ies receiving or benefiting from Federal inancial assistance CFR part 86-Nondiscrimination on the CFR part 91-Nondiscrimination on the FR 24161, June 29, 1987, as amended at 57 7.711 What other audit and inspection requirements apply to grantees? Each entity which receives a grant der this subpart must, in addition to è requirements of 45 CFR part 74, Det the requirements of section 705 of Act, concerning audit and inspec n. >proved by the Office of Management and dget under control number 0915-0060) FR 36178, June 21, 1979. Redesignated and lended at 52 FR 24161, June 29, 1987; 57 FR 37, Oct. 5, 1992] 7.712 Additional conditions. The Secretary may with respect to y grant award impose additional nditions prior to or at the time of y award when, in his or her judgent, these conditions are necessary to sure or protect advancement of the ant, the interest of the public health, the conservation of grant funds. FR 36177, June 21, 1979. Redesignated at 52 24161, June 29, 1987] Subpart 1-Programs for the Training of Physician Assistants AUTHORITY: Sec. 215 of the Public Health ervice Act, 58 Stat. 690, as amended by 63 cat. 35 (42 U.S.C. 216); sec. 701(8)(B), 90 Stat. 47, as amended by 95 Stat. 913 and 99 Stat. 5-526 (42 U.S.C. 292a(8)(B)). 57.801 Purpose and scope. (a) Section 701(8)(B) of the Public ealth Service Act (42 U.S.C. 2a(8)(B)) requires the Secretary to deelop regulations for programs for the raining of physician assistants. The urpose of this subpart is to comply with this requirement. of physician assistants supported under title VII of the Public Health Service Act. [44 FR 36177, June 21, 1979, as amended at 52 FR 24160, June 29, 1987] $57.802 Definitions. For purpose of this subpart: Academic year means the approximately 9-12 month period of time during which the program is in session. Disease prevention is the health strategy which emphasizes the development of individual and community measures to protect against disease or environmental hazards and their harmful consequence. Full-time student means a student who is enrolled in a program and pursuing a course of study which constitutes a full-time academic workload, as determined by the program, and which leads to a degree, diploma, or certificate of completion. Geriatric medicine is the prevention, diagnosis, care and treatment of illness and disability as required by the distinct needs of the elderly. Health professional shortage area means an area designated under section 322 of the Public Health Service Act. Health promotion is the health strategy which emphasizes individual responsibility for one's health, and community efforts to maintain and enhance well-being through lifestyle changes. Home health care is the provision of medical and other health care services to maintain or restore the health of an ill or disabled person in their place of residence. Medical director means the individual responsible for providing competent medical direction of the program. Physician assistant means an individual who is qualified by academic and clinical training to provide patient care services under the supervision and responsibility of a doctor of medicine or osteopathic medicine. At a minimum, the physician assistant is competent to: (1) Do the initial and follow-up evaluation of patients of various age groups in any setting to elicit a de (b) The regulations in this subpart tailed and accurate history, perform an prams for the training appropriate physical examination, and $57.1510 Security for loans. Each loan with respect to which a guarantee is made or interest subsidies are paid under this subpart shall be secured in a manner which the Secretary finds reasonably sufficient to insure repayment. The security may be one or a combination of the following: (a) A first mortgage on the facility and site thereof. (b) Negotiable stocks or bonds of a quality and value acceptable to the Secretary. (c) A pledge of unrestricted and unencumbered income from an endowment or other trust fund acceptable to the Secretary. (d) A pledge of a specified portion of annual general or special revenues of the applicant acceptable to the Secretary. (e) Such other security as the Secretary may find acceptable in specific instances. § 57.1511 Opinion of legal counsel. At appropriate stages in the application and approval procedure for a loan guarantee or interest subsidy, the applicant shall furnish to the Secretary a memorandum or opinion of legal counsel with respect to the legality of any proposed note issue, the legal authority of the applicant to issue the note and secure it by the proposed collateral, and the legality of the issue upon delivery. "Legal counsel" means either a law firm or individual lawyer, thoroughly experienced in the long-term financing of construction projects, and whose approving opinions have previously been accepted by lenders or lending institutions. The legal memorandum or opinion to be provided by legal counsel in each case shall be as follows: (a) A memorandum, submitted with the application for a loan guarantee or interest subsidy, stating that the applicant is or will be lawfully authorized to finance, construct, and maintain the project, and to issue the proposed obligations and to pledge or mortgage the assets and/or revenues offered to secure the loan, citing the basis for such authority; and (b) A final approving opinion, delivered to the Secretary at the time of delivery of the evidence of indebtedness 2 Loan guarantee. Each agreement Lining to a loan guarantee shall in> the following provisions: That the loan guarantee evidenced he agreement shall be incontest(i) in the hands of the applicant on se behalf such loan guarantee is e except for fraud or misrepresenon on the part of such applicant, (ii) as to any person who makes or racts to make a loan to such appliin reliance on such guarantee, exfor fraud or misrepresentation on >part of such other person. That the applicant shall be perted to prepay up to 15 percent of =original principal amount of such in any calendar year without addihal charge. The applicant and the ler may further agree that the apsant shall be permitted to prepay in ess of 15 percent of the original fount of the loan in any calendar ar without additional charge, but no h payment in excess of 15 percent ill be made without the prior writ1 approval of the Secretary. 3 That if the applicant shall default making periodic payment, when due, the principal and interest on the An guaranteed under the agreement, Ale holder of the loan shall promptly ve the Secretary written notification such default. The Secretary shall, amediately upon receipt of such noce, provide the holder with written knowledgement of such receipt. (4) That if such default in making riodic payment when due of the prinpal and interest on the guaranteed an is not cured within 90 days after ceipt by the Secretary of notice of ich default, the holder of the loan hall have the right to make demand (pon the Secretary, in such form and nanner as the Secretary may precribe, for payment of 90 percent of the mount of the overdue payments of rincipal and accrued interest, totether with such reasonable late charges as are made in accordance with the terms of the credit instrument or security instrument evidencing or securing such loan. The Secretary shall pay such amount from funds available to him for these purposes. (5) That in the event of exercise by the holder of the loan of any right to accelerate payment of such loan as a result of the applicants default in making periodic payment when due of the principal and interest on the guaranteed loan, the Secretary shall, upon demand by the holder not less than 90 days after receipt by the Secretary of notification of such default, pay to such holder 90 percent of the total amount of principal and of interest on the loan remaining unpaid after the holder has exercised his right to foreclose upon and dispose of the security and has applied the proceeds thereby received to reduce the outstanding balance of the loan, in accordance with applicable law and the terms of the security instrument. (6) That the Secretary shall not guarantee any funds which are disbursed by a lender following notification by the Secretary to such lender that the Assurance executed by the Applicant under section 799A of the Act is no longer satisfactory. (b) Interest subsidy. Each agreement pertaining to the payment of interest subsidies with respect to a loan shall include the following provisions: (1) That the holder of the loan shall have a contractual right to receive from the United States interest subsidy payments in amounts sufficient to reduce by up to 3 percent per annum the net effective interest rate determined by the Secretary to be otherwise payable on such loan. (2) That payments of interest subsidies pursuant to paragraph (b)(1) of this section will be made by the Secretary, in accordance with the terms of the loan with respect to which the interest subsidies are paid, directly to the holder of such loan, or to a trustee or agent designated in writing to the Secretary by such holder, until s time as the Secretary is notified writing by the holder that such has been transferred. Pursuant to written notification of Secretary will make suc ments directly to th (transferee) of the loan: Provided, however, That it shall be the responsibility of the holder to remit any payments of interest subsidy to the new holder which the Secretary may have made to the holder after such transfer and prior to receipt of such written notice, and the Secretary shall not be liable to any party for amounts remitted to the holder prior to receipt of such written notice and acknowledgment in writing by the Secretary of receipt of such notice. (3) That the holder of the loan will promptly notify the Secretary of any default or prepayment by the applicant with respect to the loan. (4) In the event of any exercise by the holder of the loan of the right to accelerate payment of such loan, whether as a result of default on the part of the applicant or otherwise, the Secretary's obligations with respect to the payment of interest subsidies shall cease. (5) Where, during the life of the loan with respect to which interest subsidies are to be paid, the applicant ceases to use the facility for the purposes for which constructed, the Secretary's obligation with respect to the payment of interest subsidies shall cease: Provided, however, That where the applicant is continuing to use the facility for purposes eligible for support under part B of title VII of the act, the Secretary may make a determination, based upon the health manpower needs of the community served by the facility as well as other relevant factors, to continue to make interest subsidy payments in accord with the agreement. (6) Where during the life of the loan with respect to which interest subsidies are to be paid, it is determined, after an opportunity for a hearing pursuant to 45 CFR part 83, that the Assurance executed by the applicant under section 704 (or its predecessor, section 799A) of the Act, is no longer satisfactory, the Secretary's obligation with respect to the payment of interest subsidies shall cease: Provided, however, That the Secretary shall resume making interest subsidy payments if he determines that a subsequent Assurance submitted by the applicant is satisfactory. ti (a) to s retar (7) Where during the life of the $57.1 with respect to which interest sidies are to be paid, it is determi by the Secretary, after an oppor tled for a hearing pursuant to 45 CFB loan 80 and 81, that the applicant has ces amo to comply with the Assurance executed under 45 CFR 80.4(d) cet ing nondiscrimination on the bas prov race, color or national origin, the retary's obligation with respect t payment of interest subsidies cease: Provided, however, That the retary shall resume making in subsidy payments if he subseque determines that the applicant 157. come into compliance with the requ ments of title VI of the Civil R Act of 1964 and implementing re tions. purs this subr reci to w (8) Where during the life of the with respect to which interests sidies are to be paid, it is determ by the Secretary after an opportu for a hearing pursuant to title the Education Amendments of $ that the applicant has ceased to cu ply with such title, and its implens ing regulations, the Secretary's oble tion with respect to the payment terest subsidies shall cease: Pro however, That the Secretary shall sume making interest subsidy ments if he subsequently determi that the applicant has come into c pliance with the requirements of IX of the Education Amendments 1972 and implementing regulations. (c) General. In addition to the app cable requirements of paragraphs and (b) of this section, each agreeme whether pertaining to a loan guarante or interest subsidy or both, shall c tain such other provisions as the Se retary finds necessary in order to pr tect the financial interests of the Un ed States. [38 FR 31836, Nov. 19, 1973, as amended at FR 38113, Sept. 27, 1984] $57.1515 Loan closing. Closing of any loan with respect to which a guarantee is made or interes subsidies are paid under this subpar shall be accomplished at such time may be agreed upon by the parties such loan and found acceptable to the Secretary. The United States shall be enti recover from the applicant for a uarantee under this subpart the at of any payment made pursuant ch guarantee, unless the Secwaives such right of recovery as led in §57.1517. Upon making of any payments ant to a loan guarantee under ubpart, the United States shall be gated to all of the rights of the ent of the payments with respect Sich the guarantee was made. 517 Waiver of right to recovery. letermining whether there is good for waiver of any right of recovhich he may have against any apnt by reason of any payments pursuant to a loan guarantee Er this subpart, the Secretary shall into consideration the extent to The facility with respect to which loan guarantee was made will cone to be devoted by the applicant or er owner to the teaching of health essions personnel, or to other pures in the sciences related to health which funds are available under t B of title VII of the act and these ulations; ›) A hospital or outpatient facility 1 be used as provided for under title of the act; e) There are reasonable assurances it for the remainder of the repaynt period of the loan other facilities t previously utilized for the purpose which the facility was constructed 11 be so utilized and are substantially Puivalent in nature and extent for ch purposes; and (d) Such recovery would seriously Purtail the training of qualified health ofessions personnel in the rved by the facility. 57.1518 Modification of loans. area No official of the Department of [ealth and Human Services will aprove any proposal to modify the terms f a loan guaranteed under title VII of he Public Health Service Act (42 J.S.C. 293 et seq.) and this subpart which would permit the use of the guaranteed loan (or the guarantee) as collateral for an issue of tax-exempt securities. (Secs. 215 and 726, Public Health Service Act, 58 Stat. 690 and 85 Stat. 432, 42 U.S.C. 216 and 2931, as amended). [48 FR 42984, Sept. 21, 1983] in These regulations apply to the award of grants under section 786(a) of the Public Health Service Act (42 U.S.C. 295g-6(a)) to schools of medicine or osteopathic medicine, hospitals, and other public or private nonprofit entities for projects to: (a) Plan, develop, and operate, or participate predoctoral, graduate, or faculty development educational programs in family medicine; and (b) provide financial assistance to trainees participating in predoctoral or graduate educational programs who are in need of financial assistance and who plan to practice family medicine or to trainees in faculty development programs who plan to teach in family medicine training programs. [57 FR 45738, Oct. 5, 1992] § 57.1602 Definitions. Act means the Public Health Service Act, as amended. Clerkship means supervised clinical training in a specific field of medicine for predoctoral medical (M.D. or D.O.) students. Faculty development program means a systematic training program to increase faculty competence in teaching skills and in other areas related to academic responsibilities. Family medicine means the field of medicine, including osteopathic general practice, in which the physician: |