Federal Register, Volume 61 Issue 213 (Friday, November 1, 1996)

[Federal Register Volume 61, Number 213 (Friday, November 1, 1996)]
[Notices]
[Pages 56550-56559]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 96-28112]

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DEPARTMENT OF HEALTH AND HUMAN SERVICES
Health Resources and Services Administration

Program Announcement for Grant Programs Administered by the
Division of Associated, Dental and Public Health Professions, Bureau of
Health Professions for Fiscal Year 1997

The Health Resources and Services Administration (HRSA) announces
that applications will be accepted for eight grant programs for fiscal
year (FY) 1997 under the authority of title VII of the Public Health
Service (PHS) Act, as amended by the Health Professions Education
Extension Amendments of 1992, Pub. L. 102-408, dated October 13, 1992.
These programs include:
1. Grants for Interdisciplinary Training for Health Care for Rural
Areas (section 778, PHS Act) Review criteria are proposed.
2. Grants for Residency Training and Advanced Education in the
General Practice of Dentistry (section 749, PHS Act)
3. Public Health Special Project Grants (section 762, PHS Act)
Review criteria are proposed.
4. Chiropractic Demonstration Project Grants (section 782, PHS Act)
5. Allied Health Grant Program (section 767, PHS Act)
6. Geriatric Education Centers (GECs) (section 777(a), PHS Act)
Review criteria are proposed.
7. Grants for the Health Administration Traineeships and Special
Projects Program (section 771, PHS Act)
8. Dental Public Health Specialty Training Grants (section 763, PHS
Act) Review criteria and the minimum percentages for ``high rate'' and
``Significant Increase in the Rate'' for implementation of the general
statutory funding preference are proposed.
The table below provides budget information for the grant programs
administered by the Division of Associated, Dental and Public Health
Professions in FY 1997.

----------------------------------------------------------------------------------------------------------------
Available for
Program title Available for Continuation competing Average competing award expected
this program support awards and number of awards
----------------------------------------------------------------------------------------------------------------
Interdisciplinary Training $4,081,000 $1,708,276 $2,372,473 $175,000 (14 grants).
for Health Care for Rural
Areas.
Residency Training and $3,720,000 $2,178,000 $1,542,000 $100,000 (11 grants).
Advanced Education in the
General Practice of
Dentistry.
Public Health Special $3,000,000 $500,000 $2,500,00 $150,000 (11 grants).
Projects.
Chiropractic Demonstration $788,500 None $788,500 $200,000 (3 grants).
Projects.
Allied Health Projects....... $3,767,000 $1,122,906 $2,644,095 $100,000 (26 grants).
Geriatric Education Centers.. $5,778,000 $3,720,000 $1,853,000 $145,000 (12 grants).
Health Administration $1,076,000 None $1,076,000 $25,000 (40 grants).
Traineeships and Special
Projects.
Dental Public Health $500,000 None $500,000 $90,000 (6 grants).
Specialty Training.
----------------------------------------------------------------------------------------------------------------

The purpose and eligibility for each of these programs are listed
below as well as additional information depending on the individual
program.

1. Grants for Interdisciplinary Training for Health Care for Rural
Areas

Purpose

Section 778 of the Public Health Service Act, as amended,
authorizes the Secretary to award grants for interdisciplinary training
projects designed to provide or improve access to health care in rural
areas. Specifically, projects funded under this authority shall be
designed to:
(a) use new and innovative methods to train health care
practitioners to provide services in rural areas;
(b) demonstrate and evaluate innovative interdisciplinary methods
and models designed to provide access to cost-effective comprehensive
health care;
(c) deliver health care services to individuals residing in rural
areas;
(d) enhance the amount of relevant research conducted concerning
health care issues in rural areas; and
(e) increase the recruitment and retention of health care
practitioners in rural areas and make rural practice a more attractive
career choice for health care practitioners.
A recipient of funds may use various methods in carrying out the
projects described above. The legislation cites the following methods
as examples:
(a) the distribution of stipends to students of eligible
applicants;
(b) the establishment of a postdoctoral fellowship program;
(c) the training of faculty in the economic and logistical problems
confronting rural health care delivery systems; or
(d) the purchase or rental of transportation and telecommunication
equipment where the need for such equipment due to unique
characteristics of the rural area is demonstrated by the recipient.

Eligibility

To be eligible for a Grant for Interdisciplinary Training for
Health Care for Rural Areas, each applicant must be located in a State
and be:
1. a local health department, or
2. a nonprofit organization, or
3. a public or nonprofit college, university or school of, or
program that specializes in nursing, mental health practice, optometry,
public health, dentistry, osteopathic medicine, physician assistants,
pharmacy, podiatric medicine, allopathic medicine, chiropractic, or
allied health professions.
Applicants eligible to obtain funds under this grant program shall
not include for-profit entities, either directly or through a
subcontract or subgrant.
Each application must be jointly submitted by at least two eligible
applicants. One of the applicants must be an academic institution. Each
application must demonstrate the need and demand for health care
services, knowledge of available resources and the most significant
service and educational gaps within its targeted geographic area. One
applicant must be designated the principal organization responsible and
accountable for the conduct of the proposed project. Support may be
requested for this grant program for a project period of not more than
three years.

Definitions

1. Interdisciplinary training means a planned and coordinated
program of education or training aimed at preparation of functioning
teams of two or more health care practitioners from different health
disciplines who will coordinate their activities to provide services to
a client or group of clients.
2. Rural means geographic areas that are located outside of
standard metropolitan statistical areas.
3. School of or program that ``specializes'' in health professions

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education means programs that provide education in nursing, mental
health practice, optometry, public health, dentistry, osteopathy,
physicians assistants, pharmacy, podiatry, medicine, chiropractic, and
allied health professions that leads to a certificate, baccalaureate
degree or associate degree (or an equivalent degree of either) or to a
more advance degree which is accredited by a recognized body or bodies
approved for such purposes by the Secretary of Education, or which
provides to the Secretary satisfactory assurance by such accrediting
body or bodies that reasonable progress is being made toward
accreditation.

Statutory Project Requirements

Interdisciplinary training projects funded under section 778 must:
1. Assist individuals in academic institutions in establishing
long-term collaborative relationships with health care facilities and
providers in rural areas;
2. Designate a rural health care agency or agencies for clinical
treatment or training, including hospitals, community health centers,
migrant health centers, rural health clinics, community mental health
centers, long-term care facilities, Native Hawaiian health centers, or
facilities operated by the Indian Health Service or an Indian tribe or
tribal organization or Indian organization under a contract with the
Indian Health Service under the Indian Self-determination Act;
3. Not more than 10 percent of the individuals receiving training
with section 778 funds shall be trained as doctors of medicine or
osteopathic medicine; and
4. A grantee may not use more than 10 percent of the grant funds
for administrative cost.
5. Funds received under this section shall be used to supplement,
not supplant, amounts made available by such institution for activities
of the type described in the ``Purpose.''

Established Funding Priority

The following funding priority was established in FY 1993 after
public comment (58 FR 5741, January 22, 1993) and the Administration is
extending this funding priority in FY 1997. In determining the order of
funding of approved applications a priority will be given to applicant
institutions (academic) which demonstrate either substantial progress
over the last three years or a significant experience of ten or more
years in enrolling and graduating trainees from those minority or low-
income populations identified as at risk of poor health outcomes.

Proposed Review Criteria

The substantive content of the review criteria of the program have
not changed from those previously published; however, they have been
re-worded to make them more understandable. In addition, a new
criterion is proposed in number (11) relating to the evaluation
procedures of the program.
Applications will be reviewed and rated according to the
applicant's ability to meet the following:
(1) The potential effectiveness of the proposed project in carrying
out the training purposes of section 778 of the act.
(2) The extent to which the project explains the need for the
project in the rural area to be served;
(3) The degree to which the proposed project adequately provides
for the interdisciplinary training of health professionals to practice
in the rural area to be addressed by the project;
(4) The degree to which the applicant offers interdisciplinary
training experiences with at least three disciplines in rural health
care settings of sufficient length and content;
(5) The degree to which the applicant demonstrates a commitment to
establishing and maintaining long-term collaborative relationships
between academic institutions and health care facilities and providers
in rural areas;
(6) The degree to which the effectiveness of the organizational
arrangements necessary to carry out the project have been documented to
include the administrative and organizational relationships between and
among the various academic programs, health departments, and/or
nonprofit organizations and rural health care agencies;
(7) The administrative and management capability of the applicant
to carry out the proposed didactic and clinical curriculum in an
effective manner working with three or more health care disciplines;
(8) The capability of the proposed staff and faculty to provide the
competencies/skills needed by the trainees to enhance their ability to
pursue rural health practice and interdisciplinary care;
(9) The extent to which the trainee recruitment and selection
process assures that qualified trainees with significant interest or
background in rural health care are involved in the project;
(10) The extent to which the budget justification is reasonable and
indicates that institutional and community support to the project are
provided to the maximum extent possible;
(11) The adequacy of the evaluation mechanism to measure the
education performance outcomes using primary, secondary and tertiary
data for each objective for each grant year and to provide the basis
for continual quality improvement at the academic institution and the
rural health facility; and
(12) The extent to which the financial information provided
indicates a cost-effective utilization of grant funds and indicates
that the project will continue on a self-sustaining basis.

2. Grants for Residency Training and Advanced Education in the General
Practice of Dentistry

Purpose and Legislative Authority

Section 749 of the PHS Act authorizes the Secretary to make grants
to any public or nonprofit private school of dentistry or accredited
postgraduate dental training institution (e.g., hospitals and medical
centers):
(1) to plan, develop, and operate an approved residency program in
the general practice of dentistry or an approved advanced educational
program in the general practice of dentistry;
(2) to provide financial assistance to participants in such a
program who are in need of financial assistance and who plan to
specialize in the practice of general dentistry; and
(3) to fund innovative, nontraditional models for the provision of
postdoctoral General Dentistry training.

Eligibility

To be eligible for a Grant for Residency Training and Advanced
Education in the General Practice of Dentistry, the applicant shall:
(1) be a public or nonprofit private school of dentistry or an
accredited postgraduate dental training institution (hospital, medical
center, or other entity) and be accredited by the appropriate
accrediting body, and
(2) be located in any one of the several States, the District of
Columbia, the Commonwealth of Puerto Rico, the Commonwealth of the
Northern Mariana Islands, the Virgin Islands, Guam, American Samoa, the
Republic of Palau, the Republic of the Marshall Islands, and the
Federated States of Micronesia.
To receive support, programs must meet the requirements of final
regulations at 42 CFR Part 57, Subpart L. The period of Federal support
may not exceed 3 years.

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Categories of Program Support

There is no funding preference between residency training programs
and advanced educational programs in general dentistry. Grant support
will be available for three distinct categories of program development.
Applications must address at least one of these categories.

Category 1: Program Initiation

An applicant may request support to assist in establishing a new
program. Support may be for 3 years of program operation, or for up to
1 year of program planning and development, followed by 2 years of
program operation. An applicant must show, at a minimum, preliminary
provisional approval from the Commission on Dental Accreditation before
the initial grant award date (grants will be effective July 1, 1997).
Before a second year grant award will be made, the grantee must show an
accreditation classification of Accreditation Eligible.

Category 2: Program Expansion

An applicant may request support for an existing program which has
full approval accreditation classification to fund the cost of a first-
year enrollment increase in the program.

Category 3: Program Improvement

An applicant may request support for an existing program which has
conditional approval or provisional approval accreditation to correct
deficiencies or weaknesses in order to gain full approval accreditation
status.
Support is also available for an existing program which has full
approval accreditation for changes or additions in faculty, curriculum
and/or facilities to enhance the quality of the program.

Review Criteria

The review of applications will take into consideration the
following criteria:
1. The potential effectiveness of the proposed project in carrying
out the training purposes of section 749 of the Act.
2. The degree to which the proposed project adequately provides for
meeting the project requirements.
3. The administrative and managerial capability of the applicant to
carry out the proposed project in a cost-effective manner.
4. The extent to which the objectives of the program are consistent
with the purposes of the grant program and the extent to which the
evaluation methodology will effectively assess the impact of the
project.
5. The extent to which the proposal demonstrates a need for the
project.
6. The extent to which present or potential problems are understood
by the applicant and the extent to which solutions to these problems
have been developed.
7. The extent to which the organizational and administrative
relationships between institutional and programmatic components of the
project enhance the achievement of project objectives.
8. The extent to which the curriculum will enhance the trainee's
ability to become an efficient, effective, and competent practitioner
of general dentistry.
9. The qualifications of proposed staff and faculty.
10. The extent to which the trainee recruitment and selection
process assures that highly qualified trainees with a true interest in
general practice are enrolled in the program.
11. The extent to which the facilities and equipment used in the
training program are appropriate to the general practice of dentistry.
12. The potential of the project to continue on a self-sustaining
basis after the period of grant support.
13. The extent to which the budget justification is reasonable and
indicates that institutional support to the project is provided to the
maximum extent possible.
14. The degree to which the proposed project proposes to attract,
maintain and graduate minority and disadvantaged students.

Program Requirements

The Program Requirements referenced in Review Criterion Number 2,
above, are published in 42 CFR Ch.I, Sec. 57.1105. They are listed
below.
A. The project staff must plan, develop, and/or operate an approved
residency or advanced educational program in the general practice of
dentistry;
B. Each project must have at least two participants enrolled in the
training program;
C. If the training site provides medical care, then the medical and
dental care of patients must be coordinated;
D. If a primary care medical residency program is conducted by the
applicant, then joint training experiences must be provided. For
purposes of this paragraph, primary care means internal medicine,
family medicine, or pediatrics;
E. Each participant who receives stipend support must sign a
statement of intent to work in the practice of general dentistry; and
F. The training program, the performance of each participant, and
the quality of patient care must be evaluated.

Statutory General Preference

As provided in Section 791(a) of the PHS Act, preference will be
given to any qualified applicant that--
(A) has a high rate for placing graduates in practice settings
having the principal focus of serving residents of medically
underserved communities; or
(B) during the 2-year period preceding the fiscal year for which
such an award is sought, has achieved a significant increase in the
rate of placing graduates in such settings.
This preference will only be applied to applications that rank
above the 20th percentile of proposals recommended for approval by the
peer review group.
``High rate'' is defined as a minimum of 25 percent of graduates in
academic years 1993-94, 1994-95, and 1995-96 who spend at least 50
percent of their work time in clinical practice in the specified
settings. Graduates who are providing care in a medically underserved
community as a part of a fellowship or other educational experience can
be counted.
``Significant increase in the rate'' means that, between academic
years 1994-95 and 1995-96, the rate of placing graduates in the
specified settings has increased by a minimum of 50 percent and that
not less than 15 percent of graduates from the most recent year are
working in these settings.
Additional information concerning the implementation of this
preference has been published in the Federal Register at 59 FR 15741,
dated April 4, 1994.

Information Requirements Provision

Under section 791(b) of the Act, the Secretary may make an award
under the Grants for Residency Training and Advanced Education in the
General Practice of Dentistry program only if the applicant for the
award submits to the Secretary the following information:
1. A description of rotations of preceptorships for students, or
clinical training programs for residents, or clinical training programs
of residents, that have the principal focus of providing health care to
medically underserved communities.
2. The number of faculty on admissions committees who have a
clinical practice in community-based ambulatory settings in medically
underserved communities.
3. With respect to individuals who are from disadvantaged
backgrounds or

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from medically underserved communities, the number of such individuals
who are recruited for academic programs of the applicant, the number of
such individuals who are admitted to such programs, and the number of
such individuals who graduate from such programs.
4. If applicable, the number of recent graduates who have chosen
careers in primary health care.
5. The number of recent graduates whose practices are serving
medically underserved communities.
6. A description of whether and to what extent the applicant is
able to operate without Federal assistance under this title.

3. Public Health Special Project Grants

Purpose

Section 762 of the PHS Act, as amended, authorizes the Secretary to
award grants to accredited schools of public health to plan, develop,
demonstrate, operate and evaluate projects that further goals
established by the Secretary.
As requested by section 762(e) of the Act, the Secretary
established the following four goals for projects as set forth in the
1994 Report to Congress on Evaluation of Special Projects in Public
Health Program:
Linkages. Establishing and strengthening community-
academic partnerships, including linkages with State and local health
agencies; community-based organizations; health care facilities,
including managed care organizations; industry; schools; and other
education and training programs.
Education. Developing strategies to make public health
education more relevant to practice and more available to employed
public health practitioners.
Recruitment. Improving methods to recruit minority and
disadvantaged individuals into careers in public health.
Access and Quality. Improving access and quality in health
care for vulnerable populations and the public at large.
Copies of the Report to Congress are available by contacting the
Public Health and Dental Education Branch, Division of Associated,
Dental and Public Health Professions, BHPr/HRSA, 5600 Fishers Lane,
Room 8C-09, Rockville, MD 20857; telephone: 301/443-6896; fax: 301/443-
1164.
In fiscal year 1997, HRSA is soliciting applications that carry out
the Program's purpose and goals in the following areas:
Expand the number of community-academic linkages with
State and local public health agencies, community-based organizations,
health care facilities, including managed care organizations, industry,
and local educational institutions for the purpose of developing on-
site educational experiences for public health students and distance-
based continuing education programs for employed public health
personnel.
Expand the number of public health students and faculty
who participate in collaborative projects that foster creative
partnering with community-based organizations to address pressing
community health needs.
Establish partnerships with managed care organizations to
provide public health faculty, students, and practitioners with the
knowledge base and practical skills experience to apply community and
population-based health assessment to the needs of managed and
integrated systems of care.
Promote curriculum development, field placements, and
collaborative projects with community organizations, public health
agencies, schools, the aging network, and other entities in such areas
as domestic violence prevention, interdisciplinary team training,
communication and interpersonal skills, cultural diversity, and
partnerships with other health professions schools and programs to
increase their public health and population-based science content.
Develop recruitment and retention strategies to increase
the number of minority and disadvantaged individuals enrolled in and
completing degree and continuing education programs in public health.

Eligibility

To be eligible for a Public Health Special Project Grant, the
applicant shall be a school of public health that has been accredited
by the Council on Education for Public Health pursuant to sections
799(1) (A) and (E) of the PHS Act, and shall be located in a State as
defined in section 799(9) of the Act. Applicants must assure that
students of the school will, through participation in the project for
which the award is made, receive training in the activities carried out
by the project.

Period of Support

The period of Federal support for a new project may not exceed
three years. A competing continuation application may be submitted for
2 additional years of support for the same project, extending the total
project period to 5 years. Competing continuation applications may
request support for ongoing activities, for new or expanded activities,
or for both ongoing and new or expanded activities.

Proposed Review Criteria

The following criteria for review of applications are proposed for
public comment:
Proposal addresses the purposes of the Public Health
Special Projects Grant Program and is supported by a well-documented
rationale;
Objectives are consistent with the rationale, measurable,
and achievable within the project period;
Methodology is consistent with the objectives and
explained in appropriate detail;
Evaluation is linked to the objectives and addresses
outcomes;
Administrative and management capability required to carry
out the project is documented;
Budget justification is complete, appropriate, cost-
effective, and justified; and
Plan for institutionalizing project outcomes is specific
and realistic.

Statutory Preference

A funding preference is defined as the funding of a specific
category or group of approved applications ahead of other categories or
groups of approved applications.
As prescribed by section 762(b) of the Act, preference in funding
will be given to qualified applicants that agree the project for which
the award is made will: (1) establish or strengthen field placements
for students in public or nonprofit private health agencies or
organizations; and (2) involve faculty members and students in
collaborative projects to enhance public health services to medically
underserved communities.

4. Chiropractic Demonstration Project Grants

Purpose

Section 782 of the Public Health Service Act authorizes the
Secretary to award grants to carry out demonstration projects in which
chiropractors and physicians collaborate to identify and provide
effective treatment for spinal and lower-back conditions. The period of
support is three years.

Eligibility

To be eligible for a Chiropractic Demonstration Project, the
applicant shall be:
1. a public or private nonprofit school, college or University of
Chiropractic; and
2. enter into a formal agreement as necessary to ensure that a
school of

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allopathic or osteopathic medicine will collaborate in the project.

Project Requirements

Specific project requirements published in the Federal Register at
59 FR 44995, dated August 31, 1994 will be used for FY 1997:
1. The project must address the identification and treatment of
spinal and/or lower-back conditions.
2. The project must be founded on collaborative efforts between the
school(s) of chiropractic and school(s) of allopathic or osteopathic
medicine.
3. Each project must include a strong research protocol which will
result in a significant expansion of documented research in the area
addressed and which is suitable for publication in refereed health
professions journals, including research oriented publications.
4. The project must include an explicit strategy for case-finding
and a strategy for making direct comparisons to other forms of
treatment. The results must be generalizable to patients cared for in
clinical practices addressing spinal and/or lower-back conditions.
5. Whenever feasible, minorities and women should be included in
study populations so that research findings can be of benefit to all
persons at risk of the disease, disorder, or condition under study.

Review Criteria

The review of applications will take into consideration for FY 1997
the following criteria published in the Federal Register at 59 FR
44995, dated August 31, 1994:
1. The strength of the rationale for the project;
2. The quality and clarity of the objectives to be achieved in
relation to the stated statutory purposes of the program and the
potential of the project for meeting them;
3. The strength of the applicant's institutional background in
chiropractic training and research;
4. The competency of all faculty, both chiropractic and allopathic
or osteopathic medicine, to be involved in the project, including past
experience in chiropractic and/or chiropractic research and allopathic
or osteopathic research;
5. The proposed methodology to be used in carrying out the goals
and objectives of the project, including those pertaining to research
and its outcomes;
6. The appropriateness of timelines to be used in achieving the
project's goals and objectives;
7. The strength of the proposed evaluation methodology to be used
in evaluating the accomplishments of the project, including those
pertinent to research;
8. The strength of the evidence of the applicant institution's
commitment, including letters of support, to carrying out the project
successfully and the institutional commitment of the allopathic or
osteopathic school of medicine collaborating in the project;
9. The suitability and availability of all proposed facilities and
resources to be used in carrying out the project;
10. The appropriateness of the proposed budget and fiscal plan for
carrying out the project and the administrative and management
capability of the applicant to implement the project in a cost-
effective manner; and
11. The documentation, terms, and specificity of a formal agreement
with a school of allopathic or osteopathic medicine for its
collaboration in carrying out the goals, objectives, and evaluation of
the project.
The peer review group which reviews applications for this program
will include no fewer than two, and no more than three chiropractors.

5. Allied Health Grant Program

Section 767 authorizes the Secretary to award grants to eligible
entities to assist such entities in meeting the costs associated with
expanding or establishing programs that will increase the number of
individuals trained in allied health professions. Projects will address
expansion of enrollments, community-based interdisciplinary training,
health promotion and disease prevention, partnerships, and innovative
approaches to the training of allied health personnel and the delivery
of allied health services. The period of support is three years.
Programs funded under this section may include--
(1) those that expand enrollments in allied health professions with
the greatest shortages or whose services are most needed by the
elderly;
(2) those that provide rapid transition training programs in allied
health fields to individuals who have baccalaureate degrees in health-
related sciences;
(3) those that establish community-based allied health training
programs that link academic centers to rural clinical settings;
(4) those that provide career advancement training for practicing
allied health professionals;
(5) those that expand or establish clinical training sites for
allied health professionals in medically underserved or rural
communities in order to increase the number of individuals trained;
(6) those that develop curriculum that will emphasize knowledge and
practice in the areas of prevention and health promotion, geriatrics,
long-term care, home health and hospice care, and ethics;
(7) those that expand or establish interdisciplinary training
programs that promote the effectiveness of allied health practitioners
in geriatric assessment and the rehabilitation of the elderly;
(8) those that expand or establish demonstration centers to
emphasize innovative models to link allied health clinical practice,
education, and research.

Eligibility

``Eligible entity'' for the purpose of this grant program means:
(1) public or private nonprofit schools, universities, or other
educational entities that provide for education and training in the
allied health professions; or
(2) other public or nonprofit private entities capable, as
determined by the Secretary, of carrying out the purpose of the Allied
Health Project Grants Program as described in the application; and
(3) be located in the several States, the District of Columbia, the
Commonwealth of Puerto Rico, the Commonwealth of the Northern Mariana
Islands, the Virgin Islands, Guam, American Samoa and the Republic of
Palau, the Republic of the Marshall Islands, and the Federated States
of Micronesia.

Funding Preference

The statutory preferences identified in Sections 767(b)(2) and
791(a) of the Public Health Service Act are set forth below. Applicants
who meet one or more of the following criteria will receive funding
preference. Greater priority will be given to applicants who qualify in
two or three preference categories.
(A) expand and maintain first-year enrollment by not less than 10
percent over enrollments in base year 1992; or
(B) demonstrate that not less than 20 percent of the graduates of
such training programs during the preceding 2-year period are working
(at least 50% of worktime in clinical settings having the principal
focus of serving residents of medically underserved communities).
Graduate who are providing care in a medically underserved community as
a part of a fellowship or other educational experience can be counted;
or

[[Page 56555]]

(C) during the 2-year period preceding the fiscal year for which
such an award is sought, has achieved a significant increase in the
rate of placing graduates in such settings. ``Significant increase in
the rate'' means that, between academic years 1994-95 and 1995-96, the
rate of placing graduates in the specified settings has increased by a
minimum of 50 percent and that not less than 15 percent of graduates
from the most recent year are working in these settings.

New Program Funding Preference

Implementation specifics for new programs was published in the
Federal Register at 59 FR 15742, dated April 4, 1994. A new program is
defined as any program which has graduated less than three classes. A
new program will qualify for the above funding preferences if four or
more of the following criteria are met:
1. The mission statement of the program identifies a specific
purpose of preparing health professionals to serve underserved
populations.
2. The curriculum includes content which will help to prepare
practitioners to serve underserved populations.
3. Substantial clinical training experience is required in
medically underserved communities.
4. A minimum of 20 percent of the faculty spend at least 50 percent
of their time providing/supervising care in medically underserved
communities.
5. The entire program or a substantial portion of the program is
physically located in a medically underserved community.
6. Student assistance, which is linked to service in medically
underserved communities following graduation, is available to the
students in the program.
7. The program provides a placement mechanism for placing graduates
in medically underserved communities.

Review Criteria

The review criteria, stated below, which were established in FY
1990 (55 FR 12424, dated April 3, 1990) after public comment, will
remain unchanged in FY 1997.
1. The extent to which the proposed project meets the legislative
purpose;
2. The background and rationale for the proposed project;
3. The extent to which the project contains clearly stated
realistic and achievable objectives;
4. The extent to which the project contains a methodology which is
integrated and compatible with project objectives, including
collaborative arrangements and feasible workplans;
5. The evaluation plans and procedures for program and trainees, if
involved;
6. The administrative and management capability of the applicant to
carry out the proposed project, including institutional infrastructure
and resources;
7. The extent to which the budget justification is complete, cost-
effective and includes cost-sharing, when applicable; and
8. Whether there is an institutional plan and commitment for self-
sufficiency when Federal support ends.

Information Requirements Provision

Under section 791(b) of the Act, the Secretary may make an award
under the Allied Health Project Grants only if the applicant for the
award submits to the Secretary the following information:
1. A description of rotations or preceptorships for students, or
clinical training programs for residents, that have the principal focus
of providing health care to medically underserved communities.
2. The number of faculty on admissions committees who have a
clinical practice in community-based ambulatory settings in medically
underserved communities.
3. With respect to individuals who are from disadvantaged
backgrounds or from medically underserved communities, the number of
such individuals who are recruited for academic programs of the
applicant, the number of such individuals who are admitted to such
programs, and the number of schools individuals who graduate from such
programs.
4. If applicable, the number of recent graduates who have chosen
careers in primary health care.
5. The number of recent graduates whose practices are serving
medically underserved communities.
6. A description of whether and to what extent the applicant is
able to operate without Federal assistance under this title.

6. Grants for Geriatric Education Centers

Section 777(a) of the Public Health Service Act authorizes the
Secretary to make grants to support the development of collaborative
arrangements involving several health professions schools and health
care facilities. These arrangements, called Geriatric Education Centers
(GECs), facilitate training of health professional faculty, students,
and practitioners in the diagnosis, treatment, and prevention of
disease, disability, and other health problems of the aged. Health
professionals include allopathic physicians, osteopathic physicians,
dentists, optometrists, podiatrists, pharmacists, nurses, nurse
practitioners, physician assistants, chiropractors, clinical
psychologists, health administrators, and allied health professionals.
Projects supported under these grants must offer training involving
four or more health professions, one of which must be allopathic or
osteopathic medicine. Projects must address one or more of the
statutory purposes listed below:
(a) improve the training of health professionals in geriatrics;
(b) develop and disseminate curricula relating to the treatment of
the health problems of elderly individuals;
(c) expand and strengthen instruction in methods of such treatment;
(d) support the training and retraining of faculty to provide such
instruction;
(e) support continuing education of health professionals and allied
health professionals who provide such treatment; and
(f) establish new affiliations with nursing homes, chronic and
acute disease hospitals, ambulatory care centers, and senior centers in
order to provide students with clinical training in geriatric medicine.
Recommendations to assist GECs in developing programmatic
objectives are set forth in the HRSA's publication entitled A National
Agenda for Geriatric Education: White Papers. Copies of the White
Papers and the GEC excerpts from it are available by contacting the
Interdisciplinary, Geriatrics and Allied Health Branch, Division of
Associated, Dental and Public Health Professions, BHPr/HRSA, 5600
Fishers Lane, Room 8-103, Rockville, MD 20857; telephone: 301/443-6887;
fax: 301/443-1164.

Eligibility

Grants may be made to accredited health professions schools as
defined by section 799(1), or programs for the training of physician
assistants as defined by section 799(3), or schools of allied health as
defined in section 799(4), or schools of nursing as defined by section
853(2).
Applicants must be located in the United States, the Commonwealth
of Puerto Rico, the Commonwealth of the Northern Mariana Islands, the
Virgin Islands, Guam, American Samoa, the Republic of Palau, the
Republic of the Marshall Islands, or the Federated States of
Micronesia. The initial period of Federal support should not exceed 3
years. Projects may recompete for an additional 3 years.

[[Page 56556]]

Proposed Review Criteria

The following review criteria are proposed for FY 1997:
(1) The degree to which the proposed project adequately provides
for the project requirements;
(2) The extent to which the rationale and specific objectives of
the project are based upon a needs assessment of the status of
geriatrics training in the institutions to be assisted and/or the
geographic area to be served;
(3) The ability of the project to achieve the project objectives
within the proposed geographic area;
(4) The adequacy of educational facilities and clinical training
settings to accomplish objectives;
(5) The adequacy of organizational arrangements involving
professional schools and other organizations necessary to carry out the
project;
(6) The adequacy of the qualifications and experience in geriatrics
of the project director, staff and faculty;
(7) The administrative and managerial ability of the applicant to
carry out the proposed project in a cost-effective manner, and;
(8) The potential of the project to continue on a self-sustaining
basis.
(9) If applicable, the extent to which there is evidence that the
institutions jointly have planned and jointly will conduct the proposed
consortia activities.
(10) The potential of the project to recruit and/or retain minority
faculty members and trainees for participation in long term and/or
short term training experiences.
(11) The adequacy of the evaluation mechanisms to measure the
education performance outcomes of each objective at primary (aggregated
outcome data) and secondary (results that can be attributed to the
program's efforts) levels.
(12) The degree to which the proposed project objectives relate to
recommendations from the HRSA's publication of the White Papers.

7. Grants for the Health Administration Traineeships and Special
Projects Program

Purpose

Section 771 of the Public Health Service Act authorizes the
Secretary to:
(1) award grants which provide traineeships for students enrolled
in an accredited program of health administration, hospital
administration, or health policy analysis and planning programs; and
(2) assist programs of health administration in the development or
improvement of programs to prepare students for employment with public
or nonprofit private entities.
The period of Federal support is for three years.
This program is governed by regulations at 42 CFR part 58, subpart
D to the extent to which these regulations are not inconsistent with
the amended statute.

Eligibility

Eligible applicants are public or nonprofit private educational
entities, including graduate schools of social work but excluding
accredited schools of public health, offering a graduate program in
health administration, hospital administration, or health policy
analysis and planning accredited by the Accrediting Commission on
Education in Health Services Administration. Applicants must assure
that, in providing traineeships, priority will be given to students who
demonstrate a commitment to employment with public or nonprofit private
entities in health administration and management.

Review Criteria

The review of applications will take into consideration the
following criteria:
1. The administrative and management ability of the applicant to
carry out the proposed project in a cost-effective manner;
2. The adequacy of the staff and faculty;
3. The adequacy of institutional resources available to conduct
graduate level education, to include the adequacy of teaching
facilities;
4. The adequacy of recruitment and placement assistance for
students in accord with the legislative purpose and intent; and
5. The extent to which the application justifies the need for
traineeships and the rationale, objectives, methodology, and evaluation
of special project grants.

Statutory Funding Preference

Preference will be given to qualified applicants meeting the
following conditions:
1. Not less than 25 percent of the graduates of the applicant are
engaged in full-time practice settings in medically underserved
communities;
2. The applicant recruits and admits students from medically
underserved communities;
3. For the purpose of training students, the applicant has
established relationships with public and nonprofit providers of health
care in the community involved; and
4. In training students, the applicant emphasizes employment with
public or nonprofit private entities.
The term ``medically underserved community is defined in the
Federal Register at 58 FR 9570 dated February 22, 1993.
This preference will only be applied to applications that rank
above the 20th percentile of proposals recommended for approval by the
peer review group.

8. Dental Public Health Specialty Training Grants Purpose and
Legislative Authority

Section 763 of the Public Health Service Act authorizes the
Secretary to make grants to schools of public health and dentistry to
meet the costs of projects to:
(1) plan and develop new residency training programs and to
maintain or improve existing residency training programs in dental
public health; and
(2) provide financial assistance to residency trainees enrolled in
such programs.

Eligibility

To be eligible for a Dental Public Health Specialty Training Grant,
the applicant must:
(1) Be a public or nonprofit private school of dentistry or public
health and be accredited by the appropriate accrediting body,
(2) Be located in any one of the several States of the United
States, the District of Columbia, the Commonwealth of Puerto Rico, the
Commonwealth of the Northern Mariana Islands, the Virgin Islands, Guam,
American Samoa, the Republic of Palau, the Republic of the Marshall
Islands, and the Federated States of Micronesia.
(3) Evidence that it has, or will have available, full-time faculty
members with training and experience in the field of dental public
health and support from faculty members trained in public health and
other relevant specialties and disciplines; and
(4) Have a program accredited by the American Dental Association
Commission on Dental Accreditation.
Support may be requested for this grant program for a project
period of not more than three years.

Program Priorities for Fiscal Year 1997

Applicants are encouraged to address one or more of the program
priorities within their proposals:
Education. Developing strategies to make dental public health
education more relevant to practice and more available to dental public
health practitioners. Particularly, expanding opportunities for the
specialty education of working dentists with a master's in public
health (MPH) or equivalent degrees through

[[Page 56557]]

nontraditional or innovative approaches.
Linkages. Establishing and strengthening community-academic
partnerships, including linkages with State and local health
departments; community-based organizations; managed care organizations;
industry; schools; and other education and training programs.
Access and Quality. Improving access and quality in health care,
particularly oral health care, for vulnerable populations and the
public at large.

Proposed Review Criteria

The following review criteria are proposed for Dental Public Health
Specialty Training Grants.
Applications will be reviewed and rated according to the
applicant's ability to meet the following:
1. The proposal addresses the legislative intent of the program and
is supported by a well-documented rationale.
2. The proposal is responsive to the program priorities.
3. Objectives are consistent with the rationale, measurable, and
achievable within the project period.
4. Methodology is consistent with the objectives and explained in
appropriate detail.
5. Evaluation is linked to the objectives and addresses project
outcomes.
6. The applicant demonstrates the administrative and managerial
capability to carry out the proposed project.
7. The proposed budget is complete, appropriate, cost-effective,
and clearly justified.
8. The plan for institutionalizing the project is specific and
realistic.

Statutory Preference

Minimum Percentages for ``High Rate'' and ``Significant Increase in the
Rate''

``High rate'' is defined as a minimum of 20 percent of graduates in
academic years 1993-94, 1994-95, and 1995-96 who spend at least 50
percent of their work time in clinical practice in the specified
settings. Graduates who are providing care in a medically underserved
community as a part of a fellowship or other educational experience can
be counted.
``Significant increase in the rate'' means that, between academic
years 1994-95 and 1995-96, the rate of placing graduates in the
specified settings has increased by a minimum of 50 percent and that
not less than 15 percent of graduates from the most recent year are
working in these settings.
Applicants which usually graduate fewer than four trainees per
academic year or which are less than three years old will qualify for
the funding preference if they meet four or more of the following
criteria:
1. The mission statement of the program identifies a specific
purpose of preparing health professionals to serve underserved
populations.
2. The curriculum includes content which will help to prepare
practitioners to serve underserved populations.
3. Substantial clinical training experience is required in
medically underserved communities.
4. A minimum of 20 percent of the faculty spend at least 50 percent
of their time providing/supervising care in medically underserved
communities.
5. The entire program or a substantial portion of the program is
physically located in a medically underserved community.
6. Student assistance, which is linked to service in medically
underserved communities following graduation, is available to the
students in the program.
7. The program provides a placement mechanism for deploying
graduates to medically underserved communities.
This preference will only be applied to applications that rank
above the 20th percentile of proposals recommended for approval by the
peer review group.

Statutory Information Requirement

Under Section 791(b) of the PHS Act, the Secretary may make a grant
only if the applicant for the award meets the ``information
requirement'' of the grant through the submission of the following
regarding the applicant's program:
1. A description of rotations or preceptorships for students, or
clinical training programs for residents, that have the principal focus
of providing health care to medically underserved communities.
2. The number of faculty on admissions committees who have a
clinical practice in community-based ambulatory settings in medically
underserved communities.
3. With respect to individuals who are from disadvantaged
backgrounds or from medically underserved communities, the number of
such individuals who are recruited for academic programs of the
applicant, the number of such individuals who are admitted to such
programs, and the number of such individuals who graduate from such
programs.
4. If applicable, the number of recent graduates who have chosen
careers in primary health care.
5. The number of recent graduates whose practices are serving
medically underserved communities.
6. A description of whether and to what extent the applicant is
able to operate without Federal assistance under this title.
Interested individuals are invited to comment on the proposed
review criteria for Grants for Interdisciplinary Training for Health
Care for Rural Areas, Public Health Special Project Grants, Grants for
Geriatric Education Centers, and Dental Public Health Specialty
Training Grants. Also, individuals are invited to comment on the
proposed minimum percentages for ``high rate'' and ``Significant
Increase in the Rate'' for implementation of the general statutory
funding preference for the Dental Public Health Specialty Training
Program.
The comment period is 30 days. All comments received on or before
December 2, 1996 will be considered before the final review criteria
are established.
Written comments should be addressed to: Neil Sampson, Director,
Division of Associated, Dental and Public Health Professions, Bureau of
Health Professions, Health Resources and Services Administration,
Parklawn Building, Room 8-101, 5600 Fishers Lane, Rockville, MD 20857.
All comments received will be available for public inspection and
copying at the Division of Associated, Dental and Public Health
Professions, 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 Availability

Application materials are available on the World Wide Web at
address: ``http://www.hrsa.dhhs.gov/bhpr/grants.html''. In Fiscal Year
1997, the Bureau of Health Professions (BHPr) will use Adobe Acrobat to
publish the grants documents on the Web page. In order to download,
view and print these grants documents, you will need a copy of Adobe
Acrobat Reader. This can be obtained without charge from the Internet
by going to the Adobe Web page (``http://www.adobe.com'') and

[[Page 56558]]

downloading the version of the Adobe Acrobat Reader which is
appropriate for your operating system, i.e., Windows, Unix, Macintosh,
etc. A set of more detailed instructions on how to download and use the
Adobe Acrobat Reader can be found on the BHPr Grants Web page under
``Notes on this WWW Page.
If additional programmatic information is needed, please contact
the Division of Associated, Dental and Public Health Professions,
Bureau of Health Professions, Health Resources and Services
Administration, Parklawn Building, Room 8-101, 5600 Fishers Lane,
Rockville, Maryland 20857. Questions regarding grants policy and
business management issues should be directed to the Grants Management
Branch in Room 8C-26 at the above address. Please refer to Table 1 for
specific BHPr contact names and phone numbers.
For applicants who are unable to access application materials
electronically, a hard copy will be provided by contacting the HRSA
Grants Application Center. The Center may be contacted by: Telephone
Number: 1-888-300-HRSA; FAX Number: 301-309-0579; Email Address:
[email protected].
Completed applications should be returned to: Grants Management
Officer (CFDA#), HRSA Grants Application Center, 40 West Gude Drive,
Suite 100, Rockville, Maryland 20850.

Application Forms

The standard application form PHS 398 (revised 5/95), Competing
Training Grant Application and General Instructions, will be used for
the Chiropractic Demonstration Project program. This form has been
approved by the Office of Management and Budget under the Paperwork
Reduction Act. The OMB Clearance Number is 0925-0001.
The standard application form PHS 6025-1, HRSA Competing Training
Grant Application, General Instructions will be used for all other
programs announced in this notice. This form has been approved by the
Office of Management and Budget under the Paperwork Reduction Act. The
OMB Clearance Number is 0915-0060.

Deadline Dates

The deadline dates for receipt of applications for each of these
grant programs are shown in Table 1. 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. In addition, applications which exceed the page
limitation and/or do not follow format instructions will not be
accepted for processing and will be returned to the applicant.

Table 1
----------------------------------------------------------------------------------------------------------------
Grants management contact/ Programmatic contact/ Deadline date
PHS title VII section number/program phone number/Email address phone number FAX: (301) for competing
title/CFDA number FAX: (301) 443-6343 443-1164 applications
----------------------------------------------------------------------------------------------------------------
778--Health Care for Rural Areas: Brenda Selser, (301) 443-6960, Judy Arndt, (301) 443- 12/18/96
Interdisciplinary Training G[email protected]. 6867.
93.192.
749--Residency Training and Advanced Brenda Selser, (301) 443-6960, Kathy Hayes, (301) 443- 12/16/96
Education in the General Practice of [email protected]. 6896 OR (301) 443-4832.
Dentistry--93.897.
762--Public Health Special Projects-- Wilma Johnson, (301) 443-6880, Anne Kahl, (301) 443- 1/06/97
93.188. [email protected]. 6896.
782--Chiropractic Demonstration Brenda Selser, (301) 443-6960, Shannon Mulroney, (301) 2/10/97
Project Grants. [email protected]. 443-6765.
767--Allied Health Grant Program-- Wilma Johnson, (301) 443-6880, Norman Clark, (301) 443- 12/23/96
93.191. [email protected]. 1346.
777(a)--Geriatric Education Centers Wilma Johnson, (301) 443-6880, Susan Klein, (301) 443- 1/27/97
(GECs)--93.969. [email protected]. 6889.
771--Health Administration Wilma Johnson, (301) 443-6880, Stuart Bernstein, (301) 12/13/96
Traineeships and Special P[email protected]. 443-6896, OR (301) 443-
93.962. 3231.
763--Dental Public Health Specialty Brenda Selser, (301) 443-6960, Kathy Hayes, (301) 443- 12/13/96
Training Grants--93.117. [email protected]. 6896 OR (301) 443-4832.
----------------------------------------------------------------------------------------------------------------

National Health Objectives for the Year 2000

The Public Health Service urges applicants to submit work plans
that address specific objectives of Healthy People 2000. 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).

Academic and Community Partnerships

As part of its cross-cutting program priorities, HRSA will be
targeting its efforts to strengthening linkages between U.S. Public
Health Service education programs and programs which provide primary
care services to the underserved.

Smoke-Free Workplace

The Public Health Service strongly encourages all grant recipients
to provide a smoke-free workplace and to promote the non-use of all
tobacco products and Public Law 103-227, the Pro-Children Act of 1994,
prohibits smoking in certain facilities that receive Federal funds in
which education, library, day care, heath care, and early childhood
development services are provided to children.
These programs are not subject to the provisions of Executive Order
12372, Intergovernmental Review of Federal Programs (as implemented
through 45 CFR part 100). These programs are also not subject to the
Public Health System Reporting Requirements.

[[Page 56559]]

Dated: October 29, 1996.
Ciro V. Sumaya,
Administrator.
[FR Doc. 96-28112 Filed 10-31-96; 8:45 am]
BILLING CODE 4160-15-P