Request for Comments for Scholarships for Disadvantaged Students

DEPARTMENT OF HEALTH AND HUMAN SERVICES

Health Resources and Services Administration

Request for Comments for Scholarships for Disadvantaged Students

The Health Resources and Services Administration (HRSA) announces

that applications for fiscal year (FY) 1999 for the Scholarships for

Disadvantaged Students (SDS) program are being accepted under the

authority of section 737 of the Public Health Service Act (the Act),

Title VII, Part B, as amended by the Health Professions Education

Partnerships Act of 1998, Pub. L. 105-392, dated November 13, 1998.

This notice requesting comments on proposed eligibility criteria,

preferences and priorities includes updates to information provided in

the January 6, 1999 program announcement.

Purpose

The SDS program provides funds to health professions and nursing

schools for the purpose of assisting such schools in providing

scholarships to individuals from disadvantaged backgrounds who are

enrolled (or accepted for enrollment) as full-time students in the

schools.

For purposes of the SDS program in FY 1999, an ``individual from a

disadvantaged background'' is defined in 42 CFR 57.1804, subpart S, as

one who:

(1) Comes from an environment that has inhibited the individual

from obtaining the knowledge, skill, and abilities required to enroll

in and graduate from a health professions or nursing school, or from a

program providing education or training in allied health professions;

or

(2) Comes from a family with an annual income below a level based

on low-income thresholds according to family size published by the U.S.

Bureau of the Census, adjusted annually for changes in the Consumer

Price Index, and adjusted by the Secretary for use in all health

professions and nursing programs. The Secretary will periodically

publish these low income levels in the Federal Register.

The following income figures determine what constitutes a low-

income family for purposes of the SDS program for FY 1999.

------------------------------------------------------------------------

Income

Size of parents' family \1\ level \2\

------------------------------------------------------------------------

1............................................................ $10,900

2............................................................ 14,100

3............................................................ 16,800

4............................................................ 21,500

5............................................................ 25,400

6 or more.................................................... 28,500

------------------------------------------------------------------------

\1\ Includes only dependents listed on Federal income tax forms.

\2\ Adjusted gross income for calendar year 1998, rounded to nearest

$100.

Under the FY 1999 appropriations bill, $38.1 million has been

appropriated for this program. Of the funds available for FY 1999, 16

percent shall be made available to schools agreeing to expend the funds

only for nursing scholarships. The balance will support scholarships

for eligible health professions students. An estimated 490 awards will

be made to institutions participating in this program. The period of

fund availability will be for one academic year.

Use of Funds

Funds awarded to a school under this program may be used as

follows:

(1) To award scholarships to former recipients of scholarships

under the Exceptional Financial Need (EFN) Scholarship program and the

Financial Assistance for Disadvantaged Health Professions Students

(FADHPS) program (sections 736 and 740(d)(2)(B) of the Public Health

Service Act, as such sections existed prior to the enactment of Pub. L.

105-392), at levels comparable to what these students would have

received prior to phase out of the EFN and FADHPS programs, and with

service agreements that are consistent with those the students entered

into to receive EFN and FADHPS funds in FY 1998. The Secretary has

notified those schools with former EFN and FADHPS recipients (who are

enrolled in allopathic medical, osteopathic medical, or dental schools

only) regarding the procedures for receiving funding for these

students.

(2) To award scholarships to eligible students enrolled in the

school, to be expended only for tuition expenses, other reasonable

educational expenses, and reasonable living expenses (as defined by the

school for all students attending the school) incurred while enrolled

in a school as a full-time student. The amount of the scholarship may

not, for any year of attendance, exceed the total amount required for

the year for the expenses specified above, and may not exceed the

student's financial need, as determined in accordance with a need

analysis procedure approved by the Department of Education.

Any school receiving SDS funds must maintain separate

accountability for these funds.

School Eligibility

An entity that is eligible to receive funds under this program is:

(1) As defined in section 799B of the Act, a school of medicine,

osteopathic medicine, dentistry, pharmacy, podiatric medicine,

optometry, veterinary medicine, public health, chiropractic, or allied

health, a school offering a graduate program in behavioral and mental

health practice, or an entity providing programs for the training of

physician assistants; or, as defined in section 801 of the Act, is a

school of nursing. Each school or program must be accredited by a

recognized body or bodies approved for such purpose by the Secretary of

Education, and by a specialized accrediting body approved for the

health discipline applying for program participation; and

(2) Carrying out a program for recruiting and retaining students

from disadvantaged backgrounds, including students who are members of

racial and ethnic minorities.

Proposed School or Program Eligibility Criteria

The Senate Report accompanying Pub. L. 105-392 states that the

committee expects the Secretary to apply appropriate standards in

determining which schools or programs from all eligible disciplines

have complied with the requirement to be carrying out a program for

recruiting and retaining students from disadvantaged backgrounds, using

[[Page 29661]]

outcome-based measures that provide an indication of the success of the

program. The report further states that the existence of a recruitment

and retention program for students from disadvantaged backgrounds

should not, in itself, result in the eligibility of a school or program

if the school or program is unable to demonstrate that the recruitment

and retention program has achieved success, based on the number and/or

percentage of disadvantaged students who graduate from the school (p.

20, Senate Report 105-220). Accordingly, the Secretary is proposing to

establish the following outcome-based measures with which a school or

program must comply to be eligible to receive SDS funds in FY 1999:

(1) Individuals from disadvantaged backgrounds must comprise at

least 5 percent of the total enrollment in the school or program for

which funds are requested, based on enrollment data for academic year

1997-98;

(2) Individuals from disadvantaged backgrounds must comprise at

least 5 percent of the total graduates from the school or program for

which funds are requested, based on graduates for academic year 1997-

98; and

(3) The ratio of individuals from disadvantaged backgrounds who

graduated, compared with the individuals from disadvantaged backgrounds

who are enrolled, must be at least 15 percent for 5-year programs, 20

percent for 4-year programs, 25 percent for 3-year programs, and 40

percent for 2-year programs.

Since the use of outcome measures to determine eligibility would be

a new requirement in FY 1999, and since the timing of the enactment of

the new statute has provided very little lead time to notify schools or

programs of the new outcome measures, the Secretary has established

very low measures for FY 1999. It is the Secretary's view that any

school or program that cannot meet the 5 percent thresholds and the

retention ratio described above cannot reasonably be considered to have

a strong commitment to the recruitment and retention of individuals

from disadvantaged backgrounds. However, recognizing that these initial

levels are very low, and that many schools and programs have indicated

since the SDS program began that they have activities in place to

support the education of individuals from disadvantaged backgrounds,

the Secretary is proposing that the outcome-based measures with which a

school or program must comply to be eligible to receive SDS funds be

increased, for FY 2000, to the following levels:

(1) Individuals from disadvantaged backgrounds must comprise at

least 10 percent of the total enrollment in the school or program for

which funds are requested, based on enrollment data for academic year

1998-99;

(2) Individuals from disadvantaged backgrounds must comprise at

least 10 percent of the total graduates from the school or program for

which funds are requested, based on graduates for academic year 1998-

99; and

(3) The ratio of individuals from disadvantaged backgrounds who

graduated, compared with the individuals from disadvantaged backgrounds

who are enrolled, must be at least 15 percent for 5-year programs, 20

percent for 4-year programs, 25 percent for 3-year programs, and 40

percent for 2-year programs.

The Secretary intends that the proposed threshold levels for

determining a school or program's eligibility will continue to increase

gradually each year until they reach an optimal level for assuring that

disadvantaged students are represented in the health care workforce at

levels that best address the HRSA goals of improved diversity and

distribution.

Evaluation Criteria for Fiscal Year 1999

For FY 1999, the Secretary is proposing that applications will be

evaluated based on the degree to which a school or program meets the

requirements listed above under ``School Eligibility.'' Guidance for

presenting the information will be provided in the FY 1999 application

materials. Due to the new eligibility requirements, all applicant

schools and programs, including schools and programs that received

funds for academic year 1998-99, must submit an application to be

considered for funding in FY 1999.

Student Eligibility

To qualify for the SDS program, a student would be required to:

(1) Be a resident of the U.S. and either be a U.S. citizen, a U.S.

national, an alien lawfully admitted for permanent residence in the

U.S., a citizen of the Commonwealth of the Northern Mariana Islands, a

citizen of the Commonwealth of Puerto Rico, or a citizen of the

Republic of Palau, or a citizen of the Marshall Islands, or a citizen

of the Federated States of Micronesia;

(2) Meet the definition of an ``individual from a disadvantaged

background'' as defined above; and

(3) Have a financial need for a scholarship, in accordance with a

need analysis procedure approved by the Department of Education (Pub.

L. 105-244, Part F, The Higher Education Act of 1965 as amended). In

addition, any student who is enrolled (or accepted for enrollment) in a

health profession school or program must provide information on his or

her parents' financial situation, regardless of the tax status of the

student; and

(4) Be enrolled (or accepted for enrollment) at an eligible school

for enrollment as a full-time student in a program leading to a degree

in a health profession or nursing.

Student Preferences

The law requires that in providing SDS scholarships, the school or

program give preference to students for whom the cost of attending an

SDS school or program would constitute a severe financial hardship.

Severe financial hardship is to be determined by the school or program

in accordance with standard need analysis procedures prescribed by the

Department of Education for its Federal student aid programs. The

school or program has discretion in deciding how to determine which

students have ``severe financial hardship,'' as long as the standard is

applied consistently to all eligible students.

The law also requires that schools give preference to former

recipients of scholarships under sections 736 (EFN Scholarships) and

740(d)(2)(B) (FADHPS Scholarships), as such sections existed on

November 12, 1998. The Secretary is implementing this preference by

making a separate allocation of funds for these students, based on

information provided by schools (allopathic medical, osteopathic

medical, and dental schools with former EFN and FADHPS recipients

only), prior to allocating the remaining SDS money for all other

eligible students.

Proposed Student Preference

The Secretary is also proposing that, beginning in academic year

2000-2001, schools or programs give preference in the awarding of SDS

funds to students who have participated in an academic enrichment

program funded in whole or in part by the Health Careers Opportunity

Program (HCOP), authorized by section 739 of the Act. This preference

is intended to help assure that students who have participated in HCOP

programs are not deterred from enrolling in a health professions school

or program due to a lack of financial aid. Under this preference, it

would be the school's or program's responsibility to identify HCOP

students to assure that they receive preference in the awarding of SDS

funds. For example, the school or

[[Page 29662]]

program could ask, as part of the financial aid application, whether

the student participated in an academic enrichment program funded by

HCOP, or could work with the admissions office to determine which

students have been involved in HCOP programs. The Secretary intends

that schools and programs implement this preference without a

significant additional burden. Under this preference, the school or

program would continue to have discretion in determining the amount of

funds to award to HCOP students, but would be required to identify and

fund HCOP students (provided they have financial need) before funding

other eligible students who do not meet a student preference.

Schools and programs that currently have access to information on

which students have participated in HCOP programs are encouraged to

implement this preference beginning in academic year 1999-2000.

However, since some schools and programs may not currently have access

to this information, the Secretary would not require schools and

programs to implement the preference for HCOP students until academic

year 2000-2001.

Definitions

Black or African American means a person having origins in any of

the black racial groups of Africa.

Hispanic or Latino means a person of Cuban, Mexican, Puerto Rican,

South or Central American or other Spanish culture or origin,

regardless of race.

American Indian or Alaska Native means a person having origins in

any of the original peoples of North and South America (including

Central America) and who maintains tribal affiliation or community

attachment.

Definitions listed above are contained in Directive No. 15 of

Office of Management and Budget Circular No. A-46, as revised.

Native American as defined in Pub. L. 101-527, means American

Indian, Alaska Native, Aleut, or Native Hawaiian.

Graduate program in behavioral health and mental health practice

means a graduate program in clinical psychology, clinical social work,

professional counseling, or marriage and family therapy as defined in

section 799B(1)(D) of the Act.

Graduate program in clinical social work means an accredited

graduate program in a public or nonprofit private institution in a

State that provides training in a concentration in health or mental

health care leading to a graduate degree in social work as defined in

section 799B(1)(C) of the Act.

Graduate program in marriage and family therapy means an accredited

graduate program in a public or nonprofit private institution in a

State that provides training in a concentration leading to a graduate

degree in marriage and family therapy as defined in section 799B(1)(C)

of the Act.

Graduate program in professional counseling means an accredited

graduate program in a public or nonprofit private institution in a

State that provides training in a concentration leading to a graduate

degree in gerontological counseling, mental health counseling, or

rehabilitation counseling.

Medically underserved community means any geographic area and/or

population served by any of the following practice sites--

(1) Community Health Centers (section 330 of the Act);

(2) Migrant Health Centers (section 329 of the Act);

(3) Health Care for the Homeless Grantees (section 340 of the Act);

(4) Public Housing Primary Care Grantees (section 340A of the Act);

(5) Rural Health Clinics, federally designated (section 1861(aa)(2)

of the Social Security Act);

(6) National Health Service Corps sites, freestanding (section 333

of the Act);

(7) Indian Health Service sites (Pub. L. 93-638 for tribally

operated sites and Pub. L. 94-437 for Indian Health Service operated

sites);

(8) Federally Qualified Health Centers (section 1905(a) and (1) of

the Social Security Act);

(9) Primary Medical Care, Mental Health, and Dental Health

Professional Shortage Areas (HPSAs) (designated under section 332 of

the Act);

(10) State or Local Health Departments as defined and published in

the Federal Register Notice of April 4, 1994 (59 FR 15741-44); or

(11) Ambulatory practice sites designated by State Governors as

serving medically underserved communities as defined and published in

the Federal Register Notice of April 4, 1994 (59 FR 15741-44).

Proposed Institutional Preferences

The Senate Report accompanying Pub. L. 105-392 directs the

Secretary to restrict eligibility, for purposes of ``allied health,''

to the following baccalaureate or graduate degree allied health

professions schools or programs: Dental hygiene, medical laboratory

technology, occupational therapy, physical therapy, radiologic

technology, speech pathology, audiology, and registered dieticians

(Senate Report 105-220, p. 20). Accordingly, for fiscal year 1999 and

beyond, among allied health schools or programs, the Secretary proposes

to give preference to the allied health schools or programs listed

above.

Proposed Institutional Funding Priorities

In accordance with section 737(c) of the Act, the Secretary shall

give priority to eligible entities based on the proportion of

graduating students going into primary care, the proportion of

underrepresented minority students, and the proportion of graduates

working in medically underserved communities. Any eligible school or

program that qualifies for one or more funding priorities will receive

extra weighting in the allocation formula.

Primary Care Funding Priority

For purposes of determining which schools and programs receive

priority based on the proportion of graduating students going into

primary care, the Secretary proposes to define primary care to include:

(1) Allopathic and osteopathic medical students that enter family

medicine, general internal medicine, general pediatrics, and preventive

medicine, and general osteopathic medicine. This is consistent with the

statutory definition of primary care for the Primary Care Loan (PCL)

program, authorized under section 723 of the Act;

(2) General dentistry, which has been included as primary care for

purposes of the Exceptional Financial Need (EFN) Scholarship program

and the Financial Assistance for Disadvantaged Health Professions

Students (FADHPS) program;

(3) Nurse practitioners and nurse midwives who are practicing

primary care; and

(4) Physician assistants who are practicing primary care.

For purposes of the SDS program, the Secretary is defining

``primary care'' to include the above disciplines because, with the

exception of general dentistry, they are involved in the provision of

comprehensive and continuous care and provide an entry to the health

care system. The Secretary has included general dentistry because it

acts as the entry to the health care system for a particular type of

care which is not covered by the other disciplines.

For the above disciplines, a school or program may qualify for the

primary care priority if at least 50 percent of its graduates from the

specified year are practicing primary care. For allopathic and

osteopathic medical schools, the determination of which schools are

eligible for the funding priority would

[[Page 29663]]

be based on the same data used to determine compliance with the PCL

school requirements. Thus, for the FY 1999 award process, priority

would be based on the activities, during academic year 1997-98, of Post

Graduate Year (PGY)-3 graduates (i.e., those who graduated during

academic year 1994-95), but for FY 2000, priority would be based on the

activities, during academic year 1998-99, of PGY-4 graduates (i.e.,

those who graduated during academic year 1994-95). This would allow

allopathic and osteopathic medical schools to submit, for the SDS

program, the same data submitted for the PCL program if they are PCL

participants. For the remaining primary care disciplines, the

determination of compliance would be based on the activities, during

academic year 1997-98, of students who graduated during academic year

1996-97.

Underrepresented Minority Funding Priority

For purposes of granting priority based on the proportion of

underrepresented minority students in FY 1999, the Secretary proposes

to give priority to any school or program that has an underrepresented

minority enrollment that is above the national average for the

discipline. It is the Secretary's intention to gradually increase this

percentage in future years until it is equal to the underrepresented

minority enrollment needed to reach parity in the health care

workforce.

Medically Underserved Community Funding Priority

For purposes of granting priority based on the proportion of

graduates working in medically underserved communities, the Secretary

proposes to give priority to any school or program for which at least

10 percent of the graduates from the specified year are practicing in

medically underserved communities. It is the Secretary's intention to

gradually increase this percentage in future years until it is

representative of a level that has a meaningful impact on the

elimination of medically underserved communities. For allopathic and

osteopathic medical schools, the determination of which schools are

eligible for the funding priority would be based on the same population

of graduates used to determine compliance with the primary care funding

priority. Thus, for the FY 1999 awards, priority would be based on the

activities, during academic year 1997-98, of allopathic and osteopathic

medical students who graduated 3 years earlier (academic year 1994-95),

but for FY 2000, priority would be based on the activities, during

academic year 1998-99, of allopathic and osteopathic medical students

who graduated 4 years earlier (academic year 1994-95). For other

schools and programs, priority would be based on the activities of

students during 1997-98 who graduated in 1996-97. Schools and programs

that do not have data on the percentage of their graduates who are

practicing in medically underserved communities may still apply for SDS

funds, but would not be considered for this funding priority.

Proposed Procedures for Calculating Awards

Awards to eligible schools and programs would be calculated by

comparing the weighted number of eligible students in each eligible

school and program with the total weighted number of eligible students

in all eligible schools and programs. For FY 1999 and beyond, the

number of ``eligible students'' for each school or program would be the

lesser of:

(1) The number of disadvantaged graduates for academic year 1997-98

multiplied times the number of years required to complete the program

(based on a 9-month academic year); or

(2) The total disadvantaged enrollment during academic year 1997-

98. For example, if a 4-year program had 100 disadvantaged graduates

and a disadvantaged enrollment of 500, its award would be based on 400

eligible students (100 graduates times 4). If another 4-year program

had 100 disadvantaged graduates and a disadvantaged enrollment of 300,

its award would be based on 300 eligible students (the total

disadvantaged enrollment).

After determining the number of eligible students at each school or

program, this number would be adjusted to reflect the extra weighting

associated with any funding priorities. Depending upon the number of

schools and programs that qualify for one or more funding priorities,

it is possible that some eligible schools and programs may not receive

funding.

National Health Objectives for the Year 2000

The Public Health Service is committed to achieving the health

promotion and disease prevention objectives of Healthy People 2000, a

PHS-led national activity for setting priority areas. The Scholarships

for Disadvantaged Students program is related to the priority area of

Academic and Community Partnership 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 20402-0325; 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 Department education programs

and programs which provide comprehensive primary care services to the

underserved.

Smoke-Free Workplace

The Department strongly encourages all award recipients to provide

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

and Pub. L. 103-227, the Pro-Children Act of 1994, prohibits smoking in

certain facilities that receive Federal funds in which education,

library, day care, health care, and early childhood development

services are provided to children.

Interested persons are invited to comment on the proposed

eligibility criteria and preferences for participating institutions,

institutional funding priorities and preferences, nonstatutory

preference of awarding funds to prior HCOP recipients, and procedures

for calculating scholarship awards. The comment period will close on

July 2, 1999.

All comments received before the deadline date will be considered

before final acceptability of the eligibility criteria for

participating institutions, institutional funding priorities and

preferences, nonstatutory preference of awarding funds to prior HCOP

recipients, and procedures for calculating scholarship awards for the

FY 2000 will be applied.

Written comments should be addressed to: Capt. Bruce C. Baggett,

Director, Division of Student Assistance; Bureau of Health Professions,

Health Resources and Services Administration, Parklawn Building, room

8-48, 5600 Fishers lane, Rockville, Maryland 20857; telephone (301)

443-5395.

Application Availability

Applications are required from all schools and programs which are

interested in applying for funding in FY 1999. The SDS application for

FY 1999 must be filed via the Internet. Schools may access the SDS

application at www.hrsa.gov/bhpr/dsa/sds. All applications and fiscal

reports will be required to be filed electronically. However, if

assistance is required,

[[Page 29664]]

please contact the Scholarship Team at the above address.

The deadline for submitting application materials is July 2, 1999.

The materials for this program have been approved by the Office of

Management and Budget (OMB) under the Paperwork Reduction Act. The OMB

clearance number is 0915-0061.

The Catalog of Federal Domestic Assistance Number for the

Scholarships for Disadvantaged Students program is 93.925. This program

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 Systems Reporting

Requirements.

Dated: May 25, 1999.

Claude Earl Fox,

Administrator.

[FR Doc. 99-13925 Filed 6-1-99; 8:45 am]

BILLING CODE 4160-15-P