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CHAPTER 24RURAL IOWA PRIMARY CARE LOAN REPAYMENT PROGRAM283—24.1(261) Rural Iowa primary care loan repayment program. The rural Iowa primary care loan repayment program is a state-supported and administered loan repayment program for students who agree to practice as physicians in service commitment areas for five consecutive years and meet the requirements of these rules.Related ARC(s): 1320C, 1685C283—24.2(261) Definitions. As used in this chapter:
"Contribution" means a nonrefundable $20,000 contribution paid by the service commitment area to the rural Iowa primary care trust fund for each physician in the community who is participating in the program. Each physician participating in the program must contract with the service commitment area to ensure the service commitment area provides the nonrefundable contribution. Payment of the nonrefundable contribution to the trust fund can be made by, but is not limited to, the following organizations: community agencies, hospitals, medical groups, municipalities, community foundations, local government agencies, or other community entities.
"Eligible loan" means the physician’s total subsidized, unsubsidized, and consolidated Federal Stafford Loan amount under the Federal Family Education Loan Program, Federal Direct Loan Program, federal Graduate PLUS Loan, or federal Perkins Loan, including principal and interest. Only the outstanding portion of a federal consolidation loan that was used to repay an eligible subsidized or unsubsidized Federal Stafford Loan qualifies for loan repayment. A physician who receives loan repayment under this program and who refinances an eligible loan by obtaining a private educational loan may continue to receive loan repayment awards.
"Eligible university" means either the State University of Iowa Carver College of Medicine or Des Moines University College of Osteopathic Medicine.
"Maximum award" means the maximum amount of loan repayments that the physician can receive after completing all obligations under the rural Iowa primary care loan repayment program, not to exceed a total of $200,000. The maximum award can be applied only to eligible loans; thus, payments cannot exceed the outstanding eligible loan balance at the time of payment.
"Part-time practice" means that the physician is employed at least 28 hours of a 40-hour workweek in a service commitment area.
"Physician" means an individual who holds a practitioner’s license issued by an agency or board under the Iowa department of public health and is employed in the practice of medicine and surgery or osteopathic medicine and surgery, specializing in family medicine, pediatrics, psychiatry, internal medicine, obstetrics and gynecology, neurology, or general surgery.
"Residency program" means an accredited medical residency program.
"Service commitment area" means a medically underserved Iowa city that provides a nonrefundable contribution for each physician in the community who is participating in the rural Iowa primary care loan repayment program, and the city meets any of the following conditions:
Related ARC(s): 1320C, 1685C, 5137C, 5222C, 5965C, 6731C283—24.3(261) Eligibility requirements. 24.3(1) An eligible university will recommend applicants to the commission for loan repayment benefits. Priority will be given to students who are Iowa residents upon enrolling in the eligible university. “Iowa resident” means an individual who meets the residency requirements established in 283—Chapter 10. The percentage of the agreements to be entered into by students attending each eligible university shall be evenly divided. a. The commission will annually determine and communicate the number of recommendations that can be funded at each eligible university. b. If fewer than the recommendations in 24.3(1)“a” are fulfilled by students at one eligible university, the commission may obtain additional recommendations from the other eligible university to award the remaining agreements. c. If fewer than the total number of recommendations in 24.3(1)“a” are filled by students at the eligible universities, the commission may enter into additional agreements under the surplus funds provisions. 24.3(2) An applicant must enter into an agreement with the commission during the applicant’s final year of study leading to a doctor of medicine or osteopathy degree. 24.3(3) An applicant must be enrolled on a full-time basis and graduate with a doctor of medicine or osteopathy degree from an eligible university. The commission may waive the full-time enrollment requirement for a temporary time frame only in the instance of a leave of absence approved by an eligible university. The applicant must request a waiver from the commission in writing. 24.3(4) An applicant must apply for, enter, and complete a residency program. 24.3(5) Within nine months of graduating from the residency program, an applicant must receive a permanent license to practice medicine and surgery or osteopathic medicine and surgery in the state of Iowa and engage in full-time or part-time practice of medicine and surgery or osteopathic medicine and surgery specializing in family medicine, pediatrics, psychiatry, internal medicine, obstetrics and gynecology, neurology, or general surgery for a period of five consecutive years in a service commitment area. 24.3(6) An applicant must annually complete and return to the commission an affidavit of acceptance into and completion of residency programs and acceptance of and completion of employment obligations in a service commitment area. 24.3(7) Prior to or upon engagement in full-time or part-time practice in a service commitment area, the physician must contract with a service commitment area to provide a nonrefundable $20,000 contribution for deposit in the rural Iowa primary care trust fund. Payment must be received by the commission from a service commitment area prior to payment of any loan repayment awards. 24.3(8) Failure by the applicant to meet all eligibility requirements under this rule and in the agreement will result in forfeiture of all remaining unpaid payments.Related ARC(s): 1320C, 1685C, 2205C, 5965C, 6731C283—24.4(261) Awarding of funds. 24.4(1) Prior to accepting an offer of employment, the physician must notify the commission of the service commitment area in which the physician will be employed, and the commission will verify the eligibility of the service commitment area. 24.4(2) The maximum award will be paid to the physician’s eligible loan holder in five equal installments, upon successful completion of each of five 12-month employment obligations. Failure to complete all, or any portion, of the five-consecutive-year employment obligation will result in the forfeiture of all remaining unpaid payments. A physician who fails to meet the requirements of these rules may also be subject to repayment of moneys advanced by the service commitment area as provided in any contract between the physician and the service commitment area. 24.4(3) No loan repayment amounts will be paid until the service commitment area provides the nonrefundable $20,000 contribution for deposit into the rural Iowa primary care trust fund.Related ARC(s): 1320C, 1685C283—24.5(261) Waivers. 24.5(1) Service commitment area. The commission may waive the requirement that the physician practice in the same service commitment area for five years. The physician must request a waiver from the commission in writing. 24.5(2) Full-time employment. The commission may waive the requirement that the physician be employed full-time if the physician requests a waiver from the commission in writing and is working at least 28 hours per week. If a waiver request is granted by the commission, the agreement will be amended to provide an allowance for part-time employment. For agreements entered into pursuant to 24.3(2) prior to July 1, 2022, the five-year employment obligation will be proportionally extended to ensure the physician is employed in a service commitment area for the equivalent of five full-time years. 24.5(3) Postponement of physician employment. The physician obligation to engage in practice in accordance with 24.3(5) may be postponed for no more than two years from the time full-time or part-time practice was to commence. The physician must request a waiver from the commission in writing for one of the following purposes: a. Active duty service in the armed forces, the armed forces military reserve, or the national guard. b. Service in Volunteers in Service to America or the federal Peace Corps. c. A service commitment to the United States Public Health Service Commissioned Corps. d. A period of religious missionary work conducted by an organization exempt from federal income taxation pursuant to Section 501(c)(3) of the Internal Revenue Code.The physician obligation to engage in practice in accordance with 24.3(5) may be postponed for a period exceeding two years for any period of temporary medical incapacity, including leave approved under the Family and Medical Leave Act, during which the physician is unable to engage in full-time or part-time practice. The physician must request a waiver from the commission in writing. 24.5(4) Satisfaction of physician employment. All obligations under the rural Iowa primary care loan repayment program are considered to be satisfied when any of the following conditions are met: a. All terms of the agreement are met. b. The person who entered into the agreement dies. c. The person who entered into the agreement, due to permanent disability, is unable to meet the requirements of these rules. d. The person who entered into the agreement has no remaining eligible loan balance to repay.Related ARC(s): 1320C, 1685C, 5965C, 6731C283—24.6(261) Surplus funds. 24.6(1) In the event that fewer than the total number of recommendations in 24.3(1)“a” are filled by students at the eligible universities, the commission may enter into additional agreements. 24.6(2) A surplus funds applicant must meet the following criteria: a. Must have graduated with a doctor of medicine or osteopathy degree from an eligible university and completed a residency program. b. Must receive a permanent license to practice medicine and surgery or osteopathic medicine and surgery in the state of Iowa and engage in full-time or part-time practice of medicine and surgery or osteopathic medicine and surgery specializing in family medicine, pediatrics, psychiatry, internal medicine, obstetrics and gynecology, neurology, or general surgery for a period of five consecutive years in a service commitment area. The applicant must notify the commission of the applicant’s service commitment area prior to beginning practice in the service commitment area. c. Must complete and return to the commission an affidavit of acceptance into and completion of a residency program, acceptance of employment, and completion of annual employment obligations in a service commitment area. d. Must contract with a service commitment area to provide a nonrefundable $20,000 contribution for deposit in the rural Iowa primary care trust fund. Payment must be received by the commission from a service commitment area prior to payment of any loan repayment awards. 24.6(3) An applicant under rule 283—24.6(261) is subject to the provisions in 24.4(2) and rules 283—24.5(261), 283—24.7(261), and 283—24.8(261). 24.6(4) In the event that the total amount of surplus funds is insufficient to award all eligible applicants, awards will be prioritized as follows: a. Physicians employed in a different state than Iowa and individuals in their final year of residency or fellowship, by date of application. b. All other applicants by date of application.Related ARC(s): 6731C283—24.7(261) Loan repayment cancellation. 24.7(1) Within 30 days following withdrawal from an eligible university, or termination of employment from a residency program or as a physician in a service commitment area, the applicant must notify the commission. 24.7(2) The applicant is responsible for notifying the commission immediately of a change in contact information including, but not limited to, name, telephone number, email address, and place of employment.Related ARC(s): 1320C, 6731C283—24.8(261) Restrictions. A physician who is in default on a Federal Stafford Loan, Grad PLUS Loan, SLS Loan, Perkins/National Direct/National Defense Student Loan, Health Professions Student Loan (HPSL), or Health Education Assistance Loan (HEAL) or who owes a repayment on any Title IV grant assistance or state award shall be ineligible for loan repayment. Eligibility may be reinstated upon payment in full of the delinquent obligation or by commission ruling on the basis of adequate extenuating evidence presented in appeal under the procedures set forth in 283—Chapters 4 and 5.Related ARC(s): 1320C, 6731CThese rules are intended to implement Iowa Code section 261.113 as amended by 2014 Iowa Acts, Senate File 2347.Related ARC(s): 1320C, 1685C, 2205C, 5137C, 5222C, 5965C, 6731C
- Is a city within a federal mental health shortage area, as designated by the Health Resources and Services Administration of the United States Department of Health and Human Services, if the physician participating in the rural Iowa primary care loan repayment program specializes in psychiatry.
- Is a city with a population of less than 26,000 that is located more than 20 miles from a city with a population of 50,000 or more. Locations and distances between cities will be consistently measured and verified by calculating the shortest travel distance on paved roads.