Ariz. Admin. Code § R9-15-304 - Supplemental Application

A. By July 1 of each calendar year, the Department shall determine if the Department has sufficient remaining funds available for additional awards under the Behavioral Health Care Provider Loan Repayment Program.

1. If the Department determines that funds are available, the Department shall post, on the Department's website, the information that the Department is accepting applications as specified in subsection (B), including the deadline for accepting applications.

a. The Department shall post the information in subsection (A)(1) at least 15 calendar days before the date the Department begins accepting applications.

b. The deadline for submission of applications is 30 calendar days after the date the Department begins accepting applications.

2. If the Department determines that the Department does not have sufficient funds available for loan repayment awards, the Department shall, on the Department's website:

a. Post the information that the Department is not accepting applications, and

b. Maintain the information until the next review.

B. An applicant may reapply to participate or apply to renew participation in the Behavioral Health Care Provider Loan Repayment Program by submitting an application to the Department according to subsection (A)(1)(b) that contains:

1. The information and documentation according to subsection (C), if the applicant submitted an initial application to the Department, according to R9-15-302, and was not approved to participate in the Behavioral Health Care Provider Loan Repayment Program during the initial application allocation process for the same calendar year;

2. The information and documentation according to R9-15-302(B), if the applicant previously participated in the Behavioral Health Care Provider Loan Repayment Program and completed at least the first two years of participation in the Behavioral Health Loan Care Provider Repayment Program; and

3. The information and documentation according to R9-15-303(B), if the applicant:

a. Provides services at the Arizona State Hospital and will have completed at least the initial two years of participation in the Behavioral Health Care Provider Loan Repayment Program before December 31 of the same calendar year,

b. Will have completed at least the initial two years of participation in the Behavioral Health Care Provider Loan Repayment Program before December 31 of the same calendar year and was previously denied participation because loan repayment funds were not available,

c. Will have completed at least the initial two years of participation in the Behavioral Health Care Provider Loan Repayment Program before December 31 of the same calendar year at a service site with a HPSA score of less than 14, or

d. Will complete three or more years of participation in the Behavioral Health Care Provider Loan Repayment Program before December 31 of the same calendar year.

C. An applicant reapplying according to subsection (B)(1) shall submit an application to the Department that contains:

1. The following information in a Department-provided format:

a. The applicant's name, home address, telephone number, and e-mail address;

b. The name, street address, telephone number, e-mail address, and fax number for each service site;

c. For each applicant lender, the following:

i. The lender's name, street address, e-mail address, and telephone number;

ii. The loan identification number; and

iii. The loan balance including principal and interest;

d. Whether the applicant agrees to allow the Department to submit supplemental requests for additional information or documentation in R9-15-305 ;

e. The applicant's attestation that:

i. The Department is authorized to verify all information provided in the supplemental application;

ii. The applicant is applying to participate in the Behavioral Health Care Provider Loan Repayment Program for two years for loan repayment of all or part of qualifying educational loans identified in the initial application, as specified in R9-15-302(B)(1)(f) ;

iii. The information and documentation submitted according to R9-15-302 is still accurate, except for loan or lender information; and

iv. The information and documentation submitted as part of the application is true and accurate; and

f. The applicant's signature and date of signature;

2. A copy of the most recent billing statement for the loans listed according to R9-15-302(B)(1)(f) ;

3. An attestation from a designee of the governing authority for each service site listed according to subsection (B)(1)(b) that includes:

a. The name and mailing address of the service site;

b. The name, title, e-mail address, and telephone number of a contact individual for the service site;

c. Whether the service site is a public or non-profit service site in A.R.S. § 36-2175;

d. That the applicant is providing behavioral health services full-time;

e. The dates that the applicant started and, if applicable, is expected to end providing behavioral health services at the service site;

f. The service site's agreement to notify the Department when the employment status of the applicant changes, as required in R9-15-301(A)(2) ;

g. A statement that the information submitted in the attestation is true and accurate; and

h. The signature of the designee of the governing authority for the service site and date of signature; and

4. If the applicant's employer is not the governing authority of the service site identified in subsection (B)(1)(b), an attestation from the employer that includes:

a. The name and mailing address of the employer;

b. The name, title, e-mail address, and telephone number of a contact individual for the employer;

c. The dates that the applicant started and, if applicable, is expected to end providing behavioral health services for the employer;

d. The employer's agreement to notify the Department when the employment status of the applicant changes, as required in R9-15-301(A)(2) ;

e. A statement that the information submitted in the attestation is true and accurate; and

f. The employer's signature and date of signature; and

5. If applicable, documentation of the service site's HPSA designation and HPSA score, dated within 30 calendar days before the supplemental application submission date.

D. The Department shall accept an application submitted according to subsection (A)(1)(b) no more than 30 calendar days before the submission date specified in subsection (A).

E. The Department shall review an application according to R9-15-305.

F. If the Department receives an application at a time other than the date stated in subsection (A), the Department shall return the application to the applicant.

Notes

Ariz. Admin. Code § R9-15-304

New Section made by final rulemaking at 7 A.A.R. 2823, effective August 9, 2001 (Supp. 01-2). Repealed by exempt rulemaking at 22 A.A.R. 852, effective 4/1/2016. Adopted by emergency rulemaking at 28 A.A.R. 3684, effective 11/15/2022. Renumbered and amended from R9-15-303 by emergency rulemaking at 29 A.A.R. 1274, effective 5/14/2023. New Section made by final rulemaking at 29 A.A.R. 3837, effective 12/6/2023.