Final Minimum Percentages for ``High Rate'' and ``Significant Increase in the Rate'' for Implementation of the Statutory General Funding Preference and Revisions to the Established Funding Preference for Grants for Residency Training in General Internal Medicine and General PediatricsFiscal Year 1994

DEPARTMENT OF HEALTH AND HUMAN SERVICES

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

Increase in the Rate'' for Implementation of the Statutory General

Funding Preference and Revisions to the Established Funding Preference

for Grants for Residency Training in General Internal Medicine and

General Pediatrics--Fiscal Year 1994

The Health Resources and Services Administration (HRSA) announces

the final minimum percentages for ``high rate'' and ``significant

increase in the rate'' for implementation of the statutory general

funding preference and revisions to parts 2 and 3 of the established

funding preference for Fiscal Year (FY) 1994 for Grants for Residency

Training in General Internal Medicine and General Pediatrics authorized

under the authority of section 748, 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.

Purpose

Section 748 authorizes the award of grants for planning,

developing, operating or participating in approved residency training

programs which emphasize the training for the practice of general

internal medicine or general pediatrics. In addition, section 748

authorizes assistance in meeting the cost of supporting residents who

are in need thereof, who are participants in any such program, and who

plan to specialize or work in the practice of general internal medicine

or general pediatrics. A separate grant program is in effect for the

faculty development component of this provision. In addition, section

748 now authorizes grants or contracts to support predoctoral training

in general internal medicine and general pediatrics.

Statutory General 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 of

applications that have been recommended for approval by the peer review

group.

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

Increase in the Rate

The following minimum percentages for ``high rate'' and

``significant increase in the rate'' and revisions to the established

funding preference were published in the Federal Register at 58 FR

51838 on October 5, 1993 for public comment. No comments were received

during the 30-day comment period. Therefore, the proposed minimum

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

will be retained as follows:

``High rate'' is defined as a minimum of 25 percent of combined

graduates of the residency training program in academic years 1990-91

through 1992-93.

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

years 1991-92 through 1992-93, the rate of placing graduates in the

specified settings has increased by a minimum of 50 percent and not

less than 15 percent of graduates from the most recent year are working

in these areas.

In addition, the following revisions to the established funding

preference will be retained as follows:

Generalism Outcomes/Continuity of Care Training Experiences

A funding preference will be awarded to any approved application

that meets the following criteria: (A) Applicants that had a separate

match number for an identified primary care track or program in 1993 OR

that received support from this grant program in the last 3 years must:

1. Have 80 percent or more of their 1991 to 1993 primary care

program graduates in primary care practice, OR demonstrate an increase

of 50 percent or more in the number of graduates trained in the primary

care program or track from academic years 1990-91 to 1992-93; AND

2. Provide evidence of institutional commitment, resources and a

workable plan demonstrating that by the beginning of the second (02)

year of the grant ALL entering residents in the internal medicine or

pediatric residency training program will receive training that meets

the following continuity of care standards: Each resident must serve a

panel of patients and/or families who recognize him or her as their

provider of longitudinal and comprehensive (including preventive and

psychosocial) health care. This continuity experience must be scheduled

principally in ambulatory care settings described in Project

Requirement #9 of the Program Guide. A resident's time in these

settings must (a) comprise at least 10 percent of his or her total

training time (excluding vacation time) during each year of the program

(ie., at least one-half day per week); (b) comprise at least 20 percent

of his or her total training time (excluding vacation time for the

entire training period; and (c) be scheduled in at least 9 months of

each year of training.

(B) Applicants that did not have a separate match number for an

identified primary care track or program in 1993 AND that did not

receive support from this grant program in the last 3 years can qualify

for this preference by:

1. Demonstrating institutional commitment to training all residents

for primary care careers;

2. Providing continuity of care experience for ALL internal

medicine and/or pediatrics residents in accordance with the provisions

cited in A.2 above by the beginning of the second year of grant support

(July 1, 1995).

Additional Information

If additional programmatic information is needed, please contact:

Ms. Sara Kearney, Primary Care Medical Education Branch, Division of

Medicine, Bureau of Health Professions, Health Resources and Services

Administration, 5600 Fishers Lane, Parklawn Building, Room 9A-20,

Rockville, Maryland 20857, Telephone: (301) 443-6820, FAX: (301) 443-

8890.

This program is listed at 93.884 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: April 20, 1994.

Ciro V. Sumaya,

Administrator.

[FR Doc. 94-9957 Filed 4-22-94; 8:45 am]

BILLING CODE 4160-15-P