[Federal Register Volume 59, Number 4 (Thursday, January 6, 1994)]
[Notices]
[Pages 771-774]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 94-180]


[[Page Unknown]]

[Federal Register: January 6, 1994]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES
 

Program Announcement for Grants for Interdisciplinary Training 
for Health Care for Rural Areas for FY 1994

    The Health Resources and Services Administration (HRSA) announces 
that applications are being accepted for fiscal year (FY) 1994, Grants 
for Interdisciplinary Training for Health Care for Rural Areas under 
the authority of section 778, 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.
    Approximately $4,017,000 will be available in FY 1994 for this 
program. Total continuation support recommended is approximately 
$1,600,000. It is anticipated that $2,417,000 will be available to 
support 12 competing awards averaging approximately $180,000.
    Funding for this program is designed to test innovative training 
approaches that may be replicated in similar settings.

Previous Funding Experience

    Previous funding experience is provided to assist potential 
applicants to make better informed decisions regarding submission of an 
application for this program. In FY 1993, HRSA reviewed 29 applications 
for Grants for Interdisciplinary Training for Health Care for Rural 
Areas. Of those applications, 45 percent were approved and 55 percent 
were disapproved. Eight projects, or 28 percent of the applications 
received, were funded. There was no competitive cycle for FY 1992.

Purposes

    Section 778 of the Public Health Service Act, as amended, 
authorizes the Secretary to award grants for interdisciplinary training 
projects designed to provide or improve access to health care in rural 
areas. Specifically, projects funded under this authority shall be 
designed to:
    (a) Use new and innovative methods to train health care 
practitioners to provide services in rural areas;
    (b) Demonstrate and evaluate innovative interdisciplinary methods 
and models designed to provide access to cost-effective comprehensive 
health care;
    (c) Deliver health care services to individuals residing in rural 
areas;
    (d) Enhance the amount of relevant research conducted concerning 
health care issues in rural areas; and
    (e) Increase the recruitment and retention of health care 
practitioners in rural areas and make rural practice a more attractive 
career choice for health care practitioners.
    A recipient of funds may use various methods in carrying out the 
projects described above. The legislation cites the following methods 
as examples:
    (a) The distribution of stipends to students of eligible 
applicants;
    (b) The establishment of a postdoctoral fellowship program;
    (c) The training of faculty in the economic and logistical problems 
confronting rural health care delivery systems; or
    (d) The purchase or rental of transportation and telecommunication 
equipment where the need for such equipment due to unique 
characteristics of the rural area is demonstrated by the recipient.

Eligibility

    To be eligible for a Grant for Interdisciplinary Training for 
Health Care for Rural Areas, each applicant must be located in a State 
and be:
    1. A local health department, or
    2. A nonprofit organization, or
    3. A public or nonprofit college, university or school of, or 
program that specializes in nursing, mental health practice, optometry, 
public health, dentistry, osteopathic medicine, physician assistants, 
pharmacy, podiatric medicine, allopathic medicine, chiropractic, or 
allied health professions.
    Applicants eligible to obtain funds under this grant program shall 
not include for-profit entities, either directly or through a 
subcontract or subgrant.
    Each application must be jointly submitted by at least two eligible 
applicants. One of the applicants must be an academic institution. Each 
application must demonstrate the need and demand for health care 
services, knowledge of available resources and the most significant 
service and educational gaps within its targeted geographic area. One 
applicant must be designated the principal organization responsible and 
accountable for the conduct of the proposed project.
    Support may be requested for this grant program for a project 
period of not more than three years.

Definitions

    ``Clinical Treatment or Training'' means direct, supervised 
participation in patient care by observation, examination and 
performance of procedures as are appropriate for the assigned role of 
the trainee on the rural health care team.
    ``Community Health Center'' means an entity as defined in section 
330 (a) and (b) of the Act and in regulations at 42 CFR 51c.102(c).
    ``Community Mental Health Center'' means for purposes of this grant 
program a multiservice mental health facility which provides essential 
elements of comprehensive mental health services:
    (1) Inpatient services;
    (2) Outpatient services;
    (3) Partial hospitalization services--must include at least day 
care service;
    (4) Emergency services provided 24 hours per day--must be available 
within at least one of the first three services listed above; and/or
    (5) Consultation and education services available to community 
agencies and professions personnel.
    ``Indian Tribe'' or ``Tribal Organization'' means an organization 
or entity as defined in section 4(e) and 4(l) of the Indian Self-
Determination and Education Assistance Act (25 U.S.C. 450b).
    ``Interdisciplinary Training'' means a planned and coordinated 
program of education or training aimed at preparation of functioning 
teams of two or more health care practitioners from different health 
disciplines who will coordinate their activities to provide services to 
a client or group of clients.
    ``Long-Term Care Facility'' is a facility which offers services 
designed to provide diagnostic, preventive, therapeutic, 
rehabilitative, supportive and maintenance services for individuals who 
have chronic physical or mental impairments. This facility may have a 
variety of institutional and non-institutional health settings, 
including the home, and the goal of the service provided is to promote 
the optimum level of physical, social and psychological functioning.
    ``Migrant Health Center'' means an entity as defined in section 
329(a) of the Act and in regulations at 42 CFR 56.102(g)(1).
    ``Native Hawaiian Health Center'' means an entity as defined in the 
Native Hawaiian Health Care Act of 1988 (Pub. L. 100-579) (42 U.S.C. 
11707(4)).
    ``Nonprofit'' as applied to any entity means one, no part of the 
net earnings of which inures, or may lawfully inure, to the benefit of 
any private shareholder or individual.
    ``Postdoctoral Fellowship Program'' means a program of advanced 
academic or professional work, after the attainment of a doctoral 
degree, that is sponsored by a school of/or program that specializes in 
medicine, osteopathic medicine, nursing, dentistry, mental health 
practice, optometry, public health, pharmacy, podiatric medicine, 
physician assistant, chiropractic, or allied health.
    ``Rural'' means geographic areas that are located outside of 
standard metropolitan statistical areas.
    ``Rural Health Care Agency'' means a hospital, community health 
center, migrant health center, rural health clinic, community mental 
health center, long-term care facility, Native Hawaiian health center, 
or facility operated by the Indian Health Service or an Indian tribe or 
tribal organization or Indian organization under a contract with the 
Indian Health Service under the Indian Self-Determination Act.
    ``Rural Health Clinic'' means an entity as defined under section 
1861(aa)(2) of the Social Security Act and in regulations at 42 CFR 
491.2.
    ``State'' means, in addition to the 50 States, only the District of 
Columbia, the Commonwealth of Puerto Rico, the Commonwealth of the 
Northern Mariana Islands, the Virgin Islands, Guam, American Samoa, the 
Trust Territory of the Pacific Islands (the Republic of Palau), the 
Republic of the Marshall Islands, and the Federated States of 
Micronesia.

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, Grants for Interdisciplinary Training for Health Care for 
Rural Areas, 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.

Statutory Project Requirements

    Interdisciplinary training projects funded under section 778 must:
    1. Assist individuals in academic institutions in establishing 
long-term collaborative relationships with health care facilities and 
providers in rural areas, and;
    2. Designate a rural health care agency or agencies for clinical 
treatment or training, including hospitals, community health centers, 
migrant health centers, rural health clinics, community mental health 
centers, long-term care facilities, Native Hawaiian health centers, or 
facilities operated by the Indian Health Service or an Indian tribe or 
tribal organization or Indian organization under a contract with the 
Indian Health Service under the Indian Self-Determination Act.
    Not more than 10 percent of the individuals receiving training with 
section 778 funds shall be trained as doctors of medicine or 
osteopathic medicine. A grantee may not use more than 10 percent of the 
grant funds for administrative costs.

Established Nonstatutory Project Requirements

    The following project requirements were established in fiscal year 
1990 (55 FR 24321, June 15, 1990) and 1991 (56 FR 37713, August 8, 
1991), after public comment, and are being extended in FY 1994.
    A project supported under this grant program must meet the 
following requirements:
    (1) Carry out the following two project purposes, at a minimum, 
among those authorized by section 778:
    (a) Interdisciplinary training to prepare health care practitioners 
to provide services in rural areas; and
    (b) increase the recruitment and retention of health care 
practitioners in rural areas.
    (2) Collaborate with the resources of an Area Health Education 
Center (AHEC) or Geriatric Education Center(GEC) if these centers are 
present in a State or part of a State where the rural interdisciplinary 
training project is conducted.
    (3) Evaluate in a systematic manner, as prescribed by the 
Secretary, its project activity, including determination of a baseline 
at the outset of the project and measurement of progress by trainees 
and faculty.
    (4) Provide and clearly define for each level of training 
(undergraduate, graduate, postgraduate, continuing education and 
faculty training) the disciplines and numbers of students to receive 
training as well as the duration of the training. This is to include an 
outline of basic criteria for the selection of students to participate 
in the training. These project elements are to be tracked and linked to 
project outcomes.
    (5) Provide specific indicators of the extent and means by which it 
plans to become self-sufficient.
    (6) Implement integrated recruitment and retention strategies.
    (7) Establish curriculum elements that address the uniqueness of 
health conditions and ethnic or cultural characteristics of the 
populations in the rural areas to be served.
    (8) Enroll a significant proportion of individuals from rural 
areas, particularly rural health professions shortage areas or 
medically underserved areas.

Review Criteria

    The review of applications will take into consideration the 
following criteria:
    (1) The potential effectiveness of the proposed project in carrying 
out the training purposes of section 778 of the Act;
    (2) The extent to which the project explains the need for the 
project in the rural area to be served;
    (3) The degree to which the proposed project adequately provides 
for the interdisciplinary training of health professionals to practice 
in the rural area to be addressed by the project;
    (4) The degree to which the applicant offers appropriate clinical 
training experiences in rural health care settings;
    (5) The degree to which the applicant demonstrates a commitment to 
establishing and maintaining long-term collaborative relationships 
between academic institutions and health care facilities and providers 
in rural areas;
    (6) The effectiveness of the organizational arrangements necessary 
to carry out the project;
    (7) The administrative and management capability of the applicant 
to carry out the proposed project in a cost-effective manner;
    (8) The capability of the proposed staff and faculty to provide the 
proposed instruction;
    (9) The extent to which the trainee recruitment and selection 
process assures that qualified trainees with significant interest or 
background in rural health care are involved in the project;
    (10) The extent to which the budget justification is reasonable and 
indicates that institutional and community support to the project are 
provided to the maximum extent possible; and
    (11) The extent to which the financial information provided 
indicates an effective utilization of grant funds and indicates that 
the project will continue on a self-sustaining basis.

Other Considerations

    In addition, the following funding factors may be applied in 
determining funding of approved applications.
    A funding preference is defined as the funding of a specific 
category or group of approved applications ahead of other categories or 
groups of approved applications.
    A 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 Preference

    The following funding preference was established in FY 1990, after 
public comment (55 FR 24321, June 15, 1990), and the Administration is 
extending it in FY 1994.
    A funding preference will be given to interdisciplinary training 
involving three or more disciplines. This funding preference will be 
given to applicants that propose and implement training for health care 
practitioners, faculty or students representing three or more 
disciplines.

Established Funding Priority

    The following funding priority was established in FY 1993 after 
public comment (58 FR 5741, January 22, 1993) and the Administration is 
extending this funding priority in FY 1994. In determining the order of 
funding of approved applications a priority will be given to applicant 
institutions (academic) which demonstrate either substantial progress 
over the last three years or a significant experience of ten or more 
years in enrolling and graduating trainees from those minority or low-
income populations identified as at risk of poor health outcomes.

Application Requests

    Application forms will be sent only upon request. Requests for 
application materials and questions regarding grants policy and 
business management issues should be directed to: Ms. Theda Duvall, 
Grants Management Specialist (D-36), Bureau of Health Professions, 
HRSA, Parklawn Building, room 8C-26, 5600 Fishers Lane, Rockville, MD 
20857, Telephone: 301-443-6002, FAX: 301-443-6343.
    Completed applications should be returned to the Grants Management 
Branch at the above address.
    If additional programmatic information is needed, please contact: 
Dr. Marcia Brand, Program Officer, Division of Associated, Dental and 
Public Health Professions, Bureau of Health Professions, HRSA, Parklawn 
Building, room 8C-02, 5600 Fishers Lane, Rockville, MD 20857, 
Telephone: 301-443-6763, FAX: 301-443-1164.
    The standard application for State and local governments is form 
PHS 5161. For other applicants, 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 January 31, 1994. 
Applications will 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 date 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 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, Grants for Interdisciplinary Training for Health care 
for Rural Areas, is listed at 93.192 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 19, 1993.
William A. Robinson,
Acting Administrator.
[FR Doc. 94-180 Filed 1-5-94; 8:45 am]
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