H.F. 2389 Section 1. NEW SECTION . 261.115 Rural Iowa primary care 1 loan repayment program —— fund —— appropriations. 2 1. Program established. A rural Iowa primary care loan 3 repayment program is established to be administered by the 4 college student aid commission for purposes of providing loan 5 repayments for medical students who agree to practice as 6 physicians in service commitment areas for five years and meet 7 the requirements of this section. 8 2. Eligibility. An individual is eligible to apply to enter 9 into a program agreement with the commission if the individual 10 is enrolled full-time in and receives a recommendation 11 from the state university of Iowa college of medicine or 12 Des Moines university —— osteopathic medical center in a 13 curriculum leading to a doctor of medicine degree or a doctor 14 of osteopathy degree. 15 3. Program agreements. A program agreement shall be 16 entered into by an eligible student and the commission when 17 the eligible student begins the curriculum leading to a doctor 18 of medicine or osteopathy degree. Under the agreement, to 19 receive loan repayments pursuant to subsection 5, an eligible 20 student shall agree to and shall fulfill all of the following 21 requirements: 22 a. Receive a doctor of medicine or osteopathy degree from 23 an eligible university and apply for, enter, and complete a 24 residency program approved by the commission. 25 b. Apply for and obtain a license to practice medicine and 26 surgery or osteopathic medicine and surgery in this state. 27 c. Complete their residency program requirement with an 28 Iowa-based residency program. 29 d. Within nine months of graduating from their residency 30 program and receiving a permanent license in accordance with 31 paragraph “b” , engage in the full-time practice of medicine 32 and surgery or osteopathic medicine and surgery specializing 33 in family medicine, pediatrics, psychiatry, internal medicine, 34 or general surgery for a period of sixty consecutive months 35 -1- LSB 5456HV (2) 84 kh/nh 1/ 7

H.F. 2389 in the service commitment area specified under subsection 6, 1 unless the loan repayment recipient receives a waiver from the 2 commission to complete the months of practice required under 3 the agreement in another service commitment area pursuant to 4 subsection 6. 5 4. Priority to Iowa residents. The commission shall give 6 priority to eligible students who are residents of Iowa upon 7 enrolling in the university. 8 5. Loan repayment amounts. 9 a. The amount of loan repayment an eligible student who 10 enters into an agreement pursuant to subsection 3 shall receive 11 upon fulfilling the requirements of subsection 3 shall be not 12 more than fifty thousand dollars annually for an eligible loan. 13 b. The commission shall not enter into more than twenty 14 program agreements annually. Fifty percent of the agreements 15 shall be entered into by students attending each university 16 described in subsection 2. However, if there are fewer than 17 ten eligible student applicants at one university, eligible 18 student applicants enrolled in the other university may be 19 awarded the remaining agreements. 20 6. Selection of service commitment area. A loan repayment 21 recipient shall notify the commission of the recipient’s 22 service commitment area prior to beginning practice in the area 23 in accordance with subsection 3, paragraph “d” . The commission 24 may waive the requirement that the loan repayment recipient 25 practice in the same service commitment area for all sixty 26 months. 27 7. Rules for additional loan repayment. The commission 28 shall adopt rules to provide, in addition to loan repayment 29 provided to eligible students pursuant to this section and 30 subject to the availability of surplus funds, loan repayment 31 to a physician who received a doctor of medicine or osteopathy 32 degree from an eligible university as provided in subsection 33 2, obtained a license to practice medicine and surgery or 34 osteopathic medicine and surgery in this state, completed the 35 -2- LSB 5456HV (2) 84 kh/nh 2/ 7

H.F. 2389 physician’s residency program requirement with an Iowa-based 1 residency program, and is engaged in the full-time practice of 2 medicine and surgery or osteopathic medicine and surgery as 3 specified in subsection 3, paragraph “d” . 4 8. Part-time practice —— agreement amended. A person who 5 entered an agreement pursuant to subsection 3 may apply to the 6 commission to amend the agreement to allow the person to engage 7 in less than the full-time practice specified in the agreement 8 and under subsection 3, paragraph “d” . If the commission 9 determines exceptional circumstances exist, the commission and 10 the person may consent to amend the agreement under which the 11 person shall engage in less than full-time practice of medicine 12 and surgery or osteopathic medicine and surgery specializing in 13 family medicine, pediatrics, psychiatry, internal medicine, or 14 general surgery in a service commitment area for an extended 15 period of part-time practice determined by the commission to 16 be proportional to the amount of full-time practice remaining 17 under the original agreement. 18 9. Postponement and satisfaction of service obligation. 19 a. The obligation to engage in practice in accordance with 20 subsection 3 shall be postponed for the following purposes: 21 (1) Active duty status in the armed forces, the armed forces 22 military reserve, or the national guard. 23 (2) Service in volunteers in service to America. 24 (3) Service in the federal peace corps. 25 (4) A period of service commitment to the United States 26 public health service commissioned corps. 27 (5) A period of religious missionary work conducted by an 28 organization exempt from federal income taxation pursuant to 29 section 501(c)(3) of the Internal Revenue Code. 30 (6) Any period of temporary medical incapacity during which 31 the person obligated is unable, due to a medical condition, to 32 engage in full-time practice as required under subsection 3, 33 paragraph “d” . 34 b. Except for a postponement under paragraph “a” , 35 -3- LSB 5456HV (2) 84 kh/nh 3/ 7

H.F. 2389 subparagraph (6), an obligation to engage in practice under an 1 agreement pursuant to subsection 3, shall not be postponed for 2 more than two years from the time the full-time practice was to 3 have commenced under the agreement. 4 c. An obligation to engage in full-time practice under 5 an agreement entered into pursuant to subsection 3 shall be 6 considered satisfied when any of the following conditions are 7 met: 8 (1) The terms of the agreement are completed. 9 (2) The person who entered into the agreement dies. 10 (3) The person who entered into the agreement, due to 11 a permanent disability, is unable to practice medicine and 12 surgery or osteopathic medicine and surgery. 13 10. Trust fund established. 14 a. A rural Iowa primary care trust fund is created in the 15 state treasury as a separate fund under the control of the 16 commission. The commission shall remit all repayments made 17 pursuant to this section to the rural Iowa primary care trust 18 fund. All moneys deposited or paid into the trust fund are 19 appropriated and made available to the commission to be used 20 for meeting the requirements of this section. Notwithstanding 21 section 8.33, any balance in the fund on June 30 of each fiscal 22 year shall not revert to the general fund of the state, but 23 shall be available for purposes of this section in subsequent 24 fiscal years. 25 b. There is appropriated from the general fund of the 26 state to the rural Iowa primary care trust fund, the following 27 amounts for the following designated fiscal years for purposes 28 of the rural Iowa primary care loan repayment program: 29 (1) For the fiscal year beginning July 1, 2012, and ending 30 June 30, 2013, the sum of one million dollars. 31 (2) For the fiscal year beginning July 1, 2013, and ending 32 June 30, 2014, the sum of two million dollars. 33 (3) For the fiscal year beginning July 1, 2014, and ending 34 June 30, 2015, the sum of three million dollars. 35 -4- LSB 5456HV (2) 84 kh/nh 4/ 7

H.F. 2389 (4) For the fiscal year beginning July 1, 2015, and each 1 fiscal year thereafter, the sum of four million dollars. 2 11. Definitions. For purposes of this section: 3 a. “Eligible loan” means the physician’s total federally 4 guaranteed Stafford loan amount under the federal family 5 education loan program or the federal direct loan program, 6 including principal and interest. 7 b. “Eligible university” means either the state university 8 of Iowa college of medicine or Des Moines university —— 9 osteopathic medical center. 10 c. “Service commitment area” means a city in Iowa with a 11 population of less than twenty thousand that is located more 12 than twenty miles from a city with a population of fifty 13 thousand or more and which provides a twenty thousand dollar 14 contribution for deposit in the rural Iowa primary care trust 15 fund for each physician in the community who is participating 16 in the loan repayment program. 17 EXPLANATION 18 This bill establishes a rural Iowa primary care loan 19 repayment program to be administered by the college student 20 aid commission for purposes of providing loan repayment to 21 medical students who agree to practice as physicians in service 22 commitment areas for five years, establishes a rural Iowa 23 primary care trust fund, and appropriates moneys to the fund 24 from the general fund of the state in escalating amounts of $1 25 million, $2 million, $3 million, and $4 million for each fiscal 26 year in the fiscal period beginning in FY 2012-2013 and ending 27 in FY 2015-2016, and appropriating $4 million to the fund for 28 each fiscal year thereafter. 29 An individual is eligible to apply to the commission to 30 enter into a program agreement with the commission if the 31 individual is enrolled in the university of Iowa college of 32 medicine or Des Moines university —— osteopathic medical center 33 in a curriculum leading to a doctor of medicine or osteopathy 34 degree. 35 -5- LSB 5456HV (2) 84 kh/nh 5/ 7

H.F. 2389 Under the agreement, the eligible student will receive 1 up to $50,000 of loan repayment for an eligible loan if the 2 eligible student receives a doctor of medicine or osteopathy 3 degree; applies for, enters, and completes a residency program 4 approved by the commission; applies for and obtains a license 5 to practice medicine and surgery or osteopathic medicine and 6 surgery in this state; and, within nine months of receiving 7 a license, engages in the full-time practice of medicine 8 and surgery, specializing in family medicine, pediatrics, 9 psychiatry, internal medicine, or general surgery for 60 10 consecutive months in the service commitment area, unless the 11 loan repayment recipient receives a waiver from the commission 12 to complete the months of practice required under the agreement 13 in another service commitment area. 14 A service commitment area is defined to mean a city in Iowa 15 with a population of less than 20,000 that is located more than 16 20 miles from a city with a population of 50,000 or more and 17 which provides a $20,000 contribution for deposit in the fund 18 for each physician in the community who is participating in the 19 program. 20 The bill defines “eligible loan” to mean a federally 21 guaranteed Stafford loan. 22 The commission shall give priority to eligible students who 23 are residents of Iowa upon enrolling in the university. 24 Not more than 20 program agreements may be entered into 25 annually. Fifty percent of the agreements shall be entered 26 into with students attending each university, though if 27 there are fewer than 10 eligible student applicants at one 28 university, eligible student applicants enrolled in the other 29 university may be awarded the remaining agreements. 30 A person may apply to the commission to amend the agreement 31 to allow the person to engage in less than full-time practice. 32 If the commission determines exceptional circumstances 33 exist, the commission and the person may consent to amend 34 the agreement to provide for an extended period of part-time 35 -6- LSB 5456HV (2) 84 kh/nh 6/ 7

H.F. 2389 practice determined by the commission to be proportional to 1 the amount of full-time practice remaining under the original 2 agreement. 3 The obligation shall be considered satisfied when the terms 4 of the agreement are completed, the person dies, or the person, 5 due to a permanent disability, is unable to practice medicine 6 and surgery. 7 The bill directs the commission to adopt rules to provide, 8 subject to the availability of surplus funds, loan repayment 9 to a physician who did not enter into an agreement as a medical 10 student but who meets the other relevant requirements of the 11 program. 12 -7- LSB 5456HV (2) 84 kh/nh 7/ 7