§ 53.23 Existing tuberculosis hospital beds.

(a) The count of existing tuberculosis hospitals beds shall include the beds in tuberculosis hospitals, which are not included in the count of beds for any other category, and also beds in any general hopsital which are specifically assigned for the care of patients with tuberculosis, provided the beds so assigned in any such general hospital number 10 or more.

(b) Existing tuberculosis hospital beds shall be classified as conforming or non-conforming according to plant evaluation standards as set forth in Subpart B of this part.

Subpart D-Eligibility, Distribution, and Priority of Beds for the Mentally III 1

1

SOURCE: The provisions of this Subpart D appear at 31 F.R. 12095, Sept. 16, 1966, unless otherwise noted.

§ 53.31 Mental health services principally for persons residing in the community.

(a) For the purpose of determining need and priority, the State plan ap- proved or approvable under the Community Mental Health Centers Act (P.L. 788-164, 42 U.S.C. 2681 et seq.) shall constitute that portion of the plan under Title VI of the PHS Act (Hill-Burton) for construction of facilities for providing services principally for persons residing in a particular community or communities in or near which the facility is situated for the prevention or diagnosis of mental illness, or care and treatment of mentally ill patients, or rehabilitation of such persons.

(b) Special consideration shall be given to those projects for which the applicant sets forth in his application a reasonable and feasible proposal for the development, within a reasonable period of time, of a program for the provision of those essential elements of comprehensive mental health services prescribed in § 54.212 of this chapter relating to community mental health centers.

(c) An application for the construction of facilities specified in paragraph

1 Amended, 31 F.R. 12095, Sept. 16, 1966.

(a) of this section may be approved under this part only if the Secretary determines that funds are not available under the Community Mental Health Centers program (Part 54, Subpart C, of this chapter).

§ 53.32 Mental health services not principally for persons residing in the community.

(a) With respect to facilities for the mentally ill which do not provide services principally for persons residing in a particular community in or near which the facility is situated, special consideration shall be given to those projects for remodeling or replacing services and facilities which do not increase bed capacity, or if services are being expanded, the applicant demonstrates that no alternative plan for provision of such expanded services is feasible.

(b) An application for construction of facilities specified in paragraph (a) of this section may be approved only if it conforms with the State plan approved under Title VI of the Public Health Service Act (Hill-Burton).

(c) The number of beds required to provide adequate hospital services for mentally ill patients in any State or service area shall be determined by the following method: Divide the current average daily census of each hospital by 0.90 (occupancy factor).

(d) The count of existing mental hospital beds shall include the beds in mental hospitals which are not included in the count of beds in any other category, and also beds in any general hospital which are specifically assigned for the inpatient care of patients with mental illness.

(e) Existing mental hospital beds shall be classified as conforming or nonconforming according to plant evaluation standards as set forth in Subpart B of this part.

Subpart E-Distribution of Public
Health Centers

§ 53.43

Existing public health centers. (a) Where the State Health Department is not the State agency, the number of existing public health centers shall be determined after consultation with the State health authority.

(b) Existing public health centers shall be classified as conforming or nonconforming according to plant evaluations standards, which shall include:

(1) Fire-resistivity of each building; (2) Fire and other safety factors of each building;

(3) Design and structural factors affecting the function of the center. Subpart F-Distribution of Diagnostic or Treatment Centers

Diagnostic or treatment centers shall be planned in sufficient number to make at least the basic minimum services readily available to all persons in the State. Provision of the basic minimum services requires facilities for examination of patients by a physician or a dentist, and the provision of clinical laboratory and diagnostic X-ray services. § 53.52 Distribution (service areas).

(a) To facilitate the necessary relationship between hospitals and diagnostic or treatment centers, distribution of diagnostic or treatment centers shall be planned in the same areas used for distribution of general hospitals and facilities for long-term care.

(b) In determining the need for additional facilities for diagnostic or treat

ment services in an area as a basis for distribution of such facilities, special consideration shall be given to areas in which there is a shortage of services provided by private physicians and dentists. § 53.53 Existing diagnostic or treatment

centers.

(a) The count of existing diagnostic or treatment centers shall exclude:

(1) Offices of private physicians and dentists, whether for individual or group practice;

(2) Industrial clinics for employees only, first aid clinics, and similar facilities not furnishing a community service.

(b) Existing diagnostic or treatment centers shall be classified as conforming or nonconforming according to plant evaluation standards as set forth in Subpart E of this part.

Subpart G-Distribution of

Rehabilitation Facilities

§ 53.61 State need (standards of adequacy).

all

or

(a) Rehabilitation facilities shall be planned by each State so that all persons in the State shall have access to integrated rehabilitation services for types of disabilities. The facility facilities may be programed in the State or by joint planning with one or more other States to serve the residents of such States. In determining the number of rehabilitation facilities and services needed, the State shall consider such factors as the particular needs of the population to be served and the scope and nature of service of the existing and proposed facilities.

Subpart H-Distribution of Modernization Projects for all Categories of Facilities

§ 53.71 Determination of need.

(a) Not later than January 1, 1966, the need for modernization shall be determined for each category of facilities by evaluation of existing facilities and with initial consideration being given to the most densely populated areas of the State. The evaluation shall be based on specific standards of plant evaluation, which shall include:

(1) Fire-resistivity of each building; (2) Fire and other safety factors of each building;

(3) Design and structural factors affecting the function of the facility.

(b) Based on the evaluation, beds or facilities shall be classified as conforming or nonconforming. Those beds or facilities which are classified as nonconforming shall represent the beds and facilities in need of modernization.

(c) In the event that an area has a total of existing conforming beds or facilities and existing nonconforming beds or facilities needing modernization which exceeds the total need for the area, the number of beds or facilities to be modernized shall be reduced accordingly. At no time shall the beds or facilities to be modernized, when added to the existing conforming beds or facilities, be greater than the total beds or facilities needed in any one category. § 53.72 Distribution.

Modernization shall be planned for general hospitals, facilities for longterm care, and diagnostic or treatment centers in the service areas used for planning new construction. For other categories of facilities, modernization may be planned on a Statewide basis. Subpart I-Priority of Projects (Excluding Mental Hospitals)

§ 53.82 Hospitals (new construction). Special consideration shall be given to hospitals which will serve rural communities and areas with relatively small financial resources; and prior to July 1, 1965 (and to the extent deemed feasible by the State agency), to hospital facilities which will include new or expanded facilities for nurse training. Relative need for new construction shall be expressed in terms of the ratio of existing conforming beds to total beds needed in each area.

§ 53.83 Facilities for long-term care (new construction).

Priority shall be determined on the basis of the relative need for beds in facilities for long-term care in the area to be served by the project taking into account the utilization of existing beds and giving special consideration to projects operated by or affiliated with hospitals. Relative need for new construction shall be expressed in terms of the ratio of existing conforming beds to total beds needed in each area.

§ 53.84 Diagnostic or treatment Centers (new construction).

The priority of diagnostic or treatment center projects shall be determined on the basis of the relative need for additional diagnostic or treatment services in the area to be served by the project taking into account existing available services and their utilization. § 53.85

Rehabilitation facilities (new construction).

Priority shall be given to rehabilitation facility projects in the order of importance as given below taking into consideration existing rehabilitation services in the community and the need for additional services in the community.

(a) Facilities operated in connection with a university teaching hospital which will provide an integrated program of medical, psychological, social, and vocational evaluation and services under competent supervision.

(b) Facilities offering rehabilitation services for multiple disabilities in hospitals and medical facilities capable of sustaining an organized department of physical medicine and rehabilitation.

(c) All other rehabilitation facilities.

§ 53.86 Public health centers (new construction).

Highest priority in this category shall be given to the provision of facilities for local health units serving rural communities and communities with relatively small financial resources. Where the agency designated to administer the State plan is not the State health authority, the State agency shall determine the relative priorities to be established after consultation with the State health authority.

§ 53.87 Modernization.

Special consideration for modernization shall be given to facilities serving areas of high population density. For each category, relative need shall be expressed for inpatient facilities in terms of the ratio of existing conforming beds in each area to (a) total existing beds in such area, or (b) total beds needed in such area, whichever is less, and for ambulatory (outpatient) facilities the ratio of existing conforming outpatient facilities in each area to (c) total existing outpatient facilities in such area or (d) total outpatient facilities needed in such area, whichever is less. [30 F.R. 9980, Aug. 11, 1965]

Subpart J-Allotments for Modernization and Transfer of State Allotments

§ 53.91

Allotments for modernization.

The allotment to the several States under section 602 (a) (2) of the Act for modernization shall be computed as follows:

(a) 33% percent will be allotted to each State on the basis of population weighted by per capita income; and

(b) 663 percent will be allotted to each State on the basis of the extent of the need for modernization of the facilities:

Provided, however, That the Secretary may make such adjustments as are necessary to assure that the allotment to any State for any fiscal year shall not be less than the allotment to such State for the fiscal year 1966.

[31 F.R. 12095, Sept. 16, 1966]

§ 53.92 Transfer of allotments to another State.

A State may submit a request in writing to the Secretary that a specified portion of its allotment for the construction of hospitals and public health centers, facilities for long-term care, diagnostic or treatment centers, rehabilitation facilities, or for modernization, be added to the corresponding allotment of another State for the purpose of meeting a portion of the Federal share of the cost of a project for the construction or modernization of a facility of the type authorized under the allotments in such other State. In determining whether the facility with respect to which the request is made will meet needs of the State making the request and that use of the specified portion of such State's allotment as requested by it will assist in carrying out the purposes of the Federal Act, the Secretary shall consider the accessibility of the facility and the extent to which services will be made available to the residents of the State making the request for the transfer.

[29 F.R. 18447, Dec. 29, 1964, as amended at 33 F.R. 10145, July 16, 1968]

§ 53.93 Transfer of allotments for modernization to another category within a State.

(a) For the purpose of transfer of allotments as authorized by section 602 (e) (1) of the Federal Act, a reasonable opportunity for applicants to submit approvable applications for modernization projects shall include a period of time during which applications may be submitted which is not less than 12 months from the date an application for such a project could first have been approved in accordance with the Act and these regulations.

(b) A determination under section 602(e) (2) of the Federal Act that there is a greater need for facilities other than modernization projects shall be made only after completion of the determination of the State's needs for modernization projects pursuant to Subpart H of this part and in accordance with the approved State plan.

(a) Plans and specifications for each project submitted to the Secretary for approval, and in the case of rehabilitation facilities, the approval of the Secretary, under the Federal Act shall be prepared in accordance with "General Standards of Construction and equipment for Hospital and Medical Facilities" (PHS No. 930-A-7), and any amendments or revisions thereof, which document is hereby incorporated by reference and deemed published herein. Said document will be provided to all applicants for construction grants under this part, and is available to any interested person, whether or not affected by the provisions of this part, upon request to the Division of Hospital and Medical Facilities,1 Public Health Service, Department of Health, Education, and Welfare, or to the Public Health Service Information Center or Regional Office Information Center as listed in 45 CFR $5.31 (32 F.R. 9316). The Secretary may approve plans and specifications which contain deviations from the requirements prescribed if he is satisfied that the purposes of such requirements have been fulfilled.

(b) The design and construction covered by the plans and specifications must conform with the applicable State and local laws, codes, and ordinances and with the approved State plan. The plans and specifications must be complete and adequate for contract purposes and have the approval and recommendation of the State agency.

(c) Equipment shall be provided in the kind and to the extent necessary for the proper functioning of the facility as planned.

[29 F.R. 18447, Dec. 29, 1964, as amended at 32 FR. 17662, Dec. 12, 1967; 33 F.R. 10145, July 16, 1968]

53.102 Size of mental hospitals.

No application for construction of a mental hospital for intensive care with a capacity of more than 500 beds or of a mental hospital for long-term care with

1 The Division also maintains an official, historic file of PHS No. 930-A-7.

a capacity of more than 3,000 beds shall be approved. This requirement shall not be construed to prevent approval of applications for improvements of mental hospitals with bed capacities equal to or greater than those specified above, if such improvements are designed to provide more intensive treatment facilities within such hospitals.

§ 53.103 Size of tuberculosis hospitals.

No application for construction of a tuberculosis hospital with a capacity of less than 100 beds shall be approved, except that an application for construction of a tuberculosis hospital with a capacity from 50 to 100 beds may be approved where necessary (a) to provide facilities for an isolated area too small to support a larger hospital, or (b) to expand, remodel, or alter existing hospital facilities.

§ 53.104 Size of facilities for long-term

care.

No application shall be approved for construction of a facility for long-term care, not an addition to a hospital, with a capacity of less than 10 beds.

Subpart L-Community Service; Services for Persons Unable To Pay; Nondiscrimination

§ 53.111 Community service; services for persons unable to pay; nondiscrimination on account of creed.

Before an application for the construction of a hospital or medical facility is recommended by a State agency for approval, the State agency shall obtain assurances from the applicant that:

(a) The facility will furnish a community service;

(b) The facility will furnish below cost or without charge a reasonable volume of services to persons unable to pay therefor. As used in this paragraph, "persons unable to pay therefor" includes persons who are otherwise selfsupporting but are unable to pay the full cost of needed services. Such services may be paid for wholly or partly out of public funds or contributions of individuals and private and charitable organizations such as community chest or may be contributed at the expense of