Program Overview and Background, Doctors Across New York (DANY), Physician Practice Support and Physician Loan Repayment Programs - Cycle IV

Overview

Doctors Across New York (DANY) is a series of state-funded programs enacted in 2008 to help train and place physicians in a variety of settings and specialties to care for New York's diverse population. DANY programs include: Physician Practice Support (PPS), Physician Loan Repayment (PLR), Ambulatory Care Training, Studies on the Physician Workforce, and the Diversity in Medicine/Post-Baccalaureate Program.

Physician Practice Support provides up to $100,000 in funding over a two-year period to applicants who can identify a licensed physician that has completed training and will commit to a two-year service obligation in an underserved region within New York State.

Physician Loan Repayment provides up to $150,000 in funding over a five-year period for physicians who commit to a five-year service obligation in an underserved region.

This document provides information on the Physician Practice Support and Physician Loan Repayment programs only; this is the fourth cycle of funding for these programs.

Background

Although New York's physician-to-population ratio is currently above the national average, there are physician shortages in many communities and specialties. For example:

  • Health Professional Shortage Areas (HPSAs) are designated by the federal Health Resources and Services Administration (HRSA) as having shortages of primary medical care, dental or mental health providers and may be geographic (a county or service area), demographic (low income population) or institutional (comprehensive health center, federally qualified health center or other public facility). According to HRSA data as of March 31, 2015, there are approximately 3.9 million New Yorkers who are identified as residing in areas designated as "underserved" for primary care services in New York's 93 area (i.e., non-institutional) primary care HPSAs. It would require over 607 primary care practitioners in these areas to remove the shortage status.[1]
  • The majority of the area primary care HPSAs (50 or 54%) are located in urban counties as defined by the New York State Legislative Commission on Rural Resources[2] and 43 (46%) of primary care HPSAs are located in rural counties.
  • Of the 93 area primary medical care HPSAs designations, the majority (70 or 75%) are designated as having a shortage of primary care services only to Medicaid-eligible and low-income individuals. The remaining 23 (25%) are designated as having a shortage of primary care services to the entire area population.
  • A 2013 survey of Healthcare Association of New York State (HANYS) members reported a need for more than 1,026 physicians of all specialties statewide, including over 360 in rural areas alone.[3]

Other statistics demonstrate the need for physicians due to retirements and reductions in hours across New York State. For example, since 2002, the average age of a physician practicing in the state has increased from 50 to 52 years of age. In addition, New York physicians practicing in rural counties were 57% more likely to have plans to retire than physicians practicing in urban counties (2.5% compared to 1.6%). Physicians in rural counties were also more likely to have plans to reduce patient care hours compared to physicians in urban counties (10.0% compared to 8.8%). Retirements and reductions in hours could worsen the current maldistribution of physicians in underserved areas, especially in rural areas.[4]

In addition, in 2013, New York State had 71,039 physicians who were licensed and actively providing patient care in the state. Of those, about 25,700, or 36%, were primary care physicians (family medicine, OB/GYN, general internal medicine, or general pediatrics).[5] The ratio of full-time equivalent (FTE) primary care physicians to the population averaged 94 FTEs per 100,000 population statewide.[6] Although the density of primary care physicians statewide does not suggest a shortage in the aggregate, when compared to commonly used national ratios[7], New York State exhibits a maldistribution of primary care physicians in specific geographic regions, primarily in densely populated urban neighborhoods and rural communities, and in communities with high proportions of low-income and Medicaid populations. Physician supply varied across geographic region, ranging from a low of 70.5 FTEs/100,000 in the Mohawk Valley region to 100.6 FTEs/100,000 in New York City.[8] Between 2005 and 2009, the number of primary care physicians increased by 1,271 FTEs or 7% statewide.[9] Eight rural counties, however, lost primary care physician FTEs over the same period – Chemung, Chenango, Greene, Herkimer, Livingston, Seneca, Ulster, and Wayne counties.

By 2030, growth in demand for physicians in New York State will likely outpace growth in the supply of physicians. Using forecasting models adapted to include data specific to New York, in 2010, the Center for Health Workforce Studies concluded that between 2006 and 2030, growth in the demand for physicians in New York would likely outpace growth in the supply of physicians. The forecasts suggested that New York was likely to face a physician shortage in 2030, and, in the case of areas and populations already experiencing shortages, the intensification of current shortages. The forecasted gap between supply and demand growth would result in a shortage of between 2,500 and 17,000 additional physicians by 2030.[10]

The greatest gap between supply and demand growth statewide is projected in specialties that are forecasted to lose physicians over the period of forecast (2006-2030), including psychiatry, one of the primary care disciplines targeted by the Doctors Across New York program. The supply of psychiatrists is forecasted to decrease between 11.6% and 17.5%, depending on the specific assumptions behind the forecasts. Demand is projected to increase between 4.1% and 28%, resulting in a potential shortage of between 1,182 and 2,653 psychiatrists by 2030. Large gaps are also projected for some primary care physicians that are forecasted to experience a period a growth until 2020 and then decline by 2030. These include physicians practicing general internal medicine, family medicine, and OB/GYN. Statewide physician shortages are predicted for general internal medicine (2,286-3,546), family medicine (595-1,011), and OB/GYN (24-355). In pediatrics, a discipline that is projected to grow more quickly than demand, a surplus of physicians is projected. On a regional basis, New York City and the Hudson Valley region (Dutchess, Orange, Putnam, Rockland, Sullivan, Ulster, and Westchester counties) are projected to experience potential gaps between physician supply and demand up to 14% by 2030. The resulting shortage of primary care physicians would range from 1,223 to 3,153 physicians in New York City and from 225 to 458 physicians in the Hudson Valley.

Table 1: Projected Differences Between Supply and Demand in New York State for Primary Care Specialties in 2030
Physician
Specialty
Baseline Supply
(2006)
Projected Supply
(2030)
Projected Demand
(2030)
Projected Surplus/(Shortage)
(2030)
General Internal Medicine 14,242 14,438- 17,289 17,096 – 18,357 (2,286) – (3,546)
Family Medicine 5,108 4,953 – 5,927 5,643 – 6,059 (595) – (1,011)
Pediatrics 5,939 6,464 – 7,740 5,901 – 6,336 1,404 – 1,839
OB/GYN 3,832 3,832 – 4,373 3,872 – 4,150 (14) – (355)
Psychiatry 6,166 5,236 – 6,166 6,420 – 7,891 (1,182) – (2,653)

The DANY programs recognize that there is a need to encourage physicians to practice in underserved communities in New York State. The DANY initiative continues to address areas of the state that currently lack diverse and adequate physician services.

DANY was first developed based upon policy recommendations of the New York State Council on Graduate Medical Education in the report, Policy Recommendations to the Commissioner of Health, March 2008, and in the New York State Department of Health's (NYSDOH) report to the New York State Legislature (endorsed by the New York State Rural Health Council), Employment Incentives to Encourage Physicians and Nurse Practitioners to Practice in Rural, Underserved Areas, November 2007.

A total of $10.65 million is available to fund the Physician Loan Repayment Program, and $10.5 million to fund the Physician Practice Support Program during Cycle IV. These funds will support up to 71 additional Physician Loan Repayment awards, plus approximately 105 additional Physician Practice Support slots.

In addition to continuing the funding for these programs, the 2014-15 State Budget continued to authorize changes made in the 2012-13 budget for the DANY Physician Practice Support and Physician Loan Repayment programs. These provisions include:

  • Awards shall be made without a competitive bid or Request for Proposal (RFP) process; a work group was established to develop a streamlined application process; and the application process is to be clearer and more user-friendly;
  • Applicants can access technical assistance provided by NYSDOH, and timelines for acting on applications were streamlined; and
  • Applications are available to specific New York State-operated facilities.

Program Information 2015

Submission, Review and Award Process

Applications are currently being accepted for Physician Practice Support and Physician Loan Repayment only. There are three options to apply for funding:

  1. Physician Loan Repayment - Qualified Educational Loan Repayment – An individual physician can apply for funds to be used to repay qualified educational loans up to $150,000;
  2. Physician Practice Support to Establish or Join Practices – An individual physician can apply for funds to support the costs of establishing or joining a practice in an underserved community up to $100,000; or
  3. Physician Practice Support to Recruit New Physicians - General hospitals and other qualified health care providers can apply for up to $100,000 in funding to help recruit new physicians to provide services in underserved communities. Funds may be used for sign-on bonuses, income guarantees or other financial incentives or compensation. - General hospitals and other qualified health care providers can apply for up to $100,000 in funding to help recruit new physicians to provide services in underserved communities. Funds may be used for sign-on bonuses, income guarantees or other financial incentives or compensation.

In all three cases, funds must be provided directly to the physician. No administrative funding may be requested by facilities under any of the above options.

Applications will be accepted continuously beginning July 8, 2015 until July 31, 2015 . Applications received before or after the posted dates will be rejected, and the applicant will be notified of such.

Applicants should submit their applications electronically no later than July 31, 2015 to gme@health.ny.gov.

You may contact Lianne Ramos at (518) 473-3513 (Physician Practice Support), or Amy Harp at (518) 473-7019 (Physician Loan Repayment) for any assistance or clarification that may be necessary. All staff are also available via email at gme@health.ny.gov. An applicant conference will not be held for this project.

Applicants other than individual physicians (e.g., health care facilities and physician practices) may submit two applications per Operating Certificate (OpCert) or Federal Employer Identification Number (FEIN) during the entire application period of July 8, 2015 - July 31, 2015. No more than two DANY awards will be made to any single facility (based on OPCERT or FEIN). To maximize the diversity of applicants, facility applicants are encouraged to collaborate with other facilities in the catchment or service area before applying.

Individual physician applicants may submit one DANY application during the entire application period. No more than one award will be made to any one individual physician.

Applications will be time and date stamped upon receipt, and Department staff will review applications in the order in which they are received. An applicant shall be notified in writing by NYSDOH within 10 business days of receipt of an application as to whether the application is complete or incomplete. If the application is incomplete, NYSDOH will inform the applicant what information remains outstanding, and the applicant may submit missing information within 10 business days of email notification by NYSDOH. NYSDOH will act within 30 days of receipt of the complete application.

Applicants will be selected for an award on a first-come first-served basis if their applications are complete and meet the minimum threshold for an award, as described in the instructions, and funding remains available within the category in Table 2 below. It is anticipated that in Cycle IV approximately 71 Physician Loan Repayment and 105 Physician Practice Support awards will be made during this cycle. Ineligible expenses will be deducted from the amount of the award.

An applicant may withdraw an application at any time by notifying NYSDOH in writing. An applicant who receives an award but is subsequently unable to fulfill the requirements of the award or resulting contract also must notify the NYSDOH in writing. Any applicant who submits an application that is deemed ineligible or who withdraws an application may resubmit a new application. When funding has been depleted to a level such that an applicant's total requested funding amount cannot be met, the applicant will be offered a reduced award amount. If the applicant accepts that amount, no further awards will be made. If the applicant declines that amount, the next eligible applicant will be offered an award until funds are completely exhausted.

Allocation of Funding

Based on statute, funding will be allocated as follows for each program:

Table 2.
Rest of State Percent of Funding
Hospitals 33.35%
Non-Hospitals 33.35%
Sub-total, Rest of State 66.7%
New York City Percent of Funding
Hospitals 16.65%
Non-Hospitals 16.65%
Sub-total, New York City 33.3%
Total, NYS 100%

Tax Issues

Section 10908 of the Patient Protection and Affordable Care Act (PL 111-148) addresses federal taxability of state loan repayment programs that are not part of the Federal State Loan Repayment (SLRP) program. This section puts the state loan repayment programs on par with the federal/state SLRP programs in terms of federal taxability. The text is as follows:

SEC. 10908. EXCLUSION FOR ASSISTANCE PROVIDED TO PARTICIPANTS IN STATE STUDENT LOAN REPAYMENT PROGRAMS FOR CERTAIN HEALTH PROFESSIONALS.

(a) IN GENERAL.—Paragraph (4) of section 108(f) of the Internal Revenue Code of 1986 is amended to read as follows:

''(4) PAYMENTS UNDER NATIONAL HEALTH SERVICE CORPS LOAN REPAYMENT PROGRAM AND CERTAIN STATE LOAN REPAYMENT PROGRAMS.—In the case of an individual, gross income shall not include any amount received under section 338B(g) of the Public Health Service Act, under a State program described in section 338I of such Act, or under any other State loan repayment or loan forgiveness program that is intended to provide for the increased availability of healthcare services in underserved or health professional shortage areas (as determined by such State).''

(b) EFFECTIVE DATE — The amendment made by this section shall apply to amounts received by an individual in taxable years beginning after December 31, 2008.

Loan repayment funds under the Physician Loan Repayment and Physician Practice Support programs are exempt from federal and state taxes. Funds used for purposes other than loan repayment in the Physician Practice Support program are not tax exempt. Please consult your tax professional for more information about your specific tax situation.

Payment Issues

DANY Physician Loan Repayment

Obligated physicians may receive up to $150,000 over 5 years, payable upon contract execution and submission and verification of the physician's employment contract with the applicant facility, educational debt levels and semi-annual employment verification reports. Payments will be made in increments of 10 payments each of one-half the annual award as follows:

Payment 1 (Year 1): 7.5% of total qualified debt not to exceed ten thousand dollars;
Payment 2 (Year 1): 7.5% of total qualified debt not to exceed ten thousand dollars;
Payment 3 (Year 2): 7.5% of total qualified debt not to exceed twelve thousand five hundred dollars;
Payment 4 (Year 2): 7.5% of total qualified debt not to exceed twelve thousand five hundred dollars;
Payment 5 (Year 3): 10% of total qualified debt not to exceed seventeen thousand five hundred dollars;
Payment 6 (Year 3): 10% of total qualified debt not to exceed seventeen thousand five hundred dollars;
Payment 7 (Year 4): 12.5% of total qualified debt not to exceed seventeen thousand five hundred dollars;
Payment 8 (Year 4): 12.5% of total qualified debt not to exceed seventeen thousand five hundred dollars;
Payment 9 (Year 5): 50% of the lesser of (1) the total qualified debt minus the total of payments 1-8 or (2) the award amount minus the total of payments 1-8;
Payment 10 (Year 5): 50% of the lesser of (1) the total qualified debt minus the total of payments 1-8 or (2) the award amount minus the total of payments 1-8.

The first payment will be made subsequent to the successful completion of all of the following:

  • execution of the contract between the physician and the NYSDOH; and
  • verification of the physician's qualifying educational debt; and
  • verification of the physician's employment contract; and
  • verification that the physician has completed a minimum of six months' eligible obligated service at the awarded site.

Subsequent payments will be made in six-month periods thereafter, pending verification of employment, renewal of the contract with NYSDOH (as required) and the continued availability of funds.

DANY Physician Practice Support

Awardees may receive up to $100,000 over 2 years payable upon execution and submission and verification of the expenditures, physicians service commitment, and education debt (if funds were received for loan forgiveness). The first payment will be made upon contract execution, when awardee submits a voucher for payment and proof of expenditures. Subsequent payments will be made by NYSDOH when funds are expended to the physician by the facility when proof of educational debts and payments are provided to NYSDOH.

Award notifications

All applicants awarded DANY funds will be notified by email or U.S. mail within a reasonable time following the conclusion of the application period.

Debriefing

Following the announcement of awards resulting from this opportunity, applicants may request a debriefing from NYSDOH no later than ten (10) calendar days from the date of the announcement. This debriefing will be limited to the positive and negative aspects of the specific applicant's application.

Administrative Requirements

Issuing agency

This funding opportunity is issued by NYSDOH's Office of Primary Care and Health Systems Management. NYSDOH is responsible for the requirements specified herein and for the evaluation of all applications.

Question and answer phase

An applicant conference will not be held for this project. Questions regarding this funding opportunity and application materials should be submitted to the following address:

By email:

By mail:

  • NYS Department of Health
    Office of Primary Care and Health Systems Management
    Corning Tower, Room 1695
    Albany, NY 12237

To the degree possible, each inquiry should cite the funding opportunity or application section, paragraph or numbered item to which it refers. DANY staff will make every attempt to answer all questions within 72 hours of the submission of the question. DANY staff may elect to answer questions posed via telephone or in writing, at their convenience. Applicants wishing to be contacted by phone should indicate such in the questions, and include a phone number.

Prospective applicants should note that all clarifications and exceptions, including those relating to the terms and conditions of the contract, are to be raised prior to the submission of an application. However, NYSDOH may contact applicants with questions after the submission of an application. This funding opportunity has been posted on the NYSDOH public websiteat: http://www.health.ny.gov/professionals/doctors/graduate_medical_education/doctors_across_ny/.

Questions and answers, as well as any updates and/or modifications, mayl also be posted on the above website.

Term of Contract

Any contract resulting from this application will be effective only upon approval by the New York State Office of the Comptroller and will be for a 24 month term for PPS or 60 month term for PLR, with an anticipated start date on the first day of the month in January, February, March or April 2016.

Physician Loan Repayment Program applicants should note significant penalties will be instituted (see sample contract, Attachment C) in the event the applicant cannot fulfill the full 5 year service obligation.

Change in Location of Obligation

Obligated physicians are permitted to change their service location(s) provided; (1) that the physician notifies NYSDOH in writing prior to the change; (2) the new service location is eligible for a DANY obligated service; and (3) NYSDOH approves the change.

Deferral of Obligation

Obligated clinicians who need to defer their service obligations (e.g., for maternity/paternity leave, military service, etc.) must request permission from NYSDOH in writing 30 days prior to the requested date of deferral. The decision to permit a deferral will be solely at the discretion of NYSDOH; any deferral periods granted by NYSDOH will be added to the obligated clinician's term of obligation.

Default of Obligation

A default is defined as the obligated clinician's failure to comply with the service obligations as stated in the Master Grant Contract, Attachment C. Please see the "General Specifications" below and the Sample Contracts on the website to review these criteria, at: http://www.health.ny.gov/professionals/doctors/graduate_medical_education/doctors_across_ny/.

Payment Methods & Reporting Requirements

The contractor shall submit verification, on at least an annual basis, of the employment status of the obligated physician. All payment and reporting requirements will be detailed in Attachment D of the grant contract.

See: http://www.health.ny.gov/professionals/doctors/graduate_medical_education/doctors_across_ny/.

When requested, contractor shall report aggregate data on the demographics and socio-economic status of patients seen by the obligated physician.

When requested, the contractor shall report to the Department the use of all funds received under this contract.

In addition, the contractor will provide a final report (format to be provided by NYSDOH) regarding the status of the physician at the termination of the service obligation.

The grant contractor will be required to submit claims for reimbursement and required reports of expenditures to the State's designated payment office as per Attachment D of the contract:

  • New York State Department of Health
    Office of Primary Care and Health Systems Management
    Corning Tower, Room 1695
    Albany, New York 12237

Grant contractors must provide complete and accurate billing invoices, as appropriate, to the office noted above in order to receive payment. Billing invoices submitted to the Department must contain all information and supporting documentation required by the contract, the Department and the State Comptroller. Payment to the contractor shall be made as specified in the "Payment Issues" section, and shall only be rendered electronically unless payment by paper check is expressly authorized by the Commissioner, in the Commissioner's sole discretion, due to extenuating circumstances.

Such electronic payment shall be made in accordance with OSC's procedures and practices to authorize electronic payments Authorization forms are available at the State Comptroller's website at: http://www.osc.state.ny.us/epay/ or by telephone at 855-233-8363. The contractor acknowledges that it will not receive payment on any claims for reimbursement submitted under this contract if it does not comply with the State Comptroller's electronic payment procedures, except where the Commissioner has expressly authorized payment by paper check as set forth above.

Payment of such claims for reimbursement by the State (NYSDOH) shall be made in accordance with Article XI-A of the New York State Finance Law. All payment and reporting terms will be detailed in Attachment D of the final Master Grant Contract.

Vendor Identification Number

Effective January 1, 2012, in order to do business with New York State, you must have a vendor identification number. As part of the Statewide Financial System (SFS), the Office of the State Comptroller's Bureau of State Expenditures has created a centralized vendor repository called the New York State Vendor File. In the event of an award and in order to initiate a contract with the New York State Department of Health, vendors must be registered in the New York State Vendor File and have a valid New York State Vendor ID.

If already enrolled in the Vendor File, please include the Vendor Identification number on the application cover sheet. If not enrolled, to request assignment of a Vendor Identification number, please submit a New York State Office of the State Comptroller Substitute Form W-9, which can be found on-line at: http://www.osc.state.ny.us/vendors/substitute_formw9.pdf or by referencing Attachment 12 (Statewide Vendor File Registration SFS Portal Format).

Additional information concerning the New York State Vendor File can be obtained on-line at: http://www.osc.state.ny.us/vendor_management/index.htm, by contacting the SFS Help Desk at 855-233-8363 or by emailing at helpdesk@sfs.ny.gov.

Vendor Responsibility Questionnaire

The New York State Department of Health recommends that vendors file the required Vendor Responsibility Questionnaire online via the New York State VendRep System. To enroll in and use the New York State VendRep System, see the VendRep System Instructions available at http://www.osc.state.ny.us/vendrep/vendor_index.htm or go directly to the VendRep system online at https://portal.osc.state.ny.us.

Vendors must provide their New York State Vendor Identification Number when enrolling. To request assignment of a Vendor ID or for VendRep System assistance, contact the Office of the State Comptroller's Help Desk at 866-370-4672 or 518-408-4672 or by email at ciohelpdesk@osc.state.ny.us.

Vendors opting to complete and submit a paper questionnaire can obtain the appropriate questionnaire from the VendRep website at: http://www.osc.state.ny.us/vendrep/forms_vendor.htm or may contact the Office of the State Comptroller's Help Desk for a copy of the paper form.

Applicants should complete and submit the Vendor Responsibility Attestation.

General Specifications

  1. By signing Section A, item 6, of the Application each signatory attests to his/her express authority to sign on behalf of the applicant.
  2. The contractor will possess, at no cost to the State, all qualifications, licenses, and permits to engage in the required business as may be required within the jurisdiction where the work specified is to be performed. Workers to be employed in performance of this contract will possess the qualifications, training, licenses and permits as may be required within such jurisdiction.
  3. Submission of an application indicates the applicant's acceptance of all conditions and terms contained in this funding opportunity, including the terms and conditions of the contract.
  4. An applicant may be disqualified from receiving an award if such applicant or any subsidiary, affiliate, partner, officer, agent or principal thereof, or anyone in its employ, has previously failed to perform satisfactorily in connection with public bidding or contracts.
  5. In the event that a Physician Practice Support applicant receives an award and the physician identified on the application is no longer employed by the applicant, the applicant may select a replacement physician and receive the awarded funds if the following conditions are met: The physician must meet all of the program eligibility requirements, and must practice in the specialty, and at the site specified on the original application. The awardee must notify the NYSDOH and provide an employment contract for the replacement physician within 60 days.
  6. Provisions Upon Default.
    1. The services to be performed by the applicant shall be at all times subject to the direction and control of the Department as to all matters arising in connection with or relating to the contract resulting from this funding opportunity.
    2. In the event that the Contractor, through any cause, fails to perform any of the terms, covenants or promises of any contract resulting from this funding opportunity, the Department acting for and on behalf of the State, shall thereupon have the right to terminate the contract by giving notice in writing of the fact and date of such termination to the Contractor.
    3. If, in the judgment of the Department, the Contractor acts in such a way which is likely to or does impair or prejudice the interests of the State, the Department acting on behalf of the State, shall thereupon have the right to terminate any contract resulting from this funding opportunity by giving notice in writing of the fact and date of such termination to the Contractor. In such case the Contractor shall receive equitable compensation for such services as shall, in the judgment of the State Comptroller, have been satisfactorily performed by the Contractor up to the date of the termination of this agreement, which such compensation shall not exceed the total cost incurred for the work which the Contractor was engaged in at the time of such termination, subject to audit by the State Comptroller.
    4. Specific Provisions of this application:

      If a Physician Practice Support Program obligated physician (the "Contractor") defaults on his/her service obligation, the Contractor will be responsible for repayment of any payments made under the contract to the State of New York, plus interest at the personal income tax late payment rate at the time of default, as follows:

      • Service of less than 12 months requires repayment of 100% of the total funds received.
      • Service of more than 12 months but less than 18 months requires repayment of 75% of the total funds received.
      • Service of more than 18 months but less than 24 months requires repayment of 50% of the total funds received.

      If a Physician Loan Repayment Program obligated physician (the "Contractor") defaults on his/her service obligation, the Contractor shall repay the State of New York the greater of either $31,000 or the amount determined in accordance with the following formula:
      The sum of:

      • The proportionate amount of the loan repayments paid by the State of New York to the CONTRACTOR representing any period of obligated service not completed; AND
      • $7,500 multiplied by the number of months of obligated service not completed; AND
      • Interest on the above amount calculated from the date of default at a rate equal to that owed on underpayments of New York State personal income tax.

      The CONTRACTOR will be notified of a finding of default via a demand letter and given the option of repayment of funds owed in one lump sum, or based on a repayment plan to be determined by the State of New York.

      The STATE, by and through the concurrence of the Department of Health, the Office of the Attorney General, and the Office of the State Comptroller, reserves the right to postpone, change or waive the service obligation and repayment amounts in individual circumstances where there is compelling need or hardship due to circumstances beyond the control of the CONTRACTOR, which causes or is likely to cause CONTRACTOR's default under this contract.

Reservation of Rights

NYSDOH reserves the right to:

  1. Reject any or all applications received in response to this funding opportunity.
  2. Withdraw the funding opportunity any time, at the sole discretion of the department.
  3. Make an award under the funding opportunity in whole or in part.
  4. Disqualify any applicant whose conduct and/or proposal fails to conform to the requirements of the funding opportunity.
  5. Seek clarifications and revisions of applications.
  6. Use application information obtained through site visits, management interviews and the state's investigation of an applicant's qualifications, experience, ability or financial standing, and any material or information submitted by the applicant in response to the agency's request for clarifying information in the course of evaluation and/or selection under the funding opportunity.
  7. Prior to application opening, amend the funding opportunity specifications to correct errors or oversights, or to supply additional information, as it becomes available.
  8. Prior to application opening, direct applicants to submit proposal modifications addressing subsequent funding opportunity amendments.
  9. Change any of the scheduled dates.
  10. Waive any requirements that are not material.
  11. Award more than one contract resulting from this funding opportunity.
  12. Conduct contract negotiations with the next responsible applicant, should NYSDOH be unsuccessful in negotiating with the selected applicant.
  13. Utilize any and all ideas submitted with the applications received.
  14. Unless otherwise specified in the funding opportunity, every offer is firm and not revocable for a period of 60 days from the bid opening.
  15. Waive or modify minor irregularities in applications received after prior notification to the applicant.
  16. Require clarification at any time during the procurement process and/or require correction of arithmetic or other apparent errors for the purpose of assuring a full and complete understanding of an offerer's application and/or to determine an offerer's compliance with the requirements of the funding opportunity.
  17. Negotiate with successful applicants within the scope of the funding opportunity in the best interests of the State.
  18. Eliminate any mandatory, non-material specifications that cannot be complied with by all applicants; and
  19. Award grants based on geographic or regional considerations to serve the best interests of the state.

Standard Contract

An example of a standard contract, including all attachments, resulting from this application can be found on: http://www.health.ny.gov/professionals/doctors/graduate_medical_education/doctors_across_ny/.

Freedom of Information Law

All applications may be disclosed or used by NYSDOH to the extent permitted by law. NYSDOH may disclose an application to any person for the purpose of assisting in evaluating the application or for any other lawful purpose. All applications will become State agency records, which will be available to the public in accordance with the Freedom of Information Law. Any portion of the application that an applicant believes constitutes proprietary information entitled to confidential handling, as an exception to the Freedom of Information Law, must be clearly and specifically designated in the application. If DOH agrees with the proprietary claim, the designated portion of the application will be withheld from public disclosure. Blanket assertions of proprietary material will not be accepted, and failure to specifically designate proprietary material may be deemed a waiver of any right to confidential handling of such material.


[1] Excludes facility HPSAs. As of March 31, 2015. See http://datawarehouse.hrsa.gov/topics/shortageAreas.aspx

[2] Socioeconomic Trends in New York State: 1950-1990. Albany, NY: New York State Legislative Commission on Rural Resources, September 1994. HPSA data as of May 2012 for rural/urban and September 2014 for HPSA types.

[3] "Doctor Shortage: Outpatient and Primary Care Need Growing: Results of HANYS' 2013 Physician Advocacy Survey," 2013

[4] Center for Health Workforce Studies, "New York Physicians' Plans to Retire or Reduce Patient Care Hours, 2010"(June 2013), see http://chws.albany.edu/archive/uploads/2013/09/nyphysretire2013.pdf

[5] Center for Health Workforce Studies. Cited in http://www.health.ny.gov/health_care/medicaid/redesign/dsrip_workforce_information.htm

[6] Center for Health Workforce Studies. Annual New York Physician Workforce Profile. 2010 edition. See http://chws.albany.edu/archive/uploads/2012/07/nyphysprofile2010.pdf

[7] Merritt Hawkins & Associates. A Review of Physician-to-Population Ratios. Available at: http://www.merritthawkins.com/pdf/Merritt-Hawkins-Physician-to-Population-Ratios.pdf Accessed May 24, 2012.

[8] & [9] Center for Health Workforce Studies. See Note [6].

[10] Center for Health Workforce Studies, New York Physician Supply and Demand Through 2030. See: http://chws.albany.edu/archive/uploads/2012/07/nyphyss&d2010f.pdf