[Federal Register Volume 64, Number 105 (Wednesday, June 2, 1999)]
[Notices]
[Pages 29660-29664]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 99-13925]
-----------------------------------------------------------------------
DEPARTMENT OF HEALTH AND HUMAN SERVICES
Health Resources and Services Administration
Request for Comments for Scholarships for Disadvantaged Students
The Health Resources and Services Administration (HRSA) announces
that applications for fiscal year (FY) 1999 for the Scholarships for
Disadvantaged Students (SDS) program are being accepted under the
authority of section 737 of the Public Health Service Act (the Act),
Title VII, Part B, as amended by the Health Professions Education
Partnerships Act of 1998, Pub. L. 105-392, dated November 13, 1998.
This notice requesting comments on proposed eligibility criteria,
preferences and priorities includes updates to information provided in
the January 6, 1999 program announcement.
Purpose
The SDS program provides funds to health professions and nursing
schools for the purpose of assisting such schools in providing
scholarships to individuals from disadvantaged backgrounds who are
enrolled (or accepted for enrollment) as full-time students in the
schools.
For purposes of the SDS program in FY 1999, an ``individual from a
disadvantaged background'' is defined in 42 CFR 57.1804, subpart S, as
one who:
(1) Comes from an environment that has inhibited the individual
from obtaining the knowledge, skill, and abilities required to enroll
in and graduate from a health professions or nursing school, or from a
program providing education or training in allied health professions;
or
(2) Comes from a family with an annual income below a level based
on low-income thresholds according to family size published by the U.S.
Bureau of the Census, adjusted annually for changes in the Consumer
Price Index, and adjusted by the Secretary for use in all health
professions and nursing programs. The Secretary will periodically
publish these low income levels in the Federal Register.
The following income figures determine what constitutes a low-
income family for purposes of the SDS program for FY 1999.
------------------------------------------------------------------------
Income
Size of parents' family \1\ level \2\
------------------------------------------------------------------------
1............................................................ $10,900
2............................................................ 14,100
3............................................................ 16,800
4............................................................ 21,500
5............................................................ 25,400
6 or more.................................................... 28,500
------------------------------------------------------------------------
\1\ Includes only dependents listed on Federal income tax forms.
\2\ Adjusted gross income for calendar year 1998, rounded to nearest
$100.
Under the FY 1999 appropriations bill, $38.1 million has been
appropriated for this program. Of the funds available for FY 1999, 16
percent shall be made available to schools agreeing to expend the funds
only for nursing scholarships. The balance will support scholarships
for eligible health professions students. An estimated 490 awards will
be made to institutions participating in this program. The period of
fund availability will be for one academic year.
Use of Funds
Funds awarded to a school under this program may be used as
follows:
(1) To award scholarships to former recipients of scholarships
under the Exceptional Financial Need (EFN) Scholarship program and the
Financial Assistance for Disadvantaged Health Professions Students
(FADHPS) program (sections 736 and 740(d)(2)(B) of the Public Health
Service Act, as such sections existed prior to the enactment of Pub. L.
105-392), at levels comparable to what these students would have
received prior to phase out of the EFN and FADHPS programs, and with
service agreements that are consistent with those the students entered
into to receive EFN and FADHPS funds in FY 1998. The Secretary has
notified those schools with former EFN and FADHPS recipients (who are
enrolled in allopathic medical, osteopathic medical, or dental schools
only) regarding the procedures for receiving funding for these
students.
(2) To award scholarships to eligible students enrolled in the
school, to be expended only for tuition expenses, other reasonable
educational expenses, and reasonable living expenses (as defined by the
school for all students attending the school) incurred while enrolled
in a school as a full-time student. The amount of the scholarship may
not, for any year of attendance, exceed the total amount required for
the year for the expenses specified above, and may not exceed the
student's financial need, as determined in accordance with a need
analysis procedure approved by the Department of Education.
Any school receiving SDS funds must maintain separate
accountability for these funds.
School Eligibility
An entity that is eligible to receive funds under this program is:
(1) As defined in section 799B of the Act, a school of medicine,
osteopathic medicine, dentistry, pharmacy, podiatric medicine,
optometry, veterinary medicine, public health, chiropractic, or allied
health, a school offering a graduate program in behavioral and mental
health practice, or an entity providing programs for the training of
physician assistants; or, as defined in section 801 of the Act, is a
school of nursing. Each school or program must be accredited by a
recognized body or bodies approved for such purpose by the Secretary of
Education, and by a specialized accrediting body approved for the
health discipline applying for program participation; and
(2) Carrying out a program for recruiting and retaining students
from disadvantaged backgrounds, including students who are members of
racial and ethnic minorities.
Proposed School or Program Eligibility Criteria
The Senate Report accompanying Pub. L. 105-392 states that the
committee expects the Secretary to apply appropriate standards in
determining which schools or programs from all eligible disciplines
have complied with the requirement to be carrying out a program for
recruiting and retaining students from disadvantaged backgrounds, using
[[Page 29661]]
outcome-based measures that provide an indication of the success of the
program. The report further states that the existence of a recruitment
and retention program for students from disadvantaged backgrounds
should not, in itself, result in the eligibility of a school or program
if the school or program is unable to demonstrate that the recruitment
and retention program has achieved success, based on the number and/or
percentage of disadvantaged students who graduate from the school (p.
20, Senate Report 105-220). Accordingly, the Secretary is proposing to
establish the following outcome-based measures with which a school or
program must comply to be eligible to receive SDS funds in FY 1999:
(1) Individuals from disadvantaged backgrounds must comprise at
least 5 percent of the total enrollment in the school or program for
which funds are requested, based on enrollment data for academic year
1997-98;
(2) Individuals from disadvantaged backgrounds must comprise at
least 5 percent of the total graduates from the school or program for
which funds are requested, based on graduates for academic year 1997-
98; and
(3) The ratio of individuals from disadvantaged backgrounds who
graduated, compared with the individuals from disadvantaged backgrounds
who are enrolled, must be at least 15 percent for 5-year programs, 20
percent for 4-year programs, 25 percent for 3-year programs, and 40
percent for 2-year programs.
Since the use of outcome measures to determine eligibility would be
a new requirement in FY 1999, and since the timing of the enactment of
the new statute has provided very little lead time to notify schools or
programs of the new outcome measures, the Secretary has established
very low measures for FY 1999. It is the Secretary's view that any
school or program that cannot meet the 5 percent thresholds and the
retention ratio described above cannot reasonably be considered to have
a strong commitment to the recruitment and retention of individuals
from disadvantaged backgrounds. However, recognizing that these initial
levels are very low, and that many schools and programs have indicated
since the SDS program began that they have activities in place to
support the education of individuals from disadvantaged backgrounds,
the Secretary is proposing that the outcome-based measures with which a
school or program must comply to be eligible to receive SDS funds be
increased, for FY 2000, to the following levels:
(1) Individuals from disadvantaged backgrounds must comprise at
least 10 percent of the total enrollment in the school or program for
which funds are requested, based on enrollment data for academic year
1998-99;
(2) Individuals from disadvantaged backgrounds must comprise at
least 10 percent of the total graduates from the school or program for
which funds are requested, based on graduates for academic year 1998-
99; and
(3) The ratio of individuals from disadvantaged backgrounds who
graduated, compared with the individuals from disadvantaged backgrounds
who are enrolled, must be at least 15 percent for 5-year programs, 20
percent for 4-year programs, 25 percent for 3-year programs, and 40
percent for 2-year programs.
The Secretary intends that the proposed threshold levels for
determining a school or program's eligibility will continue to increase
gradually each year until they reach an optimal level for assuring that
disadvantaged students are represented in the health care workforce at
levels that best address the HRSA goals of improved diversity and
distribution.
Evaluation Criteria for Fiscal Year 1999
For FY 1999, the Secretary is proposing that applications will be
evaluated based on the degree to which a school or program meets the
requirements listed above under ``School Eligibility.'' Guidance for
presenting the information will be provided in the FY 1999 application
materials. Due to the new eligibility requirements, all applicant
schools and programs, including schools and programs that received
funds for academic year 1998-99, must submit an application to be
considered for funding in FY 1999.
Student Eligibility
To qualify for the SDS program, a student would be required to:
(1) Be a resident of the U.S. and either be a U.S. citizen, a U.S.
national, an alien lawfully admitted for permanent residence in the
U.S., a citizen of the Commonwealth of the Northern Mariana Islands, a
citizen of the Commonwealth of Puerto Rico, or a citizen of the
Republic of Palau, or a citizen of the Marshall Islands, or a citizen
of the Federated States of Micronesia;
(2) Meet the definition of an ``individual from a disadvantaged
background'' as defined above; and
(3) Have a financial need for a scholarship, in accordance with a
need analysis procedure approved by the Department of Education (Pub.
L. 105-244, Part F, The Higher Education Act of 1965 as amended). In
addition, any student who is enrolled (or accepted for enrollment) in a
health profession school or program must provide information on his or
her parents' financial situation, regardless of the tax status of the
student; and
(4) Be enrolled (or accepted for enrollment) at an eligible school
for enrollment as a full-time student in a program leading to a degree
in a health profession or nursing.
Student Preferences
The law requires that in providing SDS scholarships, the school or
program give preference to students for whom the cost of attending an
SDS school or program would constitute a severe financial hardship.
Severe financial hardship is to be determined by the school or program
in accordance with standard need analysis procedures prescribed by the
Department of Education for its Federal student aid programs. The
school or program has discretion in deciding how to determine which
students have ``severe financial hardship,'' as long as the standard is
applied consistently to all eligible students.
The law also requires that schools give preference to former
recipients of scholarships under sections 736 (EFN Scholarships) and
740(d)(2)(B) (FADHPS Scholarships), as such sections existed on
November 12, 1998. The Secretary is implementing this preference by
making a separate allocation of funds for these students, based on
information provided by schools (allopathic medical, osteopathic
medical, and dental schools with former EFN and FADHPS recipients
only), prior to allocating the remaining SDS money for all other
eligible students.
Proposed Student Preference
The Secretary is also proposing that, beginning in academic year
2000-2001, schools or programs give preference in the awarding of SDS
funds to students who have participated in an academic enrichment
program funded in whole or in part by the Health Careers Opportunity
Program (HCOP), authorized by section 739 of the Act. This preference
is intended to help assure that students who have participated in HCOP
programs are not deterred from enrolling in a health professions school
or program due to a lack of financial aid. Under this preference, it
would be the school's or program's responsibility to identify HCOP
students to assure that they receive preference in the awarding of SDS
funds. For example, the school or
[[Page 29662]]
program could ask, as part of the financial aid application, whether
the student participated in an academic enrichment program funded by
HCOP, or could work with the admissions office to determine which
students have been involved in HCOP programs. The Secretary intends
that schools and programs implement this preference without a
significant additional burden. Under this preference, the school or
program would continue to have discretion in determining the amount of
funds to award to HCOP students, but would be required to identify and
fund HCOP students (provided they have financial need) before funding
other eligible students who do not meet a student preference.
Schools and programs that currently have access to information on
which students have participated in HCOP programs are encouraged to
implement this preference beginning in academic year 1999-2000.
However, since some schools and programs may not currently have access
to this information, the Secretary would not require schools and
programs to implement the preference for HCOP students until academic
year 2000-2001.
Definitions
Black or African American means a person having origins in any of
the black racial groups of Africa.
Hispanic or Latino means a person of Cuban, Mexican, Puerto Rican,
South or Central American or other Spanish culture or origin,
regardless of race.
American Indian or Alaska Native means a person having origins in
any of the original peoples of North and South America (including
Central America) and who maintains tribal affiliation or community
attachment.
Definitions listed above are contained in Directive No. 15 of
Office of Management and Budget Circular No. A-46, as revised.
Native American as defined in Pub. L. 101-527, means American
Indian, Alaska Native, Aleut, or Native Hawaiian.
Graduate program in behavioral health and mental health practice
means a graduate program in clinical psychology, clinical social work,
professional counseling, or marriage and family therapy as defined in
section 799B(1)(D) of the Act.
Graduate program in clinical social work means an accredited
graduate program in a public or nonprofit private institution in a
State that provides training in a concentration in health or mental
health care leading to a graduate degree in social work as defined in
section 799B(1)(C) of the Act.
Graduate program in marriage and family therapy means an accredited
graduate program in a public or nonprofit private institution in a
State that provides training in a concentration leading to a graduate
degree in marriage and family therapy as defined in section 799B(1)(C)
of the Act.
Graduate program in professional counseling means an accredited
graduate program in a public or nonprofit private institution in a
State that provides training in a concentration leading to a graduate
degree in gerontological counseling, mental health counseling, or
rehabilitation counseling.
Medically underserved community means any geographic area and/or
population served by any of the following practice sites--
(1) Community Health Centers (section 330 of the Act);
(2) Migrant Health Centers (section 329 of the Act);
(3) Health Care for the Homeless Grantees (section 340 of the Act);
(4) Public Housing Primary Care Grantees (section 340A of the Act);
(5) Rural Health Clinics, federally designated (section 1861(aa)(2)
of the Social Security Act);
(6) National Health Service Corps sites, freestanding (section 333
of the Act);
(7) Indian Health Service sites (Pub. L. 93-638 for tribally
operated sites and Pub. L. 94-437 for Indian Health Service operated
sites);
(8) Federally Qualified Health Centers (section 1905(a) and (1) of
the Social Security Act);
(9) Primary Medical Care, Mental Health, and Dental Health
Professional Shortage Areas (HPSAs) (designated under section 332 of
the Act);
(10) State or Local Health Departments as defined and published in
the Federal Register Notice of April 4, 1994 (59 FR 15741-44); or
(11) Ambulatory practice sites designated by State Governors as
serving medically underserved communities as defined and published in
the Federal Register Notice of April 4, 1994 (59 FR 15741-44).
Proposed Institutional Preferences
The Senate Report accompanying Pub. L. 105-392 directs the
Secretary to restrict eligibility, for purposes of ``allied health,''
to the following baccalaureate or graduate degree allied health
professions schools or programs: Dental hygiene, medical laboratory
technology, occupational therapy, physical therapy, radiologic
technology, speech pathology, audiology, and registered dieticians
(Senate Report 105-220, p. 20). Accordingly, for fiscal year 1999 and
beyond, among allied health schools or programs, the Secretary proposes
to give preference to the allied health schools or programs listed
above.
Proposed Institutional Funding Priorities
In accordance with section 737(c) of the Act, the Secretary shall
give priority to eligible entities based on the proportion of
graduating students going into primary care, the proportion of
underrepresented minority students, and the proportion of graduates
working in medically underserved communities. Any eligible school or
program that qualifies for one or more funding priorities will receive
extra weighting in the allocation formula.
Primary Care Funding Priority
For purposes of determining which schools and programs receive
priority based on the proportion of graduating students going into
primary care, the Secretary proposes to define primary care to include:
(1) Allopathic and osteopathic medical students that enter family
medicine, general internal medicine, general pediatrics, and preventive
medicine, and general osteopathic medicine. This is consistent with the
statutory definition of primary care for the Primary Care Loan (PCL)
program, authorized under section 723 of the Act;
(2) General dentistry, which has been included as primary care for
purposes of the Exceptional Financial Need (EFN) Scholarship program
and the Financial Assistance for Disadvantaged Health Professions
Students (FADHPS) program;
(3) Nurse practitioners and nurse midwives who are practicing
primary care; and
(4) Physician assistants who are practicing primary care.
For purposes of the SDS program, the Secretary is defining
``primary care'' to include the above disciplines because, with the
exception of general dentistry, they are involved in the provision of
comprehensive and continuous care and provide an entry to the health
care system. The Secretary has included general dentistry because it
acts as the entry to the health care system for a particular type of
care which is not covered by the other disciplines.
For the above disciplines, a school or program may qualify for the
primary care priority if at least 50 percent of its graduates from the
specified year are practicing primary care. For allopathic and
osteopathic medical schools, the determination of which schools are
eligible for the funding priority would
[[Page 29663]]
be based on the same data used to determine compliance with the PCL
school requirements. Thus, for the FY 1999 award process, priority
would be based on the activities, during academic year 1997-98, of Post
Graduate Year (PGY)-3 graduates (i.e., those who graduated during
academic year 1994-95), but for FY 2000, priority would be based on the
activities, during academic year 1998-99, of PGY-4 graduates (i.e.,
those who graduated during academic year 1994-95). This would allow
allopathic and osteopathic medical schools to submit, for the SDS
program, the same data submitted for the PCL program if they are PCL
participants. For the remaining primary care disciplines, the
determination of compliance would be based on the activities, during
academic year 1997-98, of students who graduated during academic year
1996-97.
Underrepresented Minority Funding Priority
For purposes of granting priority based on the proportion of
underrepresented minority students in FY 1999, the Secretary proposes
to give priority to any school or program that has an underrepresented
minority enrollment that is above the national average for the
discipline. It is the Secretary's intention to gradually increase this
percentage in future years until it is equal to the underrepresented
minority enrollment needed to reach parity in the health care
workforce.
Medically Underserved Community Funding Priority
For purposes of granting priority based on the proportion of
graduates working in medically underserved communities, the Secretary
proposes to give priority to any school or program for which at least
10 percent of the graduates from the specified year are practicing in
medically underserved communities. It is the Secretary's intention to
gradually increase this percentage in future years until it is
representative of a level that has a meaningful impact on the
elimination of medically underserved communities. For allopathic and
osteopathic medical schools, the determination of which schools are
eligible for the funding priority would be based on the same population
of graduates used to determine compliance with the primary care funding
priority. Thus, for the FY 1999 awards, priority would be based on the
activities, during academic year 1997-98, of allopathic and osteopathic
medical students who graduated 3 years earlier (academic year 1994-95),
but for FY 2000, priority would be based on the activities, during
academic year 1998-99, of allopathic and osteopathic medical students
who graduated 4 years earlier (academic year 1994-95). For other
schools and programs, priority would be based on the activities of
students during 1997-98 who graduated in 1996-97. Schools and programs
that do not have data on the percentage of their graduates who are
practicing in medically underserved communities may still apply for SDS
funds, but would not be considered for this funding priority.
Proposed Procedures for Calculating Awards
Awards to eligible schools and programs would be calculated by
comparing the weighted number of eligible students in each eligible
school and program with the total weighted number of eligible students
in all eligible schools and programs. For FY 1999 and beyond, the
number of ``eligible students'' for each school or program would be the
lesser of:
(1) The number of disadvantaged graduates for academic year 1997-98
multiplied times the number of years required to complete the program
(based on a 9-month academic year); or
(2) The total disadvantaged enrollment during academic year 1997-
98. For example, if a 4-year program had 100 disadvantaged graduates
and a disadvantaged enrollment of 500, its award would be based on 400
eligible students (100 graduates times 4). If another 4-year program
had 100 disadvantaged graduates and a disadvantaged enrollment of 300,
its award would be based on 300 eligible students (the total
disadvantaged enrollment).
After determining the number of eligible students at each school or
program, this number would be adjusted to reflect the extra weighting
associated with any funding priorities. Depending upon the number of
schools and programs that qualify for one or more funding priorities,
it is possible that some eligible schools and programs may not receive
funding.
National Health Objectives for the Year 2000
The Public Health Service 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 Scholarships
for Disadvantaged Students program is related to the priority area of
Academic and Community Partnership 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, DC 20402-0325; 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 Department education programs
and programs which provide comprehensive primary care services to the
underserved.
Smoke-Free Workplace
The Department strongly encourages all award recipients to provide
a smoke-free workplace and promote the non-use of all tobacco products,
and Pub. L. 103-227, the Pro-Children Act of 1994, prohibits smoking in
certain facilities that receive Federal funds in which education,
library, day care, health care, and early childhood development
services are provided to children.
Interested persons are invited to comment on the proposed
eligibility criteria and preferences for participating institutions,
institutional funding priorities and preferences, nonstatutory
preference of awarding funds to prior HCOP recipients, and procedures
for calculating scholarship awards. The comment period will close on
July 2, 1999.
All comments received before the deadline date will be considered
before final acceptability of the eligibility criteria for
participating institutions, institutional funding priorities and
preferences, nonstatutory preference of awarding funds to prior HCOP
recipients, and procedures for calculating scholarship awards for the
FY 2000 will be applied.
Written comments should be addressed to: Capt. Bruce C. Baggett,
Director, Division of Student Assistance; Bureau of Health Professions,
Health Resources and Services Administration, Parklawn Building, room
8-48, 5600 Fishers lane, Rockville, Maryland 20857; telephone (301)
443-5395.
Application Availability
Applications are required from all schools and programs which are
interested in applying for funding in FY 1999. The SDS application for
FY 1999 must be filed via the Internet. Schools may access the SDS
application at www.hrsa.gov/bhpr/dsa/sds. All applications and fiscal
reports will be required to be filed electronically. However, if
assistance is required,
[[Page 29664]]
please contact the Scholarship Team at the above address.
The deadline for submitting application materials is July 2, 1999.
The materials for this program have been approved by the Office of
Management and Budget (OMB) under the Paperwork Reduction Act. The OMB
clearance number is 0915-0061.
The Catalog of Federal Domestic Assistance Number for the
Scholarships for Disadvantaged Students program is 93.925. This program
is not subject to the provisions of Executive Order 12372,
Intergovernmental Review of Federal Programs (as implemented through 45
CFR part 100).
This program is not subject to the Public Health Systems Reporting
Requirements.
Dated: May 25, 1999.
Claude Earl Fox,
Administrator.
[FR Doc. 99-13925 Filed 6-1-99; 8:45 am]
BILLING CODE 4160-15-P