Cal. Code Regs. Tit. 22, § 97931.03 - Application; Process
(a) A
physician who desires to participate in the program shall submit an application
to the program on a form prescribed by the program that includes all of the
following:
(1) Applicant's name, address,
telephone numbers, social security number, date of birth, date on which first
medical license was issued and name of issuing body, and, if available, e-mail
address.
(2) Which of the criteria
listed in Section
128553(c) of the
code or in section
97931.02 the applicant meets and
why, including dates of and institutions where postgraduate training or
fellowships occurred.
(3) A
statement as to why the physician wants to participate in the
program.
(4) The name of each
lender from which the applicant has obtained an educational loan, together with
a current loan statement that contains the lender's name and mailing address,
the applicant's name and loan account number, the outstanding balance of the
loan, and the date on which the loan statement was issued.
(5) Whether the applicant has ever been in
default or had a judgment lien against the applicant for any debt, and an
explanation for each default or judgment lien.
(6) Whether the applicant is willing to sign
or has signed a written agreement with the practice setting(s) committing to
three years of full-time service in a medically underserved area.
(7) The name and address of each practice
setting at which services are to be provided under the program.
(8) A certification under penalty of perjury
as to the contents of the application and any attachments, signed and dated by
the applicant.
(9) A statement
authorizing release to the program of information enumerated in the application
and any attachments thereto.
(10) A
certification under penalty of perjury, signed and dated by the practice
setting's administrative officer, whose name is printed below his/her
signature, that the facility has entered into an agreement with the applicant
for a minimum of three years; that the applicant can speak a Medi-Cal threshold
language; that it will pay the applicant a prevailing wage and not offset any
loan repayments by the program against the applicant's salary; and that it is a
"practice setting" as defined in Section
128552(i) of the
code.
(b) Application
filing periods will be dependent upon available funding and the number of
openings in the program. Every application filing period shall be posted on the
Office's Web site and shall close not earlier than 30 days after the date on
which openings are first posted on the Office's Web site. Notwithstanding
section 97931.04(a), an
application that is either not complete or not received by the final filing
date shall not be considered but shall be returned to the applicant.
(c) A participating physician shall sign a
written agreement with the Office committing to all terms of the program and
acknowledging that loan repayment will be made in accordance with Section
128556. If (1) a participating
physician ceases full-time practice; or (2) both the practice setting and the
physician have agreed to termination of the physician's employment, and the
physician has been successful in obtaining subsequent qualifying employment
within 3 months after termination of employment, loan repayment will be reduced
proportionately by the time spent away from qualifying practice during that
contract year.
(d) If a physician
participating in the program receives a loan repayment of less than $105,000,
24 percent of the loan repayment amount will be made at the end of the first
year, 33 percent at the end of the second year, and 43 percent at the end of
the third year.
Notes
Note: Authority cited: Section 128554, Health and Safety Code. Reference: Sections 128553 and 128556, Health and Safety Code.
2. Certificate of Compliance as to 4-25-2003 order transmitted to OAL 8-19-2003 and filed 9-30-2003 (Register 2003, No. 40).
3. Change without regulatory effect renumbering title 16, section 1313.03 to title 22, section 97931.03 filed 6-25-2015 pursuant to section 100, title 1, California Code of Regulations (Register 2015, No. 26).
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