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areas in which no migrant health center exists and in which not more than 6,000 migratory agricultural workers and their families reside for more than two months.

856.602 Application.

To be approved by the Secretary under this subpart, an application for a grant must, in addition to meeting the requirements of $56.104 of subpart A of this part,

(a) Be submitted for a project with a catchment area which

(1) Is not served, in whole or in part, by a migrant health center, and

(2) Has not more than 6,000 migratory agricultural workers and the members of their families residing therein for more than two months per year; and

(b) Contain information sufficient to enable the Secretary to determine that the project for which the grant is sought will meet the requirements of this part.

$56.603 Project elements.

A project for operating a migrant health program supported under this subpart must:

(a) Provide to migratory and seasonal agricultural workers and the members of their families in its catchment area one or more of the following groups of services so that such services are available and accessible promptly as appropriate, and in a manner which will assure continuity of care, as approved by the Secretary and set forth (including specific services to be provided) in the grant award:

(1) Emergency health care, including diagnostic and treatment services in an ambulatory health care setting or hospital and dental services for the alleviation of acute pain and suffering for medical emergencies, when provision of such services is necessary to avoid jeopardizing the patient's condition until appropriate services from other providers can reasonably be obtained;

(2) Primary care;

(3) Arrangements with existing health care facilities to furnish primary health services (other than primary care);

(4) Other services set forth in $ 56.102(g)(1) which are needed to improve the health of such individuals.

(b) Implement a system for maintaining the confidentiality of patient records in accordance with the requirement of $56.111 of subpart A of this part.

(c) Develop management and control systems which are in accordance with sound financial management procedures, including the provision for an audit conducted in accordance with the DHHS Audit Agency Guide for Audits of Migrant Health Grants, as amended, on at least an annual basis (unless waived for cause by the Secretary), by an independent certified public accountant or public accountant licensed before December 31, 1970, to determine, at a minimum, the fiscal integrity of grant financial transactions and reports and compliance with the regulations of this part and the terms and conditions of the grant.

(d) When the cost of care and services furnished by or through the project is to be reimbursed under title XIX or title XX of the Social Security Act, obtain or make every reasonable effort to obtain a written agreement with the title XIX or title XX State agency for such reimbursement.

(e) Have prepared a schedule of fees or payments for the provision of its services designed to cover its reasonable costs of operation and a corresponding schedule of discounts adjusted on the basis of the patient's ability to pay. The schedule of discounts must provide for a full discount to individuals and families with annual incomes at or below those set forth in the most recent CSA Poverty Income Guidelines (42 CFR 1060.2) (except that nominal fees for service may be collected from individuals and families with annual incomes at or below such levels if imposition of such fees is consistent with project goals) and for no discount to individuals and families with annual incomes greater than twice those set forth in the Guidelines.

(f) Make every reasonable effort, including the establishment of systems for eligibility determination, billing, and collection, to

(1) Collect reimbursement for its costs in providing health services to persons who are entitled to insurance benefits under title XVIII of the Social Security Act, to medical assistance under a State plan approved under title XIX of such Act, to social services and family planning under title XX of such Act, or to assistance for medical expenses under any other public assistance program, grant program, or private health insurance or benefit program on the basis of the schedule of fees prepared pursuant to paragraph (e) of this section without application of any discounts, and

(2) Secure from patients payments for services in accordance with the schedule of fees and discounts required by paragraph (e) of this section.

(g) Develop an overall financial management plan and an operating budget for the project which include and identify, in accordance with generally accepted accounting principles, all anticipated current income and expense items and capital income and expense items, if any.

(h) Establish basic statistical data, cost accounting, management information, and reporting or monitoring systems which will meet the project's management needs and shall enable the project to provide such statistics and other information as the Secretary may reasonably require relating to the project's costs of operation, patterns of utilization of services, and the availability, accessibility, and acceptability of its services, and to make such reports to the Secretary in a timely manner with such frequency as the Secretary may reasonably require.

(i) Review its catchment area annually to insure that the criteria set out in $56.104(b)(2) are met and, where such criteria

not met, revise its catchment area, with the approval of the Secretary, to conform with such criteria to the extent feasible.

(j) In the case of a project which serves a population including a substantial proportion of individuals of limited English-speaking ability, have a plan and made arrangements responsive to the needs of these populations for providing services to the extent practicable in the language and cultural context most appropriate to such individuals, and have identified an individual on its staff who is fluent in both that language and in English and whose responsibilities include providing guidance to such individuals and

to appropriate staff members with respect to cultural sensitivities and bridging linguistic and cultural differences. If more than one non-English language is spoken by such group or groups, an individual or individuals fluent in those languages and English must be so identified.

(k) Be operated in a manner calculated to preserve human dignity and to maximize acceptability and effective utilization of services.

(1) To the extent possible, coordinate and integrate project activities with the activities of other federally funded, as well as State and local, health services delivery projects and programs serving the same population.

(m) Establish means for evaluating progress toward the achievement of the specific objectives of the project.

(n) Provide sufficient staff, qualified by training and experience, to carry out the activities of the project.

(0) Assure that facilities utilized in the performance of the project meet applicable fire and life safety codes.

(p) Utilize, to the maximum extent feasible, other Federal, State and local, and private resources available for support of the project, prior to use of project funds under this part.

(q) Provide for community participation through, for example, contributions of cash or services, loans of fullor part-time staff, equipment, space, materials, or facilities, and, to the extent feasible, establishment of an advisory council to advise with respect to the overall management of the project including services to be provided, the manner of their provision, and appointment of personnel. The membership of such advisory council shall be representative of the population to be served in terms of appropriate demographic characteristics, such as race, sex, and ethnicity.

(r) Where the project will provide services through contract or other cooperative arrangements with other providers of services, the project must

(1) Enter into any such contract or arrangement only if the provider of services will provide the services in a timely manner and make the services accessible and acceptable to the population to be served; and

are

(2) Make payment for services so provided in accordance with a schedule of rates and payment procedures established and maintained by the project. The project must be prepared to substantiate that such rates are reasonable and necessary.

(s) Operate in a manner such that no migratory or seasonal agricultural worker or member of their families will be denied service by reason of his or her inability to pay therefor. Provided, however, That a charge for the provision of services will be made to the extent that a third party (including a Government agency) is authorized or is under legal obligation to pay such charges.

(t) Have an ongoing quality assurance program as described in $56.303(c) except as the Secretary finds that such a program would not be feasible.

(2) Where all such applicants are community-based organizations representative of the population to be served by the project, the Secretary shall award the grant to the applicants which will, in his judgment, best promote the purposes of section 319(d)(1)(C) of the Act and the applicable regulations of this part, taking into account with respect to each application:

(i) The degree to which the proposed project satisfactorily provides for the elements set forth in 856.203;

(ii) The administrative and management capability of the applicant;

(iii) The extent to which community resources will be utilized in the project; and

(iv) The degree to which the applicant intends to integrate services supported by a grant under this part with health services provided under other federally assisted health services or reimbursement programs or projects.

Subpart G Grants for Technical

Assistance

$56.604 Grant evaluation and award.

(a) Within the limit of funds determined by the Secretary to be available the Secretary may award grants under this subpart to applicants therefor which will, in his judgment, provide needed health services in a catchment area which will not be served by another project funded under this part and meet the applicable requirements of section 319(d)(1)(C) of the Act and this subpart, in accordance with priorities established pursuant to section 319(b) of the Act and $ 56.107 of subpart A of this part; Provided, That in the case of applicants which propose to serve substantially the catchment areas or where available funds are insufficient to fund all approvable applications within a priority category specified in $ 56.107,

(1) Priority shall be given to applications submitted by community-based organizations which are representative of the population to be served by the project. For purposes of this paragraph, an applicant shall be deemed to be such an organization if it provides a formal mechanism (such as membership on the organization's governing body or membership on an advisory body) which gives migratory seasonal agricultural workers and their families significant involvement in the formulation of the organization's policies; and

$ 56.701 Applicability.

The regulations of this subpart, in addition to the regulations of subpart A of this part except as otherwise set forth herein, are applicable to grants awarded pursuant to section 319(g) of the Act for the provision of technical and other non-financial assistance to grantees under sections 319(c)(1)(A), 319(d)(1)(A) and 319(d)(1)(B) of the Act. $56.702 Application.

To be approved by the Secretary under this subpart, an application for a grant must meet the requirements of $856.104(a), 56.104(b) (1), (4), (7), (10), and (11), and 56.104(c) of subpart A of this part.

same

$ 56.703 Project elements.

A project for the provision of technical assistance to migrant health centers and entities which intend to become migrant health centers which is supported under this subpart must:

(a) Provide to such centers and entities as are specified in the grant award, such technical and other nonfinancial assistance (such as fiscal and program management assistance or training of erences to section 330 of the Act shall be deemed to be references to section 319 of the Act.

[43 FR 5353, Feb. 7, 1978)

PART 57-GRANTS FOR CON

STRUCTION OF TEACHING FACILITIES EDUCATIONAL IMPROVEMENTS, SCHOLARSHIPS AND STUDENT LOANS

Subparts A-B [Reserved]

Subpart C-Health Professions Student

Loans

as

the staff of such center or entity in such management) as may be specified in the grant award. Such technical or other nonfinancial assistance shall be designed to assist such centers and entities in:

(1) Developing plans for becoming migrant centers; and/or

(2) Meeting the requirements of sections 319(f)(2) of the Act.

(b) Provide such assistance through its own staff or resources.

(c) Where the project will provide training to the staff of a center or entity in management or the provision of health services, provide such training consistent,

applicable, with $56.108(b)(7).

(d) Maintain such records and make such reports on the expenditure of funds under this subpart and provision of such assistance as the Secretary may require. 856.704 Grant evaluation and award.

Within the limits of funds determined by the Secretary to be available for such purpose, the Secretary may award grants under this subpart to applicants therefor which will, in his judgment, best promote the purposes of section 319(g) of the Act and applicable regulations of this part, taking into consideration:

(a) The cost-effectiveness of the application; and

(b) The number of centers and entities to be served by the applicant.

57.201 Applicability. 57.202 Definitions. 57.203 Application by school. 57.204 Payment of Federal capital contribu

tions and reallocation of funds remitted

to the Secretary. 57.205 Health professions student loan

funds. 57.206 Eligibility and selection of health

professions student loan applicants. 57.207 Maximum amount of health profes

sions student loans. 57.208 Health professions student loan

promissory note and disclosure require

ments. 57.209 Payment of health professions stu

dent loans. 57.210 Repayment and collection of health

professions student loans. 57.211 Cancellation of health professions

student loans for disability or death. 57.212 [Reserved] 57.213 Continuation of provisions for can

cellation of loans made prior to Novem

ber 18, 1971. 57.213a Loan cancellation reimbursement. 57.214 Repayment of loans made after No

vember 17, 1971, for failure to complete a

program of study. 57.215 Records, reports, inspection, and

audit. 57.216 What additional Department regula

tions apply to schools? 57.216a Performance standard. 57.217 Additional conditions. 57.218 Noncompliance.

Subpart H-Acquisition and Modernization of Existing Buildings

856.801 Applicability of 42 CFR part

51c, subpart E. The provisions of 42 CFR part 51c, subpart E, establishing requirements for the acquisition and modernization of existing buildings, shall apply to all grants under section 319 of the Act for project costs which include the cost of acquisition and/or modernization of existing buildings (including the cost of amortizing the principal of, and paying the interest on, loans); except that, for purposes of this subpart, references within subpart E to part 51c, or to subparts of part 51c, shall be deemed to be references to part 56, or to the appropriate subparts of part 56, and ref

Subpart D-Nursing Student Loans 57.301 Applicability. 57.302 Definitions. 57.303 Application by school. 57.304 Payment of Federal capital contribu

tions and reallocation of funds remitted

to the Secretary. 57.305 Nursing student loan funds. 57.306 Eligibility and selection of nursing

student loan applicants.

57.706 Evaluation of applications. 57.707 Grant award. 57.708 Grant payments. 57.709 Purposes for which grant funds must

be spent. 57.710 What additional Department regula

tions apply to grantees? 57.711 What other audit and inspection re

quirements apply to grantees? 57.712 Additional conditions.

57.307 Maximum amount of nursing student

loans. 57.308 Nursing student loan promissory

note. 57.309 Payment of nursing student loans. 57.310 Repayment and collection of nursing

student loans. 57.311 Cancellation of nursing student loans

for disability or death. 57.312 Repayment of loans for service in a

shortage area. 57.313 Loan cancellation for full-time em

ployment as a registered nurse. 57.313a Loan cancellation reimbursement. 57.314 Repayment of loans made after No

vember 17, 1971, for failure to complete a

program of study. 57.315 Records, reports, inspection, and

audit. 57.316 What additional Department regula

tions apply to schools? 57.316a Performance standard. 57.317 Additional conditions. 57.318 Noncompliance.

Subpart Programs for the Training of

Physician Assistants

57.801 Purpose and scope. 57.802 Definitions. 57.803 Requirements.

Subpart E-Grants for Construction of

Nurse Training Facilities 57.409 Good cause for other use of completed

facility.

Subpart Grants for Nurse Anesthetist

Traineeships 57.501 To what programs these regula

tions apply? 57.502 Definitions. 57.503 Who is eligible to apply for a grant? 57.504 How will applications be evaluated? 57.505 How long does grant support last? 57.506 How is the amount of the award de

termined? 57.507 For what purposes may grant funds

be spent? 57.508 What financial support is available to

trainees? 57.509 Who is eligible for financial assist

ance as a trainee? 57.510 What are the requirements for

traineeships and the appointment of

trainees? 57.511 Duration of traineeships. 57.512 Termination of traineeships. 57.513 What additional Department regula

tions apply to grantees? 57.514 Additional conditions.

Subparts J-K [Reserved) Subpart Grants for Residency Training

and Advanced Education in the Gen

eral Practice of Dentistry 57.1101 To what projects do these regula

tions apply? 57.1102 Definitions. 57.1103 What entities are eligible to apply

for a grant? 57.1104 How must an entity apply for a

grant? 57.1105 What requirements must a project

meet? 57.1106 How will applications be evaluated? 57.1107 How will grant awards be made? 57.1108 How will grant payments be made? 57.1109 Purposes for which grant funds may

be spent. 57.1110 What additional Department regula

tions apply to grantees? 57.1111 What other audit and inspection re

quirements apply to grantees? 57.1112 What additional conditions apply to

grantees?

Subparts MO [Reserved)

Subpart P-loan Guarantees and Interest

Subsidies to Assist in Construction of
Teaching Facilities for Health Protes-

sion Personnel 57.1501 Applicability. 57.1502 Definitions. 57.1503 Eligibility. 57.1504 Application. 57.1505 Approval of applications. 57.1506 Priority. 57.1507 Limitations applicable to loan guar

antee. 57.1508 Amount of interest subsidy pay

ments; limitations. 57.1509 Forms of credit and security instru

ments. 57.1510 Security for loans. 57.1511 Opinion of legal counsel. 57.1512 Length and maturity of loans.

Subpart G [Reserved]

Subpart H-Grants for Physician Assistant

Training Programs

57.701 Applicability. 57.702 Definitions. 57.703 Eligibility. 57.704 Application. 57.705 Project requirements.

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