Rule Requiring Institutions to Provide Students with Geographically Accessible Clinical Opportunities to Go Into Effect July 1

Last Fall, the Department of Education issued a final rule on Financial Responsibility, Administrative Capability, Certification Procedures, Ability To Benefit (ATB). The rule goes into effect on July 1, 2024.

The rule includes language in the Administrative Capability section to add § 668.16(r) to require institutions to provide students with geographically accessible clinical or externship opportunities related to and required for completion of the credential or licensure in a recognized occupation, within 45 days of the completion of other required coursework.

Last Summer, prior to the rule being finalized, ASAHP submitted comments to the Department of Education, as well as joined a joint-comment letter led by the American Council on Education (ACE), both of which expressed concern with this language.

While ASAHP welcomes more accessible clinical opportunities, we informed the Department of Education that a requirement is not the best way to address the issue. An unintended consequence of this proposed language could be that institutions, to ensure compliance, may enroll only the number of students that the institution feels certain will have accessible clinical opportunities, decreasing access to postsecondary enrollment for allied health students at a time when the demand for allied health workers is expanding rapidly.

Unfortunately, the final rule, which goes into effect on July 1 still includes this requirement. Please find below the language included in the final rule:

Department of Education on what experiences the language applies to

This language applies to the clinical or externship experiences that are needed for students to complete their programs. Thus, experiences that occur as part of credential completion, such as those in the third or fourth year of a program or at the end of a program, would be included. It does not apply to post-graduation parts of the career ladder, which include things like the national residency program for graduates from medical school. The reference to how the externship or clinical is related to licensure in a recognized occupation is to note that some licensure requirements state that there must be a clinical or externship completed as part of the credential earned. The result is that residencies, clerkships, and other similar post-graduation experiences are not covered by this requirement.

Department of Education on the 45 day timeframe

The requirement is that institutions provide the students with the opportunity within 45 days of successful completion of other required coursework. That does not mean the experiences must start exactly within 45 days. However, the Department will consider whether a pattern where these experiences start well outside reasonable periods, e.g., offering a spot that starts in a year so the student has an extended gap after finishing their coursework is in fact a sign that an institution is not abiding by this requirement and does not have sufficient spots for clinical or externships and thus should result in a finding of a lack of administrative capability. We decline to adopt a longer timeframe. Making a student wait 90 days to receive their spot and then potentially waiting longer to begin that experience risks delaying their ability to complete their program and begin entering the workforce.”

Department of Education on geographic accessibility

The Department declines to provide a specific set of metrics for measuring what is geographically accessible, as there could be programs on the edge of one commuting zone or another and that different program types could have different expectations for what is geographically accessible. For example, a clinical experience tied to a highly specialized field as part of a graduate program may see a geographically accessible option as one that is in another part of the country. By contrast, a commuting zone concept is likely to be a better fit for certificate programs where students are more likely to be staying close to where they live. The Department also declines to remove the geographically accessible requirement. This is a critical concept to maintain because we do not want institutions to otherwise get out of providing the required clinical or externship options by simply offering students an opportunity that is completely infeasible for them to reach. We also remind commenters that this requirement only applies to precompletion situations, so concerns about how students with medical degrees participate in a national matching program would not be affected.

In terms of assessing geographic accessibility, the Department would consider how accessible distances look very different in rural areas versus urban ones. The level of the credential will also likely affect this consideration. Someone completing a professional degree in a highly specialized field is almost certainly going to have travel longer distances for a clinical and so something quite far away would still be viewed as accessible and in line with their expectations. By contrast, a student completing a 12-month certificate program is not likely expecting to move hundreds of miles away for a clinical experience. Nor would they be completing a credential with a level of specialization such that there may only be a handful of relevant placement options in the country. Preserving the concept of geographic accessibility while recognizing the need for flexibility in how that is considered based upon the credential level, type, and the physical location of the institution is appropriate.

The rule may be accessed here.

2024 ASAHP Election: Call for Candidates

ASAHP's annual election will be conducted this summer. The following positions are open for the 2024 election:

Board of Directors (three-year term) - 3 open positions

Treasurer (two-year term) - 1 open position

Nominations & Elections Committee (two-year term) - 3 open positions

Applications must be submitted here no later than Tuesday, April 30, 2024. Voting will begin Summer 2024.

Administration Releases Student Debt Relief Plan, 30 Day Public Comment Period

On Tuesday, the Biden-Harris Administration released a preliminary rule on student debt relief for up to 30 million borrowers. The proposed rules will be formally published in the Federal Register on Wednesday, April 17 for a 30-day public comment period. In the coming weeks, the Administration is expected to release a second package of proposed rules, which will include a proposal for borrowers experiencing hardship.

The preliminary rule released Tuesday is here and the proposed rule released on Wednesday is here. A fact sheet from the Administration is available here. A press release from the Department of Education is available here.

House Appropriations Hearing on the Department of Education's FY 25 Budget Request

The House Labor-HHS Appropriations Subcommittee held a wide-ranging and sometimes heated hearing on the Department of Education's budget request which focused on the Department’s rocky rollout of its new FAFSA application form. Several Republican Appropriators questioned whether FSA’s unprecedented loan forgiveness activities caused staff to be moved away from the implementation of the new FAFSA form, causing delays and challenges for institutions seeking to provide students with their financial aid awards. In addition, there were questions about the Department’s Title IX rulemaking and the role of transgender students in women college sports, challenges to free speech on college campuses, as well as the need for accountability with the funds directed to the Department.

Our hearing summary can be found here.

Upcoming Webinar: So how are you feeling TODAY?

So how are you feeling TODAY? webinar is hosted by ASAHP's Clinical Education Committee. The webinar will address some of the causes of stress and burnout in today's world. We will then look at what self-care and resiliency may look like for us to help overcome and thrive in today's world.

Webinar Objectives:
- Stress: what causes it?
- Burnout: what is it and what are the symptoms of it?
- Self-care/Resiliency – suggestions to address and thrive in times of craziness

Learn more about the speakers and register here.

Webinar: How AI can help us become better humans, clinicians, educators, and administrators

AI tools are leading a necessary shift in how educators teach and learn. After defining AI in the context of higher education, this webinar will review the purpose, ethics, and fairness of AI, including the ethical and responsible application of this far-reaching tool. Best practices to unlock Human-AI potential in higher education will be discussed, including time for Q & A with our expert presenters from Liaison International and Weber State University.

ASAHP and Friends of HRSA Urge Robust HRSA Funding for FY 25

ASAHP was one of 84 members of the Friends of HRSA coalition and other supporting organizations that urged congressional appropriators to include at least $10.5 billion for discretionary Health Resources and Services Administration (HRSA) programs in the FY 2025 Labor, Health and Human Services, Education, and Related Agencies appropriations bill.

The letter to Congressional appropriators may be accessed here.

ASAHP and CDC Coalition Urge Robust CDC Funding for FY 25

ASAHP was one of 171 organizations that are members of the CDC Coalition and joined in sending a letter to congressional appropriators urging at least $11.581 billion in funding for the CDC’s programs in FY 2025.

The letter may be accessed here.

Congress Passes FY 24 Funding Package

Congress passed and President Biden on Saturday signed the second and final tranche of FY 24 funding bills. The six bill package consists of a bit over 70 percent of annual discretionary funding and includes the Labor-HHS-ED bill.

The House passed the funding package on Friday under suspension of the rules, which requires a two-thirds majority for passage. Due to absences, 280 votes were required, and the House passed the bill 286-134. Just 101 Republicans supported the measure, less than a majority of the majority, with 112 opposed. 185 Democrats supported the package, with 22 opposed. The Senate passed the bill on Saturday around 2am in a 74-24 vote.

The bill provides a 3 percent increase for defense funding and flat-funding for nondefense discretionary programming. See our previous post here, and the links below for more details.

The House and Senate are both scheduled to be on recess for the next two weeks, returning the week of April 8th. Speaker Mike Johnson (R-LA) has previously said that aid to Ukraine and Israel would be a priority for the House once it wrapped up FY 24 funding.

Text of the FY 24 funding package is here. The Labor-H explanatory statement is here, and the Labor-H Congressionally Directed Spending is here.

A six page Labor-H bill summary from Senate Appropriations Committee Democrats is here.

A 10 page summary from the House Appropriations Committee Democrats on Labor-H is here.

A 24 page summary from the House Appropriations Committee Democrats on the six-bill package is here.

A press release from the House Appropriations Committee Republicans is here.

A 35-page summary from the House Appropriations Committee Republicans is here.

A press release and summary from the Senate Appropriations Committee is here and here.

Congress Releases FY 24 Spending Bills

On Thursday, congressional leaders released their second and final tranche of FY 24 fiscal bills. The six-bill $1.2 trillion package includes funding for the Labor-HHS-Education bill. The House is expected to vote on the funding package today under suspension of the rules, which requires a two-thirds majority for passage. A Senate vote on the six-bill, $1.2 trillion-plus measure may come later today, or Sunday or Monday. President Biden has said he will sign the legislation.

The package provides $117.4 billion for HHS. According to a summary from House Democrats, after adjusting for earmarks the HHS bill is an increase of $955 million (0.8 percent) above FY 23. The bill includes $8.9 billion for HRSA, an increase of $54 million above FY 23 (excluding earmarks). The agreement will provide $815,776,000 for the HRSA Title VII and Title VIII programs, which is $8 million (7%) above funding in FY 2023. The Title VII programs for healthcare providers include levels equal to FY 2023 funding for the Centers of Excellence, Health Careers Opportunity Program, Faculty Loan Repayment, Scholarships for Disadvantaged Students, and the Primary Care Training and Enhancement Program. The Geriatric Workforce Enhancement Program is provided with a $1 million increase above FY 2023 funding.

The package provides $79.1 billion for ED. According to a summary from House Democrats, after adjusting for earmarks, the total amount is a decrease of $201 million (0.3 percent) compared to FY 23. The bill provides $7,395 for the maximum Pell Grant, same as in FY 23.

Earlier this month, Congress passed a six-bill FY 24 package to fund about 30 percent of the government for the remainder of the fiscal year, through September 30. The package passed 339-85 in the House, 75-22 in the Senate, and was signed by President Biden.

Text of the funding package is here. The Labor-H bill summary is here, the Labor-H explanatory statement is here, and the Labor-H Congressionally Directed Spending is here.

A press release and summary from the Senate Appropriations Committee is here and here. A press release and summary from the House Appropriations Committee is here, here and here.

Call for Applications: 2024 ASAHP Scholarship of Excellence

Each year, ASAHP offers a scholarship program for health professions students enrolled in its member institutions. The purpose is to recognize outstanding students in the health professions who are achieving excellence in their academic programs and have significant potential to assume future leadership roles in health professions. Each student chosen for an award will receive a $1,000 scholarship. The most exemplary Scholarship of Excellence recipient will also receive the “Elwood Scholar” award, qualifying an additional $1,000 in scholarship funds. We are now accepting applications for this year’s awards. The deadline is Friday, June 7.

More information may be accessed here.

President's FY 25 Budget Request Released

Today, the White House released the President’s FY 25 Budget Request. As the FY 24 appropriations process is still underway, the FY 25 proposal reflects funding levels in comparison to FY 23 enacted levels. The budget proposes to reduce the deficit by about $3 trillion over a decade. The budget does not provide the type of dramatic increases for domestic programs that was included in prior year budgets due to funding caps installed by the Fiscal Responsibility Act last year. As it’s an election year, there is little chance the FY 25 appropriations process will conclude until at some point after the November elections

The President is proposing $82 billion in spending for the Department of Education (ED), a $3.1 billion (3.9%) increase from the FY 23 enacted level. The Department describes its budget as providing targeted investments within the caps created by the Fiscal Responsibility Act.

The Budget would increase the discretionary maximum Pell Grant by $100, and increase the mandatory add-on by $650 for a total maximum award increase of $750 (from $7,395 for the 2024-25 award year to $8,145 for the 2025-26 award year), expanding access and making college more affordable for an estimated 7.2 million students students. Students attending public and non-profit institutions would be eligible to receive the increased mandatory add-on, but not those attending for-profit institutions where the Pell maximum would be $7,495. The Administration’s overall goal is to double the overall Pell maximum grant by 2029.

The budget also calls for eliminating origination fees that are charged to borrowers on new federal student loans.

The budget request proposes a $93 million funding increase above the FY 23 enacted level for HBCUs, TCCUs, and MSIs, as well as a $100 million to expand research and development infrastructure at these institutions. It also proposes offering two years of subsidized tuition to students from families earning less than $125,000 who are enrolled in a four-year HBCU, TCCU, or MSI.

The budget would expand free community college programs through a Federal-State partnership. The Administration proposes two years of free Community College through a $90 billion mandatory program that would create partnerships between the federal government and States, territories, and Tribes for first-time students and workers wanting to reskill. The proposal would provide funding for two years of subsidized tuition up to $4,500 per year for students from families earning less than $125,000.

The budget includes $12 billion mandatory Reducing the Costs of College Fund that would offer competitive grants to public institutions. It would also provide over $7 billion for states to provide access to at least 12 credits of transferable career-connected dual enrollment credits to high school students.

The President is proposing $130.7 billion in discretionary (a $2.2 billion increase from FY 23) and $1.7 trillion in mandatory proposed budget authority for FY 2025 for the Department of Health and Human Services (HHS).

The President’s Budget proposes $636.3 million, a $57 million (9.8%) increase over FY 2023 for the Title VII health professions programs, primarily directed to increases for a consolidated set of behavioral health programs ($253.6 million, a $56.5 million or 28.7% increase) and a proposed new “Health Care Workforce Innovation” program ($10 million), that seeks to incentivize the development of innovative new ways to recruit and train health professionals in order to accelerate progress in addressing workforce shortages.

The budget proposes nearly $72 billion in funding for mental health care over the next 10 years, including funding for the behavioral health workforce and technological infrastructure for behavioral health clinics.

The budget proposes $9.683 billion for the CDC.

The President’s FY 25 budget request may be accessed here. Details on the FY 25 budget request for ED and HHS may be accessed here and here. A funding chart from the Health Professions and Nursing Education Coalition (HPNEC) may be accessed here.

Negotiated Rulemaking Committee Fails to Reach Consensus On State Authorization, Distance Education, and Accreditation

This week, the Department of Education concluded its third and final negotiated rulemaking session on Program Integrity and Institutional Quality, concerning state authorization, distance education, accreditation, return of title IV funds, cash management, and the TRIO programs. The National Association of Student Financial Aid Administrators (NASFAA) covered the negotiations on state authorization, distance education, accreditation.

Details from NASFAA may be accessed here.

ED Concludes Negotiated Rulemaking on State Authorization, Accreditation, and More

This week, the Department of Education concluded its third and final negotiated rulemaking session on Program Integrity and Institutional Quality, concerning state authorization, distance education, accreditation, return of title IV funds, cash management, and the TRIO programs. The committee only reached consensus on opening up some of the federal TRIO programs to undocumented students. Thus, ED may put forward its own regulatory language on the various topics.

From Inside Higher Ed:

“The Biden administration can now move forward with its plans to give states greater authority over online programs after an advisory rule-making committee rejected a compromise proposal Thursday.

The Education Department said last week that it wants to change the terms of state authorization reciprocity agreements to give state regulators more authority to enforce their own laws on out-of-state institutions that enroll their residents. Currently, reciprocity agreements allow colleges to enroll out-of-state students online without getting direct approvals from the individual states—and they exempt institutions from some laws in the states where the students are located.

Department officials have said that the current structure fails to protect students and taxpayers by limiting states’ oversight.”

Details are here. Coverage from Inside Higher Ed may be accessed here. NC-SARA provides a “Status of State Authorization Reciprocity at Conclusion of 2023-2024 Negotiated Rulemaking Session 3”, here.

House Education and the Workforce Subcommittee Hearing on DEI

On Thursday, the House Education and the Workforce Committee’s Subcommittee on Higher Education and Workforce Development, chaired by Rep. Burgess Owens (R-UT), held a hearing entitled, “Divisive, Excessive, Ineffective: The Real Impact of DEI on College Campuses”. The hearing was starkly partisan. Republicans primarily directing questions to their three witnesses, while Democrats primarily directed questions to their sole witness, Dr. James Murphy of Education Reform Now. More details are here, the House Republican recap is here, and a recording of the hearing may be viewed here.  

2024 ASAHP Election: Call for Candidates

ASAHP's annual election will be conducted this summer. The following positions are open for the 2024 election:

Board of Directors (three-year term) - 3 open positions

Treasurer (two-year term) - 1 open position

Nominations & Elections Committee (two-year term) - 3 open positions

Applications must be submitted here no later than Tuesday, April 30, 2024. Voting will begin Summer 2024.

ED Negotiated Rulemaking on Student Debt Relief Reaches Consensus

The Department of Education (ED) held a virtual negotiated rulemaking session last week regarding student loan forgiveness for those with financial hardship. The negotiated rulemaking session was the fourth and final round of negotiated rulemaking on student debt relief, following three rulemaking sessions on student loan debt relief last year, aimed at debt relief for several categories of borrowers.

Ahead of this week’s session, the Department of Education released draft regulatory text on Thursday, February 15. The proposal listed numerous factors that the Secretary could use to determine if a borrower is eligible for forgiveness due to hardship. It also included language allowing ED to offer immediate relief for those at least 80 percent likely to default within the next two years.

Some language from the proposal was tweaked, and ED added language clarifying that an application for debt relief is not required. Consensus was reached, as there was no dissent among members of the negotiated rulemaking committee. While most representatives on the negotiated rulemaking committee gave a thumbs up, the representative for for-profit institutions gave a sideways thumb, and the representative for servicers abstained.

The Department has previously said it aims to release the plans for public comment in May. Rules finalized by November 1 go into effect July 1 of the following year. ED could take action to implement provisions of the final rule earlier, using its authority under the Higher Education Act (HEA). Legal challenges are expected. ED’s negotiated rulemaking page may be accessed here.

Webinar: The Changing Landscape for Health Professions Education: Part 1 – Upheaval in Higher Education

This is part 1 of a 2-part webinar series looking at the challenges health professions education programs face as the higher education landscape changes.  In this session, we explore the history of disruptive change in higher education and the disruptive forces currently at play.  We provide real-world examples of these disruptive forces in health professions education colleges and provide suggestions to help leaders prepare for the future. In part 2 (fall 2024) we will focus on the changing student population and their needs, challenges, and opportunities.

Speakers

Stacy Jaffee Gropack, PT, PhD, FASAHP
Dean, School of Health Professions
Stony Brook University

Susan Gordon-Hickey, AuD, PhD, FASAHP
Dean, Pat Capps Covey College of Allied Health Professions
University of South Alabama

Moderator: Mark Merrick, PhD, AT, ATC, FNATA, FNAP
Dean, College of Health and Human Services
University of Toledo

Register Here