[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: 42CFR56.603]



[Page 259-261]

 

                         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



[[Page 260]]



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 

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.

    (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



[[Page 261]]



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.

    (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 proj ect 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.