doctoral degree, or postbaccalaureate training, in a science relating to health care and meets the requirements as established in section 799(5) of the Act.

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

Continuing education means structured educational programs for practicing health professionals and allied health professionals for the purpose of improving the knowledge and skills in geriatrics of such practitioners with respect to treatment of the health problems of elderly individuals.

Geriatrics is the total health and social care of the elderly.

Geriatric Medicine means the prevention, diagnosis, care and treatment of illness and disability as required by the distinct needs of the elderly.

Graduate program in clinical social work and graduate program in marriage and family therapy means an accredited graduate program as defined in section 799(1)(C) of the Act.

Graduate program in mental health practice means a graduate program in clinical psychology, clinical social work, or marriage and family therapy (section 799(1)(D) of the Act).

Health professional means, for purposes of this subpart, any allopathic or osteopathic physician, dentist, optometrist, podiatrist, pharmacist, professional nurse (as defined in §57.2502), and nurse practitioner (as defined in § 57.2402), physician assistant, chiropractor, clinical psychologist, health administrator, or allied health profes

sional.

Health professions schools means any school of medicine, dentistry, osteopathic medicine, pharmacy, optometry, podiatric medicine, veterinary medicine, public health, chiropractic, graduate programs in health administration, or graduate programs in clinical psychology, as defined in section 799(1) (A), (B), (C), and (D) of the Act and as accredited in section 799(1)(E) 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.

Program for the training of physician assistants means any educational programs as defined in section 799(3) of the Act.

Project director means an individual designated by the grantee in the grant application and approved by the Secretary 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 allied health means a public or private nonprofit junior college, college, university or hospital-based educational entity which provides or is accredited to provide a program of education to enable individuals to become allied health professionals or to provide additional training for allied health professionals and which meets the criteria set forth in section 799(4) of the Act.

School of nursing means a collegiate, associate degree, or diploma school of nursing in a State (section 853(2) 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.

Training and retraining of faculty means a program to train and retrain faculty to provide geriatric instruction which is not a 1-year retraining program for faculty in schools of medicine and osteopathic medicine in geriatrics or a 1-year or 2-year internal medicine or family medicine fellowship program as identified in section 777(3)(A) and (B) of the Act.

[54 FR 5617, Feb. 6, 1989, as amended at 57 FR 45746, Oct. 5, 1992; 58 FR 66298, Dec. 20, 1993; 61 FR 6129, Feb. 16, 1996]

$57.4003 Who is eligible to apply for a grant?

Any public or private nonprofit health professions school, school of allied health, or program for the training of physician assistants located in a State may 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 the time the Secretary may prescribe.

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

$57.4004

Program requirements.

(a) The Secretary will award grants to meet the cost of carrying out one or more of the following six purposes:

(1) Improve the training of health professionals in geriatrics;

(2) Develop and disseminate curricula relating to the treatment of the health problems of elderly individuals;

(3) Expand and strengthen instruction in methods of geriatric treatment; (4) Support the training and retraining of faculty;

(5) Support continuing education of health professionals and allied health professionals who provide geriatric treatment; and

(6) Establish new affiliations with nursing homes, chronic and acute disease hospitals, ambulatory care centers, and senior centers in order to provide students with clinical training in geriatric medicine.

(b) Projects must include one or more of the activities in paragraphs (a) (1) through (6) of this section for four or more types of health professionals as defined in § 57.4002 of this subpart.

(c) Each project must evaluate the program systematically, including the determination of a baseline at the outset of the project and the measurement of the degree to which program and educational objectives are met.

[54 FR 5617, Feb. 6, 1989, as amended at 58 FR 66299, Dec. 20, 1993]

$57.4005 How will applications be evaluated?

(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 prin

cipally 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 decide which applications to approve by considering, among other factors:

(1) The degree to which the proposed project adequately provides for the project requirement described in § 57.4004;

(2) The extent to which the rationale and specific objectives of the project are based upon a needs assessment of the status of geriatrics training in the institutions to be assisted and/or the geographic area to be served;

(3) The ability of the project to achieve the project objectives within the proposed geographic area;

(4) The adequacy of educational facilities and clinical training settings to accomplish objectives;

(5) The adequacy of organizational arrangement involving professional schools and other organizations necessary to carry out the project;

(6) The adequacy of the qualifications and experience in geriatrics of the project director, staff and faculty;

(7) The administrative and managerial ability of the applicant to carry out the proposed project in a cost-effective manner; and

(8) The potential of the project to continue on a self-sustaining basis.

(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.

[54 FR 5617, Feb. 6, 1989, as amended at 57 FR 45746, Oct. 5, 1992; 58 FR 66299, Dec. 20, 1993]

§ 57.4006 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. The maximum period of support, including

the initial project period and competitive extensions, may not exceed 6 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, grantees must make separate application at such times and in such a form as the Secretary may prescribe.

[54 FR 5617, Feb. 6, 1989, as amended at 58 FR 66299, Dec. 20, 1993]

§ 57.4007 For what purposes may grant funds be spent?

(a) A grantee shall only spend funds it receives under this subpart according to the approved application and budget, 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) Grantees 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 a 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 available to the grantee for that period, including any unobligated balance carried forward from prior periods, exceeds the grantee's needs for the 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.

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

§ 57.4008 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 Departmental Grant Appeals Board

45 CFR part 46-Protection of human subjects

45 CFR part 74-Administration of grants 45 CFR part 75-Informal grant appeals procedures

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 administration 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 Federal 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 lobbying.

[54 FR 5617, Feb. 6, 1989, as amended at 57 FR 45746, Oct. 5, 1992; 61 FR 6129, Feb. 16, 1996]

§ 57.4009 What other audit and inspection requirements apply to grantees?

Each entity which receives a grant under this subpart must meet the requirements of 45 CFR part 74 concerning audit and inspection.

[61 FR 6129, Feb. 16, 1996; 61 FR 51020, Sept. 30, 1996]

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.

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 osteopathic medical 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.

a

Part-time teaching dentist means 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.