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1. The area is a rational area for the delivery of podiatric services.

2. The area's ratio of population to foot care practitioners is at least 28,000:1, and the computed podiatrist shortage to meet this ratio is at least 0.5.

3. Podiatric professional(s) in contiguous areas are overutilized, excessively distant, or inaccessible to the population of the area under consideration.

B. Methodology.

In determining whether an area meets the criteria established by paragraph A of this Part, the following methodology will be used:

1. Rational Areas for the Delivery of Podiatric Services.

(a) The following areas will be considered rational areas for the delivery of podiatric services:

(i) A county or a group of contiguous counties whose population centers are within 40 minutes travel time of each other.

(ii) A portion of a county, or an area made up of portions of more than one county, whose population, because of topography, market and/or transportation patterns or other factors, has limited access to contiguous area resources, as measured generally by a travel time of greater than 40 minutes from its population center to these resources.

(b) The following distances will be used as guidelines in determining distances corresponding to 40 minutes travel time:

(i) Under normal conditions with primary roads available: 25 miles.

(ii) In mountainous terrain or in areas with only secondary roads available: 20 miles.

(iii) In flat terrain or in areas connected by interstate highways: 30 miles.

Within inner portions of metropolitan areas, information on the public transportation system will be used to determine the area corresponding to 40 minutes travel time. 2. Population Count.

The population count used will be the total permanent resident civilian population of the area, excluding inmates of institutions, adjusted by the following formula to take into account the differing utilization rates of podiatric services by different age groups within the population: Adjusted population=total population x (1 +

2.2 x (percent of population 65 and over)

- 0.44 (percent of population under 17)). 3. Counting of Foot Care Practitioners. (a) All podiatrists providing patient care will be counted. However, in order to take into account productivity differences in podiatric practices associated with the age of the podiatrists, the following formula will be utilized:

Number of FTE podiatrists = 1.0 * (podia

trists under age 55) +.8 (podiatrists age 55 and over)

(b) In order to take into account the fact that orthopedic surgeons and general and family practitioners devote a percentage of their time to foot care, the total available foot care practitioners will be computed as follows: Number of foot care practitioners = number

of FTE podiatrists + .15 x (number of orthopedic surgeons) + .02 x (number of general and family

practioners). 4. Determination of Size of Shortage.

Size of shortage (in number of FTE podiatrists) will be computed as follows: Podiatrist shortage adjusted population

28,000 · number of FTE foot care practi

tioners. 5. Contiguous Area Considerations.

Podiatric professional(s) in areas contiguous to an area being considered for designation will be considered excessively distant, overutilized or inaccessible to the population of the area under consideration if one of the following conditions prevails in each contiguous area:

(a) Podiatric professional(s) in the contiguous area are more than 40 minutes travel time from the center of the area being considered for designation.

(b) The population-to-foot care practitioner ratio in the contiguous areas is in excess of 20,000:1, indicating that contiguous area podiatric professional(s) cannot be expected to help alleviate the shortage situation in the area for which designation is requested.

(C) Podiatric professional(s) in the contiguous area are inaccessible to the population of the area under consideration because of specified access barriers (such as economic or cultural barriers).

C. Determination of Degree of Shortage.

Designated areas will be assigned to groups, based on the ratio (R) of adjusted population to number of foot care practitioners, as follows: Group 1 Areas with no foot care practi

tioners, and areas with R > 50,000 and no

podiatrists. Group 2 Other areas with R > 50,000. Group 3 Areas with 50,000 > R > 28,000.

APPENDIX F TO PART 5CRITERIA FOR

DESIGNATION OF AREAS HAVING
SHORTAGES OF PHARMACY PROFES-
SIONAL(S)

Part 1Geographic Areas A. Criteria.

A geographic area will be designated as having a shortage of pharmacy professional(s) if the following three criteria are met:

1. The area is a rational area for the delivery of pharmacy services.

2. The number of pharmacists serving the area is less than the estimated requirement for pharmacists in the area, and the computed pharmacist shortage is at least 0.5.

3. Pharmacists in contiguous areas are overutilized or excessively distant from the population of the area under consideration.

B. Methodology.

In determining whether an area meets the criteria established by paragraph A of this Part, the following methodology will be used:

1. Rational Areas for the Delivery of Pharmacy Services.

(a) The following areas will be considered rational areas for the delivery of pharmacy services:

(i) A county, or a group of contiguous counties whose population centers are within 30 minutes travel time of each other; and

(ii) A portion of a county, or an area made up of portions of more than one county, whose population, because of topography, market or transportation patterns or other factors, has limited access to contiguous area resources, as measured generally by a travel time of greater than 30 minutes to these resources.

(b) The following distances will be used as guidelines in determining distances corresponding to 30 minutes travel time:

(i) Under normal conditions with primary roads available: 20 miles.

(ii) In mountainous terrain or in areas with only secondary roads available: 15 miles.

(iii) In flat terrain or in areas connected by interstate highways: 25 miles.

Within inner portions of metropolitan areas, information on the public transportation system will be used to determine the area corresponding to 30 minutes travel time.

2. Counting of Pharmacists.

All active pharmacists within the area will be counted, except those engaged in teaching, administration, or pharmaceutical research.

3. Determination of Estimated Requirement for Pharmacists.

(a) Basic estimate. The basic estimated requirement for pharmacists will be calculated as follows: Basic pharmacist requirement = .15 x (resi

dent civilian population/1,000) + .035 x (total number of physicians engaged in

patient care in the area). (b) Adjusted estimate. For areas with less than 20,000 persons, the following adjustment is made to the basic estimate to compensate

for the lower expected productivity of small practices. Estimated pharmacist requirement = (2

population 20,000) x basic pharmacist re

quirement. 4. Size of Shortage Computation.

The size of the shortage will be computed as follows: Pharmacist shortage = estimated pharmacist

requirement number of pharmacists

available. 5. Contiguous Area Considerations.

Pharmacists in areas contiguous to an area being considered for designation will be considered excessively distant or overutilized if either:

(a) Pharmacy professional(s) in contiguous areas are more than 30 minutes travel time from the center of the area under consideration, or

(b) The number of pharmacists in each contiguous area is less than or equal to the estimated requirement for pharmacists for that contiguous area (as computed above).

C. Determination of Degree-of-Shortage.

Designated areas will be assigned to degree-of-shortage groups, based on the proportion of the estimated requirement for pharmacists which is currently available in the area, as follows:

Group 1-Areas with no pharmacists.

Group 2-Areas where the ratio of available pharmacists to pharmacists required is less than 0.5.

Group 3-Areas where the ratio of available pharmacists to pharmacists required is between 0.5 and 1.0.

APPENDIX G TO PART 5-CRITERIA FOR

DESIGNATION OF AREAS HAVING
SHORTAGES OF VETERINARY PROFES-
SIONAL(S)

Part I-Geographic Areas A. Criteria for Food Animal Veterinary Shortage.

A geographic area will be designated as having a shortage of food animal veterinary professional(s) if the following three criteria are met:

1. The area is a rational area for the delivery of veterinary services.

2. The ratio of veterinary livestock units to food animal veterinarians in the area is at least 10,000:1, and the computed food animal veterinarian shortage to meet this ratio is at least 0.5.

3. Food animal veterinarians in contiguous areas are overutilized or excessively distant from the population of the area under consideration.

B. Criteria for Companion Animal Veterinary Shortage.

A geographic area will be designated as having a shortage of companion animal veterinary professional(s) if the following three criteria are met:

1. The area is a rational area for the delivery of veterinary services.

2. The ratio of resident civilian population to number of companion animal veterinarians in the area is at least 30,000:1 and the computed companion animal veterinary shortage to meet this ratio is at least 0.5.

3. Companion animal veterinarians in contiguous areas are overutilized or excessively distant from the population of the area under consideration.

C. Methodology.

In determining whether an area meets the criteria established by paragraphs A and B of this part, the following methodology will be used:

1. Rational Areas for the Delivery of Veterinary Services.

(a) The following areas will be considered rational areas for the delivery of veterinary services:

(i) A county, or a group of contiguous counties whose population centers are within 40 minutes travel time of each other.

(ii) A portion of a county (or an area made up of portions of more than one county) which, because of topography, market and/or transportation patterns or other factors, has limited access to contiguous area resources, as measured generally by a travel time of greater than 40 minutes to these resources.

(b) The following distances will be used as guidelines in determining distances corresponding to 40 minutes travel time:

(i) Under normal conditions with primary roads available: 25 miles.

(ii) In mountainous terrain or in areas with only secondary roads available: 20 miles.

(iii) In flat terrain or in areas connected by interstate highways: 30 miles.

2. Determination of Number of Veterinary Livestock Units (VLU) Requiring Care.

Since various types of food animals require varying amounts of veterinary care, each type of animal has been assigned a weight indicating the amount of veterinary care it requires relative to that required by a milk cow. Those weights are used to compute the number of "Veterinary Livestock Units" (VLU) for which veterinary care is required.

The VLU is computed as follows: Veterinary Livestock Units (VLU)=(number

of milk cows) + 2x(number of other cattle and calves) +.05x(number of hogs and pigs) +,05x(number of sheep) +.002x(number of poultry).

3. Counting of Food Animal Veterinarians.

The number of food animal veterinarians is determined by weighting the number of veterinarians within each of several practice

categories according to the average fraction
of practice time in that category which is de-
voted to food animal veterinary care, as fol-
lows:
Number

of
Food

Animal
Veterinarians=(number of veterinarians

in large animal practice, exclusively) +(number of veterinarians in bovine prac

tice, exclusively) +(number of veterinarians in poultry prac

tice, exclusively) +.75x(mixed practice veterinarians with

greater than 50% of practice in large ani

mal care) +.5x(mixed practice veterinarians with ap

proximately 50% of practice in large ani

mal care) +.25x(mixed practice veterinarians with less

than 50% of practice in large animal

care). 4. Counting of Companion Animal Veterinarians (that is, those who provide services for dogs, cats, horses, and any other animals maintained as companions to the owner rather than as food animals).

The number of full-time equivalent companion animal veterinarians is determined by weighting the number of veterinarians within each of several practice categories by the average portion of their practice which is devoted to companion animal care by the practitioners within that category, as follows: Number of Companion Animal

Veterinarians=(number of veterinarians

in large animal practice, exclusively) +(number of veterinarians in equine prac

tice, exclusively) +.75x(mixed practice veterinarians with

greater than 50% of practice in small ani

mal care) +.5x(mixed practice veterinarians with ap

proximately 50% of practice in small ani

mal care) +.25x(mixed practice veterinarians with less

than 50% of practice in small animal

care). 5. Size of Shortage Computation.

The size of shortage will be computed as follows:

(a) Food animal veterinarian shortage=(VLU/10,000)- (number of food animal veterinarians).

(b) Companion animal veterinarian shortage=(resident civilian

pop./ 30,000) – (number of companion animal veterinarians).

6. Contiguous Area Considerations.

Veterinary professional(s) in areas contiguous to an area being considered for designation will be considered excessively distant from the population of the area or overutilized if one of the following conditions prevails in each contiguous area:

(a) Veterinary professional(s) in the contiguous area are more than 60 minutes travel time from the center of the area being considered for designation (measured in accordance with paragraph C.1.(b) of this part).

(b) In the case of food animal veterinary professional(s), the VLU-to-food animal veterinarian ratio in the contiguous area is in excess of 5,000:1,

(c) In the case of companion animal veterinary professional(s), the population-to-companion animal veterinarian ratio in the contiguous area is in excess of 15,000:1.

C. Determination of Degree-of-Shortage.

Designated areas will be assigned to degree-of-shortage groups as follows:

Group 1-Areas with a food animal veterinarian shortage and no veterinarians.

Group 2-Areas (not included above) with a food animal veterinarian shortage and no food animal veterinarians.

Group 3-All other food animal veterinarian shortage areas.

Group 4All companion animal shortage areas (not included above) having no veterinarians.

Group 5-All other companion animal shortage areas.

partment of Justice to whom the authority involved has been delegated.

Covered entity means an entity described in $6.3 which has been deemed by the Secretary, in accordance with $6.5, to be covered by this part.

Covered individual means an individual described in $6.4.

Effective date as used in $6.5 and $6.6 refers to the date of the Secretary's determination that an entity is a covered entity.

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

Subrecipient means an entity which receives a grant or a contract from a covered entity to provide a full range of health services on behalf of the covered entity.

PART 6-FEDERAL TORT CLAIMS

ACT COVERAGE OF CERTAIN GRANTEES AND INDIVIDUALS

Sec.
6.1 Applicability.
6.2 Definitions.
6.3 Eligible entities.
6.4 Covered individuals.
6.5 Deeming process for eligible entities.
6.6 Covered acts and omissions.

AUTHORITY: Sections 215 and 224 of the Public Health Service Act, 42 U.S.C. 216 and 233.

SOURCE: 60 FR 22532, May 8, 1995, unless otherwise noted.

$6.3 Eligible entities.

(a) Grantees. Entities eligible for coverage under this part are public and nonprofit private entities receiving Federal funds under any of the following grant programs:

(1) Section 329 of the Act (relating to grants for migrant health centers);

(2) Section 330 of the Act (relating to grants for community health centers);

(3) Section 340 of the Act (relating to grants for health services for the homeless); and

(4) Section 340A of the Act (relating to grants for health services for residents of public housing).

(b) Subrecipients. Entities that are subrecipients of grant funds described in paragraph (a) of this section are eligible for coverage only if they provide a full range of health care services on behalf of an eligible grantee and only for those services carried out under the grant funded project.

$6.1 Applicability.

This part applies to entities and individuals whose acts and omissions related to the performance of medical, surgical, dental, or related functions are covered by the Federal Tort Claims Act (28 U.S.C. 1346(b) and 2671–2680) in accordance with the provisions of section 224(g) of the Public Health Service Act (42 U.S.C. 233(g)).

$ 6.2 Definitions.

Act means the Public Health Service Act, as amended.

Attorney General means the Attorney General of the United States and any other officer or employee of the De

$6.4 Covered individuals.

(a) Officers and employees of a covered entity are eligible for coverage under this part.

(b) Contractors of a covered entity who are physicians or other licensed or certified health care practitioners are eligible for coverage under this part if they meet the requirements of section 224(g)(5) of the Act.

(c) An individual physician or other licensed or certified health care practitioner who is an officer, employee, or contractor of a covered entity will not be covered for acts or omissions occurring after receipt by the entity employing such individual of notice of a final determination by the Attorney General that he or she is no longer covered by this part, in accordance with section 224(i) of the Act.

$6.5 Deeming process for eligible enti

ties. Eligible entities will be covered by this part only on and after the effective date of a determination by the Secretary that they meet the requirements of section 224(h) of the Act. In making such determination, the Secretary will receive such assurances and conduct such investigations as he or she deems necessary. $6.6 Covered acts and omissions.

(a) Only acts and omissions occurring on and after the effective date of the Secretary's determination under $ 6.5 and before the later date specified in section 224(g)(3) of the Act are covered by this part.

(b) Only claims for damage for personal injury, including death, resulting from the performance of medical, surgical, dental, or related functions are covered by this part.

(c) With respect to covered individuals, only acts and omissions within the scope of their employment (or contract for services) are covered. If a covered individual is providing services which are not on behalf of the covered entity, such as on a volunteer basis or on behalf of a third-party (except as described in paragraph (d) of this section), whether for pay or otherwise, acts and omissions which are related to such services are not covered.

(d) Only acts and omissions related to the grant-supported activity of entities are covered. Acts and omissions related to services provided to individuals who are not patients of a covered entity will be covered only if the Secretary determines that:

(1) The provision of the services to such individuals benefits patients of the entity and general populations that

could be served by the entity through community-wide intervention efforts within the communities served by such entity;

(2) The provision of the services to such individuals facilitates the provision of services to patients of the entity; or

(3) Such services are otherwise required to be provided to such individuals under an employment contract or similar arrangement between the entity and the covered individual.

(e) Examples. The following are examples of situations within the scope of paragraph (d) of this section:

(1) A community health center deemed to be a covered entity establishes a school-based or school-linked health program as part of its grant supported activity. Even though the students treated are not necessarily registered patients of the center, the center and its health care practitioners will be covered for services provided, if the Secretary makes the determination in paragraph (d)(1) of this section.

(2) A migrant health center requires its physicians to obtain staff privileges at a community hospital. As a condition of obtaining such privileges, and thus being able to admit the center's patients to the hospital, the physicians must agree to provide occasional coverage of the hospital's emergency room. The Secretary would be authorized to determine that this coverage is necessary to facilitate the provision of services to the grantee's patients, and that it would therefore be covered by paragraph (d)(2) of this section. (3) A homeless health services grant

makes arrangements with local community providers for after-hours coverage of its patients. The grantee's physicians are required by their employment contracts to provide periodic cross-coverage for patients of these providers, in order to make this arrangement feasible. The Secretary may determine that the arrangement is within the scope of paragraph (d)(3) of this section.

ee

[60 FR 22532, May. 8, 1995; 60 FR 36073, July 13, 1995)

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