[Federal Register Volume 59, Number 137 (Tuesday, July 19, 1994)]
[Unknown Section]
[Page 0]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 94-17223]


[[Page Unknown]]

[Federal Register: July 19, 1994]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Public Health Service

42 CFR Part 57

RIN 0905-AE17

 

Grant for Construction of Teaching Facilities, et al.; Grants for 
the Establishment of Departments of Family Medicine

AGENCY: Health Resources and Services Administration, HHS.

ACTION: Notice of proposed rulemaking.

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SUMMARY: This proposed regulation would amend the existing regulations 
governing the program for Grants for the Establishment of Departments 
of Family Medicine authorized by section 747(b) of the Public Health 
Service Act (the Act), to bring the regulations into conformity with 
technical amendments made by the Health Professions Extension 
Amendments of 1992 and to include other changes for consistency with 
current grant program policies.

DATES: Comments must be received by August 18, 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 
5:00 p.m.

FOR FURTHER INFORMATION CONTACT:
Marc L. Rivo, M.D., Director, Division of Medicine, Bureau of Health 
Professions, HRSA, Room 4C-25, Parklawn Building, 5600 Fishers Lane, 
Rockville, Maryland 20857; telephone (301) 443-6190.

SUPPLEMENTARY INFORMATION: This proposed rule amends the existing 
regulations for Grants for the Establishment of Departments of Family 
Medicine, authorized under section 747(b) of the Public Health Service 
Act (the Act) (42 U.S.C. 293k). The Health Professions Education 
Extension Amendments of 1992 (Pub. L. 102-408) amended and renumbered 
former section 780 of the Act (42 U.S.C. 295g) to section 747.
    Section 747(b) of the Act, as amended, authorizes the Secretary to 
make grants to and enter into contracts with accredited schools of 
medicine or osteopathic medicine to meet the costs of projects to 
establish, maintain, or improve academic administrative units (which 
may be departments, divisions, or other units) to provide clinical 
instruction in family medicine. The primary purpose of the program is 
to assist family medicine academic administrative units to achieve 
comparability in status, faculty, and curriculum with those of other 
clinical units at the applying schools.
    The proposed amendments made by Pub. L. 102-408 to section 747(b) 
are described below, according to the section numbers and the headings 
of the regulations they affect.

Section 57.1702  Definitions

    The Department is proposing to revise or add the following terms to 
this section:
    Academic administrative unit or unit means a department, division, 
or other formal academic unit of a school of medicine or osteopathic 
medicine or clinical campus of this school that provides clinical 
instruction in family medicine.
    The phrase ``or clinical campus of such schools'' is being inserted 
to permit family medicine adminsitrative units at such clinical 
campuses to apply for support of their unit separately from the parent 
medical school. The medical school, however, as the accredited entity, 
would have general oversight of such support.
    The Department encourages the movement of clinical training to 
areas that more closely resemble the future practice locations of the 
generalist physician. Increasing numbers of medical schools are 
initiating substantial training programs some distance from the school. 
In some instances, the external training site has taken the form of a 
new clinical campus with its own departmental structure. Typically 
these clinical campuses are responsible for providing most, if not all, 
of the clinical training for a cohort of medical students.
    This specific wording change and the related changes that follow 
will assist these remote clinical training programs by permitting both 
the parent school and the clinical campus to receive Federal assistance 
under this program.
    Clinical campus means a geographically separate educational entity 
of an accredited medical school that has been given the responsibility 
to coordinate or provide all clinical training for at least 10 percent 
of the school's third-year students.
    This new definition is being proposed to limit the expansion of an 
academic administrative unit to entities that have education as their 
principal purpose and have the capability and charge to provide the 
full range of experiences needed for clinical training of physicians.
    Other major clinical units means formal academic units at the 
applicant school or its clinical campus that offer clinical instruction 
in internal medicine, obstetrics and gynecology, pediatrics, 
psychiatry, or surgery.
    The phrase ``or its clinical campus'' is added to reflect the 
change to the definition of ``academic administrative unit'' cited 
above.

Section 57.1704  Program Requirements

    The Department is proposing to revise paragraph (a) of this 
section. The phrase ``in an administrative unit'' is added to permit a 
program applicant to use a program director from the clinical campus 
rather than the parent medical school. In many instances the level of 
medical school involvement in the remote campus is not sufficient to 
exercise effective management of the grant funds at the clinical 
campus.
    The Department is deleting a parenthetical phrase in paragraph (d) 
of this section, ``(or in the case of a school of osteopathic medicine, 
have control over or be closely affiliated with)'', to remove the 
redundancy within this paragraph. We are proposing to add a phrase ``or 
clinical campus'' to extend the requirement to control a residency 
program to the clinical campus program. Otherwise, a residency program 
controlled by the parent medical school department would not meet the 
residency requirement for an application for assistance for a clinical 
campus.
    We are also proposing to add a parenthetical phrase in paragraph 
(e) of this section, ``(or units in the case of schools with one or 
more decentralized units)'', to clarify that the requirement to provide 
training to all medical students can be met by the combined efforts of 
the parent family medicine administrative unit and the clinical campus 
administrative unit.
    The Department is adding the phrase ``or clinical campus'' in 
paragraph (f) of this section to clarify that in comparing numbers of 
clinical faculty, the clinical campus family medicine administrative 
unit should be compared to other clinical campus units.
    In addition to the changes proposed above, a number of technical 
and ministerial changes are included to conform the existing 
regulations with amendments made by Pub. L. 102-408. These changes 
affecting the program for the Grants for the Establishment of 
Departments of Family Medicine are being made to the regulations to:
    1. Revise the section number of the Act from ``780'' to ``747'' 
wherever it appears in subpart R, as renumbered, and the United States 
Code citation from ``(42 U.S.C. 295g)'' to ``(42 U.S.C. 293k)'', in 
accordance with Pub. L. 102-408.
    2. Revise Sec. 57.1702, entitled ``Definitions.'', to amend 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 Pub. L. 102-408.
    3. Revise Sec. 57.1704, entitled ``Program requirements.'', to 
revise the section number ``786(a)'' in paragraph (h) to ``747'', in 
accordance with Pub. L. 102-408.
    4. Revise Sec. 57.1705, entitled ``How will applications be 
evaluated?'', to reflect current statutory language regarding the 
evaluation and recommendation process of awarding grant applications by 
removing the reference to the National Advisory Council on Health 
Professions Education and the section of the Act which established it. 
Pub. L. 102-408 repealed the Advisory Council effective October 1, 
1992.
    5. Revise Sec. 57.1709, entitled ``What other audit and inspection 
requirements apply to grantees?'', to revise the section number ``705'' 
in the text to ``798(e)'', in accordance with Pub. L. 102-408.
    Further, Public Law 103-227, enacted on March 31, 1994, prohibits 
smoking in certain facilities in which minors will be present. The 
Department of Health and Human Services is now preparing to implement 
the provision of that law. Until those implementation plans are in 
place, PHS continues to strongly encourage all grant recipients to 
provide a smoke free workplace and promote the nonuse of all tobacco 
products.

Economic Impact

    This proposed rule governs a financial assistance training grant 
program in which participation is voluntary. Because this proposed rule 
makes minor changes in an existing grant program, it 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 the 
Establishment of Departments of Family Medicine.

List of Subjects

    Denatal health, Educational facilities, Grant programs--education, 
Medicine and dental schools, Education of the disadvantaged, Education 
study programs, Grant programs--health, Student aid.

(Catalog of Federal Domestic Assistance, No. 93.984, Grants for the 
Establishment of Departments of Family Medicine)

    Dated: April 12, 1994.
Philip R. Lee,
Assistant Secretary for Health.

    Approved: July 7, 1994.
Donna E. Shalala,
Secretary.
    Accordingly, 42 CFR part 57, subpart R 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 R of part 57 is revised to 
read as follows:

    Authority: 42 U.S.C. 216, 293k, 295g.


Sec. 57.1701  [Amended]

    2. Section 57.1701 is amended by revising the number ``780'' to 
read ``747'' and the cite ``(42 U.S.C. 295g)'' to read ``(42 U.S.C. 
293k)''.
    3. Section 57.1702 is amended by revising the number ``701(5)'' in 
the definition of ``School of medicine or osteopathic medicine'' to 
read ``799(1)(E)''; by revising the definitions of ``Academic 
administrative unit'' or ``unit'' and ``Other major clinical units''; 
and by adding the term ``Clinical campus'' to read as follows:


Sec. 57.1702  Definitions.

    Academic administrative unit or unit means a department, division, 
or other formal academic unit of a school of medicine or osteopathic 
medicine or clinical campuses of such schools that provides clinical 
instruction in family medicine.
* * * * *
    Clinical campus means a geographically separate educational entity 
of an accredited medical school that has been given the responsibility 
to coordinate or provide all clinical training for at least 10 percent 
of the school's third-year students.
* * * * *
    Other major clinical units means formal academic units at the 
applicant school or its clinical campus that offer clinical instruction 
in internal medicine, obstetrics and gynecology, pediatrics, 
psychiatry, or surgery.
* * * * *
    4. Section 57.1704 is amended by revising the number ``786(a)'' in 
paragraph (h) to read ``747''; and by revising paragraphs (a), (d), 
(e), and (f) to read as follows:


Sec. 57.1704  Program requirements.

* * * * *
    (a) Each project must have a project director, who works at the 
grantee institution in an administrative unit of the grantee 
institution on an appointment consistent with other major departments, 
heads or will head the unit, and has relevant training and experience 
in family medicine.
* * * * *
    (d) The unit must have control over a residency training program. 
The program must have the capacity to enroll a total of at least 9 
interns or residents annually. A unit whose applicant school or 
clinical campus does not have a residency program accredited under its 
direct authority will be considered as meeting this requirement if it 
has a written affiliation agreement with a hospital which conducts a 
residency program as described.
    (e) The unit (or units in the case of schools with one or more 
decentralized unit) must have responsibility for providing instruction 
to each member of the student body who is engaged in an education 
program leading to a degree in doctor of medicine or doctor of 
osteopathic medicine. The amount of mandatory and elective curriculum 
must be comparable to the amount of mandatory and elective curriculum 
time required for other major clinical units at the school.
    (f) The unit must have, in the judgment of the Secretary, a 
sufficient number of full-time faculty to conduct the instruction. The 
number of family medicine faculty in the unit must be comparable to 
that of full-time faculty responsible for conducting the instruction of 
one of the other major clinical units either at the school or at the 
clinical campus, whichever is the same as the unit receiving the grant 
funds.

    5. The introductory text to Sec. 57.1705 is revised to read as 
follows:


Sec. 57.1705  How will applications be evaluated?

    The Secretary will award grants to applicants whose projects will 
best promote the purposes of section 747 of the Act and these 
regulations. The Secretary will consider, among other factors:
* * * * *


Sec. 57.1709  [Amended]

    6. Section 57.1709 is amended by revising the number ``705'' to 
read ``798(e)''.

[FR Doc. 94-17223 Filed 7-18-94; 8:45 am]
BILLING CODE 4160-15-M