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sonable notice and opportunity for hearing to the State agency, finds:

(1) That the plan provision for prescribed services has been so changed that it no longer complies with the Federal requirements with respect to such prescribed services; or

(2) That in the administration of the plan there is a failure to comply substantially with such plan provision.

(c) Informal discussions. Hearings with respect to matters under paragraph (a) or (b) of this section are generally not called, however, until after reasonable effort has been made by regional and central office representatives to resolve the questions involved by conference and discussion with State officials. Formal notification of the date and place of hearing does not foreclose further negotiations with State officials.

(d) Conduct of hearings. Applicable requirements of the Administrative Procedure Act are observed in conducting the hearings referred to in paragraphs (a) and (b) of this section.

(e) Notification of noncertification. If the Commissioner makes a finding of noncompliance with respect to a matter under paragraph (a) of this section, the State agency is notified that further payments will not be made to the State (or, in the case of a plan approved under title XVI, in his discretion, that payments will be limited to categories under or parts of the plan not affected by such failure), until the Commissioner is satisfied that there will no longer be any such failure to comply. Until he is so satisfied, no further payments will be made to the State (or will be limited to categories under or parts of the title XVI plan not affected by such failure).

(f) Notification of reduction in Federal financial participation. If the Commissioner makes a finding of noncompliance with respect to a matter under paragraph (b) of this section, the State agency is notified that further payments will be made to the State at the rate of 50 per centum of the costs of services and training, until the Commissioner is satisfied that there will no longer be any failure to comply.

Subpart B-Review and Audits

§ 201.6 Continuing review of State and local administration.

(a) In order to provide a basis for determining that State agencies are adhering to Federal requirements and to

the substantive legal and administrative provisions of their approved plans, the Bureau conducts a continuing review of State and local public assistance administration.

(b) The administrative review includes analysis of procedures and policies of State and local agencies and review of decisions in case records of individual recipients. Each State agency is required to carry out a continuing quality control program primarily covering determination of eligibility in statistically selected samples of individual cases. The Bureau conducts a continuing observation of these State systems. Selected case records and agency operations are also reviewed for evaluating adherence to the other Federal requirements set forth in the pertinent titles of the Act. If the Federal or State review reveals cases in which there appear to have been an improper claim for Federal funds, the State agency is given an opportunity to provide information to substantiate the payment, or to make an adjustment on its expenditure report. If serious problems are revealed in respect to compliance with any Federal requirement, action to adjust Federal funds in all cases affected is required of the State agency, and the State agency is also required to correct its practice so that there will be no recurrence of the problem in the future. § 201.7 Personnel merit system review.

A personnel merit system review is carried out by the Division of State Merit Systems of the Office of Field Administration of the Department. The purpose of the review is to evaluate the effectiveness of the State merit system relating to the public assistance programs and to determine whether there is compliance with Federal requirements in the administration of the merit system plan. See Part 70 of this title.

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under the appropriate title of the Act; administrative expenditures claimed for Federal financial participation are proper under the Act and State plan, including State laws and regulations; amounts expended and used as the basis for claiming Federal funds under title I, IV, X, XIV, or XVI were not derived from other Federal sources or were not used as a basis for other Federal matching; and the share of the Federal Government in any recovery was accurately and promptly adjusted.

(b) If the audit results in no exceptions, the State agency is advised by letter of this result. The general course for the disposition of proposed exceptions resulting from audits involves the submittal of details of these exceptions to the State agency which then has an opportunity to concur in the proposed exceptions or to assemble and submit additional facts for purposes of clearance. Provision is made for the State agency to appeal proposed audit exceptions in which it has not concurred and which have not been deleted on the basis of clearance material. After consideration of a State agency's appeal by the Commissioner, the Bureau advises the State agency of any expenditures in which the Federal Government may not participate and requests it to include the amount as adjustments in a subsequent statement of expenditures. Expenditures in which it is found the Federal Government may not participate and which are not properly adjusted through the State's claim will be deducted from subsequent grants made to the State agency.

PART 202-MEDICAL ASSISTANCE TO STATE RESIDENTS

Sec. 202.1 Condition of plan approval; prohibition against exclusion of residents. 202.2 Furnishing of assistance to eligible residents absent from the State. AUTHORITY: The provisions of this Part 202 issued under sec. 601, 74 Stat. 987, sec. 141, 76 Stat. 197, sec. 121, 79 Stat. 343, sec. 1102, 49 Stat. 647; 42 U.S.C. 302, 1382, 1396a, 1302. Interprets or applies sec. 601, 74 Stat. 987, sec. 141, 76 Stat. 197, sec. 121, 79 Stat. 343, 42 U.S.C. 302, 1382, 1396a.

§ 202.1 Condition of plan approval; prohibition against exclusion of residents.

A State plan under Title I or XVI of the Social Security Act, as amended,

insofar as it relates to medical assistance for the aged, or a State plan for medical assistance under Title XIX of such Act to be approved under sections 2, 1602, or 1902, respectively, of such Act (42 U.S.C. 302, 1382, 1396a), may not impose, as a condition of eligibility for medical assistance for the aged or medical assistance, as the case may be, any residence requirement which excludes any individual who resides in the State. [31 F.R. 10576, Aug. 6, 1966]

§ 202.2 Furnishing of assistance to eligible residents absent from the State.

A State plan referred to in section 202.1 must provide for the furnishing of medical assistance for the aged or medical assistance, as the case may be, to eligible individuals who are residents of the State but are absent therefrom to the same extent that such assistance is furnished under the plan to meet the cost of medical care and services rendered to eligible individuals in such State, at least to the extent that medical care and services are needed in any other State (as defined in section 1101 (a) (1) of the Social Security Act, as amended, 42 U.S.C. 1301(a) (1)), under any of the following circumstances: (a) Where an emergency arises from accident or illness; (b) where the health of the individual would be endangered if the care and services are postponed until he returns to the State in which he resides; or (c) where his health would be endangered if he undertook travel to return to such State.

[31 F.R. 10576, Aug. 6, 1966]

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AUTHORITY: The provisions of this Part 211 issued under sections 1-11, 74 Stat. 308-310; 24 U.S.C. 321-329.

SOURCE: The provisions of this Part 211 appear at 29 F.R. 19252, Dec. 31, 1964, unless otherwise noted.

§ 211.1 General definitions.

When used in this part:

(a) "Act" means Public Law 86-571, approved July 5, 1960, 74 Stat. 308, entitled "An Act to provide for the hospitalization, at Saint Elizabeths Hospital in the District of Columbia or elsewhere, of certain nationals of the United States adjudged insane or otherwise found mentally ill in foreign countries, and for other purposes";

(b) The term "Secretary" means the Secretary of Health, Education, and Welfare;

(c) The term "Department" means the Department of Health, Education, and Welfare;

(d) The term "Director" means the Director of the Bureau of Family Services of the Welfare Administration, Department of Health, Education, and Welfare;

(e) The term "eligible person" means an individual with respect to whom the certificates referred to in section 211.3 are furnished to the Director in connection with the reception of an individual arriving from a foreign country;

(f) The term "Public Health Service" means the Public Health Service in the Department of Health, Education, and Welfare;

(g) The term "agency" means an appropriate State or local public or nonprofit agency with which the Director has entered into arrangements for the provision of care, treatment, and assistance pursuant to the Act;

(h) The term "State" means a State or Territory of the United States, the Commonwealth of Puerto Rico, or the District of Columbia;

(i) The term "residence" means residence as determined under the applicable law or regulations of a State or political subdivision for the purpose of determining the eligibility of an individual for hospitalization in a public mental hospital;

(j) The term "legal guardian” means a guardian, appointed by a court, whose powers, duties, and responsibilities include the powers, duties, and responsibilities of guardianship of the person. § 211.2 General.

The Director shall make suitable arrangements with agencies to the end that any eligible person will be received, upon request of the Secretary of State, at the port of entry or debarkation upon arrival in the United States from a foreign country and be provided, to the extent necessary, with temporary care, treatment, and assistance, pending transfer and release or hospitalization pursuant to the Act. The Director shall also make suitable arrangements with appropriate divisions of the Public Health Service, Bureau of Medical Services, with Saint Elizabeths Hospital in the District of Columbia, with Federal hospitals outside of the Department, or with other public or private hospitals to provide the eligible person with care and treatment in a hospital. The Director shall maintain a roster setting forth the name and address of each eligible person currently receiving care and treatment, or assistance, pursuant to the Act. § 211.3

Certificates.

The following certificates are necessary to establish that an individual is an eligible person:

(a) Certificates as to nationality. A certificate issued by an authorized official of the Department of State, stating that the individual is a national of the United States.

(b) Certificate as to mental condition. Either (1) a certificate obtained or transmitted by an authorized official of the Department of State that the individual has been legally adjudged insane in a named foreign country; or (2) a certificate of an appropriate authority or person stating that at the time of such certification the individual was in a named foreign country and was in need of care and treatment in a mental hospital. A statement shall, if possible, be incorporated into or attached to the certificate furnished under this paragraph setting forth all available medical and other pertinent information concerning the individual.

(c) Appropriate authority or person. For the purpose of paragraph (b) (2) of this section a medical officer of the Public Health Service or of another agency

of the United States, or a medical practitioner legally authorized to provide care or treatment of mentally ill persons in the foreign country, is an "appropriate authority or person," and shall be so identified in his execution of the certiflcate. If such a medical officer or practitioner is unavailable, an authorized official of the Department of State may serve as an "appropriate authority or person," and shall, in the execution of the certificate, identify himself as serving as such person due to the unavailability of a suitable medical officer or practitioner.

§ 211.4 Notification to legal guardian, spouse, next of kin, or interested persons.

(a) Whenever an eligible person arrives in the United States from a foreign country, or when such person is transferred from one State to another, the Director shall, upon such arrival or transfer (or in advance thereof, if possible), provide for notification of his legal guardian, or in the absence of such a guardian, of his spouse or next of kin, or in the absence of any of these, of one or more interested persons, if known.

(b) Whenever an eligible person is admitted to a hospital pursuant to the Act, the Director shall provide for immediate notification of his legal guardian, spouse, or next of kin, if known. § 211.5 Action under State law; appointment of guardian.

Whenever an eligible person is incapable of giving his consent to care and treatment in a hospital, either because of his mental condition or because he is a minor, the agency will take appropriate action under State law, including, if necessary, procuring the appointment of a legal guardian, to ensure the proper planning for and provision of such care and treatment.

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temporary care, treatment, and assistance, as reasonably required for the health and welfare of the eligible person. Such care, treatment, and assistance may be provided in the form of hospitalization and other medical and remedial care (including services of necessary attendants), food and lodging, money payments, transportation, or other goods and services. The agency will utilize the Public Health Service General Hospital nearest to the port of entry or debarkation or any other suitable public or private hospital, in providing hospitalization and medical care, including diagnostic service as needed, pending other appropriate arrangements for serving the eligible person.

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(a) Transfer and release to relative. If at the time of arrival from a foreign country or any time during temporary or continuing care and treatment the Director finds that the best interests of the eligible person will be served thereby, and a relative, having been fully informed of his condition, agrees in writing to assume responsibility for his care and treatment, the Director shall transfer and release him to such relative. In determining whether his best interest will be served by such transfer and release, due weight shall be given to the relationship of the individuals involved, the flnancial ability of the relative to provide for such person, and the accessibility to necessary medical facilities.

(b) Transfer and release to appropriate State authorities, or agency of the United States. If appropriate arrangements cannot be accomplished under paragraph (a) of this section, and if no other agency of the United States is responsible for the care and treatment of the eligible person, the Director shall endeavor to arrange with the appropriate State mental health authorities of the eligible person's State of residence or legal domicile, if any, for the assumption of responsibility for the care and treatment of the eligible person by such authorities and shall, upon the making of such arrangements in writing, transfer and release him to such authorities. If any other agency of the United States is responsible for the care and treatment of the eligible person, the Director shall make arrangements for his transfer and release to that agency.

§ 211.8 Continuing hospitalization.

(a) Authorization and arrangements. In the event that appropriate arrangements for an eligible person in need of continuing care and treatment in a hospital cannot be accomplished under § 211.7, or until such arrangements can be made, care and treatment shall be provided by the Director in Saint Elizabeths Hospital in the District of Columbia, in an appropriate Public Health Service Hospital, or in such other suitable public or private hospital as the Director determines is in the best interests of such person.

(b) Transfer to other hospital. At any time during continuing hospitalization, when the Director deems it to be in the interest of the eligible person or of the hospital affected, the Director shall authorize the transfer of such person from one hospital to another and, where necessary to that end, the Director shall authorize the initiation of judicial proceedings for the purpose of obtaining a commitment of such person to the Secretary.

(c) Place of hospitalization. In determining the placement or transfer of an eligible person for purposes of hospitalization, due weight shall be given to such factors as the location of the eligible person's legal guardian or family, the character of his illness and the probable duration thereof, and the facilities of the hospital to provide care and treatment for the particular health needs of such person.

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tion, he shall be discharged. In the case where hospitalization was pursuant to a judicial commitment, the head of the hospital may, in accordance with laws governing hospitalization for mental illness as may be in force and generally applicable in the State in which the hos pital is located, conditionally release him if he finds that this is in his best interests.

(b) Notification to committing court. In the case of any person hospitalized under section 211.8 who has been judicially committed to the custody of the Secretary, the Secretary will notify the committing court in writing of the discharge or conditional release of such person under this section or of his transfer and release under § 211.7.

§ 211.11 Request for release from hospitalization.

If an eligible person who is hospitalized pursuant to the Act, or his legal guardian, spouse, or adult next of kin, requests his release, such request shall be granted by the Director if his best interests will be served thereby, or by the head of the hospital if he is found not to be in need of hospitalization by reason of mental illness. The right of the Director, or the head of the hospital, to refuse such request and to detain him for care and treatment shall be determined in accordance with laws governing the detention, for care and treatment, of persons alleged to be mentally ill as may be in force and applicable generally in the State in which such hospital is located, but in no event shall the patient be detained more than forty-eight hours (excluding any period of time falling on a Sunday or a legal holiday observed by the courts of the State in which such hospital is located) after the receipt of such request unless within such time (a) judicial proceedings for such hospitalization are commenced or (b) a judicial extension of such time is obtained, for a period of not more than five days, for the commencement of such proceedings.

§ 211.12 Federal payments.

The arrangements made by the Director with an agency or hospital for carrying out the purposes of the Act shall provide for payments to such agency or hospital, either in advance or by way of reimbursement, of the costs of reception, temporary care, treatment, and assistance, continuing care and treatment, and transportation, pursuant to the Act, and payments for other expenditures neces

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