[Federal Register Volume 59, Number 237 (Monday, December 12, 1994)]
[Unknown Section]
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From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 94-30410]


[[Page Unknown]]

[Federal Register: December 12, 1994]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Public Health Service

42 CFR Part 57

RIN 0905-AE13

 

Grants for Faculty Training Projects in Geriatric Medicine and 
Dentistry

AGENCY: Health Resources and Services Administration, HHS.

ACTION: Final rule.

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SUMMARY: This final regulation revises the existing 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 statutory amendments 
made by the Health Professions Extension Amendments of 1992 and to 
include other technical and ministerial changes to conform the existing 
regulations with the amendments made by the statute. The final rule 
also removes a section in the regulations to allow for less restrictive 
requirements for those individuals who may benefit from further 
fellowship or retraining experience in a lifetime.

DATES: These regulations are effective December 12, 1994.

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: On March 3, 1994, the Assistant Secretary 
for Health, with the approval of the Secretary of Health and Human 
Services, published in the Federal Register (59 FR 10104), a Notice of 
Proposed Rulemaking (NPRM) to revise the regulations governing the 
program 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).
    The NPRM proposed amendments to implement several statutory 
provisions by: (1) Adding a definition for the term ``Geriatric 
psychiatry'' to implement the requirement for the expansion of project 
support to include the training of physicians who plan to teach 
geriatric psychiatry, and by (2) adding a definition for the term 
``Relevant advanced training or experience'' to implement the 
requirement for dentists who are awarded a 2-year internal medicine or 
family medicine fellowship. The NPRM also proposed to remove a section 
in the regulations regarding the period of time for appointment to 
fellowships to allow for less restrictive requirements for those 
individuals who may benefit from further fellowship or retraining 
experience in a lifetime.
    The public comment period on the proposed regulations closed on 
April 4, 1994. The Department received 4 public comments. The comments 
received on the proposed rule to section 777(b) and the Department's 
responses to the comments are discussed below according to the section 
numbers and headings of the regulation affected.

Section 57.4102 ``Definitions''

    The Department proposed the following definition for the term 
``Geriatric psychiatry'':
    ``Geriatric psychiatry'' means the prevention, diagnosis, 
evaluation and treatment of mental disorders and disturbances seen in 
older adults.
    This definition was proposed to be 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.
    The Department received positive responses to this definition.
    The Department also proposed the following definition for the term 
``Relevant advanced training or experience'':
    ``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 proposed to be added to the section to 
incorporate the statutory requirement for the expansion of fellowship 
eligibility of dental fellows in the program.
    One respondent found this definition ``extremely helpful in setting 
a high standard for the selection of highly motivated and qualified 
candidates''.
    The Department also received a request that dentists who have had 
``relevant teaching experience in an accredited dental school'' be 
added to the definition. The Department accepts the general intent of 
this recommendation while noting that ``relevant'' alone is not 
explicit and is open to interpretation. In response to this concern, 
the Department has expanded the definition of ``Relevant advanced 
training or experience'' in the final regulations to include an 
additional experience, ``a minimum of 2 years of teaching experience in 
an accredited dental educational program of which at least 12 months 
were devoted in part to issues pertaining to the care of older 
adults.''

Section 57.4111 ``Duration of Fellowships''

    The Department proposed to remove this section from the regulations 
to allow less restrictive requirements for those individuals who may 
benefit from further fellowship or retraining experience in a lifetime. 
The section language read:

    ``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.''

    The Department gave an example in the NPRM how this language might 
be restrictive to fellows: ``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.''
    One respondent requested the ``removal of the 1-year fellowship 
[retraining] limit of Federal support for psychiatrists who wish to 
train other psychiatrists in geriatric psychiatry''. The respondent 
stated that this is a reasonable request as it would permit the 
training to fully meet the requirements of exposure to the physical and 
mental disabilities of a diverse population of elderly individuals.
    The Department has not accepted this recommendation because the 
statute requires that the 2-year fellowship program be an internal 
medicine or family medicine fellowship program, not a psychiatry 
fellowship program. (See section 777(b)(3)(B) of the Act and 
Sec. 57.4105(d) of the regulations.) However, psychiatrists are 
eligible to participate as fellows in the 2-year programs.
    In addition to the changes proposed above, a number of technical, 
clarifying, and ministerial changes were included to conform the 
existing regulations with amendments made by Pub. L. 102-408. The 
Department also received a few comments on some of these technical 
changes. The Department's responses are also discussed below. These 
changes affecting the program for Faculty Training Projects in 
Geriatric Medicine and Dentistry are as follows:
    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 Pub. L. 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.'', to amend the 
following terms to:
    a. Remove the definition of ``Council'' regarding the National 
Advisory Council on Health Professions Education, in accordance with 
Pub. L. 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''.
    The Department received one comment regarding the proposed 
clarifying change to the phrase ``organized health care staff'' as 
having potential conflict with individual State laws or licensing 
authorities. It is the Department's view that the clarifying phrase 
includes medical staff along with all other health care professionals 
and should not be in conflict with any individual State laws or 
licensing authorities. Therefore, this amendment will remain as 
proposed.
    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 completed postdoctoral 
dental training, including postdoctoral dental education programs or 
who have relevant advanced training or experience''.
    The Department received favorable support for this change.
    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 Pub. L. 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 phrase ``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 phrase ``in existence 
as of December 1, 1987'' at the end of the sentence, in accordance with 
Pub. L. 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 Pub. L. 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 Pub. L. 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 Pub. L. 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 113.
    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 Pub. L. 102-408.
    The Department is further revising Sec. 57.4115 by removing the 
reference to ``section 705 of the PHS Act'' instead of renumbering the 
section number to ``798(e)'' as proposed in the NPRM. The reference to 
section 705 concerning audit and inspection requirements is redundant 
to the requirements that are already covered under 45 CFR part 74. We 
are also removing the parenthetical phrase at the end of the section 
text citing the OMB approval number regarding information collection 
requirements as no longer necessary.
    7. Redesignate Sec. 57.4116, entitled ``Additional conditions.'', 
as Sec. 57.4115.
    Further, Public Law 103-227, enacted on March 11, 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, the PHS continues to strongly encourage all grant recipients to 
provide a smoke-free workplace and promote the non-use of all tobacco 
products.

Economic Impact

    Executive Order 12866 requires that all regulations reflect 
consideration of alternatives, of costs, of benefits, of incentives, of 
equity, and of available information. Regulations must meet certain 
standards, such as avoiding unnecessary burden. Regulations which are 
``significant'' because of cost, adverse effects on the economy, 
inconsistency with other agency actions, effects on the budget, or 
novel legal or policy issues, require special analysis.
    The Department believes that the resources required to implement 
the requirements in these regulations are minimal. Therefore, in 
accordance with the Regulatory Flexibility Act of 1980, the Secretary 
certifies that these regulations will not have a significant impact on 
a substantial number of small entities. For the same reasons, the 
Secretary has also determined that this is not a ``significant'' rule 
under Executive Order 12866.

Paperwork Reduction Act of 1980

    This final 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 Under 42 CFR Part 57

    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: September 20, 1994.
Philip R. Lee,
Assistant Secretary for Health.
    Approved: December 5, 1994.
Donna E. Shalala,
Secretary.
    Accordingly, 42 CFR part 57, subpart PP is amended as set forth 
below:

PART 57--GRANTS FOR CONSTRUCTION OF TEACHING FACILITIES, EDUCATION 
IMPROVEMENT, SCHOLARSHIPS AND STUDENT LOANS

Subpart PP--Grants for Faculty Training Projects in Geriatric 
Medicine and Dentistry

    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 Pub. L. 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 designated 
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; (2) a minimum of 2 years of teaching experience in an 
accredited dental education program of which at least 12 months were 
devoted in part to issues pertaining to the care of older adults; or 
(3) 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) As required by section 798(a) of the Act, each application for 
a grant under this subpart shall be submitted to a peer review group, 
composed principally of non-Federal experts, for an evaluation of the 
merits of the proposals made in the application. The Secretary may not 
approve such an application unless a peer review group has recommended 
the application for approval. The Secretary will award grants to 
applicants whose projects will best promote the purposes of section 
777(b) of the Act and these regulations. 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  [Amended]

    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]

    10. Section 57.4115 is redesignated as 57.4114 and is revised to 
read as follows:


Sec. 57.4114  ``What other audit and inspection requirements apply to 
grantees?''

    Each entity which receives a grant under this subpart must meet the 
requirements of 45 CFR part 74 concerning audit and inspection.


Sec. 57.4116  [Redesignated as Sec. 57.4115]

    11. Section 57.4116, entitled ``Additional conditions.'', is 
redesignated as Sec. 57.4115.
[FR Doc. 94-30410 Filed 12-9-94; 8:45 am]
BILLING CODE 4160-15-M