$51c.101

51c.506 Use of grant funds.

51c.507 Facility which has previously received Federal grant.

AUTHORITY: Sec. 330, Public Health Service Act, 89 Stat. 342, (42 U.S.C. 254c); sec. 215, Public Health Service Act, 58 Stat. 690, (42 U.S.C. 216).

SOURCE: 41 FR 53205, Dec. 3, 1976, unless otherwise noted.

Subpart A-General Provisions

$51c.101 Applicability.

The regulations of this subpart are applicable to all project grants authorized by section 330 of the Public Health Service Act (42 U.S.C. 254c).

$51c.102 Definitions.

As used in this part:

(a) Act means the Public Health Service Act.

(b) Catchment area means the area served by a project funded under section 330 of the Act.

or

(c)(1) Community health center or center means an entity which, through its staff and supporting resources through contracts or cooperative arrangements with other public or private entities, provides for all residents of its catchment area:

(1) Primary health services;

(ii) As determined by the Secretary to be appropriate for particular centers, supplemental health services necessary for the adequate support of primary health services;

(iii) Referral to providers of supplemental health services and payment, as determined by the Secretary to be appropriate and feasible, for their provision of such services;

(iv) Environmental health services, as determined by the Secretary to be appropriate for particular centers; and (v) Information on the availability and proper use of health services.

(2) For purposes of paragraph (c)(1) of this section, the provision of a given service by a center will be determined by the Secretary to be appropriate where:

(i) There is a need, as determined the Secretary, for the provision of s service in the catchment area; and

(ii) The provision of such servic the center is feasible, taking into sideration the center's projected r

42 CFR Ch. I (10-1-95 Editor

health sec

(d) Environmental means the detection and alleviation unhealthful conditions of the envire ment of the catchment area, such problems associated with water supp sewage treatment, solid waste dispos rodent and parasite infestation, housing conditions. For the purposes this part, the detection and alleviatin of unhealthful conditions of the env ronment includes the notification and making of arrangements with propriate Federal, State, or local s thorities responsible for correcting such conditions.

(e) Medically underserved population means the population of an urban rural area designated by the Secretary as an area with a shortage of person health services or a population grow designated by the Secretary as having a shortage of such services. Medically underserved areas will be designated by the Secretary and a list of those de ignated will be published in the F ERAL REGISTER from time to time, taling into consideration the following factors, among others:

(1) Available health resources in rels tion to size of the area and its popu lation, including appropriate ratios of primary care physicians in general family practice, internal medicine, pë diatrics, or obstetrics and gynecology to population;

(2) Health indices for the population of the area, such as infant mortality rate;

(3) Economic factors affecting the population's access to health services, such as percentage of the population with incomes below the poverty level: and

(4) Demographic factors affecting the population's need and demand for health services, such as percentage of the population age 65 and over.

(f) Nonprofit, as applied to any private agency, institution, or organizaon, means one which is a corporation ssociation, or is owned and oper

one or more corporations or as3, no part of the net earnings hures-or may lawfully inure, any private share

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5) Physician means a licensed doctor
nedicine or doctor of osteopathy.
a) Primary health services means:
1)

Diagnostic, treatment, consultve, referral, and other services rened by physicians, and, where feale, by physician's extenders, such as ysicians' assistants, nurse clinicians, Id nurse practitioners;

2) Diagnostic laboratory services d diagnostic radiologic services;

3) Preventive health services, iniding medical social services, nutrional assessment and referral, prevenve health education, children's eye d ear examinations, prenatal and st-partum care, prenatal services, ell child care (including periodic reening), immunizations, and voltary family planning services; (4) Emergency medical services, inuding provision, through clearly dened arrangements, for access of users the center to health care for medical mergencies during and after the cener's regularly scheduled hours;

(5) Transportation services as needed For adequate patient care, sufficient so hat residents of the catchment area erved by the center with special dificulties of access to services provided y the center receive such services; and

(6) Preventive dental services pro

sided by a licensed dentist or other

qualified personnel, including (i) oral hygiene instruction; (ii) oral prophysaxis, as necessary; and (iii) topical application of fluorides, and the prescripion of fluorides for systemic use when not available in the community water supply.

(i) Secretary means the Secretary of Health and Human Services and any other officer or employee of the Department of Health and Human Services to whom the authority involved has been delegated.

(j) Supplemental health services means health services which are not included as primary health services and which are:

(1) Inpatient and outpatient hospital services;

(2) Home health services;

(3) Extended care facility services; (4) Rehabilitative services (including physical and occupational therapy) and long-term physical medicine;

(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.

§ 51c.103 Eligibility.

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

$51c.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:

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(1) A statement of specific, measurable objectives and the methods to be used to assess the achievement of the objectives in specified time periods and at least on an annual basis.

(2) The precise boundaries of the catchment area to be served by the applicant, including an identification of the medically underserved population or populations within the catchment area. In addition, the application shall include information sufficient to enable the Secretary to determine that the applicant's catchment area meets the following criteria:

(1) The size of such area is such that the services to be provided by the applicant are available and accessible to the residents of the area promptly and as appropriate;

(ii) The boundaries of such area conform, to the extent practicable, to relevant boundaries of political subdivisions, school districts, and areas served by Federal and State health and social service programs; and

(iii) The boundaries of such area eliminate, to the extent possible, barriers resulting from the area's physical characteristics, its residential patterns, its economic and social groupings, and available transportation.

(3) The results of an assessment of the need that the population served or proposed to be served has for the services to be provided by the project (or in the case of applications for planning and development projects, the methods to be used in assessing such need), utilizing, but not limited to, the factors set forth in §51c.102(e)(1)–(4).

(4) Position descriptions for key personnel who will be utilized in carrying out the activities of the project and a statement indicating the need for the positions to be supported with grant funds to accomplish the objectives of the project.

(5) Letters and other forms of evidence showing that efforts have been made to secure financial and professional assistance and support for the project within the proposed catchment area and the continuing involvement of the community in the development and operation of the project.

(6) An assurance that an independent certified public accountant, or a public

accountant licensed before December 31, 1970, will be engaged to certify th the system for the management control of its financial assets will be accord with sound financial ment practices, including appla Federal requirements.

(7) A list of all services propel be provided by the project.

(8) A list of services which are provided directly by the pro through its own staff and resources & a description of any contractual other arrangements (including cop of documents, where available) enta into, or planned for the provision services.

(9) The schedule of fees and/or ments and schedule of discounts & services provided by the project.

(10) Evidence that all applicable ** quirements for review and/or appro of the application under title XV of th Act have been met.

(11) An assurance that the project will be conducted in accordance with the applicable requirements of the

part.

(c) The application must be execute by an individual authorized to act the applicant and to assume on be of the applicant the obligations posed by the statute, the applicat regulations of this part, and any s tional conditions of the grant. (Sec. 330, Public Health Service Act, Stat 342, (42 U.S.C. 254c); sec. 215, Public Service Act, 58 Stat. 690, 67 Stat. 63U.S.C 216)).

[41 FR 53205, Dec. 3, 1976, as amended st FR 29201, June 24, 1983; 48 FR 45558, Oct. 1983]

$51c.105 Accord with health plannin

A grant may be made under this p only if the applicable requirements title XV of the Act relating to revie and approval by the appropriate heal planning agencies have been met.

$51c.106 Amount of grant.

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(a) The amount of any award unde this part will be determined by Secretary on the basis of his estimate of the sum necessary for a designates portion of direct project costs plus additional amount for indirect costs, any, which will be calculated by the Secretary either:

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1) On the basis of the estimate of the ual indirect costs reasonably relatto the project; or

2) On the basis of a percentage of all, Isa portion of, the estimated direct Cats of the project when there are rea

able assurances that the use of such centage will not exceed the approxiate actual indirect costs. Such award y include an estimated provisional ount for indirect costs or for desated direct costs (such as fringe nefit rates) subject to upward (withthe limits of available funds) as well

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sts when the amount properly exnded by the grantee for provisional ems has been determined by the Sectary: Provided, however, That no ant shall be made for an amount in :cess of the total cost found necessary the Secretary to carry out the oject.

(i) In determining the percentage of

woject costs to be borne by the grantted, factors which the Secretary will ake into consideration will include he following:

(A) The ability of the grantee to fiance its share of project costs from

nd toon-Federal sources;

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the (B) The need in the area served by the project for the services to be proided; and

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(C) The extent to which the project ill provide services in an innovative

Sec. 215anner which the Secretary desires to

20,67 Stimulate in the interest of developing hore effective health service delivery a regional or national 1976, stems on 48 Fasis.

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(ii) At any time after approval of an application under this part, the Secetary may retroactively agree to a

ade percentage of project costs to be borne relati mined pursuant to paragraph (a)(2)(i) of le req by the grantee lower than that deterapprop this section

where he finds that ve been changed circumstances justify a smaller contribution.

funds granted and the period for which support is recommended.

(c) Neither the approval of any project nor any grant award shall commit or obligate the United States in any way to make any additional, supplemental, continuation, or other award with respect to any approved project or portion thereof. For continuation support, grantees must make separate application.

$51c.107 Use of project funds.

(a) Any funds granted pursuant to this part, as well as other funds to be used in performance of the approved project, may be expended solely for carrying out the approved project in accordance with section 330 of the Act, the applicable regulations of this part, the terms and conditions of the award, and the applicable cost principles prescribed in subpart Q of 45 CFR part 74.

(b) Project funds awarded under this part may be used for, but need not be limited to, the following:

(1) The costs of acquiring and modernizing existing buildings (including the costs of amortizing the principal of, and paying interest on, loans), but only in accordance with subpart E of this part and as approved in the grant award;

(2) The costs of obtaining technical assistance to develop and improve the management capability of the project, but only as approved by the Secretary;

(3) The reimbursement of members of the grantee's governing board, if any, for reasonable expenses actually incurred by reason of their participation in board activities;

(4) The reimbursement of governing board members for wages lost by reason of participation in the activities of such board if the member is from a family with an annual family income below $10,000 or if the member is a single person with an annual income below $7,000;

(5) The cost of delivering health services, including services rendered on a prepaid capitation basis, to residents of the project's catchment area within the following limitations: grant funds may be used to pay the full cost of project services to individuals and families with annual incomes at or below those set forth in the most recent