[Federal Register Volume 59, Number 33 (Thursday, February 17, 1994)]
[Unknown Section]
[Page 0]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 94-3598]


[[Page Unknown]]

[Federal Register: February 17, 1994]


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FEDERAL RESERVE SYSTEM
 

DEPARTMENT OF HEALTH AND HUMAN SERVICES

Health Resources and Services Administration
[2168]

Program Announcement and Proposed Funding Priorities for 
Cooperative Agreements for Area Health Education Centers Program 
for Fiscal Year 1994

    The Health Resources and Services Administration (HRSA) announces 
that applications are now being accepted for fiscal year 1994, 
Cooperative Agreements for the Area Health Education Centers (AHEC) 
Program under the authority of section 746(a)(1), (previously section 
781(a)(1), title VII of the Public Health Service (PHS) Act, as amended 
by the Health Professions Education Extension Amendments of 1992, dated 
October 13, 1992. Comments are invited on the proposed funding 
priorities stated below.
    Approximately $18.7 million will be available for this program in 
FY 1994. Total continuation support recommended is $8.4 million. It is 
anticipated that $10.3 million will be available to support nine 
competing awards averaging $1.14 million.
    The Health Professions Education Extension Amendments of 1992, 
makes the following amendments to this program.

(1) Period of Support

    The maximum period during which the AHEC programs may receive 
payments shall be 12 years, subject to annual approval by the Secretary 
and the availability of appropriated funds. The maximum period during 
which an AHEC center developed by a program may receive payments shall 
be 6 years. The provision for a 12-year maximum shall not be construed 
as establishing a limitation on the number of awards under this 
authority that may be made to the school involved.

(2) General Requirements

    As provided in section 746(b), a medical or osteopathic medical 
school may not receive an award for operational expenses under the 
existing basic AHEC award authority unless the program:
    (a) Maintains preceptorship educational experiences for health 
science students;
    (b) Maintains community-based primary care residency programs or is 
affiliated with such programs;
    (c) Maintains continuing education programs for health professions 
or coordinates with such programs;
    (d) Maintains learning resource and dissemination systems for 
information identification and retrieval;
    (e) Has agreements with community-based organizations for the 
delivery of education and training in the health professions;
    (f) Is involved in the training of health professionals (including 
nurses and allied health professionals), except to the extent 
inconsistent with the law of the State in which the training is 
conducted; and
    (g) Carries out recruitment programs for the health science 
professions, or programs for health-career awareness, among minority 
and other elementary or secondary students from the areas the program 
has determined to be medically underserved;

(3) Requirements for Participation of Other Health Professions 
Schools or Programs

    The former requirement that participating medical schools provide 
for the active participation of at least 2 schools or programs of other 
health professions (including a school of dentistry if there is one 
affiliated with the medical school's university) is modified to require 
also participation of a graduate program of mental health practice if 
there is one affiliated with the university.

(4) Requirement for Expenditure of at Least 75 Percent of Award in 
Centers

    The former requirement that at least 75 percent of the total funds 
provided to a school under any AHEC program authority (basic AHEC 
programs, AHEC Special Initiatives or Model AHEC programs) be expended 
by the AHEC program in AHEC centers has been amended, as provided in 
section 746(e)(1)(A) to require also that the school enter into an 
agreement with each of such centers for purposes of specifying the 
allocation of the 75 percent of funds.

(5) Alternative Matching Requirements for New AHEC Programs Developed 
Under Basic AHEC Authority

    As provided in section 746(e)(2), for an AHEC center developed as 
part of an AHEC program first funded under the basic AHEC authority on 
or after October 13, 1992, the existing requirement that not more than 
75 percent of total operating funds be provided by the Federal 
Government (section 746(e)(1)(B)), is amended to establish a ceiling of 
55 percent of any fifth or sixth year of the development or operation 
of the center.

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 17 applications for Cooperative 
Agreements for the Area Health Education Centers Program. Of those 
applications, 58.9 percent were approved and 41.1 percent were 
disapproved. Eight projects, or 47 percent of the applications 
received, were funded.
    In FY 1992, HRSA reviewed 11 applications. Of those applications, 
73 percent were approved and 27 percent were disapproved. Three 
projects or 27 percent of the applications received, were funded.

Purpose

    Section 746(a)(1) of the PHS Act authorizes Federal assistance to 
schools of medicine and osteopathic medicine which have cooperative 
arrangements with one or more public or nonprofit private area health 
education centers for the planning, development and operation of area 
health education center programs.

Eligibility

    To be eligible to receive support for an area health education 
center cooperative agreement, the applicant must be a public or 
nonprofit private accredited school of medicine or osteopathic medicine 
or consortium of such schools, or the parent institution on behalf of 
such school(s).
    Applicants may request up to 3 years of support with the 
expectation that AHECs planned and developed in years 1 and 2 would be 
fully operational no later than the 3rd year. The period of Federal 
support should not exceed 12 years for an area health education center 
program and 6 years for an area health education center.
    The Health Professions Reauthorization Act of 1988, title VI of 
Public Law 100-607, amended the authority for the area health education 
center program by:
    1. Providing for a waiver, under specified circumstances, of the 
provision now contained in section 746(a)(2)(C) prohibiting an AHEC 
from being a school of medicine or osteopathic medicine, the parent 
institution of such a school, or a branch campus or other subunit of a 
school of medicine or osteopathic medicine or its parent institution, 
or a consortium of such entities. The waiver of this provision applies 
to an AHEC having, at the time of initial application, an operating 
program supported by appropriations of a State legislature as well as 
local resources;
    2. Reducing the minimum number of individuals enrolled in first-
year positions in a rotating osteopathic internship or a medical 
residency training program in family medicine, general internal 
medicine, or general pediatrics from six individuals to four; and
    3. Revising the requirement that each AHEC shall ``conduct 
interdisciplinary training and practice involving physicians and other 
health personnel including, where practicable, physician assistants and 
nurse practitioners'' to add ``and nurse midwives.''
    To receive support, programs must meet the requirements of the 
regulations as set forth in 42 CFR part 57, subpart MM.

Degree of Federal Involvement in the Planning, Development and 
Operation of Area Health Education Centers Program

    The Bureau of Health Professions, within the Health Resources and 
Services Administration, has substantial programmatic involvement in 
the planning, development, and administration of the AHEC projects by:
    1. Reviewing and approving plans upon which continuation of the 
cooperative agreement is contingent in order to permit appropriate 
direction and redirection of activities;
    2. Reviewing and approving all contracts and agreements among 
recipient medical or osteopathic schools, other health professions 
schools and community-based centers;
    3. Participating with project staff in the development of funding 
projections;
    4. Developing, with project staff, individual project data 
collection systems and procedures; and
    5. Participating with project staff in the design of project 
evaluation protocols and methodologies.

Matching Funds Requirement

    Section 746(e)(1)(B) of the Act requires that not more than 75 
percent of total operating funds of a program in any year shall be 
provided by the Federal Goverment. However, as provided in section 
746(e)(2), for an AHEC center developed as part of an AHEC program 
first funded under the basic AHEC authority on or after October 13, 
1992, a ceiling of 55 percent of any fifth or sixth year of the 
development or operation of a center is established.

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 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.

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 program requirements set forth in 42 CFR 57.3804;
    2. The capability of the applicant to carry out the proposed 
project; and
    3. The extent of the need of the area to be served by the area 
health education centers.

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 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 Preferences for Fiscal Year 1994

    The following funding preference No. 1 was established in FY 1989 
after public comment (at 54 FR 189) dated January 4, 1989. Funding 
Preference No. 2, was established in FY 1993, after public comment at 
58 FR 12245, dated March 3, 1993. These funding preferences are being 
extended in FY 1994.
    In making awards for fiscal year 1994, a funding preference will be 
given to:
    (1) Approved competing continuation applications under section 
746(a)(1); and
    (2) Approved competing new applications under section 746 (a)(1) 
which propose to plan, develop and implement an AHEC program in a State 
where there is no existing AHEC program. These applications will be 
funded after approved competing continuation applications.

Established Funding Priority for Fiscal Year 1994

    The following funding priority was established in FY 1989, after 
public comment at 54 FR 189, dated January 4, 1989, and is being 
extended in FY 1994:
    A funding priority will be given to applications which demonstrate 
substantial clinical training (a student or resident clerkship or 
preceptorship of 4 to 8 weeks) in sites that serve the medically 
underserved.

Proposed Funding Priorities for FY 1994

    It is proposed that a funding priority be given to:
    1. Applicants which demonstrate an increase in the percentage of 
graduates who have entered a Primary Care (Family Medicine, General 
Internal Medicine, General Pediatrics) Residency, for the most recent 
3-year period.
    An overall goal of the AHEC Program is to utilize educational 
interventions to improve the geographic and specialty distribution of 
primary care health personnel, and thereby increase access to health 
care to underserved populations. The achievement of AHEC Program goals 
is enhanced by medical schools (allopathic and osteopathic) which can 
demonstrate a commitment to increasing the number of students who 
select graduate training in a primary care specialty (family medicine, 
general internal medicine, general pediatrics). Such a commitment can 
be demonstrated in the performance and track record of the applicant 
medical schools, during a most recent 3-year period. In times of 
limited dollars, it is reasonable to allocate funds to: (1) Training 
institutions that have primary care training goals that are consonant 
with those of the Bureau of Health Professions and the AHEC Program; 
and (2) institutions that can demonstrate performance in training an 
increasing number of medical students who upon graduation select a 
primary care career specialty.
    2. Applicants which demonstrate an increase in the percentage of 
underrepresented minority graduates for the most recent 3-year period.
    This funding priority is proposed to encourage the training of 
underrepresented minorities in an effort to increase the number of 
underrepresented minorities who are accepted to medical school 
(allopathic or osteopathic) and complete training. It is assumed that 
these individuals, following training, are most likely to provide much 
needed care in medically underserved communities to predominantly 
minority populations. It is reasonable to provide limited funds to 
institutions which demonstrate a commitment to increasing the number of 
underrepresented minorities who graduate from medical school. Such 
commitment can be demonstrated in the performance and track record of 
the medical school, during a most recent 3-year period. Current data 
indicate that the percentage of underrepresented minorities attending 
and graduating from medical schools is not equal to the percentage of 
underrepresented minorities in the United States. This priority will 
assist in addressing the needs of underserved minority populations. The 
term ``underrepresented minorities'' means, with respect to a health 
profession, racial and ethnic populations that are underrepresented in 
the health profession relative to the number of individuals who are 
members of the population involved. For this program, it means American 
Indians or Alaskan Natives, Blacks, Hispanics, and, potentially, 
various subpopulations of Asian individuals. Applicants must evidence 
that any particular subgroup of Asian individuals is underrepresented 
in a specific discipline.

Additional Information

    Interested persons are invited to comment on the proposed funding 
priorities. All comments received on or before March 21, 1994 will be 
considered before the final funding priorities 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, room 
4C-25, Parklawn Building, 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:

Ms. Diane Murray, Grants Management Specialist (U76), Bureau of Health 
Professions, Health Resources and Services Administration, 5600 Fishers 
Lane, Parklawn Building, room 8C-26, Rockville, Maryland 20857, 
Telephone: (301) 443-6857, Fax: (301) 443-6343.

    Completed applications should be forwarded to the Grants Management 
Branch at the above address.
    If additional programmatic information is needed, please contact: 
Ms. Cherry Tsutsumida, Chief, AHEC and Special Programs Branch, 
Division of Medicine, Bureau of Health Professions, Health Resources 
and Services Administration, 5600 Fishers Lane, Parklawn Building, room 
4C-05, Rockville, Maryland 20857, Telephone : (301) 443-6817, Fax: 
(301) 443-8890.
    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 March 15, 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 commercial carrier or 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 is listed at 93.824 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: December 20, 1993.
John H. Kelso,
Acting Administrator.
[FR Doc. 94-3598 Filed 2-16-94; 8:45 am]
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