Grants for Faculty Training Projects in Geriatric Medicine and Dentistry

DEPARTMENT OF HEALTH AND HUMAN SERVICES

Public Health Service

42 CFR Part 57

RIN 0905-AE13

Grants for Faculty Training Projects in Geriatric Medicine and

Dentistry

AGENCY: Health Resources and Services Administration, HHS.

ACTION: Final rule.

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SUMMARY: This final regulation revises the existing regulations

governing the program for Grants for Faculty Training Projects in

Geriatric Medicine and Dentistry authorized by section 777(b) of the

Public Health Service Act (the Act), to implement statutory amendments

made by the Health Professions Extension Amendments of 1992 and to

include other technical and ministerial changes to conform the existing

regulations with the amendments made by the statute. The final rule

also removes a section in the regulations to allow for less restrictive

requirements for those individuals who may benefit from further

fellowship or retraining experience in a lifetime.

DATES: These regulations are effective December 12, 1994.

FOR FURTHER INFORMATION CONTACT: Neil H. Sampson, Director, Division of

Associated, Dental and Public Health Professions, Bureau of Health

Professions, HRSA, room 8-101, Parklawn Building, 5600 Fishers Lane,

Rockville, Maryland 20857; telephone: (301) 443-6853.

SUPPLEMENTARY INFORMATION: On March 3, 1994, the Assistant Secretary

for Health, with the approval of the Secretary of Health and Human

Services, published in the Federal Register (59 FR 10104), a Notice of

Proposed Rulemaking (NPRM) to revise the regulations governing the

program for Grants for Faculty Training Projects in Geriatric Medicine

and Dentistry, authorized under section 777(b) of the Public Health

Service Act (the Act) (42 U.S.C. 294o). The Health Professions

Education Extension Amendments of 1992 (Pub. L. 102-408) amended and

renumbered former section 789(b) of the Act (42 U.S.C. 295g-9(b)) to

section 777(b).

The NPRM proposed amendments to implement several statutory

provisions by: (1) Adding a definition for the term ``Geriatric

psychiatry'' to implement the requirement for the expansion of project

support to include the training of physicians who plan to teach

geriatric psychiatry, and by (2) adding a definition for the term

``Relevant advanced training or experience'' to implement the

requirement for dentists who are awarded a 2-year internal medicine or

family medicine fellowship. The NPRM also proposed to remove a section

in the regulations regarding the period of time for appointment to

fellowships to allow for less restrictive requirements for those

individuals who may benefit from further fellowship or retraining

experience in a lifetime.

The public comment period on the proposed regulations closed on

April 4, 1994. The Department received 4 public comments. The comments

received on the proposed rule to section 777(b) and the Department's

responses to the comments are discussed below according to the section

numbers and headings of the regulation affected.

Section 57.4102 ``Definitions''

The Department proposed the following definition for the term

``Geriatric psychiatry'':

``Geriatric psychiatry'' means the prevention, diagnosis,

evaluation and treatment of mental disorders and disturbances seen in

older adults.

This definition was proposed to be added to the section to

incorporate the statutory requirement for the expansion of project

support to include the training of physicians who plan to teach

geriatric psychiatry.

The Department received positive responses to this definition.

The Department also proposed the following definition for the term

``Relevant advanced training or experience'':

``Relevant advanced training or experience'' means at least one of

the following: (1) Completion of at least a 12-month graduate training

program in a health-related discipline, the basic sciences, or

education; or (2) a minimum of 2 years of clinical practice, of which

at least 12 months were devoted in part to managing older dental

patients in a hospital, long-term care facility, or other setting.

This definition was proposed to be added to the section to

incorporate the statutory requirement for the expansion of fellowship

eligibility of dental fellows in the program.

One respondent found this definition ``extremely helpful in setting

a high standard for the selection of highly motivated and qualified

candidates''.

The Department also received a request that dentists who have had

``relevant teaching experience in an accredited dental school'' be

added to the definition. The Department accepts the general intent of

this recommendation while noting that ``relevant'' alone is not

explicit and is open to interpretation. In response to this concern,

the Department has expanded the definition of ``Relevant advanced

training or experience'' in the final regulations to include an

additional experience, ``a minimum of 2 years of teaching experience in

an accredited dental educational program of which at least 12 months

were devoted in part to issues pertaining to the care of older

adults.''

Section 57.4111 ``Duration of Fellowships''

The Department proposed to remove this section from the regulations

to allow less restrictive requirements for those individuals who may

benefit from further fellowship or retraining experience in a lifetime.

The section language read:

``An appointment to a fellowship may be made for a period not to

exceed 12 months. Fellowship assistance for participants in a 1-year

fellowship program and a 1-year retraining program is limited to 12

months. Participants in 2-year fellowship programs may receive a

second 12-month appointment for a total period of 24 months.''

The Department gave an example in the NPRM how this language might

be restrictive to fellows: ``For example, a faculty fellow who

completed a 1-year retraining to have the skills required to

incorporate geriatrics into course content and clinical rotations may

discover 5 years later that another fellowship experience would provide

the opportunity to develop research skills in geriatrics required to

expand the scope and depth of practice-based geriatric research.''

One respondent requested the ``removal of the 1-year fellowship

[retraining] limit of Federal support for psychiatrists who wish to

train other psychiatrists in geriatric psychiatry''. The respondent

stated that this is a reasonable request as it would permit the

training to fully meet the requirements of exposure to the physical and

mental disabilities of a diverse population of elderly individuals.

The Department has not accepted this recommendation because the

statute requires that the 2-year fellowship program be an internal

medicine or family medicine fellowship program, not a psychiatry

fellowship program. (See section 777(b)(3)(B) of the Act and

Sec. 57.4105(d) of the regulations.) However, psychiatrists are

eligible to participate as fellows in the 2-year programs.

In addition to the changes proposed above, a number of technical,

clarifying, and ministerial changes were included to conform the

existing regulations with amendments made by Pub. L. 102-408. The

Department also received a few comments on some of these technical

changes. The Department's responses are also discussed below. These

changes affecting the program for Faculty Training Projects in

Geriatric Medicine and Dentistry are as follows:

1. Revise the section number of the Act from ``789(b)'' to

``777(b)'' wherever it appears in subpart PP, as renumbered, and the

United States Code citation from ``(42 U.S.C. 295g-9(b))'' to ``(42

U.S.C. 294o)'', in accordance with Pub. L. 102-408.

2. Revise Sec. 57.4101, entitled ``To what projects do these

regulations apply?'', by adding the words ``geriatric psychiatry'' to

reflect statutory language which expands project support to include the

training of physicians who plan to teach geriatric psychiatry.

3. Revise Sec. 57.4102, entitled ``Definitions.'', to amend the

following terms to:

a. Remove the definition of ``Council'' regarding the National

Advisory Council on Health Professions Education, in accordance with

Pub. L. 102-408. The statute repealed the Council effective October 1,

1992;

b. Revise the phrase ``by an organized medical staff'' to ``by an

organized health care staff'' at the end of the definition of

``Extended care facility'' to clarify that staff of health care

institutions includes nurses, physical therapists, social workers and

other health care staff who provide ``medically-prescribed skilled

nursing care or rehabilitative services''.

The Department received one comment regarding the proposed

clarifying change to the phrase ``organized health care staff'' as

having potential conflict with individual State laws or licensing

authorities. It is the Department's view that the clarifying phrase

includes medical staff along with all other health care professionals

and should not be in conflict with any individual State laws or

licensing authorities. Therefore, this amendment will remain as

proposed.

c. Revise the introductory text to the definition of ``Fellowship

program'' by removing the reference to a 1-year fellowship program

which is no longer a statutory provision for project support; and

revise paragraph (2) of the definition to reflect new statutory

requirements for the training of dentists who have ``demonstrated a

commitment to an academic career and who have completed postdoctoral

dental training, including postdoctoral dental education programs or

who have relevant advanced training or experience''.

The Department received favorable support for this change.

d. Revise the section number of the Act in the definition of

``School of medicine or school of osteopathic medicine'' from

``701(5)'' to ``799(1)(E)'', in accordance with Pub. L. 102-408.

4. Amend Sec. 57.4105, entitled ``Project requirements.'', to:

a. Revise paragraph (d) regarding the requirement that projects be

based in a graduate medical education program by adding the words ``or

psychiatry'' after the phrase ``or in a department of geriatrics'' to

reflect statutory language which expanded project support to include

the training of physicians who plan to teach geriatric psychiatry.

Paragraph (d) is further revised by removing the phrase ``in existence

as of December 1, 1987'' at the end of the sentence, in accordance with

Pub. L. 102-408;

b. Revise paragraph (e) regarding the requirement that projects be

staffed by at least two physicians in full-time teaching positions who

have experience or training in geriatric medicine by adding the words

``or geriatric psychiatry'', in accordance with Pub. L. 102-408; and

c. Revise the introductory text to paragraph (f) regarding the

requirement that the project must provide fellows ``with training in

geriatrics and exposure to the physical and mental disabilities of'' a

diverse population of elderly individuals, to more appropriately

reflect the language in Pub. L. 102-408.

5. Revise Sec. 57.4106, entitled ``How will applications be

evaluated?'', by:

a. Removing the reference to the National Advisory Council on

Health Professions Education, in accordance with Pub. L. 102-408, in

paragraph (a) introductory text and revising the introductory text to

reflect current statutory language regarding the evaluation and

recommendation process of awarding grant applications; and

b. Adding a comma and the words ``psychiatry, or'' after the words

``geriatric medicine'' in paragraph (a)(5) to reflect statutory

language which expanded training to include geriatric psychiatry.

5. Redesignate Sec. 57.4112, entitled ``Termination of

fellowships.'', as Sec. 57.4111, and Sec. 57.4113, entitled ``For what

purposes may grant funds be spent?'', as Sec. 57.4112, and

Sec. 57.4114, entitled ``What additional Department regulations apply

to grantees?'', as 113.

6. Redesignate Sec. 57.4115, entitled ``What other audit and

inspection requirements apply to grantees?'', as Sec. 57.4114 and

revise the section number ``705'' in the text to ``798(e)'', in

accordance with Pub. L. 102-408.

The Department is further revising Sec. 57.4115 by removing the

reference to ``section 705 of the PHS Act'' instead of renumbering the

section number to ``798(e)'' as proposed in the NPRM. The reference to

section 705 concerning audit and inspection requirements is redundant

to the requirements that are already covered under 45 CFR part 74. We

are also removing the parenthetical phrase at the end of the section

text citing the OMB approval number regarding information collection

requirements as no longer necessary.

7. Redesignate Sec. 57.4116, entitled ``Additional conditions.'',

as Sec. 57.4115.

Further, Public Law 103-227, enacted on March 11, 1994, prohibits

smoking in certain facilities in which minors will be present. The

Department of Health and Human Services is now preparing to implement

the provision of that law. Until those implementation plans are in

place, the PHS continues to strongly encourage all grant recipients to

provide a smoke-free workplace and promote the non-use of all tobacco

products.

Economic Impact

Executive Order 12866 requires that all regulations reflect

consideration of alternatives, of costs, of benefits, of incentives, of

equity, and of available information. Regulations must meet certain

standards, such as avoiding unnecessary burden. Regulations which are

``significant'' because of cost, adverse effects on the economy,

inconsistency with other agency actions, effects on the budget, or

novel legal or policy issues, require special analysis.

The Department believes that the resources required to implement

the requirements in these regulations are minimal. Therefore, in

accordance with the Regulatory Flexibility Act of 1980, the Secretary

certifies that these regulations will not have a significant impact on

a substantial number of small entities. For the same reasons, the

Secretary has also determined that this is not a ``significant'' rule

under Executive Order 12866.

Paperwork Reduction Act of 1980

This final rule does not affect the recordkeeping or reporting

requirements in the existing regulations for the Grants for Faculty

Training Projects in Geriatric Medicine and Dentistry.

List of Subjects Under 42 CFR Part 57

Dental health, Education of the disadvantaged, Educational

facilities, Educational study programs, Grant Programs--education,

Grant programs--health, Medical and dental schools, Student aid.

(Catalog of Federal Domestic Assistance, No. 93.156, Grants for

Faculty Training Projects in Geriatric Medicine and Dentistry).

Dated: September 20, 1994.

Philip R. Lee,

Assistant Secretary for Health.

Approved: December 5, 1994.

Donna E. Shalala,

Secretary.

Accordingly, 42 CFR part 57, subpart PP is amended as set forth

below:

PART 57--GRANTS FOR CONSTRUCTION OF TEACHING FACILITIES, EDUCATION

IMPROVEMENT, SCHOLARSHIPS AND STUDENT LOANS

Subpart PP--Grants for Faculty Training Projects in Geriatric

Medicine and Dentistry

1. The authority citation for subpart PP is revised to read as

follows:

Authority: Sec. 215 of the Public Health Service Act, 58 Stat.

690, 67 Stat. 631 (42 U.S.C. 216); sec. 789(b) of the PHS Act, as

amended by Public Law 100-607, 102 Stat. 3136-3138 (42 U.S.C. 295g-

9(b)); renumbered as sec. 777(b), as amended by Pub. L. 102-408, 106

Stat. 2052-54 (42 U.S.C. 294o).

2. Section 57.4101 is revised to read as follows:

Sec. 57.4101 To what projects do these regulations apply?

These regulations apply to grants to eligible schools and programs

under section 777(b) of the Act (42 U.S.C. 294o) for the purpose of

providing support for projects to train physicians and dentists who

plan to teach geriatric medicine, geriatric psychiatry, or geriatric

dentistry, including traineeships, and fellowships for participation in

these programs.

3. Section 57.4102 is amended by removing the definition of

``Council''; by amending the definition of ``Extended care facility''

by revising the phrase ``by an organized medical staff'' at the end of

the sentence to read ``by an organized health care staff''; by revising

the section number of the Act ``789(b)'' in the definitions of

``Fellow'' and ``Project director'' to read ``777(b)''; by revising the

section number of the Act ``701(5)'' in the definition of ``School of

medicine or school of osteopathic medicine'' to read ``799(1)(E)''; by

revising the definition of ``Fellowship program''; and by adding the

definitions of ``Geriatric psychiatry'' and ``Relevant advanced

training or experience'' to read as follows:

Sec. 57.4102 Definitions.

* * * * *

Fellowship program means a 2-year organized training effort

sponsored by an allopathic or osteopathic medical school, a teaching

hospital, or a graduate medical education program which is designated

to provide training for--

(1) Physicians who have completed a graduate medical education

program in internal medicine, family medicine (including osteopathic

general practice), psychiatry, neurology, gynecology, or rehabilitation

medicine; and

(2) Dentists who have demonstrated a commitment to an academic

career and who have completed postdoctoral dental training, including

postdoctoral dental education programs or who have relevant advanced

training or experience.

* * * * *

Geriatric psychiatry means the prevention, diagnosis, evaluation

and treatment of mental disorders and disturbances seen in older

adults.

* * * * *

Relevant advanced training or experience means at least one of the

following: (1) Completion of at least a 12-month graduate training

program in a health-related discipline, the basic sciences, or

education; (2) a minimum of 2 years of teaching experience in an

accredited dental education program of which at least 12 months were

devoted in part to issues pertaining to the care of older adults; or

(3) a minimum of 2 years of clinical practice, of which at least 12

months were devoted in part to managing older dental patients in a

hospital, long-term care facility, or other setting.

* * * * *

4. Section 57.4105 is amended by revising paragraphs (d), (e), and

the introductory text to paragraph (f) to read as follows:

Sec. 57.4105 Project requirements.

* * * * *

(d) The project must be under the programmatic control of a

graduate medical education program in internal medicine or family

medicine (including osteopathic general practice) or in a department of

geriatrics or psychiatry;

(e) The project must be staffed by at least two physicians in full-

time teaching positions who have experience or training in geriatric

medicine or geriatric psychiatry and be staffed, or enter into an

agreement with an institution staffed, by at least one dentist who is

employed in a full- or part-time teaching position and has experience

or training in geriatrics;

(f) The project must provide fellows with training in geriatrics

and exposure to the physical and mental disabilities of a diverse

population of elderly individuals. The population must include: * * *

* * * * *

5. Section 57.4106 is amended by revising the introductory text to

paragraph (a) and paragraph (a)(5) to read as follows:

Sec. 57.4106 How will applications be evaluated?

(a) As required by section 798(a) of the Act, each application for

a grant under this subpart shall be submitted to a peer review group,

composed principally of non-Federal experts, for an evaluation of the

merits of the proposals made in the application. The Secretary may not

approve such an application unless a peer review group has recommended

the application for approval. The Secretary will award grants to

applicants whose projects will best promote the purposes of section

777(b) of the Act and these regulations. The Secretary will consider,

among other factors:

* * * * *

(5) The extent to which the project will increase the number of

geriatric fellowship and retraining positions available for individuals

who want to prepare for academic careers in geriatric medicine,

psychiatry, or dentistry.

* * * * *

Sec. 57.4111 [Amended]

6. Subpart PP is amended by removing Sec. 57.4111, entitled

``Duration of fellowships.''

Sec. 57.4112 [Redesignated as Sec. 57.4111]

7. Section 57.4112, entitled ``Termination of fellowships.'', is

redesignated as Sec. 57.4111.

Sec. 57.4113 [Redesignated as Sec. 57.4112]

8. Section 57.4113, entitled ``For what purposes may grant funds be

spent?'', is redesignated as Sec. 57.4112.

Sec. 57.4114 [Redesignated as Sec. 57.4113]

9. Section 57.4114, entitled ``What additional Department

regulations apply to grantees?'', is redesignated as Sec. 57.4113.

Sec. 57.4115 [Redesignated as Sec. 57.4114]

10. Section 57.4115 is redesignated as 57.4114 and is revised to

read as follows:

Sec. 57.4114 ``What other audit and inspection requirements apply to

grantees?''

Each entity which receives a grant under this subpart must meet the

requirements of 45 CFR part 74 concerning audit and inspection.

Sec. 57.4116 [Redesignated as Sec. 57.4115]

11. Section 57.4116, entitled ``Additional conditions.'', is

redesignated as Sec. 57.4115.

[FR Doc. 94-30410 Filed 12-9-94; 8:45 am]

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