(4) Hospital facilities containing services for the mentally retarded shall conform to the minimum standards as outlined in the General Regulations for Hospital Licensure (ch. 23-16 of the general laws of Rhode Island).

(5) Standards for diagnostic and evaluation clinics shall be those promulgated by the American Psychiatric Association. (See p. 2a for addresses for above publications.)

J. Fair hearings.

(a) The State agency will provide full opportunity to all applicants for public hearings on their applications when, for any reason, applicants so request.

(b) Hearings are conducted by the State department of health at times and places reasonably convenient for applicants.

(c) At the conclusion of public hearings, the director of the department of health will announce the department's decision with reference to the issue under consideration during the hearings. Such decisions will be confirmed to all interested applicants in writing.

(1) Standards for State residential institutions for the mentally retarded: Monograph supplement to American Journal of Mental Deficiency, January 1964, volume 68, No. 4. The American Association on Mental Deficiency.

Editorial office: Illinois Department of Health, 401 South Spring, Springfield, Ill.

Business office: Post Office Box 96, Willimantic, Conn. (Price: $3 from business office.)

(2) Rhode Island laws on day nurseries and licensing and regulation: Revised 1956; compiled by Rhode Island Child Welfare Services, 610 Mount Pleasant Avenue, Providence, R.I., 02908.

(3) A statement of elementary standards respecting the policies, organization, operation, and service activities of sheltered workshops: Wage and Hour and Public Contracts Division, U.S. Department of Labor, Constitution Avenue at 14th Street, Washington, D.C.

(4) General regulations for hospital licensure (promulgated in accordance with ch. 23-16 of the general laws of Rhode Island): Division of Health Facilities, Rhode Island Department of Health, Room 316, State Office Building, Providence, R.I., 02903.

(5) Standards for diagnostic and evaluation clinics. Write to: American Psychiatric Association, 1700 18th Street NW., Washington, D.C.

K. Submissions of reports and accessibility of records.—

(a) The State agency agrees to make such reports in such form and containing such information as the Secretary of Health, Education, and Welfare may from time to time reasonably require, and to give the Secretary of Health, Education, and Welfare, or his representatives, upon demand, access to the records upon which such information is based.

(b) The State agency agrees that it will from time to time, as is necessary, but at least annually, review the overall Public Law 88-164, part I, title C. "Grants for construction of facilities for the mentally retarded"; and, that it will each year submit to the Secretary of Health, Education, and Welfare a report which contains such revision of the overall Public Law 88-164, part I, title C, "Grants for construction of facilities for the mentally retarded," as it considers

necessary.

(c) Inventory-general data, mental retardation facilities construction program, 1965, Rhode Island State plan: It is recognized that in a canvass of the entire State a few facilities may have been omitted inadvertently before the final due date of publication. However, annual modification and revision of the plan may permit of subsequent amendment.

L. Assurances of nondiscrmination.-The State agency will obtain from each applicant the required assurance of compliance with the Department of Health, Education, and Welfare, regulations as required by title VI of the Civil Rights Act of 1964 (Public Law 88-352).

M. Assurances to those unable to pay.-Before a construction application for a facility for the mentally retarded is recommended by the State agency for approval, the State agency shall obtain assurance from the applicant that the facility will furnish below cost or without charge a reasonable volume of services to persons unable to pay therefor.

N. Transfer of allotments.-The State agency may submit a request in writing to the Surgeon General that a specified portion of its allotment be added to the allotment under title II of the act for the construction of community mental

health centers, upon a demonstration satisfactory to the Surgeon General that the need for community mental health centers is substantially greater than for facilities for the mentally retarded, such demonstration to include the concurrence of the State Advisory Council designated under section 134(a)(3) of title I, part C of the act.

Transfer of allotment to another State: A State may submit a request in writing to the Surgeon General that its allotment or a specified portion thereof be added to the allotment of another State for the purpose of meeting a portion of the Federal share of the cost of a project for the construction of a facility for the mentally retarded in such other State. In determining whether the facility with respect to which the request is made will meet the needs of the State making the request and that use of the specified portion of such States allotment, as requested by it, will assist in carrying out the purposes of part C of title I of the act, the Surgeon General shall consider the accessibility of the facility, and the extent to which services will be made available to the residents of the State making the request.

Part 54, section 101

II. DEFINITIONS

As used in this subpart all terms not defined herein shall have the same meaning as indicated in the act.

(a) "Act" means the Mental Retardation Facilities and Community Mental Health Centers Construction Act of 1963 (Public Law 88-164).

(b) "Area, service area or region" means the geographic territory from which persons needing services for the mentally retarded come or might be expected to come to existing or proposed facilities for the mentally retarded.

(c) "Community service" means that the services furnished by the facility will be available to the general public.

(d) "Equipment" means those items which are necessary for the functioning of the facility, and which are considered depreciable and as having an estimated life of not less than 5 years. Not included are items of current operating expense such as food, fuel, drugs, paper, printed forms, and soap.

(e) "Comprehensive services" means a complete range of the services specified in part 54.104 (a) of the act in sufficient quantity to meet the needs of the mentally retarded within the area.

(f) "Population" means the latest figures of total population residing in the States as certified by the Federal Department of Commerce.

(g) "Surgeon General" means the Surgeon General of the Public Health Service.

Part 54.104. Adequate services and facilities

(a) Adequate services.-The State plan shall provide for the following services which are necessary to provide adequate services for the mentally retarded:

(1) Diagnostic services: Coordinated medical, psychological and social services, supplemented where appropriate by nursing, educational or vocational services, and carried out under the supervision of personnel qualified to:

(i) Diagnose, appraise, and evaluate mental retardation and associated disabilities, and the strengths, skills, abilities, and potentials for improvement of the individual;

(ii) Determine the needs of the individual and his family; (iii) Develop recommendations for a specific plan of services to be provided with necessary counseling to carry out recommendations; and (iv) Where indicated, periodically reassess progress of the individual.

(2) Treatment services: Services under medical direction and supervision providing specialized medical, psychiatric, neurological, or surgical treatment, including dental therapy, physical therapy, occupational therapy, speech and hearing therapy, or other related therapies which provide for improvement in the effective physical, psychological or social functioning of the individual.

(3) Educational services: Services, under the direction and supervision of teachers qualified in special education, which provide a curriculum of instruction for preschool children, for school age children unable to participate in public schools, and for the mentally retarded beyond school age. (4) Training services: Services which provide: (i) Training in self-help and motor skills;

(ii) Training in activities of daily living;

(iii) Vocational training;

(iv) Opportunity for personality development; and

(v) Experiences conducive to social development, and which are carried out under the supervision of personnel qualified to direct these services.

(5) Custodial services: Services which provide personal care including, where needed, health services supervised by qualified medical or nursing personnel.

(6) Day care services-day care center: A day care center is a facility housed in a separate private or public school or other setting for the care, training and/or education of educable, trainable, and totally dependent mentally retarded children for whom there are no available public school classes or other community provisions. A day care center may offer services for all of these children, or may elect to serve some particular section of these groups.

(7) Sheltered workshop services: Services in a facility which provides or will provide comprehensive services involving a program of paid work which provides:

(i) Work evaluation;

(ii) Work adjustment training;

(iii) Occupational training; and

(iv) Transitional or extended employment and carried out under the supervision of personnel qualified to direct these activities.

III. DELINEATION OF AREAS

In developing the regional geographic service areas there were many variables which had to be considered. Even after giving careful study to all the factors affecting the division of this State into areas and size of each respective area, there appeared to be a significant degree of latitude available. Therefore, recognizing that the selection of the areas for this program is unavoidably arbitrary and that additional experience my produce changes as the program develops, we have chosen the four planning areas. (See map.)

The basic factors considered in arriving at this area delineation are as follows:

1. The delineated areas must be of sufficient size to permit the development of a wide range of services consistent with the needs of the mentally retarded and give full consideration to all levels of retardation and age groupings.

2. Each area should contain at least one major metropolitan population center.

3. Time required to travel from home to service should not be a deterent to the full utilization of the available or planned services and should, to a significant degree, follow normal travel patterns within the State.

4. Areas planned must take into consideration the availability of trained personnel to staff the services.

5. The location of medical centers, educational facilities, and other service facilities for the mentally retarded must be considered in the designation of the

areas.

Area I. Metropolitan Providence

This area, composed of three cities, is the smallest in geographic area and is the largest in population. This area is highly urbanized and has an abundance of medical care and educational facilities including five general hospitals, two voluntary psychiatric hospitals and the Rhode Island Medical Center, five institutions of higher learning, and five facilities for the mentally retarded. Area II. Northern area

This area is composed of three cities and nine towns and is second largest of the four areas both in terms of population and geography. One-half of its land area is rural in nature and the remaining half is both urban and suburban. There are four general hospitals serving this area and the State's chronic disease hospital (Zambarano Memorial Hospital) is also located here, as well as one other facility for the mentally retarded.

Area III. Southern area

This area of the State is largest of the four areas in geography and third largest in population. The area, while primarily rural in nature, does possess two heavily populated communities; namely, Warwick and Westerly, in addition to the other 14 towns. This area contains three general hospitals, the University of Rhode Island and the Ladd School, which is the mental retardation institution for the State of Rhode Island.

Area IV. Southeastern area

The smallest of the four areas in population, this area is third largest in geography. The city of Newport is highly urbanized while Barrington, Warren, Bristol, Portsmouth, and Middletown may be characterized as suburban and Tiverton and Little Compton as rural. There is one general hospital in the area located within the city of Newport, and three colleges, two in Newport and one in Barrington.

Each of the four areas has one or more active chapters of the Rhode Island Association for Retarded Children. In addition, all of the four areas contain major travel arteries between population centers in the areas. Within any given area the travel time between any two points does not exceed 45 minutes.