(g) Scope and quality of services. The following standards shall be applicable to services furnished under the plan:

(1) The plan must show that preventive, diagnostic, treatment, and rehabilitative programs shall include special attention to the health needs of high risk population groups in terms of age, economic status, geographic location, or other relevant factors. In addition, preventive services shall be based on sound epidemiologic principles.

(2) The plan must set forth the anticipated impact on the health of the people in terms of the specific objectives toward which the activities are directed.

(3) Services under the plan must be provided by or supervised by qualified personnel, such qualification to be determined by reference to merit system occupational standards, State and local licensing laws and specialty Board requirements for health professionals.

(h) Methods of administration. In addition to any methods of administration otherwise required by the Act and the regulations of this subpart, the State plan must contain policies and procedures to assure that unnecessary duplication of services will be avoided, and that available manpower and other health resources will be utilized efficiently. The plan must also provide:

(1) For the establishment and maintenance of personnel standards on a merit basis for persons employed by the State authority, and by official local health and mental health departments, to provide or supervise the provision of public health services under the approved State plan. Substantial compliance with standards for a Merit System of Personnel Administration, 45 CFR Part 70, issued by the Secretary of Health, Education, and Welfare, the Secretary of Labor and the Secretary of Defense, including any subsequent amendments thereto, will be deemed to meet this requirement;

(2) For the provision of professional consultation to as well as supervision over services under the State plan conducted by agencies, institutions, or organizations other than the State authority, and

(3) For informing the general public in the State of the kinds and locations of services which are available under the State plan.

(i) Review and modification. The State plan must provide that the State authority will review and evaluate its approved plan at least once annually and submit appropriate modifications to the Secretary. As a minimum, the State authority shall submit annual modifications of the plan which will (1) reflect budgetary and expenditure requirements for the new fiscal year, (2) incorporate changes in the scope, quality, and location of services to be provided, and (3) update any assurances or other informational requirements included in the State plan.

(j) Reports and records. The State plan must provide, in addition to any other reports or records required by the regulations of this subpart or which may reasonably be required by the Secretary under the Act, that:

(1) The State authority shall maintain adequate records to show the disposition of all funds (Federal and non-Federal) expended for activities under the approved State plan.

(2) The State authority shall file annual progress reports detailing the accomplishments of the programs, including, if available, quantitative indices of the improvement of the health of the people receiving services under such programs.

(3) The State authority shall make annual expenditure reports.

(4) All records required by the Act and the regulations of this subpart shall be maintained for a period of 5 years, or until audits by representatives of the Department of Health, Education, and Welfare have been completed and any question arising from the audits have been resolved, whichever is sooner.

(5) The State authority will afford access to the records maintained by it to the Comptroller General of the United States and the Secretary of Health, Education, and Welfare, or their authorized representatives, for purposes of audit and examination.

(k) Accounting procedures. The State plan shall contain such fiscal control and fund accounting procedures as are necessary to assure the proper disbursement of and accounting for funds paid to the State under this subpart. Such procedures shall provide for an accurate and timely recording of receipts of Federal funds paid to the State for expenditures incurred or to be incurred under the ap

proved plan, of the amounts and purposes of expenditures made in carrying out such plan and of any unearned balances of Federal funds paid to the State. In addition, such procedures must:

(1) Provide for the separation of allowable expenditures as between the State plan for public health services and the State plan for mental health services and for the separation of allowable expenditures under each State plan between those which are for the provision of health services in communities of the State and those which are for other purposes;

(2) Provide adequate information to show exclusion from expenditures claimed for Federal participation of those costs for which payments have been received or are due under other Federal grants or contracts or which are required or used to match other Federal funds;

(3) Provide for maintaining an adequate record of refunds, proceeds from the sale of equipment, fees, and other similar adjustments received, which must be deducted from gross expenditures in computing expenditures available for Federal participation under the approved State plan;

(4) Provide for the maintenance of time records, or for other appropriate cost accounting techniques, for personnel who devote only part-time to the carrying out of the approved State plan so that only the proportion of total expenditures for such personnel will be included in expenditures for Federal participation;

(5) Provide for the maintenance of inventory records by the State authority for equipment purchased, which records must show that accountability for such property is generally compatible with the type of inventory accountability practiced throughout the State, and must clearly identify the type of equipment purchased, its cost, and its location.

[32 F.R. 8244, June 8, 1967, as amended at 33 F.R. 11359, Aug. 9, 1968; 33 F.R. 13026, Sept. 14, 1968]

§ 51.105 State allotments.

The allotments for fiscal years 1969 and 1970 to each State shall be determined in the following manner:

(a) On the basis of population (as determined from the latest available esti

mate from the Department of Commerce), $3 per person up to a maximum of 100,000 persons, plus:

(b) Fifty percent of the remainder of the amount available on the basis of population (as determined above) and 50 percent on the basis of population weighted by financial need (as determined by the latest available estimates of per capita personal income from the Department of Commerce), adjusted so that the total allotment to any State under (a) plus (b) will not be less than the total of the amounts allotted to it under formula grants for cancer control, plus other allotments under section 314 of the Act, prior to amendment, for the fiscal year ending June 30, 1967.

(c) For the purposes of these computations, American Samoa and the Trust Territory of the Pacific Islands shall each be considered to have had total allotments for fiscal year 1967 equal to the lowest total allotments of any other State for that year.

[33 F.R. 11360, Aug. 9, 1968] § 51.106

Allocation of allotments for mental health.

(a) General. The Secretary shall allocate 15 percent of each State's allotment for each fiscal year to the State mental health authority and 85 percent to the State health authority, except that when, in any case, 15 percent of the State's allotment is less than the amount of that State's fiscal year 1967 allotment for mental health services, the percentage allocated to the mental health authority of such State shall be increased to that percentage which will provide that such allocation for the year will equal the fiscal year 1967 allotment to that State for mental health services, and the percentage allocation for the year to the State health authority of such State shall be correspondingly reduced.

(b) Exception. If recommended concurrently by the State health authority and the State mental health authority, or by the Governor, for any fiscal year, the Secretary may allocate a higher percentage to the State mental health authority and a correspondingly lower percentage to the State health authority. [32 F.R. 8245, June 8, 1967, as amended at 33 F.R. 13026, Sept. 14, 1968]

§ 51.106a Allocation of allotments to support services in communities.

For fiscal years ending after June 30, 1968 at least 70 percent of the funds allotted to the State health authority, and to the State mental health authority, respectively, under section 314(d) of the Act shall be available only for the provision of health services in communities of the State. Such services in communities shall include all eligible activities conducted under the State plan which, in the judgment of the Secretary or his delegate, are directly involved in the provision of services to people, in the training of personnel for community services, and in the prevention or alleviation of health, mental health, or environmental health problems in communities, whether such activities are provided by State or local agencies, but shall not include such activities as administration, planning, consultation, and data collection and analysis activities conducted by the State agency for statewide planning and administrative purposes not directly involved in the provision of services to people.

[33 F.R. 11360, Aug. 9, 1968]

§ 51.107 Expenditures and payments.

(a) Federal share. Each State for which a State plan for public health services has been approved shall be paid from its allotment for the fiscal year an amount which equals its "Federal share" (as defined and computed within the limits of the allotment in accordance with subsections 314(d) (5) and 314(d) (6) of the Act) of the expenditures incurred by such State or a political subdivision thereof during such fiscal year under its approved State plan. The Secretary shall make such adjustments in amounts of payments as may be necessary to correct under or over payments previously made (including expenditures which are disallowed on the basis of audit findings). A State shall not be entitled to payments from any fiscal year allotment for expenditures incurred in a prior or subsequent year. Payments will be made where practicable through a letter of credit system or, when such system is not practicable, on the basis of payment requests from the State to meet its current needs.

(b) Eligible costs. Federal participation in providing "Public Health Serv

ices" under a State plan may include the costs of any physical, mental, or environmental health service which the State authority is authorized to undertake or support, or the costs of training, including in-service and specialized or shortterm training of personnel for State and local health work, except that the following costs of services and training shall not be included:

(1) The provision of air pollution control activities to the extent such costs are precluded by the Clean Air Act (P.L. 88206) as amended;

(2) The provision of community mental health services to the extent funds are available for such costs under the Community Mental Health Centers Act (P.L. 88-164) as amended;

(3) The provision of inpatient care in hospitals or other institutions, except where the Secretary determines that such care during a limited period of time is necessary for effective evaluation, demonstration, or extension of new or improved public health procedures;

(4) Research activities, other than those which are a part of health service programs or demonstrations, or of health surveys, epidemiologic studies, or case findings;

(5) The acquisition of land or construction of buildings;

(6) Such other costs as the Secretary may find to be inconsistent with the Act or the regulations of this subpart.

(c) Expenditures by nonprofit private agencies. For the purposes of determining the Federal share for any State, expenditures made by nonprofit private agencies, organizations, and groups shall be regarded as expenditures by such State or political subdivision thereof, subject to the following conditions and limitations:

(1) Such expenditures may be included only when made by such an agency, institution, or organization to which the State authority has made available funds from Federal or State sources for carrying out services to be provided under the approved State plan for the fiscal year:

(2) The amount of expenditures by such nonprofit agency which may be included for any fiscal year does not exceed the amount of the funds made available to such agency by the State under the plan plus not more than an equal amount

of expenditure by such agency from nongovernmental funds;

(3) The records of the expenditure by a nonprofit private agency, in carrying out the State plan, shall be maintained and be available for inspection and audit for the period specified in § 51.104(j) (3).

(d) Equipment. When equipment purchased from funds spent in carrying out the approved State plan is sold, a proportionate share of any receipts realized from the sale of such equipment shall be deducted from the gross expenditures claimed for Federal participation for the year in which the receipts were received. Such share will be in the same proportion as participation of the Federal funds was in the expenditures under the State plan in the year in which the equipment was purchased. In addition, when any equipment purchased from funds spent in carrying out the approved State plan is transferred or otherwise disposed of to an activity which would not be eligible for support under this subpart, its then market value shall be deducted (in the same proportion as above) from the gross expenditures claimed for Federal participation for the year in which the transfer is made.

[32 F.R. 8245, June 8, 1967, as amended at 33 F.R. 11360, Aug. 9, 1968; 33 F.R. 13026, Sept. 14, 1968]

§ 51.108 Equipment, supplies or personnel in lieu of cash.

At the request of and for the convenience of a State authority, the Secretary may, in lieu of cash payments, furnish to such authority equipment or supplies or detail officers or employees of the Public Health Service when he finds that such equipment, supplies, or personnel would be used in carrying out the approved State plan for public health services. In such cases, the Secretary shall reduce the payments to which such State authority would otherwise be entitled from its allotment for the fiscal year by an amount which equals the fair market value of the equipment or supplies furnished and by the amount of the pay, allowances, traveling expenses, and other costs in connection such detail of officers or employees. For purposes of determining the amount of the expenditures for any fiscal year made in carrying out the approved State plan and the Federal share of such expendi

with

tures, the costs incurred by the Secretary in furnishing such equipment or supplies and in detailing such personnel to the State agency during the fiscal year shall be considered as expenditures made by and funds paid to the State.

[32 F.R. 8246, June 8, 1967, as amended at 33 F.R. 13026, Sept. 14, 1968]

§ 51.109 Nondiscrimination on account of race, color, or national origin. Attention is called to the requirements of Title VI of the Civil Rights Act of 1964 (78 Stat. 252; P.L. 88-352) which provides that no person in the United States shall, on the ground of race, color, or national origin be excluded from participation in, be denied the benefits of, or be subjected to discrimination under any program or activity receiving Federal financial assistance (sec. 601). A regulation implementing such Title VI has been issued by the Secretary of Health, Education, and Welfare with the approval of the President (45 CFR Part 80). Such regulation is applicable to services and programs provided under approved State plans for public health services receiving Federal assistance under section 314(d) of the Act, and requires receipt and acceptance by the Secretary of the applicable documentation set forth therein.

[32 F.R. 8246, June 8, 1967, as amended at 33 F.R. 13026, Sept. 14, 1968]

66-095-72-7

AUTHORITY: The provisions of this Part 51a issued under sec. 1102, 49 Stat. 647, 42 U.S.C. 1302; sec. 508, 81 Stat. 926, 42 U.S.C. 708.

SOURCE: The provisions of this Part 51a appear at 36 F.R. 3814, Feb. 27, 1971, unless otherwise noted.

§ 51a.1 Applicability.

The regulations in this part are applicable to the award of grants under section 508 (a) (3) of the Social Security Act (42 U.S.C. 708(a) (3)) for projects for the provision of family planning services to ensure that individuals have available to them the freedom of choice to determine the spacing of their children and the size of their families, and to help improve the general health of mothers and children.

§ 51a.2

Definitions.

As used in this part:

(a) "Act" means section 508 of the Social Security Act as amended (42 U.S.C. 708).

(b) "State" means any of the several States, the District of Columbia, Puerto Rico, the Virgin Islands, and Guam.

(c) "Secretary" means the Secretary of Health, Education, and Welfare and any other officer or employee of the Department of Health, Education, and Welfare to whom the authority involved has been delegated.

§ 51a.3 Eligibility for grants.

In order to be eligible for a grant under this part, an applicant must be (a) the State health agency of any State; (b) with the consent of such State health agency, the health agency of a political subdivision of the State; or (c) any public or nonprofit private agency, institution, or organization.

§ 51a.4 Application.

(a) An application for a grant under this part shall be submitted to the Secretary in such form and manner and at such time as the Secretary may prescribe.1 The application shall contain a

1 Applications and instructions may be obtained from the Regional Health Director of the Health Services and Mental Health Administration at the Regional Office of the Department of Health, Education, and Welfare for the region in which the project is to be conducted.

budget and a narrative plan of the manner in which the applicant intends to conduct the project and carry out the requirements of this part.

(b) The application shall be executed by an individual authorized to act for the applicant and to assume on behalf of the applicant the obligations imposed by the terms and conditions of the grant award, including the regulations of this part and the policies and procedures prescribed by the Secretary for grants under this part.

(c) The applicant will be notified of action taken on his application.

(1) If a grant is made, the initial award will set forth the amount of funds granted and will specify the project period for which support is contemplated if the activity is satisfactorily carried out and Federal funds are available. For continuation support, grantees must make separate application annually.

(2) Neither the approval of any project nor a grant award shall commit or obligate the United States in any way to make any additional, supplemental, continuation or other award with respect to any approved project or portion thereof, but this provision shall not preclude the Secretary from making upward adjustments to actual costs as to amounts awarded on a provisional basis as provided in subparagraph (1) of this paragraph.

§ 51a.5 Matching requirements.

Federal funds will be granted on the basis of project applications and may be used to meet not more than 75 percent of the cost of the project. The non-Federal participation may be derived from a variety of sources, including (a) new State or local appropriations or other new grantee funds, and (b) existing funds and time of personnel used for the ongoing activities of the grantee agency which are made a part of the project. Voluntary services or space donated to the project may not be included as a grantee contribution. Grantee funds or services derived from other Federal funds or used for matching any other Federal grant may not be used to match the Federal funds in this program except as otherwise specifically allowed by Federal statute.