[Federal Register Volume 64, Number 55 (Tuesday, March 23, 1999)]
[Notices]
[Pages 14080-14083]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 99-7000]



[[Page 14079]]

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Part III





Department of Health and Human Services





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Office of Public Health and Science: Family Planning Nurse Practitioner 
and Specialty Training Program Funds Availability Announcement; Notice

  Federal Register / Vol. 64, No. 55 / Tuesday, March 23, 1999 / 
Notices  

[[Page 14080]]



DEPARTMENT OF HEALTH AND HUMAN SERVICES


Office of Public Health and Science; Announcement of Availability 
of Funds for Family Planning Nurse Practitioner and Specialty Training 
Program

AGENCY: Office of Population Affairs, OPHS, HHS.

ACTION: Notice.

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SUMMARY: The Office of Family Planning (OFT) of the Office of 
Population Affairs requests applications for grants under the Family 
Planning Service Training Program authorized under section 1003 of the 
Public Health Service (PHS) Act. Funds are available to train health 
care practitioners in order to maintain the high level of performance 
of family planning service projects funded under Title X of the PHS 
Act. The training programs to be funded will provide skill-based 
knowledge for registered professional nurses, qualified nurse 
practitioners, physicians assistants, Doctors of Medicine, and Doctors 
of Osteopathy employed in Title X clinics, and will enable Title X 
service providers to improve the delivery of family planning services 
to persons from low-income families and other persons desiring such 
services.

DATES: To receive consideration, applications must be received by the 
Office of Grants Management, Office of Population Affairs no later than 
May 24, 1999.

ADDRESSES: Application kits may be obtained from and applications must 
be submitted to: Grants Management Office, Office of Population 
Affairs, 4350 East-West Highway, Suite 200 West, Bethesda, Maryland 
20814.

FOR FURTHER INFORMATION CONTACT: Program Requirements: Ms. Susan 
Moskosky, Acting Deputy Director, Office of Family Planning, at (301) 
594-4008.
    Administrative and Budgetary Requirements: Office of Grants 
Management, Office of Population Affairs, at (301) 594-4012.

SUPPLEMENTARY INFORMATION: Title X of the Public Health Service Act, 42 
U.S.C. 300, et seq., authorizes the Secretary of Health and Human 
Services to award grants for projects to provide training for family 
planning services personnel. (Catalog of Federal Domestic Assistance 
Number 93.260). This notice announces the availability of approximately 
$1,800,000 in funding and solicits applications for grants for two 
training projects, each of which will serve states in five U.S. 
Department of Health and Human Services regions, as described below.

Program Background

    Title X of the PHS Act, enacted by Pub. L. 91-572, authorizes 
grants for projects to provide family planning services to persons from 
low-income families and others. Section 1001 of the Act, as amended, 
authorizes grants to ``assist in the establishment and operation of 
voluntary family planning projects which shall offer a broad range of 
acceptable and effective family planning methods and services 
(including natural family planning methods, infertility services, and 
services for adolescents).'' Section 1003 of the Act, as amended, 
authorizes the Secretary to make grants to entities to provide the 
training for personnel to carry out the family planning services 
program. The regulations set out at 42 CFR, part 59, subpart C, govern 
grants for family planning services training. Prospective applicants 
should refer to the regulations in their entirety.
    The Office of Family Planning in the Office of Population Affairs, 
through the Title X program, has funded certificate nurse practitioner 
programs since the early 1970s to prepare registered professional 
nurses to serve the clinical needs of clients in Title X agencies. More 
than 5,000 family planning and women's health nurse practitioners have 
been prepared in the Title X-supported nurse practitioner training 
since that time. Many changes are occurring, however, that are having 
an impact on the type of training that will be needed for nurse 
practitioners and other clinical providers in the Title X delivery 
system, both now and in the future.
    While it is recognized that an estimated 80 percent of the 
clinicians currently providing services in Title X clinics are 
certificate prepared women's health nurse practitioners, there has been 
a precipitous and sustained decline in the number of applicants for 
Title X nurse practitioner training over the past five years. In the 
past two years, several of the Title X-supported nurse practitioner 
training programs have canceled classes due to an insufficient number 
of applicants.
    During this same time period, only one of the five Title X-
supported nurse practitioner training programs has been able to recruit 
the number of trainees to which they committed in the applications for 
funding. This decline in the number of applicants and trainees has 
resulted in a dramatic increase in the average cost per student to the 
Title X program.
    A majority of the states (26) currently require a masters degree 
for nurse practitioner practice or for prescriptive authority. 
Beginning January 1, 2007, a masters degree in the specialty area will 
be required for nurse practitioners to be eligible for the women's 
health nurse practitioner certification examination. The change in the 
certification eligibility requirement will mean that certificate 
training of women's health nurse practitioners will no longer be a 
viable option. Compounding these factors are the changes occurring 
within the health care delivery system and the increasing complexity of 
reproductive health and other health issues requiring a broader 
understanding of related health complications (e.g., hypertension, 
diabetes, HIV-related complications, etc.).
    The declining number of applicants for traditional certificate 
Title X nurse practitioner training along with the escalating costs of 
providing such training dictates a change in the approach to training 
clinical providers for the Title X system. Other factors that reinforce 
the need for a change in approach include changing State requirements 
and the availability of already credentialed, more broadly prepared 
clinical providers, such as masters prepared family or adult nurse 
practitioners, physicians assistants, Doctors of Medicine or Doctors of 
Osteopathy. The more broadly prepared clinical providers could benefit 
from in-depth family planning and women's health information and 
clinical training In an effect to maintain the quality of family 
planning service delivery in the Title X system, a strategy for 
providing this specialized family planning and women's health 
information to broadly prepared health care providers will be addressed 
by applicants for funding under this announcement.
    It is recognized that because Title X nurse practitioner training 
has existed in its current form for many years, a period of time will 
be needed to make necessary adjustments in order to minimize 
disruption. Therefore, the changes in training health care providers 
for the Title X service delivery system that are indicated in this 
announcement will be phased in over the three year project period.
    In recognition of the changes indicated in this announcement and 
the concomitant concern that employment of masters-prepared nurse 
practitioners will increase the cost of providing clinical services, 
the Office of Family Planning will make additional funds available to 
Title X service provider grantees to help offset these additional 
expenditures. A mechanism will be developed to ensure maintenance and 
retrieval of previous nurse practitioner training program graduate 
records.

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Purpose of the Grant

    The two training grants to be funded under this announcement will 
each provide training services in five of the Department's regions as 
follows:
    (1) One grant with a range of $300,000-$1,000,000 to train 
registered professional nurses and health care practitioners, defined 
as: qualified nurse practitioners, as defined below; physicians 
assistants; Doctors of Medicine; and, Doctors of Osteopathy, from the 
following cluster of regions:
    Region I (Connecticut, Maine, Massachusetts, New Hampshire, Rhode 
Island and Vermont);
    Region II (New Jersey, New York, Puerto Rico and the Virgin 
Islands);
    Region III (Delaware, Maryland, Pennsylvania, Virginia, West 
Virginia and the District of Columbia);
    Region IV (Alabama, Florida, Georgia, Kentucky, Mississippi, North 
Carolina, South Carolina and Tennessee);
    Region V (Illinois, Indiana, Michigan, Minnesota, Ohio and 
Wisconsin).
    (2) One grant with a funding range of $300,000-$1,000,000 to train 
registered professional nurses and health care practitioners, defined 
as: Qualified nurse practitioners, as defined below; physicians 
assistants; Doctors of Medicine; and, Doctors of Osteopathy, from the 
following cluster of regions:
    Region VI (Arkansas, Louisiana, New Mexico, Texas and Louisiana);
    Region VII (Iowa, Kansas, Missouri and Nebraska);
    Region VIII (Colorado, Montana, North Dakota, South Dakota, Utah 
and Wyoming);
    Region IX (Arizona, California, Hawaii, Nevada, American Samoa, 
Federated States of Micronesia, Republic of Marshall Islands, 
Commonwealth of Northern Mariana Islands, Republic of Palau and Guam);
    Region X (Alaska, Idaho, Oregon and Washington).
    For the purpose of this announcement, ``qualified nurse 
practitioner'' is defined as: registered professional nurse who is 
authorized by the State in which services are furnished to practice as 
a nurse practitioner in accordance with state law.
    The training programs funded under this announcement will provide 
two tracks of training: (1) During Year One of the project period, 
applicants will be responsible for design and delivery of full course, 
on-site training to prepare registered professional nurses to function 
in an advanced nursing role as obstetric-gynecologic or women's health 
nurse practitioners; and (2) beginning Year Two and through Year Three 
of the project period, applicants will be responsible for design and 
delivery of a speciality course for ``health care practitioners,'' 
defined as: qualified nurse practitioners, physicians assistants, 
Doctors of Medicine and Doctors of Osteopathy. The speciality course 
will include didactic information and clinical instruction specific to 
family planning and women's health for health care practitioners who 
are seeking additional training in these areas. The purpose of both of 
these training efforts is to enhance the quality of family planning and 
women's health services in the Title X delivery system.
    The successful applicant will be responsible for all costs 
associated with training program administration and management, and for 
training costs directly associated with preparation of trainees (e.g., 
educational materials, classroom and clinical training sites, etc.). 
Trainees or employers of trainees will be responsible for all expenses 
incurred in association with transportation, housing and personal 
expenses.
    Trainees from Title X funded agencies will receive primary 
consideration to attend the training program specified for their 
region. Training applicants may also apply for admission to the 
alternate program, and may be accepted on a space available basis.

Role and Operation of the Training Program

Traditional Full Course Nurse Practitioner Training Program

    During Year One of the project period, the successful applicant 
will be responsible for the design and delivery of a high quality 
curriculum for a certificate women's health nurse practitioner program 
specific to the education and role of the nurse practitioner. The 
training curriculum must include content sufficient to prepare 
graduates to perform the full range of services required for nurse 
practitioners in the Title X clinic system. The training program must 
be accredited as a nurse practitioner program by a national nursing 
accrediting body, and program graduates must be eligible for national 
certification.
    The training project may not hold more than three full course, on-
site classes during Year One of the project period. Each full course 
may not exceed 16 weeks of on-site course work, with a preceptorship of 
approximately five and one-half months following the on-site course 
work. The number of Title X-supported students may not exceed 25 per 
class. The average cost per Title X-supported student may not exceed 
$12,000. No traditional full course nurse practitioner training may be 
initiated after the beginning of Year Two of the project period. A 
thorough report of the full course training program must be completed 
and submitted to the Office of Family Planning three months after the 
completion of the last full course training session.

Specialty Training Course

    During Year Two of the project period, the successful applicant 
will be required to design and deliver a family planning/women's health 
specialty course for health care practitioners (as defined in Purpose 
of the Grant). Development of the specialty course should begin during 
Year One of the project period and may continue during Year Two. A 
minimum of one specialty course must be held during Year Two of the 
project period. The number of specialty courses to be offered during 
Year Two may not exceed three. The number of specialty courses to be 
offered during Year Three will be negotiated during the last three 
months of Year Two. Each specialty course must not exceed six weeks in 
length, and will include both didactic and clinical course work. A 
combination of on-site and distant learning approaches may be used. 
Prior to implementation, the curriculum and admissions criteria for 
candidates (including prerequisite qualifications) for the specialty 
course must be submitted to the Office of Family Planning (OFP) for 
review and approval. The number of Title X-supported trainees may not 
exceed 15 per class. The cost per Title X-supported student for the 
specialty course may not exceed $4,000.

Project Requirements and Management

    Successful applicants will be required to work closely with Central 
and Regional Office staffs and a network of agencies, including Title X 
service providers and training advisory committees. The design of both 
the full course and the specialty course, including the curriculum, 
must be consistent with Title X statute, regulations and priorities.
    Successful applicants will be responsible for the overall 
management of the training activities within the geographic area for 
which the grant is made. This responsibility includes:
    (1) Meeting national or State recognition requirements as a 
provider of continuing education through a national nursing 
organization or one of its constituents, and facilitating the award of 
continuing education units to

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nurse practitioner trainees, where appropriate;
    (2) Developing an annual training plan which reflects an 
assessments of the needs of Title X service grantees for both types of 
training activities in the regions for which the grant is awarded;
    (3) Maintaining data on training activities and trainees sufficient 
to allow evaluation by credentialing and licensing bodies and by the 
Office of Family Planning, Office of Population Affairs;
    (4) Submitting to the Office of Family Planning a thorough report 
on the traditional nurse practitioner training course, three months 
after the completion of the last full course training session, 
including data on training activities and trainees;
    (5) Developing and implementing an evaluation plan for the 
specialty course within Year Two of the project period. A thorough 
evaluation report of the specialty course, including data on trainees, 
will be submitted to OFP at the completion of Year Two of the project 
period and six months prior to the end of Year Three of the project 
period;
    (6) Making available at cost all materials developed with Title X 
funds to other title X projects upon request; and
    (7) Participating in at least one meeting with the Office of Family 
Planning annually;
    Application Requirements: Any public or private nonprofit 
organization is eligible to apply for a grant. If the successful 
applicant is not physically located within one of the applicable 
regions, a major training facility of the organization must be located 
within the cluster of regions the applicant will serve.
    Applications must be submitted on the forms supplied (PHS-5161-1, 
Revised 5/96) and in the manner prescribed in the application kits 
available from the Office of Grants Management. Applicants are required 
to submit an application signed by an individual authorized to act for 
the applicant agency or organization and to assume for the organization 
the obligations imposed by the terms and conditions of the grant award. 
Applicants are required to submit an original application and two 
copies.
    A copy of Title X legislation and regulations that govern this 
program will be sent to applicants as part of the application kit 
package. Applicants should use the legislation, regulations and other 
information included in this announcement to guide them in developing 
their applications. Applications should be limited to 60 double-spaced 
pages, not including appendices providing curriculum vitae, curriculum, 
or statements of organizational capabilities. Awards will be made only 
to those applicants who have met all applicable requirements.
    Applications must be received on or before the deadline date to be 
accepted for review. An application received after the deadline may be 
acceptable if it carries a legible proof-of-mailing date assigned by 
the carrier and the proof-of-mailing date is not later than one week 
prior to the deadline date. Private metered postmarks will not be 
accepted as proof of timely mailing. Applications which are received by 
the Office of Grants Management after the deadline date will not be 
accepted for review. Applications which do not conform to the 
requirements of this program announcement or meet the applicable parts 
of 42 CFR part 59, subpart C will not be accepted for review. 
Applicants will be so notified and the applications will be returned.
    Accepted applications will be subjected to a competitive review 
process. The results of this review will assist the Deputy Assistant 
Secretary for Population Affairs in considering competing applications 
and making the final funding decisions.
    Application Consideration and Assessment: Eligible applications 
will be reviewed by a panel of independent reviewers and will be 
assessed against the following criteria:
    (1) The extent to which the proposed training program will increase 
the delivery of services to people, particularly low-income groups, 
with a high percentage of unmet need for family planning services, as 
evidenced by the applicant's ability to address the requirements set 
out under ``Role and Operation of the Training Program.'' (25 points);
    (2) The extent to which the proposed training program promises to 
fulfill the family planning service delivery needs of the area to be 
served, as evidenced by the applicant's ability to address: (a) The 
extent to which the training curricula and objectives will improve the 
family planning service delivery skills of registered nurses and other 
health care practitioners (as defined in ``Purposes of the Grant'') 
providing family planning services; (b) the extent to which the 
training program proposes appropriate strategies to recruit and train 
nurse practitioners and other health care practitioners requiring 
specialized family planning training; and, (c) the factors set out at 
42 CFR 59.206(a)(2)(i)-(iv). (25 points);
    (3) The capacity of the applicant to make rapid and effective use 
of the training grant (10 points);
    (4) The administrative and management capacity and competence of 
the applicant (15 points);
    (5) The competence of the project staff in relation to the services 
to be provided, including demonstrating that project staff, meet 
educational and experience requirements of appropriate credentialing 
bodies. (15 points);
    (6) The degree to which the project plan adequately provides for 
the requirements set forth in 42 CFR 59.205, including the applicant's 
presentation of the project's objectives, the methods of achieving 
project objectives, the ability to involve providers and the regional 
office, and the results or benefits expected. (10 points).
    In making grant award decisions, the Deputy Assistant Secretary for 
Population Affairs (DASPA) will fund those projects which will in her 
judgement best promote the purposes of section 1003 of the Act, within 
the limits of funds available for such projects.
    Grants will be approved for project periods of up to three years 
and will be funded in annual increments (budget periods). Funding for 
all approved budget periods beyond the first year of the grant is 
contingent upon satisfactory progress of the project, efficient and 
effective use of grant funds provided, and availability of funds.
    Review Under Executive Order 12372: Applications under this 
announcement are subject to the review requirements of Executive Order 
12372, State Review of Applications for Federal Financial Assistance, 
as implemented by 45 CFR part 100. As soon as possible, the applicant 
should discuss the project with the State Single Point of Contact 
(SPOC) for each State in the area to be served. The application kit 
contains the currently available listing of the SPOC's which have 
elected to be informed of the submission of applications. For those 
states not represented on the listing, further inquiries should be made 
by applicant regarding the submission to the relevant SPOC. The SPOC 
comment(s) should be forwarded to the Grants Management Office, Office 
of Population Affairs, 4350 East-West Highway, Suite 20 West, Bethesda, 
MD 20814. Such comments must be received by the Office of Population 
Affairs within 60 days of the closing date listed under ``Dates'' 
above.
    When final funding decisions have been made, each applicant will be 
notified by letter of the outcome. The official document notifying an 
applicant that a project application has been approved for funding is 
the Notice of Grant Award, which specifies to the grantee the amount of 
money awarded,

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the purposes of the grant, and terms and conditions of the grant award.

    Authority: 43 U.S.C. 300(a)).

    Dated: March 15, 1999.
Denese O. Shervington,
Deputy Assistance Secretary for Population Affairs.
[FR Doc. 99-7000 Filed 3-22-99; 8:45 am]
BILLING CODE 4160-17-M