I

ich payment may be made under t B of title XVIII of that Act. 1) The borrower must enter into an propriate agreement, for the time iod specified in the loan agreement, th the State agency which adminers the State plan for medical assistce under title XIX of the Social Serity Act to provide services to indiduals entitled to medical assistance der the plan.

(e) During the time period specified the loan agreement, the borrower ust provide health services to indiduals at the usual and customary te prevailing in the HMSA in which rvices are provided; however, services ust be provided at no charge or at a zominal charge to those persons unable pay for these services.

(f) The borrower must keep and preerve all documents, including bills, reeipts, checks, and correspondence which affect the operation of the priwate practice and the expenditure of soan funds for the period of the pracice obligation specified in the loan agreement plus 3 years. Accounts will be maintained under one of the accounting principles identified by the Secretary in the loan agreement.

(g) The borrower must provide the Secretary and the Controller General of the United States, or their representatives, access during normal working hours to accounts, documents, and records for the purposes of audit or evaluation; and must permit the Secretary or his or her representative to inspect the private practice at reasonable times during the period of the practice obligation specified in the loan agreement plus 3 years. All information as to personal facts and circumstances about recipients of services shall be held confidential, and shall not be divulged without the individual's consent except as may be required by law or as may be necessary to provide medical service to the individual or to provide for medical or fiscal audits by the Secretary or his or her designee with appropriate safeguards for confidentiality of records.

(h) For the entire period of loan repayment, the borrower must acquire, maintain, and when requested, must provide the Secretary with copies of policies of insurance on equipment and

supplies in amounts adequate to reasonably protect the borrower from risk, including public liability, fire, theft, and worker's compensation.

(i) If the Secretary retains a security interest pursuant to §23.33, the borrower must keep and preserve all documents which affect that security interest for the period of the loan repayment and allow the Secretary or his or her designee access, during normal working hours, to those documents.

(j) The borrower must maintain the loan proceeds in a separate account from his or her other transactions and must agree to draw upon this account and expend the loan proceeds in accordance with § 23.32.

(k) The Secretary may impose other conditions which he or she deems appropriate under law or regulation to protect the Government's interests.

EFFECTIVE DATE NOTE: At 51 FR 31948, Sept. 8, 1986, § 23.34 was added. Paragraphs (f), (h), and (i) contain information collection requirements which will not be effective until approval has been obtained from the Office of Management and Budget. A notice will be published in the FEDERAL REGISTER.

§ 23.35 What criteria are used in making loans?

Approval of loan applications will be based on the criteria set forth below:

(a) The need in the HMSA for the applicant's health profession as determined under section 332 of the Act;

(b) The applicant's need for the loan funds; and

(c) The comments from State or local health professional societies on the appropriateness of the applicant's intended private practice; and

(d) The applicant's credit worthiness and projected financial ability to repay the loan.

Subpart C-Private Startup Loans $23.41 What conditions are applicable to loans under this subpart?

The regulations set out in subpart B of this part are fully applicable to loans awarded under section 338C(e)(1) of the Public Health Service Act, except as noted below;

(a) Eligibility. (1) In lieu of §23.23(a), the following applies to loans made under this subpart:

(i) Eligibility for loans is limited to NHSC scholarship recipients who plan to enter private practice and have not begun fulfilling their scholarship service obligation or are currently fulfilling their scholarship service obligation under section 338B of the Act and have completed less than 2 years of this obligation.

(2) In lieu of §23.23(c), the following applies to loans made under this subpart:

(i) NHSC scholarship recipients who I have received loans under either this subpart or subpart B of this part are ineligible for loans under this subpart.

(b) Loan amounts. (1) In lieu of § 23.24, the following applies to loans made under this subpart:

(i) The Secretary may make loans in the amount of $12,500 if the recipient agrees to practice in accordance with the loan agreement for a period of at least 1 year but less than 2 years or the

remaining period of the borrowe NHSC scholarship service obligatic whichever is shorter.

(ii) The Secretary may make loan: the amount of $25,000 if the recipier agrees to practice in accordance wit the loan agreement for a period of least 2 years or the remaining period : the borrower's NHSC scholarship serv ice obligation, whichever is shorter.

(c) Use of funds. (1) In lieu of §23.32 £ the following applies to loans made under this subpart:

(i) The borrower must use the tot amount of the loan only to purchase lease, or both, the equipment and sup plies needed for providing health serv ices in his or her private practice Equipment and supplies purchased and or leased shall be limited to the item requested in the loan application and approved by the Secretary.

[51 FR 31950, Sept. 8, 1986]

ter

(e) First-class stations means a hospital operated by the Service.

(f) Second-class station means a medical relief facility, other than a hospital of the Service, under the charge of a commissioned officer.

(g) Third-class station means a medical relief facility, other than a hospital of the Service, under the charge of a medical officer or employee of the Service other than a commissioned officer.

(h) Fourth-class station means a medical relief facility designated by the Surgeon General, other than a first-, second-, or third-class station.

(i) Designated physician means a physician holding an appointment to act regularly for the Service for a class or classes of specified beneficiaries at a place where there is no medical relief station.

(j) Designated dentist means a dentist holding an appointment to perform dental service for the Service for a class or classes of specified bene

ficiaries.

(k) Active duty means active duty status as distinguished from being on inactive status or retired and includes periods of authorized leave or liberty.

(1) Dependent members of families in the case of male personnel means the lawful wife, the unmarried children (including stepchildren or adopted children) under 21 years of age, and the father or mother if in fact dependent upon such son for his or her chief support; and in the case of female personnel, the unmarried children (including stepchildren or adopted children) under 21 years of age if their father is dead or they are in fact dependent on such mother for their chief support, the father or mother if in fact dependent upon such daughter for his or her chief support, and the husband if in fact dependent upon such wife for his chief support: Provided, however, That in the case of members of the Women's Reserve of the Coast Guard the husbands of such members shall not be considered dependents.

(Sec. 215, 58 Stat. 690, as amended; 42 U.S.C.

216)

PROVISIONS APPLICABLE ΤΟ COAST GUARD, NATIONAL OCEAN SURVEY AND PUBLIC HEALTH SERVICE

$31.2 Persons entitled to treatment.

To the extent and under the circumstances prescribed in §§ 31.2 to 31.10, the following persons shall be entitled to medical, surgical, and dental treatment and hospitalization by the Service:

(a) Coast Guard. (1) Commissioned officers, chief warrant officers, warrant officers, cadets, and enlisted personnel of the Regular Coast Guard, including those on shore duty and those on detached duty, whether on active duty or retired;

(2) Regular members of the Coast Guard Reserve when on active duty or when retired for disability;

(3) Temporary members of the Coast Guard Reserve when on active duty or in case of physical injury incurred or sickness or disease contracted while performing active Coast Guard duty;

(4) Members of the Women's Reserve of the Coast Guard when on active duty or when retired for disability;

(5) Members of the Coast Guard Auxiliary in case of physical injury incurred or sickness or disease contracted while performing active Coast Guard duty.

(b) National Ocean Survey. Commissioned officers, ships' officers, and members of the crews of vessels of the National Ocean Survey, including those on shore duty and those on detached duty whether on active duty or retired.

(c) Public Health Service. (1) Commissioned officers of the Regular Corps of the Service, whether on active duty or retired;

(2) Commissioned officers of the Reserve Corps of the Service when on active duty or when retired for disability. (Sec. 326, 58 Stat. 697, as amended 42 U.S.C. 253)

$31.3 Use of Service facilities.

Except as otherwise provided in §§ 31.3 to 31.10, the persons specified in §31.2 shall be entitled to medical, surgical, and dental treatment and hospitalization only at medical relief stations and by designated physicians and designated dentists, and the cost of

services procured elsewhere shall :: be borne by the Service.

(Sec. 326, 58 Stat. 697, as amended 42 [ 253)

$31.4 Use of other than Service fac ties.

(a) When a person specified in §L. who is on active duty requires imme diate medical, surgical, or dental tres ment or hospitalization and the gency of the situation does not perm treatment at a medical relief static or by a designated physician or de ignated dentist, an officer of the sam service as the patient may arrange fr treatment or hospitalization at the a pense of the Service.

(b) When the circumstances are such that an officer of the same service & the patient is not available to make the necessary arrangements, the treatment or hospitalization may be ob tained by or on behalf of the patient & the expense of the Service.

(c) In every case of treatment or hos pitalization as defined in paragraph (t of this section, the responsible superic officer of the patient shall be notified as promptly as possible and a full re port shall be submitted by such office: to the Surgeon General through apprepriate official channels. As soon as practicable, unless the interests of the patient or the Government require otherwise, treatment or hospitalization shall be continued at a medical relie station or by a designated physician o designated dentist or at another appropriate Federal medical facility.

(d) When the necessary medical relief cannot be obtained from a medical relief station or a designated physician or designated dentist, preference shall be given to other Federal medical facilities when reasonably available and when conditions permit.

(e) Vouchers on proper forms covering expenses for treatment or hospitalization under the circumstances specified in paragraphs (a) and (b) of this section shall be forwarded to the Surgeon General through appropriate official channels. Each such voucher shall be accompanied by or contain a statement of the facts necessitating the treatment or hospitalization. Unreasonable charges for emergency

reatment or hospitalization will not e allowed.

(f) Expenses for consultants or speial services, or for dental treatment ther than emergency measures to reieve pain, shall not be allowed except vhen authorized in advance by the leadquarters of the Service or, in exCraordinary cases, when subsequently Approved by such headquarters upon receipt of report and satisfactory explanation as to the necessity and urgency therefor.

(Sec. 326, 58 Stat. 697, as amended; 42 U.S.C. 253)

§31.5 Application for treatment; active duty personnel.

(a) An applicant for medical relief who is on active duty shall furnish a certificate identifying him. Such certificate, in the case of Coast Guard per1sonnel, shall be signed by an officer of the Coast Guard, and in the case of National Ocean Survey personnel, shall be signed by an officer of the National Ocean Survey. Commissioned officers of any of the services mentioned in §31.2 and officers in charge of units may sign their own certificates. In an emergency, the officer in charge of a medical relief station, or a designated physician or designated dentist, may accept other evidence of status satisfactory to him.

(b) A temporary member of the Coast Guard Reserve except when on active duty or a member of the Coast Guard Auxiliary shall, when applying for medical relief, furnish a statement signed by a responsible superior officer setting forth the facts and circumstances giving rise to the need for medical relief. In emergencies, such statement shall be furnished promptly after the member has received the immediately required care and treatment. Such statement shall be presumptive evidence of the facts stated, but if investigation indicates that the injury, sickness, or disease was not incurred or contracted in the manner stated, further treatment may be denied.

(Sec. 326, 58 Stat. 697, as amended; 42 U.S.C. 253)

$31.6 Personnel absent without leave.

No member of any of the services enumerated in §31.2 shall be entitled when absent without leave to medical relief except at a medical relief station or by a designated physician or designated dentist.

(Sec. 326, 58 Stat. 697, as amended; 42 U.S.C. 253)

§31.7 Continuance of medical relief after loss of status.

If a member is separated from any of the services enumerated in §31.2, except persons specified in §31.2(a) (3) and (5) who shall be entitled to treatment after separation under the conditions set forth in such paragraphs, while undergoing treatment by the Service, his treatment shall be discontinued immediately unless the physician in charge determines that the condition of the patient does not permit interruption of treatment, in which case the treatment shall be discontinued as soon as practicable and the condition of the patient permits. At that time he shall be discharged from treatment and shall not thereafter be afforded medical relief by the Service by reason of his previous service.

(Sec. 326, 58 Stat. 697, as amended; 42 U.S.C. 253)

(a) A retired member of the Coast Guard, National Ocean Survey, or Public Health Service specified in §31.2 shall be entitled to medical, surgical, and dental treatment and hospitalization at medical relief stations of the first-, second-, and third-class, upon presentation of satisfactory evidence of his status.

(b) Elective medical or surgical treatment requiring hospitalization shall be furnished only at hospitals operated by the Service.

(c) Dental treatment shall be furnished to the extent of available facilities only at medical where full-time dental duty; at other medical the dental treatment shal