[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