Louisiana Physician Loan Repayment Program

The fully completed, signed application must be submitted along with the following forms and information:

• Online application or downloadable application. Please print the downloadable application if you prefer to submit via mail.
• Copy of executed employment contract or a letter verifying employment, if an employment contract is not available
  • For public employees, a letter of agreement with the governmental agency and verification of employment will be accepted in lieu of an employment contract
• Resume
• Copy of current professional license
• Documentation of the current principle balance of the applicant’s certified educational debt. This should include name and account number for each loan
• Signed Release from Liability Form
• Signed Consent for Release of Information Waiver of Confidentiality Form
• Completed IRS Form W-9-Request for Taxpayer ID Number that matches applicant address (this should include YOUR information, not your employer)
  • W-9 Directions
  • W-9 Form
• Completed Electronic Funds Transfer Form with voided blank check or direct deposit form from financial institution (the bottom of this form should be completed by your financial institution; please make sure the box on the middle left of the page is checked)
  • EFT Directions
  • EFT Form

Following notification of funding and receipt of the Physician Loan Repayment Program contract in the mail, the applicant should return the signed Physician Loan Repayment Program contract with the understanding that once the contract is signed by the Secretary of LDH, or their designee, and approved through the LDH contract approval process, the applicant is agreeing to accept repayment of their educational loans in exchange for providing outpatient primary care healthcare services for an agreed upon period of obligation in a federally designated HPSA.

Note: Neither the applicant nor the State is bound by the contract until:

• The Secretary of LDH, or their designee, has signed the Physician Loan Repayment Program contract;
• The contract has been approved by the Louisiana Division of Administration, Office of State Procurement.

Participating in Louisiana Physician Loan Repayment Program requires the provision of full-time clinical services at an eligible Physician Loan Repayment Program service site for the period agreed upon in the program contract. These sites are specific health care practice opportunities identified by the Physician Loan Repayment Program in certain federally designated health professional shortage areas (HPSAs) that have experienced special difficulty recruiting or retaining health professionals because of the site’s geographic isolation, severe economic need, or the chronically poor health status of the population to be served.

1. To serve a minimum of five years with two additional years possible
2. To provide primary health care services at an eligible facility, located in a federally designated HPSA that is appropriate for their discipline
3. To provide health care services and encounters as defined:
   1. Provide full-time primary healthcare service or clinical practice in a public or nonprofit private entity located in a current federally designated HPSA that is appropriate for their discipline.
   2. For all health professionals, “full-time clinical practice” is defined as a minimum of 40 hours per week of patient care at an approved service site, with no more than eight of those hours per week devoted to practice related administrative activities. The practice will include hospital treatment coverage appropriate to meet the needs of patients of the approved service site and to ensure continuity of care.
   3. With the exception of obstetrician/gynecologist (OB/GYN) physicians or family practice physicians who practice obstetrics on a regular basis, all health professionals must spend at least 32 of the minimum 40 hours per week providing direct patient care. These services must be conducted during normally scheduled clinic hours at the approved service site. The remaining hours must be spent providing inpatient care to patients of the approved site or in practice-related administrative activities.
   4. For OB/GYN physicians, family practice physicians who practice obstetrics on a regular basis, and CNMs, at least 21 of the minimum 40 hours per week must be spent providing direct patient care. These services must be conducted during normally scheduled clinic hours at the approved service site. The remaining hours must be spent providing inpatient care to patients of the approved site or in practice-related administrative activities, not to exceed eight hours per week.
   5. Submit LPV with each quarter. The LPV should contain the contractor’s name and account number generated by the loan institution and should include all posted payment since the last quarter. These payments must equal the amount of Physician Loan Repayment Program funds received from the last quarter.
4. Complete two surveys after contract is finished (3 months and 6 months post-contract).
5. Notify Well-Ahead Louisiana’s Primary Care Office of any changes in status. This may include, but is not limited to, changes in mailing address, phone number, employment, employer policies related to target patient type, loan default status, and licensure status.

Note: The contractor must have written approval from the Louisiana Primary Care Office before relocating to another employment site.

If the Contractor breaches a Physician Loan Repayment Program obligation, the contractor will be subject to pay an amount equal to the sum of the following:

• The total amount paid by the Physician Loan Repayment Program to, or on behalf of, the participant for loan repayment for any period of obligated service not served
• An amount equal to the number of months of obligated service not completed multiplied by $7,500
• Interest on the above amounts at the maximum legal prevailing rate, as determined by the treasurer of the United States, from the date of breach

Note: The minimum amount that LDH is entitled to recover will not be less than $31,000.

The only permissible basis for canceling a Physician Repayment Loan Program contract is the death of the Physician Loan Repayment Program participant. States cannot cancel a Physician Loan Repayment Program contract in order to allow an individual to participate in the NHSC LRP or for any other reason except the participant’s death.

Waiver of the Physician Loan Repayment Program obligation is a permanent status. In order to qualify for a waiver of the Physician Loan Repayment Program obligation, a participant must document a medical condition or a personal situation that makes compliance with the obligation permanently impossible or an extreme hardship, such that enforcement would be against equity and good conscience. The Secretary of LDH will review the documentation of this medical condition or personal situation. The Secretary is the only one who can grant a waiver of the Physician Loan Repayment Program obligation.

Suspensions of the Physician Loan Repayment Program contract obligations may be made for up to one year in the event of temporary physical or mental disability of the contractor or other justifiable causes. Documentation of the medical condition or personal situation which would make completion of the obligation temporarily impossible or an extreme hardship, such that enforcement would be against equity and good conscience, would be presented to the Secretary of LDH. The Secretary is the only one who can grant a suspension of the Physician Loan Repayment Program obligation.

Defaults occur when participants fail to begin or complete their Physician Loan Repayment Program service obligation or otherwise breach the terms and conditions of the obligation. Participants who are in default of their contracts are subject to the financial consequences outlined in their contracts and in this policy in the prior section entitled Financial Consequences.