[Federal Register Volume 59, Number 42 (Thursday, March 3, 1994)]
[Unknown Section]
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From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 94-4901]
[[Page Unknown]]
[Federal Register: March 3, 1994]
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DEPARTMENT OF HEALTH AND HUMAN SERVICES
Public Health Service
RIN 0905-AE13
42 CFR Part 57
Grants for Construction of Teaching Facilities, Educational
Improvements, Scholarships, and Student Loans; Grants for Faculty
Training Projects in Geriatric Medicine and Dentistry
AGENCY: Health Resources and Services Administration, PHS, HHS.
ACTION: Notice of proposed rulemaking.
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SUMMARY: This proposed regulation would revise the regulations
governing the program for Grants for Faculty Training Projects in
Geriatric Medicine and Dentistry authorized by section 777(b) of the
Public Health Service Act (the Act), to implement amendments made by
the Health Professions Extension Amendments of 1992 by: (1) Adding a
definition for the term ``Geriatric psychiatry'' to implement the
statutory requirement for the expansion of project support to include
the training of physicians who plan to teach geriatric psychiatry; (2)
adding a definition for the term ``Relevant advanced training or
experience'' to implement the statutory requirement for dentists who
are awarded a 2-year internal medicine or family medicine fellowship
(Dentists must have completed postdoctoral dental training, including
postdoctoral dental education programs or who have ``relevant advanced
training or experience''.); and (3) removing a section in the
regulations regarding the period of time for appointments to
fellowships to allow for less restrictive requirements for those
individuals who may benefit from further fellowship or retraining
experience in a life time. Additionally, technical and ministerial
revisions are being made to conform the existing regulations with the
amendments made by the statute.
DATES: As discussed below, comments are invited. To be considered,
comments must be received by April 4, 1994.
ADDRESSES: Written comments should be addressed to Fitzhugh Mullan,
M.D., Director, Bureau of Health Professions (BHPr), Health Resources
and Services Administration (HRSA), room 8-05, Parklawn Building, 5600
Fishers Lane, Rockville, Maryland 20857. All comments received will be
available for public inspection and copying at the Office of Program
Development, BHPr, room 8A-55, Parklawn Building, at the above address
weekdays (Federal holidays excepted) between the hours of 8:30 a.m. and
5 p.m.
FOR FURTHER INFORMATION CONTACT:
Neil H. Sampson, Director, Division of Associated, Dental and Public
Health Professions, Bureau of Health Professions, HRSA, room 8-101,
Parklawn Building, 5600 Fishers Lane, Rockville, Maryland 20857;
telephone: (301) 443-6853.
SUPPLEMENTARY INFORMATION: This proposed rule amends the existing
regulations for Grants for Faculty Training Projects in Geriatric
Medicine and Dentistry, authorized under section 777(b) of the Public
Health Service Act (the Act) (42 U.S.C. 294o). The Health Professions
Education Extension Amendments of 1992 (Pub. L. 102-408) amended and
renumbered former section 789(b) of the Act (42 U.S.C. 295g-9(b)) to
section 777(b).
Section 777(b) of the Act, as amended, authorizes the Secretary to
make grants to and enter into contracts with accredited schools of
medicine, schools of osteopathic medicine, teaching hospitals, and
graduate medical education programs, for the purpose of providing
support (including traineeships and fellowships) for geriatric training
projects to train physicians and dentists who plan to teach geriatric
medicine, geriatric dentistry, or geriatric psychiatry. programs
supported by these grants emphasize the principles of primary care as
demonstrated through continuity, ambulatory, preventive, and
psychosocial aspects of the practice of geriatric medicine, dentistry,
and psychiatry.
The proposed amendments made by the Health Professions Extension
Amendments of 1992 (Pub. L. 102-408) to section 777(b) are described
below, according to the section numbers and headings of the regulations
they affect.
Section 57.4102 Definitions
The Department is proposing to add the following terms to this
section:
``Geriatric psychiatry'' means the prevention, diagnosis,
evaluation and treatment of mental disorders and disturbances seen in
older adults.
This definition is adapted from the definition used by the American
Association of Geriatric Psychiatrists and is added to the section to
incorporate the statutory requirement for the expansion of project
support to include the training of physicians who plan to teach
geriatric psychiatry.
``Relevant advanced training or experience'' means at least one of
the following: (1) Completion of at least a 12-month graduate training
program in a health-related discipline, the basic sciences, or
education; or (2) a minimum of 2 years of clinical practice, of which
at least 12 months were devoted in part to managing older dental
patients in a hospital, long-term care facility, or other setting.
This definition was developed with consultation from an Ad Hoc
Committee of Geriatric Dentists and with positive internal review. The
definition is added to the section to incorporate the statutory
requirement for the expansion of fellowship eligibility of dental
fellows in the program.
Section 57.4111 Duration of fellowships.
The Department is proposing to remove this section from the
regulations. The regulatory language currently reads:
An appointment to a fellowship may be made for a period not to
exceed 12 months. Fellowship assistance for participants in a 1-year
fellowship program and a 1-year retraining program is limited to 12
months. Participants in 2-year fellowship programs may receive a
second 12-month appointment for a total period of 24 months.
Public Law 102-408 no longer provides for a 1-year fellowship program.
Further, the language regarding the period of time for appointments to
a fellowship is unnecessarily restrictive to individuals who may
benefit from further fellowship or retraining experience in a life
time. For example, a faculty fellow who completed a 1-year retraining
to have the skills required to incorporate geriatrics into course
content and clinical rotations may discover 5 years later that another
fellowship experience would provide the opportunity to develop research
skills in geriatrics required to expand the scope and depth of
practice-based geriatric research.
In addition to the changes proposed above, a number of technical,
clarifying, and ministerial changes are included to conform the
existing regulations with amendments made by Public Law 102-408. These
changes affecting the program for Faculty Training Projects in
Geriatric Medicine and Dentistry are being made to the regulations to:
1. Revise the section number of the Act from ``789(b)'' to
``777(b)'' wherever it appears in subpart PP, as renumbered, and the
United States Code citation from ``(42 U.S.C. 295g-9(b))'' to ``(42
U.S.C. 294o)'', in accordance with Public Law 102-408.
2. Revise Sec. 57.4101, entitled ``To what projects do these
regulations apply?'', by adding the words ``geriatric psychiatry'' to
reflect statutory language which expands project support to include the
training of physicians who plan to teach geriatric psychiatry.
3. Revise Sec. 57.4102, entitled ``Definitions.'', amend the
following terms to:
a. Remove the definition of ``Council'' regarding the National
Advisory Council on Health Professions Education, in accordance with
Public Law 102-408. The statute repealed the Council effective October
1, 1992;
b. Revise the phrase ``by an organized medical staff'' to ``by an
organized health care staff'' at the end of the definition of
``Extended care facility'' to clarify that staff of health care
institutions includes nurses, physical therapists, social workers and
other health care staff who provide ``medically-prescribed skilled
nursing care or rehabilitative services'';
c. Revise the introductory text to the definition of ``Fellowship
program'' by removing the reference to a 1-year fellowship program
which is no longer a statutory provision for project support; and
revise paragraph (2) of the definition to reflect new statutory
requirements for the training of dentists who have ``demonstrated a
commitment to an academic career and who have postdoctoral dental
education programs or who have relevant advanced training or
experience''; and
d. Revise the section number of the Act in the definition of
``School of medicine or school of osteopathic medicine'' from
``701(5)'' to ``799(1)(E)'', in accordance with Public Law 102-408.
4. Amend Sec. 57.4105, entitled ``Project requirements.'', to:
a. Revise paragraph (d) regarding the requirement that projects be
based in a graduate medical education program by adding the words ``or
psychiatry'' after the phase ``or in a department of geriatrics'' to
reflect statutory language which expanded project support to include
the training of physicians who plan to teach geriatric psychiatry.
Paragraph (d) is further revised by removing the phase ``in existence
as of December 1, 1987'' at the end of the sentence, in accordance with
Public Law 102-408;
b. Revise paragraph (e) regarding the requirement that projects be
staffed by at least two physicians in full-time teaching positions who
have experience or training in geriatric medicine by adding the words
``or geriatric psychiatry'', in accordance with Public Law 102-408; and
c. Revise the introductory text to paragraph (f) regarding the
requirement that the project must provide fellows ``with training in
geriatrics and exposure to the physical and mental disabilities of'' a
diverse population of elderly individuals, to more appropriately
reflect the language in Public Law 102-408.
5. Revise Sec. 57.4106, entitled ``How will applications be
evaluated?'', by:
a. Removing the reference to the National Advisory Council on
Health Professions Education, in accordance with Public Law 102-408, in
paragraph (a) introductory text and revising the introductory text to
reflect current statutory language regarding the evaluation and
recommendation process of awarding grant applications; and
b. Adding a comma and the words ``psychiatry, or'' after the words
``geriatric medicine'' in paragraph (a)(5) to reflect statutory
language which expanded training to include geriatric psychiatry.
5. Redesignate Sec. 57.4112, entitled ``Termination of
fellowships.'', as Sec. 57.4111, and Sec. 57.4113, entitled ``For what
purposes may grant funds be spent?'', as Sec. 57.4112, and
Sec. 57.4114, entitled ``What additional Department regulations apply
to grantees?'', as Sec. 57.4113.
6. Redesignate Sec. 57.4115, entitled ``What other audit and
inspection requirements apply to grantees?'', as Sec. 57.4114 and
revise the section number ``705'' in the text to ``798(e)'', in
accordance with Public Law 102-408.
7. Redesignate Sec. 57.4116, entitled ``Additional conditions.'',
as Sec. 57.4115.
Regulatory Flexibility Act and Executive Order 12688
This proposed rule governs a financial assistance training grant
program in which participation is voluntary. Because these rules make
minor changes in an existing grant program, they will have no
consequential effect on the economy, small businesses or small
governments. Therefore, the Secretary certifies that this rule will not
have a significant economic impact on small entities.
Paperwork Reduction Act of 1980
This proposed rule does not affect the recordkeeping or reporting
requirements in the existing regulations for the Grants for Faculty
Training Projects in Geriatric Medicine and Dentistry.
List of Subjects
Dental health, Education of the disadvantaged, Educational
facilities, Educational study programs, Grant programs--education,
Grant programs--health, Medical and dental schools, Student aid.
(Catalog of Federal Domestic Assistance, No. 93.156, Grants for
Faculty Training Projects in Geriatric Medicine and Dentistry)
Dated: November 12, 1993.
Philip R. Lee,
Assistant Secretary for Health.
Approved: January 24, 1994.
Donna E. Shalala,
Secretary.
Accordingly, 42 CFR part 57, subpart PP is proposed to be amended
as set forth below:
PART 57--GRANTS FOR CONSTRUCTION OF TEACHING FACILITIES,
EDUCATIONAL IMPROVEMENTS, SCHOLARSHIPS AND STUDENT LOANS
1. The authority citation for subpart PP is revised to read as
follows:
Authority: Sec. 215 of the Public Health Service Act, 58 Stat.
690, 67 Stat. 631 (42 U.S.C. 216); sec. 789(b) of the PHS Act, as
amended by Public Law 100-607, 102 Stat. 3136-3138 (42 U.S.C. 295g-
9(b)); renumbered as sec. 777(b), as amended by Public Law 102-408,
106 Stat. 2052-54 (42 U.S.C. 294o).
2. Section 57.4101 is revised to read as follows:
Sec. 57.4101 To what projects do these regulations apply?
These regulations apply to grants to eligible schools and programs
under section 777(b) of the Act (42 U.S.C. 294o) for the purpose of
providing support for projects to train physicians and dentists who
plan to teach geriatric medicine, geriatric psychiatry, or geriatric
dentistry, including traineeships, and fellowships for participation in
these programs.
3. Section 57.4102 is amended by removing the definition of
``Council''; by amending the definition of ``Extended care facility''
by revising the phrase ``by an organized medical staff'' at the end of
the sentence to read ``by an organized health care staff''; by revising
the section number of the Act ``789(b)'' in the definitions of
``Fellow'' and ``Project director'' to read ``777(b)''; by revising the
section number of the Act ``701(5)'' in the definition of ``School of
medicine or school of osteopathic medicine'' to read ``799(1)(E)''; by
revising the definition of ``Fellowship program''; and by adding the
definitions of ``Geriatric psychiatry'' and ``Relevant advanced
training or experience'' to read as follows:
Sec. 57.4102 Definitions.
* * * * *
Fellowship program means a 2-year organized training effort
sponsored by an allopathic or osteopathic medical school, a teaching
hospital, or a graduate medical education program which is designed to
provide training for--
(1) Physicians who have completed a graduate medical education
program in internal medicine, family medicine (including osteopathic
general practice), psychiatry, neurology, gynecology, or rehabilitation
medicine; and
(2) Dentists who have demonstrated a commitment to an academic
career and who have completed postdoctoral dental training, including
postdoctoral dental education programs or who have relevant advanced
training or experience.
* * * * *
Geriatric psychiatry means the prevention, diagnosis, evaluation
and treatment of mental disorders and disturbances seen in older
adults.
* * * * *
Relevant advanced training or experience means at least one of the
following: (1) Completion of at least a 12-month graduate training
program in a health-related discipline, the basic sciences, or
education; or (2) a minimum of 2 years of clinical practice, of which
at least 12 months were devoted in part to managing older dental
patients in a hospital, long-term care facility, or other setting.
* * * * *
4. Section 57.4105 is amended by revising paragraphs (d), (e), and
the introductory text to paragraph (f) to read as follows:
Sec. 57.4105 Project requirements.
* * * * *
(d) The project must be under the programmatic control of a
graduate medical education program in internal medicine or family
medicine (including osteopathic general practice) or in a department of
geriatrics or psychiatry;
(e) The project must be staffed by at least two physicians in full-
time teaching positions who have experience or training in geriatric
medicine or geriatric psychiatry and be staffed, or enter into an
agreement with an institution staffed, by at least one dentist who is
employed in a full- or part-time teaching position and has experience
or training in geriatrics;
(f) The project must provide fellows with training in geriatrics
and exposure to the physical and mental disabilities of a diverse
population of elderly individuals. The population must include: * * *
* * * * *
5. Section 57.4106 is amended by revising the introductory text to
paragraph (a) and paragraph (a)(5) to read as follows:
Sec. 57.4106 How will applications be evaluated?
(a) Competing applications are reviewed by a panel of peer
reviewers comprised primarily of non-Federal consultants whose
recommendations are given to the Secretary. The Secretary will approve
projects which best promote the purposes of section 777(b) of the Act.
The Secretary will consider, among other factors:
* * * * *
(5) The extent to which the project will increase the number of
geriatric fellowship and retraining positions available for individuals
who want to prepare for academic careers in geriatric medicine,
psychiatry, or dentistry.
* * * * *
Sec. 57.4111 [Removed]
6. Subpart PP is amended by removing Sec. 57.4111, entitled
Duration of fellowships.
Sec. 57.4112 [Redesignated as Sec. 57.4111]
7. Section 57.4112, entitled Termination of fellowships., is
redesignated as Sec. 57.4111.
Sec. 57.4113 [Redesignated as Sec. 57.4112]
8. Section 57.4113, entitled For what purposes may grant funds be
spent?, is redesignated as Sec. 57.4112.
Sec. 57.4114 [Redesignated as Sec. 57.4113]
9. Section 57.4114, entitled What additional Department regulations
apply to grantees?, is redesignated as Sec. 57.4113.
Sec. 57.4115 [Redesignated as Sec. 57.4114 and Amended]
10. Section 57.4115, entitled What other audit and inspection
requirements apply to grantees?, is redesignated as Sec. 57.4114, and
section number ``705'' in the text is revised to read ``798(e)''.
Sec. 57.4116 [Redesignated as Sec. 57.4115]
11. Section 57.4116, entitled Additional conditions., is
redesignated as Sec. 57.4115.
[FR Doc. 94-4901 Filed 3-2-94; 8:45 am]
BILLING CODE 4160-15-M