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which could be met by routine program evaluation?

851b.606 How can grant funds be

used? (a) Grant funds may be used for the costs associated with planning, organizing, and conducting applied research, demonstrations, and public information and education programs.

(b) Grant funds may also be used to reimburse individuals who agree to be participants in the applied research projects. This reimbursement, however, must be justified as necessary and reasonable. A schedule of reimbursements must be submitted with the application and approved as part of the program plan.

(c) Grant funds may not be used to supplant funds supporting existing venereal disease control services provided by a State or locality.

PART 510-GRANTS FOR COMMUNITY HEALTH SERVICES

Subpart A-General Provisions

(b) An application for a continuation grant must be submitted for each funding period. This continuation application must include the following:

(1) A budget and justification for the grant funds requested.

(2) A summary of the progress achieved during the previous budget period.

(3) A description of any changes in the information shown in the project application. $51b.605 How will grant applications

be evaluated and the grants awarded? (a) Within the limits of funds available, the Secretary may award a grant to assist in meeting the costs of special activities authorized under section 318(b) of the Act.

(b) Grant applications will be reviewed and evaluated according to the following criteria:

(1) Is there adequate evidence that the proposed project is needed and that the outcome has potential to directly benefit the national venereal disease control effort?

(2) Are the project objectives specific, measurable, realistic, time phased, and related to promoting the purposes of section 318?

(3) Is the method of operation logical and clearly related to project objectives, and does it describe how the applicant intends to proceed particularly with activities which are complex, interrelated, or unprecedented?

(4) Does the method of operation include an assessment of any possible impact, both positive and negative, that the conduct of the proposed initiative might have upon the established venereal disease control program in the locality or localities in which the project will be undertaken?

(5) Does the proposal include a comprehensive and realistic plan for the evaluation of the project, and specify the measures and instruments of measurement to be used?

(6) Is the budget request reasonable and consistent with the intended use of grant funds?

(7) If the applicant intends only to evaluate an existing disease prevention and control approach, are the objectives substantially different from those

Sec. 51c.101 Applicability. 51c.102 Definitions. 51c.103 Eligibility. 51c.104 Application. 51c.105 Accord with health planning. 51c.106 Amount of grant. 51c.107 Use of project funds. 51c.108 Grant payments. 51c.109 Nondiscrimination. 51c.110 Confidentiality. 51c.111 Publications and copyright. 51c.112 Grantee accountability. 51c.113 Applicability of 45 CFR part 74.

Subpart B-Grants for Planning and Developing Community Health Centers 51c.201 Applicability. 51c.202 Application. 510.203 Project elements. 510.204 Grant evaluation and award.

Subpart C-Grants for Operating

Community Health Centers

510.301 Applicability. 510.302 Application. 510.303 Project elements. 510.304 Governing board. 510.305 Grant evaluation and award.

Subpart D-Grants for Operating

Community Health Projects

510.401 Applicability. 510.402 Application. 51c.403 Project elements. 510.404 Grant evaluation and award.

Subpart E-Acquisition and Modernization

of Existing Buildings

51c.501 Applicability. 51c.502 Definitions. 51c.503 Application. 510.504 Project elements. 51c.505 Determination of cost. 51c.506 Use of grant funds. 51c.507 Facility which has previously re

ceived Federal grant. AUTHORITY: Sec. 330, Public Health Service Act, 89 Stat. 342, (42 U.S.C. 254c); sec. 215, Public Health Service Act, 58 Stat. 690. (42 U.S.C. 216).

SOURCE: 41 FR 53205, Dec. 3, 1976, unless otherwise noted.

Subpart A-General Provisions $51c.101 Applicability.

The regulations of this subpart are applicable to all project grants authorized by section 330 of the Public Health Service Act (42 U.S.C. 254c).

(iv) Environmental health services, as determined by the Secretary to be appropriate for particular centers; and

(v) Information on the availability and proper use of health services.

(2) For purposes of paragraph (c)(1) of this section, the provision of a given service by a center will be determined by the Secretary to be appropriate where:

(i) There is a need, as determined by the Secretary, for the provision of such service in the catchment area; and

(ii) The provision of such service by the center is feasible, taking into consideration the center's projected revenues, other resources, and grant support under this part.

(d) Environmental health services means the detection and alleviation of unhealthful conditions of the environment of the catchment area, such as problems associated with water supply, sewage treatment, solid waste disposal, rodent and parasite infestation, and housing conditions. For the purposes of this part, the detection and alleviation of unhealthful conditions of the environment includes the notification of and making of arrangements with appropriate Federal, State, or local authorities responsible for correcting such conditions.

(e) Medically underserved population means the population of an urban or rural area designated by the Secretary as an area with a shortage of personal health services or a population group designated by the Secretary as having a shortage of such services. Medically underserved areas will be designated by the Secretary and a list of those designated will be published in the FEDERAL REGISTER from time to time, taking into consideration the following factors, among others:

(1) Available health resources in relation to size of the area and its population, including appropriate ratios of primary care physicians in general or family practice, internal medicine, pediatrics, or obstetrics and gynecology to population;

(2) Health indices for the population of the area, such as infant mortality rate;

(3) Economic factors affecting the population's access to health services, such as percentage of the population

or

$51c.102 Definitions.

As used in this part:

(a) Act means the Public Health Seryice Act.

(b) Catchment area means the area served by a project funded under section 330 of the Act.

(c)(1) Community health center or center means an entity which, through its staff and supporting resources through contracts or cooperative arrangements with other public or private entities, provides for all residents of its catchment area:

(i) Primary health services;

(ii) As determined by the Secretary to be appropriate for particular centers, supplemental health services necessary for the adequate support of primary health services;

(iii) Referral to providers of supplemental health services and payment, as determined by the Secretary to be appropriate and feasible, for their provision of such services;

with incomes below the poverty level; and

(4) Demographic factors affecting the population's need and demand for health services, such as percentage of the population age 65 and over.

(f) Nonprofit, as applied to any private agency, institution, or organization, means one which is a corporation or association, or is owned and operated by one or more corporations or associations, no part of the net earnings of which inures, or may lawfully inure, to the benefit of any private shareholder or individual.

(g) Physician means a licensed doctor of medicine or doctor of osteopathy.

(h) Primary health services means:

(1) Diagnostic, treatment, consultative, referral, and other services rendered by physicians, and, where feasible, by physician's extenders, such as physicians' assistants, nurse clinicians, and nurse practitioners;

(2) Diagnostic laboratory services and diagnostic radiologic services;

(3) Preventive health services, including medical social services, nutritional assessment and referral, preventive health education, children's eye and ear examinations, prenatal and post-partum care, prenatal services, well child care (including periodic screening), immunizations, and voluntary family planning services;

(4) Emergency medical services, including provision, through clearly defined arrangements, for access of users of the center to health care for medical emergencies during and after the center's regularly scheduled hours;

(5) Transportation services as needed for adequate patient care, sufficient so that residents of the catchment area served by the center with special difficulties of access to services provided by the center receive such services; and

(6) Preventive dental services provided by a licensed dentist or other qualified personnel, including (i) oral hygiene instruction; (ii) oral prophylaxis, as necessary; and (iii) topical application of fluorides, and the prescription of fluorides for systemic use when not available in the community water supply.

(i) Secretary means the Secretary of Health and Human Services and any other officer or employee of the De

partment of Health and Human Services to whom the authority involved has been delegated.

(j) Supplemental health services means health services which are not included as primary health services and which are:

(1) Inpatient and outpatient hospital services;

(2) Home health services;
(3) Extended care facility services;

(4) Rehabilitative services (including physical and occupational therapy) and long-term physical medicine;

(5) Mental health services, including services of psychiatrists, psychologists, and other appropriate mental health professionals;

(6) Dental services other than those provided as primary health services;

(7) Vision services, including routine eye and vision examinations and provision of eyeglasses, as appropriate and feasible;

(8) Allied health services;

(9) Pharmaceutical services, including the provision of prescription drugs;

(10) Therapeutic radiologic services;

(11) Public health services (including nutrition education and social services);

(12) Ambulatory surgical services;
(13) Health education services; and

(14) Services, including the services of outreach workers, which promote and facilitate optimal use of primary health services and services referred to in the preceding subparagraphs of this paragraph and, if a substantial number of individuals in the population served by the center are of limited Englishspeaking ability, the services of outreach workers and other personnel fluent in the language or languages spoken by such individuals.

851c.103 Eligibility.

Any public or nonprofit private entity is eligible to apply for a grant under this part.

851c.104 Application.

(a) An application for a grant under this part shall be submitted to the Secretary at such time and in such form and manner as the Secretary may prescribe.

(b) The application shall contain a budget and narrative plan of the manner in which the applicant intends to conduct the project and carry out the requirements of this part. The application must describe how and the extent to which the project has met, or plans to meet, each of the requirements in subpart B (relating to grants for planning and developing community health centers), subpart C (relating to grants for the operation of community health centers), or subpart D (relating to grants for the operation of community health projects), as applicable. In addition, applications must include:

(1) A statement of specific, measurable objectives and the methods to be used to assess the achievement of the objectives in specified time periods and at least on an annual basis.

(2) The precise boundaries of the catchment area to be served by the applicant, including an identification of the medically underserved population or populations within the catchment area. In addition, the application shall include information sufficient to enable the Secretary to determine that the applicant's catchment area meets the following criteria:

(i) The size of such area is such that the services to be provided by the applicant are available and accessible to the residents of the area promptly and as appropriate;

(ii) The boundaries of such area conform, to the extent practicable, to relevant boundaries of political subdivisions, school districts, and areas served by Federal and State health and social service programs; and

(iii) The boundaries of such area eliminate, to the extent possible, barriers resulting from the area's physical characteristics, its residential patterns, its economic and social groupings, and available transportation.

(3) The results of an assessment of the need that the population served or proposed to be served has for the services to be provided by the project (or in the case of applications for planning and development projects, the methods to be used in assessing such need), utilizing, but not limited to, the factors set forth in $51c.102(e)(1)-(4).

(4) Position descriptions for key personnel who will be utilized in carrying out the activities of the project and a statement indicating the need for the positions to be supported with grant funds to accomplish the objectives of the project.

(5) Letters and other forms of evidence showing that efforts have been made to secure financial and professional assistance and support for the project within the proposed catchment area and the continuing involvement of the community in the development and operation of the project.

(6) An assurance that an independent certified public accountant, or a public accountant licensed before December 31, 1970, will be engaged to certify that the system for the management and control of its financial assets will be in accord with sound financial management practices, including applicable Federal requirements.

(7) A list of all services proposed to be provided by the project.

(8) A list of services which are to be provided directly by the project through its own staff and resources and a description of any contractual or other arrangements (including copies of documents, where available) entered into, or planned for the provision of services.

(9) The schedule of fees and/or payments and schedule of discounts for services provided by the project.

(10) Evidence that all applicable requirements for review and/or approval of the application under title XV of the Act have been met.

(11) An assurance that the project will be conducted in accordance with the applicable requirements of this part.

(c) The application must be executed by an individual authorized to act for the applicant and to assume on behalf of the applicant the obligations imposed by the statute, the applicable regulations of this part, and any additional conditions of the grant. (Sec. 330, Public Health Service Act, 89 Stat. 342, (42 U.S.C. 254c); sec. 215, Public Health Service Act, 58 Stat. 690, 67 Stat. 63 (42 U.S.C. 216)) (41 FR 53205, Dec. 3, 1976, as amended at 48 FR 29201, June 24, 1983; 48 FR 45558, Oct. 6. 1983]

$51c.105 Accord with health planning. retary may retroactively agree to a

A grant may be made under this part percentage of project costs to be borne only if the applicable requirements of

by the grantee lower than that detertitle XV of the Act relating to review

mined pursuant to paragraph (a)(2)(i) of and approval by the appropriate health

this section where he finds that planning agencies have been met.

changed circumstances justify a small

er contribution. $51c.106 Amount of grant.

(iii) In determining the grantee's (a) The amount of any award under share of project costs, costs borne by this part will be determined by the Federal grant funds, or costs used to Secretary on the basis of his estimate match other Federal grants, may not of the sum necessary for a designated be included except as otherwise proportion of direct project costs plus an vided by law or regulations. additional amount for indirect costs, if (b) All grant awards shall be in writany, which will be calculated by the ing, and shall set forth the amount of Secretary either:

funds granted and the period for which (1) On the basis of the estimate of the

support is recommended. actual indirect costs reasonably re- (c) Neither the approval of any projlated to the project; or

ect nor any grant award shall commit (2) On the basis of a percentage of all,

or obligate the United States in any or a portion of, the estimated direct

way to make any additional, supplecosts of the project when there are rea

mental, continuation, or other award sonable assurances that the use of such

with respect to any approved project or percentage will not exceed the approximate actual indirect costs. Such award

portion thereof. For continuation supmay include an estimated provisional

port, grantees must make separate apamount for indirect costs or for des

plication. ignated direct costs (such as fringe benefit rates) subject to upward (with

$ 51c.107 Use of project funds. in the limits of available funds) as well (a) Any funds granted pursuant to as downward adjustments to actual this part, as well as other funds to be costs when the amount properly ex- used in performance of the approved pended by the grantee for provisional project, may be expended solely for items has been determined by the Sec- carrying out the approved project in retary: Provided, however, That no accordance with section 330 of the Act, grant shall be made for an amount in the applicable regulations of this part, excess of the total cost found necessary the terms and conditions of the award, by the Secretary to carry out the and the applicable cost principles preproject.

scribed in subpart Q of 45 CFR part 74. (i) In determining the percentage of (b) Project funds awarded under this project costs to be borne by the grant

part may be used for, but need not be ee, factors which the Secretary will

limited to, the following: take into consideration will include

(1) The costs of acquiring and modthe following: (A) The ability of the grantee to fi

ernizing existing buildings (including

the costs of amortizing the principal nance its share of project costs from non-Federal sources;

of, and paying interest on, loans), but (B) The need in the area served by

only in accordance with subpart E of the project for the services to be pro

this part and as approved in the grant vided; and

award; (C) The extent to which the project

(2) The costs of obtaining technical will provide services in an innovative

assistance to develop and improve the manner which the Secretary desires to management capability of the project, stimulate in the interest of developing but only as approved by the Secretary; more effective health service delivery (3) The reimbursement of members of systems on a regional or national the grantee's governing board, if any, basis.

for reasonable expenses actually in(ii) At any time after approval of an curred by reason of their participation application under this part, the Sec- in board activities;

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