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-112 Grantee accountability.

(ii) Any credits for earned interest

pursuant to paragraph (b) of this secAccounting for grant award pay

tion; ts. All payments made by the Sec

(iii) Any other amounts due pursuant cry shall be recorded by the grantee

to subparts F, M, and 0 of 45 CFR part accounting records separate from

74. records of all other funds, including is derived from other grant awards. $51c.113 Applicability of 45 CFR Part h respect to each approved project, 74. grantee shall account for the sum

The provisions of 45 CFR part 74, esal of all amounts paid as well as

tablishing uniform administrative reer funds and in-kind contributions

quirements and cost principles, shall presenting or otherwise making

apply to all grants under this part to ilable evidence satisfactory to the State and local governments as those retary of expenditure for direct and

terms are defined in subpart A of that irect costs meeting the require- part 74. The relevant provisions of the nts of this part: Provided, however,

following subparts of part 74 shall also at when the amount awarded for in

apply to grants to all other grantee orect costs was based on a predeter- ganizations under this part: ned fixed-percentage of estimated diEt costs, the amount allowed for indi

45 CFR PART 74 et costs shall be computed on the

Subpart sis of such predetermined fixed-per

A General. atage rates applied to the total, or a

B Cash depositories. lected element thereof, of the reim

C Bonding and insurance. rsable direct costs incurred.

D Retention and custodial requirements for (b) Accounting for interest earned on records. ant funds. Pursuant to section 203 of

F Grant-related income. e

G Matching and cost sharing.
Intergovernmental Cooperation

K Grant payment requirements. ct of 1968 (42 U.S.C. 4213), a State will

L Budget revision procedures. ot be held accountable for interest M Grant closeout, suspension, and termicrned on grant funds, pending their nation. sbursement for grant purposes. A

O Property. cate, as defined in section 102 of the

Q Cost principles. tergovernmental Cooperation Act, eans any one of the several States, Subpart B-Grants

Subpart B-Grants for Planning ne District of Columbia, Puerto Rico, and Developing Community ny territory or possession of the Unit- Health Centers

States, or any agency or instrumenality of a State, but does not include $51c.201 Applicability. ne government of the political sub

The regulations of this subpart, in ivisions of the State. All grantees addition to the regulations of subpart ther than a State, as defined, must re- A of this part, are applicable to grants urn all interest earned on grant funds awarded pursuant to section 330(c) of o the Federal Government.

the Act for projects for planning and (c) Grant closeout—(1) Date of final ac- developing community health centers ounting. A grantee shall render, with which will serve medically underserved espect to each approved project, a full populations. ccount, as provided herein, as of the ate of the termination of grant sup

851c.202 Application. sort. The Secretary may require other To be approved by the Secretary pecial and periodic accounting.

under this subpart, an application for a (2) Final settlement. There shall be grant must, in addition to meeting the Jayable to the Federal Government as requirements of $51c.104 of subpart A, inal settlement with respect to each contain information sufficient to enipproved project the total sum of: able the Secretary to determine that - (i) Any amount not accounted for the project for which the grant is pursuant to paragraph (a) of this sec- sought will meet the requirements of ion;


and efica

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$51c.203 Project elements.

851c.204 Grant evaluation and award A project for the planning and devel- (a) Within the limits of funds det oping of a community health center mined by the Secretary to be availah supported under this subpart must: for such purpose, the Secretary

(a) Prepare an assessment of the need award grants under this subpart up of the population proposed to be served plicants therefor which will, in ? by the community health center for judgment, best promote the purpose the services set forth in $51c.102(c)(1) of section 330(c) of the Act and the ar subpart A, with special attention to cable regulations of this part, tabi the need of the medically underserved

into account: population for such services. Such as- (1) The degree to which the propos sessment of need shall, at a minimum, project satisfactorily provides for a consider the factors listed in elements set forth in $510.203; $51c.102(e)(1)(4).

(2) The relative need of the paper (b) Design a community health cen

lation to be served for the services ** ter program for such population, based

be provided; on such assessment, which indicates in

(3) The administrative and is detail how the proposed community

ment capability of the applicant, health center will fulfill the needs

(4) The potential of the project : identified in the assessment prepared

development of

new pursuant to paragraph (a) of this sec

methods for health services del he tion and how it will meet the require

and management; ments contained in subpart of this

(5) The soundness of the fiscal s part.

for assuring effective utilization th (c) Develop a plan for the implemen

grant funds and maximizing non-stan tation of the program designed pursu


14 ant to paragraph (b) of this section.

(6) The extent to which communi

PE Such implementation plan shall pro

resources will be utilized in the first vide for the time-phased recruitment


$5. and training of the personnel essential

(7) The extent to which grants

A for the operation of a community

proved under this part will provide health center and the gradual assump

appropriate distribution of the DOS

le tion of operational status of the

sources throughout the country, tabi project so that thn project will, in the

into consideration the following a

abi judgment of the Secretary, meet the


pria requirements contained in subpart C of

(i) The urban-rural area to be servi this part as of the end of the project

(ii) The nature of the organizatir Sure period.

applying; and (d) Implement the plan developed

(iii) The organizational structure in pursuant to paragraph (c) of this sec

delivery of services; tion in accordance with such para

(8) Whether the project's catchmer graph.

area is exclusive of the area served (e) Make efforts to secure, within the

a community health center; proposed catchment area of such center

(9) The degree to which the applica to the extent possible, financial and

intends to integrate services suppo professional assistance and support for

by a grant under this subpart

health services provided under the project. (1) Initiate and encourage continuing

Federally assisted health services community involvement in the devel

reimbursement programs or projects.

(b) The Secretary may: opment and operation of the project.

(1) Make no more than two grana (2) PE (8) Establish standards and qualifica- under this subpart for tions for personnel (including the project. project director).

(2) Make a grant under this subpan propose (h) Utilize, to the maximum extent to an entity which has been awarded served feasible, other Federal, State, local, one and private resources available for sup- 330(d)(1)(A) and/or section 330dX1XBT ! Be

or more grants under section shall: port of the project, prior to use of project funds under this subpart.




ing recor

(c ance follc


suppo and to



the same

and the


of the Act only if the grant under this subpart is for a new project.

under the

ppart C-Grants for Operating Community Health Centers 301 Applicability. e regulations of this subpart, in tion to the regulations of subpart -re applicable to grants awarded uant to section 330(d)(1)(A) of the for the costs of operation of comity health centers which serve ically underserved populations. .302 Application.

be approved by the Secretary er this subpart, an application for a at must, in addition to meeting the airements of $ 51c.104 of subpart A, ) Be submitted by an entity which

be a co-applicant which the Secry determines is a community lth center, and -) Contain information sufficient to ble the Secretary to determine that

center will meet the requirements 551c.103. FR 53205, Dec. 3, 1976, as amended at 42 60418, Nov. 25, 1977)

Ic.303 Project elements. 1 community health center supted under this subpart must: a) Provide the health services of the ater so that such services are availle and accessible promptly, as approiate, and in a manner which will asce continuity of service to the resints of the center's catchment area. b) Implement a system for maintain3 the confidentiality of patient cords in accordance with the requireents of $51c.110 of subpart A. (c) Have an ongoing quality assurice program which provides for the llowing: (1) Organizational arrangements, inuding a focus of responsibility, to ipport the quality assurance program ad the provision of high quality paent care; (2) Periodic assessment of the approriateness of the utilization of services nd the quality of services provided or roposed to be provided to individuals erved by the center. Such assessments hall:

(i) Be conducted by physicians or by ther licensed health professionals inder the supervision of physicians;

(ii) Be based on the systematic collection and evaluation of patient records; and

(iii) Identify and document the necessity for change in the provision of services by the center and result in the institution of such change, where indicated.

(d) Develop management and control systems which are in accordance with sound financial management procedures, including the provision for an audit on an annual basis (unless waived for cause by the Secretary) by an independent certified public accountant or a public accountant licensed prior to December 31, 1970, to determine, at a minimum, the fiscal integrity of grant financial transactions and reports, and compliance with the regulations of this part and the terms and conditions of the grant.

(e) Where the cost of care and services furnished by or through the project is to be reimbursed under title XIX or title XX of the Social Security Act, obtain or make every reasonable effort to obtain a written agreement with the title XIX or title XX State agency for such reimbursement.

(f) Have prepared a schedule of fees or payments for the provision of its services designed to cover its reasonable costs of operation and a corresponding schedule of discounts adjusted on the basis of the patient's ability to pay. Provided, That such schedule of discounts shall provide for a full discount to individuals and families with annual incomes at or below those set forth in the most recent CSA Proverty Income Guidelines (45 CFR 1060.2) and for no discount to individuals and families with annual incomes greater than twice those set forth in such Guidelines, except that nominal fees for services may be collected from individuals with annual incomes at or below such levels where imposition of such fees is consistent with project goals.

(8) Make every reasonable effort, including the establishment of systems for eligibility determination, billing, and collection, to:

(1) Collect reimbursement for its costs in providing health services to persons who are entitled to insurance benefits under title XVIII of the Social Security Act, to medical assistance

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under a State plan approved under title accessibility, and acceptability ? XIX of such Act, to social services and services and to make such repora family planning under title XX of such the Secretary in a timely manner Act, or to assistance for medical ex- such frequency as the Secretary a penses under any other public assist- reasonably require. ance program, grant program, or pri- (k) Review its catchment arti e vate health insurance or benefit pro- ally to insure that the criteria ser gram on the basis of the schedule of

in $51c.104(b)(2) of subpart A are: fees prepared pursuant to paragraph (f)

and, where such criteria are not of this section without application of revise its catchment area, with the any discounts, and

proval of the Secretary, to confora (2) Secure from patients payments such criteria to the extent feasible for services in accordance with the schedule of fees and discounts required

(1) In the case of a center by paragraph (f) of this section.

serves a population including 15 (h) Have a governing board which

stantial proportion of individas: meets the requirements of $510.304.

limited English-speaking abiliz* (i) Have developed an overall plan

developed a plan and made an and budget for the center that:

ments responsive to the needs of E (1) Provides for an annual operating

populations for providing services budget and a three-year financial man

the extent practicable in the last agement plan which include all antici

and cultural context most app pated income and expenses related to

to such individuals, and have its items which would, under generally ac

an individual on its staff who cepted accounting principles, be con

in both that language and in E sidered income and expense items;

and whose responsibilities include (2) Provides for a capital expendi

viding guidance to such individuasi tures plan for at least a three-year pe

to appropriate staff members wil riod (including the year to which the

spect to cultural sensitivities operating budget described in para

bridging linguistic and cultura graph (i)(1) of this section is applica

ferences. If more than one non-Eni ble) which includes and identifies in de

language is spoken by such gTVtail the anticipated sources of financ

groups, an individual or individuak ing for, and the objective of, each an

ent in those languages and Eli ticipated expenditure in

shall be so identified.

of $100,000 related to the acquisition of

(m) Be operated in a manner land, the improvement of land, build

culated to preserve human dignity ings, and equipment and the replace

to maximize acceptability and effe: ment, modernization and expansion of

utilization of services. buildings and equipment which would,

(n) To the extent possible, coordo under generally accepted accounting

and integrate project activities principles, be considered capital items;

the activities of other Federally (3) Provides for plan review and up

ed, as well as State and local, ha dating at least annually; and

services delivery projects and pros? (4) Is prepared under the direction of

serving the same population. the governing board, by a committee (0) Establish means for evalus consisting of representatives of the progress toward the achievement of governing board, and administrative specific objectives of the project. staff, and the medical staff, if any, of the center.

by training and experience, to car

(p) Provide sufficient staff, qualis (j) Establish basic statistical data, out the activities of the center. cost accounting, management informa- (q) Assure that facilities utilized. tion, and reporting or monitoring systems which shall enable the center to

the performance of the project met

applicable fire and life safety codes. provide such statistics and other infor- (r) Utilize, to the maximum exte mation as the Secretary may reason- feasible, other Federal, state, ably require relating to the center's costs of operation, patterns of utiliza

local, and private resources availab

for support of † tion of services, and the availability, of project fư


prior to a

Provide for community participa- (2) No more than one-half of the re

through, for example, contribu- maining members of the board may be 3 of cash or services, loans of full- individuals who derive more than 10 art-time staff, equipment, space, percent of their annual income from erials, or facilities.

the health care industry. Where the center will provide (3) The remaining members of the Fices through contract or other co- board shall be representative of the

ative arrangements with other pro- community in which the center's rs of services, establish rates and catchment area is located and shall be hods of payment for health care. selected for their expertise in commu

payments must be made pursuant nity affairs, local government, finance greements, with a schedule of rates and banking, legal affairs, trade payment procedures maintained by unions, and other commercial and inproject. The project must be pre- dustrial concerns, or social service

d to substantiate that such rates agencies within the community. reasonable and necessary.

(4) No member of the board shall be ) Operate in a manner such that no an employee of the center, or spouse or on shall be denied service by rea- child, parent, brother or sister by blood

of his inability to pay therefor: or marriage of such an employee. The rided, however, That a charge for project director may be a non-voting, provision of services will be made ex-officio member of the board. he extent that a third party (in- (c) Selection of members. The method sing a Government agency) is au- of selection of all governing board sized or is under legal obligation to members shall be prescribed in the bysuch charges.

laws or other internal governing rules In addition to the above, projects of the center. Such by-laws or other ch are supported with grant funds rules must specify a process of selec

the operation of a prepaid health tion of individuals on the governing Le plan also must provide:

board who represent the population -) A marketing and enrollment plan, served or to be served by the center so Tuding market analysis, marketing that such individuals, as a group, are ategy, and enrollment growth pro- representative of such population. tions.

Such process of selection in the by2) A plan that provides for funding laws or other rules is subject to ap

a capitation basis of such portion of proval by the Secretary. a residents of the catchment area of (d) Functions and responsibilities. (1)

center, as the Secretary shall de- The governing board for the center mine.

shall have authority for the establish3) An assurance that services shall ment of policy in the conduct of the

available to all residents of the center. tchment area without regard to (2) The governing board shall hold thod of payment or health status. regularly scheduled meetings, at least

once each month, for which minutes 10.304 Governing board.

shall be kept. A governing board for the center (3) The governing board shall have all be established by an applicant as specific responsibility for: llows:

(1) Approval for the selection and dis(a) Size. The board shall consist of at missal of a project director or chief exast 9 but not more than 25 members, ecutive officer of the center; cept that this requirement may be (ii) Establishing personnel policies aived by the Secretary for good cause and procedures, including selection and 10wn.

dismissal procedures, salary and bene(b) Composition. (1) A majority of the fit scales, employee grievance procepard members shall be individuals dures, and equal opportunity practices; -ho are or will be served by the center (iii) Adopting policy for financial nd who, as a group, represent the indi- management practices, including a sysiduals being or to be served in terms

tem to assure accountability for center f demographic factors, such as race,

resources, approval of the annual project budget, center priorities, eligi

thnicity, sex

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