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collateral do not have savings, but can pay hospital bills on an installment basis, or can pay a small deposit. Such persons may not be excluded from admission or denied services because of their inability to pay a deposit.

194.604 Posted notice.

(a) The facility shall post notices, which the Secretary supplies in Englah and Spanish, in appropriate areas of the facility, including but not limited to the admissions area, the busineas office and the emergency room.

(b) IT in the service area of the facilfly the usual language of households" of ten percent or more of the population, according to the most recent Asures published by the Bureau of the Chua is other than relish or Spanah the Berlity shall translate the notive into that language and post the Branslated #tae en stens substanBally amilar in sire and legibility to. MINE JANGAL With, those supplied under $2: ACTION.

they shall make reason ## @toria de 2 the cenWIN Heat weave te persons way 18 dex mens to Ver MAN 120 INVAM

the Secretary and must include mation that the Secretary pres to permit a determination of whe facility has met its obligations this subpart.

(3) The facility shall provide a of any report to the HSA for the when submitting it to the Secreta

(4) Institution of suit. Not later 10 days after being served with a mons or complaint, the applicant notify the Regional Health Adn trator for the Region of HHS in v it is located of any legal a brought against it alleging that i failed to comply with the requirem of this subpart.1

(b) Record maintenance requirem (1) A facility shall maintain, n available for public inspection con ent with personal privacy, and pro to the Secretary on request, records necessary to document its c pliance requirements of this subpar any fiscal year, including docume from which information required to reported under paragraph (a) of t section was obtained. A facility st maintain these records until 180 d following the close of the Secretar investigation under §124.606(a).

MARU. Nrg and reword main §124.606 Investigation and enfor

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The Secretary promptly provides spy of the complaint to each facility ed in the complaint.

When the Secretary investigates a lity, the facility shall provide to Secretary on request any docuts, records and other information cerning its operations that relate to requirements of this subpart.

The Act provides that if the Secvary dismisses a complaint or the Atmey General has not brought an acfor compliance within six months the date on which the complaint fled, the person filing it may bring rivate action to effectuate complite with the assurance. If the Secry determines that he will be unle to issue a decision on a complaint otherwise take appropriate action thin the six month period, he may, ased on priorities for the disposition complaints that are established to mote the most effective use of enfreement resources, or on the request the complainant, dismiss the compaint without a finding as to complice prior to the end of the six month period, but no earlier than 45 days after the complaint is filed.

(b) Enforcement. (1) If the Secretary inds, based on his investigation under ragraph (a) of this section, that a fality did not comply with the requirements of this subpart, he may take any Action authorized by law to secure Simpliance, including but not limited voluntary agreement or a request to the Attorney General to bring an action against the facility for specific performance.

(2) If the Secretary finds, based on his investigation under paragraph (a) of this section, that a facility has limited the availability of its services in a manner proscribed by this subpart, he may, in addition to any other action that he is authorized to take in accordance with the Act, require the facility to establish an effective affirmative acdion plan that in his judgment is designed to insure that its services are made available in accordance with the requirements of this subpart.

$124.607 Agreements with State agencies.

(a) Where the Secretary finds that it will promote the purposes of this sub

part, and the State agency is able and willing to do so, he may enter into an agreement with the State agency for the State agency to assist him in administering this subpart in the State.

(b) Under an agreement, the State agency will provide the Secretary with any assistance he requests in any one or more of the following areas, as set out in the agreement:

(1) Investigation of complaints of noncompliance;

(2) Monitoring the compliance of facilities with the requirements of this subpart;

(3) Review of affirmative action plans submitted under § 124.606(b);

(4) Review of reports submitted under § 124.605;

(5) Making initial decisions for the Secretary with respect to compliance, subject to appeal by any party to the Secretary or review by the Secretary on his own initiative; and

(6) Application of any sanctions available to it under State law (such as license revocation or termination of State assistance) against facilities determined to be out of compliance with the requirements of this subpart.

(c) A State agency may use funds received under section 1525 of the Act to pay for expenses incurred in the course of carrying out this agreement.

(d) Nothing in this subpart precludes any State from taking any action authorized by State law regarding the provision of services by any facility in the State as long as the action taken does not prevent the Secretary from enforcing the requirements of this subpart.

APPENDIX TO SUBPART G-INTERIM PRO

CEDURES AND CRITERIA FOR REVIEW
BY HEALTH SYSTEMS AGENCIES OF
APPLICATIONS UNDER SECTION 1625
OF THE PUBLIC HEALTH SERVICE ACT

In performing reviews under section 1513 (e) of the Public Health Service Act (42 U.S.C. 3001-2(c)) of applications for grants under section 1625 of the Act, health systems agencies shall use the procedures and criteria stated below. A health systems agency may not conduct such reviews until the procedures and criteria to be used in conducting the reviews have been adopted by the agency and published in newspapers of general circulation within the health service area or other public information channels.

PROCEDURES

The procedures adopted and utilized by a health systems agency for conducting reviews of applications for grants under section 1625 of the Act shall inclu ie at least the following: 1. Except as provided below, notification of the beginning of a review within seven days of the receipt by the health systems agency of the application. Where the application was received by the health systems agency prior to publication of this subpart in the FEDERAL REGISTER, notification must be made within seven days of the date on which the health systems agency adopts its procedures and criteria. The notification shall include the proposed schedule for the review, the period within which a public hearing during the course of the review may be requested (which must be a reasonable period from the transmittal of the written notification required above), and the manner in which notification will be provided of the time and place of any hearings so requested. Written notification to members of the public may be provided through newspapers of general circulation in the area and public information channels. Notification to the applicant whose application is being reviewed and all other applicants for assistance under section 1625 of the Act providing health service in the health service area shall be by mail (which may be as part of a newsletter). The health systems agency must simultaneously notify the Federal funding agency of the beginning of the review.

2. Schedules for reviews which provide that such reviews shall not exceed 60 days from the date of notification made in accordance with paragraph 1 of this section to the date of the written findings made in accordance with paragraph 4 of this section. This does not preclude a health systems agency from conducting its review in less than 60 days.

3. Provision for applicants to submit to the health systems agency (in such form and manner as the agency shall require) such information as the agency deems necessary in order to conduct its review.

4. Written findings which state the basis for the approval or disapproval of the application by the health systems agency. Such findings shall be sent to the applicant, the State health planning and development agency (or agencies), and the Secretary, and shall be available to other upon request.

5. Access by the general public to all such applications reviewed by the health systems agency and to all other written materials pertinent to the agency review.

6. Public hearings in the course of agency review, if requested by one or more persons directly affected by the review. For purposes of this paragraph, a "person directly affected by the review" is as defined in 42 CFR 122.306 (a)(7).

CRITERIA

The specific criteria adopted and 1 by a health systems of this agency duct reviews of applications for grants section 1625 of the Act shall include ae the following:

1. The relationship of the health serv the facility to the applicable health sy plan and annual implementation plan.

2. The relationship of the health serv the facility to the long-range develo plan (if any) of the applicant.

3. The need that the population ser to be served by the facility has for the 1 services of such facility.

4. The availability of alternative, less ly, or more effective methods of prov the health services which the facility vides.

5. The relationship of the health serv provided by the facility to the ext health care system of the area.

6. The availability of resources (inclu health manpower, management perso and funds for capital and operating n for the provision of services by the fac and the availability of alternative use such resources for the provision of dic health services.

7. The special needs and circumstance those entities which provide a substar portion of their services or resources, both, to individuals not residing in health service area in which the entities located or in adjacent health service ar Such entities may include medical and ot health professions schools, multidisciplin : clinics, and other speciality centers.

8. The special needs and circumstances health maintenance organizations for wh assistance may be provided under title XI 9. The costs and methods of the propos construction or modernization, including t costs and methods of energy provision.

10. The probable impact of the project I viewed on the applicant's costs of providi health services.

Subpart H-Recovery of Grant Funds

AUTHORITY: Secs. 609 and 1622 of the Publi Health Service Act as amended 98 Stat. 11 (42 U.S.C. 2911 and 300s-la).

SOURCE: 51 FR 7939, Mar. 7, 1986, unless oth erwise noted.

$124.701 Applicability.

The provisions of this subpart apply to facilities with respect to which grant funds were paid for construction or modernization—

(a) Under title VI or XVI of the Public Health Service Act; or

Pursuant to the authority of the tary under any of the following The Public Works Acceleration of 1962, Pub. L. 87-658 (42 U.S.C. It seq.);

The District of Columbia Medical Cities Construction Act of 1968, 82 (Pub. L. 90-457);

The Appalachian Regional Develent Act of 1965, as amended (40 SC. App.).

Definitions.

used in this subpart—

ct means the Public Health Service

Department means the Department of alth and Human Services.

Expected useful life means the period time during which the structure by reasonably be expected to perform function for which it was designed intended.

Facility means a facility with respect which grant funds were paid under of the authorizations listed in 4.701.

Facal year means the facility's fiscal

Improfit, as applied to any facility, as a facility that is owned and opated by one or more nonprofit corKations or associations no part of the earnings of which inures, or may fully inure, to the benefit of any Evate shareholder or individual. Secretary means the Secretary of Bath and Human Services and any ther officer or employee of the Deartment of Health and Human Serves to whom the authority involved as been delegated.

State agency means (1) in the case of facility with respect to which a grant was made under title VI of the Public Health Service Act or any of the statdes listed in §124.701(b), the State agency designated pursuant to section 4 of the Public Health Service Act or its successor agency, and (2) in the case of a facility with respect to which a grant was made under title XVI of the Public Health Service Act, the State health planning and development agency designated pursuant to title XV of the Public Health Service Act.

Then value means the value of the facility on the date the facility is sold,

transferred or ceases to be used for a permissible use as described in §124.704. $124.703 Federal right of recovery.

(a) If any facility is at any time within 20 years after the completion of the grant-assisted construction or modernization sold or transferred to any entity which is either not qualified for a grant under the statute pursuant to which the grant was awarded or not approved as a transferee by the State agency, the United States shall be entitled to recover on the basis of joint and several liability from any transferor, transferee, or successive transferee of the facility an amount determined in accordance with this subpart.

(b) If any facility at any time within 20 years after the completion of the grant-assisted construction or modernization ceases to be a public or other non-profit facility that would have been eligible for a grant under the statute pursuant to which the grant was awarded, the United States shall be entitled to recover from the owners of the facility an amount determined in accordance with this subpart.

§ 124.704 Notification of sale, transfer, or change of use.

(a) The transferor of a facility that is sold or transferred as described in § 124.703(a), or the owner of a facility which ceases to be a public or other nonprofit facility as described in §124.703(b), shall provide the Secretary written notice of such sale, transfer, or other change not later than 10 days after the date on which the sale, transfer, or change occurs.

(1) "Transfer." For purposes of this subpart, a transfer occurs when a facility is conveyed to another entity through lease, merger, bankruptcy, foreclosure, or other arrangement.

(2) "Cease to be." For purposes of this subpart,

(i) A facility "ceases to be" a facility for which a grant could have been made under the statute pursuant to which the grant was awarded when it is no longer operated as such a facility; and

(ii) A facility "ceases to be a public or nonprofit facility" when an entity that is not a public or other non-profit corporation or association assumes management responsibilities with re

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

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