[Federal Register Volume 59, Number 237 (Monday, December 12, 1994)]
[Unknown Section]
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From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 94-30410]
[[Page Unknown]]
[Federal Register: December 12, 1994]
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DEPARTMENT OF HEALTH AND HUMAN SERVICES
Public Health Service
42 CFR Part 57
RIN 0905-AE13
Grants for Faculty Training Projects in Geriatric Medicine and
Dentistry
AGENCY: Health Resources and Services Administration, HHS.
ACTION: Final rule.
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SUMMARY: This final regulation revises the existing regulations
governing the program for Grants for Faculty Training Projects in
Geriatric Medicine and Dentistry authorized by section 777(b) of the
Public Health Service Act (the Act), to implement statutory amendments
made by the Health Professions Extension Amendments of 1992 and to
include other technical and ministerial changes to conform the existing
regulations with the amendments made by the statute. The final rule
also removes a section in the regulations to allow for less restrictive
requirements for those individuals who may benefit from further
fellowship or retraining experience in a lifetime.
DATES: These regulations are effective December 12, 1994.
FOR FURTHER INFORMATION CONTACT: Neil H. Sampson, Director, Division of
Associated, Dental and Public Health Professions, Bureau of Health
Professions, HRSA, room 8-101, Parklawn Building, 5600 Fishers Lane,
Rockville, Maryland 20857; telephone: (301) 443-6853.
SUPPLEMENTARY INFORMATION: On March 3, 1994, the Assistant Secretary
for Health, with the approval of the Secretary of Health and Human
Services, published in the Federal Register (59 FR 10104), a Notice of
Proposed Rulemaking (NPRM) to revise the regulations governing the
program for Grants for Faculty Training Projects in Geriatric Medicine
and Dentistry, authorized under section 777(b) of the Public Health
Service Act (the Act) (42 U.S.C. 294o). The Health Professions
Education Extension Amendments of 1992 (Pub. L. 102-408) amended and
renumbered former section 789(b) of the Act (42 U.S.C. 295g-9(b)) to
section 777(b).
The NPRM proposed amendments to implement several statutory
provisions by: (1) Adding a definition for the term ``Geriatric
psychiatry'' to implement the requirement for the expansion of project
support to include the training of physicians who plan to teach
geriatric psychiatry, and by (2) adding a definition for the term
``Relevant advanced training or experience'' to implement the
requirement for dentists who are awarded a 2-year internal medicine or
family medicine fellowship. The NPRM also proposed to remove a section
in the regulations regarding the period of time for appointment to
fellowships to allow for less restrictive requirements for those
individuals who may benefit from further fellowship or retraining
experience in a lifetime.
The public comment period on the proposed regulations closed on
April 4, 1994. The Department received 4 public comments. The comments
received on the proposed rule to section 777(b) and the Department's
responses to the comments are discussed below according to the section
numbers and headings of the regulation affected.
Section 57.4102 ``Definitions''
The Department proposed the following definition for the term
``Geriatric psychiatry'':
``Geriatric psychiatry'' means the prevention, diagnosis,
evaluation and treatment of mental disorders and disturbances seen in
older adults.
This definition was proposed to be added to the section to
incorporate the statutory requirement for the expansion of project
support to include the training of physicians who plan to teach
geriatric psychiatry.
The Department received positive responses to this definition.
The Department also proposed the following definition for the term
``Relevant advanced training or experience'':
``Relevant advanced training or experience'' means at least one of
the following: (1) Completion of at least a 12-month graduate training
program in a health-related discipline, the basic sciences, or
education; or (2) a minimum of 2 years of clinical practice, of which
at least 12 months were devoted in part to managing older dental
patients in a hospital, long-term care facility, or other setting.
This definition was proposed to be added to the section to
incorporate the statutory requirement for the expansion of fellowship
eligibility of dental fellows in the program.
One respondent found this definition ``extremely helpful in setting
a high standard for the selection of highly motivated and qualified
candidates''.
The Department also received a request that dentists who have had
``relevant teaching experience in an accredited dental school'' be
added to the definition. The Department accepts the general intent of
this recommendation while noting that ``relevant'' alone is not
explicit and is open to interpretation. In response to this concern,
the Department has expanded the definition of ``Relevant advanced
training or experience'' in the final regulations to include an
additional experience, ``a minimum of 2 years of teaching experience in
an accredited dental educational program of which at least 12 months
were devoted in part to issues pertaining to the care of older
adults.''
Section 57.4111 ``Duration of Fellowships''
The Department proposed to remove this section from the regulations
to allow less restrictive requirements for those individuals who may
benefit from further fellowship or retraining experience in a lifetime.
The section language read:
``An appointment to a fellowship may be made for a period not to
exceed 12 months. Fellowship assistance for participants in a 1-year
fellowship program and a 1-year retraining program is limited to 12
months. Participants in 2-year fellowship programs may receive a
second 12-month appointment for a total period of 24 months.''
The Department gave an example in the NPRM how this language might
be restrictive to fellows: ``For example, a faculty fellow who
completed a 1-year retraining to have the skills required to
incorporate geriatrics into course content and clinical rotations may
discover 5 years later that another fellowship experience would provide
the opportunity to develop research skills in geriatrics required to
expand the scope and depth of practice-based geriatric research.''
One respondent requested the ``removal of the 1-year fellowship
[retraining] limit of Federal support for psychiatrists who wish to
train other psychiatrists in geriatric psychiatry''. The respondent
stated that this is a reasonable request as it would permit the
training to fully meet the requirements of exposure to the physical and
mental disabilities of a diverse population of elderly individuals.
The Department has not accepted this recommendation because the
statute requires that the 2-year fellowship program be an internal
medicine or family medicine fellowship program, not a psychiatry
fellowship program. (See section 777(b)(3)(B) of the Act and
Sec. 57.4105(d) of the regulations.) However, psychiatrists are
eligible to participate as fellows in the 2-year programs.
In addition to the changes proposed above, a number of technical,
clarifying, and ministerial changes were included to conform the
existing regulations with amendments made by Pub. L. 102-408. The
Department also received a few comments on some of these technical
changes. The Department's responses are also discussed below. These
changes affecting the program for Faculty Training Projects in
Geriatric Medicine and Dentistry are as follows:
1. Revise the section number of the Act from ``789(b)'' to
``777(b)'' wherever it appears in subpart PP, as renumbered, and the
United States Code citation from ``(42 U.S.C. 295g-9(b))'' to ``(42
U.S.C. 294o)'', in accordance with Pub. L. 102-408.
2. Revise Sec. 57.4101, entitled ``To what projects do these
regulations apply?'', by adding the words ``geriatric psychiatry'' to
reflect statutory language which expands project support to include the
training of physicians who plan to teach geriatric psychiatry.
3. Revise Sec. 57.4102, entitled ``Definitions.'', to amend the
following terms to:
a. Remove the definition of ``Council'' regarding the National
Advisory Council on Health Professions Education, in accordance with
Pub. L. 102-408. The statute repealed the Council effective October 1,
1992;
b. Revise the phrase ``by an organized medical staff'' to ``by an
organized health care staff'' at the end of the definition of
``Extended care facility'' to clarify that staff of health care
institutions includes nurses, physical therapists, social workers and
other health care staff who provide ``medically-prescribed skilled
nursing care or rehabilitative services''.
The Department received one comment regarding the proposed
clarifying change to the phrase ``organized health care staff'' as
having potential conflict with individual State laws or licensing
authorities. It is the Department's view that the clarifying phrase
includes medical staff along with all other health care professionals
and should not be in conflict with any individual State laws or
licensing authorities. Therefore, this amendment will remain as
proposed.
c. Revise the introductory text to the definition of ``Fellowship
program'' by removing the reference to a 1-year fellowship program
which is no longer a statutory provision for project support; and
revise paragraph (2) of the definition to reflect new statutory
requirements for the training of dentists who have ``demonstrated a
commitment to an academic career and who have completed postdoctoral
dental training, including postdoctoral dental education programs or
who have relevant advanced training or experience''.
The Department received favorable support for this change.
d. Revise the section number of the Act in the definition of
``School of medicine or school of osteopathic medicine'' from
``701(5)'' to ``799(1)(E)'', in accordance with Pub. L. 102-408.
4. Amend Sec. 57.4105, entitled ``Project requirements.'', to:
a. Revise paragraph (d) regarding the requirement that projects be
based in a graduate medical education program by adding the words ``or
psychiatry'' after the phrase ``or in a department of geriatrics'' to
reflect statutory language which expanded project support to include
the training of physicians who plan to teach geriatric psychiatry.
Paragraph (d) is further revised by removing the phrase ``in existence
as of December 1, 1987'' at the end of the sentence, in accordance with
Pub. L. 102-408;
b. Revise paragraph (e) regarding the requirement that projects be
staffed by at least two physicians in full-time teaching positions who
have experience or training in geriatric medicine by adding the words
``or geriatric psychiatry'', in accordance with Pub. L. 102-408; and
c. Revise the introductory text to paragraph (f) regarding the
requirement that the project must provide fellows ``with training in
geriatrics and exposure to the physical and mental disabilities of'' a
diverse population of elderly individuals, to more appropriately
reflect the language in Pub. L. 102-408.
5. Revise Sec. 57.4106, entitled ``How will applications be
evaluated?'', by:
a. Removing the reference to the National Advisory Council on
Health Professions Education, in accordance with Pub. L. 102-408, in
paragraph (a) introductory text and revising the introductory text to
reflect current statutory language regarding the evaluation and
recommendation process of awarding grant applications; and
b. Adding a comma and the words ``psychiatry, or'' after the words
``geriatric medicine'' in paragraph (a)(5) to reflect statutory
language which expanded training to include geriatric psychiatry.
5. Redesignate Sec. 57.4112, entitled ``Termination of
fellowships.'', as Sec. 57.4111, and Sec. 57.4113, entitled ``For what
purposes may grant funds be spent?'', as Sec. 57.4112, and
Sec. 57.4114, entitled ``What additional Department regulations apply
to grantees?'', as 113.
6. Redesignate Sec. 57.4115, entitled ``What other audit and
inspection requirements apply to grantees?'', as Sec. 57.4114 and
revise the section number ``705'' in the text to ``798(e)'', in
accordance with Pub. L. 102-408.
The Department is further revising Sec. 57.4115 by removing the
reference to ``section 705 of the PHS Act'' instead of renumbering the
section number to ``798(e)'' as proposed in the NPRM. The reference to
section 705 concerning audit and inspection requirements is redundant
to the requirements that are already covered under 45 CFR part 74. We
are also removing the parenthetical phrase at the end of the section
text citing the OMB approval number regarding information collection
requirements as no longer necessary.
7. Redesignate Sec. 57.4116, entitled ``Additional conditions.'',
as Sec. 57.4115.
Further, Public Law 103-227, enacted on March 11, 1994, prohibits
smoking in certain facilities in which minors will be present. The
Department of Health and Human Services is now preparing to implement
the provision of that law. Until those implementation plans are in
place, the PHS continues to strongly encourage all grant recipients to
provide a smoke-free workplace and promote the non-use of all tobacco
products.
Economic Impact
Executive Order 12866 requires that all regulations reflect
consideration of alternatives, of costs, of benefits, of incentives, of
equity, and of available information. Regulations must meet certain
standards, such as avoiding unnecessary burden. Regulations which are
``significant'' because of cost, adverse effects on the economy,
inconsistency with other agency actions, effects on the budget, or
novel legal or policy issues, require special analysis.
The Department believes that the resources required to implement
the requirements in these regulations are minimal. Therefore, in
accordance with the Regulatory Flexibility Act of 1980, the Secretary
certifies that these regulations will not have a significant impact on
a substantial number of small entities. For the same reasons, the
Secretary has also determined that this is not a ``significant'' rule
under Executive Order 12866.
Paperwork Reduction Act of 1980
This final rule does not affect the recordkeeping or reporting
requirements in the existing regulations for the Grants for Faculty
Training Projects in Geriatric Medicine and Dentistry.
List of Subjects Under 42 CFR Part 57
Dental health, Education of the disadvantaged, Educational
facilities, Educational study programs, Grant Programs--education,
Grant programs--health, Medical and dental schools, Student aid.
(Catalog of Federal Domestic Assistance, No. 93.156, Grants for
Faculty Training Projects in Geriatric Medicine and Dentistry).
Dated: September 20, 1994.
Philip R. Lee,
Assistant Secretary for Health.
Approved: December 5, 1994.
Donna E. Shalala,
Secretary.
Accordingly, 42 CFR part 57, subpart PP is amended as set forth
below:
PART 57--GRANTS FOR CONSTRUCTION OF TEACHING FACILITIES, EDUCATION
IMPROVEMENT, SCHOLARSHIPS AND STUDENT LOANS
Subpart PP--Grants for Faculty Training Projects in Geriatric
Medicine and Dentistry
1. The authority citation for subpart PP is revised to read as
follows:
Authority: Sec. 215 of the Public Health Service Act, 58 Stat.
690, 67 Stat. 631 (42 U.S.C. 216); sec. 789(b) of the PHS Act, as
amended by Public Law 100-607, 102 Stat. 3136-3138 (42 U.S.C. 295g-
9(b)); renumbered as sec. 777(b), as amended by Pub. L. 102-408, 106
Stat. 2052-54 (42 U.S.C. 294o).
2. Section 57.4101 is revised to read as follows:
Sec. 57.4101 To what projects do these regulations apply?
These regulations apply to grants to eligible schools and programs
under section 777(b) of the Act (42 U.S.C. 294o) for the purpose of
providing support for projects to train physicians and dentists who
plan to teach geriatric medicine, geriatric psychiatry, or geriatric
dentistry, including traineeships, and fellowships for participation in
these programs.
3. Section 57.4102 is amended by removing the definition of
``Council''; by amending the definition of ``Extended care facility''
by revising the phrase ``by an organized medical staff'' at the end of
the sentence to read ``by an organized health care staff''; by revising
the section number of the Act ``789(b)'' in the definitions of
``Fellow'' and ``Project director'' to read ``777(b)''; by revising the
section number of the Act ``701(5)'' in the definition of ``School of
medicine or school of osteopathic medicine'' to read ``799(1)(E)''; by
revising the definition of ``Fellowship program''; and by adding the
definitions of ``Geriatric psychiatry'' and ``Relevant advanced
training or experience'' to read as follows:
Sec. 57.4102 Definitions.
* * * * *
Fellowship program means a 2-year organized training effort
sponsored by an allopathic or osteopathic medical school, a teaching
hospital, or a graduate medical education program which is designated
to provide training for--
(1) Physicians who have completed a graduate medical education
program in internal medicine, family medicine (including osteopathic
general practice), psychiatry, neurology, gynecology, or rehabilitation
medicine; and
(2) Dentists who have demonstrated a commitment to an academic
career and who have completed postdoctoral dental training, including
postdoctoral dental education programs or who have relevant advanced
training or experience.
* * * * *
Geriatric psychiatry means the prevention, diagnosis, evaluation
and treatment of mental disorders and disturbances seen in older
adults.
* * * * *
Relevant advanced training or experience means at least one of the
following: (1) Completion of at least a 12-month graduate training
program in a health-related discipline, the basic sciences, or
education; (2) a minimum of 2 years of teaching experience in an
accredited dental education program of which at least 12 months were
devoted in part to issues pertaining to the care of older adults; or
(3) a minimum of 2 years of clinical practice, of which at least 12
months were devoted in part to managing older dental patients in a
hospital, long-term care facility, or other setting.
* * * * *
4. Section 57.4105 is amended by revising paragraphs (d), (e), and
the introductory text to paragraph (f) to read as follows:
Sec. 57.4105 Project requirements.
* * * * *
(d) The project must be under the programmatic control of a
graduate medical education program in internal medicine or family
medicine (including osteopathic general practice) or in a department of
geriatrics or psychiatry;
(e) The project must be staffed by at least two physicians in full-
time teaching positions who have experience or training in geriatric
medicine or geriatric psychiatry and be staffed, or enter into an
agreement with an institution staffed, by at least one dentist who is
employed in a full- or part-time teaching position and has experience
or training in geriatrics;
(f) The project must provide fellows with training in geriatrics
and exposure to the physical and mental disabilities of a diverse
population of elderly individuals. The population must include: * * *
* * * * *
5. Section 57.4106 is amended by revising the introductory text to
paragraph (a) and paragraph (a)(5) to read as follows:
Sec. 57.4106 How will applications be evaluated?
(a) As required by section 798(a) of the Act, each application for
a grant under this subpart shall be submitted to a peer review group,
composed principally of non-Federal experts, for an evaluation of the
merits of the proposals made in the application. The Secretary may not
approve such an application unless a peer review group has recommended
the application for approval. The Secretary will award grants to
applicants whose projects will best promote the purposes of section
777(b) of the Act and these regulations. The Secretary will consider,
among other factors:
* * * * *
(5) The extent to which the project will increase the number of
geriatric fellowship and retraining positions available for individuals
who want to prepare for academic careers in geriatric medicine,
psychiatry, or dentistry.
* * * * *
Sec. 57.4111 [Amended]
6. Subpart PP is amended by removing Sec. 57.4111, entitled
``Duration of fellowships.''
Sec. 57.4112 [Redesignated as Sec. 57.4111]
7. Section 57.4112, entitled ``Termination of fellowships.'', is
redesignated as Sec. 57.4111.
Sec. 57.4113 [Redesignated as Sec. 57.4112]
8. Section 57.4113, entitled ``For what purposes may grant funds be
spent?'', is redesignated as Sec. 57.4112.
Sec. 57.4114 [Redesignated as Sec. 57.4113]
9. Section 57.4114, entitled ``What additional Department
regulations apply to grantees?'', is redesignated as Sec. 57.4113.
Sec. 57.4115 [Redesignated as Sec. 57.4114]
10. Section 57.4115 is redesignated as 57.4114 and is revised to
read as follows:
Sec. 57.4114 ``What other audit and inspection requirements apply to
grantees?''
Each entity which receives a grant under this subpart must meet the
requirements of 45 CFR part 74 concerning audit and inspection.
Sec. 57.4116 [Redesignated as Sec. 57.4115]
11. Section 57.4116, entitled ``Additional conditions.'', is
redesignated as Sec. 57.4115.
[FR Doc. 94-30410 Filed 12-9-94; 8:45 am]
BILLING CODE 4160-15-M