[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: 42CFR53.113]



[Page 230-231]

 

                         TITLE 42--PUBLIC HEALTH

 

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

                                SERVICES

 

PART 53_GRANTS, LOANS AND LOAN GUARANTEES FOR CONSTRUCTION AND 

MODERNIZATION OF HOSPITALS AND MEDICAL FACILITIES--Table of Contents

 

    Subpart L_Services for Persons Unable to Pay; Community Service; 

                           Nondiscrimination.

 

Sec. 53.113  Community service.



    (a) Applicability. The provisions of this section apply to every 

applicant which heretofore has given or hereafter will give a community 

service assurance.

    (b) Definitions. As used in this section:

    (1) The term community service assurance means an assurance required 

by regulations promulgated pursuant to section 603(e)(1) of the Act or 

the predecessor of that section (section 622(f), Public Health Service 

Act, enacted by Pub. L. 79-725, 60 Stat. 1041).

    (2) The term facility has the same meaning as is given it in Sec. 

53.111(b)(1).

    (3) The term applicant has the same meaning as is given it in Sec. 

53.111(b)(2).



[[Page 231]]



    (4) The term fiscal year has the same meaning as is given it in 

Sec. 53.111(b)(3).

    (c) Assurance. Before an application under this part is recommended 

by a State agency to the Secretary for approval, the State agency shall 

obtain an assurance from the applicant that the facility will furnish a 

community service.

    (d) Compliance. In order to comply with its community service 

assurance an applicant must:

    (1)(i) Make the services it furnishes available to the general 

public, or

    (ii) Limit the availability of such services only on the basis of 

age, medical indigency, or type or kind of medical or mental disability, 

or

    (iii) If the facility constitutes a medical or nursing care unit of 

a home or other institution, make such home or other institution 

available in accordance with paragraph (d)(1) (i) or (ii) of this 

section; and

    (2)(i) Make arrangements, if eligible to do so, for reimbursement 

for services with:

    (A) Those principal State and local governmental third-party payors 

which provide reimbursement for services that is not less than the 

actual cost of such services as determined in accordance with accepted 

cost accounting principles; and

    (B) Those Federal governmental third-party programs, such as 

Medicare and Medicaid, to the extent that the applicant is entitled to 

reimbursement at reasonable cost under a formula established in 

accordance with applicable Federal law.

    (ii) Take such additional steps as may be necessary to ensure that 

admission to and services of the facility will be available to 

beneficiaries of the governmental programs specified in paragraph 

(d)(2)(i) of this section without discrimination (or preference) on 

account of their being such beneficiaries.

    (e) Reports. The annual statement required by section 646 of the Act 

and Sec. 53.128(q), a copy of which must be submitted to the State 

agency in accordance with the requirements of Sec. 53.111(e)(1), shall 

set forth the amount of the reimbursement received pursuant to each 

arrangement with a principal governmental third-party payor.

    (f) Evaluation and enforcement. The State plan shall provide for 

evaluation and enforcement of the community service assurance in 

accordance with the following requirements:

    (1) The State agency shall,

    (i) At least annually, evaluate the compliance of facilities with 

such assurance; and

    (ii) Establish procedures for the investigation of complaints that 

such assurance is not being complied with.

    (2) The State plan shall provide for adequate methods of enforcement 

of the assurance, including effective sanctions to be applied against 

any facility which fails to comply with such assurance. Such sanctions 

may include, but need not be limited to, license revocation, termination 

of State assistance and court action.

    (g) Reports. (1) The State agency shall, not less often than 

annually, report in writing to the Secretary its general evaluation of 

facilities' compliance with the assurance, the disposition of each 

complaint received by the State agency, proposed remedial action with 

respect to each facility found by the State agency to be not in 

compliance with the assurance, and the status of such remedial action.

    (2) In addition, the State agency shall promptly report to the 

Regional Attorney and Regional Health Director of the Department of 

Health and Human Services the institution of any legal action against a 

facility or the State agency involving compliance with the assurance.



[39 FR 31767, Aug. 30, 1974, as amended at 42 FR 16780, Mar. 30, 1977]



Subpart M [Reserved]