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take into consideration the extent to which:

(a) The facility will be devoted by the applicant or other owner to the teaching of other health personnel;

(b) There are reasonable assurances that for the remainder of such period other facilities not previously utilized for nurse training will be so utilized and are substantially the equivalent in nature and extent for such purposes. (37 FR 20548, Sept. 30, 1972)

Subpart Grants for Nurse

Anesthetist Traineeships

AUTHORITY: Sec. 215 of the Public Health Service Act, 58 Stat. 690, as amended by 67 Stat. 631 (42 U.S.C. 216); sec. 831(a) of the Public Health Service Act, 93 Stat. 580, as amended by 96 Stat. 2061, and 99 Stat. 396 397 (42 U.S.C. 297–1).

SOURCE: 53 FR 9116, Mar. 21, 1988, unless otherwise noted.

Nurse anesthetist training program means a full-time educational program which:

(1) Is designed to qualify registered nurses as nurse anesthetists;

(2) Is accredited by the Council on Accreditation of Nurse Anesthesia Educational Programs; and

(3) Has students enrolled in the program who are beyond the twelfth month of study.

Registered nurse means a person who has graduated from a school of nursing and is licensed to practice as a registered/professional nurse in a State.

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

Trainee means a student who is receiving a traineeship from a grant under this subpart. (53 FR 9116, Mar. 21, 1988, as amended at 57 FR 45735, Oct. 5, 1992; 61 FR 6124, Feb. 16, 1996)

857.501 To what programs do these

regulations apply? These regulations apply to grants awarded to public or private nonprofit institutions for the purpose of providing traineeships to registered nurses enrolled in nurse anesthetist training programs.

8 57.502 Definitions.

Act means the Public Health Service Act, as amended.

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

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).

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 the benefit of any private shareholder or individual.

Nurse anesthetist means a registered nurse who has successfully completed a nurse anesthetist training program.

857.503 Who is eligible to apply for a

grant? Any public or private nonprofit institution which is located in a State and administers a nurse anesthetist training program is eligible to apply for a grant by submitting an application at the time and in the form that the Secretary may prescribe. (53 FR 9116, Mar. 21, 1988, as amended at 57 FR 45735, Oct. 5, 1992]

$57.504 How will applications be eval.

uated? Within the limits of funds available, the Secretary will award a grant to each eligible institution whose application is found to meet the requirements of section 831(a) of the Act and these regulations. In determining the funding of applications, the Secretary will consider any special factors relating to national needs as the Secretary may from time to time announce in the FEDERAL REGISTER.

857.505 How long does grant support

last? (a) The Notice of Grant Award specifies the period during which grant funds are available for obligation by the grantee. This period, called the budget period, will not exceed 1 year.

(b) The grant will initially be funded for 1 year, and subsequent awards will also be for 1 year at a time. Decisions about the amount of all awards will be made by formula as described in $57.506 of these regulations. In all cases awards require a determination by the Secretary that 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 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. (53 FR 9116, Mar. 21, 1988, as amended at 57 FR 45735, Oct. 5, 1992]

beyond the twelfth month of study in the applicant nurse anesthetist training program. Should special factors for determining the funding of applications be announced from time to time in the FEDERAL REGISTER, N will be adjusted upward for those applicants meeting the specific criteria as announced. (This adjustment will result in the award of additional traineeship funds to successful applicants who meet the criteria of the special factors.)

(b) Students will be counted as of October 15 of the Federal fiscal year in which application is made. 857.507 For what purposes may grant

funds be spent? (a) A grantee shall only spend funds it receives under this subpart for traineeships according to $57.508, the authorizing legislation, terms and conditions of the grant award, applicable cost principles specified in subpart Q of 45 CFR part 74, and these regulations.

(b) A grantee may not spend grant funds for sectarian instruction or for any religious purpose.

(c) Any balance of federally obligated grant funds remaining unobligated by the grantee at the end of the budget period may be carried forward provided specific approval is granted by the Secretary. If at any time during a budget period it becomes apparent to the Secretary that the amount of Federal funds awarded and made available to the grantee for that period, including any unobligated balance carried forward from prior periods, exceeds the grantee's need for that period, the Secretary may adjust the amounts awarded by withdrawing the excess. A budget period is an interval of time (usually 12 months) into which the project period is divided for funding and reporting purposes. (53 FR 9116, Mar. 21, 1988, as amended at 57 FR 45735, Oct. 5, 1992) $57.508 What financial support is

available to trainees? Expenditures from traineeship funds are limited to:

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

$57.506 How is the amount of the

award determined? (a) The Secretary will use the following formula to determine the amount of the grant to be awarded to each approved nurse anesthetist training program:

N
G=Fx

E G represents the amount of grant to be awarded. F represents the amount of traineeship funds appropriated to implement section 831(a) in the fiscal year in which application is made. E represents the total number of fulltime students enrolled beyond the twelfth month of study in all the approved applicant nurse anesthetist training programs. N represents the number of full-time students enrolled

(b) Stipends in whatever amount the : grantee determines that each trainee I needs to pursue the training program,

as long as that amount does not exceed the limits established by the Public Health Service. Stipends may only be paid to the trainee in monthly install

ments. I: (c) A transportation allowance for

travel to field training if the site is be

yond a reasonable commuting distance ed and requires the trainee to establish a

temporary new residence. However, the en grantee may not pay an allowance for 1 daily commuting from the new place of

residence to the field training head

quarters. If [53 FR 9116, Mar. 21, 1988, as amended at 57

FR 45735, Oct. 5, 1992)

this statement the grantee must require each trainee to provide information and documentation of his or her eligibility.

(2) The statement of appointment must be completed by the beginning of the training period or as soon thereafter as possible if the trainee receives notice of his or her traineeship appointment after the training period has begun. The statement of appointment must include information to document the eligibility of the trainee 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 trainee 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 trainee for his or her records.

(b) The grantee may not require trainees to perform any work which is not an integral part of the nurse anesthetist training program and required for all students in the 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) (53 FR 9116, Mar. 21, 1988, as amended at 57 FR 45735, Oct. 5, 1992]

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$57.509 Who is eligible for financial

assistance as a trainee?

To be eligible for a traineeship, a regPistered nurse must:

(a) Be a resident of the United States

and either a citizen or national of the de United States, an alien lawfully admit1 ted for permanent residence in the

United States, a citizen of the Coms monwealth of the Northern Mariana Is

lands, a citizen of the Republic of Palau, a citizen of the Republic of the

Marshall Islands, or a citizen of the the Federated States of Micronesia;

(b) Be enrolled as a full-time student beyond the twelfth month of study in a nurse anesthetist training program;

(c) Demonstrate financial need, as determined by the institution; and

(d) 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. (Approved by the Office of Management and Budget under control number 0915-0060) (53 FR 9116, Mar. 21, 1988, as amended at 57 FR 45735, Oct. 5, 1992; 61 FR 6124, Feb. 16, 1996)

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$ 57.511 Duration of traineeships.

The initial appointment to traineeship must be made for a full academic year, not to exceed 12 months, except that a shorter appointment may be made when necessary to enable the trainee to complete the training program. A second appointment may not exceed 6 months. The total period of support for any trainee may not exceed 18 months.

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$57.510 What are the requirements for

traineeships and the appointment of trainees? (a)(1) The grantee must complete a statement which documents the appointment of each trainee. To complete

$57.512 Termination of traineeships.

(a) The grantee must terminate a traineeship:

(1) Upon request of the trainee;

(2) If the trainee withdraws from the grantee institution; or

(3) If the grantee determines that:

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.

(i) The trainee is no longer an enrolled student; or

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

(b) The grantee must deposit any Federal portion of the tuition refund owed to a trainee into the grant account and provide written notice to the trainee that it is doing so. (Approved by the Office of Management and Budget under control number 0915-0060) (53 FR 9116, Mar. 21, 1988, as amended at 57 FR 45735, Oct. 5, 1992)

Subpart G [Reserved]

Subpart H Grants for Physician

Assistant Training Programs

AUTHORITY: Sec. 215 of the Public Health Service Act, 58 Stat. 690, as amended by 3 Stat. 35 (42 U.S.C. 216); sec. 783(a)(1) of the Public Health Service Act, 90 Stat. 2314, and 99 Stat. 524 (42 U.S.C. 295g-3(a)(1)); redesig. nated as sec. 788(d) and amended by 102 Stat. 3135 (42 U.S.C. 295g-8(d)); renumbered as sec 750, as amended by Pub. L. 102-408, 106 Stat. 2044 (42 U.S.C. 293n).

$57.701 Applicability.

The regulations in this subpart apply to the award of grants to public or private nonprofit schools of medicine or osteopathic medicine, and other public or private nonprofit entities under section 750 of the Public Health Service Act (42 U.S.C. 293n) to meet the costs of projects to plan, develop, and operate or maintain programs for the training of physician assistants. (57 FR 45736, Oct. 5, 1992; 57 FR 53815, Nov. 12. 1992; 61 FR 6124, Feb. 16, 1996)

857.513 What additional Department

regulations apply to grantees? Several other regulations apply to grants under this subpart. These include, but are not limited to: 42 CFR part 50, subpart D--Public Health

Service grant appeals procedure 45 CFR part 16—Procedures of the Depart

mental Grant Appeals Board 45 CFR part 74Administration of grants 45 CFR part 75--Informal grant appeals pro

cedures 45 CFR part 76—Governmentwide Debarment

and Suspension (nonprocurement) and Governmentwide Requirements for Drug-Free

Workplace (Grants) 45 CFR part 80—Nondiscrimination under

programs receiving Federal assistance through the Department of Health and Human Services effectuation of title VI of

the Civil Rights Act of 1964 45 CFR part 81-Practice and procedure for

hearings under part 80 of this title 45 CFR part 83—Regulation for the adminis

tration and enforcement of sections 794 and

855 of the Public Health Service Act 45 CFR part 84-Nondiscrimination on the

basis of handicap in programs and activities receiving or benefiting from Federal

financial assistance 45 CFR part 86—Nondiscrimination on the

basis of sex in education programs and activities receiving or benefiting from Fed

eral financial assistance 45 CFR part 91-Nondiscrimination on the

basis of age in HHS programs or activities

receiving Federal financial assistance 45 CFR part 93—New restrictions on lob

bying. (53 FR 9116, Mar. 21, 1988, as amended at 57 FR 45736, Oct. 5, 1992; 61 FR 6124, Feb. 16, 1996]

$57.702 Definitions.

As used in this subpart:

Act means the Public Health Service Act, as amended.

Budget period means the interval of time into which the approved activity is divided for budgetary and reporting purposes, as specified in the grant award document.

Health professional shortage area means an area designated under section 332 of the Act.

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 the benefit of any private shareholder or individual.

Physician assistant means an individual who is qualified by academic and clinical training to provide patient care services under the supervision and

857.514 Additional conditions.

The Secretary may impose additional conditions on any grant award before or at the time of any award if he or she

American Samoa, the Republic of Palau, the Republic of the Marshall Islands, and the Federated States of Micronesia.

Supervised clinical practice means supervised clinical practice as defined in 42 CFR 57.802.

(44 FR 36178, June 21, 1979, as amended at 52 FR 24160, June 29, 1987; 57 FR 45736, Oct. 5, 1992; 61 FR 6124, Feb. 16, 1996)

$57.703 Eligibility.

Any public or private nonprofit school of medicine or osteopathic medicine or public or private nonprofit entity located in a state is eligible to apply for a grant under this subpart.

(57 FR 45736, Oct. 5, 1992)

responsibility of a doctor of medicine

or osteopathic medicine and who meets [ the requirements of 42 CFR 57.802.

Primary care means health care which may be initiated by the patient or the provider, or both, in a variety of settings, and which consists of a broad range of personal health care services including promotion and maintenance

of health, prevention of illness and dis23

ability, 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 background, including the family and community, and

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

Program for the Training of Physician

Assistants or Program means a program Dy for the training of physician assistants - as defined in 42 CFR 57.801-57.803.

Project director means an individual

designated by the grantee in the grant Il application and approved by the Sec

retary to direct the project being supported under this subpart.

Project period means the total time for which support for a project has been approved including any extensions of the project.

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,

$57.704 Application.

(a) 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.

(b) The application must be signed by an individual authorized to act for the applicant 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.

(c) In addition to other pertinent information which the Secretary may require, an application for a grant under this subpart must contain:

(1) A detailed description of the proposed project and of the manner in which the applicant intends to conduct the project and carry out the requirements of section 750 of the Act and this subpart, in particular, the requirements of $ 57.705. This must include a budget for the proposed project and a justification for the amount of grant funds requested.

(2) A copy of all laws and regulations pertaining to the practice of physician assistants in the State or States in which the applicant's supervised clinical practice will be conducted and in which the applicant will be encouraging its graduates to work.

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