House Study Bill 9 - Introduced HOUSE FILE _____ BY (PROPOSED COMMITTEE ON HEALTH AND HUMAN SERVICES BILL BY CHAIRPERSON MEYER) A BILL FOR An Act relating to the establishment of a mental health 1 practitioner loan repayment program, and providing 2 appropriations. 3 BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA: 4 TLSB 1107YC (6) 90 pf/rh
H.F. _____ Section 1. Section 261.117, Code 2023, is amended by 1 striking the section and inserting in lieu thereof the 2 following: 3 261.117 Mental health practitioner loan repayment program 4 trust fund appropriation of moneys in fund. 5 1. Program established. The commission shall establish 6 a mental health practitioner loan repayment program for 7 the purposes of providing loan repayments for mental health 8 practitioners who agree to practice in service commitment areas 9 for at least five years and who meet the requirements of this 10 section. 11 2. Eligibility. An individual is eligible to apply to enter 12 into a program agreement with the commission if the individual 13 is enrolled full-time in a curriculum leading to employment as 14 a mental health practitioner. A recipient of a loan repayment 15 award under section 261.113, 261.114, 261.115, or 261.116 shall 16 not be eligible for a loan repayment award under this chapter. 17 3. Program agreements. A program agreement shall be 18 entered into by an eligible student and the commission when the 19 eligible student begins the final year of study in an academic 20 program leading to eligibility for employment as a mental 21 health practitioner. Under the agreement, to receive loan 22 repayments pursuant to subsection 5, an eligible student shall 23 agree to and shall fulfill all of the following requirements: 24 a. Receive a graduate-level credential qualifying the 25 credential recipient for employment as a mental health 26 practitioner. 27 b. Receive a license to practice in this state. 28 c. Within nine months of meeting the requirements of a 29 mental health practitioner, engage in full-time practice as 30 a mental health practitioner for a period of five years in a 31 service commitment area. 32 d. During the five-year period of full-time practice, be 33 enrolled as an actively participating Medicaid provider. 34 4. Priorities in making awards. In making awards under this 35 -1- LSB 1107YC (6) 90 pf/rh 1/ 10
H.F. _____ section, the commission shall give priority to: 1 a. Eligible students who are residents of Iowa upon 2 enrolling in a university and who agree to practice in a 3 service commitment area located in a mental health professional 4 shortage area. 5 b. Service commitment areas that are located in mental 6 health professional shortage areas. 7 5. Loan repayment amounts. 8 a. The amount of loan repayment an eligible student who 9 enters into an agreement pursuant to subsection 3 shall receive 10 if in compliance with obligations under the agreement shall be 11 as follows: 12 (1) For a psychiatrist, forty thousand dollars annually 13 with a maximum of two hundred thousand dollars for an eligible 14 loan, not to exceed the total loan amount. 15 (2) For a psychologist or a mental health professional, 16 eight thousand dollars annually with a maximum of forty 17 thousand dollars for an eligible loan, not to exceed the total 18 loan amount. 19 (3) For a physician assistant practicing under the 20 supervision of a psychiatrist, or for a psychiatric advanced 21 registered nurse practitioner, ten thousand dollars annually 22 with a maximum of fifty thousand dollars, not to exceed the 23 total loan amount. 24 b. If the total amount of the eligible students loan 25 upon graduation is less than the maximum amount specified, 26 the commission shall divide the total amount of the eligible 27 students eligible loan by five to determine the annual amount 28 of loan repayment the loan recipient is eligible to receive. 29 c. Payments under this section may be made for each year of 30 eligible practice during a period of five consecutive years. 31 6. Refinanced loans. A loan repayment recipient who 32 refinances an eligible loan by obtaining a private educational 33 loan may continue to receive loan repayment under this section 34 if the amount of loan repayment does not exceed the lesser of 35 -2- LSB 1107YC (6) 90 pf/rh 2/ 10
H.F. _____ the amount specified in subsection 5 or the balance of the loan 1 repayment amount the loan repayment recipient qualified to 2 receive with the eligible loan. 3 7. Program agreement limitation. The commission shall by 4 rule determine the number of agreements entered into annually 5 based upon the funding available. 6 8. Selection of service commitment area. A loan repayment 7 recipient shall notify the commission of the recipients 8 service commitment area prior to beginning practice in the area 9 in accordance with subsection 3, paragraph c . Priority shall 10 be given to recipients who select service commitment areas 11 located in mental health professional shortage areas. The 12 commission may waive the requirement that the loan repayment 13 recipient practice in the same service commitment area for all 14 five years. 15 9. Rules for additional loan repayment. The commission 16 shall adopt rules to provide, in addition to loan repayment 17 provided to eligible students pursuant to this section and 18 subject to the availability of surplus funds, loan repayment to 19 a psychiatrist, a psychologist, a mental health professional, 20 a physician assistant practicing under the supervision of 21 a psychiatrist, or a psychiatric advanced registered nurse 22 practitioner, who, as provided in subsection 3, received a 23 degree from a university, obtained a license to practice 24 in this state, and is engaged in full-time practice in the 25 respective profession in a service commitment area. 26 10. Part-time practice agreement amended. A person who 27 entered into an agreement pursuant to subsection 3 may apply 28 to the commission to amend the agreement to allow the person 29 to engage in less than the full-time practice specified in the 30 agreement and under subsection 3, paragraph c . The commission 31 and the person may consent to amend the agreement under which 32 the person shall engage in less than full-time practice in a 33 service commitment area for an extended period of part-time 34 practice determined by the commission to be proportional to 35 -3- LSB 1107YC (6) 90 pf/rh 3/ 10
H.F. _____ the amount of full-time practice remaining under the original 1 agreement. For purposes of this subsection, less than 2 the full-time practice means at least seventy percent of a 3 forty-hour workweek. 4 11. Postponement and satisfaction of service obligation. 5 a. The obligation to engage in practice in accordance with 6 subsection 3 shall be postponed for the following purposes: 7 (1) Active duty status in the armed forces, the armed forces 8 military reserve, or the national guard. 9 (2) Service in volunteers in service to America. 10 (3) Service in the federal peace corps. 11 (4) A period of service commitment to the United States 12 public health service commissioned corps. 13 (5) A period of religious missionary work conducted by an 14 organization exempt from federal income taxation pursuant to 15 section 501(c)(3) of the Internal Revenue Code. 16 (6) Any period of temporary medical incapacity during which 17 the person obligated is unable, due to a medical condition, to 18 engage in full-time practice as required under subsection 3, 19 paragraph c . 20 b. Except for a postponement under paragraph a , 21 subparagraph (6), an obligation to engage in practice under an 22 agreement entered into pursuant to subsection 3 shall not be 23 postponed for more than two years from the time the full-time 24 practice was to have commenced under the agreement. 25 c. An obligation to engage in full-time practice under 26 an agreement entered into pursuant to subsection 3 shall be 27 considered satisfied when any of the following conditions are 28 met: 29 (1) The terms of the agreement are completed. 30 (2) The person who entered into the agreement dies. 31 (3) The person who entered into the agreement, due to a 32 permanent disability, is unable to practice as a mental health 33 practitioner. 34 d. If a loan repayment recipient fails to fulfill 35 -4- LSB 1107YC (6) 90 pf/rh 4/ 10
H.F. _____ the obligation to engage in practice in accordance with 1 subsection 3, the recipient shall be subject to repayment to 2 the commission of the loan amount plus interest as specified 3 by rule. A loan repayment recipient who fails to meet the 4 requirements of the obligation to engage in practice in 5 accordance with subsection 3 may also be subject to repayment 6 of moneys advanced by the service commitment area as provided 7 in any agreement with the service commitment area. 8 12. Trust fund established. A mental health practitioner 9 loan repayment program trust fund is created in the state 10 treasury as a separate fund under the control of the 11 commission. The commission shall remit all repayments made 12 pursuant to this section to the trust fund. All moneys 13 deposited or paid into the trust fund are appropriated and 14 shall be made available to the commission to be used for 15 meeting the requirements of this section. Moneys in the trust 16 fund up to the total amount that an eligible student may 17 receive for an eligible loan in accordance with this section 18 and upon fulfilling the requirements of subsection 3, shall be 19 considered encumbered for the duration of the agreement entered 20 into pursuant to subsection 3. Notwithstanding section 8.33, 21 any balance in the trust fund on June 30 of each fiscal year 22 shall not revert to the general fund of the state, but shall 23 be available for purposes of this section in subsequent fiscal 24 years. 25 13. Report. The commission shall submit in a report to 26 the general assembly by January 1, annually, the number of 27 individuals who received loan repayment pursuant to this 28 section, where the participants practiced, the amount paid to 29 each program participant, and other information identified by 30 the commission as indicators of outcomes of the program. 31 14. Rules. The commission shall adopt rules pursuant to 32 chapter 17A to administer this section. 33 15. Definitions. For purposes of this section: 34 a. Advanced registered nurse practitioner means a person 35 -5- LSB 1107YC (6) 90 pf/rh 5/ 10
H.F. _____ licensed as a registered nurse under chapter 152 or 152E who 1 is licensed by the board of nursing as an advanced registered 2 nurse practitioner. 3 b. Commission means the college student aid commission. 4 c. Eligible loan means the recipients total federally 5 guaranteed Stafford loan amount under the federal family 6 education loan program or the federal direct loan program, the 7 recipients federal grad plus loans, or the recipients federal 8 Perkins loan, including principal and interest. 9 d. 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 e. Mental health professional means an individual who 14 meets all of the following qualifications: 15 (1) The individual holds at least a masters 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 f. 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 g. 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 h. Service commitment area means a city in Iowa that 35 -6- LSB 1107YC (6) 90 pf/rh 6/ 10
H.F. _____ provides the following contribution amounts for deposit in the 1 mental health practitioner loan repayment program trust fund 2 for each loan recipient in the community who is participating 3 in the loan repayment program: 4 (1) For a psychiatrist, twenty thousand dollars. 5 (2) For a psychologist or a mental health professional, four 6 thousand dollars. 7 (3) For a physician assistant practicing under the 8 supervision of a psychiatrist, or for a psychiatric advanced 9 registered nurse practitioner, five thousand dollars. 10 Sec. 2. MENTAL HEALTH PRACTITIONER LOAN REPAYMENT PROGRAM 11 TRUST FUND APPROPRIATION. There is appropriated from the 12 general fund of the state to the college student aid commission 13 for the fiscal year beginning July 1, 2023, and ending June 14 30, 2024, the following amounts, or so much thereof as is 15 necessary, to be used for the purposes designated: 16 For deposit in the mental health practitioner loan repayment 17 program trust fund established pursuant to section 261.117, to 18 be used for the purposes of the program: 19 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 1,500,000 20 EXPLANATION 21 The inclusion of this explanation does not constitute agreement with 22 the explanations substance by the members of the general assembly. 23 This bill repeals the existing mental health professional 24 loan repayment program within the college student aid 25 commission, replaces the program with a mental health 26 practitioner loan repayment program, and provides an 27 appropriation. 28 REPEALED PROGRAM. The mental health professional loan 29 repayment program, enacted in 2022, was established to increase 30 the number of nonprescribing mental health practitioners 31 serving cities within federal mental health shortage areas in 32 the state. The program was designed to provide loan repayment 33 benefits to recipients for up to five consecutive years of 34 full-time service, unless granted a waiver for part-time 35 -7- LSB 1107YC (6) 90 pf/rh 7/ 10
H.F. _____ service. The maximum award under the program was $40,000, paid 1 in annual installments of $8,000, toward outstanding federal 2 Stafford loan, federal grad PLUS loan, and federal Perkins loan 3 balances at the end of each 12-month employment period. If a 4 recipient refinanced a federal loan with a private loan after 5 signing the program contract, the recipient could continue to 6 receive the loan repayment benefit as long as the recipient 7 contacted the college student aid commission and provided the 8 required documentation. 9 In order to be eligible for the program, a person must have 10 graduated from an eligible Iowa college or university with at 11 least a masters degree in psychology, counseling and guidance, 12 social work, marriage and family therapy, or mental health 13 counseling; have completed at least two years of post-degree 14 clinical experience in assessing and diagnosing mental health 15 needs and in providing mental health services while under the 16 supervision of another individual in the mental health field; 17 and have held a current, nonprescribing practitioner license. 18 NEW PROGRAM. The bill requires the college student aid 19 commission to establish a mental health practitioner loan 20 repayment program for the purposes of providing loan repayments 21 for mental health practitioners who agree to practice in 22 service commitment areas for at least five years and meet the 23 requirements of the bill. Mental health practitioner means 24 a psychiatrist, a psychologist, a mental health professional, 25 a physician assistant practicing under the supervision of 26 a psychiatrist, or a psychiatric advanced registered nurse 27 practitioner. 28 Under the bill, an individual is eligible to apply if the 29 individual is enrolled full-time in a curriculum leading 30 to employment as a mental health practitioner. A program 31 agreement must be entered into when the eligible student begins 32 the final year of study in an academic program leading to 33 eligibility for employment as a mental health practitioner. 34 Under the agreement, an eligible student must agree to receive 35 -8- LSB 1107YC (6) 90 pf/rh 8/ 10
H.F. _____ a graduate-level credential qualifying the credential recipient 1 for employment as a mental health practitioner; receive a 2 license to practice in this state; within nine months of 3 meeting the requirements of a mental health practitioner engage 4 in full-time practice as a mental health practitioner for a 5 period of five years in a service commitment area; and during 6 the five-year period of full-time practice, be enrolled as an 7 actively participating Medicaid provider. 8 Under the bill, the commission must give priority in making 9 awards to eligible students who are residents of Iowa upon 10 enrolling in a university and who agree to practice in a 11 service commitment area located in a mental health professional 12 shortage area. A service commitment area is defined as a city 13 in Iowa that provides a certain contribution amount, based on 14 the type of practitioner, for deposit in the mental health 15 practitioner loan repayment program trust fund for each loan 16 recipient in the community participating in the program. 17 Under the bill, the loan repayment amount for a psychiatrist 18 is $40,000 annually with a maximum of $200,000 for an eligible 19 loan, not to exceed the total loan amount; for a psychologist 20 or a mental health professional is $8,000 annually with a 21 maximum of $40,000 for an eligible loan, not to exceed the 22 total loan amount; and for a physician assistant practicing 23 under the supervision of a psychiatrist or for a psychiatric 24 advanced registered nurse practitioner is $10,000 annually with 25 a maximum of $50,000, not to exceed the total loan amount. 26 The bill includes provisions similar to those for other 27 loan repayment and loan forgiveness programs for health 28 professionals under Code chapter 261 including eligibility 29 requirements, program agreements, program priorities, loan 30 repayment amounts, refinanced loans, program agreement 31 limitations, the selection of the service commitment area, 32 rules for loan repayment, rules for additional loan repayment, 33 part-time practice agreement amendments, postponement, and 34 satisfaction of service obligations, the establishment of a 35 -9- LSB 1107YC (6) 90 pf/rh 9/ 10
H.F. _____ trust fund for the program, the submission of annual reports 1 regarding the program, and the adoption of administrative rules 2 for the program. 3 The bill provides definitions for the purposes of the bill 4 and provides for an appropriation from the general fund of the 5 state to the college student aid commission for FY 2023-2024 to 6 be deposited in the mental health practitioner loan repayment 7 program trust fund established under the bill to be used for 8 the purposes of the program. 9 -10- LSB 1107YC (6) 90 pf/rh 10/ 10