Plan for Maternal and Child Health or Crippled Children's Services;

(c) "Act" means the Social Security Act as amended (42 U.S.C. Ch. 7);

(d) "Service" means the Social and Rehabilitation Service in the Department of Health, Education, and Welfare;

(e) "Administrator" means the Administrator of the Social and Rehabilitation Service;

(f) "Bureau" means the Children's Bureau in the Social and Rehabilitation Service;

(g) "Chief" means the Chief of the Children's Bureau in the Social and Rehabilitation Service;

(h) "Obligation" means a debt properly incurred by a State agency in carrying out the provisions of an approved State Plan;

(i) "Official forms" means forms supplied by the Bureau to State agencies for requesting funds and for submitting State budgets or reports under title V of the Act;

(j) "Crippled child" means an individual below the age of 21 who has an organic disease, defect, or condition which may hinder the achievement of normal growth and development;

means

(k) "Facilitating services" transportation, subsistence away from home, drugs, biologicals, communications, supplies, and equipment as may be necessary for the provision of maternal and child health or crippled children's services;

(1) "Health" means a state of physical and mental well-being, not merely the absence of disease or infirmity;

(m) "Medical care" means services, including services in hospitals, convalescent homes, and clinics, and home health services, by physicians and the allied services of dentists, nurses, medical social workers, nutritionists, dietitians, physical therapists, occupational therapists, speech and hearing specialists, optometrists, technicians, and other personnel whose services are needed in the maternal and child health and crippled children's programs;

(n) "Maternal and child health services" means (1) the provision of educational, preventative, diagnostic, and treatment services, including medical care, hospitalization, and other institutional care and aftercare, appliances and facilitating services directed toward reducing infant mortality and improving the health of mothers and children; (2)

the development, strengthening, and improvement of standards and techniques relating to such services and care; (3) the training of personnel engaged in the provision, development, strengthening, or improvement of such services and care; and, (4) necessary administrative services in connection with the foregoing;

(o) "Crippled children's services" means (1) the early location of crippled children; (2) the provision for such children of preventive, diagnostic, and treatment services, including medical care, hospitalization, and other institutional care and aftercare, appliances and facilitating services directed toward the diagnosis of the condition of such children or toward the restoration of such children to maximum physical and mental health; (3) the development, strengthening, and improvement standards and techniques relating to the provision of such care and services; (4) the training of personnel engaged in the provision, development, strengthening, or improvement of such care and services; and (5) necessary administrative services in connection with the foregoing;

of

(p) "Demonstration services" means either (1) the provision in a county, district, or community of more and better health services than are available in any comparable area in the State, utilizing facilities meeting acceptable standards and personnel who are especially well qualified, for the purpose of establishing standards of care and service that can be shown to be practical, effective and adequate to improve the health of mothers and children, or (2) the provision of a special type of health service for the purpose of proving its value in improving the health of mothers and children and in providing information on cost, methods of development, techniques of provision and the administration of a given type of health service not generally available to mothers and children;

(q) "Specialized expenditures for Maternal and Child Health Services," "Specialized expenditures for Crippled Children's Services," "Supporting expenditures for Maternal and Child Health Services," and "Supporting expenditures for Crippled Children's Services," shall have such meaning as may be ascribed to them in policies issued by the Administrator in order to best achieve the objectives of the Act.

§ 200.2 State Plans; general requirement; form, contents, and amend

ment.

(a) The basic condition to the certification of Federal funds is a State Plan for Maternal and Child Health and Crippled Children's Services, approved as meeting requirements of title V of the Act and regulations established thereunder.

(b) The State Plan shall follow the instructions as to form and content indicated in the Plan Instructions to be released by the Bureau pursuant to these regulations and shall contain descriptions of all material phases of the Maternal and Child Health and Crippled Children's Programs, including (1) their legal bases, (2) the manner in which their purposes, as contemplated by section 501 of the Act, will be carried out, (3) their scope and content, and (4) the policies, standards, methods, and procedures relative to (i) their administration, (ii) the supervision of their administration, (iii) their operation, and (iv) their compliance with the requirements of the Act.

(c) The State Plan and Budget shall be revised, in accordance with instructions from the Bureau, whenever there are significant changes.

The State Plan shall:

(a) Provide for its administration in local communities,

(1) Directly by the State agency; or

(2) By local public agencies which are, with respect to their administration locally of such plan, supervised by the State agency; or,

(3) By a combination of the foregoing methods of administration; and

(b) Set forth the manner in which the State agency will exercise and make effective its supervision over the operations of the local public agencies with respect to their administration locally of such plan.

and coordinating of maternal and child health services and the administration of the unit and its staff as provided under the State Plan;

(2) With respect to the crippled children's services program for the establishment, in the State agency, of a separate organizational unit charged primarily with responsibilities in the field of health services for crippled children and including, at least, the planning, promoting and coordinating of crippled children's services and the administration of the unit and its staff as provided under the State Plan: Provided, That, where the major functions of the State agency relate to the provision of health services to children, as in the case of a Crippled Children's Commission, such commission shall itself be considered as the separate organizational unit required.

(b) The State Plan may provide for combining the Crippled Children's Program Unit and the Maternal and Child Health Program Unit into one organizational unit under the direction of a single program director.

The State Plan shall provide that the Maternal and Child Health and Crippled Children's Program Unit or Units, will both or each be under the direction of a program director who will be (a) a Doctor of Medicine; (b) a full-time employee of the State agency; (c) devoting his full time, during the hours of his employment by the State agency, to the work of the Program Unit of which he is the director: Provided, That the Administrator may approve a plan provision providing for the part-time employment of such Doctor of Medicine where satisfactory evidence is submitted justifying such a provision.

to individuals who are receiving medical services provided or arranged for by the State agency in accordance with the standards and policies of the plan.

§ 200.8 Crippled Children's Program; required content.

With respect to services for crippled children, the State Plan shall make provision for:

(a) Services for the early location of crippled children;

(b) The diagnosis and evaluation of the condition of such children;

(c) Treatment services including at least appropriate services by physicians, appliances, hospital care, and aftercare as needed; and

(d) The development, strengthening, and improvement of standards and services for crippled children.

§ 200.9 Crippled Children's Program; diagnostic services.

With respect to services for crippled children, the State Plan shall provide that the diagnostic services under the plan will be made available within the area served by each diagnostic center to any child (a) without charge, (b) without restriction or requirement as to the economic status of such child's family or relatives or their legal residence, and (c) without any requirement for the referral of such child by any individual or agency.

§ 200.10

Standards relating to the provision of services.

The State Plan shall describe the standards required for personnel and facilities utilized in the provision of services under the plan. These standards for personnel and facilities must be those which (a) are found, upon investigation by the State agency, to be best adapted for the attainment of the specific purpose, (b) will assure a reasonably high standard of care, and (c) are in substantial accordance with national standards as accepted by the Service or standards prescribed by the Service. $ 200.11

Authorizations of service.

The State Plan shall provide that all services purchased for individuals under the plan will be authorized by employees of the State agency, or by employees of the local public agency administering a part of the plan locally under the supervision of the State agency, and that recand of such authorizations will be re

tained by the State or local public agency as a part of the individual's case record. § 200.12 Confidential information.

The State Plan shall:

(a) Provide that all information as to personal facts and circumstances obtained by the State or local staff administering the program shall constitute privileged communications, shall be held confidential and shall not be divulged without the individual's consent except as may be necessary to provide services to individual mothers and children: Provided, That, information may be disclosed in summary, statistical or other form which does not identify particular individuals; and

(b) Set forth suitable regulations and safeguards to carry out the provisions of paragraph (a) of this section.

§ 200.13

Rates of payment for medical care, appliances, and convalescent and foster home care.

The State Plan shall:

(a) Set forth the methods utilized by the State agency in establishing and substantiating that rates of payment for medical care, appliances, and convalescent and aftercare provided under such plans are reasonable and necessary to maintain the standards relating to the provision of services established pursuant to section 200.10, and

(b) Provide that schedules of the rates thus established will be maintained by the State agency at its offices.

§ 200.14 Rates of remuneration for hospital care.

The State Plan shall provide that payment for inpatient hospital care shall be the reasonable cost of such care established in accordance with standards approved by the Administrator. § 200.15

Additional remuneration for

services.

The State Plan shall provide that professional personnel, hospitals, and other individuals, agencies, or groups providing any services authorized by the State agency, under a State Plan, shall agree not to make any charge to or accept any payment from the patient or his family for such services unless the amount of such payment is determined and authorized for each patient by the State agency. § 200.16 Maintenance of State records.

The State Plan shall provide that, for reporting purposes, there will be main

tained at the State level such accounts and supporting documents as will serve to permit an accurate and expeditious determination to be made at any time of the costs of carrying out the State Plan, including the disposition of all moneys received and the nature and amount of all charges claimed to lie against the funds authorized for carrying out the State Plan.

§ 200.17 Demonstration services.

The State Plan shall provide for the development of demonstration services (with special attention to dental care for children and family planning services for mothers) in needy areas and among groups in special need and shall set forth the policies, standards and criteria applicable to the development and provision of such services, and to the selection of such areas and groups. § 200.18

Use of subprofessional staff

and volunteers.

The State Plan shall:

(a) Provide for the training and effective use of paid subprofessional staff in the administration of the Plan. Particular emphasis shall be given to fulltime or part-time employment of persons of low income as community services aides.

(b) Provide for the use of nonpaid or partially paid volunteers in providing services and in assisting any advisory committees established by the State agency.

(c) Meet the requirements established by the Service for training and effective use of subprofessional and volunteer staff contained in Part 225 of this chapter.

(d) Provide for the utilization of staff as specified in paragraphs (a), (b), and (c) of this section, no later than July 1, 1969.

§ 200.20 Acceptance of family planning services.

The State Plan shall provide that acceptance of family planning services offered under the plan shall be voluntary on the part of the individual to whom such services are offered. Acceptance of family planning services shall not be a prerequisite to eligibility for or the receipt of any service under the plan. § 200.21 Cooperation with other agencies and groups.

The State Plan shall provide for cooperation with the State agency which administers the program of medical assistance established under title XIX of the Act and with other medical, health, nursing, educational, and welfare groups and organizations, and, with respect to the portion of the plan relating to services for crippled children, with any agency in such State charged with administering State laws providing for vocational rehabilitation of physically handicapped children.

§ 200.22 Specialized and supporting ex

penditures.

(a) The State agency shall, with respect to its total annual expenditures of Federal and required matching funds for its Crippled Children's program, identify as "specialized" expenditures for such program an amount equal to 80 percent or more of the total annual expenditures of Federal and required matching funds for that program, provided the remaining 20 percent or less of such total expenditures were for purposes within the scope of the approved Crippled Children's Services Plan.

(b) The State agency shall, with respect to its total annual expenditures of Federal and required matching funds for its Maternal and Child Health program, provide in its State Plan for the allocation of such expenditures to such program in accordance with either of the following procedures:

(1) On the basis of objective criteria set forth in the State Plan, allocate to such program a portion of "supporting expenditures" which, together with any "specialized expenditures" indentified for such program will at least equal the total annual expenditures of Federal and required matching funds;

(2) Identify as "specialized" expenditures for such program an amount equal to 80 percent or more of the total

(a) Prior to the beginning of each fiscal year the Chief will prepare and make available to the several State agencies an estimated schedule of the amounts which it is expected will be allotted to each State during the fiscal year for each program.

(b) With respect to amounts determined to be available for any fiscal year for allotments for Crippled Children's services:

(1) One-half is allotted among the States in accordance with criteria specified in the act. These funds are referred to as "Fund A." Each State receives an allotment of $70,000 and such part of the amount remaining as the number of children under 21 in the State bears to the total number of such children in the United States. The number of children under 21 is used as the index of the number of crippled children, since adequate statistics on the number of crippled children are not available; and,

(2) The other half is known as "Fund B". From this fund, an amount designated by the Appropriation Act is available to States and to nonprofit institutions of higher learning for special projects for crippled children who are mentally retarded. From the remainder of Fund B, not less than 75 percent is apportioned among the States according to the need of each State for financial assistance in carrying out its State Plan after taking into consideration the number of children under 21 years in each State and per capita income in each State. The apportionments vary directly with the number of children under 21 years of age in the State, and the number in rural areas of the State, with rural children given twice the weight of children in urban areas. The apportionments vary inversely with State per capita income. Depending upon the amount of funds available, a minimum amount is set by the Chief below which a State's apportionment may not fall. Funds thus apportioned are allotted to States as needed. The remaining 25 percent or less

of Fund B is reserved for grants to States and to nonprofit institutions of higher learning for special projects of regional or national significance which may contribute to the advancement of services for crippled children.

(c) With respect to amounts determined to be available for any fiscal year for allotments for Maternal and Child Health services:

(1) One-half is allotted among the States by a formula specified in the law. These funds are referred to as "Fund A." Each State receives an allotment of $70,000, and such part of the amount remaining as the number of live births in the State bears to the total number in the United States; and

(2) The other half is known as "Fund B." From this fund an amount designated by the Appropriation Act is available to States and to nonprofit institutions of higher learning for special projects for mentally retarded children. From the remainder of Fund B, not less than 75 percent is apportioned among the States according to the need of each State for financial assistance in carrying out its State Plan after taking into consideration the number of live births in each State and per capita income in each State. The apportionments vary directly with the number of live births in the State, and the number in rural areas of the State, with rural births given twice the weight of urban births. The apportionments vary inversely with State per capita income. Depending upon the amount of funds available, a minimum amount is set by the Chief below which a State's apportionment may not fall. Funds thus apportioned are allotted to States as needed. The remaining 25 percent or less of Fund B is reserved for grants to States and to nonprofit institutions of higher learning for special projects of regional or national significance which may contribute to the advancement of maternal and child health. § 200.24

Submission of budgets by State

agencies.

Prior to the beginning of each fiscal year, the State agency shall submit, upon official forms and in accordance with procedures established by the Bureau, an annual budget appropriately documented and supported and indicating the availability and sources of all funds and indicating the purposes for which the funds are to be expended.