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(g) Review annually and approve or disapprove any State plan and any application (and any revision of a State plan or application) submitted to the Secretary as a condition to the receipt of Federal funds, made available under allotments, in accordance with section 1524(c)(6) of the Act and applicable regulations of the Secretary.

(h) Review and approve or disapprove the State medical facilities plan prepared by the State Agency pursuant to section 1603 of the Act, on the basis of whether such State medical facilities plan is consistent with the State health plan prepared in accordance with paragraph (b) of this section.

(i) Where applicable, review and comment on State Agency actions described in § 123.502(a)(2) before such actions become final.

Subpart E-[Reserved]

Subpart F-Special Provisions for States-Section 1536 of the Act

§ 123.501 Additional grants to certain State agencies

In addition to grants pursuant to section 1525 of the Act, a State Agency designated for the Virgin Islands, Guam, the Trust Territory of the Pacific Islands, American Samoa, the Northern Mariana Islands, or any other State determined by the Secretary to meet the requirements of section 1536(a) of the Act may, where the State Agency agrees to meet the requirements of § 123.502, receive a grant under section 1516 of the Act and this subpart.

(a) Application. An application for a grant under this section must conform to the requirements of 42 CFR 122.203 and in addition shall include a detailed description of the functions under section 1513 of the Act which the applicant will perform during the period of the designation agreement, and the manner in which the State Agency proposes to carry out such functions.

(b) Amount of the grant. (1) Where a State Agency has entered into a Conditional Designation Agreement under § 123.105, the amount of the grant to the State Agency will be computed in

accordance with 42 CFR 122.204(b) as if the State Agency were a conditionally designated health systems agency.

(2) Where a State Agency has entered into a Full Designation Agreement under § 123.106, the amount of the grant to the State Agency will be computed in accordance with 42 CFR 122.204(b) as if the State Agency were a fully designated health systems agency.

(c) Population. For purposes of determining the amount of the grant under this section, the population of a State will be determined by the Secretary in accordance with 42 CFR 122.205.

(d) Assurance of expenditure of nonFederal funds. A State Agency which qualifies for a grant under this section may receive an increased amount of grant funds in accordance with section 1516 of the Act and 42 CFR 122.204 where the State Agency provides assurance in accordance with 42 CFR 122.206 that it will expend or obligate non-Federal funds during the grant period for the purposes for which grants under this section may be made.

(e) Grant payments. Payments to a grantee of a grant award will be made in accordance with 42 CFR 122.207.

(f) Use of grant funds. Funds granted pursuant to this section, as well as other funds required as a condition of the grant to be used in performance of the approved activity, shall be expended in accordance with section 1516 of the Act, terms and conditions of the award, and the applicable cost principles prescribed by Subpart Q of 45 CFR Part 74. Such funds shall be available for obligation only during the period of the State Agency's designation agreement current at the time of the grant award.

(g) Nondiscrimination. The provisions of 42 CFR 122.209 shall apply to grants made under this section.

(h) Grantee accountability. The provisions of paragraphs (a) and (b) of 42 CFR 122.211 shall apply to grants made under this section.

(i) 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 made under this section.

(j) Additional conditions. The Secretary may with respect to any grant award impose additional conditions prior to or at the time of any award when in his judgment such conditions are necessary to assure or protect advancement of the approved project, the interests of the public health, or the conservation of grant funds.

§ 123.502 Additional requirements for State agencies.

In addition to the other provisions of this part, the provisions of this section shall apply to a State Agency which receives a grant under section 1516.

(a) Additional functions-(1) Conditional designation. In the case of a State Agency designated pursuant to a Conditional Designation Agreement, the State Agency shall perform such of the functions prescribed by section 1513 of the Act and 42 CFR 122.107(c) as the secretary, in writing, directs it to perform in accordance with 42 CFR 122.106 (b) and (c), as though the State were a health service area and the State Agency a health systems agency for such area.

(2) Full designation agreement. In the case of a State Agency designated pursuant to a Full Designation Agreement, the State Agency shall perform the functions prescribed by section 1513 of the Act and 42 CFR 122.107(c), as though the State were a health service area and the State Agency a health systems agency for such area.

Provided, That: The requirements of section 1513(b)(2) of the Act and 42 CFR 122.107(c)(2) (relating to the development of a health systems plan); section 1513(f) of the Act and 42 CFR 122.107(c)(14) (relating to the review of new institutional health services proposed to be offered or developed); section 1513(g) of the Act and 42 CFR 122.107(c)(15) (relating to periodic review of all institutional health services); and section 1513(h) of the Act and 42 CFR 122.107(c)(16) (relating to recommendation of projects for modernization, construction and conversion of medical facilities) shall not apply for purposes of this section.

(b) Review and comment by SHCC. The State Agency shall afford the SHCC for such State a reasonable opportunity to review and comment upon the following actions by the State Agency before such actions are made final:

The establishment,

(1) annual review, and amendment of the annual implementation plan (“AIP”) as described in 42 CFR 122.107(c)(3);

(2) The development and publication of specific plans and programs for achieving the objectives established in the AIP, as described in 42 CFR 122.107(c)(6);

(3) The making of grants and contracts from the Area Health Services Development Fund pursuant to section 1640 of the Act, as described in 42 CFR 122.107(c)(9);

(4) The approval or disapproval of each proposed use of Federal funds within the State, as described in 42 CFR 122.107(c)(17).

(c) State agency staff. Notwithstanding any other provisions of this Part relating to State Agency staff, a State Agency to which this section is applicable shall have a staff which meets the requirements of 42 CFR 122.110. The Secretary may, for good cause shown upon application by any such State Agency, waive the requirements of 42 CFR 112.110 in whole or in part with respect to such agency. The requirements of section 1522(b)(4)(B) of the Act and § 123.104(b)(6) (relating to personnel standards on a merit basis) shall apply to each State Agency under this section.

§ 123.503 Special provisions for membership for SHCCs.

The membership of the SHCC shall number not less than 16 and shall be appointed by the Governor of such State in accordance with the provisions of 42 CFR 122.109(b), relating to the composition of the governing body of a health systems agency; Provided, That: In the case of the Virgin Islands, Guam, the Trust Territory of the Pacific Islands, American Samoa, or the Northern Mariana Islands any of the requirements of 42 CFR 122.109(b) may be waived by the Secretary upon the written request of the Governor

supported by evidence sufficient to satisfy the Secretary that such requirement cannot be met or would, under the circumstances, be inconsistent with the purposes of the Act.

§ 123.504 Preliminary State health plan. (a) In the case of a State Agency designated for the Virgin Islands, Guam, the Trust Territory of the Pacific Islands, the Northern Mariana Islands and any other State determined to meet the requirements of section 1536 of the Act, the preliminary State health plan shall be established after appropriate consideration of the recommended National Guidelines for health planning policy issued by the Secretary under section 1501, and the priorities set forth in section 1502, and shall be a detailed statement of goals (1) describing a healthful environment and health system in the area which, when developed, will assert that quality health services will be available and accessible in a manner which assures continuity of care, at reasonable cost, for all residents of the area; (2) which are responsive to the unique needs and resources of the area; and (3) which take into account and are consistent with the National Guidelines for health planning policy issued by the Secretary under section 1501 of the Act respecting supply, distribution and organization of health resources.

(b) For purposes of this part, the preliminary State health plan prepared pursuant to this section shall be deemed to be the health systems plan for the State.

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As used in this subpart

(a) "Act" means the Public Health Service Act, as amended.

(b) "Construction" means construction of new buildings and initial equipment of such buildings and, in any case in which it will help to provide a service not previously provided in the community, equipment of any buildings. It includes architect's fees, but excludes the cost of off-site improvements and, except with respect to public health centers, the cost of the acquistion of land.

(c) "Cost" means the amount found by the Secretary to be necessary for construction or modernization under a project, except that such term does not include any amount found by the Secretary to be attributable to expansion of the bed capacity of any facility.

(d) "Equipment" means those items which are necessary for the functioning of the facility but does not include items of current operating expense such as food, fuel, pharmaceuticals,

dressings, paper, printed forms, and housekeeping supplies.

(e) "Facility for long-term care" means a facility (including a skilled nursing care or intermediate care facility), providing inpatient care for convalescent or chronic disease patients who require skilled nursing or intermediate care and related medical services

(1) Which is a hospital (other than a hospital primarily for the care and treatment of mentally ill or tuberculosis patients) or is operated in connection with a hospital, or

(2) In which such care and medical services are prescribed by, or are performed under the general direction of, persons licensed to practice medicine or surgery in the State.

(f) "Health systems agency" means an agency which has been conditionally or fully designated pursuant to section 1515 of the Act and 42 CFR Part 122.

(g) "Hospital" includes general, tuberculosis, and other types of hospitals, and related facilities such as laboratories, outpatient departments, nurses' home facilities, extended care facilities, facilities related to programs for home health services, self-care units, and central service facilities, operated in connection with hospitals, and education or training facilities for health professional personnel operated as an integral part of a hospital, but does not include any facility furnishing primarily domiciliary care.

(h) "Major repair" means those repairs to an existing building, excluding routine maintenance, which restore the building to a sound state, the cost of which is a least 10 percent of plant value or $200,000, whichever is greater. "Plant value" means the historic book value of the building at the time of application for assistance under this subpart.

(i) "Medical facility" means a hospital, public health center, outpatient medical facility, rehabilitation facility, or a facility for long-term care.

(j) "Modernization” means the alteration, expansion (excluding expansion which increases bed capacity), major repair, remodeling, replacement, and renovation of existing buildings (in

cluding initial equipment thereof), and the replacement of obsolete equipment of existing buildings, including energy conservation projects.

(k) "Outpatient medical facility” means a facility, located in or apart from a hospital, for the diagnosis or diagnosis and treatment of ambulatory patients (including ambulatory inpatients):

(1) Which is operated in connection with a hospital, or

(2) In which patient care of a specialized nature (such as in an eye clinic, dental clinic, or ambulatory surgical center) is provided under the professional supervision of persons licensed to practice medicine or surgery in the State, or in the case of dental diagnosis or treatment, under the professional supervision of persons licensed to practice dentistry in the State, or

(3) Which offers to patients not requiring hospitalization the services of licensed physicians in various medical specialties, and which provides to its patients a reasonably full range of diagnostic and treatment services.

(1) "Public health center" means a publicly owned facility for the provision of public health services, including related facilities such as laboratories, clinics, and administrative offices operated in connection with such a facility.

"Quasi-public

(m) corporation" means a private, nonprofit corporation which has been formally given one or more governmental powers by a general-purpose unit of government to enable it to carry out its work.

(n) "Rehabilitation facility" means a facility which is operated for the primary purpose of assisting in the rehabilitation of disabled persons through an integrated program of medical evaluation and services, and psychological, social, or vocational evaluation and services, under competent professional supervision, and in the case of which the major portion of the required evaluation and services is furnished within the facility; and either the facility is operated in connection with a hospital, or all medical and related health services are prescribed by, or are under the general direction of persons

licensed to practice medicine or surgery in the State.

(o) "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.

(p) "State" means any one of the several States, the Commonwealth of Puerto Rico, Guam, American Samoa, the Trust Territory of the Pacific Islands, the Virgin Islands, and the District of Columbia.

(q) "State health planning and development agency" or "State Agency" means the agency of a State government which has been conditionally or fully designated under section 1521 of the Act and 42 CFR Part 123.

(r) "Title" means a fee simple, or such other estate or interest in the project site (including a leasehold on which the rental does not exceed 4 percent of the value of the land) as the Secretary finds sufficient to assure undisturbed use and possession for the purpose of construction or modernization and operation of the project for a period of not less than twenty years.

(s) "Urban or rural poverty area" means a census tract, census county division, or minor civil division, as applicable, in which the percentage of the residents with incomes below the poverty level, as defined by the Secretary of Commerce is not less than the percentage derived in accordance with the following sentence. This percentage shall be derived so that the percentage of the total population of the United States residing in all such areas is equal to the percentage of the total population of the United States with incomes below such poverty level, plus five percent.

§ 124.3 Eligibility.

(a) Eligible applicants. A grant under section 1625 may only be made to a State or political subdivision of a State, including any city, town, county, borough, hospital district authority, or public or quasi-public corporation for a project described in paragraph (b) of this section for a medical facility owned, operated, or

owned and operated by the State or political subdivision.

(b) Eligible project. A grant under section 1625 may be made only for a construction and/or modernization project designed to:

(1) Eliminate or prevent safety haz ards which under Federal, State, and/ or local fire, building or life safety codes or regulations, will, in the judgment of the Secretary result in one or more of the following:

(i) Loss of licensure for the facility. (ii) Closing of all or a substantial part of the facility,

(iii) Loss of eligibility for reimbursement under Title XVIII or Title XIX of the Social Security Act; or

(2) Avoid noncompliance with State licensure or voluntary accreditation standards where noncompliance will, in the judgment of the Secretary, result in one or both of the following: (i) Loss of licensure for the facility, (ii) Loss of accreditation resulting in loss of eligibility for reimbursement under Title XVIII or Title XIX of the Social Security Act.

§ 124.4 Application.

An application for a grant under this subpart must be submitted directly to the Secretary at such time and in such form and manner as the Secretary may prescribe. The application must be executed by an individual authorized to act for the applicant and assume on behalf of the applicant the obligations imposed by the Act, this subpart, and the terms and conditions of the grant. The application must contain the following:

(a) A description of the site of the project.

(b) A full description, with all appropriate documentation, of:

(1) The imminent safety hazards, licensure and/or accreditation problems of the facility;

(2) The type and amount of assistance sought under this subpart;

(3) The construction of modernization project for which funds are sought, describing how it will remedy the problems described pursuant to paragraph (b)(1) of this section, with a complete schedule for the proposed construction or modernization; and

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