Grants for Construction of Teaching Facilities, Educational Improvements, Scholarships, and Student Loans; Grants for Faculty Training Projects in Geriatric Medicine and Dentistry

DEPARTMENT OF HEALTH AND HUMAN SERVICES

Public Health Service

RIN 0905-AE13

42 CFR Part 57

Grants for Construction of Teaching Facilities, Educational

Improvements, Scholarships, and Student Loans; Grants for Faculty

Training Projects in Geriatric Medicine and Dentistry

AGENCY: Health Resources and Services Administration, PHS, HHS.

ACTION: Notice of proposed rulemaking.

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SUMMARY: This proposed regulation would revise the 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 amendments made by

the Health Professions Extension Amendments of 1992 by: (1) Adding a

definition for the term ``Geriatric psychiatry'' to implement the

statutory requirement for the expansion of project support to include

the training of physicians who plan to teach geriatric psychiatry; (2)

adding a definition for the term ``Relevant advanced training or

experience'' to implement the statutory requirement for dentists who

are awarded a 2-year internal medicine or family medicine fellowship

(Dentists must have completed postdoctoral dental training, including

postdoctoral dental education programs or who have ``relevant advanced

training or experience''.); and (3) removing a section in the

regulations regarding the period of time for appointments to

fellowships to allow for less restrictive requirements for those

individuals who may benefit from further fellowship or retraining

experience in a life time. Additionally, technical and ministerial

revisions are being made to conform the existing regulations with the

amendments made by the statute.

DATES: As discussed below, comments are invited. To be considered,

comments must be received by April 4, 1994.

ADDRESSES: Written comments should be addressed to Fitzhugh Mullan,

M.D., Director, Bureau of Health Professions (BHPr), Health Resources

and Services Administration (HRSA), room 8-05, Parklawn Building, 5600

Fishers Lane, Rockville, Maryland 20857. All comments received will be

available for public inspection and copying at the Office of Program

Development, BHPr, room 8A-55, Parklawn Building, at the above address

weekdays (Federal holidays excepted) between the hours of 8:30 a.m. and

5 p.m.

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: This proposed rule amends the existing

regulations 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).

Section 777(b) of the Act, as amended, authorizes the Secretary to

make grants to and enter into contracts with accredited schools of

medicine, schools of osteopathic medicine, teaching hospitals, and

graduate medical education programs, for the purpose of providing

support (including traineeships and fellowships) for geriatric training

projects to train physicians and dentists who plan to teach geriatric

medicine, geriatric dentistry, or geriatric psychiatry. programs

supported by these grants emphasize the principles of primary care as

demonstrated through continuity, ambulatory, preventive, and

psychosocial aspects of the practice of geriatric medicine, dentistry,

and psychiatry.

The proposed amendments made by the Health Professions Extension

Amendments of 1992 (Pub. L. 102-408) to section 777(b) are described

below, according to the section numbers and headings of the regulations

they affect.

Section 57.4102 Definitions

The Department is proposing to add the following terms to this

section:

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

evaluation and treatment of mental disorders and disturbances seen in

older adults.

This definition is adapted from the definition used by the American

Association of Geriatric Psychiatrists and is 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.

``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 developed with consultation from an Ad Hoc

Committee of Geriatric Dentists and with positive internal review. The

definition is added to the section to incorporate the statutory

requirement for the expansion of fellowship eligibility of dental

fellows in the program.

Section 57.4111 Duration of fellowships.

The Department is proposing to remove this section from the

regulations. The regulatory language currently reads:

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.

Public Law 102-408 no longer provides for a 1-year fellowship program.

Further, the language regarding the period of time for appointments to

a fellowship is unnecessarily restrictive to individuals who may

benefit from further fellowship or retraining experience in a life

time. 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.

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

clarifying, and ministerial changes are included to conform the

existing regulations with amendments made by Public Law 102-408. These

changes affecting the program for Faculty Training Projects in

Geriatric Medicine and Dentistry are being made to the regulations to:

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 Public Law 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.'', amend the

following terms to:

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

Advisory Council on Health Professions Education, in accordance with

Public Law 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'';

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 postdoctoral dental

education programs or who have relevant advanced training or

experience''; and

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 Public Law 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 phase ``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 phase ``in existence

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

Public Law 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 Public Law 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 Public Law 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 Public Law 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 Sec. 57.4113.

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 Public Law 102-408.

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

as Sec. 57.4115.

Regulatory Flexibility Act and Executive Order 12688

This proposed rule governs a financial assistance training grant

program in which participation is voluntary. Because these rules make

minor changes in an existing grant program, they will have no

consequential effect on the economy, small businesses or small

governments. Therefore, the Secretary certifies that this rule will not

have a significant economic impact on small entities.

Paperwork Reduction Act of 1980

This proposed 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

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: November 12, 1993.

Philip R. Lee,

Assistant Secretary for Health.

Approved: January 24, 1994.

Donna E. Shalala,

Secretary.

Accordingly, 42 CFR part 57, subpart PP is proposed to be amended

as set forth below:

PART 57--GRANTS FOR CONSTRUCTION OF TEACHING FACILITIES,

EDUCATIONAL IMPROVEMENTS, SCHOLARSHIPS AND STUDENT LOANS

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 Public Law 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 designed 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; 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.

* * * * *

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) Competing applications are reviewed by a panel of peer

reviewers comprised primarily of non-Federal consultants whose

recommendations are given to the Secretary. The Secretary will approve

projects which best promote the purposes of section 777(b) of the Act.

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 [Removed]

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 and Amended]

10. Section 57.4115, entitled What other audit and inspection

requirements apply to grantees?, is redesignated as Sec. 57.4114, and

section number ``705'' in the text is revised to read ``798(e)''.

Sec. 57.4116 [Redesignated as Sec. 57.4115]

11. Section 57.4116, entitled Additional conditions., is

redesignated as Sec. 57.4115.

[FR Doc. 94-4901 Filed 3-2-94; 8:45 am]

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