H.F. 2549 Section 1. NEW SECTION . 261.117 Mental health practitioner 1 loan repayment program —— trust fund —— appropriation. 2 1. Program established. The commission shall establish 3 a mental health practitioner loan repayment program for 4 the purposes of providing loan repayments for mental health 5 practitioners who agree to practice in service commitment areas 6 for at least five years and who meet the requirements of this 7 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 from a 11 university in a curriculum leading to licensure as a mental 12 health practitioner. A recipient of a loan repayment award 13 under section 261.113, 261.114, 261.115, or 261.116 shall not 14 be eligible for a loan repayment award under this chapter. 15 3. Program agreements. A program agreement shall be 16 entered into by an eligible student and the commission when the 17 eligible student begins the final year of study in an academic 18 program leading to eligibility for licensure as a mental health 19 practitioner. Under the agreement, to receive loan repayments 20 pursuant to subsection 5, an eligible student shall agree to 21 and shall fulfill all of the following requirements: 22 a. Receive a graduate-level credential qualifying the 23 credential recipient for a license to practice as a mental 24 health practitioner. 25 b. Receive a license to practice as a mental health 26 practitioner in this state. 27 c. Within nine months of graduating from the applicable 28 professional program, residency program, or certification 29 program and receiving a permanent license in accordance with 30 paragraph “b” , engage in full-time practice as a mental health 31 practitioner for a period of five years in a service commitment 32 area. 33 d. During the five-year period of full-time practice, be 34 enrolled as an actively participating Medicaid provider. 35 -1- LSB 5467HZ (3) 89 pf/rh 1/ 8

H.F. 2549 4. Priorities in making awards. In making awards under this 1 section, the commission shall give priority to: 2 a. Eligible students who are residents of Iowa upon 3 enrolling in a university and who agree to practice in a 4 service commitment area located in a mental health professional 5 shortage area. 6 b. Service commitment areas that are located in mental 7 health professional shortage areas. 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 if in compliance with obligations under the agreement shall be 12 as follows: 13 (1) For a psychiatrist, forty thousand dollars annually 14 with a maximum of two hundred thousand dollars for an eligible 15 loan, not to exceed the total loan amount. 16 (2) For a psychologist or a mental health professional, 17 eight thousand dollars annually with a maximum of forty 18 thousand dollars for an eligible loan, not to exceed the total 19 loan amount. 20 (3) For a physician assistant practicing under the 21 supervision of a psychiatrist, or for a psychiatric advanced 22 registered nurse practitioner, ten thousand dollars annually 23 with a maximum of fifty thousand dollars, not to exceed the 24 total loan amount. 25 b. If the total amount of the eligible student’s loan 26 upon graduation is less than the maximum amount specified, 27 the commission shall divide the total amount of the eligible 28 student’s eligible loan by five to determine the annual amount 29 of loan repayment the loan recipient is eligible to receive. 30 c. Payments under this section may be made for each year of 31 eligible practice during a period of five consecutive years. 32 6. Refinanced loans. A loan repayment recipient who 33 refinances an eligible loan by obtaining a private educational 34 loan may continue to receive loan repayment under this section 35 -2- LSB 5467HZ (3) 89 pf/rh 2/ 8

H.F. 2549 if the amount of loan repayment does not exceed the lesser of 1 the amount specified in subsection 5 or the balance of the loan 2 repayment amount the loan repayment recipient qualified to 3 receive with the eligible loan. 4 7. Program agreement limitation. The commission shall by 5 rule determine the number of agreements entered into annually 6 based upon the funding available. 7 8. Selection of service commitment area. A loan repayment 8 recipient shall notify the commission of the recipient’s 9 service commitment area prior to beginning practice in the area 10 in accordance with subsection 3, paragraph “c” . Priority shall 11 be given to recipients who select service commitment areas 12 located in mental health professional shortage areas. The 13 commission may waive the requirement that the loan repayment 14 recipient practice in the same service commitment area for all 15 five years. 16 9. Rules for additional loan repayment. The commission 17 shall adopt rules to provide, in addition to loan repayment 18 provided to eligible students pursuant to this section and 19 subject to the availability of surplus funds, loan repayment to 20 a psychiatrist, a psychologist, a mental health professional, 21 a physician assistant practicing under the supervision of 22 a psychiatrist, or a psychiatric advanced registered nurse 23 practitioner, who, as provided in subsection 3, received a 24 degree from a university, obtained a license to practice 25 in this state, and is engaged in full-time practice in the 26 respective profession in a service commitment area. 27 10. Part-time practice —— agreement amended. A person who 28 entered into an agreement pursuant to subsection 3 may apply 29 to the commission to amend the agreement to allow the person 30 to engage in less than the full-time practice specified in the 31 agreement and under subsection 3, paragraph “c” . The commission 32 and the person may consent to amend the agreement under which 33 the person shall engage in less than full-time practice in a 34 service commitment area for an extended period of part-time 35 -3- LSB 5467HZ (3) 89 pf/rh 3/ 8

H.F. 2549 practice determined by the commission to be proportional to 1 the amount of full-time practice remaining under the original 2 agreement. For purposes of this subsection, “less than 3 the full-time practice” means at least seventy percent of a 4 forty-hour workweek. 5 11. Postponement and satisfaction of service obligation. 6 a. The obligation to engage in practice in accordance with 7 subsection 3 shall be postponed for the following purposes: 8 (1) Active duty status in the armed forces, the armed forces 9 military reserve, or the national guard. 10 (2) Service in volunteers in service to America. 11 (3) Service in the federal peace corps. 12 (4) A period of service commitment to the United States 13 public health service commissioned corps. 14 (5) A period of religious missionary work conducted by an 15 organization exempt from federal income taxation pursuant to 16 section 501(c)(3) of the Internal Revenue Code. 17 (6) Any period of temporary medical incapacity during which 18 the person obligated is unable, due to a medical condition, to 19 engage in full-time practice as required under subsection 3, 20 paragraph “c” . 21 b. Except for a postponement under paragraph “a” , 22 subparagraph (6), an obligation to engage in practice under an 23 agreement entered into pursuant to subsection 3 shall not be 24 postponed for more than two years from the time the full-time 25 practice was to have commenced under the agreement. 26 c. An obligation to engage in full-time practice under 27 an agreement entered into pursuant to subsection 3 shall be 28 considered satisfied when any of the following conditions are 29 met: 30 (1) The terms of the agreement are completed. 31 (2) The person who entered into the agreement dies. 32 (3) The person who entered into the agreement, due to a 33 permanent disability, is unable to practice as a mental health 34 practitioner. 35 -4- LSB 5467HZ (3) 89 pf/rh 4/ 8

H.F. 2549 d. If a loan repayment recipient fails to fulfill 1 the obligation to engage in practice in accordance with 2 subsection 3, the recipient shall be subject to repayment to 3 the commission of the loan amount plus interest as specified 4 by rule. A loan repayment recipient who fails to meet the 5 requirements of the obligation to engage in practice in 6 accordance with subsection 3 may also be subject to repayment 7 of moneys advanced by the service commitment area as provided 8 in any agreement with the service commitment area. 9 12. Trust fund established. A mental health practitioner 10 loan repayment program trust fund is created in the state 11 treasury as a separate fund under the control of the 12 commission. The commission shall remit all repayments made 13 pursuant to this section to the trust fund. All moneys 14 deposited or paid into the trust fund are appropriated and 15 made available to the commission to be used for meeting the 16 requirements of this section. Moneys in the trust fund up 17 to the total amount that an eligible student may receive 18 for an eligible loan in accordance with this section and 19 upon fulfilling the requirements of subsection 3, shall be 20 considered encumbered for the duration of the agreement entered 21 into pursuant to subsection 3. Notwithstanding section 8.33, 22 any balance in the trust fund on June 30 of each fiscal year 23 shall not revert to the general fund of the state, but shall 24 be available for purposes of this section in subsequent fiscal 25 years. 26 13. Report. The commission shall submit in a report to 27 the general assembly by January 1, annually, the number of 28 individuals who received loan repayment pursuant to this 29 section, where the participants practiced, the amount paid to 30 each program participant, and other information identified by 31 the commission as indicators of outcomes of the program. 32 14. Rules. The commission shall adopt rules pursuant to 33 chapter 17A to administer this section. 34 15. Definitions. For purposes of this section: 35 -5- LSB 5467HZ (3) 89 pf/rh 5/ 8

H.F. 2549 a. “Advanced registered nurse practitioner” means a person 1 licensed as a registered nurse under chapter 152 or 152E who 2 is licensed by the board of nursing as an advanced registered 3 nurse practitioner. 4 b. “Eligible loan” means the recipient’s total federally 5 guaranteed Stafford loan amount under the federal family 6 education loan program or the federal direct loan program, the 7 recipient’s federal grad plus loans, or the recipient’s federal 8 Perkins loan, including principal and interest. 9 c. “Mental health practitioner” means a psychiatrist, 10 a psychologist, a mental health professional, a physician 11 assistant practicing under the supervision of a psychiatrist, 12 or a psychiatric advanced registered nurse practitioner. 13 d. “Mental health professional” means an individual who 14 meets all of the following qualifications: 15 (1) The individual holds at least a master’s degree in 16 a mental health field, including psychology, counseling and 17 guidance, social work, marriage and family therapy, or mental 18 health counseling. 19 (2) The individual holds a current Iowa license if 20 practicing in a field covered by an Iowa licensure law. 21 (3) The individual has at least two years of post-degree 22 clinical experience, supervised by another individual in the 23 mental health field, in assessing mental health needs and 24 problems and in providing appropriate mental health services. 25 e. “Mental health professional shortage area” means a mental 26 health health professional shortage area designated by the 27 health resources and services administration of the United 28 States department of health and human services. 29 f. “Psychiatric advanced registered nurse practitioner” 30 means an individual currently licensed as a registered nurse 31 under chapter 152 or 152E who holds a national certification in 32 psychiatric mental health care and who is licensed by the board 33 of nursing as an advanced registered nurse practitioner. 34 g. “Service commitment area” means a city in Iowa that 35 -6- LSB 5467HZ (3) 89 pf/rh 6/ 8

H.F. 2549 provides a twenty thousand dollar contribution for deposit in 1 the mental health practitioner loan repayment trust fund for 2 each loan recipient in the community who is participating in 3 the loan repayment program. 4 Sec. 2. MENTAL HEALTH PRACTITIONER LOAN REPAYMENT PROGRAM 5 TRUST FUND —— APPROPRIATION. There is appropriated from the 6 general fund of the state to the college student aid commission 7 for the fiscal year beginning July 1, 2022, and ending June 8 30, 2023, the following amounts, or so much thereof as is 9 necessary, to be used for the purposes designated: 10 For deposit in the mental health practitioner loan repayment 11 program trust fund established pursuant to section 261.117, to 12 be used for the purposes of the program: 13 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 1,500,000 14 EXPLANATION 15 The inclusion of this explanation does not constitute agreement with 16 the explanation’s substance by the members of the general assembly. 17 This bill establishes a mental health practitioner loan 18 repayment program, and provides an appropriation. 19 The bill requires the Iowa student aid commission to 20 establish a mental health practitioner loan repayment program 21 for the purposes of providing loan repayments for mental health 22 practitioners who agree to practice in service commitment 23 areas for at least five years and meet the requirements of 24 the bill. “Mental health practitioner” means a psychiatrist, 25 a psychologist, a mental health professional, a physician 26 assistant practicing under the supervision of a psychiatrist, 27 or a psychiatric advanced registered nurse practitioner. 28 The bill includes provisions, similar to those for other 29 loan repayment and loan forgiveness programs for health 30 professionals under Code chapter 261, including the rural Iowa 31 primary care loan repayment program, relating to eligibility, 32 program agreements, program priorities, loan repayment amounts, 33 refinanced loans, program agreement limitations, the selection 34 of the service commitment area, rules for loan repayment, 35 -7- LSB 5467HZ (3) 89 pf/rh 7/ 8

H.F. 2549 rules for additional loan repayment, part-time practice 1 agreement amendments, postponement and satisfaction of service 2 obligations, the establishment of a trust fund for the program, 3 the submission of annual reports regarding the program, and the 4 adoption of administrative rules for the program. 5 Under the bill, the loan repayment amount for a psychiatrist 6 is $40,000 annually with a maximum of $200,000 for an eligible 7 loan, not to exceed the total loan amount; for a psychologist 8 or a mental health professional is $8,000 annually with a 9 maximum of $40,000 for an eligible loan, not to exceed the 10 total loan amount; and for a physician assistant practicing 11 under the supervision of a psychiatrist or for a psychiatric 12 advanced registered nurse practitioner is $10,000 annually with 13 a maximum of $50,000 not to exceed the total loan amount. 14 The bill provides definitions for the purposes of the bill 15 and provides for an appropriation from the general fund of the 16 state to the college student aid commission for FY 2022-2023 to 17 be deposited in the mental health practitioner loan repayment 18 program trust fund established under the bill to be used for 19 the purposes of the program. 20 -8- LSB 5467HZ (3) 89 pf/rh 8/ 8