[Federal Register Volume 59, Number 4 (Thursday, January 6, 1994)]
[Notices]
[Pages 767-769]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 94-178]


[[Page Unknown]]

[Federal Register: January 6, 1994]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES
Health Resources and Services Administration

 

Program Announcement, Proposed Minimum Percentages for ``High 
Rate'' and ``Significant Increase in the Rate'' for Implementation of 
the General Statutory Funding Preference and Proposed Funding Priority 
for Grants for Establishment of Departments of Family Medicine for 
Fiscal Year 1994

    The Health Resources and Services Administration (HRSA) announces 
that applications for fiscal year (FY) 1994 Grants for Establishment of 
Departments of Family Medicine are being accepted under the authority 
of section 747(b), (previously section 780) of the Public Health 
Service (PHS) Act, title VII, as amended by the Health Professions 
Education Extension Amendments of 1992, Public Law 102-408, dated 
October 13, 1992. Comments are invited on the proposed minimum 
percentage for ``High Rate'' and ``Significant Increase in the Rate'' 
for Implementation of the General Statutory Funding Preference, and 
proposed funding priority stated below.
    Approximately $9.4 million will be available for the Grants for 
Establishment of Departments of Family Medicine program in FY 1994. 
Total continuation support recommended is $5.7 million. It is 
anticipated that $3.7 million will be available to support 
approximately 22 competing awards averaging $170,000.

Purpose

    Section 747(b) of the PHS Act authorizes support to schools of 
medicine and osteopathic medicine to meet the costs of projects to 
establish, maintain, or improve family medicine academic administrative 
units (which may be departments, divisions, or other units) to provide 
clinical instruction in family medicine. Funds awarded will be used to: 
(l) Plan and develop model educational predoctoral, faculty development 
and graduate medical education programs in family medicine which will 
meet the requirements of section 747(a), by the end of the project 
period of section 747(b) support; and (2) support academic and clinical 
activities relevant to the field of family medicine.
    The program may also assist schools to strengthen the 
administrative base and structure that is responsible for the planning, 
direction, organization, coordination, and evaluation of all 
undergraduate and graduate family medicine activities. Funds are to 
complement rather than duplicate programmatic activities for actual 
operation of family medicine training programs under section 747(a).

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 50 competing applications for the Grants 
for Departments of Family Medicine program. Of those applications 82 
percent were approved and 18 percent were disapproved. Twelve projects, 
or 24 percent of applications received, were funded.
    In FY 1992, HRSA reviewed 71 competing applications. Of those 
applications, 66 percent were approved and 34 percent were disapproved. 
Thirty-six projects, or about 50 percent of the applications received, 
were funded.

Eligibility

    To be eligible to receive support for this grant program, the 
applicant must be a public, or nonprofit private, accredited school of 
medicine or osteopathic medicine.
    To receive support, programs must meet the requirements of final 
regulations as set forth in 42 CFR part 57, subpart R, and section 
791(b) of the PHS Act.
    The period of Federal support will not exceed 5 years.

National Health Objectives for the Year 2000

    The Public Health Service urges applicants to submit work plans 
that address specific objectives of Healthy People 2000. 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 project requirements in section 57.1704;
    2. The administrative and management capability of the applicant to 
carry out the proposed project in a cost effective manner;
    3. The qualifications of the proposed staff and faculty of the 
unit; and
    4. The potential of the project to continue on a self-sustaining 
basis.

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 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.

General Statutory 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 that have 
been recommended for approval by the peer review group.

Proposed Minimum Percentages for ``High Rate'' and ``Significant 
Increase in the Rate''

    ``High rate'' means that 20 percent of all graduates of the medical 
school in 1989 or 1990, whichever is greater, are spending at least 50 
percent of their work time in clinical practice in the specified 
settings.
    ``Significant increase in the rate'' means that, between academic 
years 1991-92 and 1992-93, the rate of placing 1989 or 1990 graduates 
in the specified settings has increased by at least 50 percent and that 
not less than 15 percent of graduates from the most recent year (1990) 
are working in these settings.
    Additional information concerning the implementation of this 
preference has been published in the Federal Register at 58 FR 40659, 
dated July 29, 1993.
Establishment and Expansion
    Public Law 102-408 has amended section 747(b), (previously section 
780) to include the following statutory funding preference for this 
program.
    Section 747(b)(2) provides that preference shall be given to any 
qualified applicant that agrees to expend the award for one of the 
following purposes:
    (a) Establishing an academic administrative unit (defined as a 
department, division, or other unit), for programs in family medicine; 
or
    (b) Substantially expanding the programs of such a unit.
    A program will meet the definition of ``substantial expansion'' if 
it has developed an acceptable plan for a 50 percent increase in a 
sufficient number of the following areas to qualify for 70 points. The 
expansion must be completed within 3 years. 

------------------------------------------------------------------------
                                                                 Points 
------------------------------------------------------------------------
(1) Required 3rd Year Clerkship................................       30
(2) Required Preceptorship.....................................       20
(3) Family Medicine Research...................................       10
(4) Expansion of Faculty.......................................       10
(5) Faculty Development Program for Community Based Faculty....       10
(6) Family Medicine Faculty Represented on Medical School               
 Standing Committees of Admissions or Curriculum...............       10
(7) Family Medicine Faculty Represented on Dean's Executive             
 Committee that determines Tenure..............................      10 
------------------------------------------------------------------------


    More detail on each of these areas will be provided in the program 
application materials.

Established Funding Priority for FY 1994

    The following funding priority was established in FY 1993, after 
public comment at 58 FR 35019, June 30, 1993, and is being continued in 
FY 1994.
    A funding priority will be given to applicants that demonstrate 
either substantial progress over the last 3 years or a significant 
experience of 10 or more years in influencing graduates from those 
minority or low-income populations identified as at-risk of poor health 
outcomes to enter family medicine residency training.

Proposed Funding Priority for FY 1994

    It is proposed that a funding priority be given to applicants based 
on their level of accomplishment in relation to the outcome or process 
measures cited below: 

------------------------------------------------------------------------
        Outcome measures           Points         Process measures      
------------------------------------------------------------------------
--25% of students who graduated        100                              
 in 1991, 1992 and 1993 entered                                         
 family practice residencies.                                           
--20% of students who graduated         75                              
 in 1991, 1992 and 1993 entered                                         
 family practice residencies.                                           
--15% of students who graduated         50  --Required 3rd Year         
 in 1991, 1992 and 1993 entered              Clerkship* (of at least 4  
 family practice residencies.                weeks duration).           
--12% of students who graduated         35  --Required primary care     
 in 1991, 1992 and 1993 entered              preceptorship/mentorship   
 family practice residencies.                program* in preclinical    
                                             years.                     
------------------------------------------------------------------------
*Curricular elements must be in place at the time of application or the 
  applicant must provide satisfactory evidence (including commitments   
  from institutional officials) that the clerkship or preceptorship will
  be operational by the beginning of the third year of the grant.       

Applicants May Only Receive Priority Points in One of the Above Six 
Categories

Information Requirements Provision in Statute

    Under section 791(b) of the Act, the Secretary may make an award 
under the Grants for the Establishment of Departments of Family 
Medicine program only if the applicant for the award submits to the 
Secretary the following information:
    l. A description of rotations or preceptorships for students, or 
clinical training programs for residents, that have the principal focus 
of providing health care to medically underserved communities.
    2. The number of faculty on admissions committees who have a 
clinical practice in community-based ambulatory settings in medically 
underserved communities.
    3. With respect to individuals who are from disadvantaged 
backgrounds, or from medically underserved communities, the number of 
such individuals who are recruited for academic programs of the 
applicant, the number of such individuals who are admitted to such 
programs, and the number of such individuals who graduate from such 
programs.
    4. If applicable, the number of recent graduates who have chosen 
careers in primary health care.
    5. The number of recent graduates whose practices are serving 
medically underserved communities.
    6. A description of whether and to what extent the applicant is 
able to operate without Federal assistance under this title.
    Additional details concerning the implementation of this 
information requirement have been published in the Federal Register at 
58 FR 43642, August 17, 1993, and will be provided in the application 
materials.

Additional Information

    Interested persons are invited to comment on the proposed minimum 
percentages for ``high rate'' and ``significant increase in the rate'' 
for implementation of the general statutory funding preference, and 
funding priority. All comments received on or before February 7, 1994 
will be considered before the final minimum percentages for ``high 
rate'' and ``significant increase in the rate'' for implementation of 
the general statutory funding preference, and funding priority 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, Parklawn 
Building, room 4C-25, 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: Mrs. Judy 
Bowen, Grants Management Specialist (D-32), Residency and Advanced 
Grants Section, Bureau of Health Professions, Health Resources and 
Services Administration, Parklawn Building, room 8C-26, 5600 Fishers 
Lane, Rockville, Maryland 20857, Telephone: (301) 443-6960, FAX: (301) 
443-6343.
    Completed applications should be returned to the Grants Management 
Branch at the above address.
    Questions regarding programmatic information should be directed to: 
Ms. Shelby Biedenkapp, Program Specialist, Resources Development 
Section, PCMEB, Division of Medicine, Bureau of Health Professions, 
Health Resources and Services Administration, Parklawn Building, room 
4C-04, 5600 Fishers Lane, Rockville, Maryland 20857, Telephone: (301) 
443-3614, FAX: (301) 443-8890.

Paperwork Reduction Act

    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. This approval includes the burden for 
collection of information for the statutory general preference and for 
the information requirement provision. (OMB #0915-0060, expiration date 
7/31/95)
    The deadline date for receipt of applications is February 4, 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 postmark or obtain a legibly dated receipt from a 
commercial carrier or the 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 93.984 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: November 29, 1993.
William A. Robinson,
Acting Administrator.
[FR Doc. 94-178 Filed 1-5-94; 8:45 am]
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