H.F. _____ Section 1. NEW SECTION . 261.115 Rural Iowa primary care 1 grant and forgivable loan program —— fund —— appropriations. 2 1. Program established. A rural Iowa primary care grant and 3 forgivable loan program is established to be administered by 4 the college student aid commission for purposes of providing 5 grants and forgivable loans to medical students who agree to 6 practice as physicians in service commitment areas for two 7 years. 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 in the state university of Iowa college of medicine 11 or Des Moines university —— osteopathic medical center in a 12 curriculum leading to a doctor of medicine degree or a doctor 13 of osteopathy degree. 14 3. Program agreements. A program agreement shall be 15 entered into by an eligible student and the commission when 16 the eligible student begins the curriculum leading to a doctor 17 of medicine or osteopathy degree. Under the agreement, the 18 eligible student shall receive a grant award and forgivable 19 loan in accordance with subsection 5, and the eligible student 20 shall agree to meet all of the following requirements: 21 a. Receive a doctor of medicine or osteopathy degree from 22 an eligible university and apply for, enter, and complete a 23 residency program approved by the commission. 24 b. Apply for and obtain a license to practice medicine and 25 surgery or osteopathic medicine and surgery in this state. 26 c. Within nine months of receiving a license in accordance 27 with paragraph “b” , engage in the full-time practice of medicine 28 and surgery or osteopathic medicine and surgery specializing in 29 family medicine, pediatrics, psychiatry, internal medicine, or 30 general surgery for a period of forty-eight consecutive months 31 in the service commitment area specified under subsection 32 6, unless the grant recipient receives a waiver from the 33 commission to complete the months of practice required under 34 the agreement in another service commitment area pursuant to 35 -1- LSB 5456YC (6) 84 kh/nh 1/ 9

H.F. _____ subsection 6. 1 4. Priority to Iowa residents. In awarding grants, the 2 commission shall give priority to eligible students who are 3 residents of Iowa upon enrolling in the university. 4 5. Grant awards and forgivable loan amounts. 5 a. The amount of a program grant to a full-time student 6 who enters into an agreement pursuant to subsection 3 shall 7 be not more than thirty thousand dollars annually for tuition 8 and mandatory fees. The amount of a forgivable loan shall be 9 not more than twenty thousand dollars annually for the living 10 expenses of the grant recipient. 11 b. The commission shall not enter into more than twenty 12 program agreements annually, and the aggregate total of grants 13 awarded shall not exceed eighty in a fiscal year. Fifty 14 percent of the grants shall be awarded to students attending 15 each university described in subsection 2. However, if 16 there are fewer than ten eligible student applicants at one 17 university, eligible student applicants enrolled in the other 18 university may be awarded the remaining grants. 19 6. Selection of service commitment area. A grant recipient 20 shall notify the commission of the recipient’s service 21 commitment area prior to beginning practice in the area in 22 accordance with subsection 3, paragraph “c ”. The commission 23 may waive the requirement that the grant recipient practice in 24 the same service commitment area for all forty-eight months. 25 7. Failure to satisfy agreement —— repayment provisions. 26 a. Except as otherwise provided in this subsection, a 27 person who entered into an agreement pursuant to subsection 3 28 and fails to meet the requirements of the agreement shall be 29 subject to the following: 30 (1) Except as provided in subsection 8, a person who fails 31 to engage in the full-time practice of medicine and surgery or 32 osteopathic medicine and surgery within a service commitment 33 area for the required period of time shall repay the commission 34 an amount equal to the total of the amount of grant and 35 -2- LSB 5456YC (6) 84 kh/nh 2/ 9

H.F. _____ forgivable loan moneys received by the person pursuant to the 1 agreement or the amount of money determined under rules adopted 2 by the commission, plus annual interest at the rate of ten 3 percent per annum from the date such money was received. 4 (2) A person who fails to apply for and enter residency 5 in accordance with the agreement shall be required to repay 6 the commission, upon graduation from the eligible university 7 or upon termination or completion of a residency that does 8 not comply with the provisions of the agreement, whichever is 9 later, an amount equal to the total of the amount of grant and 10 forgivable loan moneys received by the person pursuant to the 11 agreement or the amount of money determined under rules adopted 12 by the commission, plus annual interest at the rate of fifteen 13 percent per annum. 14 b. Repayment of an amount determined pursuant to paragraph 15 “a” shall be made in not more than ten equal annual installment 16 payments. Repayment shall commence six months after the 17 date on which the commission determined that the person was 18 noncompliant with the agreement pursuant to paragraph “a” . 19 If an installment payment is more than ninety days overdue, 20 the entire repayment amount, including interest, shall become 21 immediately due and payable. The total repayment obligation 22 imposed on a person pursuant to this subsection may be 23 satisfied by the person at any time prior to graduation from 24 an eligible university if the person makes a single lump-sum 25 payment equal to the total of the entire amount received, plus 26 all amounts of interest accrued as determined by the commission 27 under the terms of the agreement. 28 c. If at any time a person who is making repayments pursuant 29 to paragraph “a” , subparagraph (1), takes actions which 30 secure compliance with the agreement entered into pursuant 31 to subsection 3, the commission shall waive the balance of 32 the repayment amount, including any interest accrued on the 33 balance of the repayment amount, from the time the commission 34 determines that the person secured compliance with the 35 -3- LSB 5456YC (6) 84 kh/nh 3/ 9

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

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

H.F. _____ (3) For the fiscal year beginning July 1, 2014, and ending 1 June 30, 2015, the sum of three million dollars. 2 (4) For the fiscal year beginning July 1, 2015, and each 3 fiscal year thereafter, the sum of four million dollars. 4 11. Definitions. For purposes of this section: 5 a. “Eligible university” means either the state university 6 of Iowa college of medicine or Des Moines university —— 7 osteopathic medical center. 8 b. “Service commitment area” means a city in Iowa with a 9 population of less than twenty thousand that is located more 10 than twenty miles from a city with a population of fifty 11 thousand or more. 12 EXPLANATION 13 This bill establishes a rural Iowa primary care grant and 14 forgivable loan program to be administered by the college 15 student aid commission for purposes of providing grants and 16 forgivable loans to medical students who agree to practice 17 as physicians in service commitment areas for four years, 18 establishes a rural Iowa primary care trust fund, and 19 appropriates moneys to the fund from the general fund of the 20 state in escalating amounts of $1 million, $2 million, $3 21 million, and $4 million for each fiscal year in the fiscal 22 period beginning in FY 2012-2013 and ending in FY 2015-2016, 23 and appropriating $4 million to the fund for each fiscal year 24 thereafter. 25 An individual is eligible to apply to the commission to 26 enter into a program agreement with the commission if the 27 individual is enrolled in the university of Iowa college of 28 medicine or Des Moines university —— osteopathic medical center 29 in a curriculum leading to a doctor of medicine or osteopathy 30 degree. 31 Under the agreement, the eligible student receives an annual 32 grant award of up to $30,000 for tuition and mandatory fees 33 and an annual forgivable loan amount of up to $20,000 for 34 living expenses, and the eligible student agrees to receive a 35 -6- LSB 5456YC (6) 84 kh/nh 6/ 9

H.F. _____ doctor of medicine or osteopathy degree; apply for, enter, and 1 complete a residency program approved by the commission; apply 2 for and obtain a license to practice medicine and surgery or 3 osteopathic medicine and surgery in this state; and, within 4 nine months of receiving a license, engage in the full-time 5 practice of medicine and surgery, specializing in family 6 medicine, pediatrics, psychiatry, internal medicine, or general 7 surgery for 48 consecutive months in the service commitment 8 area, unless the grant recipient receives a waiver from the 9 commission to complete the months of practice required under 10 the agreement in another service commitment area. A service 11 commitment area is defined to mean a city in Iowa with a 12 population of less than 20,000 that is located more than 20 13 miles from a city with a population of 50,000 or more. 14 In awarding grants, the commission shall give priority to 15 eligible students who are residents of Iowa upon enrolling in 16 the university. 17 Not more than 20 program agreements may be entered into 18 annually, and the aggregate total of grants awarded shall not 19 exceed 80 in a fiscal year. Fifty percent of the grants shall 20 be awarded to students attending each university, though if 21 there are fewer than 10 eligible student applicants at one 22 university, eligible student applicants enrolled in the other 23 university may be awarded the remaining grants. 24 A person who fails to meet the requirements of the program 25 agreement shall be subject to repayment. If the person fails 26 to engage in the full-time practice of medicine and surgery 27 within a service commitment area for the required period of 28 time, the person must repay the commission the total amount 29 of the grant and forgivable loan moneys received plus annual 30 interest at the rate of 10 percent per annum from the date such 31 money was received. A person who fails to apply for and enter 32 residency shall be required to repay, upon graduation or upon 33 termination or completion of a residency that does not comply 34 with the provisions of the agreement, whichever is later, an 35 -7- LSB 5456YC (6) 84 kh/nh 7/ 9

H.F. _____ amount equal to the total of the amount of grant and forgivable 1 loan moneys received, plus annual interest at the rate of 15 2 percent per annum. 3 Repayment shall be made in not more than 10 equal annual 4 installment payments, and shall commence six months after 5 the date on which the commission determined that the person 6 was noncompliant. If an installment payment is more than 90 7 days overdue, the entire repayment amount including interest 8 shall become immediately due and payable. The total repayment 9 obligation may be satisfied at any time prior to graduation if 10 the person makes a single lump-sum payment equal to the total 11 amount received plus all amounts of interest accrued. 12 The commission is authorized to waive future repayments 13 for a person who is making repayments but who takes action to 14 secure compliance with the agreement. Any repayment amount due 15 prior to the time the commission determines that the person 16 secured compliance with the agreement shall continue to be 17 payable as determined by the commission. 18 A person may apply to the commission to amend the agreement 19 to allow the person to engage in less than full-time practice. 20 If the commission determines exceptional circumstances 21 exist, the commission and the person may consent to amend 22 the agreement to provide for an extended period of part-time 23 practice determined by the commission to be proportional to 24 the amount of full-time practice remaining under the original 25 agreement. 26 The obligation to engage in practice may be postponed 27 for active duty status in the armed forces, the armed forces 28 military reserve, or the national guard; service in volunteers 29 in service to America; service in the federal peace corps; a 30 period of service commitment to the U.S. public health service 31 commissioned corps; a period of religious missionary work; or 32 any period of temporary medical incapacity. However, except 33 for periods of medical incapacity, a postponement cannot last 34 more than two years. 35 -8- LSB 5456YC (6) 84 kh/nh 8/ 9