CFR part 93-New restrictions on lobbying.

2 FR 27347, July 21, 1987, as amended at 57 R 45742, Oct. 5, 1992]

≈157.2510 Additional conditions.

The Secretary may with respect to y grant award impose additional onditions prior to or at the time of hy award when in his or her judgment ich conditions are necessary to assure r protect advancement of the aproved project, the interests of the ublic health, or the conservation of grant funds.

3 FR 43416, Sept. 25, 1978. Redesignated at
FR 27347, July 21, 1987]

ubpart AA-Grants for
for Nurse
Practitioner and Nurse Mid-
wifery Traineeship Programs

AUTHORITY: Sec. 215 of Public Health Servce Act, 58 Stat. 690, 67 Stat. 631 (42 U.S.C. 16); sec. 822(b) of the Public Health Service Act; 91 Stat. 393; amended by 95 Stat. 930; mended by 99 Stat. 395; and as amended by 02 Stat. 3157 (42 U.S.C. 296m).

57.2601 To what programs do these regulations apply?

These regulations apply to grants awarded to schools of nursing and public health, schools of medicine which received grants or contracts under this subsection prior to October 1, 1985, public or private nonprofit hospitals, and other public or private nonprofit entities to meet the costs of traineeships under section 822(b) of the Public Health Service Act.

[57 FR 45742, Oct. 5, 1992]

Secretary determines has a shortage of health professionals:

(a) An urban or rural area (which need not conform to the geographic boundaries of a political subdivision and which is a rational area for the delivery of health services);

(b) A population group; or

(c) A public or nonprofit private nonprofit medical facility.

Indian Health Service health center means a health care facility (whether operated directly by the Indian Health Service or operated by a tribal contractor or grantee under the Indian SelfDetermination Act, as described in 42 CFR part 36, subparts H and I), which is physically separated from a hospital, and which provides one or more clinical treatment services, such as physician, dentist or nursing services (as described in 42 CFR 36.11), available at least 40 hours a week for outpatient care to persons of Indian or Alaska Native descent as described in 42 CFR 36.12.

Migrant health center means an entity as defined under section 329(a) of the Public Health Service Act, and in regulations at 42 CFR 56.102(g).

National of the United States means a citizen of the United States or a person who, though not a citizen of the United States, owes permanent allegiance to the United States (as defined in 8 U.S.C. 1101(a)(22), the Immigration and Nationality Act).

Native Hawaiian health centermeans an entity

(a) Which is organized under the laws of the State of Hawaii,

(b) Which provides or arranges for health care services through practitioners licensed by the State of Hawaii, where licensure requirements are applicable,

(c) Which is a public or nonprofit private entity, and

(d) In which Native Hawaiian health practitioners significantly participate in the planning, management, monitoring, and evaluation of health services.

Nonprofit refers to the status of an entity which is a corporation or association, or is owned and operated by one or more corporations or associations, no part of the net earnings of which inures, or may lawfully inure, to

$57.2602

the benefit of any private shareholder or individual.

Nurse midwife means a registered nurse who has completed a formal program of study designed to prepare registered nurses to perform in an expanded role in the delivery of primary health care to women and babies including the management of normal antepartum, intrapartum, and postpartum care, as well as family planning and gynecology.

Nurse practitioner means a registered nurse who has successfully completed a formal program of study designed to prepare registered nurses to perform in an expanded role in the delivery of primary health care, including the ability to:

(a) Assess the health status of individuals and families through health and medical history taking, physical examination, and defining health and developmental problems;

(b) Institute and provide continuity of health care to clients (patients), work with the client to insure understanding of and compliance with the therapeutic regimen within established protocols, and recognize when to refer the client to a physician or other health care provider;

(c) Provide instruction and counseling to individuals, families, and groups in the areas of health promotion and maintenance, including involving these persons in planning for their health care; and

(d) Work in collaboration with other health care providers and agencies to provide and, where appropriate, coordinate services to individuals and families.

Nurse practitioner or nurse midwifery educational program means a full-time educational program for registered nurses (irrespective of the type of school of nursing in which the nurses received their education) which meets the guidelines prescribed by the Secretary in 42 CFR part 57, subpart Y, Appendix. The objective of this program is the education of nurses (including pediatric and geriatric nurses) who will, upon completion of their studies in this program, be qualified to perform effectively in an expanded role in the delivery of primary health care, including care in homes, in ambulatory

42 CFR Ch. I (10-1-95 Edition

and long-term care facilities, and other health care institutions.

Primary health care means care whit may be initiated by the client or p vider in a variety of settings and which consists of a broad range of perso health care services, including: (a) Promotion and maintenance d health;

(b) Prevention of illness and disabi ity;

(c) Basic care during acute and chronic phases of illness;

(d) Guidance and counseling of individuals and families;

(e) Referral to other health care previders and community resources whe appropriate; and

(f) Nurse midwifery services (whe appropriate).

Program director means a qualified in dividual designated by the grantee and approved by the Secretary who is to functionally responsible for the traineeship program(s) being supporte under this subpart.

Public health care facility means agency, institution, or other entity controlled by a public agency or anot profit private organization which pr vides health care.

Rural health clinic means an entity defined under section 1861 (aa)(2) of the Social Security Act, and in regulation at 42 CFR 491.2

School of medicine or school of publi health means a school of medicine of school of public health as defined i section 701(4) of the Act.

School of nursing means a collegiate associate degree, or diploma school d nursing, as defined in section 853 of the Act.

Secretary means the Secretary Health and Human Services and an other officer or employee of the De partment of Health and Human Ser ices to whom the authority involved has been delegated.

The term State means a State, the Commonwealth of Puerto Rico, the District of Columbia, Guam, American Samoa, the Virgin Islands, the Com monwealth of the Northern Mariana I lands, the Trust Territory of the På cific Islands (the Republic of Palau the Republic of the Marshall Islands and the Federated States of Microne sia.

Trainee means a student who is regiving a traineeship from a grant

der this subpart.

FR 25892, July 17, 1986, as amended at 55 , 10066, Mar. 19, 1990; 57 FR 45742, Oct. 5, 2]

7.2603 Who is eligible to apply for a grant?

Any school of nursing or public alth, or school of medicine which reived grants or contracts under this ction prior to October 1, 1985, public private nonprofit hospital or other blic or private nonprofit entity ich is located in a State and which ovides a nurse practitioner or nurse idwifery educational program is eli ́ble to apply for a grant. Each eligible >plicant desiring a grant under this bpart shall submit an application in le form and at such time as the Sectary may prescribe.

7 FR 45742, Oct. 5, 1992]

57.2604 How will applications be evaluated?

approve

(a) The Secretary will rojects which will best promote the urpose of section 822(b) of the Act. he Secretary will take into considertion, among other factors:

(1) The adequacy of the qualifications and experience of the program director, taff and faculty to carry out the pro;ram;

(2) The administrative and manageial ability of the applicant to carry put the proposed project, including Compliance with the nurse practitioner and nurse midwifery program guidelines in 42 CFR part 57, subpart Y, Appendix; and

(3) The extent to which the applicant will recruit trainees who are residents of primary care health professional shortage areas, designated under section 332 of the Act.

(b) In determining the level of funding for traineeship programs funded under this section, the Secretary shall give special consideration to applications for traineeships to educate individuals who are residents of primary care health professional shortage areas, designated under section 332 of the Act. However, should specific needs warrant, the Secretary will consider any other special factors relating to

national needs as the Secretary may from time to time announce in the FEDERAL REGISTER.

[51 FR 25892, July 17, 1986, as amended at 55 FR 10067, Mar. 19, 1990; 57 FR 45742, Oct. 5, 1992]

§ 57.2605 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 3 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 availability of funds and the grantee's progress and management practices. Failure to comply with the requirements of §57.2610 will jeopardize continuation of grant awards. 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 commit or obligate the United States in any way to make any additional, supplemental, continuation or other award with respect to any approved application or portion of an approved application. For continuation support, grantees must make separate application at such times and in such a form as the Secretary may prescribe.

[51 FR 25892, July 17, 1986, as amended at 55 FR 10067, Mar. 19, 1990]

§ 57.2606 How is the amount of the award determined?

The amount of the award to the grantee will be determined on the basis of the Secretary's estimate of the sum necessary during the budget period to cover reasonable living and moving expenses (including stipends), books, fees, necessary transportation, and 100 pe cent of the costs of tuition for traineeship awarded to the gr The number of traineeships funde

$57.2613

(b) If the trainee is no longer enrolled full-time in the nurse practitioner or nurse midwifery educational program for which the trainee was receiving a traineeship under this subpart; or

(c) If the trainee fails to maintain the level of academic standing required by the institution's standards and practices for full-time enrollment.

[51 FR 25892, July 17, 1986, as amended at 55 FR 10069, Mar. 19, 1990]

$57.2613 What must a trainee agree to do in return for traineeship support?

(a) General. (1) Each trainee must sign a commitment with the Secretary to practice as a nurse practitioner or nurse midwife on a full-time basis (at least 35 hours per week) in a primary care health professional shortage area (designated under section 332 of the Act), or in an Indian Health Service health center, a Native Hawaiian health center, a public health care facility, a migrant health center, a rural health clinic, or in a community health center.

(2) With respect to the primary care health professional shortage areas, designated under section 332 of the Act, designations in effect at the time the trainee completes the educational program or, designations in effect 90 days prior to completion of the educational program if a trainee has received a written commitment of employment, will qualify for approval as a practice site.

(b) Duration of practice. The period for which a trainee must agree to practice is equal to 1 month for each month for which the trainee receives support from grant funds. Once practice has begun, it must be continuous for the entire period of practice required by the commitment, unless the Secretary permits suspension of the obligation in accordance with § 57.2615.

(c) Beginning of practice. The trainee must inform the Secretary within 30 days after his or her completion of the educational program of the intended practice site, selected from one of the health centers specified in §57.2613(a), or in a rural health clinic, a public health care facility, or a primary care health professional shortage area (designated under section 332 of the Act).

occurrence.

(2) At the end of the period of th practice commitment, the tra must report to the Secretary, in ing on the employer's stationery, dates and practice site. The w statement must be signed by the ployer who attests the dates and p tice site. The practice commitme will not be considered fulfilled this statement has been received the dates and practice site are accepta by the Secretary.

[55 FR 10069, Mar. 19, 1990; 57 FR 4574,0F 5, 1992]

$57.2614 What are the consequence the trainee fails to comply with terms of the commitment? If a trainee fails to complete the ey cational program or fails to begin complete the period of practice quired by the commitment und $57.2613, the trainee must repay

traineeship support to the Unit States Treasury. The trainee must the amount owed within 36 month the date on which he or she failed complete the educational program

failed to begin or complete the peri of required practice, as determined

the Secretary.

(a) Failure to complete the education program. A trainee who is dismiss from the academic program or who untarily terminates academic ede cation must repay the traineeship sup port to the United States Treasury This individual shall be liable for amount equal to the cost of tuition and other education expenses paid to or for such individual from Federal funds pl any other payments which were re ceived under the traineeship.

(b) Failure to begin or complete the

riod of practice. If for any reason an in

re

al who received a traineeship and eted the educational program To complete a practice obligation,

individual must repay the 2beship support plus interest to the nd States Treasury. The amount of :ment must equal the sum of all eeship support received, together interest at the maximum legal iling rate in effect on the date the ee initially received traineeship tance. The Secretary will also re this individual the Departr's administrative costs of collect

T

he repayment, as well as the pencharge of 6 percent a year if the yment is more than 90 days overLate payment charges will accrue the date the repayment becomes due until the overdue amount is

R 10069, Mar. 19, 1990]

2615 When can the practice or payment obligation be waived or suspended?

Application for waiver or suspen4. A trainee may seek waiver or sussion of the commitment to practice obligation to repay traineeship suprt by written request to the Secary setting forth the basis, cirmstances, and causes which support e requested action. The total period ring which the practice or repayent obligation may be suspended may t exceed 2 years.

(b) Conditions for suspension. The Sectary may suspend any practice or reyment obligation whenever he or she nds good cause based on such factors

3:

(1) The trainee's efforts to secure emloyment which satisfies practice obliation;

(2) The trainee's present and estinated future financial resources and bligations; or

(3) The extent to which the trainee as problems of a personal nature, such As physical or mental disability, or terminal illness in the immediate family, which temporarily prevent the trainee from performing the obligation incurred.

(c) Conditions for waiver. The Secretary may waive any practice or repayment obligation:

(1) Upon the death of the trainee:

(2) If the trainee is found to be permanently and totally disabled as supported by whatever medical certification the Secretary may require. A trainee is totally and permanently disabled if he or she is unable to engage in any substantial gainful activity because of a medically determinable impairment which is expected to continue indefinitely or result in death.

(3) Whenever the Secretary finds that compliance is impossible or would involve extreme hardship to such individual and if enforcement of such obligation would be against equity and good conscience. In order to make this determination, the Secretary may require the trainee to provide supporting documentation.

Among the factors which will be considered by the Secretary in the waiver of any obligation are the extent to which the trainee has personal problems due to circumstances beyond his or her control such as a mental or physical disability; the extent to which the trainee has problems in his or her immediate family which prevent the trainee from either repaying training costs or performing his or her service obligation; and the extent to which the trainee's good faith efforts fail to secure employment which satisfies the practice obligation.

[51 FR 25892, July 17, 1986; 52 FR 49250, Dec. 30, 1987, as amended at 55 FR 10070, Mar. 19, 1990; 57 FR 45742, Oct. 5, 1992]

$57.2616 What additional Department regulations apply to grantees?

Several other Department regulations apply to grantees. They include, but are not limited to:

42 CFR part 50, subpart D-Public Health Service grant appeals procedure

42 CFR part 51c-Grants for Community Health Centers

42 CFR part 56 Grants for Migrant Health Services

42 CFR part 57, subpart Y-Grants for Nurse Practitioner and Nurse Midwifery Programs

42 CFR part 491-Certification of Certain Health Facilities

45 CFR part 5-Designation of Health Professional Shortage Areas

45 CFR part 16-Procedures of the Departmental Grant Appeals Board

45 CFR part 30-Claims Collection