[Federal Register Volume 59, Number 42 (Thursday, March 3, 1994)]
[Unknown Section]
[Page 0]
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