[Federal Register Volume 77, Number 100 (Wednesday, May 23, 2012)]
[Notices]
[Pages 30536-30540]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2012-12568]
-----------------------------------------------------------------------
DEPARTMENT OF HEALTH AND HUMAN SERVICES
Health Resources and Services Administration
Final Notice Regarding Updates and Clarifications of the
Implementation of the Scholarships for Disadvantaged Students Program
AGENCY: Health Resources and Services Administration, Department of
Health and Human Services.
ACTION: Notice.
-----------------------------------------------------------------------
SUMMARY: The Health Resources and Services Administration (HRSA)
announces updates and clarifications for the implementation of the
Scholarships for Disadvantaged Students (SDS) program under authority
of Section 737 of the Public Health Service Act (PHS Act). This notice
supersedes all previous notices regarding the SDS program.
A notice which proposed updates and clarified implementation of the
SDS program was published in the Federal Register on March 20, 2012 (77
FR 16244). A period of 30 days was established to allow public comment
concerning the proposed updates and implementation. Twenty-two letters
were received, each with multiple comments. This notice discusses the
comments and sets forth the final updates and implementation to the SDS
program.
DATES: Effective Date: The program clarifications described in this
notice will be implemented in fiscal year (FY) 2012 and beyond and will
become effective for SDS funds awarded to schools in FY 2012 and
beyond.
Purpose: HRSA is updating the SDS program to increase the impact of
the program in the areas addressed in the program's authorizing
statute. Specifically, the authorizing statute allows the Secretary to
make grants to eligible entities that are carrying out a program for
recruiting and retaining students from disadvantaged backgrounds,
including students who are members of racial and ethnic minority groups
(PHS Act, Sec. 737(d)(1)(B)). In addition, grantees provide
scholarships to individuals who meet the following requirements: (1)
Are from disadvantaged backgrounds; (2) have a financial need for a
scholarship; and (3) are enrolled (or accepted for enrollment) at an
eligible health professions or nursing school as a full-time student in
a program leading to a degree in nursing or a health profession (PHS
Act, Sec. 737(d)(2)(A-C)). Under the statute, priority is given 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 (PHS Act, Sec. 737(c)). There is also a
requirement to award at least 16 percent of the available funds to
schools of nursing (PHS Act, Sec. 740(a)).
The SDS Program required updating, because the program grantee
population had grown from 401 schools in FY 2000 to almost 700 health
profession schools in FY 2011. Since all SDS eligible schools received
grant awards, the funding had been divided into ever decreasing amounts
per school over the years. Many of the schools, in an effort to provide
funding to each of their disadvantaged students, spread the award
equally among the disadvantaged students and the smaller school award
amounts resulted in smaller student scholarship amounts. While the
student scholarship amounts decreased, the tuition rates increased. For
many students with insufficient financial resources, the small award
size was unlikely to provide enough funding to continue in school.
Also, the primary care and underrepresented minority student priority
weights used were too small to adequately incentivize and reward
schools that were successful in graduating primary care
underrepresented minority students or who had excellent plans to
improve their programs to recruit and retain students from
disadvantaged
[[Page 30537]]
backgrounds, including students who are members of racial and ethnic
minority groups. The primary care weights were also not enough to
incentivize schools to increase the proportion of graduating students
going into primary care. Additionally, the practice of awarding grants
for 1 year at a time did not allow the schools to select financially
disadvantaged applicants with greater assurance that a student would
receive SDS financial aid for the entire time the student is enrolled.
Changes: To provide larger award amounts to schools and to increase
the retention and graduation of disadvantaged students, including
students who are members of racial and ethnic minority groups, HRSA's
Bureau of Health Professions (BHPr) announces the following changes to
the SDS program:
(1) Convert the formula-based SDS program to a competitive peer-
reviewed grant program.
Comments: Four comments were received regarding the use of peer
review in the grant award process. The first ``welcomed'' the change to
a peer review process. The second comment was concerned that the peer
review process did not include peer review of priority points. The
third commenter believed that the application process for peer review
would be a burden, and the fourth commenter gave no readily discernible
reason for not supporting peer review.
In response, HRSA points out that the base score totals 100 points
and is determined by the results of the peer review. The additional
priority points are calculated based on set numeric standards.
Therefore, the majority of an applicant's score (100 out of 111 points
total) will be derived from peer reviewers. The priority points (a
maximum of 11 points, in addition to the maximum of 100 base points)
will be based on an applicant's successful past performance and points
will be designated using data provided by the applicant (percent of
graduates entering service in medically underserved communities or
primary care and the percent of students that are underrepresented
minorities). The calculation of set numeric standards for the awarding
of priority points does not require the judgment of a peer reviewer.
The priority point evaluation process described is, in HRSA's
consideration, the most objective means of evaluating applicants for
the SDS program. Regarding the third comment about the application
being burdensome, narrative grant applications are commonly used by
HRSA health professions programs. The narrative grant application
allows peer reviewers and HRSA to understand the applicant's approach
and proposal more fully. The overall grant application format has been
reviewed and approved for general use. In addition, since the grants
will be awarded for multiple years, applicants will only apply once
every four years instead of annually.
(2) Convert the grant award from a current 1-year project period to
a project period of 4-years. A successful institutional applicant would
be awarded a 4-year project period with funding provided annually
subject to appropriations, the availability of funds and successful
progress.
Comments: Eight comments were received on the project period. Two
comments support the 4-year project period. One of them said, ``The 4-
year commitment will be key in incentivizing students to enter one of
these much needed professions and allow the student to have a firm
financial plan in tackling the cost of the education.'' Other comments
included two that were concerned that Congress might not fund the full
4-year project period; another was interested in knowing how a 2-year
school would fare in funding with a 4-year cycle; another worried that
a student's economic status might change over the 4-year period, and
another provided no readily discernible reason for not supporting the
change.
In response, the multi-year project period has historically been
used by many HRSA health profession training programs. There is no
concern that the SDS program would encounter any special difficulties.
Grants are awarded with a multiyear project period which allows
grantees the opportunity to plan for long-term activities. Regarding
the remaining comments on the project period, there appears to be a
misunderstanding regarding the school award project period and the
student award. The SDS school 4-year project period assures the school
of SDS funding each year, pending availability of funding and dependent
upon the school's performance. The school has the responsibility to
select the SDS students each year and the school must ensure recipients
comply with all eligibility requirements each year. Schools may not
provide a student with all four years of funding in the first year,
however; the school may fund the same student each year if the school
has the funds and the student meets the eligibility requirements.
Having a 2-, 3- or 4-year curriculum should not be an issue.
(3) Add a new requirement that individual student awards must be at
least 50 percent of the student's annual tuition costs, for tuition
$30,000 or less, but no student can be awarded over $15,000 SDS funds
per year. Individual student awards must be $15,000 for students whose
tuitions are over $30,000 per year. The use of funds have not changed
and the amount of the scholarship still may not exceed a recipient's
cost of tuition expenses, other reasonable educational expenses, and
reasonable living expenses incurred in attendance at the SDS eligible
health professions school. As before, the scholarship may be expended
by the student only for such allowable costs.
Comments: There were 11 comments on the tuition award amounts.
Three comments supported the change. Six comments said they prefer to
provide scholarships to more students rather than increase scholarship
amounts to fewer students and there was concern that they would not be
able to fund as many students as they usually do. One of the six said
her preference was to leave the scholarship amount entirely up to the
grantee. Another comment suggested lowering the minimum scholarship
amount and another suggested having a minimum per semester rather than
per year.
In response, HRSA maintains that providing small amounts to more
students is unlikely to affect student outcomes in a way consistent
with the statutory aims. The requirement of 50 percent of the tuition
up to $15,000 per year will provide a significant award amount to allow
disadvantaged students with financial need to better complete their
health profession education. A 50 percent tuition per year award
minimum provides more flexibility than a per semester minimum.
Regarding the concern that a school may have to select fewer SDS
students due to the changes being made, HRSA points out that the total
grant award to a school will be based on the disadvantaged students'
need up to $650,000 rather than basing it on a formula that determines
the portion of shared available funds.
(4) Increase the weight and provide a range of points for primary
care and underrepresented minority priorities.
Comments: There were 4 comments regarding the weights for the
priority points. Two comments supported the priority point weights. One
comment that supported the weights also said attaining high percentages
of graduates entering primary care service would be difficult. One
commenter did not like the high weight on primary care and the other
did not like the high weight given for applicants with high percentages
of underrepresented minority students, or for graduates serving in
primary care.
[[Page 30538]]
Both said that this would increase primary care at the expense of other
disciplines.
In response, service in primary care and having high percentages of
students from underrepresented minority backgrounds are two of the
priorities required by the authorizing statute. Increasing primary care
practitioners and increasing the diversity of the health professions
are emphasized in the statute. They are also both initiatives of HRSA
and the priority points are weighted to meet these initiatives.
(5) Expand the disciplines eligible for the primary care priority
(currently allopathic and osteopathic medicine, dentistry, graduate
nurse practitioners, and physician assistants) to also include dental
hygiene and behavioral and mental health discipline (clinical
psychology, clinical social work, professional counseling, marriage and
family therapy).
Comments: There were six comments regarding the primary care
priority disciplines. Two supported the expansion. Another comment said
they did not support the expansion, because it would decrease funds to
those already receiving the primary care priority. Three additional
commentors wanted HRSA to also add pharmacy as a primary care
discipline, because in ``three states,'' there is ``* * * a second
level of pharmacist licensure known as the pharmacist clinician
(Ph.C.). Under protocol with a physician, a Ph.C. acts as a mid-level
provider with similar rights and responsibilities to that of a Nurse
Practitioner or Physician Assistant.''
In response to the comment that disciplines eligible for the
primary care priority should not be expanded, because the change might
decrease the amount of funds to current primary care priority
recipients, HRSA points out that the identified primary care priority
disciplines can rationally and consistently be defined as primary care
across the states following the IOM definition. Possible funding
scenarios should not be a criterion for deciding whether a discipline
is primary care. In response to those commentors who wanted to expand
the primary care definition to include disciplines that had a primary
care role in three states, HRSA points out that the expanded list of
disciplines proposed were those with fairly consistent licensure and
duties nationally. Seven states offer prescribing privileges and many
other states support collaborative drug therapy management, thereby
expanding scope of practice and allowing pharmacists to work in a team
environment to initiate, modify or continue drug therapy for a specific
patient. HRSA will continue to assess the pharmacist clinician
occupation for possible inclusion in the primary care discipline
category in the future.
(6) Use the Institute of Medicine's primary care definition to
identify primary care service for the primary care priority within the
eligible primary care disciplines:
Primary Care is the provision of integrated, accessible health
care services by clinicians who are accountable for addressing a
large majority of personal health care needs, developing a sustained
partnership with patients, and practicing in the context of family
and community. (Institute of Medicine. Primary Care: America's
Health in a New Era. Washington, DC: National Academy Press, 1996).
Comments: There were three comments regarding the use of the IOM
definition. Two supported the use of the definition. Another comment
did not support the use of the IOM definition unless there would be
full disclosure that other health professions, authorized to
participate in the SDS program, were also included in the primary care
priority.
In response, the primary care definition as written does not
mention specific disciplines but describes tasks to better define
primary care activities.
(7) Increase the school eligibility requirement for disadvantaged
students enrolled and disadvantaged students graduated to 20 percent
each.
Comments: There were six comments regarding the increase in the
eligibility requirements. One comment said that the change ``seems
reasonable'' though it may be difficult to maintain. Another said that
its school would likely be able to attain the 20 percent levels but
worried about what would happen if after receiving the grant, the
school fell below 20 percent for one of the years. Four other comments
said that raising the eligibility to 20 percent would eliminate the
school from the program and two of those who said they would be
eliminated, went on to say that the discipline itself as a whole didn't
have near the 20 percent level of disadvantaged students or
practitioners.
In response, the proposed increase in eligibility that will occur
in FY 2012 was designed in order to focus funds on schools that have a
strong commitment to educating and graduating disadvantaged students.
Based on an analysis of FY 2010 grantees, over 400 programs met the 20
percent eligibility criteria. The SDS program eligibility criteria
could help drive improvement in disciplines with low percentages of
disadvantaged enrollees and graduates. Prior to the FY 2012 increase,
the level had not been increased since 1999.
Eligibility Requirements: Eligible entities are: schools of
allopathic and osteopathic medicine; dentistry; optometry; pharmacy;
podiatric medicine; veterinary medicine; nursing (associate, diploma,
baccalaureate, and graduate degree); public health; chiropractic;
allied health (baccalaureate and graduate degree programs of dental
hygiene, medical laboratory technology, radiology technology, speech
pathology, audiology, registered dieticians, and occupational therapy
and physical therapy); mental and behavioral health (graduate degree
programs in clinical psychology, clinical social work, professional
counseling, marriage and family therapy); and entities providing
physician assistant training programs. (PHS Act, Sec. 737(d)(1)(A)).
There are five requirements a school must meet in order to be
eligible for the SDS grant program. The requirements, starting in FY
2012, are as follows:
(1) Twenty (20) percent of enrolled students must be disadvantaged;
(2) Twenty (20) percent of graduates must be disadvantaged;
(3) Schools must have a recruitment program for disadvantaged
students;
(4) Schools must have a retention program for disadvantaged
students; and
(5) Student award must be at least 50 percent of the annual tuition
cost with a $15,000 maximum award per year, when annual tuition is
$30,000 or below--above $30,000 annual tuition equals $15,000 award.
Student Eligibility Requirements: To qualify for the SDS program, a
student must:
(1) Meet the following definition of an individual from a
disadvantaged background. For the purposes of the SDS program, an
individual from a disadvantaged background is defined as one who: (a)
Comes from an environment that has inhibited the individual from
obtaining the knowledge, skills, and abilities required to enroll in
and graduate from a health profession or nursing school, or from a
program providing education or training in allied health professions;
or (b) comes from a family with an annual income below the established
Census Bureau low-income thresholds, adjusted by the Secretary for
health professions and nursing programs eligibility;
(2) Have a financial need for a scholarship, in accordance with a
need analysis procedure approved by the Department of Education (20
U.S.C. 1087kk-1087vv). In addition, any student who is enrolled (or
accepted for enrollment) in a health profession school or program must
provide
[[Page 30539]]
information on his or her parents' financial situation or his or her
own depending upon the tax status of the student; and
(3) Be enrolled (or accepted for enrollment), as a full-time
student, at an eligible health professions or nursing school in a
program leading to a degree in nursing or a heath profession (PHS Act,
Sec. 737).
Comments: There was one comment regarding financial information
required on graduate students. That comment requested that HRSA change
its policy requesting that graduate students provide parental financial
information to determine financial need, because it may be burdensome
to the students. The commenter noted that some Department of Education
loan programs do not require parental information.
In response, HRSA points out that SDS is a scholarship program, and
strong documentation is needed for the student scholarship selection
process. The consequence of providing a scholarship to a non-eligible
student is the loss of funds, whereas with loans, students repay the
funds with interest. During technical assistance meetings, many
grantees were very favorable to the SDS financial-need documentation
policy and said that the information was needed to both make
appropriate student selections and the policy helpful when explaining
financial document requests to students. SDS policy is for the parental
income to be used to determine a student's eligibility for economically
disadvantaged status in all cases except in those cases where the
student is considered independent by being at least 24 years old and
has not been listed as a dependent on his or her parents' income tax
for 3 or more years. In those cases, the student's family income will
be used instead of parental family income.
Student Award Selection: The law requires that in providing SDS
scholarships, the school or program must 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 awards to students who were
former recipients of scholarships under PHS Act sections 736
(Exceptional Financial Need Scholarships) and 740(d)(2)(B) (Financial
Assistance for Disadvantaged Health Professions Students Scholarships),
as such sections existed on November 13, 1998, if such recipients are
still students in financial need.
Elements of Peer Review: Peer reviewers will assess a school's
allocations based on accomplishment of, or commitment to, the following
criteria:
(1) Degree to which applicant demonstrates its commitment to the
education of disadvantaged students, including underrepresented
minorities (10 points);
(2) Degree to which applicant demonstrates its commitment to
increasing primary care practitioners (10 points);
(3) Degree to which applicant demonstrates its commitment to
increasing graduates working in medically underserved communities
(MUCs) (10 points);
(4) Level of achievements and successes in educating disadvantaged
students, including underrepresented minorities, in a way that
eliminates barriers along the educational pipeline for disadvantaged
students and assures graduates practice in primary care and serve in
MUCs (30 points); and
(5) Level of adequacy of proposed plan to increase and educate
disadvantaged students, including underrepresented minorities, and
retain students in their academic programs, and encourage them to enter
primary care and serve in MUCs (40 points).
Comments: There were 17 different comments regarding the review
criteria. One comment said that the school liked the focus on
recruitment and retention programs. Three comments indicated that they
would prefer that HRSA provide administrative costs to acquire the data
needed to apply and report on students. Eight comments requested that
the changes not be implemented this year for the following reasons: in
order to complete a study of the likely outcomes of these changes, to
provide time for institutions to gather information to write better
applications, and to assure the SDS scholarship funds can be provided
to students this year and be a recruitment tool despite the later than
normal grantee award date this year. Two comments said that the MUC
service review criterion was problematic since service was a student
decision and beyond the school's control. One comment said that the
goal of increasing disadvantaged students in primary care would destroy
the SDS program as it currently exists. Two comments were that the
school disagreed with the focus on primary care.
In response, HRSA is unable to fund administrative costs for this
program at this time. Regarding the request for an impact study, HRSA
will base the programmatic changes on information it has gathered from
grantees about program operations and analysis of grantee data. HRSA
will assess the impact of these changes after they are implemented to
determine if they had the intended effect. In regard to the additional
application burden, HRSA points out that the applications for the SDS
will include much of the same information requested in the past, but
will have additional opportunities for applicants to describe their
programs in narrative and check-box format. Program has determined that
the time allocated to complete the application will be appropriate to
satisfy any new requirements. Regarding timing of the awards in FY
2012, HRSA grantees (in meetings with HRSA) said that schools will be
able to award the funds requested for FY 2012 even if the awards come
out in September. In response to the comments regarding the MUC review
criteria, the SDS program already awards funds to schools that have
programs and activities to support and encourage students to provide
service in MUCs and grantees have been tracking students' service in
MUCs for years. The mission of the SDS program is to provide funding to
disadvantaged students, including students from racial and ethnic
minority backgrounds in financial need, so they may study at and
graduate from a health professions school and enter a health
profession, preferably in primary care in a medically underserved
community, as per the statutory preferences. The review criteria focus
on program activities that will produce those results.
Priority Scoring: Additional points ranging from two through four
will be given for having a high percentage of the following priorities:
(1) Underrepresented minority students and (2) graduates entering
primary care service. Additional points ranging from one through three
will be given for having a high percentage of graduates serving in
medically underserved communities. The number of points awarded to each
applicant for meeting the priorities will be determined by the
applicant's percentage in meeting these priorities. A higher number of
points will be assigned to applicants with higher percentages of
meeting these priorities. There will be no institutional or discipline
preferences.
[[Page 30540]]
Additional Letters: There were three additional letters that did
not contain comments. They asked questions that were answered in the
text of this Notice or required very detailed responses that were more
appropriate for response in technical assistance meetings.
Dated: May 17, 2012.
Mary K. Wakefield,
Administrator.
[FR Doc. 2012-12568 Filed 5-22-12; 8:45 am]
BILLING CODE 4165-15-P