areawide health planning project grants under section 314(b) of the Act.

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

(2) The Secretary shall be provided copies of each recommendation, plan or portion of a plan adopted by the State agency;

(3) An annual narrative summary of the planning activities undertaken during the preceding year will be submitted to the Secretary;

(4) Cumulative expenditure reports on forms prescribed by the Public Health Service will be submitted within 30 days after the end of the first half of any Federal fiscal year and within 60 days after the close of the Federal fiscal year; (5) 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 questions arising from the audits have been resolved, whichever is sooner; and (6) The State agency 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.

(h) Review and modification. The State program must provide that the State agency will review and evaluate its approved program at least once annually and submit appropriate modifications to the Secretary. As a minimum, the State agency shall submit annual modifications of the State program which will (1) reflect budgetary and expenditure requirements for the next fiscal year, (2) set forth priorities established for planning activity to be undertaken in the next fiscal year, and (3) update any assurances or other informational requirements included in the State program.

(i) The State program shall provide for assisting, through consultation, provision of information, and advice, each health care facility in the State to de

velop a program for capital expenditures for replacement, modernization, and expansion which is consistent with such overall State plan as has been developed in accordance with criteria established as provided in section 314(a) (2) (I) of the Act, and shall provide that the State agency furnishing such assistance will periodically review such capital expenditures program of each health care facility in the State and recommend appropriate modification thereof. The assistance and review required under this paragraph may be provided either by the State comprehensive health planning agency itself, or, under such State agency's control and supervision, by a local public or a private nonprofit agency, or by another State agency qualified and authorized to provide such assistance and designated in the State program as the agency with the primary responsibility therefor. For the purposes of this section the term "health care facility" includes all hospitals, sanitoriums, nursing homes, and other facilities for the inpatient care of the sick, injured, or disabled, which are licensed or formally approved for such purposes by an officially designated State standards-setting authority, and all public or private nonprofit clinics, health centers, and other facilities a major purpose of which is to provide diagnostic, preventive or therapeutic outpatient health care by or under the supervision of doctors of medicine, osteopathy, or dentistry: Provided, That such term shall not include facilities operated by religious groups relying solely on spiritual means through prayer and healing and in which health care by or under the supervision of doctors of medicine, osteopathy, or dentistry is not provided.

(j) Accounting procedures. The State program 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 funds from State and Federal sources, of expenditures made from such funds for comprehensive health planning purposes under the State program, and of any unearned balances of Federal funds paid to the State. Controls shall be established by the State agency to ensure that expenditures charged to comprehensive State health planning funds

(a) Determination. The allotment of funds for any year to each State shall be the product of—

(1) The percentage which the State's weighted population bears to the total of the weighted populations of all States, multiplied by

(2) The amount of appropriated funds available for allotment for the fiscal year; except that the allotment for any State which, as a result of such computation, is less than one percent of the amount available for allotment shall be increased to one percent of such amount and the allotments to other States shall be proportionately reduced as necessary but not below an amount equal to 1 percent.

For the purposes of this section, the term "weighted population" means (1) the population of the State (as determined from the latest available estimate from the Department of Commerce) multiplied by (ii) the per capita income of the United States divided by the per capita income of the State (as determined from the latest available estimates from the Department of Commerce).

(b) Availability. The funds allotted to any State for a fiscal year shall remain available to the State for obligation in accordance with its approved State program during the fiscal year for which the allotment was made and the succeeding fiscal year. If the Secretary, after consultation with the head of any State agency, or the Governor of the State if such an agency has not been designated, determines that a State will not utilize all of its allotment during the period for which it is available, such balances shall be available for reallotment to other States in accordance with the provisions of subsection 314(a) (3) (B) of the Act. The Secretary shall make a determination as to the balances of funds available for reallotment as of the end of each 6-month period during which such allotments are available for expenditures by the States and shall reallot such balances as soon as possible after such a determination is made.

[32 F.R. 10793, July 22, 1967, as amended at 33 F.R. 13026, Sept. 14, 1968]

Each State for which a State program has been approved shall from time to time be paid from its allotment for the fiscal year amounts which equal the Federal share, as determined pursuant to section 314(a) (4) of the Act, of expenditures incurred during the period for which such allotment is available. The "Federal share" for any State shall be all or such part of the expenditures for comprehensive State health planning made by or under the supervision of the State health planning agency as the Secretary may determine at the time of approval of the State program, except that in the case of the allotment to the State for the fiscal year ending June 30, 1970, it shall not exceed 75 per centum of such expenditures. Payments to a State under this section will be made where practicable through a letter of credit system or, when such a system is not practicable, on the basis of payment requests from the State to meet its current needs. 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). [33 F.R. 13027, Sept. 14, 1968]

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

At the request of and for the convenience of the designated State agency, the Secretary may, in lieu of cash payments, furnish to the State agency equipment or supplies or detail to the State agency officers or employees of the Public Health Service when he finds such equipment, supplies, or personnel would be used in carrying out the approved State program. In such case, the Secretary shall reduce the payments to which the State agency 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 with 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 program and the Federal share of such expenditures, 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. 10793, July 22, 1967, as amended at 33 F.R. 13026, Sept. 14, 1968]

§ 51.8

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 approavl of the President (45 CFR Part 80). Such regulation is applicable to comprehensive State health planning activities which receive Federal financial assistance and requires receipt and acceptance by the Secretary of the applicable documentation set forth therein.

[32 F.R. 10794, July 22, 1967, as amended at 33 F.R. 13026, Sept. 14, 1968]

Subpart B-Grants to States for Public Health Services

The regulations of this subpart apply to grants to State health and mental health authorities to assist the States, including the District of Columbia, Puerto Rico, the Virgin Islands, Guam, American Samoa, and the Trust Territory of the Pacific Islands, in establishing and maintaining adequate public health services, including the training of personnel for State and local health work, as authorized pursuant to section 314(d) of the Public Health Service Act, as amended, hereinafter referred to as the "Act."

[33 F.R. 11359, Aug. 9, 1968]

(b) "State authority” means the State health, or with respect to mental health, the State mental health authority.

(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 may be delegated.

[32 F.R. 8243, June 8, 1967, as amended at 33 F.R. 13026, Sept. 14, 1968]

§ 51.103 Submission of State plans.

In order to receive funds from an allotment under this part, a State must submit to and have approved by the Secretary, a State plan which contains the information and meets the requirements specified in the Act and in the regulations of this subpart. Such plan shall be submitted by the State health authority, or in the case of mental health, the State mental health authority. Where both the State health and State mental health authorities are contained in a single agency, a single plan may be submitted provided the mental health programs are separately identified.

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

§ 51.104 State plan requirements.

(a) Responsibility of State authority. The plan must provide that the State authority will either administer or supervise the administration of the activities to be carried out under the State plan. In providing funds to any activity which it does not administer, the State authority shall apply the same standards and require conformance to the same criteria for services to be supported as are applicable to activities which it undertakes to conduct directly. In order to assure adequate supervision by the State authority of the administration of activities carried out by other agencies, institutions, organizations, or individuals, the State plan must show with respect to any such activity that the State authority (1) obtains from the agency, institution, organization, or individual, the data needed for program planning, evaluation, and accounting purposes, (2) has established methods for performing continuing professional and administrative evaluations of the activities conducted by such agency, institution, organization, or individual, and (3) will take such steps as may be necessary to assure that such activities meet Federal and State requirements.

(b) Expenditure of grant funds. In addition to providing for proper fiscal control and fund accounting procedures as specified in paragraph (k) of this section, the State plan must contain:

(1) The policies and procedures by which other governmental and nonprofit private agencies, institutions, and organizations will be made aware of the availability of Federal and State funds for the conduct of public health activities, including those locally initiated or sponsored, under the State plan, and by which requests for commitment of such funds will be evaluated and approved.

(2) Methods of evaluating the performance of activities being carried out under the plan to assure that they meet the standards set forth in the plan and those prescribed in the regulations of this subpart.

(3) An assurance that professional standards will be followed in approving individuals (other than employees under a governmental merit system), agencies, institutions, and organizations to provide public health services under the plan.

(4) An assurance that schedules or other bases upon which payments are made to individuals (other than employees under a governmental merit system), agencies, institutions, and organizations I will be in accord with the usual and customary practices in that State.

(c) Providing and strengthening local public health services. The plan must contain satisfactory assurance that the funds paid to the State for the activities to be carried out under it will be used to provide and strengthen public health services in the various political subdivisions in order to improve the health of the people of the State. In evaluating such assurance, the Secretary shall consider (1) the extent to which services provided under the State plan are made available to all people in all areas of the State, and (2) the extent to which such funds and services represent a strengthening of public health services in such areas, including expansion, or improved alignment of services or initiation of new services.

(d) Participation by local, regional, metropolitan, and other public or private nonprofit agencies. The State plan shall contain satisfactory assurance that:

(1) In accordance with the standards and criteria required in paragraph (a) of this section, funds will be made available by the State authority to other

public or nonprofit private agencies, institutions and organizations initiating, sponsoring, or providing public health services which qualify for inclusion in and support under, the State plan;

(2) Such agencies, institutions, and organizations to which funds are made available are required to participate in the costs of such services;

(3) In determining to which agencies, institutions, and organizations funds are to be made available, and the amount of funds which are to be made available to each, the State authority shall consider the extent to which the services to be provided will be directed to public health programs of high priority, will be of high quality, and will reach the people in local communities in greatest need of such services;

(4) In its evaluation of requests for such funds the State authority shall consider the comments relating to such requests of the regional, metropolitan, or local area comprehensive health planning agency serving the area, if such agency exists.

(e) Federal funds to supplement nonFederal funds otherwise available. The State plan must contain satisfactory assurances that Federal funds will not supplant non-Federal funds otherwise available for providing the services and carrying out the activities under the plan and that such funds will, to the extent practical, be used to increase the level of funds otherwise available for such services and activities. Substantial compliance with such assurances will be deemed to have been met if:

(1) The level of State funds available to and spent by the State authority for those public health services under the approved State plan (including State funds allocated to other public or nonprofit private agencies, institutions and organizations) is at least no lower for any fiscal year than it was for the immediately preceding fiscal year, except that the Secretary may also take into consideration the extent to which the level of such funds for any fiscal year may have included emergency or other funds for an activity of a nonrecurring nature.

(2) The aggregate level of non-Federal funds (other than State funds allocated by the State authority) available to and spent by other public or nonprofit private agencies, institutions, and organizations to which Federal grant funds are made available under the State plan

from the State's allotment is no lower for any fiscal year than it was for the immediately preceding fiscal year.

(f) Accord with comprehensive planning. (1) Where a State comprehensive health planning agency has been designated pursuant to section 314(a) of the Act, and where such agency has adopted planning recommendations pertaining to services to be provided under the State plan for public health services, the State plan must provide for furnishing such services in accordance with such recommendations.

(2) If the State comprehensive health planning agency has not adopted or incorporated into its planning recommendations State mental health plans, community mental health services under the approved plan for this part shall be in accordance with State mental health plans developed with the assistance of Federal funds appropriated for fiscal years 1963 and 1964 (P.L. 87-582, P.L. 88-136).

(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