III. Defining Scope of Project

The scope of project defines the activities that the total approved section 330 grant-related project budget supports.3 Specifically, the scope of project defines the approved service sites, services, providers, service area(s) and target population(s) which are wholly or in part section 330 grant funds. A grantee's scope of project must be consistent with applicable statutory and regulatory requirements, Health Center Program Expectations, and the mission of the health center.4

A health center's scope of project is important because it:

• Stipulates the total approved section 330 grant-related project budget, specifically defining the services, sites, providers, target population, and service area for which grant funds have been approved. This total project budget includes program income and other non-section 330 funds.
• Determines the maximum potential scope of coverage (subject to certain exceptions) of the Federal Tort Claims Act (FTCA) program that provides medical malpractice coverage for deemed health centers and most individual employees (see Scope of Project and FTCA Coverage).
• Provides the necessary site information which enables covered entities to purchase discounted drugs for their patients under the section 340B Drug Pricing Program (see Scope of Project and The Section 340B Drug Pricing Program).
• Defines the approved service sites and services necessary for State Medicaid Agencies to calculate payment rates under the Prospective Payment System (PPS) or other State-approved alternative payment methodology (see PAL 2001-09 and section 1902(bb) of the Social Security Act).5
• Defines the approved service sites necessary for the Centers for Medicare and Medicaid Services (CMS) to determine a health center's eligibility for Federally Qualified Health Center (FQHC) Medicare all-inclusive rate.

It is important to note that certain benefits, i.e., utilization of section 330 funds and related program income, FQHC Medicaid reimbursement, Medicare FQHC reimbursement, FTCA coverage, and 340B Drug Pricing benefits, require that activities be part of the 330 approved scope of project and do not apply to activities that are not part of the approved scope of project. A section 330 grantee's approved scope of project may be part of a larger health care delivery system and, as such, must be distinctly defined within that context. Section 330 funded health centers may carry out other activities (i.e., other lines of business) that are not part of their scope of project and, thus, are not subject to section 330 requirements and expectations. For example, a grantee corporation may run a day care center that is not within the scope of the Federal project and does not use section 330 funds or related program income for support; therefore, it would not be eligible for the benefits that extend to activities within the grantee's scope of project such as FTCA coverage or Medicare or Medicaid reimbursement. In addition, the revenue generated from other activities (in the example above, the day care center) should be sufficient to support direct costs of the activity plus a reasonable share of overhead to ensure that section 330 funds and other grant-related income are not used inappropriately to support costs outside the approved scope of project.

NOTE: While identification as a service site within a scope of project is required for participation in the FTCA, 340B Drug Pricing, and FQHC programs, it is not a guarantee that these benefits will be realized. Each of these programs has a specific application process and a comprehensive set of requirements, of which scope of project is only one. In other words, identification as a service site within a scope of project is necessary, but not sufficient, to ensure participation in the other programs. To participate, all of the requirements of the other programs must also be met. For additional information, see Section VI: Additional Scope of Project Policy Issues of this PIN.

A. Role of the Board in Scope of Project
The governing board of a health center provides leadership and guidance in support of the health center's mission and is legally responsible for ensuring that the health center is operating in accordance with applicable Federal, State and local laws and regulations. The health center governing board is responsible for establishing and approving the health center's scope of project. The annual application for section 330 funds details the scope of project supported by the grant and, per section 330(k)(3)(H) of the PHS Act (42 U.S.C. 254b), the health center governing board must approve the health center's application. It is the responsibility of the governing board to approve the overall plan and budget for the health center, the hours of operation for the health center sites, as well as the selection of the services provided by the health center. In fulfilling these responsibilities to accurately and completely delineate the health center's scope of project, the health center governing board is assuring that the health center will effectively utilize its available resources in pursuing its mission. As the board is responsible for the oversight of the health center operations, all requests for change in scope of project must be approved by the health center's governing board with approval documented in the board minutes.

B. Five Core Elements of Scope of Project
Five core elements constitute scope of project and address these fundamental questions:

• Where will services be provided (service sites)?
• What services will be provided (services)?
• Who will provide the services (providers)?
• What geographic area will the project serve (service area)?
• Who will the project serve (target population)?

1. Service Sites
   A service site is any location where a grantee, either directly or through a sub-recipient or established arrangement, provides primary health care services to a defined service area or target population (discussed respectively in Sections III.B.4. and III.B.5. of this PIN). Sites may be permanent, seasonal, mobile van, migrant voucher or intermittent as defined further below based on many factors and as appropriate for providing health care services to the target population. A service site may provide comprehensive primary care services or may provide a single service such as oral or mental health services, based on the identified needs in the community/population. Only those service sites listed on Form 5-Part B: Service Sites from the most recent approved application for Federal support or approved change in scope request are a part of a grantee's approved scope of project.

a. Definition of a Service Site
Service sites are defined as locations where all of the following conditions are met:

• health center encounters are generated by documenting in the patients' records face-to-face contacts between patients and providers;
• providers exercise independent judgment in the provision of services to the patient;
• services are provided directly by or on behalf of the grantee, whose governing board retains control and authority over the provision of the services at the location; and
• services are provided on a regularly scheduled basis (e.g., daily, weekly, first Thursday of every month).7 However, there is no minimum number of hours per week that services must be available at an individual site.

b. Permanent Service Sites
Permanent sites meet the definition of a service site above at a fixed address specified on Form 5 – Part B: Service Sites. These sites are open year round and may be operated on a full-time or part-time basis as appropriate to meet the needs of the target population. Services at a permanent site may be offered either directly or through an established arrangement. The name and address of each permanent service site at which the grantee provides care must be listed on Form 5 – Part B: Service Sites.

c. Seasonal Service Sites
Due to the seasonality of employment, shelter, or the mobility of patients served, grantees may operate some service sites on a seasonal basis or for only part of the year. Seasonal sites meet the definition of a service site above but operate at a fixed location for less than 12 months during the year. When open, seasonal sites may be operated on a full-time or part-time basis as appropriate to meet the needs of the target population. Grantees should list the name and address of each seasonal site on Form 5 – Part B: Service Sites and indicate the approximate number of months that the site is open during the year.

d. Special Instructions for Recording Mobile Van Sites
A fully-equipped mobile van that is staffed by health center clinicians providing direct primary care services (e.g., primary medical or oral health services) at various locations on behalf of the grantee is considered a service site. Mobile vans must meet the definition of a service site above, except that services do not need to be provided on a regularly scheduled basis, although this is encouraged to provide continuity and access to care for the target population. A grantee should separately list each mobile van (i.e., Mobile Van #1, Mobile Van #2, etc.) as a site on Form 5 – Part B: Service Sites. The specific locations where the van provides direct health care services do not need to be listed.
Vans that are not equipped or utilized for direct patient care are not service sites. These vans may be used by a grantee to transport patients or staff or to support and facilitate outreach or other enabling services. These vans should be listed on Form 5 – Part C: Other Activities (discussed in detail below), in the application for Federal support with a brief description of how the van is used.

e. Intermittent Sites
Grantees may utilize intermittent sites to provide direct primary health care services to the target population. Intermittent sites meet the definition of a service site above but operate on a regular scheduled basis for a short period of time (two months or less) at locations that change frequently as necessary to continue services to the target population. Generally, these sites are established to assure access to care for more mobile populations, such as homeless persons or migrant or seasonal farmworkers and their families, who may not be in one area for an extended period of time and, therefore, may not access services at a grantee's permanent or seasonal sites. Often, intermittent sites are established at migrant camps or homeless shelters that are open for only a short time to bring health care services directly to the target population and will be closed and re-opened at a new location as the population moves or the availability of space changes. The following are examples of potential locations for intermittent sites:
1) Shelters - Family, Adult, Homeless, Runaway Youth;
2) Day Shelters, Soup Kitchens, or Homeless Service Centers ;
3) Outdoor Encampments;
4) Migrant Camps.
Grantees should list intermittent sites as a category on Form 5 – Part B: Service Sites. The specific locations where the grantee establishes an intermittent site to provide the services do not need to be listed; however, the number of such locations should be indicated on Form 5 – Part B: Service Sites and should be updated at least annually in the grantee's application for Federal support.

f. Migrant Voucher Screening Sites
Migrant Voucher Programs are established when there is insufficient sustained demand in an area for health care services from migrant and seasonal farmworkers to warrant establishing a permanent or seasonal service site. Often migrant voucher grantees do not provide direct health care services; rather, the grantee may establish a screening site(s) where the clinical needs of a patient are assessed and then a referral for care is made to a local provider through an established contractual arrangement. The local provider will provide the primary care services to those individuals who are referred by the voucher program. Under these arrangements, services are provided on behalf of the health center through a contractual arrangement; however, services under the contracts are generally not provided on a regular scheduled basis but instead on an as-needed basis.
Grantees should list each migrant voucher assessment/screening site as a category on Form 5 – Part B: Service Sites. As the functions of migrant voucher screening sites are predominantly administrative, where little clinical services are provided, the assessment/screening sites should be listed as administrative sites. Those voucher locations which meet the requirements of a service site should be listed as administrative/service site. The specific locations where the grantee maintains contracts for direct services do not need to be listed; however, the number of such locations should be indicated on Form 5 – Part B: Service Sites and should be updated at least annually in the grantee's application for Federal support.
Grantees often provide activities that are included in the scope of project at locations that:
(1) do not meet the definition of a service site,
(2) are conducted on an irregular timeframe/schedule and
(3) offer a limited activity from within the full complement of health center activities included within the scope of project.
These activities and locations, where clinicians and project staff go from time-to-time to seek out, engage and serve persons eligible for the project's services, are covered under the scope of the project; however, compiling an exhaustive list of such activities and locations is impractical and, therefore, should be included as general categories of activities at various locations as part of the approved scope of project.

g. Other Activities
“Other activities” may also include
(1) locations for off-site activities required by the health center and documented as part of the employment agreement or contract between the health center and a provider (e.g., health center physicians providing coverage at the hospital emergency room or participating in hospital call coverage for unassigned patients in order to maintain their hospital admitting privileges) and/or
(2) locations where the only services delivered do not generate encounters (i.e., filling prescriptions, taking X-rays, conducting street outreach or providing health education, etc.).
Some examples of other activities include:

• Immunizations. Providing immunizations at 15 different senior centers. Grantees should list the activity as “immunizations,” the location as “senior centers” and the frequency as appropriate (e.g., four times per year).
• Admitting. Following the health center's patients to the hospital (admitting privileges). Grantees should list the activity as “admitting,” the location as “hospital” and the frequency as appropriate (e.g., as required for on call arrangement, three times per week) and indicate in the description the specific hospital(s) with which the health center has such arrangements and whether health center providers see non-health center patients as part of his/her admitting privileges.
• Medical Rounds. Grantees should list the activity as “medical rounds,” the location as “hospital” and the frequency as appropriate (e.g., as required for patient care, twice per week) and indicate in the description the specific hospital(s) with which the health center has such arrangements and whether the health center providers see non-health center patients as part of his/her admitting privileges.
• Home Visits. If it is the policy of the grantee that providers occasionally make home visits to health center patients, the grantee should list the activity as “home visits,” the location as “patients' homes” and the frequency as appropriate (e.g., as required for patient care, five times per month)
• Health Fairs. If it is the policy of the grantee to occasionally participate in health fairs, the grantee should list the activity as “health fairs,” the location as appropriate (e.g., various schools, community service centers) and the frequency as appropriate (e.g., three times per year).
• Non-Clinical Outreach. If it is the policy of the grantee that staff conduct outreach where no clinical services are offered, the grantee should list the activity as “non-clinical outreach,” the location as appropriate (e.g., community neighborhoods, schools, community service centers) and the frequency as appropriate (e.g., weekly).
• Portable Clinical Care. If it is the policy of the grantee that providers conduct clinical care as part of a mobile team (for example, as part of a primary care street outreach team to serve a homeless individuals or utilizing portable dental equipment to provide oral health services at schools), the grantee should list the activity as “portable clinical care,” the types of locations as appropriate (e.g., street, temporary shelters, schools, soup kitchens, labor camps) and the frequency as appropriate (e.g., weekly).
• Health Education. Grantees should list the activity as “health education,” the location as appropriate (e.g., community service centers, schools) and the frequency as appropriate (e.g., six times per year).

All “other activities,” their locations, estimated frequency and a brief description of the activity should be identified and briefly described on Form 5 – Part C: Other Activities in the annual application for Federal support. In addition, these activities should be described in the grant application, as they contribute to the provision of comprehensive primary care services. For items listed on Form 5-Part C, grantees should ensure that adequate and appropriate documentation has been secured to support and enable performance of these activities.

2. Services

a. Requirements and Discussion of Services
Section 330 funded health centers are required to provide, either directly or through an established arrangement, a set of primary health care services. These are defined in section 330 of the PHS Act as health services related to family medicine, internal medicine, pediatrics, obstetrics and gynecology, diagnostic laboratory and radiological services, pharmaceutical services as appropriate, and defined preventive health services. (For the complete list of required services see section 330(b)(1)(A) of the PHS Act). The specific amount and level of these services will vary by grantee based on a number of factors including, among others, the population served, demonstrated unmet need in the community, provider staffing, collaborative arrangements and/or licensing requirements.
Services provided by the grantee are defined for the organization/entity, not by individual site. Not all services must be available at every grantee service site; rather, the patients must have reasonable access to the full complement of services offered by the center as a whole, either directly or through formal established arrangements.
Because health centers provide service to diverse populations, health centers should assure services are provided in culturally and linguistically appropriate manner based on the target population(s).
Health centers may also provide “additional health services” defined in the section 330 statute as “services that are not included as required primary health services and that are appropriate to meet the needs of the population served by the health center…”8 Grantees are reminded that once a service is included in the approved scope of project, it must be available equally to all patients regardless of ability to pay and available through a sliding fee scale.9 Grantees, therefore, should thoroughly investigate the costs, benefits, and risks to the grantee before providing these services.
In general, a grantee should demonstrate that all required primary health services are available to all patients before proposing to add additional health services.
Health centers often provide both clinical and non-clinical services. Generally, clinical services are those services related to the provision of direct care and include medical, dental, mental health, substance abuse, diagnostic laboratory and X-ray, and pharmacy services. Non-clinical services are those services that support and assist in the delivery of medical care and facilitate patient access to care, often described as enabling services.  These include case management, outreach, transportation, translation and interpretation, health education and eligibility assistance.
The specific range of services that are available at a health center may vary based on provider qualifications and licensing requirements. Many professional, State and/or local certifying/licensing boards require and/or sanction levels or types of service based on a provider's qualifications. Similarly, State and/or local certifying bodies may require different accrediting or licensing standards for facilities. If a grantee determines that all professional, State, and local qualifications necessary for a grantee provider to provide a specific service have been met, and State and local standards/accreditation requirements of the facility have also been fully met, the procedures or levels of service sanctioned by the certifying board are included in the grantee's scope of project. For example, if the grantee employs an obstetrician who performs colposcopy, that service would be appropriate to be included in the scope of the center's project because that procedure is a normal part of the practice of obstetrics and is recognized as such under State certifying boards.
As a reminder, all providers of medical, dental, and mental health services (whether required or additional services) must be properly credentialed and privileged (i.e., appropriately trained and licensed) to perform the activities and procedures expected of them by the grantee. It is the responsibility of the grantee to ensure that all necessary credentialing of providers and licensing of the facility(ies) to provide a service, are completed before requesting that a service be included in the scope of project. (See PIN 02-22: Clarification of BPHC Credentialing and Privileging Policy Outlined in PIN 01-16 for additional guidance on the credentialing of providers).

b. Delivery Method and Scope of Project
In order to ensure the availability of comprehensive services for their patients, health centers may utilize one or more of the following delivery methods to provide a service:

1. Direct by Grantee and/or Formal Written Agreement
   When a service is provided directly by the grantee (Form 5-Part A, Column I) or through a formal written contract/agreement (Form 5-Part A, Column II), the grantee is accountable for providing and/or paying/billing for the direct care. Services provided by the grantee may include, but are not limited to, those rendered by salaried employees, certain contractors, National Health Service Corps staff, and sub-recipients. In most cases, services delivered by the grantee are provided on-site at a service delivery location listed on Form 5- Part B: Service Sites. If the service is provided by formal written agreement, the agreement must describe how the service will be documented in the patient record and if applicable, how the grantee will pay and/or bill for the service.
2. Formal Written Referral Agreement
   Under a formal written referral arrangement (Form 5-Part A, Column III), the grantee maintains responsibility for the patient's treatment plan and will be providing and/or paying/billing for appropriate follow-up care based on the outcome of the referral. These referral arrangements should be formally documented in a written agreement that at a minimum describes the manner by which the referral will be made and managed and the process for referring patients back to the grantee for appropriate follow-up care.
   Under these types of formal referral arrangements, if the actual service is provided and paid/billed for by another entity, then the SERVICE IS NOT included in the grantee's scope of project. However, establishment of the referral arrangement and any follow-up care provided by the grantee subsequent to the referral is considered to be part of the grantee's scope of project. For example, a grantee may have a referral arrangement for diagnostic X-ray with a hospital. As part of the referral arrangement, the hospital performs the diagnostic X-ray, bills the patient for the services and provides feedback and/or results to the grantee for appropriate follow-up care. The diagnostic X-ray service would NOT be part of the grantee's scope of project but the establishment of the referral and follow-up care provided by the grantee would be part of the grantee's scope of project.
3. Informal Referral Arrangments or Agreements
   Under informal referral arrangements or agreements (these arrangements are not captured on Form 5-Part A and are not a part of the grantee's scope of project), a grantee refers a patient to another provider who is responsible for the treatment plan and billing for the services provided and no grant funds are used to pay for the care provided. These informal arrangements/agreements are not required by HRSA to be documented in a written agreement and do not require the other provider to refer patients back to the grantee for appropriate follow-up care. For services provided by informal referral arrangements or agreements, the referral and the service and any follow-up care provided by the other entity, are considered outside of the grantee's scope of project.

Required primary health services must be provided directly by the grantee or through an established arrangement10 such as through a formal agreement or through a formal referral arrangement. In addition, required services provided directly by the grantee or by formal agreements or formal referral arrangements must be offered on a sliding fee scale and available equally to all patients regardless of ability to pay. Therefore, informal referral arrangements are not acceptable for the provision of a required service.
Grantees should ensure that all agreements/contracts/arrangements with other providers and organizations comply with section 330 requirements and administrative regulations for the Department of Health and Human Services.11 Grantees should also ensure that providers for any formal arrangements/agreements are properly credentialed and licensed to perform the activities and procedures expected of them by the grantee.
Note: FTCA and 340B Drug Pricing coverage does not extend to all types of contractual and referral arrangements. Health centers should refer to FTCA-related guidances, listed on page 26 of this PIN, and to Federal Register, Vol. 61, No. 207, page 55156-8, “Patient and Entity Eligibility” for clarification of the 340B Drug Pricing benefit for referrals. Remember, FTCA and 340(B) each has its own independent requirements that must be met for participation.

c. Recording Services and Delivery Method
The services provided by a grantee under the section 330 grant and the method in which they are provided must be documented on Form 5 – Part A: Services Provided. Services are reported on Form 5-Part A: Services Provided in aggregate for the grantee, not on a site-by-site basis. Since more than one delivery method may apply for a given service, more than one type of service delivery method may be indicated on the Form. Grantees must indicate at least one delivery method for each required service listed on Form 5-Part A. Only those services listed on this Form from the most recent annual application for Federal support or approved change in scope request are considered to be part of a grantee's scope of project.
Service delivery methods should be updated at least annually in the grantee's application for Federal support. If services are provided, regardless of method, at a location that meets the definition of service site, the location should be listed on Form 5 – Part B: Service Sites.

3. Providers

a. Requirements and Discussion of Providers
Providers are individual health care professionals who deliver services to health center patients on behalf of the health center. They assume primary responsibility for assessing the patient and documenting services in the patient's record. Providers include only those individuals who exercise independent judgment as to the services rendered to the patient during an encounter.
Grantees utilize a variety of mechanisms for provider staffing in order to maximize access to comprehensive, efficient, cost-effective, and quality health care. For instance, grantees may directly employ or contract with individual providers, may have arrangements with other organizations or may utilize volunteers. Grantees are encouraged to carefully consider the benefits and risks associated with each type of staffing arrangement because of the impact it may have on management and operations. It is preferable that grantees directly employ providers; however, there can be certain situations under which it may be necessary and appropriate for grantees to engage in alternative arrangements. Grantees must ensure that for all contracted clinical staff or volunteers, there is a separate, written agreement.
As a reminder, all providers of medical, dental and mental health services must be appropriately trained and properly credentialed and licensed to perform the activities and procedures expected of them by the grantee. It is the responsibility of the health center to ensure that all necessary credentialing of providers has been completed. (See PIN 02-22: Clarification of BPHC Credentialing and Privileging Policy Outlined in PIN 01-16 for additional guidance on the credentialing of providers).
For health centers funded under section 330(e) and/or section 330(g), please see PIN 98-24: Amendment to PIN 97-27 Regarding Affiliation Agreements of Community and Migrant Health Centers for further discussion of affiliation arrangements.

b. Instructions for Recording Providers
The type and number of clinical providers including volunteers and other staff must be listed on Form 2: Staffing Profile. Providers and other staff are reported in aggregate for the grantee, not on a site-by-site basis. Providers should be updated at least annually in the grantee's application for Federal support.

c. FTCA Considerations
Please note that the definition of “provider” under the scope of project may not be consistent with the definition of provider under FTCA. Individuals covered by FTCA may include others, such as lab and radiology technicians, as described in section 224 of the PHS Act. Likewise, not all provider arrangements in the scope of project are covered by FTCA. For example, volunteer providers, physicians contracted under a professional corporation or employed by another corporation, as well as interns/residents/medical students not employed by the health center may be included as part of scope of project, but are not covered under FTCA. If providers are employees of another company the health center would still need to have a separate written agreement with the providers.
Also of note, moonlighting, defined as engaging in professional activities outside of the provider's employment responsibilities to the primary employer (in this case the health center), is not a part of the grantee's approved scope of project.
Therefore, neither the grantee nor the moonlighting provider may receive FTCA coverage for moonlighting activities.

4. Service Area

a. Requirements and Discussion of Service Area
The concept of a service or “catchment” area has been part of the Health Center Program since its beginning. Although in general, the service area is the area in which the majority of the health center's patients reside, health centers may use other geographic or demographic characteristics to describe their service area. The Health Center Program's authorizing statute requires that each grantee periodically review its catchment area to:

(i) ensure that the size of such area is such that the services to be provided through the center (including any satellite) are available and accessible to the residents of the area promptly and as appropriate; 13
(ii)ensure that the boundaries of such area conform, to the extent practicable, to relevant boundaries of political subdivisions, school districts, and Federal and State health and social service programs; and
(iii) ensure that the boundaries of such area eliminate, to the extent possible, barriers to access to the services of the center, including barriers resulting from the area's physical characteristics, its residential patterns, its economic and social grouping, and available transportation.
Public Health Service Act sec. 330(k)(3)(J)

This periodic assessment of service area should be incorporated into a grantee's annual application for Federal support. Routine patient origin studies/analyses will help to ensure that the reported service area is accurate.
The service area should, to the extent practicable, be identifiable by county and by census tracts within a county. Describing service areas by census tracts enables analysis of service area demographics. Service areas may also be described by other political or geographic subdivisions (e.g., county, township, zip codes as appropriate). Starting with calendar year (CY) 2005 Uniform Data System (UDS) data, grantees annually report information on the aggregate geographic area in which its patients reside. This enables grantees and HRSA to better identify service areas. The service area must be federally designated as a Medically Underserved Area in full or in part or contain a federally designated Medically Underserved Population (MUP).14

b. Recording Service Area
The service area for the grantee must be listed by census tracts and zip codes on Form 5 – Part B: Service Sites. Census tracts and zip codes for the service area are reported on a site-by-site basis. In general, those census tracts and/or zip codes listed on this Form from the most recent annual application for Federal support and/or approved change in scope request form the basis for determining service area for a grantee's scope of project. The service area for each service site should be updated at least annually in the grantee's application for Federal support.

5. Target Population

a. Requirements and Discussion of Target Population
Health centers are required to serve a “medically underserved, or special medically underserved population.”15 Each health center must define an underserved population from within the established service area to which it will direct its services. The underserved populations often face barriers in accessing health care services and disparities in their health status which are addressed through the health center operation.
This target population is usually a subset of the entire service area population, but in some cases, may include all residents of the service area if it is determined that the entire population of the service area is underserved, and lacking access to adequate comprehensive, culturally competent quality primary health care services. Although a grantee may serve diverse populations at several sites, the target population is reported in aggregate at the grantee level not on a site-by-site basis.
Section 330(e) grantees are required to make services available to all residents of the health center's service area, regardless of the individual's ability to pay.16 Health centers may also extend services to those residing outside the service area. However, HRSA recognizes that health centers must operate in a manner consistent with sound business practices. Nonetheless, health centers should address the acute care needs of all who present for service, regardless of residence.
Some health centers receive funding to target a special population within a community. There are three such special populations: migrant and seasonal agricultural workers and their families, persons who are homeless, and/or residents of public housing. Grantees receiving special populations funding (i.e., grants under only section 330(g), (h), and/or (i) of the PHS Act) are not subject to the requirement to make services available to all residents of the service area.17 However, these grantees are expected to address the acute care needs of anyone who presents for service.
Individuals who are not members of the special population(s) served by a special populations-only grantee may then be referred to more appropriate settings for their non-acute health care needs.

b. Recording Target Population
Information on the grantee's target population must be listed on Form 4: Community and Target Population Characteristics. Demographic, income, insurance status and other information on the service area and target population should be recorded on this Form in aggregate for the grantee as a whole, not on a site-by-site basis, and should be updated at least annually in the grantee's application for Federal support.

next: Change in Scope Requests