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These same groups were 12 percent and 7 percent respectively of the general population. Figures are unavailable for American Indians.

HEALTH PROFESSIONS PROGRAMS

Question. Please provide to the Committee detailed information for FY 1988, FY 1989, and FY 1990 on the number of applications made, the number approved, and the number of grants funded for each health professions and nurse training account.

Answer. The information requested follows.

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Number: Number of Number Number: Number of Number
Awarded: Applicat. Approved Awarded: Applicat.

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156

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Fiscal Year 1989

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Fiscal Year 1990

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Number

Approved Awarded

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Question. In total, what funds are available to medical students, dental students, nursing, and allied health programs and students?

Answer. The FY 1992 BHPr budget request provides $40.3 million for student assistance and includes: $17 million for the Exceptional Financial Need Scholarships; $8.3 million for Scholarships for Disadvantaged Students; and $15 million for new capital contribution to the Health Profession Student Loan program. Also available is $185 million from the Health Education Assistance Loan program and approximately $78 million in the Health Profession Student and Nursing Student Loan programs revolving fund.

Question. What is the definition of the term "disadvantaged" in Title VII and VIII authorizations used by HRSA? Has there been any change during the past several years in the definition, or in the weight or preference given to "disadvantaged" students?

Answer. The HRSA is in the process of redefining the term "disadvantaged". A proposed redefinition will be published in the Program Announcement (Federal Register Notice) for each of the relevant programs. In each announcement interested persons will be invited to comment on the proposed redefinition. All comments received will be considered before the final redefinition is established.

The current definition for the term "disadvantaged" is as follows:

"(1) Comes from an environment that has inhibited the

individual from obtaining the knowledge, skill, and abilities required to enroll in and graduate from a health professions school, or from a program providing education or training in an allied health profession; or

(2) Comes from a family with an annual income below a level based on low income thresholds according to family size published by the U.S. Bureau of the Census, adjusted annually for changes in the Consumer Price Index, and adjusted by the Secretary for use in all health professions programs. The Secretary will periodically publish these income levels in the FEDERAL REGISTER."

[45 FR 73052, Nov. 4, 1980, as amended at 47 FR 54438, Dec. 3, 1992]

Question. Please provide the Committee with detailed information on which schools are receiving funds from health professions programs targeted to disadvantaged students.

Answer. The information was provided to the Committee.

ORGAN TRANSPLANT DIVISION

A very disturbing Inspector General's report notes that blacks wait nearly twice as long for donated kidneys as whites 13.9 months as opposed to 7.6 months. And while there are fewer black organ donors, the relative risk of end-stage renal disease is about fourfold higher for blacks than for whites. Clearly, we need to pay much more attention to these organ transplant issues.

A recent evaluation of the United Network for Organ Sharing (UNOS) conducted by Abt Associates found that UNOS has been unable to monitor and enforce appropriate allocations of organs.

Question. What actions has HRSA taken in response to these

reports?

In

Answer. The Department is requiring that the contractor for the Organ Procurement and Transplantation Network (OPTN), UNOS, further study the medical and non-medical reasons for the disparity in transplantation waiting list waiting times for transplantation. This study is due to be completed during this fiscal year. addition, the Assistant Secretary for Planning and Evaluation is supporting a followup study to the Inspector General's report under contract with the Rand Corporation. Data will be provided by UNOS to the Rand Corporation by April and July of 1991. Anticipated completion of the study will be in late 1991.

Regarding enforcement of organ allocation policies, Section 1138 of the Social Security Act makes membership in UNOS and compliance with its rules and requirements mandatory for transplant hospitals and organ procurement organizations (OPOs). The penalty for non-compliance with membership requirements is loss of Medicare and Medicaid reimbursement for the entire hospital. As a result, UNOS policies have the same effect as Medicare conditions of participation. Consequently, the Department has determined that all mandatory UNOS policies are subject to the Federal rulemaking process and must be codified as Federal regulations before they can be enforceable. A Notice of Proposed Rule Making (NPRM) is currently undergoing Departmental clearance but until it is published in final, membership in the OPTN and conformance with its policies is voluntary.

With respect to the Abt Report, many of the recommendations included in the report were incorporated in the new OPTN contract which was signed at the end FY 1990. Among the recommendations included were data verification and compliance monitoring. HRSA is working with UNOS in the implementation of these new systems.

Question. The Abt Associates report recommends that the HRSA's Division of Organ Transplantation should focus on improving donation rates, transplantation outcomes, cutting costs, and increasing access to organs for minorities and rural patients. What suggestions do you have to achieve these goals?

Answer. There are also three current contracts within the Division of Organ Transplantation with objectives to educate the Black community about organ transplantation, and in the longer run, to increase minority organ donation. These contracts specifically aim to: (1) find and disseminate successful public education efforts directed toward the Black population, (2) develop a culturallysensitive education program for organ donation requestors, and (3) train Black clergy to educate their congregations about organ donation and transplantation.

In addition, the Division's grant program continues to focus on projects that lead to greater participation of minority communities in organ donation and transplantation.

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