Jerfod as the agency has been in pers don:

4. In the case of a home health agency which plans to expand is array of services or to open a subunit

(1) A copy of the 33.A. Form #1515 which may be obtained from the Bureau of Health Insurance which it has subnitted to the applicable State agency as evidence of its intent to become certified: and

1) A detailed plan indicating how he applicant agency plans to meet the contitions of participation necessary to doain certification by the State agency for the new services) and, or subuner and

5 In the case of a home health agency which plans to enlarge its catchment area or open a new branch ice, he information requested in paragraph a4 of this section for both is current catchment area and is proposed new catchment area or new branch office. Fle.105 Fiscal management.

The Health Services Finding Regulations, 42 CFR Part 30, Subpart A, appig to ail grants under this subpart consistent with the provisions of § 516.136 a7.

351e. 106 Project elements.

(a) All projects. A project funded under this subpart must:

(1) Provide its services directly and make such services available to all residents of its catchment area:

(2) Recrits personnel necessary to meet the requirements of this subpart in accordance with the plan submitted pursuant to 51e.104/a) (10);

(3) Assure that staff professionals and paraprofessionals meet all applicable licensure, certication, or other legal requirements for the practice of their professions;

(4) Establish and maintain referral procedures (such as forms designed for referrals, or the designation of a hospital staff member to coordinate and follow-up referrals) to handle patients referred to the project from hospitals, skilled nursing and intermediate care faci.itles, and other appropriate institutional and ambulatory health care providers;

(5) Carry out the marketing plan provided pursuant to 51e.104(a) (9) of this subpart and approved by the Secretary in the Notice of Grant Award;

(6) Establish basic statistical data, cost accounting, management informa

ion, and reporting systems which shall macle he project to provide such statistics and other information as the Secetary may reasonacy require relating to is costs of operation, patterns of utilization of service, and the availability, accessibility and acceptability of us services, and to make such reports the Secretar in a cmer manner with such fremency as the Secretary may reasonably

equre:

Have prepared, and make every reasonable efor a dotain payment for services in accordance with, a schedule of fees and payments for the provision of Is services designed a cover its reasonable costs of operation and a corresponding schedule of discounts adjusted on the bass of patents acuity to pay. Pronded, that such schedule of discounts shall provide for a full discount to individuals and families with annual incomes as or below those set forth in the most recent "CSA come Poverty Guidelines":45 CFR § 2060.2) and for no discount to individuals and families with annual incomes greater than twice those set forth in such Guidelines; and

(3 Carry cut the pian provided pursuant to § 5le104 a 11) and approved by the Secretary in the Notice of Grant Award to secure sufficient funding sourees to connue providing home health services after Federal financial assistance under this subpart is no longer available.

Home health organizations. In addition to the requirements of paragraph (a) of this section, a project described in § 51e.103(b)(1) must:

(1) Implement the pian provided pursuant to § 51e.104(b)(20:

(2) Octain certification from the State agency in accordance with 20 CFR Part 405. Subpart S. within 60 days from the date of grant award, unless the applicant demonstrates to the Secretary's satisfaction that failure to obtain such certification within such time period is due to circumstances beyond the applicant's control, in which case the project will obtain certification within the revised time limit imposed by the Secretary:

(3) Be certified by the State agency before utilizing grent funds under this subpart for providing any home health services; and

(4) Provide skilled nursing care and such other home health services as are specified in the Notice of Grant Award following certification by the State

agency to the residents of its catchment

area.

(c) Home health agencies.

(1) In addition to the requirements of paragraph (a) of this section, a project described in § 51e.103(b) (2) must do the following, as applicable:

(i) In the case of a project as described in § 51e.103(b) (2) (i), make available one or more home health services, not previously provided by the agency, for which there is a need in the catchment area, as determined by the Secretary and as specified in the Notice of Grant Award.

(ii) In the case of a project described in § 51e.103(b) (2) (ii), expand its catchment area, and provide home health services therein, sufficient to increase the number of persons served by the agency in the calendar year of the grant by a percentage equal to the ratio of the amount of the grant under this part to the agency's total operating budget for the calendar year preceding the grant; Provided, however, that where the Secretary determines the project will expand its catchment area so as to serve a substantially less densely populated area, he may approve a lower percentage.

(iii) In the case of a project described in § 51e.103(b)(2) (iii), provide services to an additional number of residents of the agency's catchment area sufficient to increase the number of persons served by the agency in the calendar year of the grant by a percentage equal to the ratio of the amount of the grant under this part to the agency's total operating budget for the calendar year preceding the grant.

(2) In the case of an agency which plans to expand its services in such a way as to require a new or amended provider agreement, the project must:

(i) Obtain State agency certification pursuant to 20 CFR Part 405, Subpart S, within 30 days of the grant award, unless the applicant can demonstrate to the Secretary's satisfaction that failure to obtain such certification within such time period was due to circumstances beyond the applicant's control, in which case the project will obtain certification within a revised time limit imposed by the Secretary; and

(ii) Be certified by the State agency before providing any of the expanded services.

§ 51e.107 Grant evaluation and award.

(a) Within the limits of funds available for such purposes, the Secretary will evaluate applications submitted under this part and will award grants to applicants which submit approvable applications for projects to provide home health services in areas where such services are not otherwise available, as determined under subparagraph (4) of this paragraph, in accordance with the following procedures:

(1) The funds appropriated to carry out section 602(a) of the Act will be allocated among the regions of the Department of Health, Education, and Welfare, as set forth in § 1.30(A), 35 Fed. Reg. 14334 (1970), on the basis of the relative needs of the State within each such region. Such relative need shall be determined by comparing the number of individuals within each State who are elderly, medically indigent, or both, as determined for purposes of § 51e.108 of this part in areas determined in accordance with § 51e.108 to have a high percentage of such individuals; Provided, that a minimum of $100,000 will be allocated to each region for the States within such region; and Provided further, that where the Secretary determines that there will not be enough approvable applications within a region to utilize the grant funds allocated to it, he may reallocate such excess funds to regions which he determines will have approvable applications which would otherwise not be funded.

(2) In awarding grants under this subpart, the Secretary will give preference to approvable applications for projects which will serve catchment areas in which a high percentage of the population is composed of individuals who are elderly, medically indigent, or both, as determined under § 51e.108 of this part.

(3) Where the funds allocated to a region are insufficient to fund all approvable applications for projects which I will serve catchment areas in which a high percentage of the population is composed of individuals who are elderly, medically indigent, or both, or, in considering approvable applications for projects which will not serve catchment areas in which a high percentage of the population is composed of individuals who are elderly, medically indigent, or both, the Secretary may award grants under this subpart to:

(i) The projected number of users who are elderly and/or medically indigent,

(b) The extent to which the project will meet the requirements set forth in $ble.105 and § 51e.106,

(iii) The degree to which the applicant intends to integrate services (such as combining services with other public or nonprofit private agencies receiving other grants for the delivery of health services), and

(0) The extent to which community resources will be utilized in the project, and the extent to which such community resources will continue to support home he services after funds under this subpart are no longer available.

For purposes of this section, home health services will be considered to be not otherwise available in a catchment area where:

(1) There are no home health agencies in the area; or

(i) There is a home health agency providing the services but the services are unavailable to a significant portion of the population; or,

(iii) There is a home health agency in the area, but it does not provide at least one of the home health services which the applicant proposes to provide.

(b) The amount of any award under this subpart will be determined by the Secretary on the basis of his estimate of the sum necessary for a designated portion of direct project costs; Provided, however, that no grant shall be made for an amount in excess of the total cost as found necessary by the Secretary for the carrying out of the project.

(1) In determining the percentage of project costs to be borne by the grantee, the Secretary will take into consideration the following factors:

(1) The ability of the grantee to finance its share of project costs from non-Federal sources; and

(ii) The need of the area served by the project for the services to be provided.

(2) At any time after approval of an application under this subpart, the Secretary may retroactively agree to a lower percentage of project costs to be borne by the grantee than that determined pursuant to paragraph (b)(1) of this section where he finds that changed circumstances justify a smaller contribution.

(3) In determining the grantee's share of project costs, if any, costs borne by Federal grant funds or costs used to match other Federal grants may not be

included except as otherwise provided by law or regulations.

(e) Grants under this part may be made for a period up to 17 months if necessary to provide sufficient time for the applicant to achieve an operational level which will support the continued provision of home health services in the area.

(d) All grant awards shall be in writing, and shall set forth the amount of funds granted and the period for which support is recommended.

(e) Neither the approval of any project nor any grant award shall commit or obligate the United States in any way to make any additional, supplemental, or other award with respect to any approved project or portion thereof.

§ 51e.108 Determination of preference.

(a) For purposes of § 51e.107 of this part, a catchment area will be considered to have a high percentage of individuals who are elderly, medically indigent, or both if any one of the following is present.

(1) More than 13.7 percent of its population consists of noninstitutionalized individuals who are 65 years old or older;

(2) More than 26.9 percent of its population consists of persons with annual family incomes below the poverty level, as defined by the Social Security Administration in 1964, modified by a Federal Interagency Committee in 1969, and used in the 1970 United States Census; or

(3) More than 5.6 percent of its population consists of individuals who are both 65 years old or older and whose annual family income is below the poverty level, as specified in subparagraph (2) above.

(b) (1) An applicant may demonstrate that its catchment area has a high percentage of individuals who are elderly, medically indigent, or both by using data from:

(i) The United States Census Bureau, United States Census of the Population: 1970, General Social and Economic Characteristics, PC(1)-C, Tables 119 and 120, or 124; or

(ii) The United States Census Bureau, United States Census of the Population: 1970, General Population Characteristics, PC(1)-B, Table 37; or

(iii) More current data appropriate to the proposed catchment area, if such data is shown, to the Secretary's satisfaction, to be more appropriate and valid

for the purposes of such calculation. Data such as that complied most recently by the Administration on Aging, the most current data on Medicare enrollees or recipients of other categorical assistance programs, as appropriate (e.g. Old Age Assistance), may be submitted and used to update the 1970 data.

(2) In computing the percentage of the population of its catchment area which is elderly, medically indigent, or both, an applicant must exclude individuals who are inmates of institutions, and those in military barracks and college dormitories as set forth in the tables referred to in subparagraph (b) (1) above, unless it can be reasonably demonstrated that a portion or all of the individuals in such institutions would otherwise reside in the catchment area. § 51e.109

Use of project funds.

(a) Any funds granted pursuant to this subpart, as well as other funds to be used in performance of the approved project, may be expended solely for carrying out the approved project in accordance with section 602 (a) of the Act, the regulations of this subpart, the terms and conditions of the award, and the applicable cost principles prescribed in Subpart Q of 45 CFR Part 74.

(b) Project funds awarded under this part to establish, expand, or operate a home health agency may be used for, but need not be limited to, the following:

(1) The costs of obtaining technical assistance to develop the project, to improve its management capability, to establish an adequate data collection system, and to develop methodology for evaluation; and

(2) The cost of delivering home health services to individuals and families with annual incomes lower than those set forth in the most recent "CSA Income Poverty Guidelines" (45 CFR 1060.2) established by the Community Services Administration, and the uncompensated portion of the cost of services provided to individuals and families with annual incomes greater than, but not over twice, those set forth in such Guidelines.

(c) Grant funds shall not be used to pay the salaries of project staff members whose qualifications do not meet applicable requirements under the conditions of participation.

(d) Prior approval by the Secretary of revisions of the budget and project plan is required whenever there is to be

(a) Attention is called to the requirements of Title VI of the Civil Rights Act of 1964 (78 Stat. 252, 42 U.S.C. 2000d et seq.) and in particular section 601 of such Act which provides that no person in the United States shall, on the grounds 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. A regulation implementing such title VI, which applies to grants made under this part, has been issued by the Secretary of Health, Education, and Welfare with the approval of the President (45 CFR Part 80). In addition, no person shall be denied employment in or by such program or activity on the grounds of age, sex, creed, or marital status.

(b) Attention is called to the requirements of Section 504 of the Rehabilitation Act of 1973, as amended, which provides that no otherwise qualified handicapped individual in the United States shall, solely by reason of his handicap, be excluded from participation in, be denied the benefits of, or be subjected to discrimination under any program or activity receiving Federal financial assistance.

form which does not identify particular individuals.

§ 51e.113 Publications and copyright.

Except as may be provided under the terms and conditions of the award, the Department of Health, Education, and Welfare copyright requirement, set forth in 45 CFR 74.140, shall apply to any book or otherwise copyrightable material developed or resulting from the activity supported by a grant under this subpart. § 51e.114 Grantee accountability.

(a) Accounting for grant award payments. All payments made by the Secretary shall be recorded by the grantee in accounting records separate from the records of all other grant funds, including funds derived from other grant awards. With respect to each approved project the grantee shall account for the sum total of all amounts paid by presenting or otherwise making available evidence, satisfactory to the Secretary, for expenditures for direct and indirect costs meeting the requirements of this part: Provided, however, that when the amount awarded for indirect costs was based on a predetermined fixed-percentage of estimated direct costs, the amount allowed for indirect costs shall be computed on the basis of such predetermined fixedpercentage rates applied to the total, or a selected element thereof, of the reimbursable direct cost incurred.

(b) Copyright royalties. Copyright royalties shall be accounted for as provided in 45 CFR 74.44.

(c) Grant closeout.

(1) Date of final accounting. A grantee shall render, with respect to each approved project, a full account, as provided herein, as of the date of the termination of grant support. The Secretary may require other special and periodic accounting.

(2) Final settlement. There shall be payable to the Federal Government as final settlement with respect to each approved project the total sum of:

(i) Any amount not accounted for pursuant to paragraph (a) of this section; and

(ii) Any other amounts due pursuant to Subparts F, M, and O of 45 CFR Part 74. Such total sum shall constitute a debt owed by the grantee to the Federal Government and shall be recovered from the grantee or its successors or assignees by setoff or other action as provided by law.

§ 51e.15 Performance report.

A grantee shall submit a performance report meeting the requirements of 45 CFR 74.82(c), and a financial status report at the end of the assigned project period.

§ 51e.116 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: