$57.4010 Additional conditions.

The Secretary may impose additional conditions in the grant award before or at the time of the award if he or she determines that these conditions are necessary to assure or protect the advancement of the approved activity, the interest of the public health, or the conservation of grant funds.

Subpart PP-Grants for Faculty Training Projects in Geriatric Medicine and Dentistry

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. 2940).

SOURCE: 55 FR 37481, Sept. 12, 1990, unless otherwise noted.

$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. 2940) 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.

[59 FR 63902, Dec. 12, 1994]

§ 57.4102 Definitions.

Act means the Public Health Service Act, as amended.

Budget period means the interval of time (usually 12 months) into which the project period is divided for budgetary and funding purposes.

Elderly means a population with health care conditions and needs which differ significantly from those of younger people, which are often complicated by the physical, behavioral, and social changes associated with aging. This would include all persons over 60, but may include slightly younger people who are subject to similar physical and/or mental conditions.

Extended care facility means a health care institution or distinct part of an

institution that furnishes, in lieu of hospitalization, room and board and medically-prescribed skilled nursing care or rehabilitative services 24 hours a day by an organized health care staff. Fellow means an allopathic physician, osteopathic physician, or dentist participating in a retraining program or fellowship program supported by a grant under section 777(b).

or

Fellowship program means a 2-year organized training effort sponsored by an allopathic medical osteopathic 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 experi

ence.

Full-time teaching physician means an allopathic or osteopathic physician who is a faculty member of the grantee institution and who is engaged in teaching, research, clinical, and administrative activities normally performed by teaching faculty employed on a fulltime basis, as defined by the grantee institution.

Full-time teaching dentist means a dentist who is a faculty member and who is engaged in teaching, research, clinical, and administrative activities normally performed by teaching faculty employed on a full-time basis, as defined by the institution. The dental faculty member does not have to be employed by the grantee institution but can be a dental faculty member at another institution which has an affiliation agreement with the grantee institution.

Full-time training means full-time training, as defined by the grantee institution.

Geriatric dentistry means the provision of dental care for elderly persons, particularly those with one or more chronic or debilitating, physical or

mental illnesses with associated medication or psychosocial problems.

Geriatric medicine means the prevention, diagnosis, and medical treatment of illness and disability as required by the needs of the elderly.

Geriatric psychiatry means the prevention, diagnosis, evaluation and treatment of mental disorders and disturbances seen in older adults.

Graduate medical education program means a program sponsored by a school of medicine, a school of osteopathic medicine, a hospital, or a public or private nonprofit institution, which:

(1) Offers postgraduate medical training in the specialties and subspecialties of medicine; and

(2) Has been accredited by the Accreditation Council for Graduate Medical Education or the American Osteopathic Association through its Committee on Postdoctoral Training.

Grantee means an entity that receives a grant and assumes legal and financial responsibility both for the awarded funds and for the performance of the grant-supported activity.

Longitudinal care means the provision of medical or dental care to the same panel of elderly patients for a period of at least 9 months in each year of training.

Part-time teaching dentist means a dentist who is a faculty member and who is engaged in teaching, research, clinical, and administrative activities normally performed by teaching faculty employed on a part-time basis, as defined by the institution. The dental faculty member does not have to be employed by the grantee institution but can be a dental faculty member at another institution which has an affiliation agreement with the grantee institution.

Postdoctoral dental education program means a program sponsored by a school of dentistry, a hospital, or a public or private nonprofit institution, which:

(1) Offers postdoctoral training in the specialties of dentistry, advanced education in general dentistry, or a dental general practice residency; and

(2) Has been accredited by the Commission on Dental Accreditation.

Primary care means health care which may be initiated by the patient or the provider, or both, in a variety of set

tings, and which consists of a broad range of personal health care services including promotion and maintenance of health, prevention of illness and disability, basic care during acute and chronic phases of illness, guidance and counseling of individuals and families, and referral to other health care providers and community resources when appropriate. In providing the services:

(1) The physical, emotional, social, and economic status of the patient is considered in the context of his or her cultural and environmental back ground, including the family and community; and

(2) The patient is provided timely access to the health care system.

Project means all activities, including training programs, specified or described in a grant application as approved for funding.

Project director means an individual designated by the recipient and approved by the Secretary to direct the project being supported under section 777(b).

Project period means the total time for which support for a project has been approved, including any extension thereof, by the awarding unit.

Relevant advanced training or experience means at least one of the following: (1) Completion of at least a 12month 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.

Retraining program means a 1-year program of full-time individualized training in clinical geriatrics and geriatric research for physicians who are faculty members in departments of internal medicine, family medicine (including osteopathic general practice), gynecology, geriatrics, or psychiatry at schools of medicine and osteopathic medicine, and dentists who are faculty members at schools of dentistry or at hospital departments of dentistry.

School of medicine or school of osteopathic medicine means a public or private nonprofit school which provides training leading, respectively, to a degree of doctor of medicine or a degree of doctor of osteopathic medicine, and which is accredited as provided in section 799(1)(E) of the Act.

Secretary means the Secretary of Health and Human Services, and any other officer or employee of the Department of Health and Human Services to whom the authority involved has been delegated.

State means, in addition to the several States, the District of Columbia, the Commonwealth of Puerto Rico, the Commonwealth of the Northern Mariana Islands, the Virgin Islands, Guam, American Samoa, the Republic of Palau, the Republic of the Marshall Islands, and the Federated States of Micronesia.

Teaching hospital means a public or private nonprofit hospital which is:

(1) Accredited by the Joint Commission on Accreditation of Hospitals or the American Osteopathic Association; and

(2) Operates at least one postdoctoral training program which is fully or provisionally accredited by the Accreditation Council for Graduate Medical Education or approved by the American Osteopathic Association.

[55 FR 37481, Sept. 12, 1990, as amended at 56 FR 29194, June 26, 1991; 57 FR 45746, Oct. 5, 1992; 59 FR 63902, Dec. 12, 1994; 61 FR 6129, Feb. 16, 1996]

§ 57.4103 Who is eligible to apply for a grant?

Public or private nonprofit schools of medicine, schools of osteopathic medicine, teaching hospitals, and graduate medical education programs located in a State are eligible to apply for a grant under this subpart. Each eligible applicant desiring a grant under this subpart shall submit an application in the form and at such time as the Secretary may prescribe.

(Approved by the Office of Management and Budget under control number 0915-0060)

[54 FR 5617, Feb. 6, 1989, as amended at 57 FR 45746, Oct. 5, 1992]

$57.4104 For what projects may grant funds be requested?

Each eligible applicant must propose a fellowship program or a retraining program.

[54 FR 5617, Feb. 6, 1989, as amended at 57 FR 45746, Oct. 5, 1992]

§ 57.4105 Project requirements.

A project supported under this subpart must be conducted in accordance with the following requirements:

(a) The project must have a project director who is employed full time by the grantee institution;

(b) Projects must have an appropriate administrative and organizational plan, and adequate faculty, physical, and administrative resources for the achievement of stated objectives;

(c) Projects must systematically evaluate the training program, including the performance and competence of trainees and faculty, the administration of the program, and the degree to which program and educational objectives are met;

(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:

(1) Elderly in various levels of wellness from fully independent and well, to patients confined to bed with serious illness; and

(2) Elderly from a range of socioeconomic, racial and ethnic backgrounds;

(g) The project must provide medical and dental training experiences in:

(1) An ambulatory care setting; (2) An inpatient service; and (3) An extended care facility, During the course of the training, each fellow must receive experience in primary care, consultation, and longitudinal care;

(h) Fellowship programs must have a curriculum which includes training in clinical geriatrics, teaching skills, administrative skills, and research skills for physicians and dentists;

(i) Retraining programs must provide 1 year of full-time training suited to the individual needs of each fellow. To assure that the needs of all fellows can be met, each retraining program must have the resources available to provide clinical, research, administrative, and teacher-training experience; and

(j) Effective in the second year of grant support, a minimum of three entering fellows, including at least one physician and one dentist, must be enrolled in each training program for which grant support is received. The Secretary may suspend this requirement if the Secretary determines that a grantee has made a good faith effort to comply with this requirement through the various recruitment means available in its institution and at the national level, and has met the other requirements stated in this section but is unable to have the required number of fellows in the program due to circumstances beyond its control.

[55 FR 37481, Sept. 12, 1990, as amended at 56 FR 29194, June 26, 1991; 57 FR 45746, Oct. 5, 1992; 59 FR 63902, Dec. 12, 1994]

(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:

(1) The extent to which the proposed training program will prepare physicians and dentists to perform the research, teaching, administrative and clinical duties of a faculty member specializing in geriatrics;

(2) The degree to which the project plan adequately provides for meeting the requirements set forth in §57.4105;

(3) The administrative, management and resource capability of the applicant to carry out the proposed project in a cost-effective manner;

(4) The potential for the applicant to continue the program without Federal support after completion of the requested project period; and

(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.

(b) In determining the funding of applications approved under paragraph (a) of this section, the Secretary will consider any special factors relating to national needs as the Secretary may from time to time announce in the FEDERAL REGISTER.

[55 FR 37481, Sept. 12, 1990, as amended at 59 FR 63902, Dec. 12, 1994]

$57.4107 How long does grant support last?

(a) The notice of grant award specifies the length of time the Secretary intends to support the project without requiring the project to recompete for funds. This period, called the project period, will not exceed 5 years.

(b) Generally, the grant will initially be funded for 1 year, and subsequent continuation awards will also be for 1 year at a time. Decisions regarding continuation awards and the funding levels of these awards will be made after consideration of such factors as the grantee's progress and management practices, existence of legislative authority, and the availability of funds. In all cases, continuation awards require a determination by the Secretary that continued funding is in the best interest of the Federal Government.

(c) Neither the approval of any application nor the award of any grant shall

(a) Tuition and fees, in accordance with the established rates of the institution, except as limited by the Secretary;

(b) Stipend support, in accordance with established Public Health Service postdoctoral stipend levels; and

(c) Travel to field training if the site is beyond a reasonable commuting distance and requires the fellow to establish a temporary new residence. However, fellowship funds may not be used for daily commuting from the new place of residence to the field training headquarters.

$57.4109 Who is eligible for financial assistance as a fellow?

To be eligible for a fellowship an individual must:

(a) Be a resident of the United States and either a citizen or national of the United States, an alien lawfully admitted for permanent residence in the United States, a citizen of the Commonwealth of the Northern Mariana Islands, a citizen of the Republic of Palau, a citizen of the Republic of the Marshall Islands, or a citizen of the Federated States of Micronesia;

(b) Be a physician or a dentist enrolled in a "fellowship program" or a “retraining program” as defined in $57.4102; and

(c) Not be receiving concurrent support for the same training from another Federal education award which provides a stipend or otherwise duplicates financial provisions except education benefits under the Veteran's Re

adjustment Benefits Act, and loans from Federal sources.

[55 FR 37481, Sept. 12, 1990, as amended at 61 FR 6129, Feb. 16, 1996]

§ 57.4110 What are the requirements for fellowships and the appointment of fellows?

(a) The grantee must complete a statement which documents the appointment of each fellow. To complete this statement the grantee must require the provision of information and documentation of eligibility by each fellow. The statement of appointment must be completed by the beginning of the training period or as soon thereafter as possible if the fellow receives notice of his or her fellowship appointment after the training period has begun. The statement of appointment must include information to document the eligibility of the fellow and certify that there will be compliance with all applicable Public Health Service terms and conditions governing the appointment. The program director must sign the statement on behalf of the grantee, and the fellow must sign it thus certifying the statements are true and complete. The original copy of the statement must be retained by the grantee to be available for program review and financial audit. A copy shall be provided to the fellow for his or her records.

(b) The grantee may not require fellows to perform work which is not an integral part of the geriatric training program, or to perform services which detract from or prolong their training. (Approved by the Office of Management and Budget under control number 0915-0060)

[55 FR 37481, Sept. 12, 1990, as amended at 56 FR 29194, June 26, 1991]

§ 57.4111 Termination of fellowships. (a) The grantee must terminate a fellowship:

(1) Upon request of the fellow; (2) If the fellow withdraws from the grantee institution; or

(3) If the grantee determines that: (i) The fellow is no longer an active participant in the training program; or

(ii) The fellow is not eligible or able to continue in accordance with its standards and practices.