[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: 42CFR56.603]

[Page 253-255]
 
                         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 F--Grants for Operating Migrant Health Programs
 
Sec. 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 Sec. 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 Sec. 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

[[Page 254]]

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 Sec. 56.104(b)(2) are met and, where such criteria are 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.
    (l) 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.

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    (o) 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 full- or 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
    (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 
Sec. 56.303(c) except as the Secretary finds that such a program would 
not be feasible.