This rule amends the requirements for the Medical Education Reimbursement and Loan Repayment Program implemented as the Florida Reimbursement Assistance for Medical Education (FRAME) Program. The function of the program ....

 

DEPARTMENT OF HEALTH

Division of Public Health Statistics and Performance Management

RULE NOS.:RULE TITLES:

64W-4.001Definitions

64W-4.002Eligibility Requirements

64W-4.003Documentation Requirements

64W-4.004Application Processing

64W-4.005Award Prioritization and Awards

PURPOSE AND EFFECT: This rule amends the requirements for the Medical Education Reimbursement and Loan Repayment Program implemented as the Florida Reimbursement Assistance for Medical Education (FRAME) Program. The function of the program is to make payments that offset student loans incurred by students for studies leading to a medical or nursing degree, medical or nursing licensure, or advanced practice registered nurse licensure or physician assistant licensure. The amendments to the rule are intended to add definitions, clarify eligibility and documentation requirements, establish a new application period, and update the award prioritization methodology.

SUMMARY: The FRAME program reimburses student loans incurred by students for studies leading to a medical or nursing degree, medical or nursing licensure, or advanced practice registered nurse licensure or physician assistant licensure.

SUMMARY OF STATEMENT OF ESTIMATED REGULATORY COSTS AND LEGISLATIVE RATIFICATION:

The Agency has determined that this will not have an adverse impact on small business or likely increase directly or indirectly regulatory costs in excess of $200,000 in the aggregate within one year after the implementation of the rule. A SERC has not been prepared by the Agency.

The Agency has determined that the proposed rule is not expected to require legislative ratification based on the statement of estimated regulatory costs or if no SERC is required, the information expressly relied upon and described herein: Based on the SERC checklist, this rulemaking will not have an adverse impact on regulatory costs in excess of $1 million within five years as established in s.120.541(2)(a), F.S.

Any person who wishes to provide information regarding a statement of estimated regulatory costs, or provide a proposal for a lower cost regulatory alternative must do so in writing within 21 days of this notice.

RULEMAKING AUTHORITY: 1009.65 FS.

LAW IMPLEMENTED: 1009.65 FS.

IF REQUESTED WITHIN 21 DAYS OF THE DATE OF THIS NOTICE, A HEARING WILL BE SCHEDULED AND ANNOUNCED IN THE FAR.

THE PERSON TO BE CONTACTED REGARDING THE PROPOSED RULE IS: Jeffrey Johnson at 850-617-1471 or [e-mail]

 

THE FULL TEXT OF THE PROPOSED RULE IS:

 

64W-4.001 Definitions.

(1) “Eligible professions” means medical doctors with primary care specialties, doctors of osteopathic medicine with primary care specialties, physician assistants, licensed practical nurses, registered nurses, advanced practice registered nurses (APRNs) with primary care specialties, and autonomous advanced practice registered nurses engaged in autonomous practice as defined in section 464.0123(3)(a), F.S. (autonomous APRNs).

(2) No Change

(3) “Lender” means any entity involved in making, holding, consolidating, originating, servicing, or guaranteeing any loan to students to finance higher education expenses. This includes lenders who provide private educational loans as well as lenders who provide loans that are made, insured, or guaranteed by the U.S. Department of Education.

(4) “Primary care specialties” means as follows:

(a) Medical doctors and doctors of osteopathic medicine (physicians) practicing in obstetrics; gynecology; general and family practice, which includes geriatrics; general internal medicine, which includes geriatrics; general pediatrics; and psychiatry.

(b) Autonomous APRNs and advanced practice registered nurses APRNs practicing in general and family medicine, general pediatrics, general internal medicine, or midwifery.

(5) “Public health program” means a county health department, the Children’s Medical Services program, a federally funded community health center (a Federally Qualified Health Center (FQHC) and FQHC Look-Alike designated by the HRSA), or a federally funded migrant health center, any publicly funded health care program, or a nonprofit health care program.

(a) A publicly funded health care program is an organization or business that provides healthcare and is funded by either the federal government, or the State of Florida, or a local government. Acceptance of Medicare and/or Medicaid does not render a program publicly funded.

(b) A nonprofit health care program is an organization or business that provides healthcare and is registered as a nonprofit with the Florida Department of State or approved for 501(c)(3) status by the Internal Revenue Service.

(6) “Qualified loan” means a federal and/or private student loan with a U.S.-based lender that has a verified principal balance remaining which loan proceeds were used to pay educational expenses enumerated in sections 1009.65(1)(a)1. or (1)(b), F.S., incurred by students for studies leading to a medical degree, nursing degree, medical licensure, nursing licensure, advanced practice registered nurse licensure, or physician assistant licensure. Loans whose proceeds were used for any educational expenses that did not directly lead to these degrees or licenses are not qualified loans. Loans from an individual or entity that does not meet the definition of lender are not qualified loans.

(7) through (8) No change

(9) “Direct patient care hours” means in-person, face-to-face care with live patients. Hours spent providing telemedicine services, performing research, conducting administrative duties, or traveling are not direct patient care hours.

(10) “U.S.-based lender” means any financial institution headquartered within the United States. Financial institutions headquartered outside of the U.S., even if they have branches in the U.S., are not U.S.-based lenders.

(11) “FRAME” means the Medical Education Reimbursement and Loan Repayment Program established pursuant to section 1009.65, F.S.

(12)(9) This rule will be reviewed and repealed, modified, or renewed through the rulemaking process five years from the effective date.

Rulemaking Authority 1009.65 FS. Law Implemented 1009.65 FS. History– History– New 4-20-23, Amended: ________.

 

64W-4.002 Eligibility Requirements.

(1) To be eligible to receive reimbursement or loan repayment from the program, applicants in eligible professions, other than autonomous APRNs, must:

(a) through (c) No change

(d) Not have received an award from any other State of Florida-funded student loan repayment program since July 1 of the previous year, and

(e) Have a qualified loan as defined in subsection 64W-4.001(6) F.A.C.,

(f) Accept Medicaid reimbursement unless the practice is not eligible. The only Medicaid ineligible practices are correctional institutions; military locations, including Veteran Affairs clinics; state mental health hospitals; free clinics; and state facilities for the developmentally disabled,

(g) Be employed in an eligible location, which employment must be in effect on the first day of the application period and extend, at a minimum, through the date of loan repayment, pursuant to Rule 64W-4.005, and

(h) Have a valid email address for program correspondence.

(2) To be eligible to receive reimbursement or loan repayment from the program, autonomous APRN applicants must:

(a) through (d) No change

(e) Be actively employed and providing in-person primary care services in a public health program, an independent practice, or a group practice that serves Medicaid recipients and other low-income patients, and

1. Proof of serving Medicaid recipients must include verifiable Medicaid billing.

2. Proof of serving other low-income patients must include documentation that the practice location has a sliding fee scale or does not charge the patients (free clinic).

(f) Practice in a location that is in a HRSA designated primary care HPSA with a score of at least 18, a rural area as identified by the Federal Office of Rural Health Policy, or a rural hospital as defined in section 395.602(2)(b), F.S.,

(g) Practice in a primary care specialty as defined in subsection 64W-4.001(4) F.A.C., and

(h) Have a valid email address for program correspondence.

(3) No change

Rulemaking Authority 1009.65 FS. Law Implemented 1009.65 FS. History– New 4-20-23, Amended: ________.

 

64W-4.003 Documentation Requirements.

(1) Applications are to be completed and documents uploaded to the FRAMEworks portal or mailed to the Florida Department of Health, Division of Public Health Statistics and Performance Management, State Primary Care Office, FRAME Program, 4052 Bald Cypress Way, Bin #A05, Tallahassee, Florida 32399-1720. Hand-delivered application packets will not be accepted.

(2) Submit a completedApplicants must complete the Florida Reimbursement Assistance for Medical Education (FRAME) Application in the FRAMEworks portal., The FRAME Application, DH8013-PHSPM-01/202423, is incorporated by reference and available at https://www.flrules.org/Gateway/reference.asp?No=Ref-XXXXhttps://www.flrules.org/Gateway/reference.asp?No=Ref-15268.

(3) Based on employment type, one of the following must be either submitted to the Department in the physical application packet or uploaded to the FRAMEworks portal:

(2)(a) A completed Florida Reimbursement Assistance for Medical Education (FRAME) Employment Verification Form must be uploaded to the FRAMEworks portal (PDF only). One form is required for each employer, including self-employment or partnerships if the applicant is an employee. The FRAME Employment Verification Form, DH8015-PHSPM-01/202423, is incorporated by reference and available at https://www.flrules.org/Gateway/reference.asp?No=Ref-XXXX. https://www.flrules.org/Gateway/reference.asp?No=Ref-15271, Signatures on this form must be in ink.

or

(b) A completed Florida Reimbursement Assistance for Medical Education (FRAME) Solo Practitioner Attestation, if the applicant is not an employee. If the application is completed in the FRAMEworks portal, the information in this form may be completed in the portal, without the need to upload the form. The Solo Practitioner Attestation, DH8016-PHSPM-01/2023, is incorporated by reference and available at https://www.flrules.org/Gateway/reference.asp?No=Ref-15270.

(3)(4) A completed Florida Reimbursement Assistance for Medical Education (FRAME) Loan Certification Form for each educational loan must be either submitted to the Department in the application packet or uploaded to the FRAMEworks portal (PDF format only). The FRAME Loan Certification Form, DH8014-PHSPM-01/202423, is incorporated by reference and available at https://www.flrules.org/Gateway/reference.asp?No=Ref-XXXX.http://www.flrules.org/Gateway/reference.asp?No=Ref-15269. Signatures must be in ink, except that the financial institution may utilize a legally binding eSignature.

(4)(5) The following FRAME program documents must should be either submitted to the Department in the application packet or uploaded to the FRAMEworks portal, as applicable:

(a) For all practice locations that are in an FQHC; correctional facility; a rural health clinic; an Indian Health Service, Tribal Health, and Urban Indian Health Organizations; or a state mental hospital, upload documentation of primary care shortage designation status by HRSA. A PDF copy of the HRSA “Find Shortage Areas State/County” query result for each practice site location (https://data.hrsa.gov/tools/shortage-area/hpsa-find) is considered acceptable documentation.For all practice locations that are in a primary care HPSA, submit documentation of primary care shortage designation status. A copy of the HRSA “Find Shortage Areas by Address” query result for each practice site location (https://data.hrsa.gov/tools/shortage-area/by-address) is considered acceptable documentation.

(b) For all practice locations that are not listed in paragraph (a) above, but are in a primary care HPSA, upload a PDF copy of the query result for each practice site location from the HRSA “Find Shortage Areas by Address” query result for each practice site location (https://data.hrsa.gov/tools/shortage-area/by-address).

(c)(b) For all practice locations that are not in a primary care HPSA but are in a designated rural health area or rural hospital, submit documentation of the rural health status. A PDF copy of the query result for each practice site location from the Federal Office of Rural Health Policy (https://data.hrsa.gov/tools/rural-health) is considered acceptable documentation.

(d)(c) If requested by the Department, PDF documentation of status as a United States citizen (U.S. born or naturalized) or United States national, as defined by 8 U.S.C. 1401 - 1440, shall be provided by the applicant within five (5) business days.

(5)(6) The FRAME Employment Verification Form and FRAME Loan Certification Form All Department forms for the FRAME program will also be made available on the Department’s website at https://www.fdohframe.com/s/forms https://www.floridahealth.gov/provider-and-partner-resources/community-health-workers/HealthResourcesandAccess/FRAMEProgram/index.html.

(6)(7) This rule will be reviewed and repealed, modified, or renewed through the rulemaking process five years from the effective date.

 

64W-4.004 Application Processing.

(1) FRAME Applications will only be accepted via the FRAMEworks portal between February 15 at 12:00 am (EST) and March 31 at 11:59 pm (EST) for any fiscal year in which the program is funded by the legislature. Applications for reimbursement or loan repayment will only be accepted:

(a) For state fiscal year 2022-23, applications must be submitted no later than 11:59 pm (EST) April 28, 2023, via either the FRAMEworks portal or a postmark no later than April 28, 2023.

(b) The provisions of this rule will be amended through rulemaking to provide for future application cycles to the extent this program is funded in subsequent fiscal years.

(c) The Department may extend the application period in the event funds are still available. Any extension to the application period will be announced on the Department’s website (https://www.floridahealth.gov/provider-and-partner-resources/community-health-workers/HealthResourcesandAccess/FRAMEProgram/index.html) and on the FRAMEworks portal 14 days prior to the new closing date.

(2) through (5) No change

Rulemaking Authority 1009.65 FS. Law Implemented 1009.65 FS. History– New 4-20-23, Amended: ________.

 

64W-4.005 Award Prioritization and Awards.

(1) No change

(2) Within each tier, applicants will be prioritized from highest to lowest by the following method:

(a) The FRAME Frame Prioritization Score will reflect a weighted total of 75% of the Adjusted Primary Care HPSA Sscore and 25% of the Service Score.

(b) The Adjusted Primary Care HPSA Score will be computed by:

1. For only one practice location: (average weekly direct patient care hours for the month immediately preceding application, [DPCH] ÷ 40) x Primary Care HPSA Score).

2. For multiple practice locations: each location will be scored individually using the above calculation and the results will be added together.

(c) The Service Score will be computed by (end date of application period prioritization score data run – date of applicant’s first day with the employer) ÷ 100)). If the applicant works for multiple employers, the applicant’s longest employer’s start date will be used.

(d) The calculations set forth in paragraphs (2)(a), (b), and (c) above are illustrated in Figure 1 below.

Figure 1.

(3) Underserved areas not designated by HRSA as a primary care HPSA will use a Primary Care HPSA score of 1 less than the lowest primary care HPSA score designated on January 15, or the next business day if the 15th falls on a weekend or holiday the first day of the application period, but not less than zero for the Primary Care HPSA Score in the computed Adjusted Primary Care HPSA Score. All Primary Care HPSA scores will be the score that was applicable on January 15, or the next business day if the 15th falls on a weekend or holiday. Any applicant working at a facility that is eligible to have its own HPSA score will use that facility’s primary care HPSA score.

(4) No change

(5) Payments made to a lender cannot exceed a recipient’s outstanding qualified principal loan balance and all payments made by the Department shall only be applied to the recipient’s principal balance.

(6) In the event that there are mathematical ties (to the eighth decimal place) in the priority scores where funding will be exhausted, those applicants with a tied priority score will be funded in the following order of precedence:

(a) First, by the highest Adjusted Primary Care HPSA score as calculated in paragraph (2)(b). In the event this does not resolve the tied priority scores, then

(b) Second, by the highest Medicaid participation percentages as reported on the FRAME Employment Verification Form. In the event this does not resolve the tied priority scores, then

(c) The remaining amount of funding will be equally divided among the tied applicants.

(7)(6) This rule will be reviewed and repealed, modified, or renewed through the rulemaking process five years from the effective date.

Rulemaking Authority 1009.65 FS. Law Implemented 1009.65 FS. History– New 4-20-23, Amended: ________.

 

NAME OF PERSON ORIGINATING PROPOSED RULE: Jeffrey Johnson

NAME OF AGENCY HEAD WHO APPROVED THE PROPOSED RULE: Joseph Ladapo, MD, PhD, Surgeon General and Secretary

DATE PROPOSED RULE APPROVED BY AGENCY HEAD: 12/14/2023

DATE NOTICE OF PROPOSED RULE DEVELOPMENT PUBLISHED IN FAR: 08/18/2023