[Code of Federal Regulations]

[Title 42, Volume 1]

[Revised as of October 1, 2005]

From the U.S. Government Printing Office via GPO Access

[CITE: 42CFR51c.303]



[Page 180-182]

 

                         TITLE 42--PUBLIC HEALTH

 

    CHAPTER I--PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN 

                                SERVICES

 

PART 51c_GRANTS FOR COMMUNITY HEALTH SERVICES--Table of Contents

 

         Subpart C_Grants for Operating Community Health Centers

 

Sec. 51c.303  Project elements.



    A community 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 residents of the center's 

catchment area.

    (b) Implement a system for maintaining the confidentiality of 

patient records in accordance with the requirements of Sec. 51c.110 of 

subpart A.

    (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 

to individuals served by the center. Such assessments shall:

    (i) Be conducted by physicians or by other licensed health 

professionals under the supervision of physicians;

    (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



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sound financial management procedures, including the provision for an 

audit on an annual basis (unless waived for cause by the Secretary) by 

an independent certified public accountant or a public accountant 

licensed prior to 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.

    (e) Where the cost of care and services furnished by or through the 

proj ect 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. Provided, That such schedule of discounts 

shall provide for a full discount to individuals and families with 

annual incomes at or below those set forth in the most recent CSA 

Proverty Income Guidelines (45 CFR 1060.2) and for no discount to 

individuals and families with annual incomes greater than twice those 

set forth in such Guidelines, except that nominal fees for services may 

be collected from individuals with annual incomes at or below such 

levels where imposition of such fees is consistent with project goals.

    (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. 

51c.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 include 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 expenditures plan for at least a three-

year period (including the year to which the operating budget described 

in paragraph (i)(1) of this section 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, and 

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 shall 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. 51c.104(b)(2) of subpart A are met and, where such 

criteria are not met,



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revise its catchment area, with the approval of the Secretary, to 

conform to such criteria to the extent feasible.

    (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 shall 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, establish 

rates and methods of payment for health care. Such payments must be made 

pursuant to agreements, with a schedule of rates and payment procedures 

maintained by the project. The proj ect must be prepared to substantiate 

that such rates are reasonable and necessary.

    (u) Operate in a manner such that no person shall be denied service 

by reason of his 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.

    (v) In addition to the above, projects which are supported with 

grant funds for the operation of a prepaid health care plan also must 

provide:

    (1) A marketing and enrollment plan, including market analysis, 

marketing strategy, and enrollment growth projections.

    (2) A plan that provides for funding on a capitation basis of such 

portion of the residents of the catchment area of the center, as the 

Secretary shall determine.

    (3) An assurance that services shall be available to all residents 

of the catchment area without regard to method of payment or health 

status.