Page images
PDF
EPUB

tion of its adopted budget for the current fiscal year relating to the support of uncompensated services in such year. Such budget for uncompensated services shall be based on the operating costs of the applicant for the preceding fiscal year and shall give due cognizance to probable increases in operating costs. Except in the case of a certification pursuant to paragraph (d)2) of this section, if the budget statement does not conform to the presumptive compliance guideline, the applicant shall submit with its statement.

(1) A justification therefor, showing that such lower level of uncompensated services is reasonable under the circumstances, and

(ii) A plan to increase such uncompensated services to meet the presumptive compliance guideline or such other level of uncompensated services as may have been established or as it requests the State agency to establish in accordance with paragraph (h) of this section.

(4) The applicant shall also submit such additional reports related to compliance with its assurance as the State agency may reasonably require.

(5) Pending the establishment of a level of uncompensated services for any fiscal year pursuant to paragraph (h) of this section, the applicant shall, in such fiscal year, provide a level of services which is the higher of

(i) The level established for the preceding fiscal year (or if no such level has been established for such prior year, the level of services provided in such year) or

(ii) The level proposed in its adopted budget for the current fiscal year.

(f) Qualifying services. (1) In determining the amount of uncompensated services provided by an applicant, there shall be included only those services provided to an individual with respect to whom the applicant has made a written determination prior to the provision of such services that such individual is unable to pay therefor under the criteria established pursuant to 42 CFR 53.111(g), except that:

(1) Such determination may be made after the provision of such services in the case of services provided on an emergency basis: Provided, That when billing is made for such service, such

[blocks in formation]

need

(a)

cally pose

pend

(b)

min

(e)

Opp

lines (ii

pro

(ii) Such determination may be after the provision of such service the case of a change in circumsta as a result of the illness or injury sioning such services (e.g., the tient's financial condition has cha due to a loss of wages resulting the illness) or in case of insurance erage or other resources being than anticipated or the costs of ices being greater than anticip whi Further, in all cases where such mination was not made prior to provision of services, such services not be included as uncompensated ices if any collection effort has made other than the rendering of permissible in the above except of Provided, That such a determix may be made at any time if the mination was hindered or dela reason of erroneous or incompl formation furnished by or in be the patient.

(2) There shall be excluded fra computation of uncompensated

ices:

(i) Any amount which the app has received, or is entitled to re from a third party insurer or unde governmental program; and

(ii) The reasonable cost of any ices for which payment in whole part would be available under a go mental program (e.g., Medicare Medicaid) in which the applicant though eligible to do so, does not ticipate, but only to the extent of otherwise available payment.

mi for

[ocr errors]

pro que

see

(g) Persons unable to pay for sent (1) The State agency shall set fort its State plan, subject to approva the Secretary, criteria for identif persons unable to pay for serv which shall include persons who otherwise self-supporting but unabipay the full charge for needed serv Such criteria shall be based on the lowing or similar factors:

[ocr errors]

T St

m

le

[merged small][ocr errors]

(i) The health and medical care surance coverage, personal or fam income, the size of the patient's far ily, and other financial obligations resources of the patient or the fam

1 1

elation to the reasonable cost of ervices;

Generally recognized standards of such as:

The State standard for the medineedy as determined for the pur ́s of the Aid for Families with Deent Children program;

The current Social Security Adstration poverty income level;

The current Office of Economic rtunity Income Poverty Guideapplicable in the area; or

) Any other equivalent measures h are found by the Secretary to ide a reasonable basis for deterng an individual's ability to pay medical and hospital services.

A copy of such criteria shall be ided by the applicant, upon ret, to any patient or former patient he applicant and to any person ing services from the applicant.

The State agency shall provide a of such criteria to any person reting it.

:) Level of uncompensated services. (1) State agency shall set forth in its e plan procedures for the deteration for each applicant of the 1 of uncompensated services which stitutes reasonable volume of ices to persons unable to pay thereprovided that in no event shall the el of uncompensated services estabsed under this section exceed the sumptive compliance guideline.

a

) The State agency shall for the pose of making such determination, lew, and evaluate the annual stateat, the budget and the related docunts submitted by each applicant suant to paragraph (e) of this secn, by applying the following criia:

i) The financial status of the appliat, taking account of income from sources, and its financial ability to vide uncompensated services; (ii) The nature and quantity of servs provided by the applicant; iii) The need within the area served the applicant for the provision, thout charge or at charge which is is than reasonable cost, for services the nature provided or to be proded by the applicant; and

(iv) The extent and nature of joint or operative programs with other facili

ties for the provision of uncompensated services, and the extent and nature of outreach services directed to the needs of underserved areas.

(3) In accordance with its findings made after such review and evaluation, the State agency shall, within 60 days after receipt of the annual statement and related documents required by paragraph (e) of this section, for each fiscal year of an applicant which begins following the expiration of 90 days after the effective date of this regulation:

(i) Establish a level of uncompensated services for each applicant which may be equal to or less than the presumptive compliance guideline: Provided, That if the State agency determines, in accordance with paragraph (h)(2) of this section, that (a) there is a need in the area served by an applicant for a level of uncompensated services greater than the level proposed in the applicant's budget statement, and (b) the applicant is financially able to provide such greater level of uncompensated services, the State agency shall establish such greater level as the level applicable to the applicant; and

(ii) Accept or modify a plan submitted pursuant to paragraph (e) of this section.

(4) The State agency shall notify the applicant in writing of the level of uncompensated services which it has established for the applicant for the fiscal year. At the time of notifying the applicant, the State agency shall also publish as a public notice in a newspaper of general circulation within the community served by the applicant the rate that has been established and a statement that the documents upon which the agency based its determination are available for public inspection at a location and time prescribed. In the case of the establishment by the State agency of a rate which is less than the presumptive compliance guideline, such notice shall also include a statement that persons wishing to object to the rate established may do so by writing to the State agency within 20 days after publication of the notice: Provided, That the applicant may object to any level established which is greater than the level pro

54a.508-54a.509 [Reserved] 54a.510 Additional conditions.

Subparts A-D (Reserved)

Subpart E-Grants for National Alcohol Research Centers

AUTHORITY: Sec. 504, 90 Stat. 1035 (42 U.S.C.

4588).

SOURCE: 44 FR 17921, Mar. 23, 1979, unless otherwise noted.

$54a.501 Applicability.

The regulations in this subpart apply to grants to develop, establish, and support centers for interdisciplinary research relating to alcoholism and other alcohol problems, as authorized by section 504 of the Comprehensive Alcohol Abuse and Alcoholism Prevention, Treatment, and Rehabilitation Act (42 U.S.C. 4588).

§ 54a.502 Definitions.

Terms not defined in this section shall have the same meaning as given them in §54a.102. As used in this subpart:

National Alcohol Research Center or Center means an institution engaged in long-term interdisciplinary research focused on a central theme relating to alcoholism and other alcohol problems.

§ 54a.503 Eligibility.

To be eligible for a grant under this subpart, an applicant must be:

(a) A public (except Federal) or nonprofit private institution which is or is affiliated with an institution (such as a university, medical center or research center) with the resources to sustain a long-term research program; and

(b) Located in a State, the District of Columbia, Puerto Rico, the Virgin Islands, Guam, American Samoa, the Trust Territory of the Pacific Islands, or the Northern Mariana Islands.

$54a.504 Application.

(a) Each institution desiring a grant under this subpart shall submit an application in the form and manner and on or before such dates as the Secretary may from time to time require.1

1 Grant applications, instructions, and program guidelines may be obte from the

[blocks in formation]

lo

ot

C

t Ca

(4) A detailed 5-year plan for the posed Center program which ident the principal areas of propos search, the relationship of each proposed research to the central of the proposed Center progra disciplines to be involved, and pip coordination among them; (5) A detailed description of each o arate research project for which are requested;

(6) The names and qualification the Center director and key staff ri bers who would be responsible for ducting proposed activities of the t ter;

(7) The opportunities that woul available for training;

(8) The organizational structur the proposed Center and its relat ship to the organizational structu the applicant;

(9) The proposed project period * to exceed 5 years); a detailed bud and justification of funds requested core support as well as for each rate research project (not exceed $1,000,000 in total in any year); and list of other anticipated sources of port for all research activities at applicant institution, both planned & ongoing, relevant to alcoholism

[blocks in formation]

A

C

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

social, and related disciplines, -term research on alcoholism and r alcohol problems and to coordithat research among such disnes;

Have available to its staff, faciliand other resources with which to y out the objectives of the proCd program;

Have available to it sufficient labory facilities and reference serv(including reference services that afford access to scientific alcohol rature);

Have facilities and personnel to vide training in the prevention and betment of alcoholism and other alol problems;

) Have the capacity to train Moctoral and postdoctoral students careers in research on alcoholism AC other alcohol problems; ter Have the capacity to conduct urses on alcohol problems and rerch on alcohol problems for underduate and graduate students and for

t&dical and osteopathic students and

sicians;

3) Provide assurances that the Cenwill be an identifable organizaAnal unit of the applicant headed by ted Center director resonsible for the hater program;

bh) Provide assurances that any sigicant changes in the Center's scitific activities or other activities ll be made only with the prior apoval of the Secretary; and

(i) Establish a Program Advisory Committee, chaired by the Center director, to review and make recommendations to the Center director on the conduct of all activities of the Center. The Committee shall be composed of persons who are not associated with the Center (apart from their membership on the Committee).

$54a.506 Grant awards.

(a) Within the limits of funds available, the Secretary, after taking into account the comments of an appropriate peer review group, may award grants to applicants with proposed programs which have been recommended for approval by the council and will in his judgment best promote the purposes of section 504 of the Act, taking into consideration among other pertinent factors:

(1) The scientific and technical merit of the proposed program and its individual components;

(2) The qualifications and experience of the Center director and other key personnel;

(3) The extent to which the various components of the proposed research program would be coordinated into an interdisciplinary effort within the Cen

ter;

(4) The administrative and managerial capability of the applicant;

(5) The reasonableness of the proposed budget in relation to the proposed program;

(6) The adequacy of proposed methods for monitoring and evaluating the overall Center program and its components including proposed mechanisms for review of the Center's program by its Program Advisory Committee;

(7) The potential of the proposed Center to become a significant regional and national research resource; and

(8) The degree to which the application adequately provides for the requirements of § 54a.505.

(b) The notice of grant award specifies how long HHS intends to support the project without requiring the project to recompete for funds. This period, called the project period, will not exceed 5 years.

(c) Generally the grant will initially be for one year and subsequent continuation awards will also be for one

year at a time. A grantee must submit a separate application to have the support continued for each subsequent year. Decisions regarding continuation awards and the funding level of those awards will be made after consideration of such factors as the grantee's progress and management practices, and the availability of funds. In any case, a grant award shall not exceed $1 million in any fiscal year. In all cases, continuation awards require a determination by HHS that continued funding is in the best interest of the government.

(d) Neither the approval of any application nor the award of any grant commits or obligates the United States in any way to make any additional, supplemental, continuation, or other award with respect to any approved application or portion of an approved application.

(e) An initial 5-year project period may be extended by the Secretary for additional periods not in excess of 5 years each, after review of the operations of the grantee by an appropriate peer review group and with the Council's recommendation for approval, except that if an additional period of support involves only the expenditure of funds previously awarded, peer review and consultation with the Council are not required.

[44 FR 17921, Mar. 23, 1979, as amended at 45 FR 31095, May 12, 1980]

$54a.507 Expenditure of grant funds.

(a) Any funds granted under this subpart shall be expended solely for the purpose for which the funds were granted in accordance with the approved application and budget, the regulations on this part, the terms and conditions of the award, and the applicable cost principles prescribed by subpart Q of 45 CFR part 74, except that those funds may not be expended for trainee stipends, fees, or other expenses directly relating to training or for the purchase or rental of any land or the rental, purchase, construction, preservation, or repair of any building. For purposes of this paragraph, construction means the construction of new buildings, and the expansion, remodeling, and alteration of existing buildings, including architects' fees,

but not including the cost of a 55.10 tion of land or off-site improveme P and equipping new buildings and 55a.1 ing buildings, whether or not expan 558.1 remodeled, or altered.1

[ocr errors]

(b) Any balance of federally oblig grant funds remaining unobligat the grantee at the end of a budes 55 riod may be carried forward to the budget period, for use as prescribe the Secretary, provided a continu award is made. If at any time dura budget period it becomes appare 55a. the Secretary that the amount ! eral funds awarded and available grantee for that period, including ty unobligated balance carried f from prior periods, exceeds the p ee's needs for the period, the Sect may adjust the amounts award withdrawing the excess.

[44 FR 17921, Mar. 23, 1979, as amende FR 31095, May 12, 1980]

01

[ocr errors]
[blocks in formation]
« PreviousContinue »