Nondiscrimination.

Attention is called to the requireof title VI of the Civil Rights of 1964 (78 Stat. 252, 42 U.S.C. 2000d and in that particular section such Act which provides that no in the United States shall, on rounds of race, color or national

be excluded from participation be denied the benefits of, or be subto discrimination under any proactivity receiving Federal fihi assistance. A regulation impleSy such title VI, which is applica

grants made under this subpart, been issued by the Secretary with approval of the President (45 CFR 80).

Attention is called to the requirets of section 504 of the Rehabilita

Act of 1973, as amended, which andes that no otherwise qualified ticapped individual in the United es shall, solely by reason of the cap, be excluded from participain, be denied the benefits of, or be sected to discrimination under any gram or activity receiving Federal azcial assistance. A regulation immenting section 504 has been issued CFR part 84 (42 FR 22676, May 4,

All portions and services of the re facility for the construction or dernization of which, or in connecwith which aid under the Act is pt must be made available without amination on account of creed and applicant may not discriminate st any qualified person on acfront of creed with respect to the vilege of professional practice in the Belity.

Attention is also called to the reurements of title IX of the Education mendments of 1972 and in particular section 901 of such Act (20 U.S.C.

which provides that no person in United States shall, on the basis of Er be excluded from participation in, denied the benefits of, or be subjected to discrimination under any edutation program or activity receiving Federal financial assistance (45 CFR art 86).

(e) Each construction contract is subject to the condition that the applicant shall comply with the requirements of section 321 of the Comprehensive Alco

hol Abuse and Alcoholism Prevention, Treatment, and Rehabilitation Act of 1970, as amended, which provides that alcohol abusers and alcoholics who are suffering from medical conditions shall not be discriminated against in admission or treatment, solely because of their alcohol abuse or alcoholism by any private or public general hospital that receives support in any form from any federally funded program.

(f) Each construction contract is subject to the condition that the applicant shall comply with the requirements of section 407 of the Drug Abuse Office and Treatment Act of 1972, as amended, which provides that drug abusers who are suffering from medical conditions shall not be discriminated against because of their drug abuse or drug dependence, by any private or public general hospital that receives support in any form from any federally funded program.

$124.10 Additional conditions.

The Secretary may impose additional conditions prior to or at the time of any grant award when in the Secretary's judgment such conditions are necessary to assure or protect advancement of the project in accordance with the purposes of the Act and the regulations of this subpart or the conservation of grant funds.

M Grant closeout, suspension, and termi

nation.

O Property.

P Procurement standards.

Q Cost principles.

Subparts B-E (Reserved)

Subpart F-Reasonable Volume of Uncompensated Services to Persons Unable to Pay

AUTHORITY: 42 U.S.C. 216; 42 U.S.C. 300s(3). SOURCE: 52 FR 46031, Dec. 3, 1987, unless otherwise noted.

§ 124.501 Applicability.

(a) The provisions of this subpart apply to any recipient of Federal assistance under title VI or XVI of the Public Health Service Act that gave an assurance that it would make available, in the facility or portion of the facility constructed, modernized or converted with that assistance, a reasonable volume of services to persons unable to pay for the services.

(b) The provisions of this subpart apply to facilities for the following periods:

(1) Facilities assisted under title VI. Except as otherwise herein provided, a facility assisted under title VI of the Act shall provide uncompensated services at the annual compliance level required by § 124.503(a) for:

(1) Twenty years after the completion of construction, in the case of a facility for which the Secretary provided grant assistance under section 606 of the Act;

the facility's application for assist under title VI of the Act;

(C) If the date of final approva available, it means whatever d Secretary determines most rea approximates the date of fil proval.

(2) Facilities assisted under titer The provisions of this subpart a a facility assisted under title the Act at all times following tan retary's approval of the facility' cation for assistance under titl except that if the facility does the time of that approval health services, the assurance pa at all times following the facility tial provision of health services tients, as determined by the Secr

§ 124.502 Definitions.

As used in this subpart(a) Act means the Public Health ice Act, as amended.

(b) Allowable credit for services vided to a specific patient mean lesser of the facility's usual charg those services, or the usual ch multiplied by the percentage which total allowable cost as reported by facility in the facility's preceding cal year under title XVIII of the Sc Security Act (42 U.S.C. 1395, et seq.), the implementing regulations (42 C part 413) bears to the facility's to patient revenues for the year.

(c) Applicant means a person who quests uncompensated services or whose behalf uncompensated servi are requested.

(d) CPI means the National Consun Price Index for medical care.

(e) Facility means an entity that ceived assistance under title VI or X of the Act and provided an assuran that it would provide a reasonable vo ume of services to persons unable t pay for the services.

(f) Federal assistance means assistanc received by the facility under title V or title XVI of the Act and any assist ance supplementary to that title VI of title XVI assistance received by the fa cility under any of the following acts: the District of Columbia Medical Fa cilities Construction Act of 1968, 82 Stat. 631 (Pub. L. 90-457); the Public Works Acceleration Act of 1962 (42 U.S.C. 2641, et seq.); the Public Works

།

nomic Development Act of 1965 &C. 3121, et seq.); the Appalachian Development Act of 1965, as (40 U.S.C. App.); the Local Works Capital Development and ment Act of 1976 (Pub. L. 94-369). case of a loan guaranteed by the ry with an interest subsidy, the of Federal assistance under War title XVI for a fiscal year is tal amount of the interest subthat the Secretary will have paid dose of that fiscal year, as well ther payments which the Secas made as of the beginning of ul year on behalf of the facility ection with the loan guarantee direct loan which has been sold. Fiscal year means the facility's year.

Nursing home means a facility received Federal assistance for perates as a facility for long-term

defined at, as applicable, sec165(h) or section 1624(6) of the Act. Operating costs for any fiscal year as the total operating expenses of a ity as set forth in an audited flal statement, minus the amount imbursement, if any, received (or t received, claimed) in that year titles XVIII and XIX of the SoSecurity Act.

Persons unable to pay means perwho meet the eligibility criteria out in §124.505.

Request for uncompensated services ans any indication by or on behalf of individual seeking services of the lity of the individual's inability to for services. A request for uncomated services may be made at any e, including following institution of collection action against the individ

Secretary means the Secretary of Health and Human Services or [his or er) delegatee.

(m) Uncompensated services means: (1) For facilities other than those Certified under §124.513, § 124.514, $14.515, or $124.516, health services that are made available to persons unable to pay for them without charge or st a charge which is less than the allowable credit for those services. The Amount of uncompensated services provided in a fiscal year is the total allowable credit for services less the amount

charged for the services following an eligibility determination. Excluded are services provided more than 96 hours following notification to the facility by a peer review organization that it disapproved the services under section 1155(a)(1) or section 1154(a)(1) of the Social Security Act.

or

(2) For facilities certified under §124.513, §124.514, §124.515, or §124.516, services as defined in paragraph (m)(1) of this section and services that are made available to persons unable to pay for them under programs described by the documentation provided under §124.513(c)(2), § 124.514(c)(2), §124.516(c)(2), as applicable, or pursuant to the terms of the applicable grant or agreement as provided in §124.515. Except as provided in §124.516, excluded are services reimbursed by Medicare, Medicaid, or other third party programs, including services for which reimbursement was provided as payment in full, and services provided more than 96 hours following notification to the facility by a peer review organization that it disapproved the services under section 1155(a)(1) or section 1154(a)(1) of the Social Security Act.

[52 FR 46031, Dec. 3, 1987, as amended at 59 FR 44639, Aug. 30, 1994]

§ 124.503 Compliance level.

(a) Annual compliance level. Subject to the provisions of this subpart, a facility is in compliance with its assurance to provide a reasonable volume of services to persons unable to pay if it provides for the fiscal year uncompensated services at a level not less than the lesser of

(1) Three percent of its operating costs for the most recent fiscal year for which an audited financial statement is available;

(2) Ten percent of all Federal assistance provided to or on behalf of the facility, adjusted by a percentage equal to the percentage change in the CPI between the year in which the facility received assistance or 1979, whichever is later, and the most recent year for which a published index is available.

(b) Deficits. If in any fiscal year a facility fails to meet its annual compliance level, it shall provide uncompensated services in an amount sufficient to make up that deficit in subsequent

years, and a tad of itigation shal be extended in the teint s nade 10

2. Types of teficits. Fr purposes of tetermining the aming and amount of any teficit made-ip here are swa yes of ledica

Astrable tects. A stabie teficit a me in which he facility nd 10t meet its annual compitance Levai fue a ather inanca. nality as tebermined inder §14.5) r. 1though therwise in compitance with This subpart a lack of atgbie apuitsanta for incompensated services furing the Escal year.

Noncompliance teficits. A 100compitance teñas s men whch the facility failed to meet annual compicance level the so oncompliance with this subpart

Timing of teficit make-up- As afanie tefica A. A facility assisted ander se VI of the Act may make up a justifiable deficit as any time furing

ita period of colgation or in the year

for years, if necessary immediately following ita period of obligation.

(B) A facility assisted under title XVI of the Act is not required to make up a justidable deficit.

(11) Noncompliance deficits. (A) A facility must begin to make up a noncompitance deficit in the fiscal year following the finding of noncompliance by the Secretary.

(B) A facility which claimed financial inability under § 124.509(a)(2) (iii) and is found by the Secretary, pursuant to $124.511(c), to have been financially able to provide uncompensated services in the year in which the deficit was incurred shall begin to make up the deficit beginning in the fiscal year following the Secretary's finding.

(C) A facility required to make up a noncompliance deficit but which is determined by the Secretary, pursuant to $124.511(c), to be financially unable to do so in the year following the Secretary's finding of noncompliance shall make up the deficit in accordance with a schedule set by the Secretary.

(3) Deficit make-up amount. (i) The amount of a deficit in any fiscal year is the difference between the facility's annual compliance level for that year and the amount of uncompensated services provided in that year.

ii. The amount of a justi nt must be adjusted by a

iscal ye

Amount

facili e facilit

that y

be adj

the per

Eween th

mal to the percentage cha OP! between the CPI availa iscal year in which the defic murred and the CPI available ca year in which it was made An amount equal to the tivating the amount of any n ance teñas for a fiscal yea number of years of abigation ing and adjusting it by a p equal to the percentage chan CPI between the CPI availabi iscal year in which the defici scal curred and the CPI available in the e cal year in which it was made be added to a facility's annual ration ance level for each fiscal year fin me fscal year of the finding ph compitance.

year in 122 excel

a

(4) Affirmative action plan for Acunt mg future deficits. Except where-Ar ity reports to the Secretary in 2012 ob ance with §124.509(a)(2)(iii) that ser financially unable to provide pensated services at the annual c ance level, a facility that fails to mal its annual compliance level in apari cal year shail, in the following of develop and implement a plan of ston that can reasonably be expected A able the facility to meet its act compliance level. Such actions may clude special notice to the commit through newspaper, radio, and m vision, or expansion of service to Sc egory B. or, with respect to nulay homes. Category C, persons. The ars retary may require changes to plan. Where a facility fails to conte with this section, the Secretary Par require it to make up the deficit in the fiscal year following the year in whic it was required to institute the plan

(c) Excesses. (1) Except for facilita certified under §124.513, §124.514, §124.515, if a facility provides in a fista year uncompensated services in amount exceeding its annual compo ance level, it may apply the amount excess to reduce its annual complianc level in any subsequent fiscal year. The facility may use any excess amount t reduce its annual compliance leve only if the services in excess of the ang nual compliance level are provided in accordance with the requirements of this subpart.