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51c.506 Use of grant funds.

nues, other resources, and grants 510.507 Facility which has previously re

port under this part. ceived Federal grant.

(d) Environmental health AUTHORITY: Sec. 330, Public Health Service

means the detection and alleviatio: Act, 89 Stat. 342, (42 U.S.C. 254c); sec. 215,

unhealthful conditions of the entire Public Health Service Act, 58 Stat. 690, (42 U.S.C. 216).

ment of the catchment area, such

problems associated with water supp SOURCE: 41 FR 53205, Dec. 3, 1976, unless sewage treatment, solid waste dispose otherwise noted.

rodent and parasite infestation,

housing conditions. For the purposes Subpart A-General Provisions this part, the detection and alleviatis

of unhealthful conditions of the en $51c.101 Applicability.

ronment includes the notification The regulations of this subpart are and making of arrangements with applicable to all project grants author- propriate Federal, State, or local ized by section 330 of the Public Health thorities responsible for correctin Service Act (42 U.S.C. 254c).

such conditions. $51c.102 Definitions.

(e) Medically underserved population

means the population of an urban a As used in this part:

rural area designated by the Secretary (a) Act means the Public Health Serv

as an area with a shortage of persone ice Act.

health services or a population gro4 (b) Catchment area means the area

designated by the Secretary as having served by a project funded under sec

a shortage of such services. Medicals tion 330 of the Act.

underserved areas will be designated to (c)(1) Community health center or cen

the Secretary and a list of those des ter means an entity which, through its

ignated will be published in the For staff and supporting resources


ERAL REGISTER from time to time, tali through contracts or cooperative ar

ing into consideration the followin: rangements with other public or pri

factors, among others: vate entities, provides for all residents of its catchment area:

(1) Available health resources in rels(1) Primary health services;

tion to size of the area and its pop! (ii) As determined by the Secretary

lation, including appropriate ratios of to be appropriate for particular cen

primary care physicians in general of ters, supplemental health services nec

family practice, internal medicine, pe essary for the adequate support of pri

diatrics, or obstetrics and gynecologi mary health services;

to population; (111) Referral to providers of supple

(2) Health indices for the population mental health services and payment, as

of the area, such as infant mortality determined by the Secretary to be ap

rate; propriate and feasible, for their provi

(3) Economic factors affecting the sion of such services;

population's access to health services. (iv) Environmental health services, such as percentage of the population as determined by the Secretary to be

with incomes below the poverty level: appropriate for particular centers; and

and (v) Information on the availability (4) Demographic factors affecting the and proper use of health services.

population's need and demand for (2) For purposes of paragraph (c)(1) of health services, such as percentage of this section, the provision of a given the population age 65 and over. service by a center will be determined (1) Nonprofit, as applied to any priby the Secretary to be appropriate vate agency, institution, or organizawhere:

on, means one which is a corporation (1) There is a need, as determined

sociation, or is owned and oper the Secretary, for the provision of

v one or more corporations or 88service in the catchment area; and

... no part of the net earnings (ii) The provision of such servi

s may lawfully inure, the center is feasible, taking into

Dy private sharesideration the center's projected i

) Physician means a licensed doctor medicine or doctor of osteopathy. ) Primary health services means: ) Diagnostic, treatment, consultre, referral, and other services rened by physicians, and, where feae, by physician's extenders, such as -sicians' assistants, nurse clinicians,

nurse practitioners; 2) Diagnostic laboratory services I diagnostic radiologic services; :) Preventive health services, inding medical social services, nutrinal assessment and referral, preven

health education, children's eye 1 ear examinations, prenatal and -t-partum care, prenatal services, il child care (including periodic eening), immunizations, and voltary family planning services; 4) Emergency medical services, inding provision, through clearly deed arrangements, for access of users the center to health care for medical nergencies during and after the cenr's regularly scheduled hours; (5) Transportation services as needed r adequate patient care, sufficient so at residents of the catchment area rved by the center with special difculties of access to services provided - the center receive such services; and (6) Preventive dental services proded by a licensed dentist or other ualified personnel, including (i) oral ygiene instruction; (ii) oral prophy-xis, as necessary; and (iii) topical apication of fluorides, and the prescripon of fluorides for systemic use when ot available in the community water apply.

(i) Secretary means the Secretary of Iealth and Human Services and any ther officer or employee of the Deartment of Health and Human Servces to whom the authority involved Las been delegated.

(j) Supplemental health services means Lealth services which are not included s primary health services and which

(5) Mental health services, including services of psychiatrists, psychologists, and other appropriate mental health professionals;

(6) Dental services other than those provided as primary health services;

(7) Vision services, including routine eye and vision examinations and provision of eyeglasses, as appropriate and feasible;

(8) Allied health services;

(9) Pharmaceutical services, including the provision of prescription drugs;

(10) Therapeutic radiologic services;

(11) Public health services (including nutrition education and social services);

(12) Ambulatory surgical services;
(13) Health education services; and

(14) Services, including the services of outreach workers, which promote and facilitate optimal use of primary health services and services referred to in the preceding subparagraphs of this paragraph and, if a substantial number of individuals in the population served by the center are of limited Englishspeaking ability, the services of outreach workers and other personnel fluent in the language or languages spoken by such individuals.

851c.103 Eligibility.

Any public or nonprofit private entity is eligible to apply for a grant under this part.

851c.104 Application.

(a) An application for a grant under this part shall be submitted to the Secretary at such time and in such form and manner as the Secretary may prescribe.

(b) The application shall contain a budget and narrative plan of the manner in which the applicant intends to conduct the project and carry out the requirements of this part. The application must describe how and the extent to which the project has met, or plans to meet, each of the requirements in subpart B (relating to grants for planning and developing community health centers), subpart C (relating to grants for the operation of community health centers), or subpart D (relating to grants for the operation of community health projects), as applicable. In addition, applications must include:


(1) Inpatient and outpatient hospital ervices; (2) Home health services; (3) Extended care facility services;

(4) Rehabilitative services (including Qhysical and occupational therapy) and long-term physical medicine;

157-163 0-95-7

(1) A statement of specific, measur- accountant licensed before Decek able objectives and the methods to be 31, 1970, will be engaged to certify used to assess the achievement of the the system for the management e objectives in specified time periods and control of its financial assets wil : at least on an annual basis.

accord with sound financial manat (2) The precise boundaries of the ment practices, including applist catchment area to be served by the ap- Federal requirements. plicant, including an identification of (7) A list of all services propter the medically underserved population be provided by the project. or populations within the catchment (8) A list of services which are t area. In addition, the application shall provided directly by the pre include information sufficient to en- through its own staff and resources able the Secretary to determine that a description of any contractual the applicant's catchment area meets other arrangements (including cup the following criteria:

of documents, where available) eta (1) The size of such area is such that into, or planned for the provision the services to be provided by the ap- services. plicant are available and accessible to (9) The schedule of fees and/or the residents of the area promptly and ments and schedule of discounts as appropriate;

services provided by the project. (ii) The boundaries of such area con

(10) Evidence that all applicable ? form, to the extent practicable, to rel- quirements for review and/or appropi evant boundaries of political subdivi- of the application under title XV 01 03 sions, school districts, and areas served

Act have been met. by Federal and State health and social (11) An assurance that the protect service programs; and

will be conducted in accordance with (iii) The boundaries of such area

the applicable requirements of eliminate, to the extent possible, bar

part. riers resulting from the area's physical (c) The application must be execute characteristics, its residential pat

by an individual authorized to act." terns, its economic and social

the applicant and

to assume on bebi groupings, and available transpor

of the applicant the obligations tation.

posed by the statute, the applican (3) The results of an assessment of

regulations of this part, and any ada the need that the population served or

tional conditions of the grant. proposed to be served has for the services to be provided by the project (or in

(Sec. 330, Public Health Service Act, Sa the case of applications for planning

342, (42 U.S.C. 254c); sec. 215, Publt &

Service Act, 58 Stat. 690, 67 Stat. 6.00SC and development projects, the methods 216)). to be used in assessing such need), utilizing, but not limited to, the factors

(41 FR 53205, Dec. 3, 1976, as amended ett

FR 29201, June 24, 1983; 48 FR 45658. Oct set forth in 851c.102(e)(1)-(4).

1983) (4) Position descriptions for key personnel who will be utilized in carrying

851c.105 Accord with health planning out the activities of the project and a A grant may be made under this De statement indicating the need for the only if the applicable requirements positions to be supported with grant title XV of the Act relating to revie funds to accomplish the objectives of the project.

and approval by the appropriate heal

planning agencies have been met. (5) Letters and other forms of evidence showing that efforts have been

851c.106 Amount of grant. made to secure financial and professional assistance and support for the

(a) The amount of any award unde

this part will be determined by project within the proposed catchment Secretary on the basis of his estimat area and the continuing involvement of of the sum necessary for a designate the community in the development and portion of direct project costs plus at operation of the project. (6) An assurance that an independent

additional amount for indirect costs, il

any, which will be calculated by certified public accountant, or a public Secretary either

On the basis of the estimate of the funds granted and the period for which al indirect costs reasonably relat- support is recommended. the project; or

(c) Neither the approval of any projOn the basis of a percentage of all, ect nor any grant award shall commit - portion of, the estimated direct or obligate the United States in any 3 of the project when there are rea- way to make any additional, suppleble assurances that the use of such mental, continuation, or other award entage will not exceed the approxi- with respect to any approved project or e actual indirect costs. Such award portion thereof. For continuation sup - include an estimated provisional port, grantees must make separate apunt for indirect costs or for des- plication. cted direct costs (such as fringe

851c.107 Use of project funds. efit rates) subject to upward (withhe limits of available funds) as well (a) Any funds granted pursuant to downward adjustments to actual this part, as well as other funds to be us when the amount properly ex

used in performance of the approved ded by the grantee for provisional project, may be expended solely for ns has been determined by the Sec- carrying out the approved project in ary: Provided, however, That no

accordance with section 330 of the Act, nt shall be made for an amount in the applicable regulations of this part, ess of the total cost found necessary

the terms and conditions of the award, the Secretary to carry out the

and the applicable cost principles preject.

scribed in subpart Q of 45 CFR part 74. -) In determining the percentage of

(b) Project funds awarded under this ject costs to be borne by the grant

part may be used for, but need not be factors which the Secretary will

limited to, the following: se into consideration will include

(1) The costs of acquiring and mod; following:

ernizing existing buildings (including

the costs of amortizing the principal A) The ability of the grantee to fi

of, and paying interest on, loans), but ace its share of project costs from

only in accordance with subpart E of 2-Federal sources;

this part and as approved in the grant B) The need in the area served by

award; project for the services to be pro

(2) The costs of obtaining technical ied; and

assistance to develop and improve the C) The extent to which the project

management capability of the project, Il provide services in an innovative

but only as approved by the Secretary; inner which the Secretary desires to

(3) The reimbursement of members of mulate in the interest of developing

the grantee's governing board, if any, ore effective health service delivery

for reasonable expenses actually instems a regional or national

curred by reason of their participation sis.

in board activities; (ii) At any time after approval of an

(4) The reimbursement of governing plication under this part, the Sec- board members for wages lost by reatary may retroactively agree to a son of participation in the activities of rcentage of project costs to be borne

such board if the member is from a , the grantee lower than that deter- family with an annual family income ined pursuant to paragraph (a)(2)(i) of below $10,000 or if the member is a sinis section where he finds


gle person with an annual income anged circumstances justify a small- below $7,000; contribution.

(5) The cost of delivering health serv(iii) In determining the grantee's ices, including services rendered on a lare of project costs, costs borne by prepaid capitation basis, to residents of -deral grant funds, or costs used to the project's catchment area within atch other Federal grants, may not the following limitations: grant funds

included except as otherwise pro- may be used to pay the full cost of ded by law or regulations.

project services to individuals and fam(b) All grant awards shall be in writ- ilies with annual incomes at or below ig, and shall set forth the amount of those set forth in the most recent


"CSA Income Poverty Guidelines" (45 CFR 1060.2) issued by the Community Services Administration; and to pay the portion of the cost of services provided in accordance with the schedule of discounts which, under such schedule, is uncompensated; Provided, That (1) charges will be made to such individuals and families in accordance with $510.303(1) of subpart C; (ii) reasonable effort shall be made to collect such charges under a billing and collections system; and (iii) the charge to grant funds shall exclude any amounts collected pursuant to paragraph (b)(5)(ii) of this section;

(6) The cost of insurance for medical emergency and out-of-area coverage;

(7) The cost of providing to the staff of the project training related to the provision of health services provided or to be provided by the project, and, to the staff and governing board, if any, training related to the management of an ambulatory care facility, consistent with the applicable requirements of 45 CFR part 74; and

(8) The cost of developing and maintaining a reserve fund where required by State law for prepaid health care plans.

(c) Prior approval by the Secretary of revisions of the budget and project plan is required whenever there is to be a significant change in the scope or nature of project activities.

gram or activity receiving Federal ? nancial assistance. A regulation imple menting such title VI, which applies to grants made under this part, has been issued by the Secretary of Health a. Human Services with the approval ? the President (45 CFR part 80). In ad tion, no person shall, on the ground age, sex, creed, or marital status ( less otherwise medically indicated), * excluded from participation in, bet nied the benefits of, or be subjected is discrimination under any program activity so receiving Federal finance assistance.

(b) Attention is called to the requirt ments of section 504 of the Rehabilita tion Act of 1973, as amended, wh provides that no otherwise qualif: handicapped individual in the Unit States shall, solely by reason of handicap, be excluded from partic tion in, be denied the benefits of, or be subjected to discrimination under ans program or activity receiving Federal financial assistance. 851c.110 Confidentiality.

All information as to personal faci and circumstances obtained by the project staff about recipients of sert ices shall be held confidential, and shall not be divulged without the inde vidual's consent except as may be quired by law or as may be necessar to provide service to the individual * to provide for medical audits by the Secretary or his designee with appr priate safeguards for confidentiality * patient records. Otherwise, informe tion may be disclosed only in sur mary, statistical, or other form which does not identify particular individ uals. $51c.111 Publications and copyright

Except as may otherwise be provide under the terms and conditions of the award, the grantee may copyrigði without prior approval any publics tions, films, or similar materials devel oped or resulting from a project sup som ported by a grant under this part, sub ject, however,

to a royalty-free. Da nonexclusive, and irrevocable license, an or right in the Government to repro- & duce, translate, publish, use, disseminate, and dispose of such materials and DIE to authorize others to do so.


851c.108 Grant payments.

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, to the extent he determines such payments necessary to promote prompt initiation and advancement of the approved project.

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851c.109 Nondiscrimination.

(a) Attention is called to the requirements of title VI of the Civil Rights Act of 1964 (78 Stat. 252, (42 U.S.C. 20000 et seq.)) and in particular section 601 of such Act which provides that no person in the United States shall the grounds of race, color, or national origin be excluded from participation, in be denied the benefits of, or be subjected to discrimination under any pro


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