[Federal Register Volume 59, Number 249 (Thursday, December 29, 1994)]
[Unknown Section]
[Page 0]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 94-32064]


[[Page Unknown]]

[Federal Register: December 29, 1994]


-----------------------------------------------------------------------

DEPARTMENT OF HEALTH AND HUMAN SERVICES
Health Resources and Services Administration
RIN: 0905-ZA82

 

Program Announcement and Proposed Additional Review Criteria for 
Cooperative Agreements for Basic/Core Area Health Education Centers 
Programs and Model State-Supported Area Health Education Centers 
Programs for Fiscal Year 1995

    The Health Resources and Services Administration (HRSA) announces 
that applications will be accepted for fiscal year (FY) 1995 
Cooperative Agreements for Basic/Core Area Health Education Centers 
(AHEC) Programs authorized under section 746(a)(1) and Model State-
Supported Area Health Education Centers Programs authorized under 
section 746(a)(3), title VII of the Public Health Service Act, as 
amended by the Health Professions Education Extension Amendments of 
1992, Pub. L. 102-408, dated October 13, 1992. Comments are invited on 
the proposed additional review criteria stated below.

Purpose and Eligibility

    In general, an area health education centers program shall be a 
cooperative program of one or more allopathic or osteopathic medical 
schools and one or more public or nonprofit private regional area 
health education centers.
    Section 746(a)(1) of the PHS Act authorizes Federal assistance to 
schools of allopathic or osteopathic medicine which have cooperative 
arrangements with one or more public or nonprofit private area health 
education centers for the planning, development and operation of area 
health education centers programs.
    To be eligible to receive support for an area health education 
centers cooperative agreement, the applicant must be a public or 
nonprofit private accredited school of allopathic or osteopathic 
medicine or consortium of such schools, or the parent institution on 
behalf of such school(s).
    Section 746(a)(3) authorizes Federal assistance to any school of 
allopathic or osteopathic medicine that is operating an area health 
education centers program and that is not receiving financial 
assistance under section 746(a)(1), title VII of the PHS Act.
    The statutory authority for the Model State-Supported AHEC Program 
contains explicit language regarding activities and agreements between 
the medical and osteopathic schools which develop AHEC programs and the 
free-standing, community-based area health education centers which 
provide training sites and resources for the activities. To accomplish 
these specific tasks, a system of subcontracts is developed between the 
health professions schools and the independent AHEC centers in the 
communities.
    Certain programmatic agreements are required for the operation of a 
Model State-Supported AHEC Program. In operating this program, the 
school must agree to:
    a. coordinate the activities of the program with the activities of 
any office of rural health established by the State or States in which 
the program is operating;
    b. conduct health professions education and training activities 
consistent with national and State priorities in the area served by the 
program in coordination with the National Health Service Corps, 
entities receiving funds under section 329 or 330 and public health 
departments; and
    c. cooperate with any entities that are in operation in the area 
served by the program and that receive Federal or State funds to carry 
out activities regarding the recruitment and retention of health care 
providers.
    Applicants in States where more than one eligible entity exits are 
encouraged to collaborate in the submission of a single Model State-
Supported AHEC Program application, which reflects a consortium of 
Statewide programs to coordinate community-based health professionals 
training activities.
    The principal objective of the legislation for the Model State-
Supported AHEC Program is to encourage State coordination and support 
for AHEC activities. The most effective approach for obtaining support 
from State legislatures is to present a unified plan showing how all 
the programs are working together to provide the needed services in the 
State. Competitive applications from one State tend to be divisive 
rather than unifying in reaching common goals.
    To receive support, these programs must meet the requirements of 
the regulations as set forth in 42 CFR part 57, subpart MM.

Funding

    Approximately $19.9 million will be available for the Basic/Core 
Area Health Education Centers Programs in FY 1995. Total continuation 
support recommended is $16.5 million. It is anticipated that $3.4 
million will be available to support 6 competing awards (renewals and 
new starts) averaging $566.000.
    Approximately $4.4 million will be available for the Model State-
Supported Area Health Education Centers Programs in FY 1995. It is 
anticipated that 20 competing awards averaging $220,000 will be made.

Period of Support

    Applicants for Basic/Core AHEC Programs may request up to 3 years 
of support with the expectation that AHECs planned and developed in 
years 1 and 2 would be fully operational no later than the 3rd year. 
The period of Federal support should not exceed 12 years for an area 
health education centers program and 6 years for an area health 
education center.
    Model State-Supported Area Health Education Centers Programs may 
request up to 3 years of support.

Substantial Federal Involvement

    The Bureau of Health Professions, within the Health Resources and 
Services Administration, has substantial programmatic involvement in 
the planning, development, and administration of the AHEC projects by:
    1. Reviewing and approving plans upon which continuation of the 
cooperative agreement is contingent in order to permit appropriate 
direction and redirection of activities;
    2. Reviewing and approving all contracts and agreements among 
recipient medical or osteopathic schools, other health professions 
schools and community-based centers;
    3. Participating with project staff in the development of funding 
projections;
    4. Developing, with project staff, individual project data 
collection systems and procedures; and
    5. Participating with project staff in the design of project 
evaluation protocols and methodologies.

National Health Objectives for the Year 2000

    The Public Health Service (PHS) is committed to achieving the 
health promotion and disease prevention objectives of Healthy People 
2000, a PHS led national activity for setting priority areas. The 
Cooperative Agreements for the Basic/Core AHEC Programs and the Model 
State-Supported Area Health Education Centers Programs are related to 
the priority area of Educational and Community-Based Programs. 
Potential applicants may obtain a copy of Healthy People 2000 (Full 
Report; Stock No. 017-001-00474-0) or Healthy People 2000 (Summary 
Report; Stock No. 017-001-00473-1) through the Superintendent of 
Documents, Government Printing Office, Washington, D.C. 20402-9325 
(Telephone 202-783-3238).

Education and Service Linkage

    As part of its long-range planning, HRSA will be targeting its 
efforts to strengthening linkages between U.S. Public Health Service 
education programs and programs which provide comprehensive primary 
care services to the underserved.

Smoke-Free Workplace

    The Public Health Service strongly encourages all grant and 
cooperative agreement recipients to provide a smoke-free workplace and 
promote the non-use of all tobacco products. This is consistent with 
the PHS mission to protect and advance the physical and mental health 
of the American people.

General Requirements

    As provided in section 746(b), an allopathic or osteopathic medical 
school may not receive an award for operational expenses under the 
existing Basic/Core AHEC Program or under the Model State-Supported 
AHEC Program unless the program:
    (A) maintains preceptorship educational experiences for health 
science students;
    (B) maintains community-based primary care residency programs or is 
affiliated with such programs;
    (C) maintains continuing education programs for health 
professionals or coordinates with such programs;
    (D) maintains learning resource and dissemination systems for 
information identification and retrieval;
    (E) has agreements with community-based organizations for the 
delivery of education and training in the health professions;
    (F) is involved in the training of health professionals (including 
nurses and allied health professionals), except to the extent 
inconsistent with the law of the State in which the training is 
conducted; and
    (G) carries out recruitment programs for the health science 
professions, or programs for health-career awareness, among minority 
and other elementary or secondary students from the areas the program 
has determined to be medically underserved;

Requirements for Schools

    As required by section 746(c), each allopathic or osteopathic 
medical school participating in an AHEC program shall:
    (1) provide for the active participation in such program by 
individuals who are associated with the administration of the school 
and each of the departments (or specialties if the school has no such 
departments) of internal medicine, pediatrics, obstetrics and 
gynecology, surgery, psychiatry, and family medicine;
    (2) provide that no less than 10 percent of all undergraduate 
allopathic and osteopathic medical clinical education of the school 
will be conducted in an area health education center and at locations 
under the sponsorship of such center;
    (3) be responsible for, or conduct, a program for the training of 
physician assistants (as defined in section 799) or nurse practitioners 
(as defined under section 822) which gives special consideration to the 
enrollment of individuals from, or intending to practice in, the area 
served by the area health education center of the program; and
    (4) provide for the active participation of at least 2 schools or 
programs of other health professions (including a school of dentistry 
and a graduate program of mental health practice if there are ones 
affiliated with the university with which the school of allopathic or 
osteopathic medicine is affiliated) in the educational program 
conducted in the area served by the area health education center.
    The requirement of paragraph (3) shall not apply to an allopathic 
or osteopathic medical school participating in an AHEC program if 
another such school participating in the same program meets the 
requirement of that paragraph.

Requirements for Centers

    As required by section 746(d), each AHEC shall specifically 
designate a geographic area or a medically undeserved population it 
will serve, which is in a location remote from the main site of the 
teaching facilities of the school or schools which participate in the 
program with such center.
    In addition, each AHEC shall:
    (A) provide for or conduct training in health education services, 
including education in nutrition evaluation and counseling, in the area 
served by the center;
    (B) assess the health personnel needs of the area served by the 
center and assist in the planning and development of training programs 
to meet such needs;
    (C) provide for or conduct a rotating osteopathic internship or a 
medical residency training program in family medicine, general internal 
medicine, or general pediatrics in which no fewer than four individuals 
are enrolled in first-year positions in such program;
    (D) provide opportunities for continuing medical education 
(including education in disease prevention) to all physicians and other 
health professionals (including allied health personnel) practicing 
within the area served by the center;
    (E) provide continuing medical education and other educational 
support services to the National Health Service Corps members serving 
within the area served by the center;
    (F) conduct interdisciplinary training and practice involving 
physicians and other health personnel including, where practicable, 
physician assistants, nurse practitioners, and nurse midwives;
    (G) arrange and support educational opportunities for medical and 
other students at health facilities, ambulatory care centers, and 
health agencies throughout the area served by the center; and
    (H) have an advisory board of which at least 75 percent of the 
members shall be individuals, including both health service providers 
and consumers, from the area served by the center.
    Any AHEC which is participating in an AHEC program in which another 
center has a medical residency training program (described in (C) 
above) need not provide for or conduct such a medical residency 
training program.

Funding Provisions

    At least 75 percent of the total funds provided to a school under 
any AHEC program authority (Basic/Core AHEC program or Model State-
Supported AHEC programs) must be expended by the AHEC program in AHEC 
centers and the school is required to enter into an agreement with each 
of such centers for purposes of specifying the allocation of the 75 
percent of funds.
    Section 746(e)(1)(B) of the Act requires that not more than 75 
percent of total operating funds of a Basic/Core AHEC Program in any 
year shall be provided by the Federal Government. However, as provided 
in section 746(e)(2), for an AHEC center developed as part of an AHEC 
program first funded under the basic AHEC authority on or after October 
13, 1992, a ceiling of 55 percent of the costs of any fifth or sixth 
year of the development or operation of a center is established.
    With respect to the costs of operating the Model State-Supported 
AHEC program, the school will make available (directly or through 
donations from public or private entities) non-Federal contributions in 
cash toward such costs in an amount that is not less than 50 percent of 
such costs. These funds must be for the express use of the AHEC Program 
and Centers, and not funds designated for other categorical or specific 
purposes. Amounts provided by the Federal Government may not be 
included in determining the amount of non-Federal contributions in 
cash.
    Section 746(a)(3)(D) states that schools must maintain expenditures 
on non-Federal amounts at a level that is not less than the level of 
such expenditures for the fiscal year preceding the first fiscal year 
for which the school receives an award.
    The following criteria for allocation of funds for Model State-
Supported AHEC programs were established in the Federal Register on 
September 14, 1993, (at 58 FR 48068) after public comment and are being 
continued in FY 1995.
    As a condition of receiving funding:
    (1) applicants must meet the eligibility conditions of programs as 
set forth in section 746(b), and the AHEC centers they wish to have 
included must meet eligibility requirements in accordance with section 
746(d);
    (2) the non-Federal cash contribution to the AHEC program(s) in the 
current year is at least equal to the amount to be received from the 
Federal program as required by section 746(a)(3)(B); and
    (3) the program activities for which support is requested are 
determined by peer reviewers to be qualitatively acceptable.
    Programs that submit acceptable applications, in accordance with 
the above criteria, will receive funding based on the following 
allocation of funds:
    1. Annually, the total amount available for funding under section 
746(a)(3) will be divided by the total number of qualifying AHEC 
centers in approved applications. This will yield the per center 
allocation. The coordinating AHEC applicant for each State will receive 
an amount equal to the number of qualifying centers in the approved 
application times the per center allocation subject to the amount of 
non-Federal cash contributions and approved program activities.
    2. In accordance with the provisions of section 746(e)(1)(A), the 
award will clearly indicate that 75 percent of the awarded funds are to 
be spent in approved centers. The remaining 25 percent may be allocated 
to the AHEC program office and/or other participating schools. Awardees 
may distribute 75 percent or more of awarded funds to centers according 
to need.
    The State matching provision was included in this new legislation 
to promote State funding. The allocation of Federal funds to all 
qualifying AHEC programs is intended to provide as broad as possible a 
base for the accomplishment of this purpose. The number of qualifying 
AHEC centers provides the means for distribution of funds because the 
statute requires that 75 percent of the funds are designated to go to 
these entities.

Review Criteria

    The following review criteria apply to the Basic/Core AHEC 
Programs, section 746(a)(1) and the Model State-Sponsored AHEC 
Programs, section 746(a)(3).
    The review of applications will take into consideration the 
following criteria:
    1. The degree to which the proposed project adequately provides for 
the program requirements set forth in sections 746(a)(1) and 746(a)(3);
    2. The capability of the applicant to carry out the proposed 
project activities in a cost-efficient manner; and
    3. The extent of the need of the area to be served by the proposed 
area health education center.

Proposed Additional Review Criteria

    The following additional criteria are proposed for review of 
applications for these programs:
    4. The potential of the proposed AHEC program and participating 
centers to continue on a self-sustaining basis; and
    5. The extent to which the proposed project adequately responds to 
AHEC program performance measures and outcome indicators.

Outcome Measures and Future Directions for the AHEC Program

    The development of outcome measures and other types of 
effectiveness measures is stressed in the title VII authorization 
legislation, the Health Professions Education Extension Amendments of 
1992, Pub. L. 102-408. The Division of Medicine of the Bureau of Health 
Professions is continuing to identify and develop outcome measures for 
ongoing categorical programs. Applicants are encouraged to respond in 
their applications to outcomes that have been developed. Outcome 
measures are based on legislative intent and strategic directions 
adopted by the Division of Medicine. The current strategic directions 
include:
     Generalism--Increasing the number of generalist physicians 
including the coordination and integration of training opportunities 
designed to produce generalists;
     Workforce Diversity, particularly the training of 
minorities;
     Strategies to Improve Care for the Underserved;
     Improve Primary Care Quality;
     Increase Primary Care Faculty and Researchers; and
     Emphasize Public Health and Interdisciplinary Training.

Information on Performance Measures and Outcome Indicators

    Following are the performance measures and outcome indicators:
    A. State/local Funding (100 points). The current level of State 
funding or local funding for the proposed or ongoing AHEC program, and 
the percentage of funds from nonfederal sources which make up the 
annual budget of the AHEC program and/or AHEC center(s).
    B. AHEC Program Elements (280 points). (1) 10 percent Clinical 
Training with an emphasis on Ambulatory Care Settings (40 points). The 
anticipated number of medical students trained annually in AHEC-
supported remote ambulatory care sites, and the percentage (10 percent 
or more) of clinical undergraduate training of the medical school 
provided at AHEC-supported sites.
    (2) Primary Care Residency (40 points). The number of residents 
participating in at least one AHEC affiliated primary care residency 
(in Family Medicine, General Internal Medicine, or General Pediatrics) 
and the percentage of medical school graduates selecting primary care 
specialties over a most recent three-year period.
    (3) PA/NP Training and Recruitment (30 points). The number of 
students participating in at least one AHEC affiliated PA or NP 
training program.
    (4) Linkages to Other Federal Initiatives--Underserved Sites (30 
points). The active working relationships with other federally 
supported primary care oriented programs such as CHCs, MHCs, NHSC, and 
IHS facilities serving the underserved.
    (5) Linkages to other State Initiatives (10 points). Active working 
relationships with State supported programs such as state offices of 
rural health, state loan repayment programs, state health department, 
primary care associations, and other statewide initiatives.
    (6) Statewide Consortium (10 points). Participation within a 
statewide consortium which addresses health professions training needs 
and improvement of access to health services through educational 
interventions, including the supply and distribution of primary care 
personnel to underserved areas.
    (7) Multidisciplinary/Interdisciplinary training (40 points). The 
sites, number of trainees and the expected impact on primary care needs 
of underserved areas by proposed or ongoing AHEC-supported primary care 
multidisciplinary training programs.
    (8) Disadvantaged and/or Minority Recruitment/Retention 
Institutional Performance--Percent Minority Graduates (40 points). The 
relationship of minority recruitment efforts to admission and retention 
at specific health career training programs/institutions, and the 
percentage of disadvantaged and underrepresented minority graduates of 
the programs/institutions.
    (9) Evidence of proposed or existing AHEC(s), and participation in 
community-based decision-making (20 points). Collaboration of 
community-based AHEC centers with medical and other health professions 
training programs and a network of primary care training sites.
    (10) AHEC Services to enhance the practice environment of program 
area (20 points). The range of AHEC services provided to enhance the 
practice environment (i.e., learning resources, telecommunications as a 
teaching tool), and the number of regional practitioners involved in 
the AHEC as adjunct faculty.
    C. Expected outcomes in AHEC geographic areas (20 points). A system 
is proposed or in place for tracking AHEC-experienced trainees 
(students, residents) who eventually practice in primary care in 
underserved areas.

Additional Information

    Interested persons are invited to comment on the proposed 
additional review criteria. The comment period is 30 days. All comments 
received on or before January 30, 1995 will be considered before the 
final additional review criteria are established. Written comments 
should be addressed to: Marc L. Rivo, M.D., M.P.H., Director, Division 
of Medicine, Bureau of Health Professions, Health Resources and 
Services Administration, 5600 Fishers Lane, Parklawn Building, Room 9A-
25, Rockville, Maryland 20857.
    All comments received will be available for public inspection and 
copying at the Division of Medicine, Bureau of Health Professions, at 
the above address, weekdays (Federal holidays excepted) between the 
hours of 8:30 a.m. and 5:00 p.m.

Application Requests

    Requests for application materials and questions regarding grants 
policy and business management issues should be directed to: Ms. Diane 
Murray, Grants Management Specialist (U76), Bureau of Health 
Professions, Health Resources and Services Administration, Parklawn 
Building, Room 8C-26, 5600 Fishers Lane, Rockville, Maryland 20857, 
Telephone: (301) 443-6857, FAX: (301) 443-6343.
    Completed applications should be returned to the Grants Management 
Branch at the above addesss.
    If additional programmatic information is needed, please contact: 
Louis Coccodrilli, M.P.H., Acting Chief, AHEC and Special Programs 
Branch, Division of Medicine, Bureau of Health Professions, Health 
Resources and Services Administration, Parklawn Building, Room 9A-25, 
5600 Fishers Lane, Rockville, Maryland 20857, Telephone: (301) 443-
6950, FAX: (301) 443-8890.

Paperwork Reduction Act

    The standard application form PHS 6025-1, HRSA Competing Training 
Grant Application, General Instructions and supplement for these grant 
programs have been approved by the Office of Management and Budget 
under the Paperwork Reduction Act. The OMB Clearance Number is 0915-
0060.

Deadline Date

    The deadline date for receipt of applications for each of these 
grant programs is February 13, 1995. Applications will be considered to 
be ``on time'' if they are either:
    (1) Received on or before the established deadline date, or
    (2) Sent on or before the established deadline date and received in 
time for orderly processing. (Applicants should request a legibly dated 
U.S. Postal Service postmark or obtain a legibly dated receipt from a 
commercial carrier or U.S. Postal Service. Private metered postmarks 
shall not be acceptable as proof of timely mailing.)
    Late applications not accepted for processing will be returned to 
the applicant.
    The Cooperative Agreement for Basic/Core Area Health Education 
Centers Programs is listed at 93.824 and the Model State-Supported Area 
Health Education Centers Programs is listed at 93.107 in the Catalog of 
Federal Domestic Assistance. These programs are not subject to the 
provisions of Executive Order 12372, Intergovernmental Review of 
Federal Programs (as implemented through 45 CFR Part 100) or the Public 
Health System Reporting Requirements.

    Dated: November 18, 1994.
Ciro V. Sumaya,
Administrator.
[FR Doc. 94-32064 Filed 12-28-94; 8:45 am]
BILLING CODE 4160-15-M