A National Health Service Corps (NHSC) approved site is a health care facility that generally provides comprehensive outpatient, primary health care, dental health, or mental health services to populations residing in Health Professional Shortage Areas (HPSAs) and has been determined to meet the NHSC site eligibility requirements and qualifications. To become an NHSC-approved site, most sites must submit an NHSC Site Application through the Bureau of Health Workforce (BHW) Customer Service Portal for review and approval and must apply for recertification every three years.  More information on NHSC Site approval can be found online at https://nhsc.hrsa.gov/sites/become-nhsc-site.   For organizations with multiple facilities, each physical location and/or mobile unit requires a separate application regardless of site type.  The  TX Primary Care Office (TPCO) conducts the first line review then submits a recommendation to the  BHW Division of Regional Operations (DRO) who will make the final determination.

NHSC requires each site (except: solo private practices) to list two site Points of Contacts (POCs).  At least one POC must be serving in each of the following NHSC roles:

• Administrator
• Personnel Verifier, and
• Recruiter

For a POC to submit a site application, they must:

• Own, oversee, or manage a significant portion of their organization; and
• Have the ability to answer questions about organization policies and operating procedures.

If the site is approved, the POC information will be publicly available via the Health Workforce Connector.

Before submitting a site application or recertification, sites should contact the TX Primary Care Office (TPCO) to determine eligibility, and read the current Site Reference Guide which is updated annually.  Please note that since 2021, the Site Data Tables (now Payments & Insurance) and Behavioral Health Checklist are part of the online application, not a separate document to be uploaded.  As part of the NHSC site approval or recertification process, sites must upload the following documents:

Sliding Fee Schedule Documents.  Review the information in the Site Reference Guide then upload the following:

• Discounted/Sliding Fee Scale (SFS)
  • Ensure that your Sliding Fee Schedule is goes up to 200% of the current Federal Poverty Guidelines; which are updated annually at the end of January, and can be found at Poverty Guidelines | ASPE
• Patient Application for SFS
  • Make sure the SFS applications does not include the evaluation of assets, which NHSC does not allow.
  • The form used for the County Indigent Health Care Program (CIHCP) can no longer be used as a SFS application as it creates eligibility and compliance issues.  Sites participating in CIHCP must utilize a separate SFS application that meets NHSC requirements.
• SFS Policy; include: Ensure that the site’s SFS applies to all residents of your site’s HPSA(s).
  • How your site will advertise the SFS
  • The procedures for patients who wish to apply
  • Policies and procedures on processing applications

Organizations that utilize multiple charity care/assistance programs should outline the policies for each program separately in the organizations charity care/assistance policy document as different programs have different eligibility and therefore require different policies.  The Apply to Become an NHSC Site Related Resource section has a Sample Site Sliding Fee Discount Program Policy which includes a template of acceptable policy language, application, Sliding Fee Scale and Public Notice Signage.

Required Signage.  Review the information in Site Reference Guide, then submit photographs of posted signs regarding the following:

• Your site will not deny services based on a patient’s inability to pay.
• Discounts are available based on family size and income.
• The availability of the Sliding Fee Discount Program

One photograph needs to be up close and readable.  The second photograph needs to show where the notice is posted in the facility.  The Sample Sliding Fee Discount Program Policy package has a example of an acceptable posted notice.

Information regarding the above items should be on the home page of the facility's website and be easily accessible to patients.  Websites will be fully reviewed as part of the site application/recertification process.  Once approved as a NHSC site, the facility can post eligible signs found on the NHSC website at https://nhsc.hrsa.gov/sites/current-sites/maintain-site-status

Proof of Access to Ancillary, Inpatient and Specialty Care. Upload proof of referral arrangements not available on-site.

Acceptable documents include:

• Signed Memorandums of Understanding (MOU)
• Signed Memorandums of Agreement (MOA)
• Signed contracts with ancillary, inpatient, and specialty facilities

If formal referral arrangements do not exist, the applicant site should provide a finalized description of how it refers patients to ancillary, inpatient, and specialty care. The Related Resources section has a Proof of Access Referral Letter Template available to download. 

Note that Mental Health/SUD sites must submit a written formal affiliation agreement.  A sample Affiliation Agreement can be found in Appendix G of the Site Reference Guide

 Outpatient substance use disorder (SUD) treatment facilities.* IF your site provides any of these services: 

• General Substance Use Disorder Treatment (SUD);
• Medication for Opioid Use Disorder (MOUD); or
• Opioid Treatment Program (OTP)

Review the Substance Use Disorder documentation information located in the  Site Reference Guide and complete the Comprehensive Behavioral Health Services Checklist.  Submit the applicable documentation indicated in the Instructions. A sample MOUD Attestation Letter can be found in the Related Resources section on the Apply to become a NHSC Site page.

Recruitment and Retention Plan. Submit documentation that clearly states the policies and processes that a site will use to recruit and maintain clinical staffing levels needed to appropriately serve the community, in accordance with the NHSC Site Agreement. A sample Recruitment & Retention Plan can be downloaded from the NHSC Related Resources. 

Other documents that may be requested by HRSA or Primary Care Office (PCO) - Credentialing Plan: Submit documentation of the facility's credentialing process that, at a minimum, includes reference review, licensure verification, and a query of the National Practitioner Data Bank (NPDB) of those clinicians for whom the NPDB maintains data. 

Note: You may not be able to upload additional documents or make certain changes after you submit the application.  If additional documentation is needed it will be requested by the TPCO, and will need to be submitted by e-mail.  Also the Division of Regional Operations may return the application to the site for corrections if it is determined by their staff that it is needed.

NHSC Site Recertification
Once a site is approved, the POCs can determine if the site will need to apply for recertification by logging into the BHW Customer Service Portal. If there is an “Expiration Date” listed under the NHSC Approved Sites section, then the site will need to recertify during the fall recertification cycle of the expiration year. NHSC approved sites are required to apply for recertification every three (3) years. The site recertification process and required documents are the same as that for new site applications.  If a site needs recertification, a button to recertify will be shown on the site record.

Federally Qualified Health Centers (FQHCs) that need to add new sites do not need to upload the supporting documents, but will need to complete all sections indicated in the online application.  The FQHC should also upload a copy of the Notice of Award, Change in Scope, or Form 5b to verify that the site is under the scope of the FQHC grant.  

Definitions for commonly used terms and acronyms are on the TPCO Definitions page