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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.

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§ 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).

Fellowship program means a 2-yea ganized training effort sponsored by allopathic or osteopathic media school, a teaching hospital, or a p uate medical education program vit is designated to provide training ft

(1) Physicians who have complete graduate medical education program internal medicine, family medicine cluding osteopathic general practis psychiatry, neurology, gynecology. rehabilitation medicine; and

(2) Dentists who have demonstrate commitment to an academic a and who have completed postdoct dental training, including postdoct dental education programs or who b relevant advanced training or expe

ence.

Full-time teaching physician mean allopathic or osteopathic physi who is a faculty member of the grazz institution and who is engaged : teaching, research, clinical, and admi istrative activities normally perform by teaching faculty employed on sí time basis, as defined by the gran institution.

Full-time teaching dentist means tist who is a faculty member and is engaged in teaching, research, d cal, and administrative activities 1 mally performed by teaching fact employed on a full-time basis, as d fined by the institution. The den faculty member does not have to employed by the grantee institutt but can be a dental faculty member another institution which has an af ation agreement with the grantee stitution.

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

Geriatric dentistry means the pro sion of dental care for elderly person particularly those with one or m chronic or debilitating, physical mental illnesses with associated met cation or psychosocial problems.

Geriatric medicine means the preve tion, diagnosis, and medical treatme of illness and disability as required l the needs of the elderly.

Geriatric psychiatry means the preve tion, diagnosis, evaluation and trea ment of mental disorders and distur ances seen in older adults.

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aduate medical education program as a program sponsored by a school hedicine, a school of osteopathic icine, a hospital, or a public or prinonprofit institution, which:

Offers postgraduate medical trainin the specialties and subspecialof medicine; and

Has been accredited by the Acitation Council for Graduate MediEducation or the American OsteoFic Association through its ComSee on Postdoctoral Training. crantee means an entity that repes a grant and assumes legal and ficial responsibility both for the rded funds and for the performance he grant-supported activity.

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cart-time teaching dentist means tist who is a faculty member and is engaged in teaching, research, ical, and administrative activities mally performed by teaching facy employed on a part-time basis, as ined by the institution. The dental Culty member does not have to be ployed by the grantee institution

can be a dental faculty member at other institution which has an affilion agreement with the grantee intution.

Postdoctoral dental education program ans a program sponsored by a school dentistry, a hospital, or a public or vate nonprofit institution, which: 1) Offers postdoctoral training in the cialties of dentistry, advanced edution in general dentistry, or a dental neral practice residency; and 2) Has been accredited by the Comission on Dental Accreditation. Primary care means health care which ay be initiated by the patient or the ovider, or both, in a variety of setngs, and which consists of a broad nge of personal health care services cluding promotion and maintenance health, prevention of illness and disbility, basic care during acute and hronic phases of illness, guidance and ounseling of individuals and families, nd referral to other health care proiders and community resources when ppropriate. 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

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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 Trust Territory of the Pacific Islands (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]

$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]

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(c) Projects must systematial evaluate the training program, in ing the performance and competens trainees and faculty, the administ tion of the program, and the degre which program and educational obvi tives are met; Sec

(d) The project must be under programmatic control of a grad medicine or family medicine (inciat medical education program in inten osteopathic general practice) or department of geriatrics or psychia

(e) The project must be staffed least two physicians in full-time ing positions who have experiens training in geriatric medicine ar atric psychiatry and be staffed enter into an agreement with an tution staffed, by at least one dens who is employed in a full- or part-tim teaching position and has experience training in geriatrics;

(f) The project must provide fellow with training in geriatrics and en sure to the physical and mental abilities of a diverse population of derly individuals. The population m include:

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

(2) Elderly from a range of soc economic, racial and ethnic bac grounds;

(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. fellow must receive experience in p mary care, consultation, and longit dinal care;

Fellowship programs must have a culum which includes training in cal geriatrics, teaching skills, adstrative skills, and research skills hysicians and dentists;

"Retraining programs must provide ar of full-time training suited to ndividual needs of each fellow. To re that the needs of all fellows can Set, each retraining program must the resources available to provide cal, research, administrative, and her-training experience; and

Effective in the second year of It support, a minimum of three eng fellows, including at least one ician and one dentist, must be ened in each training program for h grant support is received. The etary may suspend this requiret if the Secretary determines that rantee has made a good faith effort comply with this requirement ugh the various recruitment means ilable in its institution and at the ional level, and has met the other irements stated in this section but nable to have the required number ellows in the program due to ciristances beyond its control.

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

.4106 How will applications be -evaluated?

4) As required by section 798(a) of Act, each application for a grant ler this subpart shall be submitted a peer review group, composed prinally of non-Federal experts, for an aluation of the merits of the proposmade in the application. The Secary may not approve such an applition unless a peer review group has commended the application for apI oval. The Secretary will award Pants to applicants whose projects

11 best promote the purposes of secon 777(b) of the Act and these regulaons. The Secretary will consider, nong other factors:

(1) The extent to which the proposed aining program will prepare physians and dentists to perform the rearch, teaching, administrative and linical duties of a faculty member speializing 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 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,

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(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 Trust Territory of the Pacific Islands (TTPI) (consisting of the Republic of Palau), or a citizen of the Republic of the Marshall Islands or the Federated States of Micronesia (both formerly part of the TTPI);

(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 Readjustment Benefits Act, and loans from Federal sources.

$57.4110 What are the requires for fellowships and the app ment of fellows?

(a) The grantee must complete statement which documents the pointment of each fellow. To comp this statement the grantee must quire the provision of information documentation of eligibility by fellow. The statement of appointm must be completed by the beginning the training period or as soon the after as possible if the fellow rece notice of his or her fellowship app ment after the training period begun. The statement of appointm must include information to docum the eligibility of the fellow and cert that there will be compliance with applicable Public Health Service and conditions governing the app ment. The program director must the statement on behalf of the gra and the fellow must sign it thus tifying the statements are true complete. The original copy of statement must be retained by grantee to be available for program view and financial audit. A copy be provided to the fellow for hist records.

(b) The grantee may not require lows to perform work which is n integral part of the geriatric train program, or to perform services detract from or prolong their traini (Approved by the Office of Management Budget under control number 0915-0060) [55 FR 37481, Sept. 12, 1990, as amended FR 29194, June 26, 1991]

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

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

(3) If the grantee determines that (1) The fellow is no longer an acti participant in the training program

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

(b) The grantee must deposit Federal portion of the tuition ref owed to a fellow into the grant accou

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