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

§ 51.101 Applicability.

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 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

36-095-70- -6

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

Welfare have been completed and any question arising from the audits have been resolved, whichever is sooner.

(5) The State authority 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.

(k) Accounting procedures. The State plan 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 Federal funds paid to the State for expenditures incurred or to be incurred under the approved plan, of the amounts and purposes of expenditures made in carrying out such plan and of any unearned balances of Federal funds paid to the State. In addition, such procedures must:

(1) Provide for the separation of allowable expenditures as between the State plan for public health services and the State plan for mental health services and for the separation of allowable expenditures under each State plan between those which are for the provision of health services in communities of the State and those which are for other purposes;

(2) Provide adequate information to show exclusion from expenditures claimed for Federal participation of those costs for which payments have been received or are due under other Federal grants or contracts or which are required or used to match other Federal funds;

(3) Provide for maintaining an adequate record of refunds, proceeds from the sale of equipment, fees, and other similar adjustments received, which must be deducted from gross expenditures in computing expenditures available for Federal participation under the approved State plan;

(4) Provide for the maintenance of time records, or for other appropriate cost accounting techniques, for personnel who devote only part-time to the carrying out of the approved State plan so that only the proportion of total expenditures for such personnel will be included in expenditures for Federal participation;

(5) Provide for the maintenance of inventory records by the State author

The allotments for fiscal years 1969 and 1970 to each State shall be determined in the following manner:

(a) On the basis of population (as determined from the latest available estimate from the Department of Commerce), $3 per person up to a maximum of 100,000 persons, plus:

(b) Fifty percent of the remainder of the amount available on the basis of population (as determined above) and 50 percent on the basis of population weighted by financial need (as determined by the latest available estimates of per capita personal income from the Department of Commerce), adjusted so that the total allotment to any State under (a) plus (b) will not be less than the total of the amounts allotted to it under formula grants for cancer control, plus other allotments under section 314 of the Act, prior to amendment, for the fiscal year ending June 30, 1967.

(c) For the purposes of these computations, American Samoa and the Trust Territory of the Pacific Islands shall each be considered to have had total allotments for fiscal year 1967 equal to the lowest total allotments of any other State for that year.

[33 F.R. 11360, Aug. 9, 1968]

§ 51.106 Allocation of allotments for mental health.

(a) General. The Secretary shall allocate 15 percent of each State's allotment for each fiscal year to the State mental health authority and 85 percent to the State health authority, except that when, in any case, 15 percent of the State's allotment is less than the amount of that State's fiscal year 1967 allotment for mental health services, the percentage allocated to the mental health authority of such State shall be increased to that percentage which will provide that such allocation for the year will equal the fiscal year 1967 allotment to that State for mental health services,

and the percentage allocation for the year to the State health authority of such State shall be correspondingly reduced.

(b) Exception. If recommended concurrently by the State health authority and the State mental health authority, or by the Governor, for any fiscal year, the Secretary may allocate a higher percentage to the State mental health authority and a correspondingly lower percentage to the State health authority. [32 F.R. 8245, June 8, 1967, as amended at 33 F.R. 13026, Sept. 14, 1968]

§ 51.106a Allocation of allotments to support services in communities.

For fiscal years ending after June 30, 1968 at least 70 percent of the funds allotted to the State health authority, and to the State mental health authority, respectively, under section 314(d) of the Act shall be available only for the provision of health services in communities of the State. Such services in communities shall include all eligible activities conducted under the State plan which, in the judgment of the Secretary or his delegate, are directly involved in the provision of services to people, in the training of personnel for community services, and in the prevention or alleviation of health, mental health, or environmental health problems in communities, whether such activities are provided by State or local agencies, but shall not include such activities as administration, planning, consultation, and data collection and analysis activities conducted by the State agency for statewide planning and administrative purposes not directly involved in the provision of services to people.

[33 F.R. 11360, Aug. 9, 1968]

§ 51.107 Expenditures and payments.

(a) Federal share. Each State for which a State plan for public health services has been approved shall be paid from its allotment for the fiscal year an amount which equals its "Federal share" (as defined and computed within the limits of the allotment in accordance with subsections 314(d) (5) and 314(d) (6) of the Act) of the expenditures incurred by such State or a political subdivision thereof during such fiscal year under its approved State plan. 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). A State shall not be entitled to payments from any fiscal year allotment for expenditures incurred in a prior or subsequent year. Payments will be made where practicable through a letter of credit system or, when such system is not practicable, on the basis of payment requests from the State to meet its current needs.

(b) Eligible costs. Federal participation in providing "Public Health Services" under a State plan may include the costs of any physical, mental, or environmental health service which the State authority is authorized to undertake or support, or the costs of training, including in-service and specialized or shortterm training of personnel for State and local health work, except that the following costs of services and training shall not be included:

(1) The provision of air pollution control activities to the extent such costs are precluded by the Clean Air Act (P.L. 88206) as amended;

(2) The provision of community mental health services to the extent funds are available for such costs under the Community Mental Health Centers Act (P.L. 88-164) as amended;

(3) The provision of inpatient care in hospitals or other institutions, except where the Secretary determines that such care during a limited period of time is necessary for effective evaluation, demonstration, or extension of new or improved public health procedures;

(4) Research activities, other than those which are a part of health service programs or demonstrations, or of health surveys, epidemiologic studies, or case findings;

(5) The acquisition of land or construction of buildings;

(6) Such other costs as the Secretary may find to be inconsistent with the Act or the regulations of this subpart.

(c) Expenditures by nonprofit private agencies. For the purposes of determining the Federal share for any State, expenditures made by nonprofit private agencies, organizations, and groups shall be regarded as expenditures by such State or political subdivision thereof, subject to the following conditions and limitations:

(1) Such expenditures may be included only when made by such an agency, institution, or organization to which the State authority has made available funds from Federal or State