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Secretary. The application must be signed by an individual authorized to act for the applicant and to assume on behalf of the applicant the obligations imposed by law, the Act, this regulation, and any additional conditions of assignment imposed under these authorities.

(b) In addition to other pertinent information required by the Secretary, an application for the assignment of Corps personnel must include

(1) A description of the applicant's overall organizational structure;

(2) A justification of the request for the assignment of personnel based upon the needs of the health manpower shortage area;

(3) A description of the applicant's financial plan for operating the National Health Service Corps site including a proposed budget, sources of non-Federal support obtained, and the proposed expenditures for obtaining adequate support staff, equipment and supplies;

(4) A list of the proposed fees and discounted fees to be charged for the provision of health services; and

(5) If an entity wishes to request an interest free loan (not to exceed $50,000) under section 335(c) of the Act to assist the applicant in establishing the practice of the assigned National Health Service Corps personnel, a detailed justification of the amount requested must be included.

(c) An application for assignment must include evidence that the applicant has provided a copy of the completed application for review to (1) each health systems agency designated under section 1515 of the Act for the health service area which includes all or part of the health manpower shortage area for which as assignment of National Health Service Corps personnel is sought or (2) if no health systems agency has been designated for such a health service area, to each State health planning and development agency designated under section 1521 of the Act for each State which includes all or part of the health manpower shortage area for which an assignment

$ 23.5 What are the criteria for decid.

ing which applications for assign

ment will be approved? (a) In approving or disapproving an application for assignment of Corps personnel, the Secretary will consider, among other pertinent factors:

(1) The applicant's ability and plans to meet the operational requirements in $23.8.

(2) The administrative and managerial capability of the applicant.

(3) The soundness of the applicant's financial plan for operating the National Health Service Corps site.

(4) The extent to which community resources will be used in operating the National Health Service Corps site.

(5) Comments received from any designated health systems agency or any designated State health planning and development agency to which an application was submitted for review under 823.4(c).

(6) Comments received from health professional societies serving the health manpower shortage area.

(b) Special consideration for the assignment of Corps personnel will be given to the entity which is located in a health manpower shortage area over an entity which is not located in a health manpower shortage area but has a demonstrated interest in it.

1 Applications and instructions may be obtained from Regional Offices of the Department of Health and Human Services at the addresses set forth at 45 CFR 5.31(b).

8 23.6 What are the criteria for deter

mining the entities to which National Health Service Corps per

sonnel will be assigned? (a) The Secretary may, upon approving an application for the assignment of personnel and after entering into an

agreement with an applicant under personnel to be assigned to the site, $23.7, assign National Health Service and other requirements which the SecCorps personnel to provide health serv- retary determines necessary to carry ices in or to a health manpower short- out the purposes of the Act. age area.

(b) Termination. An agreement en(b) In assigning National Health

tered into under this section may be Service Corps personnel to serve in a

terminated by either party on 30-days health manpower shortage area, the

written notice or modified by mutual Secretary will seek to assign personnel

consent consistent with section 333 of who have those characteristics which

the Act. will increase the probability of their remaining to serve in the health man- [45 FR 12790, Feb. 27, 1980, as amended at 51 power shortage area upon completion FR 31948, Sept. 8, 1986) of the period of assignment. In addition, the Secretary will apply a weight

$23.8 What operational requirements ed-value system in which the first fac- apply to an entity to which Nator listed below is assigned the great

tional Health Service Corps perest eight and the second, and third

sonnel are assigned? factors are assigned lesser weights in Each National Health Service Corps descending order:

site must: (1) The need of the health manpower (a) Operate a health care delivery shortage area as determined by criteria

system within a planned or existing established under section 332(b) of the

community structure to assure: Act.

(1) The provision of high quality com(2) The willingness of individuals,

prehensive health care; government agencies, or health entities within the health manpower short

(2) To the extent feasible, full profes

sional health care coverage for the age area to cooperate with the National Health Service Corps in pro

health manpower shortage area; viding effective health services.

(3) Continuum of care; and (3) The comments of health profes- (4) The availability and accessibility sional societies serving the health of secondary and tertiary health care manpower shortage area.

(the two more sophisticated levels of

health care beyond primary care); (45 FR 12790, Feb. 27, 1980, as amended at 51 FR 31948, Sept. 8, 1986)

(b) Establish and maintain a patient

record system; $ 23.7 What must an entity agree to do (c) Implement a system for maintainbefore the assignment is made?

ing the confidentiality of patient (a) Requirements. To carry out the records; purposes of section 334 of the Act, each (d) Meet the requirements of applicaNational Health Service Corps site ble fire and safety codes; must enter into an agreement with the

(e) Develop, to the extent feasible, Secretary under which the site agrees

linkages with other health care facilito:

ties for the provision of services which (1) Be responsible for charging for health services provided by assigned

supplement or complement the services National Health Service Corps per

furnished by the assigned Corps per

sonnel; sonnel; (2) Take reasonable action for the

(f) Operate a quality assurance syscollection of the charges for those

tem which meets the requirements of health services;

42 CFR 510.303(c) for the establishment (3) Reimburse the United States the and operation of a quality assurance sums required under section 334 of the system in a community health center; Act; and

and (4) Prepare and submit an annual re- (g) Establish basic data, cost acport. The agreement will set forth the counting, and management informaperiod of assignment (not to exceed 4 tion and reporting systems as preyears), the number and type of Corps scribed by the Secretary.

$ 23.9 What must an entity to which

National Health Service Corps per. sonnel are assigned (i.e., a National Health Service Corps site) charge for the provision of health services

by assigned personnel? (a) Except as provided in paragraph (b) of this section, individuals receiving services from assigned National Health Service Corps personnel must be charged on a fee-for-service or other basis at a rate which is computed to permit recovery of the value of the services and is approved by the Secretary.

(b) In determining whether to approve fees to be charged for health services, the Secretary will consider: The costs to the National Health Seryice Corps of providing the health services; the costs to the health manpower shortage area for providing the services; and the charges for similar services by other practitioners or facilities in or nearby the health manpower shortage area. However, if assigned National Health Service Corps personnel are providing services within the framework of an established health services delivery system, the Secretary may approve the fees charged under that system without regard to the foregoing factors.

(c)(1) No charge or a nominal charge will be made for health services provided by assigned National Health Service Corps personnel to individuals within the health manpower shortage area with annual incomes at or below the "CSA Income Poverty Guidelines" (45 CFR 1060.2). However, no individual will be denied health services based upon inability to pay for the services. Any individual who has an annual income above the “CSA Income Poverty Guidelines," but whose income does not exceed 200 percent of the CSA levels, will receive health services at a nominal charge. However, charges will be made for services to the extent that payment will be made by a third party which is authorized or under legal obligation to pay the charges.

(2) The provisions of this paragraph also apply with respect to services provided by an individual who is fulfilling an NHSC scholarship obligation under section 753 or who received a special grant under section 755.

8 23.10 Under what circumstances may

a National Health Service Corps site's reimbursement obligation to

the Federal Government be waived? (a) The Secretary may waive in whole or in part the reimbursement requirements of section 334(a)(3) of the Act if he determines that:

(1) The National Health Service Corps site is financially unable to meet the reimbursement requirements or that compliance with those requirements will unreasonably limit the ability of the site to adequately support the provision of services by assigned Corps personnel. In making these determinations, the Secretary will consider

(i) The costs necessary to adequately support the health services provided by the assigned National Health Service Corps personnel and the income and financial resources available to meet the costs;

(ii) The ability of the applicant to obtain credit from suppliers, lending institutions, private organizations and individuals;

(iii) The need of the health manpower shortage area for health services; and

(iv) The extent to which the National Health Service Corps site utilizes health professions personnel.

(2) A significant percentage of the individuals who are located in the health manpower shortage area and are receiving the health services of the assigned National Health Service Corps personnel are elderly, living in poverty, or have other characteristics which indicate an inability to pay. For purposes of this section, "elderly" means persons 65 years or older and the “CSA Income Poverty Guidelines" will be used as the standard for determining whether individuals are living in poverty. Other characteristics indicating inability to pay include, but are not to be limited to, the ratio of unemployment in the health manpower shortage area and the area's cost-of-living index.

(b) The Secretary may waive in whole or in part the reimbursement requirements of section 334(f)(1) of the Act if he or she determines that the National Health Service Corps site is a small health center (as defined by section 334(f)(5) of the Act) that needs all

or part of the amount otherwise payable to

(1) Expand or improve its provision of health services;

(2) Increase the number of individuals served;

(3) Renovate or modernize facilities for its provision of health services;

(4) Improve the administration of its health service programs; or

(5) Establish a financial reserve to assure its ability to continue providing health services;

(c) Where the Secretary determines that a National Health Service Corps site is eligible for a waiver under paragraph (a) (1) or (2) of this section. the Secretary may waive the application of the reimbursement requirements of section 334(a)(3) of the Act and apply the reimbursement requirements of section 334(f)(1) of the Act. The Secretary may waive in whole or in part the reimbursement requirements of section 334(f)(1) for such a site if he or she determines that the National Health Service Corps site meets the requirements of paragraph (a)(1) of this section. Funds retained by a National Health Service Corps site as a result of such waiver must be used for the purposes set forth in paragraphs (b) (1) through (5) of this section.

(d) Requests for a prospective or retrospective waiver must be made at the time and in the manner and contain the documentation prescribed by the Secretary. (45 FR 12790, Feb. 27, 1980, as amended at 51 FR 31948, Sept. 8, 1986)

nancially unable to purchase equipment or property at fair market value, the Secretary will consider (1) the present financial resources of the entity available to purchase the equipment or property based upon its current liabilities, and (2) the entity's ability to obtain the funds necessary to purchase the equipment or property. However, the Secretary will not sell the equipment or property for less than fair market value to a profitmaking organization unless the organization gives reasonable assurance that it will use the equipment or property to provide health services in or to the health manpower shortage area.

(b) The Secretary will give priority to sales to an entity providing reasonable assurance that it will use the equipment or property for the purpose of retaining within the health manpower shortage area National Health Service Corps personnel who have completed their assignments. $ 23.12 Who will supervise and control

the assigned personnel? Assigned National Health Service Corps personnel will at all times remain under the direct supervision and control of the Secretary. Observance of institutional rules and regulations by the assigned personnel is a mere incident of the performance of their Federal functions and does not alter their direct professional and administrative responsibility to the Secretary.

re

$ 23.11 Under what circumstances may

the Secretary sell equipment or other property of the United States used by the National Health Service

Corps site? (a) Upon expiration of the assignment of all Corps personnel to a health manpower shortage area, the Secretary may sell equipment and other property of the United States used by the assigned personnel. The equipment may be sold at the fair market value or less than the fair market value to any entity providing health services in or to a health manpower shortage area if the Secretary determines that an entity is unable to pay the fair market value. In determining whether an entity is fi

$ 23.13 What nondiscrimination

quirements apply to National

Health Service Corps sites? National Health Service Corps sites are advised that in addition to complying with the terms and conditions of this regulation, the following laws and regulations are applicable

(a) Title VI of the Civil Rights Act of 1964 (43 U.S.C. 2000d et seq.) and its implementing regulations, 45 CFR part 80 (prohibiting discrimination in federally assisted programs on the grounds of race, color, or national origin); and

(b) Section 504 of the Rehabilitation Act of 1973 (29 U.S.C. 794) and its implementing regulations, 45 CFR part 84 (prohibiting discrimination in federally assisted programs on the basis of handicap).

(c) The Age Discrimination Act of 1975 (42 U.S.C. 6101 et seq.) and its implementing regulations, 45 CFR part 91 (prohibiting nondiscrimination on the basis of age in HHS programs or activities receiving Federal financial assistance). (45 FR 12790, Feb. 27, 1980, as amended at 49 FR 38109, Sept. 27, 1984)

Subpart B-Private Practice Spe

cial Loans for Former Corps Members

ice obligations at a NHSC site. NHSC scholarship recipients remain eligible for loans under this subpart for 1 year after they have completed their service obligations at a NHSC site.

(b) Scholarship recipients who are in arrears 31 days or more on a Health Professions Student Loan (42 U.S.C. 294m et seq.), Health Education Assistance Loan (42 U.S.C. 294, et seq.), Nursing Student Loan (42 U.S.C. 297a et seq.), or any other Federally guaranteed or direct student loan are ineligible for this loan program.

(c) NHSC scholarship recipients who have received loans under either this subpart or subpart C of this part are ineligible for loans under this subpart. $ 23.24 In what amounts

are loans made? The Secretary may make loans either 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 $25,000, if the recipient agrees to practice in accordance with the loan agreement for a period of at least 2 years.

SOURCE: 51 FR 31948, Sept. 8, 1986, unless otherwise noted.

$ 23.21 Definitions.

As used in this subpart, terms have the same meanings as those given to them in subpart A, $23.2. In addition:

National Health Service Corps scholarship recipient means an individual receiving a scholarship under the Public Health and National Health Service Corps Scholarship Training Program authorized by section 225 of the Act as in effect on September 30, 1977, and repealed on October 1, 1977, or a scholarship under the NHSC Scholarship Program authorized by section 338A of the Act, formerly section 751 of the Act.

Private full-time clinical practice means the provision of ambulatory clinical services for a minimum of 40 hours per week for at least 45 weeks a year, including the provision of hospital coverage services appropriate to meet the needs of patients treated and to assure continuity of care. The 40 hours per week must be performed in no less than 4 days per week with no more than 12 hours of work being performed in any 24-hour period. $ 23.22 What is the purpose of a pri

vate practice loan? The purpose of the private practice loan is to assist NHSC scholarship recipients in establishing private fulltime clinical practices in designated health manpower shortage areas.

8 23.25 How will interest rates for

loans be determined? Interest will be charged at the Treasury Current Value of Funds (CVF) rate in effect on April 1 immediately preceding the date on which the loan is approved and will accrue from the date the loan funds are disbursed to the borrower.

$ 23.26 How is the loan repaid?

Payments shall be made at monthly intervals, beginning 1 month from the date of the loan disbursement, in accordance with the repayment schedule established by the Secretary and set forth in the loan agreement. Only interest payments are required during the first 2 years. The repayment schedule may be extended in accordance with $23.31(a). $ 23.27 What happens if scheduled pay.

ments are late? (a) Failure to make full payment of principal and/or interest when due will subject the borrower to the assessment of administrative costs and penalty

$ 23.23 Who is eligible to receive a pri

vate practice option loan? (a) Eligibility for loans is limited to NHSC scholarship recipients who have completed at least 2 years of their serv

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