DEPARTMENT OF HEALTH AND HUMAN SERVICES

FEDERAL RESERVE SYSTEM

DEPARTMENT OF HEALTH AND HUMAN SERVICES

Health Resources and Services Administration

[2168]

Program Announcement and Proposed Funding Priorities for

Cooperative Agreements for Area Health Education Centers Program

for Fiscal Year 1994

The Health Resources and Services Administration (HRSA) announces

that applications are now being accepted for fiscal year 1994,

Cooperative Agreements for the Area Health Education Centers (AHEC)

Program under the authority of section 746(a)(1), (previously section

781(a)(1), title VII of the Public Health Service (PHS) Act, as amended

by the Health Professions Education Extension Amendments of 1992, dated

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

priorities stated below.

Approximately $18.7 million will be available for this program in

FY 1994. Total continuation support recommended is $8.4 million. It is

anticipated that $10.3 million will be available to support nine

competing awards averaging $1.14 million.

The Health Professions Education Extension Amendments of 1992,

makes the following amendments to this program.

(1) Period of Support

The maximum period during which the AHEC programs may receive

payments shall be 12 years, subject to annual approval by the Secretary

and the availability of appropriated funds. The maximum period during

which an AHEC center developed by a program may receive payments shall

be 6 years. The provision for a 12-year maximum shall not be construed

as establishing a limitation on the number of awards under this

authority that may be made to the school involved.

(2) General Requirements

As provided in section 746(b), a medical or osteopathic medical

school may not receive an award for operational expenses under the

existing basic AHEC award authority unless the program:

(a) Maintains preceptorship educational experiences for health

science students;

(b) Maintains community-based primary care residency programs or is

affiliated with such programs;

(c) Maintains continuing education programs for health professions

or coordinates with such programs;

(d) Maintains learning resource and dissemination systems for

information identification and retrieval;

(e) Has agreements with community-based organizations for the

delivery of education and training in the health professions;

(f) Is involved in the training of health professionals (including

nurses and allied health professionals), except to the extent

inconsistent with the law of the State in which the training is

conducted; and

(g) Carries out recruitment programs for the health science

professions, or programs for health-career awareness, among minority

and other elementary or secondary students from the areas the program

has determined to be medically underserved;

(3) Requirements for Participation of Other Health Professions

Schools or Programs

The former requirement that participating medical schools provide

for the active participation of at least 2 schools or programs of other

health professions (including a school of dentistry if there is one

affiliated with the medical school's university) is modified to require

also participation of a graduate program of mental health practice if

there is one affiliated with the university.

(4) Requirement for Expenditure of at Least 75 Percent of Award in

Centers

The former requirement that at least 75 percent of the total funds

provided to a school under any AHEC program authority (basic AHEC

programs, AHEC Special Initiatives or Model AHEC programs) be expended

by the AHEC program in AHEC centers has been amended, as provided in

section 746(e)(1)(A) to require also that the school enter into an

agreement with each of such centers for purposes of specifying the

allocation of the 75 percent of funds.

(5) Alternative Matching Requirements for New AHEC Programs Developed

Under Basic AHEC Authority

As provided in section 746(e)(2), for an AHEC center developed as

part of an AHEC program first funded under the basic AHEC authority on

or after October 13, 1992, the existing requirement that not more than

75 percent of total operating funds be provided by the Federal

Government (section 746(e)(1)(B)), is amended to establish a ceiling of

55 percent of any fifth or sixth year of the development or operation

of the center.

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 17 applications for Cooperative

Agreements for the Area Health Education Centers Program. Of those

applications, 58.9 percent were approved and 41.1 percent were

disapproved. Eight projects, or 47 percent of the applications

received, were funded.

In FY 1992, HRSA reviewed 11 applications. Of those applications,

73 percent were approved and 27 percent were disapproved. Three

projects or 27 percent of the applications received, were funded.

Purpose

Section 746(a)(1) of the PHS Act authorizes Federal assistance to

schools of medicine and osteopathic medicine which have cooperative

arrangements with one or more public or nonprofit private area health

education centers for the planning, development and operation of area

health education center programs.

Eligibility

To be eligible to receive support for an area health education

center cooperative agreement, the applicant must be a public or

nonprofit private accredited school of medicine or osteopathic medicine

or consortium of such schools, or the parent institution on behalf of

such school(s).

Applicants may request up to 3 years of support with the

expectation that AHECs planned and developed in years 1 and 2 would be

fully operational no later than the 3rd year. The period of Federal

support should not exceed 12 years for an area health education center

program and 6 years for an area health education center.

The Health Professions Reauthorization Act of 1988, title VI of

Public Law 100-607, amended the authority for the area health education

center program by:

1. Providing for a waiver, under specified circumstances, of the

provision now contained in section 746(a)(2)(C) prohibiting an AHEC

from being a school of medicine or osteopathic medicine, the parent

institution of such a school, or a branch campus or other subunit of a

school of medicine or osteopathic medicine or its parent institution,

or a consortium of such entities. The waiver of this provision applies

to an AHEC having, at the time of initial application, an operating

program supported by appropriations of a State legislature as well as

local resources;

2. Reducing the minimum number of individuals enrolled in first-

year positions in a rotating osteopathic internship or a medical

residency training program in family medicine, general internal

medicine, or general pediatrics from six individuals to four; and

3. Revising the requirement that each AHEC shall ``conduct

interdisciplinary training and practice involving physicians and other

health personnel including, where practicable, physician assistants and

nurse practitioners'' to add ``and nurse midwives.''

To receive support, programs must meet the requirements of the

regulations as set forth in 42 CFR part 57, subpart MM.

Degree of Federal Involvement in the Planning, Development and

Operation of Area Health Education Centers Program

The Bureau of Health Professions, within the Health Resources and

Services Administration, has substantial programmatic involvement in

the planning, development, and administration of the AHEC projects by:

1. Reviewing and approving plans upon which continuation of the

cooperative agreement is contingent in order to permit appropriate

direction and redirection of activities;

2. Reviewing and approving all contracts and agreements among

recipient medical or osteopathic schools, other health professions

schools and community-based centers;

3. Participating with project staff in the development of funding

projections;

4. Developing, with project staff, individual project data

collection systems and procedures; and

5. Participating with project staff in the design of project

evaluation protocols and methodologies.

Matching Funds Requirement

Section 746(e)(1)(B) of the Act requires that not more than 75

percent of total operating funds of a program in any year shall be

provided by the Federal Goverment. However, as provided in section

746(e)(2), for an AHEC center developed as part of an AHEC program

first funded under the basic AHEC authority on or after October 13,

1992, a ceiling of 55 percent of any fifth or sixth year of the

development or operation of a center is established.

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 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.

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 program requirements set forth in 42 CFR 57.3804;

2. The capability of the applicant to carry out the proposed

project; and

3. The extent of the need of the area to be served by the area

health education centers.

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 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 Preferences for Fiscal Year 1994

The following funding preference No. 1 was established in FY 1989

after public comment (at 54 FR 189) dated January 4, 1989. Funding

Preference No. 2, was established in FY 1993, after public comment at

58 FR 12245, dated March 3, 1993. These funding preferences are being

extended in FY 1994.

In making awards for fiscal year 1994, a funding preference will be

given to:

(1) Approved competing continuation applications under section

746(a)(1); and

(2) Approved competing new applications under section 746 (a)(1)

which propose to plan, develop and implement an AHEC program in a State

where there is no existing AHEC program. These applications will be

funded after approved competing continuation applications.

Established Funding Priority for Fiscal Year 1994

The following funding priority was established in FY 1989, after

public comment at 54 FR 189, dated January 4, 1989, and is being

extended in FY 1994:

A funding priority will be given to applications which demonstrate

substantial clinical training (a student or resident clerkship or

preceptorship of 4 to 8 weeks) in sites that serve the medically

underserved.

Proposed Funding Priorities for FY 1994

It is proposed that a funding priority be given to:

1. Applicants which demonstrate an increase in the percentage of

graduates who have entered a Primary Care (Family Medicine, General

Internal Medicine, General Pediatrics) Residency, for the most recent

3-year period.

An overall goal of the AHEC Program is to utilize educational

interventions to improve the geographic and specialty distribution of

primary care health personnel, and thereby increase access to health

care to underserved populations. The achievement of AHEC Program goals

is enhanced by medical schools (allopathic and osteopathic) which can

demonstrate a commitment to increasing the number of students who

select graduate training in a primary care specialty (family medicine,

general internal medicine, general pediatrics). Such a commitment can

be demonstrated in the performance and track record of the applicant

medical schools, during a most recent 3-year period. In times of

limited dollars, it is reasonable to allocate funds to: (1) Training

institutions that have primary care training goals that are consonant

with those of the Bureau of Health Professions and the AHEC Program;

and (2) institutions that can demonstrate performance in training an

increasing number of medical students who upon graduation select a

primary care career specialty.

2. Applicants which demonstrate an increase in the percentage of

underrepresented minority graduates for the most recent 3-year period.

This funding priority is proposed to encourage the training of

underrepresented minorities in an effort to increase the number of

underrepresented minorities who are accepted to medical school

(allopathic or osteopathic) and complete training. It is assumed that

these individuals, following training, are most likely to provide much

needed care in medically underserved communities to predominantly

minority populations. It is reasonable to provide limited funds to

institutions which demonstrate a commitment to increasing the number of

underrepresented minorities who graduate from medical school. Such

commitment can be demonstrated in the performance and track record of

the medical school, during a most recent 3-year period. Current data

indicate that the percentage of underrepresented minorities attending

and graduating from medical schools is not equal to the percentage of

underrepresented minorities in the United States. This priority will

assist in addressing the needs of underserved minority populations. The

term ``underrepresented minorities'' means, with respect to a health

profession, racial and ethnic populations that are underrepresented in

the health profession relative to the number of individuals who are

members of the population involved. For this program, it means American

Indians or Alaskan Natives, Blacks, Hispanics, and, potentially,

various subpopulations of Asian individuals. Applicants must evidence

that any particular subgroup of Asian individuals is underrepresented

in a specific discipline.

Additional Information

Interested persons are invited to comment on the proposed funding

priorities. All comments received on or before March 21, 1994 will be

considered before the final funding priorities 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, room

4C-25, Parklawn Building, 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:

Ms. Diane Murray, Grants Management Specialist (U76), Bureau of Health

Professions, Health Resources and Services Administration, 5600 Fishers

Lane, Parklawn Building, room 8C-26, Rockville, Maryland 20857,

Telephone: (301) 443-6857, Fax: (301) 443-6343.

Completed applications should be forwarded to the Grants Management

Branch at the above address.

If additional programmatic information is needed, please contact:

Ms. Cherry Tsutsumida, Chief, AHEC and Special Programs Branch,

Division of Medicine, Bureau of Health Professions, Health Resources

and Services Administration, 5600 Fishers Lane, Parklawn Building, room

4C-05, Rockville, Maryland 20857, Telephone : (301) 443-6817, Fax:

(301) 443-8890.

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 March 15, 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 commercial carrier or 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 is listed at 93.824 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: December 20, 1993.

John H. Kelso,

Acting Administrator.

[FR Doc. 94-3598 Filed 2-16-94; 8:45 am]

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