tions of the Division of Indian Health that the health of the afflicted Indian or that of other persons requires the isolation or quarantine of the Indian in a hospital or other place of treatment.

(b) If, after such certification the court commits the afflicted Indian to the custody of the Public Health Service, the Medical Officer in Charge may accept such commitment and transport and admit the Indian to any hospital or institution operated by the Public Health Service for the medical care and treatment of tuberculosis patients whether within or without the jurisdiction of the court.

(c) An Indian admitted to a facility of the Public Health Service pursuant to this subpart shall be subject to the rules and regulations of the Public Health Service applicable to patients and to the facility.

§ 36.32 Retention of custody; utilization of law enforcement authorities. (a) The Medical Officer in Charge having custody of a patient whose commitment has been accepted under this subpart is authorized to employ such means as may be necessary for the retention of custody of, and the provision of necessary treatment to, the afflicted Indian including the provision of attendants during periods of transportation, until such time as the patient is discharged.

(b) When necessary to retain custody of the patient the Medical Officer in

Charge is authorized to call upon the police force of the Bureau of Indian Affairs, of the tribe, or of the State, as may be appropriate.

§ 36.33

Discharge of patients.

When the Medical Officer in Charge of a medical facility to which an afflicted Indian has been admitted is satisfied that the disease is inactive and not in a communicable stage, he shall discharge the patient: Provided, That he may discharge the patient or release him on parole under such conditions as he deems appropriate if he is satisfied that such action would not endanger the health of the patient or the health of other persons.

§ 36.34 Transfer of patients.

(a) A patient admitted to a facility of the Service, pursuant to this subpart, may be transferred to any other facility of the Service within or without the jurisdiction of the committing court for necessary care and treatment.

(b) A patient admitted to a facility of the Service under this subpart may be transferred to a hospital operated by a State or local government which is authorized to receive him within or without the jurisdiction of the committing court.

(c) The transfer of a patient authorized in this section shall be made only if such transfer is in the judgment of the Medical Officer in Charge in the best interest of the health of the patient.

Subpart A-Grants to States for Com

prehensive Health Planning

§ 51.1 Applicability.

The regulations of this subpart apply to grants 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 comprehensive and continuing planning for their current and future health needs in terms of health services, health manpower and health facilities, as authorized pursuant to section 314(a) of the Public Health Service Act, as amended, hereinafter referred to as the "Act."

[33 F.R. 13026, Sept. 14, 1968] § 51.2

Definitions.

(a) "State program" refers to the State plan for comprehensive health planning which contains the information, proposals, and assurances submitted by the State agency pursuant to section 314(a) of the Act and the regulations of this subpart.

(b) "State agency" means the single State agency (which may be an interdepartmental agency) designated in the State program for administering or supervising the administration of the State's health planning functions under the State program.

(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. 10792, July 22, 1967, as amended at 33 F.R. 13026, Sept. 14, 1968]

§ 51.3 Submission of State programs.

In order to receive funds from an allotment under this subpart, a State must submit to and have approved by the Secretary, a State program which contains the information and meets the requirements specified in the Act and in the regulations of this subpart. Such program shall be submitted by the State agency officially designated and authorized to administer it and carry out the functions prescribed hereunder. The effective date for Federal financial participation in the costs of carrying out such a program from any State shall be that date, after the enactment of the first Federal appropriation act containing grant funds for the purposes authorized hereunder, on which the first

State program submitted by the State is approved by the Secretary.

[32 F.R. 10792, July 22, 1967, as amended at 33 F.R. 13026, Sept. 14, 1968]

§ 51.4 State program requirements.

(a) Responsibility of State agency. The State program must provide that the State agency will either administer or supervise the administration of the activities to be carried out under it. In order to assure adequate supervision by the State agency of the administration of activities under the State program carried out by other agencies, institutions, organizations, or individuals, the State program must show with respect to any such activity that the State agency (1) is able to obtain from such other agency, institution, organization, or individual the data needed for formulation and evaluation of, and accountability for, planning activities; (2) has established methods for performing continuing professional and administrative evaluations of such activities; and (3) is in a position to take such steps as may be necessary to assure that such activities meet Federal and State requirements.

(b) State health planning council. The State program must provide for the establishment of a State health planning council to advise the State agency in carrying out its functions under the approved State program. Council membership shall include representatives of State agencies (other than the designated State agency) and local agencies and of nongovernmental groups concerned with health services in the State. A majority of the council members must be consumer representatives whose major occupation is neither the administration of health activities nor the performance of health services. The council shall meet as often as necessary and at a minimum twice a year for the purposes of consulting with and advising the State agency with respect to:

(1) Scope of planning activities to be undertaken by the State agency;

(2) The recommendations to be made by the State agency as a result of such activities; and

(3) Necessary review and modifications of the State program.

(c) Expenditure of grant funds. The State program must set forth policies and procedures for the expenditure of funds under the program, which shall provide that:

(1) The scope of comprehensive planning will encompass the health services, facilities, and manpower to meet the physical, mental, and environmental health needs of the people of the State, and the financial and organizational resources through which these needs may be met;

(2) Such planning will be concerned with both publicly and privately supported health services and activities;

(3) A method for determining priorities of planning activity will be established to ensure that the most critical planning problems are scheduled for early attention;

(4) Methods will be established for obtaining and utilizing, in the formulation of planning priorities and recommendations, effective and appropriate informational support, including statistical data and, where feasible, social, economic, demographic, and similar base data consistent with those to be utilized for other comprehensive planning activities in the State;

(5) To administer or supervise the administration of the planning functions under the State program and to provide staff assistance to the State health planning council, the State agency will establish positions, including the full time position of comprehensive health planning director, to be filled by persons with appropriate qualifications;

(6) The State agency will cooperate with and assist in the development of needed regional, metropolitan area and other local area health planning agencies and be prepared to act upon, and to make recommendations to the Secretary with respect to, grant applications under section 314(b) of the Act.

(d) Encouraging cooperative efforts. The State program must provide for encouraging cooperative efforts among governmental and nongovernmental agencies, organizations, and groups concerned with health and related services, facilities, and manpower. As a minimum, it must provide methods for:

(1) Coordinating the State agency's planning activities with specialized health planning and other related planning activities, such as the development of mental retardation plans, construction plans for health and medical facilities, community mental health plans, regional medical programs, and environmental control plans, and with State agencies concerned with physical and economic planning;

(2) Considering the most effective and efficient manner of meeting health needs in the fields of welfare, education and vocational rehabilitation; and

(3) Considering the special needs of high-risk population groups for preventive and health care services.

(e) Federal funds to supplement State funds otherwise available. The State program must contain satisfactory assurances that Federal funds will not supplant funds that would otherwise be made available by the State for the purpose of comprehensive health planning and that Federal funds will, to the extent practicable, be used to increase the level of non-Federal funds available for such purpose. Substantial compliance with such assurance will be deemed to have been met if the level of non-Federal funds made available to and spent by the State for comprehensive health planning is at least no lower for any fiscal year than it was in 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 funds for an activity of a nonrecurring nature.

(f) Methods of administration. In addition to any methods of administration otherwise required by the Act and these regulations, the State program must provide:

(1) For the establishment and maintenance of personnel standards on a merit basis for persons employed by the comprehensive State health planning agency in carrying out the State program. Compliance with the 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) Methods for informing interested public and private agencies and organizations and the general public about the agency's activities and recommendations;

(3) That no more than 50 percent of the funds available to the State agency under the State program shall be used for contracting with other agencies and organizations to conduct planning functions under the State program without specific approval from the Secretary;

(4) Methods by which criteria will be developed for reviewing applications for

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]

§ 51.6 Payments to States.

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