(a) Act means the Public Health Serv- include any facility furnishing ice Act, as amended. (b) Construction means construction of new buildings and initial equipment of such buildings and, in any case in which it will help to provide a service not previously provided in the community, equipment of any buildings. It includes architect's fees, but excludes the cost of off-site improvements and, except with respect to public health centers, the cost of the acquistion of land. (c) Cost means the amount found by the Secretary to be necessary for construction or modernization under a project, except that such term does not include any amount found by the Secretary to be attributable to expansion of the bed capacity of any facility. (d) Equipment means those items which are necessary for the functioning of the facility but does not include items of current operating expense such as food, fuel, pharmaceuticals, dressings, paper, printed forms, and housekeeping supplies. (e) Facility for long-term care means a facility (including a skilled nursing care or intermediate care facility), providing inpatient care for convalescent or chronic disease patients who require skilled nursing or intermediate care and related medical services: (1) Which is a hospital (other than a hospital primarily for the care and treatment of mentally ill or tuberculosis patients) or is operated in connection with a hospital, or (2) In which such care and medical services are prescribed by, or are performed under the general direction of, persons licensed to practice medicine or surgery in the State. (f) Health systems agency means an agency which has been conditionally or fully designated pursuant to section 1515 of the Act and 42 CFR part 122. (g) Hospital includes general, tuberculosis, and other types of hospitals, and related facilities such as laboratories, outpatient departments, nurses' home facilities, extended care facilities, facilities related to programs for home health services, self-care units, and central service facilities, operated in connection with hospitals, and education or training facilities for health professional personnel operated as an integral part of a hospital, but does not marily domiciliary care. (h) Major repair means those re to an existing building, excluding tine maintenance, which restore building to a sound state, the co which is a least 10 percent of I value or $200,000, whichever is gre Plant value means the historic I value of the building at the time of plication for assistance under this part. (1) Medical facility means a hospi public health center, outpatient m cal facility, rehabilitation facility, facility for long-term care. (j) Modernization means the al ation, expansion (excluding expanɛ which increases bed capacity), mi repair, remodeling, replacement, renovation of existing buildings cluding initial equipment thereof), i the replacement of obsolete equipm of existing buildings, including enei conservation projects. (k) Outpatient medical facility mean facility, located in or apart from a h pital, for the diagnosis or diagnosis a treatment of ambulatory patients (1 cluding ambulatory inpatients): (1) Which is operated in connecti with a hospital, or (2) In which patient care of a specia ized nature (such as in an eye clini dental clinic, or ambulatory surgica center) is provided under the profes sional supervision of persons license to practice medicine or surgery in th State, or in the case of dental diagnosi or treatment, under the professiona supervision of persons licensed to prac tice dentistry in the State, or (3) Which offers to patients not re quiring hospitalization the services o licensed physicians in various medical specialties, and which provides to its patients a reasonably full range of diagnostic and treatment services. (1) Public health center means a publicly owned facility for the provision of public health services, including related facilities such as laboratories, clinics, and administrative offices operated in connection with such a facility. (m) Quasi-public corporation means a private, nonprofit corporation which has been formally given one or more governmental powers by a general-pur e unit of government to enable it to ry out its work. Rehabilitation facility means a faity which is operated for the priry purpose of assisting in the rehatation of disabled persons through integrated program of medical evalation and services, and psychological, cial, or vocational evaluation and rvices, under competent professional pervision, and in the case of which the major portion of the required evalation and services is furnished within de facility; and either the facility is Ented in connection with a hospital, Full medical and related health services are prescribed by, or are under the neral direction of persons licensed to practice medicine or surgery in the State. (0) Secretary means the Secretary of Balth and Human Services and any ther officer or employee of the Deartment of Health and Human Servee to whom the authority involved has been delegated. (p) State means any one of the several States, the Commonwealth of Puerto Rico, Guam, American Samoa, the Trust Territory of the Pacific Islands, the Virgin Islands, and the District of Columbia. (4) State health planning and development agency or State Agency means the ency of a State government which as been conditionally or fully despated under section 1521 of the Act d42 CFR part 123. (r) Title means a fee simple, or such sther estate or interest in the project aite (including a leasehold on which the rental does not exceed 4 percent of the value of the land) as the Secretary finds sufficient to assure undisturbed ase and possession for the purpose of Construction or modernization and operation of the project for a period of not less than twenty years. (8) Urban or rural poverty area means a census tract, census county division, or minor civil division, as applicable, in which the percentage of the residents with incomes below the poverty level, as defined by the Secretary of Commerce is not less than the percentage derived in accordance with the following sentence. This percentage shall be derived so that the percentage of the total population of the United States residing in all such areas is equal to the percentage of the total population of the United States with incomes below such poverty level, plus five per cent. $124.3 Eligibility. (a) Eligible applicants. A grant under section 1625 may only be made to a State or political subdivision of a State, including any city, town, county, borough, hospital district authority, or public or quasi-public corporation for a project described in paragraph (b) of this section for a medical facility owned, operated, or owned and operated by the State or political subdivision. (b) Eligible project. A grant under section 1625 may be made only for a construction and/or modernization project designed to: (1) Eliminate or prevent safety hazards which under Federal, State, and/or local fire, building or life safety codes or regulations, will, in the judgment of the Secretary result in one or more of the following: (i) Loss of licensure for the facility. (ii) Closing of all or a substantial part of the facility, (iii) Loss of eligibility for reimbursement under title XVIII or title XIX of the Social Security Act; or (2) Avoid noncompliance with State licensure or voluntary accreditation standards where noncompliance will, in the judgment of the Secretary, result in one or both of the following: (i) Loss of licensure for the facility, (ii) Loss of accreditation resulting in loss of eligibility for reimbursement under title XVIII or title XIX of the Social Security Act. $124.4 Application. An application for a grant under this subpart must be submitted directly to the Secretary at such time and in such form and manner as the Secretary may prescribe. The application must be executed by an individual authorized to act for the applicant and assume on behalf of the applicant the obligations imposed by the Act, this subpart, and the terms and conditions of the grant. The application must contain the following: (a) A description of the site of the project. patient populations outside the che munity in which the project is situa (b) A full description, with all appro- will receive appropriate consideratio priate documentation, of (1) The imminent safety hazards, licensure and or accreditation problems of the facility. (2) The type and amount of assistance sought under this subpart; (3) The construction of modernization project for which funds are sought, describing how it will remedy the problems described pursuant to paragraph (b/1) of this section, with a complete schedule for the proposed construction or modernization; and (4) How failure to remedy the problems described pursuant to paragraph (b) (1) of this section will affect the population served by the facility. (c) In the case of a modernization project for continuation of existing health services, a finding by the State Agency of the continued need for such services. In the case of a construction or modernization project for new health services, a finding by the State Agency of the need for such services. The finding of need shall be based on the following criteria: (1) In a State which has a program approved by the Secretary under section 1523(a)(4)(B) of the Act, a State certificate of need program, or a program under section 1122 of the Social Security Act, the State Agency shall use the criteria used in conducting reviews under such program. In a State which has more than one such program, the State Agency shall use the criteria of one of the programs and notify the Secretary of the program criteria used. (2) In a State which does not have a program approved by the Secretary under section 1523(a)(4)(B) of the Act, a State certificate of need program or a program under section 1122 of the Social Security Act, the State Agency shall base its finding of need on the following criteria: (1) Whether the proposed project is needed or projected as necessary to meet the needs in the community in terms of health services required; Provided, That projects for highly specialized services (such as open-heart surgery, renal transplantation, or radiation therapy) which will draw from (11) Whether the proposed project ste be adquately staffed and operated w completed: (111) Whether the proposed capital penditure is economically feasible can be accommodated in the pati charge structure of the health faci without unreasonable increases; and (iv) Whether the project will fol cost containment or improved qual of care through improved effciency productivity, including promotion cost-effective factors such as ambu tory care, preventive health care se ices, home health care, and design i construction economies, or through creased competition between differ health services delivery systems. (d) [Reserved] (e) An assurance that adequate fină cial support will be available for con pletion of the project, supported by detailed project budget satisfactory the Secretary which includes all exi ing and anticipated sources of funds f the project. (f) An assurance that adequate fina cial support will be available for mai tenance and operation of the proje when completed, supported by budget and detailed expenditure and revenu information satisfactory to the Sec retary for both the facility and the ap plicant for the past three fiscal year and budget and projections of expendi tures and revenue for the future thre fiscal years. Where a certificate of nee or a favorable finding under section 1122 of the Social Security Act is re quired in order for the project to oper ate and or receive reimbursement from governmental programs for health services provided, assurance from the applicant satisfactory to the the Secretary that the applicant will submit, consistent with the provisions of $124.5(d), any such required certificates of need and/or section 1122 finding. (g) An assurance that the applicant would not be able to complete the project without the grant applied for, supported by a description of all efforts to obtain funds needed to complete the project and the results of such efforts. (h) An assurance that all times after the application is approved there will made available in the facility or on thereof to be constructed or dernized, a reasonable volume of rices to persons unable to pay thereThe applicant shall comply with standards and procedures of 42 CFR am, except as the Secretary may prehe pursuant to section 1602(6) of the The functions of the State Agency dated under section 604 of the Act der 42 CFR 53.111 will be performed the Secretary, except to the extent hey are otherwise assigned. in assurance that at all times the application is approved the lity or portion thereof to be concted or modernized will be made ailable to all persons residing or emyed in the area served by the facilThe applicant shall comply with standards and procedures of 42 CFR 13, except as the Secretary may prebe pursuant to section 1602(6) of the st. The functions of the State Agency bignated under section 604 of the Act der 42 CFR 53.113 will be performed the Secretary, except to the extent hey are otherwise assigned. An assurance that title to the ject site is or will be vested in one more of the entities filing the appliation or in a public or other nonprofit auty which is to operate the facility completion of the project, with such mentation as the Secretary may quire. I) In the case of an application for struction or modernization of an tpatient medical facility, an assurare, supported by a written transfer reement (or written documentation that such agreement will be obtained) with identified hospitals, that the servbes of a general hospital will be available to patients at such facility who are in need of hospital care. (1) Evidence that: (1) The appropriate health systems agency has been given the opportunity to review the application in accordance with section 1513(e) of the Act and the requirements of the appendix to this subpart, with the result of any such review. (2) The application has been reviewed in accordance with the applicable re¡quirements of OMB Circular A-95. (m) An analysis satisfactory to the Secretary and such other information and materials as the Secretary may re quire concerning the environmental impact of the proposed construction or modernization project. (n) An assessment satisfactory to the Secretary of the project site in light of the considerations set forth in Executive Order 11296 (31 FR 10663, August 10, 1966) concerning the evaluation of flood hazards in locating Federally supported facilities. (0) In the case of a project which involves the displacement of persons or businesses, an assurance that the applicant will comply with the applicable provisions of the Uniform Relocation Assistance and Real Property Acquisition Policies Act of 1970 (42 U.S.C. 4601 et seq.). (p)(1) An assurance that all laborers and mechanics employed by contractors or subcontractors in the performance of work on a project will be paid wages at rates not less than those prevailing on similar construction in the locality as determined by the Secretary of Labor in accordance with the Act of March 3, 1931 (40 U.S.C. 276a276a-5, known as the Davis-Bacon Act); and (2) An assurance that the following conditions and provisions will be included in all construction contracts: (1) The provisions of "DHHS Requirements for Federally Assisted Construction Contracts Regarding Labor Standards and Equal Employment Opportunity," Form DHHS 514 (rev. July 1976) (issued by the Office of Grants and Procurement Management, U.S. Department of Health and Human Services) pertaining to the Davis-Bacon Act, the Contract Work Hours Standards Act, and the Copeland Act (AntiKickback) regulations except in the case of contracts in the amount of $2,000 or less; and pertaining to Executive Order 11246, September 24, 1965 (30 FR 12319), relating to nondiscrimination in construction contract employment except in the case of contracts in the amount of $10,000 or less, and (ii) Representatives of the Secretary will have access at all reasonable times to work wherever it is in preparation or progress, and the contractor shall provide proper facilities for such access and inspection. |