of support, and the approved budget for that period.

(3) A grant award shall not commit or obligate the United States in any way to make any additional, supplemental, continuation, or other grant award.

(4) Within the limits of the funds advanced by the Administrator, the amount of any grant award shall be determined by the Secretary on the basis of his estimate of the sum necessary to carry out the grant purpose.

(d)(1) Applicability of 45 CFR Part 74. The provisions of 45 CFR Part 74, establishing uniform administrative requirements and cost principles, shall apply to all grants under this part to State and local governments as those terms are defined in Subpart A of that Part 74. The relevant provisions of the following subparts of Part 74 shall also apply to grants to all other grantee organizations under this part;

Subpart

A General.

45 CFR PART 74

B Cash Depositories.

C Bonding and Insurance.

D Retention and Custodial Requirements for Records.

F Grant-Related Income.

G Matching and Cost Sharing.

K Grant Payment Requirements.

L Budget Revision Procedures.

M Grant Closeout, Suspension, and Termination.

O Property.

Q Cost Principles.

(2) Additional conditions. The Secretary may at the time of any grant award impose such conditions as in his judgment are necessary to assure or protect advancement of the supported activity, the interests of the public health, or the conservation of grant funds.

(e) Payment. The Secretary shall from time to time make payments to a grantee of all or a portion of any grant award, either in advance or by way of reimbursement for expenses incurred or to be incurred in accordance with the terms and conditions of the grant award.

(f) Grantee accountability. All payments made by the Secretary shall be recorded by the grantee in accounting records separate from the records of

all other grant funds, including funds derived from other grant awards. With respect to each approved project the grantee shall account for the sum total of all amounts paid by presenting or otherwise making available to the Secretary, satisfactory evidence of expenditures for direct and indirect costs meeting the requirements of this part.

(g) Expenditure of grant funds. (1) Any funds awarded pursuant to this part shall be expended solely for the purposes for which the funds were granted in accordance with the approved budget, the regulations of this part, the terms and conditions of the grant award, and the applicable cost principles prescribed by Subpart Q of 45 CFR Part 74.

(2) At the end of the period of support any unobligated grant funds remaining in the grant account must be refunded to the United States.

(h) Reports. Grantees shall submit the following reports to the Secretary: (1) Quarterly progress reports, to be submitted within 30 days of the end of each quarterly period within the grant period;

(2) A final report to be submitted within 90 days of the date upon which the grant period ends; and

(3) Such additional reports as the Secretary may prescribe including those which may be required to enable the Federal Coordinating Officer to carry out his functions.

§ 38.6 Nondiscrimination.

Attention is called to the requirements of 24 CFR 2205.13 relating to nondiscrimination on the grounds of race. religion, sex, color, age, economic status, or national origin in the provision of disaster assistance.

§ 38.7 Nonliability.

Attention is called to section 308 of the Act (42 U.S.C. 5148) which provides that the Federal Government shall not be liable for any claim based upon the exercise or performance of or the failure to exercise or perform a discretionary function or duty on the part of a Federal agency or an employee of the Federal Government in carrying out the provisions of the Act.

§ 38.8 Criminal and civil penalties.

Attention is called to section 317 of the Act (42 U.S.C. 5157) which provides:

(a) Any individual who fraudulently or willfully misstates any fact in connection with a request for assistance under this Act shall be fined not more than $10,000 or imprisoned for not more than one year or both for each violation.

(b) Any individual who knowingly violates any order or regulation under this Act shall be subject to a civil penalty of not more than $5,000 for each violation.

(c) Whoever knowingly misapplies the proceeds of a loan or other cash benefit ob

tained under any section of this Act shall be subject to a fine in an amount equal to one and one half times the original principal amount of the loan or cash benefit.

§ 38.9 Federal audits.

The Secretary, the Administrator, and the Comptroller General of the United States, or their duly authorized representatives shall have access to any books, documents, papers, and records that pertain to Federal funds, equipment, and supplies received under this part for the purpose of audit and examination.

246(e), 254b, 300, 300a-4, and 300b; secs. 220, 223, 242, 243, 246, 247, 251, 252, and 256, Community Mental Health Centers Act, as amended; 79 Stat. 427-29, 82 Stat. 1008, 1009, 84 Stat. 59, 1239, and 1851; 42 U.S.C. 2687, 2688c, g, h, j-1, j-2, k, 1, and n-1; sec. 410, Drug Abuse Office and Treatment Act of 1972; 86 Stat. 82; 21 U.S.C. 1177.

Subpart A-Health Services Funding

SOURCE: 39 FR 1441, Jan. 9, 1974, unless otherwise noted.

§ 50.101 Applicability.

(a) This subpart is applicable to health services delivery projects which are eligible for support pursuant to the following programs administered by the Assistant Secretary for Health: (1) Migrant health-section 310 of the PHS Act (42 U.S.C. 242h);

(2) Health services development (family health centers, health services projects)-section 314(e) of the PHS Act (42 U.S.C. 246(e));

(3) Family planning-section 1001 of the PHS Act (42 U.S.C. 300);

(4) Community mental health centers staffing-section 220 of the Community Mental Health Centers Act, as amended (CMHC Act) (42 U.S.C. 2687);

(5) Alcoholism and alcohol abuse: (i) Staffing-section 242, CMHC Act (42 U.S.C. 2688g);

(ii) Specialized facilities staffingsection 243, CMHC Act (42 U.S.C. 2688h);

(iii) Special projects-section 246, CMHC Act (42 U.S.C. 2688j-1);

(iv) Prevention and treatment-section 247, CMHC Act (42 U.S.C. 2688j2);

(6) Narcotic addiction, drug abuse, and drug dependence:

(i) Staffing-section 251, CMHC Act (42 U.S.C. 2688k);

(ii) Special projects-section 252, CMHC Act (42 U.S.C. 26881);

(iii) Special treatment and rehabilitation projects-section 256, CMHC Act (42 U.S.C. 2688n-1);

(iv) Special project grants and contracts-section 410, Drug Abuse Office and Treatment Act (21 U.S.C. 1177)

(with respect to treatment and rehabilitation);

(b) Nothing in this regulation is intended to impose any conditions which would require charges for services to people unable to pay therefor or which would supersede any requirement that priorities be given to persons from low-income families or to areas with concentrations of such per

sons.

(c) These regulations supersede any inconsistent regulation applicable to a program listed in paragraph (a) of this section except as otherwise provided with specific reference to this subpart in such other regulation.

850.102 Definitions.

As used in this subpart:

(a) "Secretary" means the Secretary of Health, Education, and Welfare and any other officer or employee of the Department of Health, Education, and Welfare to whom the authority involved has been delegated.

(b) "HSA" means the Health Services Administration and any of its constituent components.

(c) “ADAMHA" means the Alcohol, Drug Abuse and Mental Health Administration and any of its constituent components.

(d) "Program" means one of the programs listed in § 50.101(a).

(e) "Project" means any discrete health services delivery activity, whether implemented through grant or contract, which is eligible for HSA or ADAMHA support under any program.

§ 50.103 General policy.

In the delivery of health services it is the policy of HSA and ADAMHA to use their financial and technical resources to:

(a) Assist in improving the effectiveness and efficiency of the health care delivery system in meeting the health care needs of all citizens, with special emphasis upon the needs of the underserved.

(b) Develop maximum compatibility between health care services delivered with HSA or ADAMHA support and federally supported third party payment for health services and practices.

(c) Encourage development of alternate and ongoing funding sources to which HSA or ADAMHA supported activities can be constructively transferred after initial periods of HSA or ADAMHA assistance thereby creating a more equitable and efficient use of the total funds available for the delivery of health services.

§ 50.104 Project application.

In addition to other requirements imposed by law, regulation, or program guidelines, an approvable application for Federal support under a program listed in § 50.101(a) must contain:

(a) A general plan describing how the applicant intends to comply with the requirements of this subpart including plans with supporting data to recover the maximum reimbursement available for the services provided.

(b) A specific time-phased financial plan including at least:

(1) Statements of management and program objectives and needs, and planning assumptions;

(2) A description of the financial management arrangements to be utilized in supplementing or supplanting as applicable HSA or ADAMHA financial support with other sources of funding;

(3) Projections of total income including HSA or ADAMHA and other funding sources accompanied by supporting inventories and analyses of funding potentials and problems;

(4) Expenditure, cost, and utilization data and other management information which will serve to explain or clarify the plan and encourage maximum independence from grant support.

(c) Evidence that the applicant has provided not less than 30 calendar days. For review and comment (setting forth dates of submission) by the appropriate areawide comprehensive health planning agency or agencies or, if there is no such agency in the area, to such other public or nonprofit private agency or organization, if any, which performs similar functions, and to the State comprehensive health

'See sec. 247(c)(2), CMHC Act, allowing not more than 30 days for such review.

30 113 O-79--14

planning agency. The applicant shall forward comments received to the awarding authority or indicate that no response was received within the time provided.

§ 50.105 Project requirements.

In addition to other requirements and conditions imposed by law, regulation or program guidelines, an approvable project must provide the following:

(a) A management structure and methodology to carry out the general plan in §50.104(a) and the financial plan in § 50.104(b).

(b) Except in cases of persons unable to pay therefor, that charges shall be made for services rendered. Such charges shall not be a barrier to services. Where third party payors (including Government agencies) are authorized or under a legal obligation to pay all or a portion of such charges, all services covered by that reimbursement plan must be billed and every reasonable effort must be made to obtain payment. 2

(c) That where a significant percentage of the cost of care and services provided by the project is to be reimbursed by a third party, a written agreement with such third party is required unless otherwise provided by the Secretary for good cause shown.

(d) Maximum coordination of project activities with, and utilization of, the activities of other available health services delivery projects and programs (whether or not such services are supported with Federal funds) and State and local health agencies serving the same population in order to eliminate duplication of effort.

(e) An ongoing procedure to identify all persons served who are eligible for third-party reimbursement.

'Policies relating to payments under title XVIII of the Social Security Act (medicare) are set forth in Intermediary Letter No. 739, dated March 1973. Policies under title XIX of the Social Security Act (medicaid) are set forth in State Letter No. 1033, dated Apr. 23, 1968, and information memoranda to State agencies of June 23, 1970, Jan. 20, 1971, Aug. 24, 1971, and Apr. 24, 1972.

§ 50.106 Project evaluation.

In addition to other criteria established by applicable law, regulation, or program guidelines, the following will be taken into account when evaluating applications for support by HSA or ADAMHA of any project:

(a) The merit of the plan referred to in § 50.104 (a) and (b) for (1) assuring effective utilization of HSA or ADAMHA grant support and (2) to the extent feasible supplementing or supplanting such support.

(b) The potential of the project for developing new and effective methods for health services delivery and financing, preferably on a prepaid capitation basis.

(c) The administrative and management capability of the applicant.

(d) Prior performance, if any, with respect to the project requirements in § 50.105.

§ 50.107 Income earned.

Incentives to maximize income may be provided by the granting agency to projects by permitting use of a substantial portion of income generated by the project for one or more of the following purposes:

(a) To increase the number of persons served by the project.

(b) To increase the number or range of reimbursable services provided by the project.

(c) To improve the quality of the services.

(d) To develop and maintain a reserve fund to be used in offsetting underestimates of funding needs for approved project activities, and for purposes of complying with State regulations for prepaid health care services.

(e) To improve management and operational capabilities, including those related to the maximization of third party reimbursement revenues.

(f) Section 50.107 shall not apply to projects cited in §§ 50.101(a)(4) (community mental health centers), 50.101(a)(5) (alcoholism),

50.101(a)(6) (narcotic addiction).

and