PHS 1637-2 (BF). In addition, the parent concerned shall submit an affidavit on form PHS 1637-3 (BF). The parent's affidavit shall be filed to cover the period from the date basic allowance for quarters is claimed to the date of execution of the affidavit, such period to be not less than one month.

§ 21.384 Adopted parent.

If the parent claimed as a dependent is a parent by adoption, there shall be submitted, in addition to the evidence required by § 21.383, certified court orders of adoption or such other evidence as is acceptable to establish legally the fact of adoption.

§ 21.385 Stepparent.

If the parent claimed as a dependent is a stepparent, the stepparent must submit, in addition to the affidavit required by § 21.383, a sworn statement to the effect that he or she married the blood parent of the officer and that he or she has not been divorced from such blood parent.

§ 21.386 Parent "in loco parentis."

If the parent claimed as a dependent has an "in loco parentis" status, the officer, in addition to the evidence required by § 21.383 to be submitted by him, shall submit a sworn statement setting forth all circumstances relevant to proof of the relationship as may be prescribed by the Surgeon General.

Determinations of dependency and parental status, as required by this subpart, may be made by such officers and employees of the Public Health Service as may be designated by the Chief, Division of Finance, Public Health Service. Subpart S-Claims for Compensation Availability of Clinical Information § 21.401 Claims for compensation; disclosure of relevant clinical information.

Relevant clinical information in the records or in the possession of the Service concerning a commissioned officer or former officer of the Service may upon request therefor be furnished to a Federal department or agency with which a claim for compensation or other benefit has been filed based on the death of, or an injury or disease incurred by, such officer or former officer.

(Sec. 215, 58 Stat. 690 as amended; 42 U.S.C. 216)

Subpart T-Inactive Duty Training AUTHORITY: §§ 21.451 and 21.452 issued under 37 U.S.C. 206, 402 (b), 1002.

SOURCE: §§ 21.451 and 21.452 appear at 24 F.R. 11096, Dec. 31, 1959.

§ 21.451 Inactive duty training with pay.

Commissioned officers of the Reserve Corps not on active duty may, when authorized by the Surgeon General, perform such periods of training, instruction, or duty as the Surgeon General may prescribe. For each period of service performed pursuant to this section of which the duration is not less than two hours nor more than one calendar day, the officer shall be entitled to compensation at the rate of 1/30th of his basic pay. The number of such periods for which compensation shall be paid shall be limited to 48 periods during a calendar year and to 12 periods during a calendar quarter. The Surgeon General shall prescribe for each officer so authorized the minimum number of such periods of service to be performed during a calendar quarter, the performance of which will be required to entitle the officer to compensation for any period of service performed during that quarter. The Surgeon General may require each officer performing such periods of service to file reports relative to each period. If a report is required for a period of service the receipt of the report by the Service shall be a condition precedent to the payment of compensation for such period.

§ 21.452 Inactive duty for training without pay.

Commissioned officers of the Reserve Corps not on active duty may, when authorized by the Surgeon General, with their consent perform without pay inactive duty for training or such other duty as may be prescribed by the Surgeon General.

Sec.

SPECIAL CONSULTANTS

22.3 Appointment of special consultants. 22.5 Leave without pay while on detail.

AUTHORITY: §§ 22.1 and 22.3 issued under sec. 215, 58 Stat. 690, as amended; 42 U.S.C. 216, unless otherwise noted.

LEPROSY DUTY BY CIVIL SERVICE

OFFICERS AND EMPLOYEES

§ 22.1 Duty requiring intimate contact with leprosy patients; additional pay for civil service officers or employees. Every civil service officer or employee of the Service assigned to full-time duty for a period of 30 days or more at a station of the Service devoted to the care of leprosy patients shall receive, while so assigned, in addition to the basic compensation provided by law for his position, a sum equal to 25 per centum of such compensation: Provided, That the rate of total basic and additional compensation received by any such civil service officer or employee on June 30, 1952, under laws and regulations then in effect shall not, so long as the officer or employee remains on continuous assignment to such duty, be reduced prior to July 1, 1957, by reason of the foregoing provisions of this section.

(Sec. 209 (g), 58 Stat. 687, as amended; 42 U.S.C. 210(e)) [21 FR. 9821, Dec. 12, 1956] SPECIAL CONSULTANTS

§ 22.3 Appointment of special consult

ants.

(a) When the Public Health Service requires the services of consultants who cannot be obtained when needed through regular Civil Service appointment or under the compensation provisions of the Classification Act of 1949, special consultants to assist and advise in the operations of the Service may be appointed, subject to the provisions of the following paragraphs and in accordance with such instructions as may be issued from time to time by the Secretary of Health, Education, and Welfare.

(b) Appointments, pursuant to the provisions of this section, may be made by those officials of the Service to whom authority has been delegated by the Secretary or his designee.

(c) The per diem or other rates of compensation shall be fixed by the appointing officer in accordance with criteria established by the Surgeon General. (Sec. 208 (c), 58 Stat. 686, as amended; 42 U.S.C. 209(e)) [21 F.R. 9821, Dec. 12, 1956, as amended at 31 F.R. 12939, Oct. 5, 1966]

84-001-72- 4

§ 22.5

Leave without pay while on detail. The Secretary or his delegatee may, pursuant to section 214(d) of the Public Health Service Act, 42 U.S.C. 215(d), and with the consent of the officer or employee concerned, arrange, through agreements or otherwise, for a civilian officer or employee of the Public Health Service to be placed on leave without pay for the period of a detail to a State, a subdivision thereof, or a private nonprofit institution and be paid by the nonFederal organization. Such an arrangement may be for a period of not to exceed 2 years, but may be extended for additional periods of not to exceed 2 years each.

[33 F.R. 18981, Dec. 20, 1968]

Application for assignment.

23.5 Assignment of personnel.

23.6

23.7

23.8 23.9

Charges for services.

Supervision of assigned personnel and termination of assignment.

Agreements with applicants.

Use of facilities by assigned personnel. AUTHORITY: The provisions of this Part 23 issued under sec. 215, 58 Stat. 690 as amended; 42 U.S.C. 216; sec. 329, 84 Stat. 1868; 42 U.S.C. 248.

SOURCE: The provisions of this Part 23 appear at 36 F.R. 23906, Dec. 16, 1971, unless otherwise noted.

§ 23.1 Applicability.

The regulations in this part are applicable to the assignment of commissioned officers and other personnel of the U.S. Public Health Service to areas with critical health manpower shortages, as provided by section 329 of the Public Health Service Act (42 U.S.C. 248).

(d) "Assigned personnel" means health or health related personnel of the U.S. Public Health Service, including, but not limited to, physicians, dentists, pharmacists, nurses, paramedical personnel, medical services administrators or planners, and medical technicians, who are sent, in accordance with section 329 of the Act and the regulations in this part, to an area to provide needed health care or services.

(e) "Nonprofit" private health organization means a private health organization no part of the net earnings of which inures, or may lawfully inure, to the benefit of any private shareholder or individual.

(f) "Population" means the population based on the latest figures available from the U.S. Census Bureau or such other source that the Secretary finds acceptable, applicable to the area to be served.

§ 23.3 Eligibility.

(a) Eligible applicants. Application for the assignment of service personnel may be made by

(1) A State or local health agency, or (2) Any other public or nonprofit private health organization.

(b) Eligible area. Except in cases in which the Secretary is satisfied that extreme hardship exists, no assignment of physicians or dentists will be made to an area having a population of less than 4,000 people. Areas having a population of less than 4,000 people, may, however, be assigned personnel other than physicians or dentists.

§ 23.4 Application for assignment.

(a) An application for the assignment of service personnel under section 329 of the Act shall be submitted to the Secretary in such form and manner and at such time as the Secretary may prescribe. (b) The application shall set forth: (1) The population, size, and general geographical description of the area to be served;

(2) The numbers and types of health personnel, services, and facilities in the area to be served;

(3) A description of the need for and planned use and support of assigned personnel;

(4) The organizational structure of the applicant;

(5) Such other information as the Secretary may from time to time require. (c) The application shall contain the certification of the State and district medical societies (or dental societies, or other appropriate health societies as the case may be) for the area to be served, and of the local government of that area, that such health personnel are needed in the area.

(d) The application shall contain the recommendations of the appropriate State health planning agency established pursuant to section 314(a) of the Act, the appropriate Regional Medical Program established pursuant to title IX of the Act, and, where there has been such an agency established, of the appropriate areawide health planning agency established pursuant to section 314(b) of the Act, and of the State medical, dental, and other health associations and from other medical personnel of the area to be served, or establish to the satisfaction of the Secretary that such recommendations were not reasonably obtainable.

(e) Such application shall be executed by an individual authorized to act for the applicant and to assume on behalf of the applicant any obligations imposed by the statute, these regulations, or any additional conditions of assignment imposed pursuant thereto.

§ 23.5 Assignment of personnel.

(a) The Secretary may, on the basis of an application, designate an area as having a critical manpower shortage and assign service personnel to such areas where he finds such designation and assignment will best serve the purposes of section 329 of the Act and the regulations of this part, taking into account:

(1) The need of the area for the health services to be provided;

(2) The willingness of the area and the appropriate governmental agencies therein to assist and cooperate with the Service in providing effective health services to residents of the area;

nel of the area considered for assistance; and

(5) The extent to which the applicant has utilized Federal and other health resources available to the area involved.

(6) The potential ability of persons within the area to pay the cost of providing health care services in accordance with § 23.6.

(b) In determining whether an area has a critical health manpower shortage, the Secretary will, where applicable, take into account the following factors:

(1) Health resource statistics, such as numbers and ages of primary care physicians and dentists, the range of primary care and other health services available, and the types of health facilities in the area. The ratios of physicians and dentists to the population served, as compared with State and national ratios, will be a significant measure.

(2) Health status indicators, such as infant and maternal mortality rates, accident rates, and other indicators of the existence of special health problems affecting the community's needs for health care services.

(3) The accessibility of health care services in the community and the ability to obtain these services when required on a timely and effective basis. Transportation difficulty, travel times, and the ability of health resources to meet increased demands will be significant

measures.

(4) Other

socio-economic, .demographic, and environmental factors of community life which significantly impair the ability of the community to attract and retain health personnel.

(c) The Secretary may from time to time publish specific measures (e.g., ratio of doctors to population) for the factors set forth in paragraph (b) of this section which will be considered as establishing the level at which a health manpower shortage becomes critical.

(d) The Secretary may withdraw his designation of an area as one having a critical health manpower shortage upon determining that there has been a substantial change in circumstances within the area in relation to the factors set forth in paragraph (b) of this section. § 23.6 Charges for services.

(a) Any person receiving services from assigned personnel shall be charged

for such services except as otherwise provided in paragraphs (c) or (d) of this section. Such charge shall (except as provided in paragraph (b) of this section) be in accordance with the reasonable charges established pursuant to part B of title XVIII of the Social Security Act. In the case of dental services, such charges shall be in accordance with the fee structure that State dental societies have negotiated with the appropriate State government, if any, and if none, the fee structure utilized by the U.S. Veterans Administration for the area involved. In cases in which a service is rendered for which there is no applicable charge under any of the methods referred to above, the charge shall be that which the Secretary determines is or would be prevailing and reasonable for the area involved. Provided, however, In any case in which assigned personnel are providing services in the framework of an established health services delivery system, the charges for such services shall be consistent with the charges made by such system.

(b) In lieu of charging on a "fee for services" basis pursuant to paragraph (a) of this section, persons eligible to receive services from assigned personnel may be charged on a prepaid capitation basis. In such event, the amount of that charge shall be designed to recover the reasonable costs of providing such services.

(c) No charge or a reduced charge shall be made for services provided by assigned personnel under paragraph (a) or (b) of this section to any person from a family which has an annual income below the higher of (1) the State figure for the "medically needy", as determined in accordance with the Aid for Families with Dependent Children figures calculated by the Assistance Payments Administration, Social and Rehabilitation Service, or (2) the current Social Security Administration poverty income level.

(d) If a Federal agency or a State or local government agency or other third party would be responsible for all or part of the cost of the service provided under this section if such service had not been provided under section 329 of the Act, the Secretary shall collect from such agency or third party the portion of such cost for which it would be so responsible.

§ 23.7 Supervision of assigned personnel and termination of assignment. Personnel assigned in accordance with the provisions of section 329 of the act and the regulations in this part shall at all times remain under the direct supervision and control of the Secretary. Observance of institutional rules and regulations by assigned personnel are mere incidents of the performance of their Federal function and do not alter their direct professional responsibility to the Secretary. The Secretary may terminate or modify any such assignment if he determines that such assignment is not being performed in accordance with section 329 of the Act, the regulations in this part, or any agreement entered into under § 23.8 of the regulations in this part.

§ 23.8 Agreements with applicants.

The Secretary will, upon determining to assign personnel to an area, and consistent with section 329 of the act and these regulations, enter into agreements with applicants setting forth such additional terms and conditions as he deems

necessary to assure the furtherance of the purposes of section 329 of the act, the regulations in this part, the interests of the public health, or the effective utilization of assigned personnel, including but not limited to

(a) Number and type of personnel assigned;

(b) Duration of assignment; (c) Fees and methods for charging for services of assigned personnel;

(d) Types of facilities or other assistance to be provided by applicant.

§ 23.9 Use of facilities by assigned personnel.

The Secretary, to the extent feasible, may make such arrangements as he determines necessary to enable assigned personnel to utilize the health facilities of the area to be served. If there are no such facilities in such area, the Secretary may arrange to have such care and services provided in the nearest health facilities of the Public Health Service or the Secretary may lease or otherwise provide facilities in such area for the provision of care and services.