[Code of Federal Regulations]

[Title 42, Volume 1]

[Revised as of October 1, 2005]

From the U.S. Government Printing Office via GPO Access

[CITE: 42CFR64a.105]



[Page 383-386]

 

                         TITLE 42--PUBLIC HEALTH

 

    CHAPTER I--PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN 

                                SERVICES

 

PART 64a_OBLIGATED SERVICE FOR MENTAL HEALTH TRAINEESHIPS--Table of 

Contents

 

Sec. 64a.105  What are the conditions of obligated service?



    In order to receive a clinical traineeship an individual must comply 

with the following conditions:

    (a) Written assurance. Prior to the award of a clinical traineeship, 

the individual must sign a written assurance (in such form and manner as 

the Secretary prescribes) that he or she will satisfy the requirements 

of this section.

    (b) Commencement and crediting of service. (1) An individual must 

start the obligated service within twenty-four months after termination 

of the clinical traineeship and carry out the service on a continuous 

basis unless, as



[[Page 384]]



specified in paragraph (e) of this section, the individual has requested 

and had approved, respectively, an extension of the time for beginning 

the service, or a break in service.

    (2) Following termination of the traineeship, the individual must 

annually provide (in such form and manner as the Secretary prescribes) a 

written report describing those previous years' activities which are 

related to service that fulfills the payback obligation. The Secretary 

will review this report and credit all service performed in those 

categories specified in paragraph (d) of this section toward the 

individual's payback obligation, except any service which is performed:

    (i) Before termination of the individual's clinical traineeship; and

    (ii) As part of any activity, such as course work, preparation of a 

dissertation or thesis, or practicum, which is needed to complete the 

training for which the individual received the traineeship.

    (c) Duration of obligation. The period of service payback must equal 

the period of support under the clinical traineeship on a month for 

month basis.

    (d) Performance of the obligated service--(1) General requirements. 

The obligated service must consist of the provision of service for which 

the individual was trained (in the training program for which the 

clinical traineeship was received) and must be performed on a full-time 

basis (not less than 30 hours per week averaged over the obligated 

service period).

    (2) Preferred service. Except as provided under paragraph (d)(3) of 

this section, the individual must provide the obligated service in:

    (i) A public inpatient mental institution;

    (ii) Any entity which is receiving or has received a grant under the 

Mental Health Systems Act or the Community Mental Health Centers Act;

    (iii) A psychiatric manpower shortage area designated by the 

Secretary under section 332 of the Public Health Service Act and 42 CFR 

part 5;

    (iv) Any public or private nonprofit entity or in any nursing home 

(whether public, private nonprofit, or for profit) in which 50 percent 

or more of those served are within one or more of the following groups: 

Racial or ethnic minorities (American Indian or Alaskan Native, Asian or 

Pacific Islander, Black, Hispanic), chronically mentally ill, mentally 

retarded, criminal or delinquent populations, rape victims, physically 

handicapped, abusers of alcohol, or persons addicted to drugs or other 

substances, children and adolescents, the elderly, poverty populations, 

migrants, members of the armed forces (or veterans if seen in a Federal 

facility), residents of areas other than those defined as urbanized by 

the Department of Commerce, or any other special populations, such as 

groups of refugees or disaster victims, which are specifically 

designated by the Secretary for this purpose.

    (3) Alternate service. If the individual obtains the written 

approval of the Secretary, the individual may fulfill his or her 

obligation by:

    (i) Serving in any public or private nonprofit entity or in any 

nursing home (whether public, private nonprofit, or for profit) in which 

not less than 25 percent of those served are within one or more of the 

underserved population groups listed in paragraph (d)(2)(iv) of this 

section. The individual must demonstrate a service commitment of more 

than 50 percent of his or her time to the targeted populations.

    (ii) Teaching, conducting research, or conducting evaluation 

directed at improving alcohol, drug abuse or mental health services to 

one or more of the priority population groups listed in paragraph 

(d)(2)(iv) of this section, or working in a position which fosters the 

closer collaboration of health and alcohol, drug abuse or mental health 

services.

    (iii) Providing in a public or private nonprofit entity 

consultation, training and education, liaison, community support or 

other professional services for which the individual was trained when 

the individual's work is directed toward improving alcohol, drug abuse 

or mental health services to the priority populations listed in 

paragraph (d)(2)(iv) of this section.

    (e) Conditions for deferral or break in service, waiver, or 

cancellation. (1) Upon receipt of a written request showing good cause 

therefor by the individual



[[Page 385]]



having a payback obligation, the Secretary may:

    (i) Extend the period for beginning the obligated service (24 months 

after termination of the clinical traineeship), permit breaks in the 

required continuous service or extend the period for repayment under 

paragraph (g)(2) of this section, if it is determined that:

    (A) An extension or break in service is necessary for the completion 

of training;

    (B) Performance of the obligation must be delayed because a 

temporary disability makes present performance impossible; or

    (C) Performance of the obligation must be delayed because present 

performance would involve a substantial hardship and failure to extend 

the period would be against equity and good conscience.

    (ii) Waive, in whole or in part, the service payback and recovery 

requirements of this section if it is determined that fulfillment would 

be impossible because the individual is permanently and totally 

disabled.

    (iii) In making determinations under Sec. 64a.105(e)(1)(i)(C), the 

Secretary will take into consideration the following factors:

    (A) The individual's present financial resources and obligations;

    (B) The individual's estimated future financial resources and 

obligations;

    (C) The reasons for the individual's failure to complete the 

requirements within the prescribed period, such as problems of a 

personal nature;

    (D) The unavailability of employment opportunities appropriate to 

the individual's education and training; and

    (E) Any other extenuating circumstances.

    (2) Upon receipt of written notice giving evidence of a conflicting 

obligation under section 752 or 753 of the Act or of an election to 

fulfill an obligation under section 472 of the Act prior to an 

obligation under this section, the Secretary will extend the period for 

beginning service (24 months after termination of the clinical 

traineeship), permit breaks in the required continuous service or extend 

the period for repayment under paragraph (g)(1), as appropriate.

    (3) The service payback and recovery obligations of an individual 

will be cancelled upon the submission to the Secretary of a certificate 

of that individual's death or other evidence which the Secretary 

determines to be satisfactory.

    (f) Conflicting or multiple payback obligations. In any case where 

the individual has, in addition to a payback obligation incurred under 

this section, an obligation to perform service under section 752 or 753 

of the Act (because of receipt of a National Health Service Corps 

scholarship) or under section 472 of the Act (because of receipt of a 

National Research Service Award), or both, performance of the same 

activity may not be counted toward more than one of these obligations. 

In determining the order in which obligations must be fulfilled, 

obligations under section 752 or 753 take precedence over obligations 

incurred under this section. However, with respect to obligations under 

this section and 472, the individual may elect which obligation to 

fulfill first. Any individual who has an obligation under section 752 or 

753 or makes an election to fulfill an obligation under section 472 

prior to an obligation under this section, must give written notice to 

the Secretary as provided by paragraph (e)(3) of this section.

    (g) Recovery for failure to perform obligated service. (1) If an 

individual fails to begin or complete the obligated service in 

accordance with the requirements of paragraphs (a) through (f) of this 

section, that individual is obligated to repay the United States an 

amount equal to three times the cost of the award (including stipends 

and other trainee allowances) plus interest on that amount calculated 

for the total period since the trainee failed to perform the obligated 

service at the rate set by the Secretary of the Treasury for National 

Research Service Awards prevailing on the date on which the period of 

appointment begins, multiplied, in any case in which the service that 

was required has been performed in part, by the percentage which the 

length of service that was not performed is to the length of the service



[[Page 386]]



that was required to be performed. The amount will be determined under 

the following formula:

[GRAPHIC] [TIFF OMITTED] TC13NO91.004



where



A = the amount the United States is entitled to recover;

[thetas] = the cost of the clinical traineeship (including stipends and 

other trainee allowances);

m = the number of months since the trainee failed to perform obligated 

service;

i = the National Research Service Award rate on the date which the 

period of appointment begins divided by twelve;

t = the total number of months of the service obligation;

s = the number of months that have been served.



    (2) Unless the Secretary extends the repayment period as provided in 

paragraph (e) of this section, the individual shall pay to the United 

States the total amount which the United States is entitled to recover 

under paragraph (g)(1) of this section immediately upon the date that 

the individual fails to begin or complete the period of obligated 

service (including failing to comply with the applicable terms and 

conditions of an extension or break in service granted the individual) 

or upon the date that the individual indicates his or her intention not 

to fulfill the service obligation as determined by the Secretary. The 

amount is considered a debt owed to the United States, with interest 

accruing monthly upon the total debt as provided under paragraph (g)(1) 

of this section.



[46 FR 39979, Aug. 5, 1981, as amended at 52 FR 18359, May 15, 1987]