[Code of Federal Regulations]
[Title 42, Volume 1]
[Revised as of October 1, 2002]
From the U.S. Government Printing Office via GPO Access
[CITE: 42CFR56.303]

[Page 246-248]
 
                         TITLE 42--PUBLIC HEALTH
 
    CHAPTER I--PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN 
                                SERVICES
 
PART 56--GRANTS FOR MIGRANT HEALTH SERVICES--Table of Contents
 
         Subpart C--Grants for Operating Migrant Health Centers
 
Sec. 56.303  Project elements.

    A migrant health center supported under this subpart must:
    (a) Provide the health services of the center so that such services 
are available and accessible promptly, as appropriate, and in a manner 
which will assure continuity of service to the migratory and seasonal 
agricultural workers and their families within the center's catchment 
area.
    (b) Implement a system for maintaining the confidentiality of 
patient records in accordance with the requirements of Sec. 56.111 of 
subpart A of this part.
    (c) Have an ongoing quality assurance program which provides for the 
following:
    (1) Organizational arrangements, including a focus of 
responsibility, to support the quality assurance program and the 
provision of high quality patient care;
    (2) Periodic assessment of the appropriateness of the utilization of 
services and the quality of services provided or proposed to be provided 
by the center, and by other providers through contract or other 
cooperative arrangement with the center. Such assessments must:
    (i) Be conducted by physicians or by other appropriate health 
professionals under the supervision of physicians or, as appropriate, by 
health professionals who are peers of the health professionals who 
provided the services;
    (ii) Be based on the systematic collection and evaluation of patient 
records; and
    (iii) Identify and document the necessity for change in the 
provision of services by the center and result in the institution of 
such change, where indicated.
    (d) Develop management and control systems which are in accordance 
with sound financial management procedures, including the provision for 
an audit (1) conducted in accordance with the ``Guide for Audits of 
Migrant Health Grants'' of the DHHS Audit Agency, and (2) conducted with 
reasonable frequency, usually annually but not less frequently than 
every two years (unless waived for cause by the

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Secretary), to be made by qualified individuals who are sufficiently 
independent of those who authorize the expenditure of Federal funds to 
produce unbiased opinions, conclusions, or judgments, and to determine, 
at a minimum, the fiscal integrity of grant financial transactions and 
reports, and compliance with the applicable regulations of this part and 
the terms and conditions of the grant.
    (e) Where the cost of care and services furnished by or through the 
center 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.
    (f) 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 such individuals and families) and for no discount to individuals 
and families with annual incomes greater than twice those set forth in 
such Guidelines.
    (g) 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 (f) 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 (f) of this 
section.
    (h) Have a governing board which meets the requirements of 
Sec. 56.304.
    (i) Have developed an overall plan and budget for the center that:
    (1) Provides for an annual operating budget and a three-year 
financial management plan which includes all anticipated income and 
expenses related to items which would, under generally accepted 
accounting principles, be considered income and expense items;
    (2) Provides for a capital expenditure plan for at least a three-
year period (including the year to which the operating budget described 
in paragraph (h)(i)(1) is applicable) which includes and identifies in 
detail the anticipated sources of financing for, and the objective of, 
each anticipated expenditure in excess of $100,000 related to the 
acquisition of land, the improvement of land, buildings, and equipment 
and the replacement, modernization and expansion of buildings and 
equipment which would, under generally accepted accounting principles, 
be considered capital items;
    (3) Provides for plan review and updating at least annually; and
    (4) Is prepared under the direction of the governing board by a 
committee consisting of representatives of the governing board, the 
administrative staff, and the medical staff, if any, of the center.
    (j) Establish basic statistical data, cost accounting, management 
information, and reporting or monitoring systems which will enable the 
center to provide such statistics and other information as the Secretary 
may reasonably require relating to the center'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.
    (k) Review its catchment area annually to insure that the criteria 
set out in Sec. 56.104(b)(2) are met and, if criteria are not met, 
revise its catchment area, with the approval of the Secretary, to 
conform with such criteria to the extent feasible.

[[Page 248]]

    (l) In the case of a center which serves a population including a 
substantial proportion of individuals of limited English-speaking 
ability, have developed a plan and made arrangements responsive to the 
needs of such 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.
    (m) Be operated in a manner calculated to preserve human dignity and 
to maximize acceptability and effective utilization of services.
    (n) 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.
    (o) Establish means for evaluating progress toward the achievement 
of the specific objectives of the project.
    (p) Provide sufficient staff, qualified by training and experience, 
to carry out the activities of the center.
    (q) Assure that facilities utilized in the performance of the 
project meet applicable fire and life safety codes.
    (r) 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.
    (s) Provide for community participation through, for example, 
contributions of cash or services, loans of full- or part-time staff, 
equipment, space, materials, or facilities.
    (t) Where the center will provide services through contract or other 
cooperative arrangements with other providers of services, the center 
must:
    (1) Enter into the 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;
    (2) Make payment for services so provided only pursuant to 
agreements with the providers in accordance with a schedule of rates and 
payment procedures established and maintained by the center. The center 
must be prepared to substantiate that such rates are reasonable and 
necessary;
    (3) Directly provide at least primary care unless the center has 
made arrangements for the provision of primary care which include 
transfer of all medical and financial information relating to such care 
to the center; and
    (4) Enter into contracts or arrangements for the provision of 
primary health services only if alternative resources are reasonably 
available to provide these services in the event of termination of such 
arrangements.
    (u) Operate in a manner such that no migratory or seasonal 
agricultural worker or member of their family 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.