The Secretary may with respect to any grant award impose additional conditions prior to or at the time of any award when in his judgment such conditions are necessary to assure or protect advancement of the approved project, the interests of public health, or the conservation of grant funds.

§ 59.215 Applicability of 45 CFR Part 74. The provisions of 45 CFR Part 74, establishing uniform administrative requirements and cost principles, shall apply to all grants under this subpart to State and local governments as those terms are defined in Subpart A of that Part 74. The relevant provisions of the following subparts of Part 74 shall also apply to grants to all other grantee organizations under this subpart.

Subpart D-Grants for Adolescent Pregnancy Prevention and Services Projects

AUTHORITY: Sec. 215, Public Health Service Act, 42 U.S.C. 216, 58 Stat. 690; Title VI, Pub. L. 95-626, 42 U.S.C. 300a-21, et seq., 92 Stat. 3595, et seq.

SOURCE: 44 FR 43229, July 23, 1979, unless otherwise noted.

EFFECTIVE DATE NOTE: At 46 FR 48593, Oct. 1, 1981, Subpart D (§§ 59.301-59.310) was removed, effective Oct. 1, 1982.

§ 59.301 To whom do these regulations apply?

The regulations of this subpart apply to all grants for adolescent pregnancy services and prevention projects authorized under section 603 of Title VI of Public Law 95-626 (42 U.S.C. 300a-21, et seq.).

§ 59.302 How are the terms in these regulations defined?

As used in this subpart, the term: "Act" means Title VI of Public Law 95-626 (42 U.S.C. 300a-21, et seq.).

"Adolescent" means a person whose age is between the onset of puberty and the age of 21, except that a pregnant adolescent who turns 21 during the course of her pregnancy will be considered to be an adolescent for purposes of this subpart until the pregnancy ends.

"Adolescent parent" means a parent or parent-to-be under the age of 21.

"Core services" means the following which shall be provided by all grant

ees:

(a) Pregnancy testing (including menstrual history, pelvic examination, and laboratory test for pregnancy detection), maternity counseling, and referral for related services;

(b) Family planning services, except that such services for nonpregnant adolescents shall be limited to family planning counseling and referral for family planning services unless suitable and appropriate family planning services are not otherwise available in the community;

(c) Primary and preventive health services, including pre- and post-natal care;

(d) Nutrition information and counseling;

(e) Referral for screening and treatment of venereal disease;

(f) Referral to appropriate pediatric care;

(g) Educational services in sexuality and family life including sex education and family planning information;

(h) Referral to appropriate educational and vocational services;

(i) Adoption counseling and referral services; and

(j) Referral to other appropriate health services.

"Eligible person" means—

(a) With regard to the provision of all necessary core services and such necessary supplemental services as may be available, a pregnant adolescent or an adolescent parent; or

(b) With respect to the provision of the services described in paragraphs (a), (b), and (g) of the definition of "core services" and referral to such other services as may be appropriate, a nonpregnant adolescent.

"Nonprofit", as applied to any private agency, institution or organization, means one which is a corporation or association, or is owned and operated by one or more corporations or associations, no part of the net earnings of which benefits, or may lawfully benefit, any private shareholder or individual.

"Secretary" means the Secretary of the Health and Human Services or any other officer or employee of the Department of Health and Human Services to whom the authority involved has been delegated.

"Service area" means the geographic area served (or to be served) by a project supported under this subpart. "Supplemental services" those services which may be provided and are

means

(a) Child care sufficient to enable an adolescent mother to continue her education or to enter into employment;

(b) Consumer education and homemaking;

(c) Counseling for extended family members of the eligible person;

(d) Transportation; and

(e) Such other services, consistent with the purposes of the Act, as the

applicant considers appropriate and as the Secretary approves in the grant award, and which will, in his judgment, enhance the effectiveness of the core services provided to eligible per

sons.

§ 59.303 Who is eligible to apply for a grant under this subpart?

A grant under this subpart may be awarded only to a public or nonprofit private organization or agency which demonstrates, to the satisfaction of the Secretary, the capability of providing in a single setting all core services or the capability of creating a network of providers through which all core services would be provided.

§ 59.304 How is application made for a grant under this subpart?

(a) An application for a grant under this subpart shall be submitted at such time and in such form and manner as the Secretary may prescribe and shall contain—

(1) The following information, using data and methods satisfactory to the Secretary, for the applicant's service

area:

(i) An identification of the incidence of adolescent pregnancy and related problems;

(ii) A description of the economic conditions and income levels;

(iii) A description of existing pregnancy prevention and pregnancy-related services (including family life and sex education), including where, how, by whom and to whom they are provided, and the extent to which they are available and coordinated; and

(iv) A description of the major unmet needs for services for adolescents at risk of initial or repeat pregnancies, the estimated number of adolescents currently served in the area, and the estimated number of adolescents not being served in the area.

(2) A description of how all the core services and any supplemental services which the applicant proposes to provide will be provided in the project (including what particular services will be provided under each of the core services and a timetable for their provision), to whom they will be provided, how they will be coordinated, integrat

ed, and linked with other related programs (supported by any written agreements or other evidence of arrangements between the applicant, governmental, other third-party payors, and other providers of services) and services and the source or sources of funding of the such services.

(3) A description, in such detail as the Secretary may require, of—

(i) How adolescents needing services other than those provided directly by the grantee (such as school education, social services, medicaid, public assistance, employment services, child care services for adolescent parents, and other city, county, and State programs related to adolescent pregnancy) will be identified and reached; and

(ii) How access and appropriate referral to those services will be provided, including a description of the plan to coordinate those services with the project's activities and arrangements for appropriate follow-up of persons referred (supported by any written agreements or other evidence of arrangements between the applicant, governmental, other third-party payors, and other providers of services).

(4) A description of the results expected from the provision of services and activities, and the procedures to be used for evaluating those results.

(5)(i) Assurance that the applicant has prepared a schedule of fees or payments for the provision of its services which is designed to cover its reasonable costs of operation and a corresponding schedule of discounts to be applied to the payment of such fees or payments ("fee schedule"). The discounts must be adjusted on the basis of the ability to pay of the eligible person or his or her parents or legal guardians, as applicable.

(ii) A description of the fee schedule, together with the method by which it was derived. The fee schedule must provide for:

(A) A full discount to eligible persons and their parents or legal guardians, regardless of income, for pregnancy testing services;

(B) A full discount to eligible persons and their parents or legal guardians, regardless of income, for counsel

ing, education, information, and referral services provided by the project; and

(C) A full discount to eligible persons, regardless of the annual incomes of their parents or legal guardians, where the eligible persons are unable to pay for services without financial assistance from their parents or legal guardians and are unwilling to seek that financial assistance for the services.

(6) Assurances that the applicant has made and will continue to make every reasonable effort

(i) To secure from eligible persons and their parents or legal guardians payment for services in accordance with the requirements of paragraph (a)(5) of this section;

(ii) To collect reimbursement for its cost of providing services on the basis of full amount of fees and payments for such services without application of any discount, except as provided in paragraph (a)(5) of this section; and

(iii) To collect reimbursement for its costs in providing services to persons who are entitled

(A) To benefits under the program for maternal and child health services under Title V of the Social Security Act (42 U.S.C. 701 et seq.);

(B) To medical assistance under the Medicaid program (Title XIX of the Social Security Act, 42 U.S.C. 1396, et seq.);

(C) To services under a State plan for social services approved under Title XX of the Social Security Act (42 U.S.C. 1397, et seq.); or

(D) To assistance for medical expenses under any other public assistance program or private health insurance program.

(7) Assurances that fees collected by the applicant for services rendered shall be used by the applicant to further the purpose of the project.

(8) Assurances that the applicant(i) Has or will have a contractual or other arrangement with the agency or agencies of the State in which it provides services which administer or supervise the administration of the State plan approved under Titles XIX and XX of the Social Security Act for the payment of all or a part of the applicant's costs in providing services to

persons who are eligible for medical assistance or social services under such plans; or

(ii) Has made or will make every reasonable effort to enter into such an arrangement.

(9) Assurance that the applicant will have an ongoing program to assure quality in the provision of its services. The quality assurance program must provide for:

(i) Organizational arrangements, including a focus of responsibility, to support the quality assurance program and the provision of high quality care and services; and

(ii) Periodic assessment of the appropriateness of the utilization of services and the quality of services provided or proposed to be provided to persons served. Those assessments shall:

(A) Be conducted by licensed health professionals or others, as appropriate; (B) Be based on the systematic collection and evaluation of client records; and

(C) Identify and document the necessity for change in the provision of services by the project and result in the institution of such change where indicated.

(10) Assurances that the applicant will have a system for maintaining the confidentiality of patient records in accordance with the requirements of § 59.310(b) of this subpart.

(11) Assurances that

(i) The applicant will demonstrate its financial responsibility by developing management and control systems which are in accordance with sound financial management procedures, including the provision for an audit on an annual basis (unless waived for cause by the Secretary) by an independent certified public accountant or a public accountant licensed prior to December 31, 1970, to determine, at a minimum, the fiscal integrity of grant financial transactions and reports, and compliance with the regulations of this part and the terms and conditions of the grant.

(ii) The applicant will establish basic statistical data, cost accounting, management information, and reporting or monitoring systems which will enable it to provide such statistics and other information as the Secretary may rea

sonably require relating to the projects costs of operation, patterns of utilization and the availability, acceptability and accessibility of its services and to make such reports to the Secretary in a timely manner with such frequency as the Secretary may reasonably require.

(12) Assurances that the acceptance by any individual of family planning services or family planning or population growth information (including educational materials) provided by the project shall be voluntary and shall not be a prerequisite to eligibility for or receipt of any other service furnished by the applicant.

(13) Assurances that persons who are unemancipated minors under State law who request services from the applicant will be encouraged, whenever feasible, to consult with their parents or legal guardians with respect to such services. An applicant may not condition the provision of services on such consultation or on parental notification, unless State law requires it to do so.

(14) Assurances that each pregnant adolescent receiving services will be informed of the availability of counseling (either by the entity providing core services or through a referral agreement with another entity which provides such counseling) on all options regarding her pregnancy.

(15) Assurances that primary emphasis for services paid for with funds under the project shall be given to pregnant adolescents and adolescent parents 17 and under who are not able to obtain needed assistance through other means.

(16)-(17) [Reserved]

(18) A budget including required matching funds and a fiscal plan for assuring effective utilization of grant funds) and a justification of the amount of funds requested.

(19) A description of the applicant's capacity to continue services as Federal funds decrease and in the absence of Federal assistance.

(20) Assurances that the applicant will make maximum use of funds available under the program of project grants for family planning services under Title X of the Public Health Service Act.

(21) Assurance that funds received under this Act shall not supplant funds received from any other Federal, State, or local program or any private sources of funds.

(22) A summary of the views of public agencies, providers of services, and the general public in the service area, of the proposed use of the funds provided and a description of procedures used to obtain those views. In the case of applicants who propose to coordinate services administered by a State, the written comments of the appropriate State officials responsible for such services shall also be included.

(23) Evidence that the requirements of Part I of Office of Management and Budget Circular No. A-95 have been satisfied.

(b) The application shall be executed by an individual authorized to act for the applicant and to assume for the applicant the obligations imposed by the statute, the applicable regulations and any additional conditions of the grant.

[44 FR 43229, June 23, 1979, as amended at 46 FR 48597, Oct. 1, 1981]

§ 59.305 What requirements must a project funded under this subpart meet?

A project funded under this subpart shall:

(a) As appropriate, and in accordance with the assurances in the application, the grant award and applicable law, provide, supplement or improve the quality of core and supplemental services to eligible persons in its service area.

(b) Make such reports concerning its use of Federal funds as the Secretary may require. Reports must include the impact the project has had within its service area on reducing the rate of first and repeat pregnancies among adolescents, and the effect on factors usually associated with welfare dependency and any data which the Secretary requires as part of a comprehensive uniform management data system.

(c) Operate in a manner such that no person shall be denied service by reason of his or her inability to pay therefore, except that, a charge for the provision of service will be made to the

extent that a third party (including a Government agency) is authorized or is under legal obligation to pay that charge.

(d) Where a grantee under this subpart is a State using funds provided under this subpart to improve the delivery of pregnancy-prevention and pregnancy-related services throughout the State, it shall coordinate its activities with the programs of local grantees, if any, under this subpart.

in

§ 59.306 What criteria has HHS established for deciding which applications for grants under this subpart to fund? Within the limit of funds available for such purposes, the Secretary may award grants to eligible grant recipients whom he determines have submitted applications which meet the requirements of § 59.304 for projects which will help communities provide core and supplemental services easily accessible locations, assure a continuity of services and appropriate assistance, coordinate, integrate, and establish linkages among such services, and best promote the purposes of the Act. No application will be approved unless the Secretary is satisfied that core services will be available through the applicant within a reasonable time after the grant is received. In approving applications the Secretary will:

(a) Give priority to applicants who: (1) Serve an area where there is a high incidence of adolescent pregnanсу;

(2) Serve an area where the incidence of low-income families is high and where the availability of pregnancy-related services is low;

(3) Show evidence of having the ability to bring together a wide range of needed core and, as appropriate, supplemental services in comprehensive, single-site projects, or to establish a well-integrated network of such services (appropriate for the target population and geographic area to be served including the special needs of rural areas) for adolescents at risk of initial or repeat pregnancies. Written agreements with other providers of services will be considered to be the best evidence of ability to establish a

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