seminated in accordance with applicable procedures, and (c) made available to the Secretary and to the public for inspection.

§ 51a.103 Administration locally of State plans.

The State plan shall:

(a) Contain an assurance that the administration of the State plan in local communities will be performed:

(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) Incorporate by reference documents showing 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.

§ 51a.104 Program units.

(a) The State plan shall incorporate by reference documents showing:

(1) With respect to the maternal and child health services program the establishment in the State agency, under the direction of a program director, of a separate organizational unit charged primarily with responsibilities in the field of maternal and child health and including, at least, the planning, promoting, and coordinating of maternal and child health services and the administration of the unit and its staff as provided under the State plan; and

(2) With respect to the crippled children's services program, 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 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.

§ 51a.105 Program directors.

The State plan must contain an assurance 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 physician; (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, upon prior approval of the Secretary and where satisfactory evidence is incorporated by reference justifying such provision, the State plan may provide for the part-time employment of such physician.

§ 51a.106 Information on services available.

The State plan shall incorporate by reference documents showing how the public throughout the State will be fully informed as to the maternal and child health and crippled children's services available under the State plan.

§ 51a.107 Limitations on provision of services.

The State plan for maternal and child health and crippled children's services shall contain an assurance that hospital, rehabilitation, convalescent or foster home care, or appliances provided to individuals under the plan, will be made available only 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.

§ 51a.108 Crippled Children's Program; required content.

With respect to services for crippled children, the State plan shall incorpo

rate by reference documents showing that provision has been made for:

(a) Services for the early identification of children in need of health care and services;

(b) Diagnosis and evaluation of the condition of such children;

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

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

§ 51a.109 Crippled Children's Program; diagnostic services.

With respect to services for crippled children, the State plan shall contain an assurance 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 to the child or his family, except to the extent that payment will be made by a third party (including a governmental agency) which is authorized or under legal obligation to pay such charges. Where the cost of diagnostic services is to be reimbursed by a governmental agency, a written agreement with that agency is required. Reimbursement may be made either to the State or directly to the provider in accordance with such an agreement; (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.

§ 51a.110 Standards relating to personnel and facilities.

The State plan shall incorporate by reference 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) assure a reasonably high standard of care; (c) meet State and local licensing laws; and (d) are in substantial accordance with national standards as ac

cepted by the Secretary or standards prescribed by the Secretary.

§ 51a.111 Authorization of service.

The State plan shall contain an assurance 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 records of such authorizations will be retained by the State or local public agency as part of the individual's case record.

§ 51a.112 Confidential information. The State plan shall:

(a) Contain an assurance 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) Incorporate by reference the suitable regulations and safeguards to carry out the provisions of paragraph (a) of this section.

§ 51a.113 Rates of payment for medical care, appliances, and convalescent and foster home care.

The State plan shall incorporate by reference the schedule of rates and 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 plan are reasonable and necessary to maintain the standards relating to personnel and facilities established pursuant to § 51a.110. Such rates may be based on reimbursement to providers of such services on a prepaid capitation basis.

§ 51a.114 Payment for inpatient hospital services.

The State plan shall contain an assurance that payment for inpatient

The State plan shall contain an assurance 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.

§ 51a.116 State reports and records.

The State plan shall contain an assurance that in addition to any other reports or records required by these regulations or which may reasonably be required by the Secretary under Title V of the Act:

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

(b) The State agency shall make annual expenditure and performance reports in accordance with Subparts I and J of 45 CFR Part 74.

(c) All records required pursuant to title V of the Act and these regulations shall be retained in accordance with Subpart D of 45 CFR Part 74.

§ 51a.117 Demonstration services.

The State plan shall incorporate by reference documents providing 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 setting forth the policies, standards, and

criteria applicable to the development and provision of such services, and to the selection of such areas and groups.

§ 51a.118 Use of subprofessional staff and volunteers.

The State plan shall incorporate by reference documents showing:

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

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

(c) That the State plan meets the requirements established by the Secretary for training and effective use of subprofessional and volunteer staff contained in 45 CFR Part 225.

§ 51a.119 Use of optometrists.

The State plan shall contain an assurance that, where payment is authorized under the plan for services which an optometrist is licensed to perform, the individual for whom such payment is authorized may obtain such services from a licensed optometrist. This assurance does not apply, however, in cases where such services are rendered in a clinic or other appropriate institution which does not have an arrangement with optometrists licensed to perform such services.

§ 51a.120 Acceptance of family planning services.

The State plan shall contain an assurance 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.

§ 51a.121 Cooperation with other agencies and groups.

The State plan shall contain an assurance of 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.

§ 51a.122 Specialized and supporting expenditures.

(a) For its crippled children's program, the State plan shall, with respect to the State agency's total annual expenditures of Federal and required matching funds for such program, incorporate by reference documents identifying 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) For its maternal and child health program, the State plan shall, with respect to the State agency's total annual expenditures of Federal and required matching funds for such program, incorporate by reference documents providing 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 protion of "supporting expenditures" which, together with any "specialized expenditures" identified 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 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 maternal and child health services plan.

§ 51a.123 Allotments.

(a) Prior to the beginning of each fiscal year the Secretary 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 determined by the Secretary is available to States and to nonprofit institutions of higher learnings 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 Secretary 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 non-profit 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,

live

(2) The other half is known as Fund B. From this fund an amount determined by the Secretary 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 births in each State and per capital 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 Secretary 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 material and child health.

§§ 51a.124-51a.127 [Reserved]

§ 51a.128 Program of projects for maternity and infant care.

(a) The State plan shall incorporate by reference documents providing for a program of projects (carried out by the State agency directly or through grants and contracts) described in section 508(a)(1) of the Act, particularly

in areas with concentrations of lowincome families, which offers reasonable assurance of satisfactorily helping to reduce (1) the incidence of mental retardation and other handicapping conditions caused by complications associated with childbearing and (2) infant and maternal morbidity and mortality, through provision of necessary health care to prospective mothers (including, after childbirth, health care to mothers and their infants) who have or are likely to have conditions associated with childbearing or who are in circumstances which increase the hazards to the health of mothers or their infants (including those which may cause physical or mental defects in the infants).

(b) The Secretary, in determining whether the program of projects described in the documents incorporated by reference offers reasonable assurance of achieving the above-stated objectives, will take into consideration the degree to which such program of projects provides for:

(1) Appropriate diagnostic, preventive, prenatal, and postnatal health care and services, including hospital care and delivery services, and family planning services, for women and infants within the area served by the program of projects.

(2) The prompt delivery of care and services.

(3) Procedures to insure coordination and continuation of care and services, including active follow-up of

cases.

(4) Income standards established in accordance with criteria of the Secretary for determining eligibility for treatment services, which are to be applied flexibly with due regard to family size and income and the family's other financial responsibilities in relation to the cost of required care.

(5) Staff and/or consultants in the State maternal and child health program, or in each project, that will insure adequacy of services.

(6) Arrangements, which may include payment, for the provision of services to those women and infants eligible for treatment services within the area served by the program of pro

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