Sources of Revenue:

Special Fund

Legislation creates:

A New Fund

Fiscal Note Summary

Effect this measure will have on costs and revenues of state government.

    The purpose of this bill is to create a loan forgiveness program for the following health professionals: dentist, dental hygienist, pharmacist, advanced nurse practitioner, nurse anesthetist, advanced clinical nurse specialist, registered nurse, or a licensed practical nurse. Eligible participants must agree to work in a designated rural area or a for a state mental health facility and sign a contract agreeing to serve a minimum three-year, full-time service obligation.
    The Bureau for Public Health (BPH) currently administers two loan repayment programs; the State Loan Repayment Program (SLRP) and the Recruitment & Retention Community Project (RRCP). The SLRP is a grant for $150,000 awarded by the US Department of Health and Human Services, Health Resources and Services Administration (HRSA) with a match requirement for an additional $150,000 from state general revenue funds from the Primary Care Support Line Item (0407-628). The RRCP is funded with general revenue funds also from the Primary Care Support Line Item in the amount of $267,000. These two loan repayment programs currently make awards for all health care professionals listed in the proposed legislation with the exception of licensed professional nurses, registered nurses and dental hygienists. Although there has been interest in theses professions, current funding does not allow for expansion. For the purposes of this fiscal note, the Bureau is assuming that it will continue the current loan repayment programs at current level funding for those professions currently included. The Bureau estimates the fiscal impact of this bill to be approximately $258,625. This estimate represents utilizing the current RRCP program which requires a match commitment from the entity recruiting. To add the professions not currently being funded, the Bureau is assuming that an additional 10 loan repayment awards will be made. Additionally, the Bureau is allotting $21,000 for a three-year commitment for a total cost per year of $210,000. The proposed legislation specifies a minimum three-year service obligation. If additional service obligation is approved, additional funding would be required.
    The Bureau is also estimating the cost of an additional Health and Human Resources Specialist, Senior at $48,625 to support the additional professions included for consideration.

Fiscal Note Detail

Effect of Proposal Fiscal Year
Fiscal Year
(Upon Full
1. Estmated Total Cost 0 258,625 258,625
Personal Services 0 48,625 48,625
Current Expenses 0 210,000 210,000
Repairs and Alterations 0 0 0
Assets 0 0 0
Other 0 0 0
2. Estimated Total Revenues 0 0 0

Explanation of above estimates (including long-range effect):

    To expand the current repayment programs to include registered nurses, licensed professional nurses and dental hygienist, the Department is estimating at least ten (10) additional loan repayment awards per year for approximately $21,000 each ($210,000 per year). Loans shall be distributed proportionally among the eligible professions according to needs of rural areas in West Virginia.
    A Health and Human Resource Specialist, Senior (1 FTE,) would be required to administer these additional loans. Salary expense is estimated at $31,164. Fringe Benefits, totaling $17,461 are calculated as follows: administrative fees and health insurance at $7,858, FICA, retirement and workers' compensation at 23.96% of personal services is $7,467. WV OPEB contribution is $178 per month X 12 = $2,136 per year for each insurance policy holder. Total cost estimated for personal services is $48,625.


    The number of loans awarded would depend on the availability of funds; the proposed legislation does not specify the dollar amount for each award or the number to be issued. For simplicity of calculating the fiscal note, one rate of $21,000 per loan was used. If a match requirement by the health facility is not required, like the current RRCP program, the cost would be higher.
    The Bureau for Public Health does not currently provide funding for licensed professional nurses, registered nurses, or dental hygienists so the population is uncertain.
    The designated service area is defined in the proposed legislation as rural. The SLRP uses designated areas determined by the federal government established under Federal Rules for Health Profession Shortage Areas and Medically Underserved Areas. The RRCP allows placement in other areas that are determined to be "shortage areas" deemed by the Bureau. Because the term rural is somewhat vague, for purposes of this fiscal note, the Bureau would follow the RRCP placement areas.
    The current loan repayment programs require that participating health agencies must accept Medicare, Children's Health Insurance Program (CHIP), and sliding fee/no pay patients. Obligated providers must see these patients in addition to the Medicaid patients.
    The language of the bill is vague. Additional direction is needed regarding the default procedures, amounts to be awarded per profession, and to determine if the entire loan is to be forgiven in return for an obligated service commitment. Federal funded programs for loan repayment prohibit the service obligation periods being served concurrently.

    Person submitting Fiscal Note: Rocco S. Fucillo
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