Program Announcement for Grants for Interdisciplinary Training for Health Care for Rural Areas for FY 1994

DEPARTMENT OF HEALTH AND HUMAN SERVICES

Program Announcement for Grants for Interdisciplinary Training

for Health Care for Rural Areas for FY 1994

The Health Resources and Services Administration (HRSA) announces

that applications are being accepted for fiscal year (FY) 1994, Grants

for Interdisciplinary Training for Health Care for Rural Areas under

the authority of section 778, title VII of the Public Health Service

(PHS) Act, as amended by the Health Professions Education Extension

Amendments of 1992, Public Law 102-408, dated October 13, 1992.

Approximately $4,017,000 will be available in FY 1994 for this

program. Total continuation support recommended is approximately

$1,600,000. It is anticipated that $2,417,000 will be available to

support 12 competing awards averaging approximately $180,000.

Funding for this program is designed to test innovative training

approaches that may be replicated in similar settings.

Previous Funding Experience

Previous funding experience is provided to assist potential

applicants to make better informed decisions regarding submission of an

application for this program. In FY 1993, HRSA reviewed 29 applications

for Grants for Interdisciplinary Training for Health Care for Rural

Areas. Of those applications, 45 percent were approved and 55 percent

were disapproved. Eight projects, or 28 percent of the applications

received, were funded. There was no competitive cycle for FY 1992.

Purposes

Section 778 of the Public Health Service Act, as amended,

authorizes the Secretary to award grants for interdisciplinary training

projects designed to provide or improve access to health care in rural

areas. Specifically, projects funded under this authority shall be

designed to:

(a) Use new and innovative methods to train health care

practitioners to provide services in rural areas;

(b) Demonstrate and evaluate innovative interdisciplinary methods

and models designed to provide access to cost-effective comprehensive

health care;

(c) Deliver health care services to individuals residing in rural

areas;

(d) Enhance the amount of relevant research conducted concerning

health care issues in rural areas; and

(e) Increase the recruitment and retention of health care

practitioners in rural areas and make rural practice a more attractive

career choice for health care practitioners.

A recipient of funds may use various methods in carrying out the

projects described above. The legislation cites the following methods

as examples:

(a) The distribution of stipends to students of eligible

applicants;

(b) The establishment of a postdoctoral fellowship program;

(c) The training of faculty in the economic and logistical problems

confronting rural health care delivery systems; or

(d) The purchase or rental of transportation and telecommunication

equipment where the need for such equipment due to unique

characteristics of the rural area is demonstrated by the recipient.

Eligibility

To be eligible for a Grant for Interdisciplinary Training for

Health Care for Rural Areas, each applicant must be located in a State

and be:

1. A local health department, or

2. A nonprofit organization, or

3. A public or nonprofit college, university or school of, or

program that specializes in nursing, mental health practice, optometry,

public health, dentistry, osteopathic medicine, physician assistants,

pharmacy, podiatric medicine, allopathic medicine, chiropractic, or

allied health professions.

Applicants eligible to obtain funds under this grant program shall

not include for-profit entities, either directly or through a

subcontract or subgrant.

Each application must be jointly submitted by at least two eligible

applicants. One of the applicants must be an academic institution. Each

application must demonstrate the need and demand for health care

services, knowledge of available resources and the most significant

service and educational gaps within its targeted geographic area. One

applicant must be designated the principal organization responsible and

accountable for the conduct of the proposed project.

Support may be requested for this grant program for a project

period of not more than three years.

Definitions

``Clinical Treatment or Training'' means direct, supervised

participation in patient care by observation, examination and

performance of procedures as are appropriate for the assigned role of

the trainee on the rural health care team.

``Community Health Center'' means an entity as defined in section

330 (a) and (b) of the Act and in regulations at 42 CFR 51c.102(c).

``Community Mental Health Center'' means for purposes of this grant

program a multiservice mental health facility which provides essential

elements of comprehensive mental health services:

(1) Inpatient services;

(2) Outpatient services;

(3) Partial hospitalization services--must include at least day

care service;

(4) Emergency services provided 24 hours per day--must be available

within at least one of the first three services listed above; and/or

(5) Consultation and education services available to community

agencies and professions personnel.

``Indian Tribe'' or ``Tribal Organization'' means an organization

or entity as defined in section 4(e) and 4(l) of the Indian Self-

Determination and Education Assistance Act (25 U.S.C. 450b).

``Interdisciplinary Training'' means a planned and coordinated

program of education or training aimed at preparation of functioning

teams of two or more health care practitioners from different health

disciplines who will coordinate their activities to provide services to

a client or group of clients.

``Long-Term Care Facility'' is a facility which offers services

designed to provide diagnostic, preventive, therapeutic,

rehabilitative, supportive and maintenance services for individuals who

have chronic physical or mental impairments. This facility may have a

variety of institutional and non-institutional health settings,

including the home, and the goal of the service provided is to promote

the optimum level of physical, social and psychological functioning.

``Migrant Health Center'' means an entity as defined in section

329(a) of the Act and in regulations at 42 CFR 56.102(g)(1).

``Native Hawaiian Health Center'' means an entity as defined in the

Native Hawaiian Health Care Act of 1988 (Pub. L. 100-579) (42 U.S.C.

11707(4)).

``Nonprofit'' as applied to any entity means one, no part of the

net earnings of which inures, or may lawfully inure, to the benefit of

any private shareholder or individual.

``Postdoctoral Fellowship Program'' means a program of advanced

academic or professional work, after the attainment of a doctoral

degree, that is sponsored by a school of/or program that specializes in

medicine, osteopathic medicine, nursing, dentistry, mental health

practice, optometry, public health, pharmacy, podiatric medicine,

physician assistant, chiropractic, or allied health.

``Rural'' means geographic areas that are located outside of

standard metropolitan statistical areas.

``Rural Health Care Agency'' means a hospital, community health

center, migrant health center, rural health clinic, community mental

health center, long-term care facility, Native Hawaiian health center,

or facility operated by the Indian Health Service or an Indian tribe or

tribal organization or Indian organization under a contract with the

Indian Health Service under the Indian Self-Determination Act.

``Rural Health Clinic'' means an entity as defined under section

1861(aa)(2) of the Social Security Act and in regulations at 42 CFR

491.2.

``State'' means, in addition to the 50 States, only the District of

Columbia, the Commonwealth of Puerto Rico, the Commonwealth of the

Northern Mariana Islands, the Virgin Islands, Guam, American Samoa, the

Trust Territory of the Pacific Islands (the Republic of Palau), the

Republic of the Marshall Islands, and the Federated States of

Micronesia.

National Health Objectives for the Year 2000

The Public Health Service (PHS) is committed to achieving the

health promotion and disease prevention objectives of Healthy People

2000, a PHS led national activity for setting priority areas. This

program, Grants for Interdisciplinary Training for Health Care for

Rural Areas, is related to the priority area of Educational and

Community-Based Programs. 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.

Statutory Project Requirements

Interdisciplinary training projects funded under section 778 must:

1. Assist individuals in academic institutions in establishing

long-term collaborative relationships with health care facilities and

providers in rural areas, and;

2. Designate a rural health care agency or agencies for clinical

treatment or training, including hospitals, community health centers,

migrant health centers, rural health clinics, community mental health

centers, long-term care facilities, Native Hawaiian health centers, or

facilities operated by the Indian Health Service or an Indian tribe or

tribal organization or Indian organization under a contract with the

Indian Health Service under the Indian Self-Determination Act.

Not more than 10 percent of the individuals receiving training with

section 778 funds shall be trained as doctors of medicine or

osteopathic medicine. A grantee may not use more than 10 percent of the

grant funds for administrative costs.

Established Nonstatutory Project Requirements

The following project requirements were established in fiscal year

1990 (55 FR 24321, June 15, 1990) and 1991 (56 FR 37713, August 8,

1991), after public comment, and are being extended in FY 1994.

A project supported under this grant program must meet the

following requirements:

(1) Carry out the following two project purposes, at a minimum,

among those authorized by section 778:

(a) Interdisciplinary training to prepare health care practitioners

to provide services in rural areas; and

(b) increase the recruitment and retention of health care

practitioners in rural areas.

(2) Collaborate with the resources of an Area Health Education

Center (AHEC) or Geriatric Education Center(GEC) if these centers are

present in a State or part of a State where the rural interdisciplinary

training project is conducted.

(3) Evaluate in a systematic manner, as prescribed by the

Secretary, its project activity, including determination of a baseline

at the outset of the project and measurement of progress by trainees

and faculty.

(4) Provide and clearly define for each level of training

(undergraduate, graduate, postgraduate, continuing education and

faculty training) the disciplines and numbers of students to receive

training as well as the duration of the training. This is to include an

outline of basic criteria for the selection of students to participate

in the training. These project elements are to be tracked and linked to

project outcomes.

(5) Provide specific indicators of the extent and means by which it

plans to become self-sufficient.

(6) Implement integrated recruitment and retention strategies.

(7) Establish curriculum elements that address the uniqueness of

health conditions and ethnic or cultural characteristics of the

populations in the rural areas to be served.

(8) Enroll a significant proportion of individuals from rural

areas, particularly rural health professions shortage areas or

medically underserved areas.

Review Criteria

The review of applications will take into consideration the

following criteria:

(1) The potential effectiveness of the proposed project in carrying

out the training purposes of section 778 of the Act;

(2) The extent to which the project explains the need for the

project in the rural area to be served;

(3) The degree to which the proposed project adequately provides

for the interdisciplinary training of health professionals to practice

in the rural area to be addressed by the project;

(4) The degree to which the applicant offers appropriate clinical

training experiences in rural health care settings;

(5) The degree to which the applicant demonstrates a commitment to

establishing and maintaining long-term collaborative relationships

between academic institutions and health care facilities and providers

in rural areas;

(6) The effectiveness of the organizational arrangements necessary

to carry out the project;

(7) The administrative and management capability of the applicant

to carry out the proposed project in a cost-effective manner;

(8) The capability of the proposed staff and faculty to provide the

proposed instruction;

(9) The extent to which the trainee recruitment and selection

process assures that qualified trainees with significant interest or

background in rural health care are involved in the project;

(10) The extent to which the budget justification is reasonable and

indicates that institutional and community support to the project are

provided to the maximum extent possible; and

(11) The extent to which the financial information provided

indicates an effective utilization of grant funds and indicates that

the project will continue on a self-sustaining basis.

Other Considerations

In addition, the following funding factors may be applied in

determining funding of approved applications.

A funding preference is defined as the funding of a specific

category or group of approved applications ahead of other categories or

groups of approved applications.

A funding priority is defined as the favorable adjustment of

aggregate review scores of individual approved applications 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.

Established Funding Preference

The following funding preference was established in FY 1990, after

public comment (55 FR 24321, June 15, 1990), and the Administration is

extending it in FY 1994.

A funding preference will be given to interdisciplinary training

involving three or more disciplines. This funding preference will be

given to applicants that propose and implement training for health care

practitioners, faculty or students representing three or more

disciplines.

Established Funding Priority

The following funding priority was established in FY 1993 after

public comment (58 FR 5741, January 22, 1993) and the Administration is

extending this funding priority in FY 1994. In determining the order of

funding of approved applications a priority will be given to applicant

institutions (academic) which demonstrate either substantial progress

over the last three years or a significant experience of ten or more

years in enrolling and graduating trainees from those minority or low-

income populations identified as at risk of poor health outcomes.

Application Requests

Application forms will be sent only upon request. Requests for

application materials and questions regarding grants policy and

business management issues should be directed to: Ms. Theda Duvall,

Grants Management Specialist (D-36), Bureau of Health Professions,

HRSA, Parklawn Building, room 8C-26, 5600 Fishers Lane, Rockville, MD

20857, Telephone: 301-443-6002, FAX: 301-443-6343.

Completed applications should be returned to the Grants Management

Branch at the above address.

If additional programmatic information is needed, please contact:

Dr. Marcia Brand, Program Officer, Division of Associated, Dental and

Public Health Professions, Bureau of Health Professions, HRSA, Parklawn

Building, room 8C-02, 5600 Fishers Lane, Rockville, MD 20857,

Telephone: 301-443-6763, FAX: 301-443-1164.

The standard application for State and local governments is form

PHS 5161. For other applicants, 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. The OMB

clearance number is 0915-0060.

The deadline date for receipt of applications is January 31, 1994.

Applications will 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 date 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 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, Grants for Interdisciplinary Training for Health care

for Rural Areas, is listed at 93.192 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 19, 1993.

William A. Robinson,

Acting Administrator.

[FR Doc. 94-180 Filed 1-5-94; 8:45 am]

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