§ 1616a. — Indian Health Service Loan Repayment Program.
[Laws in effect as of January 24, 2002]
[Document not affected by Public Laws enacted between
January 24, 2002 and December 19, 2002]
[CITE: 25USC1616a]
TITLE 25--INDIANS
CHAPTER 18--INDIAN HEALTH CARE
SUBCHAPTER I--INDIAN HEALTH PROFESSIONAL PERSONNEL
Sec. 1616a. Indian Health Service Loan Repayment Program
(a) Establishment
(1) The Secretary, acting through the Service, shall establish a
program to be known as the Indian Health Service Loan Repayment Program
(hereinafter referred to as the ``Loan Repayment Program'') in order to
assure an adequate supply of trained health professionals necessary to
maintain accreditation of, and provide health care services to Indians
through, Indian health programs.
(2) For the purposes of this section--
(A) the term ``Indian health program'' means any health program
or facility funded, in whole or part, by the Service for the benefit
of Indians and administered--
(i) directly by the Service;
(ii) by any Indian tribe or tribal or Indian organization
pursuant to a contract under--
(I) the Indian Self-Determination Act [25 U.S.C. 450f et
seq.], or
(II) section 23 of the Act of April 30, 1908 \1\ (25
U.S.C. 47), popularly known as the ``Buy-Indian'' Act; or
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\1\ See References in Text note below.
(iii) by an urban Indian organization pursuant to subchapter
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IV of this chapter; and
(B) the term ``State'' has the same meaning given such term in
section 254d(i)(4) \1\ of title 42.
(b) Eligibility
To be eligible to participate in the Loan Repayment Program, an
individual must--
(1)(A) be enrolled--
(i) in a course of study or program in an accredited
institution, as determined by the Secretary, within any State
and be scheduled to complete such course of study in the same
year such individual applies to participate in such program; or
(ii) in an approved graduate training program in a health
profession; or
(B) have--
(i) a degree in a health profession; and
(ii) a license to practice a health profession in a State;
(2)(A) be eligible for, or hold, an appointment as a
commissioned officer in the Regular or Reserve Corps of the Public
Health Service;
(B) be eligible for selection for civilian service in the
Regular or Reserve Corps of the Public Health Service;
(C) meet the professional standards for civil service employment
in the Indian Health Service; or
(D) be employed in an Indian health program without a service
obligation; and
(3) submit to the Secretary an application for a contract
described in subsection (f) of this section.
(c) Application and contract forms
(1) In disseminating application forms and contract forms to
individuals desiring to participate in the Loan Repayment Program, the
Secretary shall include with such forms a fair summary of the rights and
liabilities of an individual whose application is approved (and whose
contract is accepted) by the Secretary, including in the summary a clear
explanation of the damages to which the United States is entitled under
subsection (l) of this section in the case of the individual's breach of
the contract. The Secretary shall provide such individuals with
sufficient information regarding the advantages and disadvantages of
service as a commissioned officer in the Regular or Reserve Corps of the
Public Health Service or a civilian employee of the Indian Health
Service to enable the individual to make a decision on an informed
basis.
(2) The application form, contract form, and all other information
furnished by the Secretary under this section shall be written in a
manner calculated to be understood by the average individual applying to
participate in the Loan Repayment Program.
(3) The Secretary shall make such application forms, contract forms,
and other information available to individuals desiring to participate
in the Loan Repayment Program on a date sufficiently early to ensure
that such individuals have adequate time to carefully review and
evaluate such forms and information.
(d) Vacancies; priority
(1) Consistent with paragraph (3), the Secretary, acting through the
Service and in accordance with subsection (k) of this section, shall
annually--
(A) identify the positions in each Indian health program for
which there is a need or a vacancy, and
(B) rank those positions in order of priority.
(2) Consistent with the priority determined under paragraph (1), the
Secretary, in determining which applications under the Loan Repayment
Program to approve (and which contracts to accept), shall give priority
to applications made by--
(A) Indians; and
(B) individuals recruited through the efforts of Indian tribes
or tribal or Indian organizations.
(3)(A) Subject to subparagraph (B), of the total amounts
appropriated for each of the fiscal years 1993, 1994, and 1995 for loan
repayment contracts under this section, the Secretary shall provide
that--
(i) not less than 25 percent be provided to applicants who are
nurses, nurse practitioners, or nurse midwives; and
(ii) not less than 10 percent be provided to applicants who are
mental health professionals (other than applicants described in
clause (i)).
(B) The requirements specified in clause (i) or clause (ii) of
subparagraph (A) shall not apply if the Secretary does not receive the
number of applications from the individuals described in clause (i) or
clause (ii), respectively, necessary to meet such requirements.
(e) Approval
(1) An individual becomes a participant in the Loan Repayment
Program only upon the Secretary and the individual entering into a
written contract described in subsection (f) of this section.
(2) The Secretary shall provide written notice to an individual
promptly on--
(A) the Secretary's approving, under paragraph (1), of the
individual's participation in the Loan Repayment Program, including
extensions resulting in an aggregate period of obligated service in
excess of 4 years; or
(B) the Secretary's disapproving an individual's participation
in such Program.
(f) Contract terms
The written contract referred to in this section between the
Secretary and an individual shall contain--
(1) an agreement under which--
(A) subject to paragraph (3), the Secretary agrees--
(i) to pay loans on behalf of the individual in
accordance with the provisions of this section, and
(ii) to accept (subject to the availability of
appropriated funds for carrying out this section) the
individual into the Service or place the individual with a
tribe or Indian organization as provided in subparagraph
(B)(iii), and
(B) subject to paragraph (3), the individual agrees--
(i) to accept loan payments on behalf of the individual;
(ii) in the case of an individual described in
subsection (b)(1) of this section--
(I) to maintain enrollment in a course of study or
training described in subsection (b)(1)(A) of this
section until the individual completes the course of
study or training, and
(II) while enrolled in such course of study or
training, to maintain an acceptable level of academic
standing (as determined under regulations of the
Secretary by the educational institution offering such
course of study or training);
(iii) to serve for a time period (hereinafter in this
section referred to as the ``period of obligated service'')
equal to 2 years or such longer period as the individual may
agree to serve in the full-time clinical practice of such
individual's profession in an Indian health program to which
the individual may be assigned by the Secretary;
(2) a provision permitting the Secretary to extend for such
longer additional periods, as the individual may agree to, the
period of obligated service agreed to by the individual under
paragraph (1)(B)(iii);
(3) a provision that any financial obligation of the United
States arising out of a contract entered into under this section and
any obligation of the individual which is conditioned thereon is
contingent upon funds being appropriated for loan repayments under
this section;
(4) a statement of the damages to which the United States is
entitled under subsection (l) of this section for the individual's
breach of the contract; and
(5) such other statements of the rights and liabilities of the
Secretary and of the individual, not inconsistent with this section.
(g) Loan repayment purposes; maximum amount; tax liability
reimbursement; schedule of payments
(1) A loan repayment provided for an individual under a written
contract under the Loan Repayment Program shall consist of payment, in
accordance with paragraph (2), on behalf of the individual of the
principal, interest, and related expenses on government and commercial
loans received by the individual regarding the undergraduate or graduate
education of the individual (or both), which loans were made for--
(A) tuition expenses;
(B) all other reasonable educational expenses, including fees,
books, and laboratory expenses, incurred by the individual; and
(C) reasonable living expenses as determined by the Secretary.
(2)(A) For each year of obligated service that an individual
contracts to serve under subsection (f) of this section the Secretary
may pay up to $35,000 (or an amount equal to the amount specified in
section 254l-1(g)(2)(A) of title 42) on behalf of the individual for
loans described in paragraph (1). In making a determination of the
amount to pay for a year of such service by an individual, the Secretary
shall consider the extent to which each such determination--
(i) affects the ability of the Secretary to maximize the number
of contracts that can be provided under the Loan Repayment Program
from the amounts appropriated for such contracts;
(ii) provides an incentive to serve in Indian health programs
with the greatest shortages of health professionals; and
(iii) provides an incentive with respect to the health
professional involved remaining in an Indian health program with
such a health professional shortage, and continuing to provide
primary health services, after the completion of the period of
obligated service under the Loan Repayment Program.
(B) Any arrangement made by the Secretary for the making of loan
repayments in accordance with this subsection shall provide that any
repayments for a year of obligated service shall be made no later than
the end of the fiscal year in which the individual completes such year
of service.
(3) For the purpose of providing reimbursements for tax liability
resulting from payments under paragraph (2) on behalf of an individual,
the Secretary--
(A) in addition to such payments, may make payments to the
individual in an amount not less than 20 percent and not more than
39 percent of the total amount of loan repayments made for the
taxable year involved; and
(B) may make such additional payments as the Secretary
determines to be appropriate with respect to such purpose.
(4) The Secretary may enter into an agreement with the holder of any
loan for which payments are made under the Loan Repayment Program to
establish a schedule for the making of such payments.
(h) Effect on employment ceiling of Department of Health and Human
Services
Notwithstanding any other provision of law, individuals who have
entered into written contracts with the Secretary under this section,
while undergoing academic training, shall not be counted against any
employment ceiling affecting the Department of Health and Human
Services.
(i) Recruiting programs
The Secretary shall conduct recruiting programs for the Loan
Repayment Program and other health professional programs of the Service
at educational institutions training health professionals or specialists
identified in subsection (a) of this section.
(j) Prohibition of assignment to other government departments
Section 215 of title 42 shall not apply to individuals during their
period of obligated service under the Loan Repayment Program.
(k) Staff needs of health programs administered by Indian tribes
The Secretary, in assigning individuals to serve in Indian health
programs pursuant to contracts entered into under this section, shall--
(1) ensure that the staffing needs of Indian health programs
administered by an Indian tribe or tribal or health organization
receive consideration on an equal basis with programs that are
administered directly by the Service; and
(2) give priority to assigning individuals to Indian health
programs that have a need for health professionals to provide health
care services as a result of individuals having breached contracts
entered into under this section.
(l) Voluntary termination of study or dismissal from educational
institution; collection of damages
(1) An individual who has entered into a written contract with the
Secretary under this section and who--
(A) is enrolled in the final year of a course of study and who--
(i) fails to maintain an acceptable level of academic
standing in the educational institution in which he is enrolled
(such level determined by the educational institution under
regulations of the Secretary);
(ii) voluntarily terminates such enrollment; or
(iii) is dismissed from such educational institution before
completion of such course of study; or
(B) is enrolled in a graduate training program, fails to
complete such training program, and does not receive a waiver from
the Secretary under subsection (b)(1)(B)(ii) of this section,
shall be liable, in lieu of any service obligation arising under such
contract, to the United States for the amount which has been paid on
such individual's behalf under the contract.
(2) If, for any reason not specified in paragraph (1), an individual
breaches his written contract under this section by failing either to
begin, or complete, such individual's period of obligated service in
accordance with subsection (f) of this section, the United States shall
be entitled to recover from such individual an amount to be determined
in accordance with the following formula:
A=3Z(t-s/t)
in which--
(A) ``A'' is the amount the United States is entitled to
recover;
(B) ``Z'' is the sum of the amounts paid under this section to,
or on behalf of, the individual and the interest on such amounts
which would be payable if, at the time the amounts were paid, they
were loans bearing interest at the maximum legal prevailing rate, as
determined by the Treasurer of the United States;
(C) ``t'' is the total number of months in the individual's
period of obligated service in accordance with subsection (f) of
this section; and
(D) ``s'' is the number of months of such period served by such
individual in accordance with this section.
Amounts not paid within such period shall be subject to collection
through deductions in Medicare payments pursuant to section 1395ccc of
title 42.
(3)(A) Any amount of damages which the United States is entitled to
recover under this subsection shall be paid to the United States within
the 1-year period beginning on the date of the breach or such longer
period beginning on such date as shall be specified by the Secretary.
(B) If damages described in subparagraph (A) are delinquent for 3
months, the Secretary shall, for the purpose of recovering such
damages--
(i) utilize collection agencies contracted with by the
Administrator of the General Services Administration; or
(ii) enter into contracts for the recovery of such damages with
collection agencies selected by the Secretary.
(C) Each contract for recovering damages pursuant to this subsection
shall provide that the contractor will, not less than once each 6
months, submit to the Secretary a status report on the success of the
contractor in collecting such damages. Section 3718 of title 31 shall
apply to any such contract to the extent not inconsistent with this
subsection.
(m) Cancellation or waiver of obligations; bankruptcy discharge
(1) Any obligation of an individual under the Loan Repayment Program
for service or payment of damages shall be canceled upon the death of
the individual.
(2) The Secretary shall by regulation provide for the partial or
total waiver or suspension of any obligation of service or payment by an
individual under the Loan Repayment Program whenever compliance by the
individual is impossible or would involve extreme hardship to the
individual and if enforcement of such obligation with respect to any
individual would be unconscionable.
(3) The Secretary may waive, in whole or in part, the rights of the
United States to recover amounts under this section in any case of
extreme hardship or other good cause shown, as determined by the
Secretary.
(4) Any obligation of an individual under the Loan Repayment Program
for payment of damages may be released by a discharge in bankruptcy
under title 11 only if such discharge is granted after the expiration of
the 5-year period beginning on the first date that payment of such
damages is required, and only if the bankruptcy court finds that
nondischarge of the obligation would be unconscionable.
(n) Annual report
The Secretary shall submit to the President, for inclusion in each
report required to be submitted to the Congress under section 1671 of
this title, a report concerning the previous fiscal year which sets
forth--
(1) the health professional positions maintained by the Service
or by tribal or Indian organizations for which recruitment or
retention is difficult;
(2) the number of Loan Repayment Program applications filed with
respect to each type of health profession;
(3) the number of contracts described in subsection (f) of this
section that are entered into with respect to each health
profession;
(4) the amount of loan payments made under this section, in
total and by health profession;
(5) the number of scholarship grants that are provided under
section 1613a of this title with respect to each health profession;
(6) the amount of scholarship grants provided under section
1613a of this title, in total and by health profession;
(7) the number of providers of health care that will be needed
by Indian health programs, by location and profession, during the
three fiscal years beginning after the date the report is filed; and
(8) the measures the Secretary plans to take to fill the health
professional positions maintained by the Service or by tribes or
tribal or Indian organizations for which recruitment or retention is
difficult.
(Pub. L. 94-437, title I, Sec. 108, as added Pub. L. 100-713, title I,
Sec. 108, Nov. 23, 1988, 102 Stat. 4789; amended Pub. L. 102-573, title
I, Secs. 106(a)-(g)(1), (h), (i), 117(b)(3), title IX, Sec. 902(2)(C),
(D), Oct. 29, 1992, 106 Stat. 4535-4537, 4544, 4591.)
References in Text
The Indian Self-Determination Act, referred to in subsec.
(a)(2)(A)(ii)(I), is title I of Pub. L. 93-638, Jan. 4, 1975, 88 Stat.
2206, as amended, which is classified principally to part A (Sec. 450f
et seq.) of subchapter II of chapter 14 of this title. For complete
classification of this Act to the Code, see Short Title note set out
under section 450 of this title and Tables.
Section 23 of the Act of April 30, 1908, referred to in subsec.
(a)(2)(A)(ii)(II), probably should be a reference to section 23 of act
June 25, 1910, ch. 431, 36 Stat. 861, which is popularly known as the
``Buy Indian Act'', and is classified to section 47 of this title. Act
Apr. 30, 1908, ch. 153, 35 Stat. 70, does not contain a section 23 but
does have provisions (at 35 Stat. 71) similar to those in section 23 of
act June 25, 1910, ch. 431, 36 Stat. 861.
Section 254d(i)(4) of title 42, referred to in subsec. (a)(2)(B),
was redesignated section 254d(j)(4) of title 42 by Pub. L. 107-251,
title III, Sec. 310(b)(1), Oct. 26, 2002, 116 Stat. 1643.
Amendments
1992--Subsec. (a)(1). Pub. L. 102-573, Sec. 106(a)(1), substituted
``health professionals'' for ``physicians, dentists, nurses, nurse
practitioners, physician assistants, clinical and counseling
psychologists, graduates of schools of public health, graduates of
schools of social work, and other health professionals''.
Subsec. (b)(1)(A)(i). Pub. L. 102-573, Sec. 106(a)(2)(A)(i), amended
cl. (i) generally. Prior to amendment, cl. (i) read as follows: ``as a
full-time student in the final year of a course of study or program in
an accredited institution, as determined by the Secretary, within any
State; or''.
Subsec. (b)(1)(A)(ii). Pub. L. 102-573, Sec. 106(a)(2)(A)(ii),
substituted ``a health profession'' for ``medicine, osteopathy,
dentistry, or other health profession''.
Subsec. (b)(1)(B). Pub. L. 102-573, Sec. 106(a)(2)(B), in cl. (i),
substituted ``a degree in a health profession; and'' for ``a degree in
medicine, osteopathy, dentistry, or other health profession;'',
redesignated cl. (iii) as (ii) and substituted ``a health profession''
for ``medicine, osteopathy, dentistry, or other health profession'', and
struck out former cl. (ii) which read as follows: ``completed an
approved graduate training program in medicine, osteopathy, dentistry,
or other health profession in a State, except that the Secretary may
waive the completion requirement of this clause for good cause; and''.
Subsec. (b)(2) to (4). Pub. L. 102-573, Sec. 106(a)(2)(C), inserted
``and'' at end of par. (2)(D), added par. (3), and struck out former
pars. (3) and (4) which read as follows:
``(3) submit an application to participate in the Loan Repayment
Program; and
``(4) sign and submit to the Secretary, at the time of submission of
such application, a written contract (described in subsection (f) of
this section) to accept repayment of educational loans and to serve (in
accordance with this section) for the applicable period of obligated
service in an Indian health program.''
Subsec. (d)(1). Pub. L. 102-573, Sec. 106(b)(1), substituted
``Consistent with paragraph (3), the'' for ``The''.
Subsec. (d)(1)(A). Pub. L. 102-573, Sec. 902(2)(C), substituted
``Indian health'' for ``Indian Health''.
Subsec. (d)(3). Pub. L. 102-573, Sec. 106(b)(2), added par. (3).
Subsec. (e)(1). Pub. L. 102-573, Sec. 106(c), amended par. (1)
generally. Prior to amendment, par. (1) read as follows: ``An individual
becomes a participant in the Loan Repayment Program only on the
Secretary's approval of the individual's application submitted under
subsection (b)(3) of this section and the Secretary's acceptance of the
contract submitted by the individual under subsection (b)(4) of this
section.''
Subsec. (e)(2)(A). Pub. L. 102-573, Sec. 106(d), inserted ``,
including extensions resulting in an aggregate period of obligated
service in excess of 4 years'' before ``; or''.
Subsec. (g)(1). Pub. L. 102-573, Sec. 106(e), in introductory
provisions, substituted ``loans received by the individual regarding the
undergraduate or graduate education of the individual (or both), which
loans were made for'' for ``loans received by the individual for''.
Subsec. (g)(2)(A). Pub. L. 102-573, Sec. 106(f), amended subpar. (A)
generally. Prior to amendment, subpar. (A) read as follows: ``Except as
provided in subparagraph (B) and paragraph (3), for each year of
obligated service for which an individual contracts to serve under
subsection (f) of this section, the Secretary may pay up to $25,000 on
behalf of the individual for loans described in paragraph (1).''
Subsec. (g)(3). Pub. L. 102-573, Sec. 106(g)(1), amended par. (3)
generally. Prior to amendment, par. (3) read as follows: ``In addition
to payments made under paragraph (2), in any case in which payments on
behalf of an individual under the Loan Repayment Program result in an
increase in Federal, State, or local income tax liability for such
individual, the Secretary may, on the request of such individual, make
payments to such individual in a reasonable amount, as determined by the
Secretary, to reimburse such individual for all or part of the increased
tax liability of the individual.''
Subsec. (i). Pub. L. 102-573, Sec. 902(2)(D), substituted ``health
professional programs of the Service'' for ``Service manpower
programs''.
Subsec. (k). Pub. L. 102-573, Sec. 106(h), amended subsec. (k)
generally. Prior to amendment, subsec. (k) read as follows: ``The
Secretary shall ensure that the staffing needs of Indian health programs
administered by any Indian tribe or tribal or Indian organization
receive consideration on an equal basis with programs that are
administered directly by the Service.''
Subsec. (n). Pub. L. 102-573, Sec. 106(i), amended subsec. (n)
generally. Prior to amendment, subsec. (n) consisted of pars. (1) and
(2) requiring submission of annual reports to Congress by the first of
March and the first of July of each year.
Subsec. (o). Pub. L. 102-573, Sec. 117(b)(3), struck out subsec. (o)
which read as follows: ``There are authorized to be appropriated such
sums as may be necessary for each fiscal year to carry out the
provisions of this section.''
Effective Date of 1992 Amendment
Section 106(g)(2) of Pub. L. 102-573 provided that: ``The amendment
made by paragraph (1) [amending this section] shall apply only with
respect to contracts under section 108 of the Indian Health Care
Improvement Act [this section] entered into on or after the date of
enactment of this Act [Oct. 29, 1992].''
Section Referred to in Other Sections
This section is referred to in sections 1613a, 1616a-1, 1616b,
1616c, 1616d, 1616j, 1616k, 1616m, 1621h, 1671 of this title; title 42
section 292d.
