(3) Subject to prior approval by the Surgeon General, these requirements may be varied for free-standing facilities containing only outpatient, educational, recreational, or workshop functions utilized by ambulant groups.

(4) Interior finish walls and ceilings of all exitways, storage rooms, laboratories, and areas of unusual fire hazard shall have a flamespread rating of less than 20. Flamespread ratings shall be on the basis of tests conducted in accordance with American Society for Testing Materials, Publication No. E84.

(5) Exit facilities shall comply with the requirements of the Building Exits Code, National Fire Protection Association Bulletin No. 101.

(e) Mechanical. All installations of fuel burning equipment, steam, heating, air conditioning and ventilation, and plumbing systems shall comply with the requirements of the following National Codes:

(1) National Board of Fire Underwriter Standards: National Board of Fire Underwriters, 85 John St., New York, N.Y. 10038.

(2) National Fire Protection Association: 60 Batterymarch St., Boston, Mass. 02110. (3) American Standards Association: 70 East 45th St., New York, N.Y. 10017.

(4) American Gas Assoication: 1725 I St., Washington, D.C. 20006.

(5) National Plumbing Code: Published by American Society of Mechanical Engineers, 29 West 39th St., New York, N.Y. 10018. Boilers shall meet the requirements of the American Society of Mechanical Engineers (A.S.M.E. Codes relating to pressure vessels), and shall be installed to meet the requirements of State and local codes and regulations.

(f) Electrical. All electrical installations and equipment shall comply with the requirements of local and State codes and the applicable sections of the National Electrical Code and the following:

(1) Hazardous locations. Installations and equipment in rooms in which flam

mable anesthetic and disinfecting agents are used or stored shall comply with the requirements of NFPA No. 56 and No. 70. (2) Fire alarms. Manually operated fire alarm system installations shall comply with the requirements of NFPA No. 72 and shall be located as required by the Building Exits Code, NFPA No. 101.

(3) Radiation protection in rooms in which X-ray, gamma-ray, or beta-ray producing equipment is used shall comply with the requirements of the following handbooks of the National Bureau of Standards:

Handbook 55, Protection Against BetatronSynchrotron Radiations up to 100 Million Electron Volts.

Handbook 73, Protection Against Radiations From Sealed Gamma Sources.

Handbook 76, Medical X-ray Protection up to Three Million Volts

(4) Emergency electric service. Emergency exit lighting shall comply with the requirements of the National Electrical Code and shall be located as required by the Building Exits Code.

(g) Elevators, dumbwaiters, and escalators. Installation of elevators, dumbwaiters, and escalators shall comply with the requirements of the American Standard Safety Code for Elevators. Dumbwaiters, and Escalators, ASA A17. 1–1960.

(h) Equipment necessary for the functioning of the facility or the program as planned shall be provided in the kind and to the extent required to perform the desired service. The necessary equipment may be included in the cost of the project.

Subpart D-Grants for Initial Cost of Professional and Technical Personnel of Community Mental Health Centers

AUTHORITY: The provisions of this Subpart D issued under sec. 223, 79 Stat. 429; 42 U.S.C. 2888c. Secs. 220-224, 408, 79 Stat. 428-429; 42 U.S.C. 2688-2688d, 2697.

SOURCE: The provisions of this Subpart D appear at 31 F.R. 3246, Mar. 1, 1966, unless otherwise noted.

§ 54.301 Definitions.

As used in this subpart all terms not defined herein shall have the same meaning as indicated in the Act or as defined in Subpart C of this part.

"Act" means the Mental Retardation Facilities and Community Mental Health

Centers Construction Act of 1963, as amended (42 U.S.C. 2661 et seq.).

"Predecessor of the applicant" means any public or private agency or organization providing services for which the applicant proposes to assume responsibility under his application.

"Initial grant period" means as to a particular application the first period with respect to which assistance is granted under Part B of Title II of the Act.

"Grant period" means an initial grant period or any subsequent grant period.

"Application" means, unless otherwise indicated, a request for assistance under Part B of Title II of the Act for an initial grant period.

§ 54.302 Eligible centers.

To be eligible for a grant to assist in the initial operation of a community mental health center under Part B of Title II of the Act the application must be in accordance with, and set forth the assurances and information required by, section 221(a) of the Act and § 54.305.

(a) For purposes of section 221(a) (2) of the Act the essential elements of a comprehensive mental health center and the program requirements of the center shall be those specified in § 54.212 (a) and (c) of Subpart C of this part.

(b) For purposes of section 221 (a) (3) of the Act the type of service will not be regarded as having been previously provided by the center if it is an element of service (1) which, during the 2 years immediately preceding an initial grant period, has not been provided by the applicant or any predecessor of the applicant in any form or (2) which the applicant proposes to provide in accordance with methods of treatment or delivery of service not used by the applicant or predecessor of the applicant during such 2-year period or (3) which the applicant proposes to provide in a way designed to meet the needs of a specific group not served by such a specific program during such 2-year period or (4) which represents the portion of an expanded element of service attributable to the needs of persons residing in an area where such element was not provided during such 2-year period or (5) which has been provided by the applicant or predecessor of the applicant only on a

pilot or development basis for a period of 9 months or less.

(c) For purposes of section 221(a) (4) of the Act, with respect to assurance that Federal funds will not supplant nonFederal funds, budget information meeting the requirements of § 54.305 (b) sufficient to support a grant under § 54.306, together with information providing an adequate basis for a determination by the Surgeon General under paragraph (d) (2) (iv) of this section that there has not been a decline in State financial support, shall be deemed to constitute such satisfactory assurance: Provided, That in determining whether there has been a decline in the porportion of public funds of the State in relation to the total funds expended in the State for mental health services as provided in paragraph (d) (2) (iv) of this section, the Surgeon General may, if he finds in a particular case that such action is consistent with section 221(a) (4) of the Act, disregard funds from private sources.

(d) In addition to describing the services to be provided by the center in the State mental health plan in accordance with section 221(a)(5) of the Act the State mental health authority shall submit to the Surgeon General:

(1) An evaluation of the application, taking into consideration such factors as the feasibility and effectiveness of the proposed program in achieving (1) the utilization of financial and personnel resources available for improving the mental health of the community, (ii) the prevention of mental illness and the more rapid and complete recovery of persons affected with mental illness in the community, (iii) the development of improved methods of treating and rehabilitating the mentally ill, and (iv) a commitment of the community, through financial undertakings and otherwise, to establish and maintain mental health services appropriate to community needs; and

(2) Such additional information as the Surgeon General may require in order to show: (1) Prospective developments in mental health manpower resources throughout the State, (ii) current and proposed efforts to meet statewide needs for such resources, (iii) a ranking of the areas of the State (according to the same geographical division as under § 54.204 of Subpart C of this part) in order of their ability to

meet their need for such manpower, (iv) the amount of funds derived from public revenues of the State expended or estimated to be expended during the current calendar year and the 2 preceding calendar years to provide public and private nonprofit mental health services for the population of the State, sufficiently documented to enable the Surgeon General to determine that the amount expended or estimated to be expended by the State for such purposes during such current year has not declined or will not decline, either on a per capita basis or in proportion to the total amount expended in the State for such services from all sources, from the amount expended in either of such 2 preceding years.

(e) Such other agencies and organizations as may be designated by the Governor of a State may transmit to the Surgeon General for consideration documents evaluating applications under this subpart.

(f) The center shall be one which will serve a population of not less than 75,000 and not more than 200,000 persons, except that the Surgeon General may, in particular cases, permit modification of this population range if he finds that such modifications will not impair the effectiveness of the services to be provided.

§ 54.303 Eligible costs.

(a) Personnel covered. For purposes of section 220 (a) of the Act and of this subpart, professional and technical personnel shall be those persons who participate in the provision of an element or elements of service in accordance with section 221(a)(3) of the Act and as set forth in § 54.302(b) and who are found by the Surgeon General to be appropriately qualified under the circumstances to occupy positions which require professional or special mental health training or experience.

(b) Allowable compensation. Federal funds may be granted under Part B of Title II of the Act, with respect to the costs of compensation of personnel of the types described in paragraph (a) of this section. For purposes of this subpart, "compensation" shall include renumeration for services, vacation, holiday and severance pay, sick leave, workmen's compensation and employee insurance, social security taxes and retirement plans costs, and such other benefits in

return for service performed as the Surgeon General finds reasonably necessary to secure the services of qualified personnel in the area.

§ 54.304 Priority of projects.

In determining the priority of projects, the Secretary will give special consideration to those applications for an initial grant with respect to which a grant has been made under Part A of the Act to assist in financing the construction of the center, and will take into account the factors enumerated in section 220(c) of the Act.

[36 F.R. 11295, June 11, 1971]

§ 54.305 Submittal of application.

Each application for assistance under Part B of Title II of the Act shall be submitted to the Surgeon General, and a copy of such application shall be submitted to the mental health authority of the applicant's State responsible for submittal of plans in accordance with Title III of the Public Health Service Act, as amended. Such application shall, in addition to any other information or assurances found necessary by the Surgeon General to act on the application, set forth the program for all community mental health services provided by the applicant or those affiliated with the applicant, including specific and detailed information and adequate assurances as to the following in such detail and in such form as may be prescribed by the Surgeon General:

(a) Supporting information and data (1) Plans on the basis of which the applicant undertakes to carry out a program providing a community service eligible under § 54.302 and to fulfill the assurances given in accordance with paragraph (c) of this section;

(2) The extent of the need in the community for the mental health services to be provided;

(3) The features of the population to be served which indicate the appropriateness of the modalities of treatment and services to be provided, as evidenced by the data of a community survey of such need and an inventory of existing services;

(4) The geographical and other characteristics of the community which indicate the appropriateness of proposed arrangements for accessibility of the services to be provided, taking into ac

count such factors as hours of service and availability of public transportation;

(5) The need for and the availability of the kinds and quantities of staff services proposed, the adequacy of the professional qualifications proposed to be required of each individual filling a proposed position, and the adequacy of plans for their recruitment and compensation;

(6) The adequacy and effectiveness of arrangements proposed to assure maximum coordination and mutual usefulness among the applicant and other public and private agencies concerned with groups and persons in the community who may have special needs for mental health services;

(7) The adequacy and effectiveness of arrangements for the efficient use of all mental health personnel employed by or affiliated with the proposed program of community mental health services, including mental health personnel in private practice permitted under such arrangements to concern themselves actively with the treatment of persons receiving services under the program;

(8) The extent to which elements of the proposed program are eligible for and are receiving financial assistance under Federal, State, and local programs other than this title;

(9) The relationship to services provided by the State or States in which the community is located and to comprehensive mental health planning.

(b) Budget. (1) A statement for each of the two 12-month periods preceding the period for which an initial grant is requested, and an estimate for each period for which a grant is requested, of costs and income incurred or to be incurred by the applicant, affiliates and predecessors of the applicant with respect to all services included in the program set forth under paragraph (a) of this section;

(2) Identification of all actual or contemplated staff positions for the initial grant period, and the qualifications and compensation for such positions; and

(3) Identification of those costs for which Federal assistance is requested, and the amount thereof.

(c) Assurance as to community service and nondiscrimination. (1) Each application for assistance under Part B of Title II of the Act shall contain the assurances required of the applicants

under § 54.210 of Subpart C of this part relating to community service and services for persons unable to pay. Such assurances shall also contain a specific assurance that the applicant and affiliates will not refuse to provide any service to an individual solely for the reason that the individual is able to pay if an equivalent program of services is not otherwise available to the individual.

(2) Each application for assistance under Part B of Title II of the Act shall contain the assurances required of the applicants as provided in § 54.210 of Subpart C of this part relating to nondiscrimination. Such assurances shall also contain a specific assurance that in the selection, compensation, or other employment practices with respect to the technical or professional personnel referred to in § 54.303 (a) there shall be no discrimination because of race, creed, color, sex, or national origin.

(d) Amendment of documents. Where the applicant requests assistance for periods subequent to the initial grant he shall submit such amendments to the documents which are submitted at the time of his application for an initial grant as may be necessary to support such request and as may be required by the Surgeon General in order to act on the request.

(e) Concurrent construction and staffing applications. Any applicant which is concurrently applying for grants under Parts A and B of Title II of the Act shall so state, and documentation meeting the requirements of paragraph (b) of this section shall be acceptable in lieu of that required by § 54.211(a) (2) of Subpart C of this part, unless and until the applicant is notified to the contrary. § 54.306 Approval of application.

The Surgeon General may approve an application for Federal participation up to the maximum percentage (specified in section 220 (b) of Title II of the Act) of eligible costs in excess of the average amount determined or estimated in such application to have been expended for mental health services by the applicant, affiliates, and predecessors of the applicant in the 2 years preceding the initial grant period for which application is made, where such application meets the eligibility requirements specified in §§ 54.302 and 54.303 and the allocation and priority requirements of § 54.304.

§ 54.307

Expenditures by applicant.

Any amounts received pursuant to an initial or other grant may be expended by the applicant for compensation of personnel as provided in § 54.303 throughout both the initial grant period and any subsequent grant period with respect to which a request for assistance is approved by the Surgeon General.

§ 54.308 Records, audits, and reports.

The applicant shall keep such records as the Surgeon General shall prescribe and as are required by section 408(a) of the Act, and shall make any books, documents, papers, and records of the applicant that are pertinent to assistance under the Act available for audit and examination by representatives of the Surgeon General and the Comptroller General of the United States as required by section 408(b) of the Act. The applicant shall also submit such reports or other information as the Surgeon General may find necessary in administering the provisions of this subpart.

Subpart E-Grants for Regional

Medical Programs

AUTHORITY: The provisions of this Subpart E issued under sec. 215, 58 Stat. 690, as amended, sec. 906, 79 Stat. 930; 42 U.S.C. 216, 2991. Interpret or apply secs. 900, 901, 902, 903, 904, 905, 909, 79 Stat. 926, 927, 928, 929, 930; 42 U.S.C. 299, 299a, 299b, 299c, 299d, 299e, 2991.

SOURCE: The provisions of this Subpart E appear at 32 F.R. 571, Jan. 18, 1967, unless otherwise noted.

(a) All terms not defined herein shall have the meaning given them in the Act. (b) "Act" means the Public Health Service Act, as amended.

(c) "Title IX" means Title IX of the Public Health Service Act, as amended.

(d) "Related diseases" means those diseases which can reasonably be considered to bear a direct relationship to heart disease, cancer, or stroke.

(e) "Title IX diseases" means heart disease, cancer, stroke, and related dis

eases.

(f) "Program" means the regional medical program as defined in section 902(a) of the Act.

(g) "Practicing physician" means any physician licensed to practice medicine in accordance with applicable State laws and currently engaged in the diagnosis or treatment of patients.

(h) "Major repair" includes restoration of an existing building to a sound state.

(1) "Built-in equipment" is equipment affixed to the facility and customarily inIcluded in the construction contract.

(j) "Advisory group" means the group designated pursuant to section 903 (b) (4) of the Act.

means

(k) "Geographic area" any area that the Surgeon General determines forms an economic and socially related region, taking into consideration such factors as present and future population trends and patterns of growth; location and extent of transportation and communication facilities and systems; presence and distribution of educational, medical and health facilities and programs, and other activities which in the opinion of the Surgeon General are appropriate for carrying out the purposes of Title IX.

§ 54.403 Eligibility.

In order to be eligible for a grant, the applicant shall:

(a) Meet the requirements of section 903 or 904 of the Act;

(b) Be located in a State;

(c) Be situated within a geographic area appropriate under the provisions of this subpart for carrying out the purposes of the Act.

§ 54.404 Application.

(a) Forms. An application for a grant shall be submitted on such forms and in such manner as the Surgeon General may prescribe.

(b) Execution. The application shall be executed by an individual authorized to act for the applicant and to assume on behalf of the applicant all of the obligations specified in the terms and conditions of the grant including those contained in these regulations.

(c) Description of program. In addition to any other pertinent information that the Surgeon General may require, the applicant shall submit a description of the program in sufficient detail to clearly identify the nature, need, purpose, plan, and methods of the program,