EXPLANATION-Matter enclosed in bold-faced brackets [thus] in this bill is not enacted
and is intended to be omitted in the law.
FIRST REGULAR SESSION
SENATE BILL NO. 555
102ND GENERAL ASSEMBLY
INTRODUCED BY SENATOR BEAN.
2116S.01I KRISTINA MARTIN, Secretary
AN ACT
To repeal sections 191.500, 191.505, 191.510, 191.515, 191.520, 191.525, 191.530, 191.535,
191.540, 191.545, 191.550, and 191.600, RSMo, and to enact in lieu thereof six new
sections relating to the health professional loan repayment program.
Be it enacted by the General Assembly of the State of Missouri, as follows:
Section A. Sections 191.500, 191.505, 191.510, 191.5 15, 1
191.520, 191.525, 191.530, 191.535, 191.540, 191.545, 191.550, 2
and 191.600, RSMo, are repealed and six new sections enacted in 3
lieu thereof, to be known as sections 191.500, 191.505, 191.510, 4
191.520, 191.530, and 191.600, to read as follows:5
191.500. [As used in sections 191.500 to 191.550, 1
unless the context clearly indicates otherwise, the 2
following terms mean: 3
(1) "Area of defined need", a community or section of 4
an urban area of this state which is certified by the 5
department of health and senior services as being in need of 6
the services of a physician to improve the patient -doctor 7
ratio in the area, to contribute professional physician 8
services to an area of economic impact, or to contribute 9
professional physician services to a n area suffering from 10
the effects of a natural disaster; 11
(2) "Department", the department of health and senior 12
services; 13
(3) "Eligible student", a full -time student accepted 14
and enrolled in a formal course of instruction leading to a 15 SB 555 2
degree of doctor of medicine or doctor of osteopathy, 16
including psychiatry, at a participating school, or a doctor 17
of dental surgery, doctor of dental medicine, or a bachelor 18
of science degree in dental hygiene; 19
(4) "Financial assistance", an amount of money paid by 20
the state of Missouri to a qualified applicant pursuant to 21
sections 191.500 to 191.550; 22
(5) "Participating school", an institution of higher 23
learning within this state which grants the degrees of 24
doctor of medicine or doctor of oste opathy, and which is 25
accredited in the appropriate degree program by the American 26
Medical Association or the American Osteopathic Association, 27
or a degree program by the American Dental Association or 28
the American Psychiatric Association, and applicabl e 29
residency programs for each degree type and discipline; 30
(6) "Primary care", general or family practice, 31
internal medicine, pediatric , psychiatric, obstetric and 32
gynecological care as provided to the general public by 33
physicians licensed and re gistered pursuant to chapter 334, 34
dental practice, or a dental hygienist licensed and 35
registered pursuant to chapter 332; 36
(7) "Resident", any natural person who has lived in 37
this state for one or more years for any purpose other than 38
the attending of an educational institution located within 39
this state; 40
(8) "Rural area", a town or community within this 41
state which is not within a standard metropolitan 42
statistical area, and has a population of six thousand or 43
fewer inhabitants as determin ed by the last preceding 44
federal decennial census or any unincorporated area not 45
within a standard metropolitan statistical area. ] 1. There 46
is hereby established within the department of health and 47 SB 555 3
senior services the "Health Professional Loan Repayme nt 48
Program" to provide forgivable loans for the purpose of 49
repaying existing loans related to applicable educational 50
expenses for health care, mental health, and public health 51
professionals. The department of health and senior services 52
shall be the administrative agency for the implementation of 53
the program established by this section. 54
2. The department of health and senior services shall 55
prescribe the form and the time and method of filing 56
applications and supervise the processing thereof, i ncluding 57
oversight and monitoring of the program, and shall 58
promulgate rules to implement the provisions of this 59
section. All rules shall be promulgated pursuant to the 60
provisions of this section and chapter 536. Any rule or 61
portion of a rule, as th at term is defined in section 62
536.010, that is created under the authority delegated in 63
this section shall become effective only if it complies with 64
and is subject to all of the provisions of chapter 536 and, 65
if applicable, section 536.028. This section and chapter 66
536 are nonseverable and if any of the powers vested with 67
the general assembly pursuant to chapter 536 to review, to 68
delay the effective date, or to disapprove and annul a rule 69
are subsequently held unconstitutional, then the grant of 70
rulemaking authority and any rule proposed or adopted after 71
August 28, 2023, shall be invalid and void. 72
3. The director of the department of health and senior 73
services shall have the discretion to determine the health 74
professionals and practitioner s who shall receive a 75
forgivable health professional loan from the department to 76
pay an applicant's existing loans. Determinations shall be 77
made each fiscal year based on evidence associated with the 78
greatest need in the best interest of the public. The 79 SB 555 4
health care, mental health, and public health professionals 80
or disciplines funded on any given year shall be contingent 81
upon consultation with the division of workforce development 82
within the department of economic development and the 83
department of mental health or their successor agencies. 84
4. The department shall enter into a contract with 85
each selected applicant who receives a health professional 86
loan. Each selected applicant shall apply the loan award to 87
their educational debt. The contract shall detail the 88
methods of forgiveness associated with a service obligation 89
and the terms associated with principal and interest 90
accruing on their loan at the time of the award. The 91
contract shall contain details concerning how forgiveness is 92
earned, including when partial forgiveness is earned through 93
a service obligation and the terms and conditions associated 94
with repayment of their loans for any obligation not served. 95
5. All loans shall be made from funds appropriated to 96
the health professional loan incentive fund under section 97
191.520 by the general assembly. 98
191.505. [The department of health and senior services 1
shall be the administrative agency for the implementation of 2
the program established by sections 191.500 to 191.550. The 3
department shall promulgate reasonable rules and regulations 4
for the exercise of its functions in the effectuation of the 5
purposes of sections 191.500 to 191.550. It shall prescribe 6
the form and the time and method of filing applications and 7
supervise the processing thereof. ] The department shall 8
designate counties, communities, or sections of Missouri 9
areas as areas of defined need for health care, mental 10
health, and public health services. Designations shall be 11
made when such county, community, or section of an area has 12
been designated or determined as a professional shortage 13 SB 555 5
area, a shortage area, or a health care, mental health, or 14
public health professional shortage area by the federal 15
Department of Health and Hu man Services or its successor 16
agency. Designations may be made when a county, community, 17
or section of an area has been determined by the director of 18
the department of health and senior services to have an 19
extraordinary need for health care profession al services, 20
without a corresponding supply of such professionals. 21
191.510. [The department shall enter into a contract 1
with each applicant receiving a state loan under sections 2
191.500 to 191.550 for repayment of the principal and 3
interest and for forgiveness of a portion thereof for 4
participation in the service areas as provided in sections 5
191.500 to 191.550.] 1. The department of health and senior 6
services shall enter into a contract with each individual 7
qualifying for repay ment of educational loans under sections 8
191.500 to 191.530. The written contract between the 9
department and an individual shall contain, but not be 10
limited to, the following: 11
(1) An agreement that the state agrees to pay loans on 12
behalf of the individual and the individual agrees to serve 13
for a time period equal to two years, or a longer period as 14
the individual may agree to, in an area of defined need as 15
designated by the department, with such service period to 16
begin on the date identified on the signed contract; 17
(2) A provision that any financial obligations arising 18
out of a contract entered into and any obligation of the 19
individual which is conditioned thereon is contingent upon 20
funds being appropriated for loan repayments; 21
(3) The area of defined need where the person will 22
practice; 23 SB 555 6
(4) A statement of the damages to which the state is 24
entitled for the individual's breach of the contract; 25
(5) Such other statements of the rights and 26
liabilities of the department and of the individual not 27
inconsistent with this section. 28
2. The department of health and senior services may 29
stipulate specific practice sites contingent upon department - 30
generated health care, mental health, and public health 31
professional need priorities where applicants shall agree to 32
practice for the duration of their participation in the 33
program. 34
191.520. [No loan to any eligible student shall exceed 1
twenty-five thousand dollars for each academic year, which 2
shall run from August first of any year through July thirty - 3
first of the following year. All loans shall be made from 4
funds appropriated to the medical school loan and loan 5
repayment program fund created by section 191.600, by the 6
general assembly.] 1. The "Health Professional Loan 7
Incentive Fund" is hereby created in the state treasury. 8
All funds recovered from an individual pursuant to section 9
191.500 and all funds generated by loan repayments and 10
penalties received pursuant to the section shall be credi ted 11
to the fund. The fund shall include moneys appropriated to 12
it by the general assembly. The moneys in the fund shall be 13
used by the department of health and senior services to 14
provide loan repayments pursuant to section 191.500 in 15
accordance with sections 191.500 to 191.530 and to provide 16
loans pursuant to sections 191.500 to 191.530. 17
2. The state treasurer shall be custodian of the 18
fund. In accordance with sections 30.170 and 30.180, the 19
state treasurer may approve disbursements. Notwithstanding 20
the provisions of section 33.080 to the contrary, any moneys 21 SB 555 7
remaining in the fund at the end of the biennium shall not 22
revert to the credit of the general revenue fund. The state 23
treasurer shall invest moneys in the fund in the same manner 24
as other funds are invested. Any interest and moneys earned 25
on such investments shall be credited to the fund. 26
191.530. [Interest at the rate of nine and one -half 1
percent per year shall be charged on all loans made under 2
sections 191.500 to 191.550 but one -fourth of the interest 3
and principal of the total loan at the time of the awarding 4
of the degree shall be forgiven for each year of 5
participation by an applicant in the practice of his 6
profession in a rural area or an area of defined need. The 7
department shall grant a deferral of interest and principal 8
payments to a loan recipient who is pursuing an internship 9
or a residency in primary care. The deferral shall not 10
exceed three years. The status of each loan recipient 11
receiving a deferral shall be reviewed annually by the 12
department to ensure compliance with the intent of this 13
provision. The loan recipient will repay the loan beginning 14
with the calendar year following completion of his 15
internship or his primary care residency in accordance with 16
the loan contract.] 1. An individual who enters into a 17
written contract with the department of health and senior 18
services under section 191.510 who fails to maintain an 19
acceptable employment status shall be liable to the state 20
for the amount paid by the department directly to the 21
individual who entered into the contract. 22
2. Failure to maintain an acceptable employment status 23
under this section shall include when the contracted 24
individual involuntarily or voluntar ily terminates 25
qualifying employment, as determined by the department in 26
rules, or is dismissed from such employment before 27 SB 555 8
completion of the contractual service obligation within the 28
specific timeframe outlined in the contract, or fails to 29
respond to requests made by the department. 30
3. If an individual breaches the written contract of 31
the individual by failing either to begin such individual's 32
contractual service obligation or to complete such service 33
obligation, the state shall be entitled t o recover from the 34
individual an amount equal to the sum of: 35
(1) The total of the amounts prepaid by the department 36
on behalf of the individual; 37
(2) The interest on the amounts which would be payable 38
if at the time the amounts were paid they were loans bearing 39
interest at the maximum prevailing rate as determined by the 40
Treasurer of the United States; 41
(3) An amount equal to any damages incurred by the 42
department as a result of the breach; and 43
(4) Any legal fees or associated co sts incurred by the 44
department or the state of Missouri in the collection of 45
damages. 46
191.600. 1. Sections 191.600 to 191.615 establish a 1
loan repayment program for graduates of approved medical 2
schools, schools of osteopathic medi cine, schools of 3
dentistry and accredited chiropractic colleges who practice 4
in areas of defined need and shall be known as the "Health 5
Professional Student Loan Repayment Program". Sections 6
191.600 to 191.615 shall apply to graduates of accredited 7
chiropractic colleges when federal guidelines for 8
chiropractic shortage areas are developed. 9
2. The "Health Professional Student Loan and Loan 10
Repayment Program Fund" is hereby created in the state 11
treasury. All funds recovered from an individual pursuant 12
to section 191.614 and all funds generated by loan 13 SB 555 9
repayments and penalties received pursuant to section 14
191.540 shall be credited to the fund. The moneys in the 15
fund shall be used by the department of health and senior 16
services to provide l oan repayments pursuant to section 17
191.611 in accordance with sections 191.600 to 191.614 [and 18
to provide loans pursuant to sections 191.500 to 191.550 ]. 19
[191.515. An eligible student may apply to 1
the department for a loan under sect ions 191.500 2
to 191.550 only if, at the time of his 3
application and throughout the period during 4
which he receives the loan, he has been formally 5
accepted as a student in a participating school 6
in a course of study leading to the degree of 7
doctor of medicine or doctor of osteopathy, 8
including psychiatry, or a doctor of dental 9
surgery, a doctor of dental medicine, or a 10
bachelor of science degree in dental hygiene, 11
and is a resident of this state. ] 12
[191.525. No more than twenty-five loans 1
shall be made to eligible students during the 2
first academic year this program is in effect. 3
Twenty-five new loans may be made for the next 4
three academic years until a total of one 5
hundred loans are available. At least one-half 6
of the loans shall be made to students from 7
rural areas as defined in section 191.500. An 8
eligible student may receive loans for each 9
academic year he is pursuing a course of study 10
directly leading to a degree of doctor of 11
medicine or doctor of osteopathy, do ctor of 12
dental surgery, or doctor of dental medicine, or 13
a bachelor of science degree in dental hygiene. ] 14
[191.535. If a student ceases his study 1
prior to receiving a degree, interest at the 2
rate specified in section 191.530 shall b e 3
charged on the amount received from the state 4
under the provisions of sections 191.500 to 5
191.550.] 6
[191.540. 1. The department shall 1
establish schedules and procedures for repayment 2
of the principal and interest of any loan mad e 3
under the provisions of sections 191.500 to 4
191.550 and not forgiven as provided in section 5
191.530. 6
2. A penalty shall be levied against a 7
person in breach of contract. Such penalty shall 8
be twice the sum of the principal and the 9
accrued interest.] 10
[191.545. When necessary to protect the 1
interest of the state in any loan transaction 2 SB 555 10
under sections 191.500 to 191.550, the board may 3
institute any action to recover any amount due. ] 4
[191.550. The contracts made with the 1
participating students shall be approved by the 2
attorney general.] 3