applicant's qualifying educational loans after the first 2 years of service is less than $35,000, however, the applicant will receive payment for the remaining qualifying educational loans in the third year.

 

e)         Applicants who agree to practice in an underserved area for 4 years are eligible for up to $25,000 annually for the first and second years of service and $35,000 annually for the third and fourth years of service.  If the balance of the applicant's qualifying educational loans after the first 2 years of service is less than $70,000, however, the applicant will receive one-half of the remaining qualifying educational loans annually in the third and fourth years.

 

f)         An additional amount of not more than 39 percent of the total amount of loan repayments made for each tax year in which these payments were made may be paid to the loan repayment program recipient in those years when National Health Service Corps State Loan Repayment Grant Program funds are available.

 

g)         Funds may not be used to monetarily repay any practice obligation resulting from educational loans or scholarships.

 

(Source:  Amended at 25 Ill. Reg. 14507, effective November 1, 2001)

 

Section 594.220  Eligibility for Application

 

a)         Any Illinois primary care physician, psychiatrist, dentist, physician assistant or advanced practice nurse, or one who can be expected to be licensed in Illinois and who intends to practice in a designated shortage area of Illinois, may apply for educational loan repayment.

 

b)         Applicants shall document currently existing educational loan indebtedness to a governmental or commercial lending institution incurred for educational expenses in pursuit of the applicant's degree or diploma.  This required documentation of indebtedness shall include a photocopy or original copy of promissory notes or other evidence of indebtedness with disclosure of lending institution or agency, loan amount, loan period, interest rate, and any amounts repaid prior to date of application.

 

c)         Applicants shall be willing to practice full-time in designated shortage areas in Illinois.

 

d)         Applicants not yet in practice, or not yet in practice in designated shortage areas, shall document intent to do so by written confirmation from a community-based organization, from a nonprofit or governmental agency, or from other health care providers located within the designated shortage area.  If the written confirmation is from a nonprofit or governmental agency, then the agency must agree to pay at least one-quarter of the applicant's outstanding principal for each year that the agency participates in the educational loan repayment program.

 

(Source:  Amended at 25 Ill. Reg. 14507, effective November 1, 2001)

 

Section 594.230  Selection Criteria for Distribution of Loan Repayment Funds

 

a)         One-third of the available funds will be used for educational loan repayment of physician assistants and advanced practice nurses, if applications are sufficient in number to warrant the amount.

 

b)         When numbers of applications are sufficient to support a geographical separation into urban and rural groupings, an equal number of applicants will be selected from each of the groups.

 

c)         When numbers of applications are sufficient, an equal number of applicants shall be selected from Chicago and from the remaining urban areas of the State.

 

d)         Within the geographical considerations, preference shall be given to applications from providers who will be working at sites that are serving a large minority population, in rural areas with ongoing problems recruiting providers, and migrant and community health centers.

 

e)         Preference shall be given to applications from those providers who have been recruited by, or are actively involved with, a community-based organization or group having as one of its goals the improvement or maintenance of the availability and accessibility of primary health care in its area.

 

f)         When all other selection criteria are essentially equal among a group of applicants, preference will be given to the applicant with the greater educational indebtedness.

 

g)         Applications shall have the following priority classifications applied to the location and other characteristics of the practice:

 

1)         Higher population-to-primary care physician ratio, new provider to area, and endorsement by community-based group or organization.

 

2)         Applicant in practice 6 months or less, higher ratio of population-to-primary care physician, and endorsement by community-based group or organization.

 

3)         Applicant new to area or in practice 6 months or less, but no endorsement by community-based group or organization.

 

h)         Applications shall be accepted between July 1 and September 30 and considered for funding according to the criteria described in this Section. If all funds are not expended, subsequent application cycles will occur on a quarterly basis until all funds are obligated.

 

i)          Applicants who have previously received funding will be given priority consideration for continued participation in the program.

 

(Source:  Amended at 25 Ill. Reg. 14507, effective November 1, 2001)

 

Section 594.240  Terms of Performance

 

a)         Each primary care physician, dentist, psychiatrist, physician assistant, or advanced practice nurse selected for educational loan repayment shall sign a written contract with the Department. The contract may contain additional terms and conditions that ensure compliance with the laws of the State of Illinois and enforcement of the contract.  In fiscal years when National Health Service Corps State Loan Repayment Grant funds are awarded to the State, federal requirements shall be included in the contract.

 

b)         Primary care physicians, dentists, psychiatrists, physician assistants, and advanced practice nurses selected for loan repayment shall practice on a full-time basis for a minimum of 2 years in a designated shortage area for a medically underserved population.  In fiscal years when National Health Service Corps State Loan Repayment Grant funds are awarded to the State for support of this program, loan repayment recipients must practice in federally designated health professional shortage areas.  In years when no federal funds from the National Health Service Corps State Loan Repayment Grant are available, the practice site may be located in a shortage area as designated by the Department.

 

c)         Loan repayment recipients who want to move their practice from the location described in the recipient's original application shall request prior approval from the Department before relocating.  The Department must ensure that the recipient relocates to another designated shortage area and that the health care provider in that area agrees to pay one-quarter of the recipient's outstanding principal each year that the provider participates in the program.

 

d)         Payments to recipients will be made by the Department on a quarterly basis.  The recipient is responsible for payments to the appropriate financial institutions holding the recipients' educational loans.

 

e)         Loan repayment recipients who first agree to the minimum 2 years of service and who, after completing those years, apply for additional years of obligated service with loan repayment shall document that their loan balances as reported at the time of their first application to the program have been decreased at least by the amount paid to them by the Department during the first obligated service period.  Documentation of loan balances shall be provided by the lending institution.

 

f)         Misrepresentation of the facts presented in the application or failure to meet the practice terms will be considered a breach of contract.

 

g)         Loan repayment recipients who agree to serve for 2 years, but fail to complete the period of obligated service, shall be liable to repay an amount equal to the sum of:

 

1)         the total amount paid to the recipient and

 

2)         the number of months of the unserved obligation multiplied by $1000.

 

h)         Loan repayment recipients who agree to serve for more than 2 years, but fail to complete at least 2 years of the period of obligated service, shall be liable to repay the sum set forth in subsection (g).

 

i)          Loan repayment recipients who agree to serve for more than 2 years, but fail to complete the period of obligated service after completing at least 2 years of obligated service, shall be liable to repay an amount equal to the sum of:

 

1)         the total amounts paid to the recipient for any period of obligated service not served and

 

2)         $10,000, if the recipient fails to give the Department at least one year prior notice of his or her intent to breach the obligation.

 

j)          Loan repayment recipients who do not complete at least one year of service shall be liable to repay an amount equal to the sum of:

 

1)         the total amount paid to the recipient and

 

2)         the total number of months in the full period of obligated service multiplied by $1000.

 

k)         Obligations of the loan repayment recipient shall be excused in the event the recipient dies or becomes totally and permanently disabled.  For purposes of this subsection, disability means a physical or mental disease, impairment or condition that prevents practice in the recipients professional field with or without reasonable accommodation.  Proof of disability shall be a declaration from the Social Security Administration, Illinois Industrial Commission, Department of Defense, or an insurer authorized to transact business in the State of Illinois who is an insurer of the recipient providing disability insurance coverage to the recipient.

 

l)          All amounts owed by the loan repayment recipient shall be paid within one year after the date the Department determines that the recipient is in breach of the program obligations.

 

m)        In the event the primary care physician, psychiatrist, dentist, physician assistant, or advanced practice nurse does not repay any funds owed to the Department, the Department may refer the matter to the Attorney General or to a collection agency.

 

(Source:  Amended at 25 Ill. Reg. 14507, effective November 1, 2001)

 

Section 594.300  Availability of Grant Funds

 

a)         In State fiscal year 1995, the monies in the Fund, less the lump sum transfer to the Illinois Development Finance Authority, and less the $150,000 allocation for the educational loan repayment program, shall be distributed in equal amounts to support the following programs:

 

1)         Grants to Develop Community Based Primary Care Centers (see the Illinois Rural Health Code, 77 Ill. Adm. Code 596, Subpart B);

 

2)         Grants to Support Expansion of Community Health Centers' Programs (see the Illinois Rural Health Code, 77 Ill. Adm. Code 596, Subpart D);

 

3)         Grants to support development, maintenance and expansion of educational experiences that will result in an increased supply of family physicians for Illinois' rural and underserved areas (see Subpart E of this Part).

 

b)         In State fiscal year 1996 and all subsequent years, the monies in the fund as of June 30 of the prior fiscal year, less the $150,000 allocation for the educational loan repayment program, shall be distributed in equal amounts to support the programs as proposed in subsection (a) of this Section.

 

c)         Monies allocated to each activity but not expended in a fiscal year shall be added to the allocation for the activity in the subsequent fiscal year.

 

(Source:  Amended at 25 Ill. Reg. 14507, effective November 1, 2001)

 

Section 594.400  Eligibility for Grants

 

The grant program in this Subpart E is designed to improve the ability of medical schools and family practice residencies both to increase the numbers of family physicians and to better prepare family physicians for practice in underserved areas of the State.

 

a)         The following applicants are eligible to apply for grants through this Subpart:

 

1)         Any accredited family practice residency program located in Illinois.

 

2)         Any school of medicine or osteopathy in Illinois with a department of family medicine or family practice.

 

3)         Any local health department serving an underserved population.

 

4)         Any non-profit, community-based organization or facility, including, but not limited to, a community health center.

 

b)         Each application must be jointly submitted by at least 2 eligible applicants, with one applicant being a residency program or a medical or osteopathic school.

 

(Source:  Amended at 25 Ill. Reg. 14507, effective November 1, 2001)

 

Section 594.410  Limitations on Use of Grant Funds

 

a)         Grant funds shall be used by the applicant to support project expenses, whether incurred at the applicants' central sites or at remote locations which are an integral part of the project.  Project expenses include:

 

1)         personal services expenses of staff directly involved in the project;

 

2)         medical equipment and supplies necessary for the operation of the project;

 

3)         staff, resident and student travel directly related to the project;

 

4)         nonmedical equipment and supplies necessary for the operation of the project;

 

5)         contractual services and rent necessary for the operation of the project;

 

6)         expenses associated with necessary facility remodeling;

 

7)         expenses associated with participation in an interactive telecommunication system, to establish telemetry and other electronic communication capabilities;

 

8)         other expenses critical to the operation of the project.

 

b)         Grant funds shall not be used to supplant other State or federal grants.

 

c)         Grant funds shall not be used to purchase real property.

 

Section 594.420  Project Requirements

 

a)         Projects to be funded through this Subpart shall respond to requests for proposals distributed by the Department which delineate project expectations.

 

b)         Examples of projects to be addressed in the requests for proposals distributed by the Department include but are not limited to the following:

 

1)         special experiences for medical students and residents that may result in an increase in the number of family physicians available for Illinois' rural areas and its medically underserved areas;

 

2)         educational programs to increase the teaching skills of practicing physicians who are, or want to become preceptors;

 

3)         educational programs to increase the teaching skills of family medicine faculty to better prepare students and residents for practice in rural and in medically underserved areas;

 

4)         innovative teaching models for students and residents interested in practices serving rural and medically underserved populations;

 

5)         interdisciplinary teaching models for health professional students;

 

6)         educational support programs to develop and maintain an interest in family medicine and other health professions for interested students from rural areas and medically underserved areas.

 

c)         Projects shall identify a director who is responsible for administrative and fiscal management of the project.

 

d)         Project directors shall annually submit fiscal and program objective reports as detailed in the Department's request for proposals.

 

Section 594.430  Application for Grants

 

a)         Applications shall be prepared and available from the Department for eligible applicants.

 

b)         Application formats shall include, but not be limited to:

 

1)         summary statement of the applicant's plan of action to address the project(s) described in the Department's request for proposals;

 

2)         thorough explanation of the manner in which the proposed project would increase the numbers of, or abilities of, family physicians to meet the needs of rural and medically underserved populations;

 

3)         statement of the measurable and relevant objectives the applicants propose to achieve in the grant year as well as the longer term goals;

 

4)         a work plan and time table for achievement of the objectives;

 

5)         an evaluation plan which will allow documentation of the project's progress in achieving its goals;

 

6)         detailed budget with narrative description of the request;

 

7)         description of the student, resident, faculty and other health professional involvement in the project;

 

8)         description of the educational benefits the project offers students and residents which, without the project, would not be available to them;

 

9)         description of the benefits the project offers other health care providers and citizens living in the rural and in the medically underserved areas affected by the projects.

 

Section 594.440  Selection Criteria

 

a)         The review of the applications shall take into consideration the following criteria:

 

1)         potential effectiveness of the project to increase the number of family physicians available for Illinois' rural and medically underserved areas;

 

2)         degree to which the proposed project adequately provides for the training of health professionals to practice in rural and medically underserved areas;

 

3)         degree to which the applicants demonstrate a commitment to establishing and maintaining long-term collaborative relationships between academic institutions and health care facilities and providers in rural and in medically underserved areas;

 

4)         effectiveness of the organizational arrangements necessary to carry out the project;

 

5)         prior experiences of the applicants in projects which addressed needs of rural and medically underserved populations;

 

6)         extent to which the budget justification is reasonable and indicates that institutional and community support are available to support the project;

 

7)         extent to which the financial information indicates an effective utilization of grant funds and indicates the project has the potential to become self-sufficient.

 

b)         Additional selection criteria which will cause an application to receive priority consideration include:

 

1)         projects which are closest to operational status at time of application;

 

2)         projects which exhibit need for funds from this grant for the shortest period of time.