[Federal Register Volume 64, Number 236 (Thursday, December 9, 1999)]
[Notices]
[Pages 69154-69158]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 99-31952]



[[Page 69153]]

_______________________________________________________________________

Part V





Department of Education





_______________________________________________________________________



National Institute on Disability and Rehabilitation Research; Notice

  Federal Register / Vol. 64, No. 236, Thursday, December 9, 1999 / 
Notices  

[[Page 69154]]


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


DEPARTMENT OF EDUCATION


National Institute on Disability and Rehabilitation Research

AGENCY: Office of Special Education and Rehabilitative Services, 
Department of Education.

ACTION: Notice of proposed funding priority for fiscal years 2000-2001 
for Model Spinal Cord Injury Centers.

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

SUMMARY: The Assistant Secretary for the Office of Special Education 
and Rehabilitative Services proposes a funding priority for Model 
Spinal Cord Injury Centers under the National Institute on Disability 
and Rehabilitation Research (NIDRR) for fiscal years 2000-2001. The 
Assistant Secretary takes this action to focus research attention on 
areas of national need. We intend this priority to improve the 
rehabilitation services and outcomes for individuals with disabilities. 
This notice contains a proposed priority under the Special Projects and 
Demonstrations for Spinal Cord Injuries Program.

DATES: Comments must be received on or before January 10, 2000.

ADDRESSES: All comments concerning this proposed priority should be 
addressed to Donna Nangle, U.S. Department of Education, 400 Maryland 
Avenue, SW, room 3418, Switzer Building, Washington, DC 20202-2645. 
Comments may also be sent through the Internet: [email protected]
    You must include the term ``Special Projects and Demonstrations for 
Spinal Cord Injuries'' in the subject line of your electronic message.

FOR FURTHER INFORMATION CONTACT: Donna Nangle. Telephone: (202) 205-
5880. Individuals who use a telecommunications device for the deaf 
(TDD) may call the TDD number at (202) 205-2742. Internet: 
[email protected]
    Individuals with disabilities may obtain this document in an 
alternate format (e.g., Braille, large print, audiotape, or computer 
diskette) on request to the contact person listed in the preceding 
paragraph.

SUPPLEMENTARY INFORMATION:

Invitation to comment:

    We invite you to submit comments regarding this proposed priority.
    We invite you to assist us in complying with the specific 
requirements of Executive Order 12866 and its overall requirement of 
reducing regulatory burden that might result from this proposed 
priority. Please let us know of any further opportunities we should 
take to reduce potential costs or increase potential benefits while 
preserving the effective and efficient administration of the program. 
During and after the comment period, you may inspect all public 
comments about this priority in Room 3424, Switzer Building, 330 C 
Street SW., Washington, DC, between the hours of 9:00 a.m. and 4:30 
p.m., Eastern time, Monday through Friday of each week except Federal 
holidays.

Assistance to Individuals With Disabilities in Reviewing the 
Rulemaking Record

    On request, we will supply an appropriate aid, such as a reader or 
print magnifier, to an individual with a disability who needs 
assistance to review the comments or other documents in the public 
rulemaking record for this proposed priority. If you want to schedule 
an appointment for this type of aid, you may call (202) 205-8113 or 
(202) 260-9895. If you use a TDD, you may call the Federal Information 
Relay Service at 1-800-877-8339.
    This proposed priority supports the National Education Goal that 
calls for every adult American to possess the skills necessary to 
compete in a global economy.
    The authority for the Secretary to establish research priorities by 
reserving funds to support particular research activities is contained 
in sections 202(g) and 204 of the Rehabilitation Act of 1973, as 
amended (29 U.S.C. 762(g) and 764). Regulations governing this program 
are found in 34 CFR parts 350 and 359.
    We will announce the final priority in a notice in the Federal 
Register. We will determine the final priority after considering 
responses to this notice and other information available to the 
Department. This notice does not preclude us from proposing or funding 
additional priorities, subject to meeting applicable rulemaking 
requirements.

    Note: This notice does not solicit applications. In any year in 
which the Assistant Secretary chooses to use this proposed priority, 
we invite applications through a notice published in the Federal 
Register. When inviting applications we designate each priority as 
absolute, competitive preference, or invitational.

Special Projects and Demonstrations for Spinal Cord Injury

    The authority for Model Spinal Cord Injury Centers is contained in 
section 204(b)(4) of the Rehabilitation Act of 1973, as amended (29 
U.S.C. 764(b)(4)). The Secretary may make awards for up to 60 months 
through grants or cooperative agreements. This program provides 
assistance to establish innovative projects for the delivery, 
demonstration, and evaluation of comprehensive medical, vocational, and 
other rehabilitation services to meet the wide range of needs of 
individuals with spinal cord injuries.

Description of Special Projects and Demonstrations for Spinal Cord 
Injuries

    This program provides assistance for projects that provide 
comprehensive rehabilitation services to individuals with spinal cord 
injuries and conduct spinal cord research, including clinical research 
and the analysis of standardized data in collaboration with other 
related projects.
    Each Spinal Cord Injury Center funded under this program 
establishes a multidisciplinary system of providing rehabilitation 
services, specifically designed to meet the special needs of 
individuals with spinal cord injuries. This includes acute care as well 
as periodic inpatient or outpatient follow up and vocational services. 
Centers demonstrate and evaluate the benefits and cost effectiveness of 
such a system for the care of individuals with spinal cord injury and 
demonstrate and evaluate existing, new, and improved methods and 
equipment essential to the care, management, and rehabilitation of 
individuals with spinal cord injuries. Grantees demonstrate and 
evaluate methods of community outreach and education for individuals 
with spinal cord injuries in connection with the problems of such 
individuals in areas such as housing, transportation, recreation, 
employment, and community activities.
    Projects funded under this program ensure widespread dissemination 
of research findings to all Spinal Cord Injury Centers, and to 
rehabilitation practitioners, individuals with spinal cord injury, and 
the parents, family members, guardians, advocates, or authorized 
representatives of such individuals. They engage in initiatives and new 
approaches and maintain close working relationships with other 
governmental and voluntary institutions and organizations to unify and 
coordinate scientific efforts, encourage joint planning, and promote 
the interchange of data and reports among spinal cord injury 
researchers.
    NIDRR requires all Centers to involve individuals with disabilities 
and individuals from minority backgrounds as recipients of research 
training, as well as clinical Service and training.
    The Department is particularly interested in ensuring that the 
expenditure of public funds is justified

[[Page 69155]]

by the execution of intended activities and the advancement of 
knowledge and, thus, has built this accountability into the selection 
criteria. Not later than three years after the establishment of any 
Center, NIDRR will conduct one or more reviews of the activities and 
achievements of the Center. In accordance with the provisions of 34 CFR 
75.253(a), continued funding depends at all times on satisfactory 
performance and accomplishment.

Proposed Priority for Model Spinal Cord Injury Centers

    Estimates of the number of people living with traumatic spinal cord 
injury (SCI) range from 183,000 to 230,000, with an incidence of 
approximately 10,000 new cases each year (``Spinal Cord Injury Facts 
and Figures at a Glance,'' National Spinal Cord Injury Statistical 
Center (NSCISC), University of Alabama at Birmingham). Although SCI 
predominately affects young adults (56% of SCIs occur among people aged 
16-30 years), there is an increasing proportion of new SCI cases in the 
population over 60 years of age (NSCISC, ibid.). The true significance 
of traumatic SCI lies not primarily in the numbers affected, but in the 
substantial impact on individuals' lives and the associated substantial 
health care costs and living expenses. A traumatic SCI has far-reaching 
repercussions on the lives of the injured persons and their families 
that can be devastating if not addressed effectively. According to a 
report from the Agency for Health Care Policy and Research (Hospital 
Inpatient Statistics, 1996, AHCPR Publication No. 99-0034), spinal cord 
injury is the most expensive condition or diagnosis treated in U.S. 
hospitals. The estimated lifetime costs for an individual injured at 
the age of 25 range from $365,000 for an incomplete injury to more than 
$1.7 million for an individual with a high cervical injury (NSCISC, op 
cit).
    The Model SCI program was developed in 1970 to demonstrate the 
value of a comprehensive integrated continuum of care for SCI. Twenty-
six sites have been designated, at various times, as Model SCI Centers 
through funding initially from the Rehabilitation Services 
Administration, and subsequently from the National Institute on 
Handicapped Research, and its successor, the National Institute on 
Disability and Rehabilitation Research (NIDRR). For the period 1995-
2000 there are 18 funded Model SCI Centers. (Additional information is 
available on the World Wide Web at http://www.ncddr.org/mscis/). The 
clinical components of the Model Centers are specified in the program 
regulations, and include ``. . . emergency medical services, acute 
care, vocational and other rehabilitation services, community and job 
placement, and long-term community follow up and health maintenance'' 
(34 CFR 359.11). In addition to demonstrating and evaluating the 
benefits of such a system the centers are required to contribute data 
on their patients to the National Spinal Cord Injury Database (NSCID), 
and engage in research both within the center, and in collaboration 
with other centers.
    During the past 30 years, there have been substantial improvements 
in outcomes following SCI (Stover, S.L, et al., Spinal Cord Injury: 
Clinical Outcomes From the Model Systems, and Special Issue, Spinal 
Cord Injury: Current Research Outcomes from the Model Spinal Cord 
Injury Care Systems, Archives of Physical Medicine and Rehabilitation, 
Vol. 80, No. 11, November, 1999). Enhanced emergency medical services 
have led to increased preservation of neurologic function. Mortality 
during the first year following injury has continuously declined. Life 
expectancy, while still below that for those without SCI, has 
significantly increased for all levels of injury. The ideal of a 
comprehensive multi-disciplinary system of care for SCI has gained 
widespread acceptance.
    However, significant challenges and opportunities remain for SCI 
rehabilitation. Recent statistics from the National Spinal Cord Injury 
Statistical Center (NSCISC) suggest that as the length of stay in 
rehabilitation settings has progressively decreased (1993-1998), there 
has been an increase in re-hospitalization during the first year after 
injury. In addition, mortality after the first anniversary of injury 
declined continuously from 1973-1992, but now has increased for the 
period 1993-1998. Secondary medical complications, including, but not 
limited to, respiratory complications, pressure ulcers and autonomic 
dysreflexia, continue to be significant problems. Injuries due to 
interpersonal violence have increased as a proportion of the total SCI 
incidence and are more likely to be neurologically complete injuries.
    There is a need to identify, evaluate, and eliminate barriers in 
the natural, built, cultural, and social environments to enable people 
with SCI to achieve the goal of fully reintegrating into their 
community. Particular focus is required to address the needs of 
minority and underserved populations. Although employment for the U.S. 
population is at historically high levels, employment for the SCI 
population remains low. Individuals with SCI due to inter-personal 
violence have an employment rate approximately half of the average for 
all individuals with SCI (NSCISC, op cit).
    NIDRR shares the concerns of the rehabilitation community about the 
impact of changes in health care delivery and financing upon the 
continuum of care for SCI. People with SCI often have more difficulty 
in obtaining adequate primary health care than non-disabled 
individuals. The unique needs of women with SCI in cardiac 
rehabilitation, reproductive health, and early cancer screening are 
special issues that need to be addressed.
    There are also new and developing opportunities for improving SCI 
care. Medical and pharmacological therapies show promise for preserving 
and enhancing function. There is a need to identify and evaluate 
therapeutic interventions, including prevention and wellness programs, 
and complementary and alternative therapies using evidence-based 
evaluation protocols.
    Advancing technology has the potential to enhance access and 
function for individuals with SCI. There is a need to develop and 
evaluate service delivery models incorporating telerehabilitation 
strategies and technologies to provide services for people with SCI. 
Assistive technologies may reduce the likelihood of secondary 
complications in SCI. For example, improved wheelchair and seating 
systems may reduce musculoskeletal trauma associated with long term 
wheelchair use. Technological advancement has the promise of providing 
greater accessibility to information, telecommunications, and 
employment. The adoption of universal design methodologies will enhance 
access to the built environment as well as rapidly developing 
electronic and information technologies.
    The development of strong collaborations by SCI centers with 
community and social support organizations has the potential to impact 
positively the independence and community integration for individuals 
with SCI. Peer support beginning early in the rehabilitation process 
may enhance return to participation in the community. The causes of 
unemployment in SCI include lack of education and skills, lack of prior 
work experience, and policy disincentives. Pending changes in 
legislation and policy to permit retention of some medical insurance 
during employment, together with the high demand for skilled 
individuals in the workforce, represents an opportunity to foster 
education and employment of individuals with SCI.

[[Page 69156]]

    NIDRR has published a Long-Range Plan (the Plan) that is based upon 
a new paradigm for rehabilitation that identifies disability in terms 
of the relationship between the individual and the natural, built, 
cultural, and social environments (63 FR 57189-57219). The Plan focuses 
on both individual and systemic factors that have an impact on the 
ability of people to function. The elements of the Plan include 
employment outcomes, health and function, technology for access and 
function, and independent living and community integration. As part of 
the Plan to attain the goals in these areas, NIDRR is committed to 
capacity building for research and training, and to ensure knowledge 
dissemination and utilization. Each area of the Plan includes 
objectives at both the individual and system levels. For example, the 
health and function objectives include research to improve medical 
rehabilitation interventions, as well as research to ensure access to 
an integrated continuum of quality health care services that address 
the unique needs of persons with disabilities. It is clear that the 
challenges and opportunities for SCI care reflect all of the priority 
areas of the Plan.
    NIDRR has recently completed Program Reviews of all current Model 
SCI Centers. Based upon presentations by the Centers, and discussion 
with the external reviewers, NIDRR has concluded that the value of a 
comprehensive integrated system of care for SCI has been demonstrated. 
Because this conclusion is widely accepted, NIDRR is shifting the focus 
of the program from demonstration, to place a greater emphasis upon 
research. Participants in the Program Reviews observed that the 
comprehensive continuum of quality care should continue to be a 
requirement for participation in the Model SCI Centers Program. There 
is significant diversity among the Centers, however, in research 
interests and capacities. This diversity extends across the priority 
areas of the Plan, and represents the strength of the program.
    Reviewers noted that uniformly comprehensive, high quality care, 
together with a common data collection system and administrative 
infrastructure makes the Model SCI Centers Program a valuable platform 
for various collaborative studies, including multi-center trials of 
therapies and technologies. To further the enhancement of the research 
mission, participants recommended a separate competition for the 
collaborative research portion of the program. A separate competition 
will facilitate focused, considered proposals, a higher level of 
scientific review, and the development of significant research projects 
in the Model SCI Centers. The competition for collaborative research 
projects will be conducted subsequent to the identification of the 
Model SCI Centers, and funds will be reserved for that purpose.
    During the Program Reviews, there was considerable discussion of 
the National SCI Database (NSCID). It is clear that the database is a 
valuable resource and that participation in the NSCID is an essential 
element for the Model SCI Centers. For the purpose of the present 
competition, the data collection activities will be maintained without 
change. NIDRR expects that applicants will include historical 
documentation of numbers of patients as well as expected new patients 
and expected annual follow-up submissions based on current eligibility 
criteria for the NSCID. However, it is anticipated that, through 
discussion among the newly identified Model SCI Centers, NIDRR staff, 
and external reviewers, details of data collection may be modified 
following the award. This process should not result in increased data 
collection workloads above current levels.

Proposed Priority

    The Assistant Secretary proposes to establish Model Spinal Cord 
Injury Centers for the purpose of generating new knowledge through 
research, development, or demonstration to improve outcomes for SCI 
through improved interventions and service delivery models. A Model 
Spinal Cord Injury Center must:
    (1) Establish a multidisciplinary system of providing 
rehabilitation services specifically designed to meet the special needs 
of individuals with spinal cord injury (SCI), including emergency 
medical services, acute care, vocational and other rehabilitation 
services, community and job placement, and long-term community follow 
up and health maintenance;
    (2) Participate as directed by the Assistant Secretary in national 
studies of SCI by contributing to a national database and by other 
means as required by the Assistant Secretary; and
    (3) Conduct a significant and substantial research program in SCI 
that will contribute to the advancement of knowledge in one of the goal 
areas of the NIDRR Long Range Plan. Applicants may select one of the 
following research objectives related to specific areas of the Plan:
     (Chapter 3, Employment Outcomes): Either (1) Assess the 
impact of legislative and policy changes on employment outcomes; or (2) 
Test direct intervention strategies for improving employment outcomes.
     (Chapter 4, Maintaining Health and Function): Either (1) 
Study interventions to improve outcomes in the preservation or 
restoration of function or the prevention and treatment of secondary 
conditions; or (2) Design and test service delivery models that provide 
quality care under constraints imposed by recent changes in the health 
care financing system.
     (Chapter 5, Technology for Access and Function): Either 
(1) Evaluate the impact of selected innovations in technology and 
rehabilitation engineering on service delivery; or (2) Evaluate the 
impact of selected innovations in technology and rehabilitation 
engineering on outcomes such as function, independence, and employment.
     (Chapter 6, Independent Living and Community Integration): 
Assess the value of peer support and early onset of services from 
community and social support organizations to improve outcomes such as 
independence and community integration, employment function, and health 
maintenance.
    (4) Provide for the widespread dissemination of research and 
demonstration findings to other SCI centers, rehabilitation 
practitioners, researchers, individuals with SCI and their families and 
representatives, and other public and private organizations involved in 
SCI care and rehabilitation. In carrying out these purposes, the SCI 
center must:
     Incorporate culturally appropriate methods of community 
outreach and education in areas such as health and wellness, housing, 
transportation, recreation, employment, and other community activities 
for individuals with diverse backgrounds with spinal cord injury;
     Demonstrate the research and clinical capacity to 
participate in collaborative projects, clinical trials, or technology 
transfer with other model SCI centers, other NIDRR grantees, and 
similar programs of other public and private agencies and institutions; 
and
     Demonstrate the likelihood of having a sufficient number 
of individuals with SCI, including newly injured persons, to conduct 
statistically significant research.

Proposed Selection Criteria

    The new emphasis on research and NIDRR's Long-Range Plan, plus the 
importance of the NSCID, require some modifications to the selection 
criteria for this program. The Secretary proposes

[[Page 69157]]

to redistribute points to reflect the increased emphasis on research, 
and to add references to the Plan and NSCID.
    The Secretary proposes to use the following criteria to evaluate 
applications under this program. The maximum score for all the criteria 
is 100 points.
    (a) Project design (30 points). The Secretary reviews each 
application to determine to what degree--
    (1) There is a clear description of how the objectives of the 
project relate to the purpose of the program and the NIDRR Long Range 
Plan;
    (2) The research is likely to produce new and useful information;
    (3) The need and target population are adequately defined and are 
sufficient for meaningful research and demonstration;
    (4) The outcomes are likely to benefit the defined target 
population;
    (5) The research hypotheses are sound; and
    (6) The research methodology is sound in the sample design and 
selection, the data collection plan, the measurement instruments, and 
the data analysis plan.
    (b) Service comprehensiveness (20 points). The Secretary reviews 
each application to determine to what degree--
    (1) The services to be provided within the project are 
comprehensive in scope, and include emergency medical services, 
intensive and acute medical care, rehabilitation management, 
psychosocial and community reintegration, and follow up;
    (2) A broad range of vocational and other rehabilitation services 
will be available to severely handicapped individuals within the 
project; and
    (3) Services will be coordinated with those services provided by 
other appropriate community resources.
    (c) Plan of operation (10 points). The Secretary reviews each 
application to determine to what degree--
    (1) There is an effective plan of operation that ensures proper and 
efficient administration of the project;
    (2) The applicant's planned use of its resources and personnel is 
likely to achieve each objective;
    (3) Collaboration between institutions, if proposed, is likely to 
be effective;
    (4) Participation in the National Spinal Cord Injury Database is 
clearly and adequately described; and
    (5) There is a clear description of how the applicant will include 
eligible project participants who have been traditionally 
underrepresented, such as--
    (i) Members of racial or ethnic minority groups;
    (ii) Women;
    (iii) Individuals with disabilities; and
    (iv) The elderly.
    (d) Quality of key personnel (10 points). The Secretary reviews 
each application to determine to what degree--
    (1) The principal investigator and other key staff have adequate 
training or experience, or both, in spinal cord injury care and 
rehabilitation and demonstrate appropriate potential to conduct the 
proposed research, demonstration, training, development, or 
dissemination activity;
    (2) The principal investigator and other key staff are familiar 
with pertinent literature or methods, or both;
    (3) All the disciplines necessary to establish the 
multidisciplinary system described in Sec. 359.11(a) are effectively 
represented;
    (4) Commitments of staff time are adequate for the project; and
    (5) The applicant is likely, as part of its non-discriminatory 
employment practices, to encourage applications for employment from 
persons who are members of groups that traditionally have been 
underrepresented, such as--
    (i) Members of racial or ethnic minority groups;
    (ii) Women;
    (iii) Individuals with disabilities; and
    (iv) The elderly.
    (e) Adequacy of resources (5 points). The Secretary reviews each 
application to determine to what degree--
    (1) The facilities planned for use are adequate;
    (2) The equipment and supplies planned for use are adequate; and
    (3) The commitment of the applicant to provide administrative and 
other necessary support is evident.
    (f) Budget/cost effectiveness (5 points). The Secretary reviews 
each application to determine to what degree--
    (1) The budget for the project is adequate to support the 
activities;
    (2) The costs are reasonable in relation to the objectives of the 
project; and
    (3) The budget for subcontracts (if required) is detailed and 
appropriate.
    (g) Dissemination/utilization (10 points). The Secretary reviews 
each application to determine to what degree--
    (1) There is a clearly defined plan for dissemination and 
utilization of project findings;
    (2) The research results are likely to become available to others 
working in the field;
    (3) The means to disseminate and promote utilization by others are 
defined; and
    (4) The utilization approach is likely to address the defined need.
    (h) Evaluation plan (10 points). The Secretary reviews each 
application to determine to what degree--
    (1) There is a mechanism to evaluate plans, progress, and results;
    (2) The evaluation methods and objectives are likely to produce 
data that are quantifiable; and
    (3) The evaluation results, where relevant, are likely to be 
assessed in a service setting.
    Within this absolute priority, we will give the following 
competitive preference under 34 CFR 75.105(c)(2)(i), to applications 
that are otherwise eligible for funding under this priority:
    Up to ten (10) points based on the extent to which an application 
includes effective strategies for employing and advancing in employment 
qualified individuals with disabilities in projects awarded under this 
absolute priority. In determining the effectiveness of such strategies, 
the Secretary will consider the applicant's success, as described in 
the application, in employing and advancing in employment qualified 
individuals with disabilities in the project.
    For purposes of this competitive preference, applicants can be 
awarded up to a total of 10 points in addition to those awarded under 
the published selection criteria for this priority. That is, an 
applicant meeting this competitive preference could earn a maximum 
total of 110 points.
    Applicable Program Regulations: 34 CFR part 359.
    Program Authority: 29 U.S.C. 762(b)(4).

[[Page 69158]]

Electronic Access to This Document

    You may view this document, as well as all other Department of 
Education documents published in the Federal Register, in text or Adobe 
Portable Document Format (PDF) on the Internet at either of the 
following sites:

http://ocfo.ed.gov/fedreg.htm
http://www.ed.gov/news.html

To use the PDF you must have the Adobe Acrobat Reader Program with 
Search, which is available free at either of the preceding sites. If 
you have questions about using the PDF, call the U.S. Government 
Printing Office (GPO), toll free, at 1-888-293-6498; or in the 
Washington, DC, area at (202) 512-1530.

    Note: The official version of document is the document published 
in the Federal Register. Free Internet access to the official 
edition of the Federal Register and the Code of Federal Regulations 
is available on GPO Access at: http://www.access.gpo.gov/nara/
index.html

(Catalog of Federal Domestic Assistance Numbers 84.133N, Special 
Projects and Demonstrations for Spinal Cord Injuries)

    Dated: December 6, 1999.
Judith E. Heumann,
Assistant Secretary for Special Education and Rehabilitative Services.
[FR Doc. 99-31952 Filed 12-8-99; 8:45 am]
BILLING CODE 4000-01-U