[Code of Federal Regulations]

[Title 42, Volume 1]

[Revised as of October 1, 2006]

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

[CITE: 42CFR56.303]



[Page 252-254]

 

                         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



[[Page 253]]



    (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 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



[[Page 254]]



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.

    (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.