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. 635
103RD GENERAL ASSEMBLY
INTRODUCED BY SENATOR GREGORY (21).
2542S.01I KRISTINA MARTIN, Secretary
AN ACT
To repeal sections 191.600, 191.603, 191.605, 191.607, 191.611, 191.614, and 191.615, RSMo,
and to enact in lieu thereof seven new sections relating to health care profession loan
repayment.
Be it enacted by the General Assembly of the State of Missouri, as follows:
Section A. Sections 191.600, 191.603, 191.605, 191.607, 1
191.611, 191.614, and 191.615, RSMo, are r epealed and seven new 2
sections enacted in lieu thereof, to be known as sections 3
191.600, 191.603, 191.605, 191.607, 191.611, 191.614, and 4
191.615, to read as follows:5
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 medicine, schools of 3
dentistry and accredited chiropractic colleges ], to be known 4
as the "Missouri State Loan Repayment Program (MOSLRP)", for 5
persons who practice in areas of defined need [and shall be 6
known as the "Health Professional Student Loan Repayment 7
Program". Sections 191.600 to 191.615 shall apply to 8
graduates of accredited chiropractic colleges when federal 9
guidelines for chiropractic shortage areas are developed ] 10
after graduating from an accredited graduate training 11
program in a discipline that is required for practice as: 12
(1) An allopathic medical doctor; 13
(2) An osteopathic medical doctor; 14
(3) A general dentist; 15 SB 635 2
(4) A dental hygienist; 16
(5) A registered nurse including, but not limited to, 17
a certified nurse practitioner, a certified nurse midwife, 18
or a psychiatric nurse; 19
(6) A physician assistant; 20
(7) A psychologist; 21
(8) A licensed clinical social worker; 22
(9) A licensed professional counselor; 23
(10) A marital and family therapist; or 24
(11) A pharmacist. 25
2. The ["Health Professional Student Loan and ] 26
"Missouri State Loan Repayment Program Fund" is hereby 27
created in the state treasury. All funds recovered from an 28
individual pursuant to section 191.614 and all funds 29
generated by loan repayments and penalties received pursuant 30
to section 191.540 shall be credited to the fund. The 31
moneys in the fund shall be used by the department of health 32
and senior services to provide loan repayments pursuant to 33
section 191.611 in accordance with sections 191.600 to 34
191.614. 35
191.603. As used in sections 191.600 to 191.615, the 1
following terms shall mean: 2
(1) "Areas of defined need", areas designated by the 3
department pursuant to section 191.605, when services of a 4
primary care physician[, including]; services of a 5
psychiatrist[, chiropractor]; services of a registered nurse 6
including, but not limited to, a certified nurse 7
practitioner, a certified nurse midwife, or a psychiatric 8
nurse; or services of a physician assistant, psychologist, 9
licensed clinical social worker, licensed professional 10
counselor, marital and family therapist, pharmacist, dental 11
hygienist, or general dentist are needed to improve the 12 SB 635 3
patient-health professional ratio in the area, to contribute 13
health care professional services to an area of economic 14
impact, or to contribute health care professional services 15
to an area suffering from the effects of a natural disaster; 16
(2) ["Chiropractor", a person licensed and registered 17
pursuant to chapter 331 ] "Certified nurse midwife", the same 18
meaning given to the term in section 335.016 ; 19
(3) "Certified nurse practitioner", the same meaning 20
given to the term in section 335.016; 21
(4) "Dental hygienist", a person licensed to practice 22
dental hygiene under chapter 332; 23
(5) "Department", the department of health and senior 24
services; 25
[(4)] (6) "General dentist", dentists licensed and 26
registered pursuant to chapter 332 engaged in general 27
dentistry and who are providing such services to the general 28
population; 29
(7) "Licensed clinical social worker", a person 30
licensed as a clinical social worker under chapter 337; 31
(8) "Licensed professional counselor", a person 32
licensed as a professional counselor under chapter 337; 33
(9) "Marital and family therapist", a person licensed 34
as a marital and family therapist under chapter 337; 35
(10) "Pharmacist", a person licensed under chapter 3 38; 36
(11) "Physician assistant", the same meaning given to 37
the term in section 334.735; 38
[(5)] (12) "Primary care physician", physicians 39
licensed and registered pursuant to chapter 334 engaged in 40
general or family practice, internal medicine, pediatrics, 41
geriatrics, or obstetrics and gynecology as their primary 42
specialties, and who are providing such primary care 43
services to the general population; 44 SB 635 4
(13) "Psychiatric nurse", the same meaning given to 45
the term in section 632.005; 46
[(6)] (14) "Psychiatrist", the same meaning as in 47
section 632.005; 48
(15) "Psychologist", a person licensed to practice 49
psychology under chapter 337; 50
(16) "Registered nurse", the same meaning given to the 51
term in section 335.016 . 52
191.605. The department shall designate counties, 1
communities, or sections of urban areas as areas of defined 2
need for medical, psychiatric, [chiropractic,] or dental 3
services when such county, community or section of an urban 4
area has been designated as a primary care health 5
professional shortage area, a mental health care 6
professional shortage area, or a dental health care 7
professional shortage area by the federal Department of 8
Health and Human Services, or has been determined by the 9
director of the department of health and senior services to 10
have an extraordinary need for health care professional 11
services, without a corresponding supply of such 12
professionals. 13
191.607. The department shall adopt and promulgate 1
regulations establishing standards for determining eligible 2
persons for loan repayment pursuant to sections 191.600 to 3
191.615. These standards shall include, but are not limited 4
to the following: 5
(1) Citizenship or permanent residency in the United 6
States; 7
(2) Residence in the state of Missouri; 8
(3) [Enrollment as a full -time medical student in the 9
final year of a course of study offered by an approved 10 SB 635 5
educational institution or licensed to practice medicine or 11
osteopathy pursuant to ch apter 334, including psychiatrists; 12
(4) Enrollment as a full -time dental student in the 13
final year of course study offered by an approved 14
educational institution or licensed to practice general 15
dentistry pursuant to chapter 332; 16
(5) Enrollment as a full-time chiropractic student in 17
the final year of course study offered by an approved 18
educational institution or licensed to practice chiropractic 19
medicine pursuant to chapter 331 ] Authorization to practice 20
as any type of health professional defined in section 21
191.603; and 22
[(6)] (4) Submission of an application for loan 23
repayment. 24
191.611. 1. A loan payment provided for an individual 1
under a written contract under the [health professional 2
student loan payment ] Missouri state loan repayment program 3
shall consist of payment on behalf of the individual of the 4
principal, interest, and related expenses on government and 5
commercial loans received by the individual for tuition, 6
fees, books, laboratory, and living exp enses incurred by the 7
individual. 8
2. For each year of obligated services that an 9
individual contracts to serve in an area of defined need, 10
the director may pay an amount not to exceed the maximum 11
amounts allowed under the National Health Service Corps Loan 12
Repayment Program, 42 U.S.C. Section 2541 -1, P.L. 106-213, 13
on behalf of the individual for loans described in 14
subsection 1 of this section. 15
3. The department may enter into an agreement with the 16
holder of the loans for which repayments are made pursuant 17
to the [health professional student loan payment ] Missouri 18 SB 635 6
state loan repayment program to establish a schedule for the 19
making of such payments if the establishment of such a 20
schedule would result in reducing the costs to the state. 21
4. Any qualifying communities providing a portion of a 22
loan repayment shall be considered first for placement. 23
191.614. 1. [An individual who has entered into a 1
written contract with the department; and in the case of an 2
individual who is enrolled in the final year of a course of 3
study and fails to maintain an acceptable level of academic 4
standing in the educational institution in which such 5
individual is enrolled or voluntarily terminates such 6
enrollment or is dismissed fr om such educational institution 7
before completion of such course of study or fails to become 8
licensed pursuant to chapter 331, 332 or 334 within one year 9
shall be liable to the state for the amount which has been 10
paid on his or her behalf under the con tract. 11
2.] If an individual breaches the written contract of 12
the individual by failing either to begin such individual's 13
service obligation or to complete such service obligation, 14
the state shall be entitled to recover from the individual 15
an amount equal to the sum of: 16
(1) The total of the amounts prepaid by the state on 17
behalf of the individual; 18
(2) The interest on the amounts which would be payable 19
if at the time the amounts were paid they were loans bearing 20
interest at the maximu m prevailing rate as determined by the 21
Treasurer of the United States; 22
(3) An amount equal to any damages incurred by the 23
department as a result of the breach; and 24
(4) Any legal fees or associated costs incurred by the 25
department or the stat e of Missouri in the collection of 26
damages. 27 SB 635 7
[3.] 2. The department may act on behalf of a 28
qualified community to recover from an individual described 29
in [subsections 1 and 2 of ] this section the portion of a 30
loan repayment paid by such community for such individual. 31
191.615. 1. The department shall submit a grant 1
application to the Secretary of the United States Department 2
of Health and Human Services as prescribed by the secretary 3
to obtain federal funds to finance the [health professional 4
student] Missouri state loan repayment program. 5
2. Sections 191.600 to 191.615 shall not be construed 6
to require the department to enter into contracts with 7
individuals who qualify for the [health professional 8
student] Missouri state loan repayment program when federal 9
and state funds are not available for such purpose. 10