[Federal Register Volume 77, Number 27 (Thursday, February 9, 2012)]
[Notices]
[Pages 6805-6808]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2012-2933]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Health Resources and Services Administration


Eligibility Criteria for the Centers of Excellence Program in 
Health Professions Education for Under-Represented Minority Individuals

AGENCY: Health Resources and Services Administration, HHS.

ACTION: Final Notice.

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SUMMARY: The Centers of Excellence (COE) program in health professions 
education for under-represented minority (URM) individuals is 
authorized by section 736 of the Public Health Service Act (PHS Act), 
42 U.S.C. 293 (2011). The purpose of this final notice is to inform 
interested individuals of the criteria that will be used to determine 
the eligibility of designated health professions schools to apply for 
COE funding in fiscal year (FY) 2012 and subsequent fiscal years. The 
Supplementary Information in this Notice provides a brief synopsis of 
the public comments that the Health Resources and Services 
Administration (HRSA) received on the updates to the proposed 
eligibility criteria in response to the November 7, 2011 Federal 
Register Notice, specifically addressing: 1) the proposed graduation 
threshold eligibility criteria, 2) the COE eligibility criteria in 
general, and 3) the purpose of the COE program as authorized by the PHS 
Act.

DATES: Effective Date: February 9, 2012.

FOR FURTHER INFORMATION CONTACT: Dr. Joan Weiss, Director, Division of 
Public Health and Interdisciplinary Education, Bureau of Health 
Professions, Health Resources and Services Administration. Dr. Weiss 
may be reached in one of three following methods: 1) via written 
request to: Dr. Joan Weiss, Designated Federal Official, Bureau of 
Health Professions, Health Resources and Services Administration, 
Parklawn Building, Room 9-36, 5600 Fishers Lane Rockville, Maryland 
20852; 2) via telephone at (301) 443-6950; or 3) via email at 
[email protected].

SUPPLEMENTARY INFORMATION:

Background

    For more than 20 years, the COE program has supported programs of 
excellence in health professions education for under-represented 
minority (URM) individuals in designated health professions schools. 
The authorized categories of designated health professions schools are: 
(1) Designated Historically Black Colleges and Universities (HBCUs), 
(2) Hispanic, (3) Native American, and (4) ``other'' health professions 
schools that meet the program requirements. COEs provide academic 
enhancement programs to URM individuals; develop a large and 
competitive applicant pool to pursue health professions careers; and 
improve the capacity of schools to recruit, train, and retain URM 
faculty. The COE program facilitates faculty and student research on 
health issues particularly affecting URM groups. In addition, the 
program carries out activities to improve information resources, 
clinical education, curricula and cultural competence of schools' 
graduates relating to minority health issues. COEs also train students 
to provide health services to URM individuals at community-based health 
facilities and provide financial assistance, as available and 
appropriate. To be eligible for funding, the PHS Act requires 
designated schools to meet each of four general conditions. The schools 
must: (1) Have a significant number of URM individuals enrolled in the 
school, including individuals accepted for enrollment in the school; 
(2) have been effective in assisting URM students of the school to 
complete the program of education and receive the degree involved; (3) 
have been effective in recruiting URM individuals to enroll in and 
graduate from the school, including providing scholarships and other 
financial assistance to such individuals and encouraging URM students 
from all levels of the educational pipeline to pursue health 
professions careers; and (4) have made significant recruitment efforts 
to increase the number of URM individuals serving in faculty or 
administrative positions at the school (See PHS Act, Section 
736(c)(1)(B)(i)--(iv)).

1. Proposed Graduation Threshold Eligibility Criteria

    The Federal Register Notice (FRN), published November 7, 2011, 
updated the eligibility criteria and requires eligible health 
professions schools to demonstrate effectiveness in assisting URM 
students to successfully complete the program of education and receive 
the appropriate degree. The eligibility criteria requires applicants to 
meet or exceed a specified minimum number of URM students graduating 
with appropriate degrees. Graduation rates are calculated and provided 
by health professions schools applying for COE funding. To account for 
varying class sizes across the landscape of health professions schools, 
the threshold percentage for Hispanic, Native American, and ``Other'' 
COEs within the designated health professions will be determined by the 
total number of URM students graduating from the health professions 
school with degrees divided by the total number of students graduating 
with degrees in a given health professions school. The percentage 
representing the cut-off point for the top quartile (75th percentile) 
will serve as the minimum percentage that Hispanic, Native American, 
and ``Other'' COEs must meet.

[[Page 6806]]

    One commenter requested removing the graduation rate as an 
eligibility requirement, and instead using it as one factor to evaluate 
a school's qualifications for a COE grant due to the number of medical 
schools that have recently opened and are undergoing accreditation and 
do not yet have a graduating class to meet the graduation threshold. 
However, section 736(c)(1)(B)(ii) of the PHS Act requires health 
professions schools to demonstrate that they have ``been effective in 
assisting under-represented minority students of the school to complete 
the program of education and receive the degree involved.'' Newly 
opened health professions schools that are undergoing accreditation may 
be unable to meet this statutory requirement.
    Another commenter expressed concern that the graduation threshold 
gives preference to institutions in the top quartile nationally for 
graduating URM students and may encourage institutions that have data 
below the threshold to inappropriately expand the number. The previous 
COE funding opportunity announcement (FY 2009) provided that, ``[t]he 
reviewers will determine if the health professions school has been 
effective in assisting URM students of the school to complete the 
program of education and receive the degree involved. Reviewers will 
verify that the applicant school meets the required URM graduation rate 
of at least 85% over 4 or 5 years. If the applicant is a Native 
American COE, reviewers will verify that the applicant school has a URM 
graduation rate of at least 75%.'' The criterion implements a statutory 
provision requiring effectiveness in assisting URM students to complete 
their degree programs, and we believe that the current formulation 
serves to standardize the minimum threshold by setting it at 75 
percent. If the result is an increase in the graduation rate, that 
would be consistent with the goals of the program.
    One commenter noted that the word ``its'' that was in the 
criterion, ``requires designated health professions schools to be 
effective in assisting its URM students to successfully complete the 
program of education and to receive the appropriate professional 
degree'' disconnects the intent of the criterion from the calculation. 
To avoid miscommunication on the intent of graduation threshold 
criteria and calculation, the word ``its'' is not used in this context 
in this Final Notice and will not be used when this criteria is 
reiterated in the COE funding opportunity announcement.

2. COE Eligibility Criteria in General

    The general conditions of a designated health professions school to 
be eligible for COE funding, as authorized by the PHS Act, Title VII, 
Section 736, include meeting the four criteria mentioned previously in 
the Background section. A public comment recommended deleting part or 
all of the first, third, and fourth eligibility criteria. Because the 
statute clearly states these four conditions are required for eligible 
applicants to receive COE funding, none can be deleted, partially or in 
full.

3. Authorized Purpose and Intent of COE Program

    Another commenter raised concern about the underlying statute, 
rather than the proposed criteria; these concerns are beyond the scope 
of this notice. The COE program, first authorized by Public Law 100-97 
(``Excellence in Minority Health Education and Care Act'') in 1987, 
funds minority health professions schools to recruit, retain, and 
graduate URMs to increase the supply and quality of URMs in the health 
professions workforce. As demonstrated by national data sources, there 
continues to be a low number of URMs applying to U.S. medical schools 
(https://www.aamc.org/download/161338/data/table15.pdf) and a low 
number in the physician workforce (AAMC, Diversity in the Physician 
Workforce, Facts and Figures 2010; Figure 14, p. 30). Due to the 
challenges in recruiting and graduating a critical mass of URM students 
to increase diversity in the health professions workforce, the 
eligibility criteria for eligible health professions schools for COE 
funding remains as defined in the authorizing statute.
    The catalog of Federal Domestic Assistance Number for the COE 
program is 93.157. This program is not subject to the provisions of 
Executive Order 12372, Intergovernmental Review of Federal Programs (as 
implemented through 45 CFR part 100). Further, these programs are not 
subject to the Public Health Systems Reporting Requirements.
    The Centers of Excellence Program application is approved under OMB 
No. 0915-0060.

    Dated: February 2, 2012.
Mary K. Wakefield,
Administrator, Health Resources and Services Administration.
    For the reasons stated above, the Heath Resources and Services 
Administration (HSRA) is adopting the Proposed Notice, published at 76 
FR 0215 on Monday, November 7, 2011, as a Final Notice with the change 
to clarify Criterion Two.

SUPPLEMENTARY INFORMATION: Purpose: The COE program supports programs 
of excellence in health professions education for URM individuals in 
designated health professions schools. The categories of designated 
health professions schools subject to this notice are: (1) Hispanic, 
(2) Native American, and (3) ``Other'' health professions schools that 
meet the program requirements. Centers of Excellence provide academic 
enhancement programs to URM individuals; develop a large and 
competitive applicant pool to pursue health professions careers; and 
improve the capacity of schools to recruit, train, and retain URM 
faculty. The COE program facilitates faculty and student research on 
health issues particularly affecting URM groups. In addition, the 
program carries out activities to improve information resources, 
clinical education, curricula, and cultural competence of schools' 
graduates relating to minority health issues. COEs also train students 
to provide health services to URM individuals at community-based health 
facilities and provide financial assistance, as available and 
appropriate.
    Eligibility Criteria: To be eligible for funding, the Public Health 
Service Act requires designated schools to meet each of four criteria. 
The schools must: (1) Have a significant number of URM students 
enrolled, including individuals accepted for enrollment; (2) have been 
effective in assisting URM students to complete their educational 
program and receive the degree involved; (3) have been effective in 
recruiting URM students to enroll in and graduate from the school, 
including providing scholarships and other financial assistance and 
encouraging URM students at all levels of the educational pipeline to 
pursue health professions careers; and (4) have made significant 
recruitment efforts to increase the number of URM individuals serving 
in faculty or administrative positions at the school.
    The COE program aims to support institutions with a commitment to 
URMs, including having demonstrated effectiveness in recruiting, 
teaching, training, and retaining current and future URM health 
professionals, both as practitioners and as faculty. This announcement 
details the proposed approach that the Secretary will use to assess 
whether schools and other eligible entities meet the eligible criteria 
defined in statute. Beginning in FY 2012, the following approach would 
be

[[Page 6807]]

used to assess whether applicants meet eligibility criteria.
    A. Criterion one: The school must have a significant number of URM 
students enrolled in the designated health professions education 
program. The Secretary will determine the significant number for 
Hispanic and Native American COEs based on a percentage of the current 
number of URM students enrolled in these schools. This determination is 
unnecessary, however, for HBCUs because they meet the significant 
number condition by virtue of their definition. With respect to the 
eligible ``Other'' COE health professions schools, the Act requires 
these schools to have a current enrollment of URMs above the national 
average.
    B. Criterion two: The second criterion requires designated health 
professions schools to be effective in assisting URM students to 
successfully complete the program of education and to receive the 
appropriate professional degree. Graduation rates are calculated, 
determined, and provided by health professions schools applying for COE 
funding. To account for varying class sizes across the health 
professions schools, the graduation rate eligibility thresholds for 
Hispanic, Native American, and ``Other'' COEs in the designated health 
professions will be determined using the following procedure:
    1. Health professions schools and programs will be ranked according 
to the percentage of URMs (e.g., Hispanic, Native American, or 
``Other'') successfully graduating from such health professions schools 
or programs with degrees each year, as calculated by the total number 
of URM students graduating from the health professions school with 
degrees divided by the total number of students graduating with degrees 
in a given health professions school.
    2. The top quartile (75th percentile) will serve as the threshold 
and eligibility percentage for Hispanic, Native American, and ``Other'' 
COE applicants.
    3. The Integrated Postsecondary Education Data System Completions 
survey will provide the raw data for threshold analysis. The Integrated 
Postsecondary Education Data System (IPEDS) is a system of interrelated 
completed surveys conducted annually by the U.S. Department of 
Education's National Center for Education Statistics (NCES). IPEDS 
collects data on postsecondary education in the United States, 
including the number of students who complete a postsecondary education 
program by type of program and level of award (certificate or degree). 
The IPEDS is available at http://nces.ed.gov/ipeds/datacenter/DataFiles.aspx. Separate thresholds will be calculated and established 
for each of the following four categories: allopathic and osteopathic 
medicine; pharmacy; dentistry; and behavioral or mental health.
    Individual schools will be responsible for calculating their 
percentage of URM graduates with degrees. Each school's graduation rate 
percentage will be compared to the thresholds established through the 
methodology described above. If a school meets or exceeds the 
threshold, it will meet the graduation eligibility criterion for the 
COE program. To calculate their URM graduation percentage, health 
professions schools would:
    1. Sum the appropriate URM (Hispanic, Native American, or 
``Other'') population that completed and successfully graduated from 
the health professions school with degrees across the most recent three 
years (A).
    2. Sum the total student population that completed and successfully 
graduated from the health professions school with degrees across the 
most recent three years (B).
    3. Divide A by B to arrive at the average designated URM percentage 
of successful graduates from the health professions schools with 
degrees across the past three years.
    To be eligible for the COE program, Hispanic, Native American and 
``Other'' applicants must meet or exceed the proposed graduation 
thresholds. The proposed graduation threshold in each of the eligible 
fields of study is the 75th percentile of URM graduation rates as 
reported to the IPEDS. The 75th percentile was determined based on an 
analysis of the IPEDS completion survey of 2009 data within the 
appropriate field of study, as defined by the Classification of 
Instructional Program (CIP) code system. The CIP is the accepted 
federal government statistical standard on instructional program 
classifications. The ``Total Programs'' per discipline represents the 
number of programs reporting a completions rate for the given CIP code 
in the U.S. within the IPEDS system.

Proposed Graduation Rate Eligibility Thresholds

    The analysis would be as follows:
    ALLOPATHIC AND OSTEOPATHIC MEDICINE PROGRAMS (Doctors of Medicine, 
Doctors of Osteopathy):
    TOTAL PROGRAMS REPORTED IN IPEDS = 142.
    Hispanic graduation rate eligibility threshold = 6.3 percent.
    Native American graduation rate eligibility threshold = 1.0 
percent.
    ``Other'' COE graduation rate eligibility threshold = 14.1 percent.
    DENTISTRY (Doctors of Dental Surgery, Doctors of Dental Medicine):
    TOTAL PROGRAMS REPORTED IN IPEDS = 59.
    Hispanic graduation rate eligibility threshold = 7.1 percent.
    Native American graduation rate eligibility threshold = 1.4 
percent.
    ``Other'' COE graduation rate eligibility threshold = 13.5 percent.
    PHARMACY (Doctor of Pharmacy):
    TOTAL PROGRAMS REPORTED IN IPEDS = 94.
    Hispanic graduation rate eligibility threshold = 3.5 percent.
    Native American graduation rate eligibility threshold = 0.5 
percent. *
    Other COE graduation rate eligibility threshold = 10.0 percent.
    BEHAVIORAL OR MENTAL HEALTH:
    TOTAL PROGRAMS REPORTED IN IPEDS = 1928.
    Hispanic graduation rate eligibility threshold = 7.7 percent.
    Native American graduation rate eligibility threshold = 0.66 
percent. *
    Other COE graduation rate eligibility threshold = 26.1percent.
    * Due to the limited number of Native Americans graduating with a 
Doctor of Pharmacy or a graduate degree in Behavioral or Mental Health 
from the school of discipline, the proposed graduation rate eligibility 
threshold for these two disciplines is based on the mean percentage and 
not on the 75th percentile of Native Americans graduating with the 
required degree.
    C. Criterion three: The third criterion requires designated health 
professions schools to have effectively recruited URMs, including 
providing scholarships and other financial assistance for individuals 
enrolled in the school, and encouraging URM students from all levels of 
the education pipeline to pursue health professions careers. Such 
schools are responsible for establishing criteria for financial 
assistance, selecting recipients within the Centers of Excellence 
program, and making reasonable determinations of need for the level of 
financial assistance for the recipients. Each school will independently 
develop the criteria to receive financial assistance, submit this 
information in their application, where it collectively will be 
objectively reviewed by the peer review panel. The availability of 
financial assistance, as formulated by the health professions school, 
is designed to assist in increasing the level of URM health 
professionals who successfully

[[Page 6808]]

complete the program as well as increase their intent to practice in 
underserved areas.
    D. Criterion four: The fourth criterion requires designated health 
professions schools to have made a significant recruitment effort to 
increase the number of URM individuals serving in faculty or 
administrative positions at the school. A major COE program focus is to 
improve the capacity of the school to train, recruit, and retain URM 
faculty and administrative personnel. A health professions school 
should demonstrate over a 5-year period a ``significant effort'' to 
recruit and retain URM faculty and administrative positions based on 
the number of URM faculty and new URM hires.

[FR Doc. 2012-2933 Filed 2-8-12; 8:45 am]
BILLING CODE 4165-15-P