§ 57.3301 Purpose.

Section 701(8)(B) of the Public Health Service Act (42 U.S.C. 292a(80(B)) requires the Secretary of Health, Education, and Welfare to prescribe regulations for programs for the training of expanded function dental auxiliaries. The purpose of this subpart is to comply with this requirement.

§ 57.3302 Definitions.

For purposes of this subpart:

(a) "Academic year" means the approximately 9-12 month period of time during which the program is in session.

(b) "Basic education program" means a dental assisting or dental hygiene education program accredited by the Commission on accreditation of Dental and Dental Auxiliary Education Programs in whcih the existing course of study is modified to include additional preparation in expanded functions, preventive dentistry, and techniques to modify patient behavior.

(c) "Dental assistant" means an individual who assists the dentist with the clinical, laboratory, or business operation of a dental practice and provides services to patients as may be delegated and supervised by the dentist in accordance with the law of the State in which the individual is employed.

(d) "Dental auxiliary" means a dental assistant or dental hygienist.

(e) "Dental hygienist" means an individual who is trained and licensed to provide who is trained and licensed to provide preventive and therapeutic direct patient care service as may be delegated and supervised by the dentist in accordance with the law of the State in which the individual is employed.

(f) "Expanded function dental auxiliaries" means dental assistants and dental hygienists who, by successfully completing a training program which meets the requirements of this subpart, are qualified to perform, under the supervision of a dentist, a new or wider range of clinical functions and direct patient care procedures.

(g) "Four-handed, sit-down dentistry" means a mode of dental practice which encourages the efficient use of

dental assistants and dental hygienists to assist the dentist or operating dental auxiliary in a manner that maximizes patient and operator comfor, saves time, and increases the potential productivity of the practice while maintaining the quality of dental care. Such chairside assistance includes, but is not limited to, the following:

(1) Preparation for patient treatment;

(2) Chair positioning of patient, operator, and dental auxiliary;

(3) Use of prearranged sterlized instrument trays'

(4) Effective hand instrument exchange techniques;

(5) Standardized sequential usage of instruments;

(6) Use of water, air, and oral evacuation equipment to maintain a clear field of operation; and

(7) Preparation and delivery of restorative and other treatment materials required for the procedures.

(h) "Full-time student" means a student who is enrolled in a program for the training of expanded function dental auxiliaries and pursuing a course of study which constitutes a full-time academic workload, as determined by the program.

(i) "Preventive dentistry" means a method of practice and patient management that included a series of diagnostic, corrective, and disease preventive procedures, including patient education and motivation, that results in the establishment and maintenance of oral health in patients.

(j) "Program director" means the individual responsible for providing competent direction of the program.

(k) "Supervision clinical practice" means direct participation by students in patient care by observation, examination, and performance of procedures as are appropriate for the assigned role of the student for the purposed of instruction, under the direction and responsibility of a licensed dentist who holds a faculty appointment at the institution conducting the program.

(1) "Supplemental education program" means a program which provides training designed to extend the knowledge and skills of practicing

dental auiliaries so that they achieve clinical proficiency in expanded functions, preventive dentistry, and techniques to modify patient behavior.

§ 57.3303 Requirements.

An education program which trains expanded function dental auxiliaries must:

(a) Be conducted by a school of dentistry or other public or nonprofit private entity accredited by the commission on Accreditation of Dental and Dental Auxiliary Education Programs;

(b) Offer expanded function training in a basic educaton program or a supplemental education program, or both;

(c) Have an enrollment of not less than eight full-time students in each class;

(d) Be a minmum of one academic year in length;

(e) Consist of supervised clinical practice and at least four months (in the aggregate) of classroom instruction;

(f) Have a project director who is a full-time faculty member at the institution conducting the program;

(g) Have faculty who are qualified, through academic preparation and experience, to teach the subjects assigned and who are experienced in four-handed, sit-down dentistry;

(h) Have faculty for laboratory and clinical instruction who are competent in laboratory procedures and experienced in clinical practice;

(i) Have, in the supervised clinical practice sessions, a faculty-to-student ratio of one faculty member to no moe than six students;

(j) Have adequate teaching facilities with sufficient space for instruction and practice in four-handed, sit-down dentistry techniques and expanded function procedures and be adequately equipped with functioning modern equipment;

(k) Have appropriate settings for the supervised clinical practice sessions which must be provided by the institution conducting the program or through written agreements with other institutions, agencies or organizations;

(1) Have adequate library, audiovisual, and other instructional resources;

(m) Before providing training in expanded functions, (1) require students to demonstrate clinical proficiency in the techniques of four-handed, sitdown dentistry or (2) train students to clinical proficiency in these techniques;

(n) Have a curriculum which provides for classroom instruction, preclinical laboratory instruction, and supervised clinical practice designed to train students to clinical proficiency in the performance of:

(1) All dental functions that may be deleghated to dental auxiliaries under the law of the State in which the program is located; or

(2) In addition to the functions described in paragraph (n)(1) of this section, the expanded functions that may be taught by the program with thewritten concurrence of the Board of Dentistry of the State in which the program is located, for such purposes as preparing students for employment in other States or for national, regional, or other State credentialing.

(0) If it is a supplemental education program, have entrance requirements for students, such as current certification or licensure, or require students to pass an entrance examination designed to determine whether they have the knowlede and skills necessary for achieving clinical proficiency in performance of expanded functions;

(p) Have a plan and methodology for evaluating student performance, including;

(1) Standards for preclinical performance which students must meet before receiving clinical training; and

(2) Standards for evaluating the performance of expanded functions which are comparable to the standards used to evaluate the performance of the same skills by dental students; and

(q) Award a degree, diploma, or certificate of completion to individuals who have successfully completed the program.

Sec.

58.504 How is application made for an advanced traineeship or training institute grant?

58.505 What are the criteria for deciding which applications are to be funded? 58.506 How will grant awards be made? 58.507 Who is eligible for financial assistance as a trainee in programs under this subpart?

58.508 What stipends and allowances will be available to trainees?

58.509 Termination of traineeship. 58.510 Purposes for which grant funds may be spent.

58.511 What prohibitions against discrimi

nation are applicable to training programs funded under this subpart? 58.512 How the grantee must account for the grants received by it.

58.513 How 45 CFR Part 74 applies to these regulations.

58.514 Record, audit, and inspection. 58.515 Additional conditions.

Subpart A-Grants for Graduate Programs in Health Administration

AUTHORITY: Sec. 215 of the Public Health Service Act, 58 Stat. 690, as amended by 63 Stat. 35 (42 U.S.C. 216); sec 791 of the Public Health Service Act, 90 Stat. 2303 (42 U.S.C. 295h).

SOURCE: 43 FR 26444, June 20, 1978, unless otherwise noted.

§ 58.1 Applicability.

The regulations of this subpart are applicable to the award of grants under section 791 of the Public Health Service Act (42 U.S.C. 295h) to public or nonprofit private educational entities (including schools of social work and excluding schools of public health) to support the graduate educational programs of these entities in health administration, hospital administration and health planning.

§ 58.2 Definitions.

As used in this subpart:

"Act" means the Public Health Service Act.

"Construction" means the construction of new buildings, the acquisition or expansion of existing buildings and the remodeling, alteration and renovation of existing buildings.

"Council" means the National Advisory Council on Health Professions

Education established by section 702 of the Act.

"Educational entity" means a school, college, or university which is accredited by a body or bodies recognized for such purposes by the Commissioner of Education.

"Fiscal year" means the Federal fiscal year, beginning October 1, and ending the following September 30.

educational

"Graduate program" means a program of education leading to a master's degree or equivalent, or a doctoral degree or equivalent.

"Nonprofit" as applied to any entity means one which is a corporation or association, or is owned or operated by one or more corporations or associations, no part of the net earnings of which inures or may be lawfully inure, to the benefit of any private shareholder or individual.

"School of public health" means a school which provides training leading to a graduate degree in public health or an equivalent degree and which has been accredited by the Council on Education for Public Health as a school of public health.

"School year" means the traditional approximately 9 month September to June annual session at an educational institution.

"State" means any one of the several States, the District of Columbia, the Commonwealth of Puerto Rico, the Northern Mariana Islands, the Virgin Islands, Guam, American Samoa, and the Trust Territory of the Pacific Islands.

§ 58.3 Eligibility.

Any public or nonprofit education entity (excluding schools of public health) located in a State is eligible to apply for a grant to support a graduate educational program which has been accredited for the training of individuals for health services administration, hospital administration, or health planning by a recognized body or bodies approved for such purpose by the Commissioner of Education. § 58.4 Application.

(a) Each eligible educational etity desiring a grant under this subpart shall submit an application, including

the assurances reuired by section 791 of the Act and 58.5 of this subpart,1 in the form and at the time as the Secretary may prescribe. The application must be signed by an individual authorized to act for the appalicant and to assume on behalf of the applicant the obligations imposed by the terms and conditions of any award, including the regulations of this subpart.

(b) Each application submitted pursuant to this subpart must include a plan, in the form and containing such information as the Secreary may prescribe, describing how the applicant proposes to utilize funds awarded under this subpart and in particular the extent to which funds may be used to strengthen the educational program in the following areas:

(1) The provision of training which will prepare health administrators and health planners for employment in a wide variety of settings, including public and voluntary agencies, extended care facilities, ambulatory facilities and health planning agencies.

(2) The development or expansion of special curriculum content in health planning, policy and regulation, health economics, quantitative methods and financial management.

(3) The provision of field training in settings described in (1) and which involves experience related to the curricular areas described in (2).

(4) The provision of field training in settings designed to provide mid-career development for practicing health administrators and planners.

(5) The development of programs designed to provide regional educational opportunities in areas where there are no accredited programs in health services administration or in which there are documented shortages of trained health services administrators or plan

(1) At least 25 individuals will complete the graduate educational programs of the applicant for which the application was made in the school year beginning in the fiscal year for which an applicant receives a grant;

(2) The applicant will expend or obligate at least $100,000 in funds from non-Federal sources to conduct the graduate educational program for which the application was made (excluding expenditures for construction) in the school year beginning in the fiscal year for which an applicant receives a grant;

(3) The applicant will maintain for the school year beginning in the fiscal year ending September 30, 1978, and for each subsequent school year for which a grant is applied for, a first year enrollment of full-time students in the graduate educational programs for which the application was made which exceeds the number of full-time first year students enrolled in that program in the school year beginning in the fiscal year ending September 30, 1976 by (i) 5 percent of that number if the number of full-time first year students enrolled was 100 or less; or (ii) the greater of 2.5 percent of that number, or 5 students if the number of full-time first year students enrolled was more than 100. For purposes of this section the term "fulltime student" means a student who is enrolled in an educational entity on a full-time basis as determined by the educational entity. The number of students enrolled in an educational entity for any year shall be the number enrolled as of October 15 of that school year. The classification of a full-time student as a first year student will be made in accordance with the usual policies of the educational entity, except that no student may be counted more than once as a first year student.

(b) The Secretary may, after consultation with the Council, waive in whole or in part the requirements of paragraph (a)(3) of this section relating to increases in enrollment upon written notification by the appropriate accreditation body or bodies that compliance with that paragraph will prevent the educational entity from