Page images
PDF
EPUB

51c.112 Grantee accountability.

(a) Accounting for grant award payents. All payments made by the Secetary shall be recorded by the grantee 1 accounting records separate from he records of all other funds, including inds derived from other grant awards. With respect to each approved project, he grantee shall account for the sum otal of all amounts paid as well as ther funds and in-kind contributions y presenting or otherwise making vailable evidence satisfactory to the ecretary of expenditure for direct and direct costs meeting the requireients of this part: Provided, however, hat when the amount awarded for inirect costs was based on a predeter

ined fixed-percentage of estimated diect costs, the amount allowed for indiect costs shall be computed on the asis of such predetermined fixed-perentage rates applied to the total, or a elected element thereof, of the reimursable direct costs incurred.

(b) Accounting for interest earned on Irant funds. Pursuant to section 203 of he Intergovernmental Cooperation Act of 1968 (42 U.S.C. 4213), a State will ot be held accountable for interest arned on grant funds, pending their isbursement for grant purposes. A state, as defined in section 102 of the ntergovernmental Cooperation Act, neans any one of the several States, he District of Columbia, Puerto Rico, ny territory or possession of the Unitd States, or any agency or instrumenality of a State, but does not include he government of the political subivisions of the State. All grantees ther than a State, as defined, must reurn all interest earned on grant funds o the Federal Government.

(c) Grant closeout―(1) Date of final acounting. A grantee shall render, with espect to each approved project, a full ccount, as provided herein, as of the date of the termination of grant support. The Secretary may require other pecial and periodic accounting.

(2) Final settlement. There shall be Dayable to the Federal Government as inal settlement with respect to each Approved project the total sum of:

(i) Any amount not accounted for pursuant to paragraph (a) of this section;

[merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][ocr errors][merged small][merged small]

Subpart B-Grants for Planning and Developing Community Health Centers

$51c.201 Applicability.

The regulations of this subpart, in addition to the regulations of subpart A of this part, are applicable to grants awarded pursuant to section 330(c) of the Act for projects for planning and developing community health centers which will serve medically underserved populations.

§ 51c.202 Application.

To be approved by the Secretary under this subpart, an application for a grant must, in addition to meeting the requirements of §51c.104 of subpart A, contain information sufficient to enable the Secretary to determine that the project for which the grant is sought will meet the requirements of § 51c.203.

$51c.203 Project elements.

A project for the planning and developing of a community health center supported under this subpart must:

(a) Prepare an assessment of the need of the population proposed to be served by the community health center for the services set forth in §51c.102(c)(1) of subpart A, with special attention to the need of the medically underserved population for such services. Such assessment of need shall, at a minimum, consider the factors listed in § 51c.102(e)(1)–(4).

(b) Design a community health center program for such population, based on such assessment, which indicates in detail how the proposed community health center will fulfill the needs identified in the assessment prepared pursuant to paragraph (a) of this section and how it will meet the requirements contained in subpart C of this part.

(c) Develop a plan for the implementation of the program designed pursuant to paragraph (b) of this section. Such implementation plan shall provide for the time-phased recruitment and training of the personnel essential for the operation of a community health center and the gradual assumption of operational status of the project so that the project will, in the judgment of the Secretary, meet the requirements contained in subpart C of this part as of the end of the project period.

(d) Implement the plan developed pursuant to paragraph (c) of this section in accordance with such paragraph.

(e) Make efforts to secure, within the proposed catchment area of such center to the extent possible, financial and professional assistance and support for the project.

(f) Initiate and encourage continuing community involvement in the development and operation of the project.

(g) Establish standards and qualifications for personnel (including the project director).

(h) Utilize, to the maximum extent feasible, other Federal, State, local, and private resources available for support of the project, prior to use of project funds under this subpart.

$51c.204 Grant evaluation and award Sub

(a) Within the limits of funds dete mined by the Secretary to be availab for such purpose, the Secretary award grants under this subpart w plicants therefor which will, in judgment, best promote the purpose section 330(c) of the Act and the cable regulations of this part, taki into account:

(1) The degree to which the prop project satisfactorily provides for t elements set forth in §51c.203;

(2) The relative need of the pop
lation to be served for the services i
be provided;

(3) The administrative and manage
ment capability of the applicant
(4) The potential of the project *
development of
methods for health services de
and management;

new

and effer

$51c

Th

addi A, pur Act

mu

med

$51

T

und

gra red

[ocr errors]

ma

re

he

(5) The soundness of the fiscal P for assuring effective utilization grant funds and maximizing non-gran

[blocks in formation]

en

th 0

[ocr errors]

S

bpart C-Grants for Operating Community Health Centers

c.301 Applicability.

he regulations of this subpart, in ition to the regulations of subpart are applicable to grants awarded suant to section 330(d)(1)(A) of the for the costs of operation of comnity health centers which serve lically underserved populations.

c.302 Application.

၁ be approved by the Secretary
er this subpart, an application for a
at must, in addition to meeting the
uirements of § 51c.104 of subpart A,
) Be submitted by an entity which
y be a co-applicant which the Sec-
ary determines is a community
lth center, and

b) Contain information sufficient to ble the Secretary to determine that ess center will meet the requirements ec51c.103.

FR 53205, Dec. 3, 1976, as amended at 42 60418, Nov. 25, 1977]

1c.303 Project elements.

community health center supErted under this subpart must:

a) Provide the health services of the nter so that such services are availle and accessible promptly, as approiate, and in a manner which will asre continuity of service to the resints of the center's catchment area. b) Implement a system for maintainthe 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 apport the quality assurance program nd 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.

(g) 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

$51c.303

under a State plan approved under title XIX of such Act, to social services and family planning under title XX of such Act, or to assistance for medical expenses under any other public assistance program, grant program, or private health insurance or benefit program on the basis of the schedule of fees prepared pursuant to paragraph (f) of this section without application of any discounts, and

(2) Secure from patients payments for services in accordance with the schedule of fees and discounts required by paragraph (f) of this section.

(h) Have a governing board which meets the requirements of § 51c.304.

(i) Have developed an overall plan and budget for the center that:

(1) Provides for an annual operating budget and a three-year financial management plan which include all anticipated income and expenses related to items which would, under generally accepted accounting principles, be considered income and expense items;

(2) Provides for a capital expenditures plan for at least a three-year period (including the year to which the operating budget described in paragraph (1)(1) of this section is applicable) which includes and identifies in detail the anticipated sources of financing for, and the objective of, each anticipated expenditure in excess of $100,000 related to the acquisition of land, the improvement of land, buildings, and equipment and the replacement, modernization and expansion of buildings and equipment which would, under generally accepted accounting principles, be considered capital items;

(3) Provides for plan review and updating at least annually; and

(4) Is prepared under the direction of the governing board, by a committee consisting of representatives of the governing board, and administrative staff, and the medical staff, if any, of the center.

(j) Establish basic statistical data, cost accounting, management information, and reporting or monitoring systems which shall enable the center to provide such statistics and other information as the Secretary may reasonably require relating to the center's costs of operation, patterns of utilization of services, and the availability,

42 CFR Ch. 1 (10-1-95 Editori

(8)

tion

accessibility, and acceptability dis services and to make such report tions the Secretary in a timely manner v. such frequency as the Secretary reasonably require.

or p

mat

(t)

serv

ope

vid

me Su

to

and

(k) Review its catchment area ally to insure that the criteria se in §51c.104(b)(2) of subpart A are! and, where such criteria are not revise its catchment area, with the proval of the Secretary, to conform such criteria to the extent feasible (1) In the case of a center serves a population including stantial proportion of individuare limited English-speaking abili developed a plan and made an ments responsive to the needs of populations for providing services the extent practicable in the lang and cultural context most appr

the par

[ocr errors]

pe

SC

P

th to

th

to such individuals, and have cl an individual on its staff who in both that language and in and whose responsibilities include viding guidance to such individuals to appropriate staff members with spect to cultural

sensitivities

bridging linguistic and cultural ferences. If more than one non-Eng language is spoken by such gro groups, an individual or individuals ent in those languages and E

shall be so identified.

(m) Be operated in a manner a culated to preserve human dignity to maximize acceptability and effect

utilization of services.

(n) To the extent possible, coordi and integrate project activities the activities of other Federally ed, as well as State and local, he services delivery projects and prog serving the same population.

(0) Establish means for evalus progress toward the achievement of specific objectives of the project.

by training and experience, to c (p) Provide sufficient staff, qualif out the activities of the center.

(q) Assure that facilities utilized the performance of the project mee

applicable fire and life safety codes. (r) Utilize, to the maximum exte feasible, other Federal, State, local, and private resources availab

for support of th of project fur

rior to

C

[ocr errors]

es

43

Provide for community participathrough, for example, contribu3 of cash or services, loans of fullart-time staff, equipment, space, erials, or facilities.

Where the center will provide ices through contract or other cogative arrangements with other prors of services, establish rates and hods of payment for health care. payments must be made pursuant Agreements, with a schedule of rates payment procedures maintained by project. The project must be pred to substantiate that such rates reasonable and necessary. a) Operate in a manner such that no on shall be denied service by reaof his inability to pay therefor: vided, however, That a charge for

for provision of services will be made

[ocr errors]

stad

ral

he extent that a third party (ining a Government agency) is auized or is under legal obligation to Such charges.

In addition to the above, projects ch are supported with grant funds the operation of a prepaid health e plan also must provide:

) A marketing and enrollment plan, luding market analysis, marketing ategy, and enrollment growth protions.

rer 2) A plan that provides for funding a capitation basis of such portion of è residents of the catchment area of è center, as the Secretary shall demine.

ed.

and is

[ocr errors]

e pre

3) An assurance that services shall available to all residents of the tchment area without regard to ethod of payment or health status.

1c.304 Governing board.

A governing board for the center all be established by an applicant as llows:

(a) Size. The board shall consist of at ast 9 but not more than 25 members, cept that this requirement may be aived by the Secretary for good cause lown.

(b) Composition. (1) A majority of the pard members shall be individuals ho are or will be served by the center nd who, as a group, represent the indiiduals being or to be served in terms f demographic factors, such as race, thnicity, sex

(2) No more than one-half of the remaining members of the board may be individuals who derive more than 10 percent of their annual income from the health care industry.

(3) The remaining members of the board shall be representative of the community in which the center's catchment area is located and shall be selected for their expertise in community affairs, local government, finance and banking, legal affairs, trade unions, and other commercial and industrial concerns, or social service agencies within the community.

(4) No member of the board shall be an employee of the center, or spouse or child, parent, brother or sister by blood or marriage of such an employee. The project director may be a non-voting, ex-officio member of the board.

(c) Selection of members. The method of selection of all governing board members shall be prescribed in the bylaws or other internal governing rules of the center. Such by-laws or other rules must specify a process of selection of individuals on the governing board who represent the population served or to be served by the center so that such individuals, as a group, are representative of such population. Such process of selection in the bylaws or other rules is subject to approval by the Secretary.

(d) Functions and responsibilities. (1) The governing board for the center shall have authority for the establishment of policy in the conduct of the center.

(2) The governing board shall hold regularly scheduled meetings, at least once each month, for which minutes shall be kept.

(3) The governing board shall have specific responsibility for:

(i) Approval for the selection and dismissal of a project director or chief executive officer of the center;

(ii) Establishing personnel policies and procedures, including selection and dismissal procedures, salary and benefit scales, employee grievance procedures, and equal opportunity practices;

(iii) Adopting policy for financial management practices, including a system to assure accountability for center resources, approval of the annual project budget, center priorities, eligi

« PreviousContinue »