Program Announcement, Proposed Minimum Percentages for ``High Rate'' and ``Significant Increase in the Rate'' for Implementation of the General Statutory Funding Preference and Proposed Funding Priority for Grants for Establishment of Departments of Family Medicine for Fiscal Year 1994

DEPARTMENT OF HEALTH AND HUMAN SERVICES

Health Resources and Services Administration

Program Announcement, Proposed Minimum Percentages for ``High

Rate'' and ``Significant Increase in the Rate'' for Implementation of

the General Statutory Funding Preference and Proposed Funding Priority

for Grants for Establishment of Departments of Family Medicine for

Fiscal Year 1994

The Health Resources and Services Administration (HRSA) announces

that applications for fiscal year (FY) 1994 Grants for Establishment of

Departments of Family Medicine are being accepted under the authority

of section 747(b), (previously section 780) of the Public Health

Service (PHS) Act, title VII, as amended by the Health Professions

Education Extension Amendments of 1992, Public Law 102-408, dated

October 13, 1992. Comments are invited on the proposed minimum

percentage for ``High Rate'' and ``Significant Increase in the Rate''

for Implementation of the General Statutory Funding Preference, and

proposed funding priority stated below.

Approximately $9.4 million will be available for the Grants for

Establishment of Departments of Family Medicine program in FY 1994.

Total continuation support recommended is $5.7 million. It is

anticipated that $3.7 million will be available to support

approximately 22 competing awards averaging $170,000.

Purpose

Section 747(b) of the PHS Act authorizes support to schools of

medicine and osteopathic medicine to meet the costs of projects to

establish, maintain, or improve family medicine academic administrative

units (which may be departments, divisions, or other units) to provide

clinical instruction in family medicine. Funds awarded will be used to:

(l) Plan and develop model educational predoctoral, faculty development

and graduate medical education programs in family medicine which will

meet the requirements of section 747(a), by the end of the project

period of section 747(b) support; and (2) support academic and clinical

activities relevant to the field of family medicine.

The program may also assist schools to strengthen the

administrative base and structure that is responsible for the planning,

direction, organization, coordination, and evaluation of all

undergraduate and graduate family medicine activities. Funds are to

complement rather than duplicate programmatic activities for actual

operation of family medicine training programs under section 747(a).

Previous Funding Experience

Previous funding experience information is provided to assist

potential applicants to make better informed decisions regarding

submission of an application for this program.

In FY 1993, HRSA reviewed 50 competing applications for the Grants

for Departments of Family Medicine program. Of those applications 82

percent were approved and 18 percent were disapproved. Twelve projects,

or 24 percent of applications received, were funded.

In FY 1992, HRSA reviewed 71 competing applications. Of those

applications, 66 percent were approved and 34 percent were disapproved.

Thirty-six projects, or about 50 percent of the applications received,

were funded.

Eligibility

To be eligible to receive support for this grant program, the

applicant must be a public, or nonprofit private, accredited school of

medicine or osteopathic medicine.

To receive support, programs must meet the requirements of final

regulations as set forth in 42 CFR part 57, subpart R, and section

791(b) of the PHS Act.

The period of Federal support will not exceed 5 years.

National Health Objectives for the Year 2000

The Public Health Service urges applicants to submit work plans

that address specific objectives of Healthy People 2000. Potential

applicants may obtain a copy of Healthy People 2000 (Full Report; Stock

No. 017-001-00474-0) or Healthy People 2000 (Summary Report; Stock No.

017-001-00473-1) through the Superintendent of Documents, Government

Printing Office, Washington, DC 20402-9325 (Telephone (202) 783-3238).

Education and Service Linkage

As part of its long-range planning, HRSA will be targeting its

efforts to strengthening linkages between U.S. Public Health Service

education programs and programs which provide comprehensive primary

care services to the underserved.

Review Criteria

The review of applications will take into consideration the

following criteria:

1. The degree to which the proposed project adequately provides for

the project requirements in section 57.1704;

2. The administrative and management capability of the applicant to

carry out the proposed project in a cost effective manner;

3. The qualifications of the proposed staff and faculty of the

unit; and

4. The potential of the project to continue on a self-sustaining

basis.

Other Considerations

In addition, the following funding factors may be applied in

determining funding of approved applications:

1. Funding preference is defined as the funding of a specific

category or group of applications ahead of other categories or groups

of approved applications such as competing continuation projects ahead

of new projects.

2. Funding priority is defined as the favorable adjustment of

aggregate review scores when applications meet specified criteria.

It is not required that applicants request consideration for a

funding factor. Applications which do not request consideration for

funding factors will be reviewed and given full consideration for

funding.

General Statutory Funding Preference

As provided in section 791(a) of the PHS Act, preference will be

given to any qualified applicant that--

(A) Has a high rate for placing graduates in practice settings

having the principal focus of serving residents of medically

underserved communities; or

(B) During the 2-year period preceding the fiscal year for which an

award is sought, has achieved a significant increase in the rate of

placing graduates in such settings. This preference will only be

applied to applications that rank above the 20th percentile that have

been recommended for approval by the peer review group.

Proposed Minimum Percentages for ``High Rate'' and ``Significant

Increase in the Rate''

``High rate'' means that 20 percent of all graduates of the medical

school in 1989 or 1990, whichever is greater, are spending at least 50

percent of their work time in clinical practice in the specified

settings.

``Significant increase in the rate'' means that, between academic

years 1991-92 and 1992-93, the rate of placing 1989 or 1990 graduates

in the specified settings has increased by at least 50 percent and that

not less than 15 percent of graduates from the most recent year (1990)

are working in these settings.

Additional information concerning the implementation of this

preference has been published in the Federal Register at 58 FR 40659,

dated July 29, 1993.

Establishment and Expansion

Public Law 102-408 has amended section 747(b), (previously section

780) to include the following statutory funding preference for this

program.

Section 747(b)(2) provides that preference shall be given to any

qualified applicant that agrees to expend the award for one of the

following purposes:

(a) Establishing an academic administrative unit (defined as a

department, division, or other unit), for programs in family medicine;

or

(b) Substantially expanding the programs of such a unit.

A program will meet the definition of ``substantial expansion'' if

it has developed an acceptable plan for a 50 percent increase in a

sufficient number of the following areas to qualify for 70 points. The

expansion must be completed within 3 years.

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Points

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(1) Required 3rd Year Clerkship................................ 30

(2) Required Preceptorship..................................... 20

(3) Family Medicine Research................................... 10

(4) Expansion of Faculty....................................... 10

(5) Faculty Development Program for Community Based Faculty.... 10

(6) Family Medicine Faculty Represented on Medical School

Standing Committees of Admissions or Curriculum............... 10

(7) Family Medicine Faculty Represented on Dean's Executive

Committee that determines Tenure.............................. 10

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More detail on each of these areas will be provided in the program

application materials.

Established Funding Priority for FY 1994

The following funding priority was established in FY 1993, after

public comment at 58 FR 35019, June 30, 1993, and is being continued in

FY 1994.

A funding priority will be given to applicants that demonstrate

either substantial progress over the last 3 years or a significant

experience of 10 or more years in influencing graduates from those

minority or low-income populations identified as at-risk of poor health

outcomes to enter family medicine residency training.

Proposed Funding Priority for FY 1994

It is proposed that a funding priority be given to applicants based

on their level of accomplishment in relation to the outcome or process

measures cited below:

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Outcome measures Points Process measures

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--25% of students who graduated 100

in 1991, 1992 and 1993 entered

family practice residencies.

--20% of students who graduated 75

in 1991, 1992 and 1993 entered

family practice residencies.

--15% of students who graduated 50 --Required 3rd Year

in 1991, 1992 and 1993 entered Clerkship* (of at least 4

family practice residencies. weeks duration).

--12% of students who graduated 35 --Required primary care

in 1991, 1992 and 1993 entered preceptorship/mentorship

family practice residencies. program* in preclinical

years.

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*Curricular elements must be in place at the time of application or the

applicant must provide satisfactory evidence (including commitments

from institutional officials) that the clerkship or preceptorship will

be operational by the beginning of the third year of the grant.

Applicants May Only Receive Priority Points in One of the Above Six

Categories

Information Requirements Provision in Statute

Under section 791(b) of the Act, the Secretary may make an award

under the Grants for the Establishment of Departments of Family

Medicine program only if the applicant for the award submits to the

Secretary the following information:

l. A description of rotations or preceptorships for students, or

clinical training programs for residents, that have the principal focus

of providing health care to medically underserved communities.

2. The number of faculty on admissions committees who have a

clinical practice in community-based ambulatory settings in medically

underserved communities.

3. With respect to individuals who are from disadvantaged

backgrounds, or from medically underserved communities, the number of

such individuals who are recruited for academic programs of the

applicant, the number of such individuals who are admitted to such

programs, and the number of such individuals who graduate from such

programs.

4. If applicable, the number of recent graduates who have chosen

careers in primary health care.

5. The number of recent graduates whose practices are serving

medically underserved communities.

6. A description of whether and to what extent the applicant is

able to operate without Federal assistance under this title.

Additional details concerning the implementation of this

information requirement have been published in the Federal Register at

58 FR 43642, August 17, 1993, and will be provided in the application

materials.

Additional Information

Interested persons are invited to comment on the proposed minimum

percentages for ``high rate'' and ``significant increase in the rate''

for implementation of the general statutory funding preference, and

funding priority. All comments received on or before February 7, 1994

will be considered before the final minimum percentages for ``high

rate'' and ``significant increase in the rate'' for implementation of

the general statutory funding preference, and funding priority are

established.

Written comments should be addressed to: Marc L. Rivo, M.D., M.P.H.

Director, Division of Medicine, Bureau of Health Professions, Health

Resources and Services Administration, 5600 Fishers Lane, Parklawn

Building, room 4C-25, Rockville, Maryland 20857.

All comments received will be available for public inspection and

copying at the Division of Medicine, Bureau of Health Professions, at

the above address, weekdays (Federal holidays excepted) between the

hours of 8:30 a.m. and 5 p.m.

Application Requests

Requests for application materials and questions regarding grants

policy and business management issues should be directed to: Mrs. Judy

Bowen, Grants Management Specialist (D-32), Residency and Advanced

Grants Section, Bureau of Health Professions, Health Resources and

Services Administration, Parklawn Building, room 8C-26, 5600 Fishers

Lane, Rockville, Maryland 20857, Telephone: (301) 443-6960, FAX: (301)

443-6343.

Completed applications should be returned to the Grants Management

Branch at the above address.

Questions regarding programmatic information should be directed to:

Ms. Shelby Biedenkapp, Program Specialist, Resources Development

Section, PCMEB, Division of Medicine, Bureau of Health Professions,

Health Resources and Services Administration, Parklawn Building, room

4C-04, 5600 Fishers Lane, Rockville, Maryland 20857, Telephone: (301)

443-3614, FAX: (301) 443-8890.

Paperwork Reduction Act

The standard application form PHS 6025-1, HRSA Competing Training

Grant Application, General Instructions and supplement for this program

have been approved by the Office of Management and Budget under the

Paperwork Reduction Act. This approval includes the burden for

collection of information for the statutory general preference and for

the information requirement provision. (OMB #0915-0060, expiration date

7/31/95)

The deadline date for receipt of applications is February 4, 1994.

Applications shall be considered to be ``on time'' if they are either:

(1) Received on or before the established deadline date, or

(2) Sent on or before the established deadline and received in time

for orderly processing. (Applicants should request a legibly dated U.S.

Postal Service postmark or obtain a legibly dated receipt from a

commercial carrier or the U.S. Postal Service. Private metered

postmarks shall not be acceptable as proof of timely mailing.)

Late applications not accepted for processing will be returned to

the applicant.

This program is listed at 93.984 in the Catalog of Federal Domestic

Assistance. It is not subject to the provisions of Executive Order

12372, Intergovernmental Review of Federal Programs (as implemented

through 45 CFR part 100).

This program is not subject to the Public Health System Reporting

Requirements.

Dated: November 29, 1993.

William A. Robinson,

Acting Administrator.

[FR Doc. 94-178 Filed 1-5-94; 8:45 am]

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