PURPOSE: This rule implements a system of incentives to develop coordinated health care services available and accessible to all persons under Primary Care Resource Initiative for Missouri (PRIMO).

1. (1) The following definitions shall be used in the interpretation and enforcement of this rule:

   1. (A) Approved family practice residency program means a graduate medical education program designed to train family or general practice physicians and approved by the Accreditation Council for Graduate Medical Education for allopatric residencies or by the American Osteopathic Association for osteopathic residencies;
   2. (B) Approved primary care residency program means a graduate medical education program designed to train family practice, general practice, general pediatric or general internal medicine physicians and approved by the Accreditation Council for Graduate Medical Education for allopatric residencies or by the American Osteopathic Association for osteopathic residencies;
   3. (C) Area of defined need means a geographic area or population designated by the Missouri Department of Health and Senior Services as experiencing a shortage of accessible primary and preventive health care providers and adverse health outcomes;
   4. (D) Department means the Missouri Department of Health and Senior Services;
   5. (E) Director means the Director of the Missouri Department of Health and Senior Services;
   6. (F) Forgivable loan means the financial assistance provided by the Department of Health and Senior Services for professional education that may be forgiven, fully or partially, in return for qualifying employment;
   7. (G) Forgiveness means the monetary reduction of a recipient’s PRIMO debt in exchange for qualifying employment in a defined area of need;

   8. (H) Eligible student means a Missouri resident accepted or enrolled in a participating institution in a formal course of instruction leading to:

      1. 1. A bachelor of science degree leading

to certification as a primary care advanced practice nurse, a doctor of dentistry or a doctor of allopatric or osteopathic medicine;

1. 2. A master of science degree in nursing

leading to a primary care advanced practice nursing degree;

1. 3. A degree as a doctor of allopatric or

osteopathic medicine;

1. 4. A degree as a doctor of dentistry;
2. 5. A degree leading to licensure as a

registered dental hygienist; or

1. 6. Based on documented need assess-

ments utilizing a scientifically proven methodology, all other health profession students will be considered for funding pending resource availability;

1. (I) Participating institution means an institution in Missouri, which grants degrees as a doctor of allopatric or osteopathic medicine; as a doctor of dentistry; as a master of science in nursing leading to certification as a primary care advanced practice nurse; as a bachelor of science in a field leading to acceptance into a school of allopatric or osteopathic medicine, school of dentistry or a master of science in nursing program; leading to licensure as a registered dental hygienist; or an institution, which offers an approved primary care residency program;
2. (J) Advanced practice nurse means a nurse who has received a graduate degree from a participating accredited college or university with a concentration in advanced practice nursing and who has received from the Missouri State Board of Nursing a “Document of Recognition” authorizing the nurse to practice as a certified nurse practitioner or a certified clinical specialist. Nursing specialties are limited to family, adult, women’s health, gerontology and pediatric nurse practitioner;
3. (K) Primary health care provider means a generalist physician, advanced practice nurse, dentist or dental hygienist specializing in the provision of primary and preventive health care services;
4. (L) Qualified employment means employment at a minimum of thirty (30) hours per week in this state providing primary health care services in an area of defined need;
5. (M) Resident means an individual who has lived in this state for any purpose, other than attending an educational institution located within this state, for one (1) or more years before submitting an application for financial assistance from the department;
6. (N) Rural area means a town or community within this state, which is not an urbanized area. An urbanized area is defined as a central city(ies) and its contiguous, closely settled territory with a combined population of at least fifty thousand (50,000); and
7. (O) Primary health care services are defined as the actual, hands-on provision of 19 CSR 10-4

primary and preventive health care services by a licensed physician specializing in family practice, general practice, general internal medicine or general pediatrics, or by an advanced practice nurse specialist certified in family, women’s health, pediatric, gerontology, or adult health or a licensed general dentist or dental hygienist.

1. (2) The department in cooperation with appropriate public and nonprofit agencies, institutions and organizations, shall develop and implement a statewide, integrated primary and preventive health care delivery system including the education, recruitment and retention of health care professionals, extending from high school student identification and support systems to placement of professionals in areas of defined need.

   1. (A) The department may contract with appropriate public and/or nonprofit agencies, institutions and organizations to develop and implement a statewide recruitment, education and support system for high school and undergraduate college students to enter into primary and preventive health care professional education.

      1. 1. The system shall assure appropriate

and academically sound pre-college academic preparation.

1. 2. The system shall provide experiential,

hands-on learning opportunities.

1. 3. The system shall emphasize recruit-

ment of minority students and students from areas of defined need or rural areas.

1. (B) The department may provide financial assistance to eligible students and resident physicians.

   1. 1. Eligible students and resident physi-

cians may apply for financial assistance from the Primary Care Resource Initiative for Missouri (PRIMO) Program, upon acceptance for admission into an approved Missouri institution or residency program.

1. 2. To qualify for assistance the applicant

shall have no other conflicting service obligation, with the exception of the National Guard or military reserves.

1. 3. Recipients must apply for funding

annually.

1. 4. In return for an obligation to provide

primary health care services in an area of defined need upon completion of their training eligible students may receive forgivable loans as follows:

1. A. Full-time undergraduate and den-

tal hygienist students may receive five thousand dollars ($5,000) per academic year not to exceed four (4) loans;

1. B. Full-time graduate nursing students

may receive five thousand dollars ($5,000) AND SENIOR SERVICES

per academic year not to exceed two (2) loans;

1. C. Part-time undergraduate and dental

hygienist students may receive three thousand dollars ($3,000) per academic year not to exceed six (6) loans;

1. D. Part-time graduate nursing stu-

dents may receive three thousand dollars ($3,000) per academic year not to exceed four (4) loans;

1. E. Graduate nursing students engaged

in a clinical experience with a preceptor may receive one (1) five thousand dollar ($5,000) loan.

1. 5. In return for an obligation to provide

primary health care services in an area of defined need upon completion of their training eligible students at schools of allopatric and osteopathic medicine and dentistry may receive forgivable loans as follows:

1. A. Students enrolled in a six (6)-year

program may receive ten thousand dollars ($10,000) per academic year for year one (1) and year two (2) of the program;

1. B. Students enrolled in a six (6)-year

program may receive from twenty thousand dollars ($20,000) to twenty-five thousand dollars ($25,000) based upon the participating institution’s tuition, for academic years three (3) through six (6), not to exceed four (4) loans;

1. C. Students enrolled in a four (4)-year

program may receive from twenty thousand dollars ($20,000) to twenty-five thousand dollars ($25,000) based upon the participating institution’s tuition, not to exceed four (4) loans.

1. 6. Selected primary care resident physi-

cians may receive ten thousand dollars ($10,000) per year in forgivable loans, not to exceed three (3) loans.

1. 7. Interest at the rate of nine and one-

half percent (9 1/2%) per year from the date of check issuance shall be charged on all PRIMO loans.

1. 8. The department may grant a deferral

of repayment of principal and interest when deferral is in the best interests of the state and the PRIMO program.

1. 9. Interest accrued during a deferral

period by a PRIMO scholar shall be forgiven on the same basis as the original principal and interest.

1. 10. Forgiveness of interest and principal

for financial assistance recipients engaged in qualified employment shall occur at the rate of twenty percent (20%) per calendar year of the total financial assistance provided through the PRIMO program. If a recipient receives assistance for less than five (5) years, forgiveness shall occur on a year-for-year basis.

1. 11. Forgiveness and cash repayment

periods shall begin no later than six (6) months following the completion of training.

1. 12. Recipients found to be in default of

their contracts shall be allowed a cash repayment period of up to sixty (60) months. The repayment period shall begin the first day of the calendar month following the month the recipient is found to be out of compliance.

1. 13. Preference for financial assistance

shall be given to:

1. A. Students previously participating

in the PRIMO or PRIMO approved programs;

1. B. Minority students and students

from areas of defined need or rural areas;

1. C. Students with an interest in pro-

viding primary health care services in areas of defined need.

1. (C) The department may provide support to participating institutions to facilitate development of programs to increase the number of primary health care professionals and clinical training sites in areas of defined need.

2. (D) The department may facilitate the development of community-based, comprehensive primary health care delivery systems throughout the state.

   1. 1. The department may contract with

organizations to develop community-based, comprehensive primary health care delivery systems.

1. 2. Participation will be prioritized

according to community health care needs, extent of community support and a documented community strategic intervention plan.

1. 3. Participants will be reviewed annual-

ly and may be approved for continued funding, not to exceed five (5) consecutive years, based on:

1. A. Availability of state funds;
2. B. Participant’s documented accom-

plishments and adherence to project activities; and

1. C. Annual detailed record to the

department of the expenditure of PRIMO funds.

1. (3) PRIMO program participants shall file with the department the following completed forms:

   1. (A) All applicants for financial assistance shall file form MO 580-1968 (4-99);
   2. (B) Applicants approved for financial assistance shall file the contract form MO 580- 1966 (3-96).

AUTHORITY: section 191.411, RSMo Supp. 2001. This rule was previously filed as 19 CSR 50-4.010. Emergency rule filed Nov. 1, 1994, effective Nov. 11, 1994, expired March 10, 1995. Emergency rule filed Feb. 23, 1995, effective March 5, 1995, expired July 2, 1995. Original rule filed Nov. 1, 1994, effective June 30, 1995. Changed to 19 CSR 10-4.010, July 30, 1998. Rescinded and readopted: Filed Feb. 15, 2002, effective Aug. 30, 2002. **

*Original authority: 191.411, RSMo 1993 amended 2001. **Pursuant to Executive Order 21-07, 19 CSR 10-4.010, paragraph (2)(B)7. was suspended from March 25, 2020 through August 31, 2021.