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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 conferenc

and discussion with State oficiais. 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 8 201.6 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 Ofice 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, 201.8 Public assistance fiscal audits.

(a) Annually, or at other times as necessary, the State agency's claims for Federal funds and supporting records are audited by the Division of Grant-in-Aid Audits of the Officer of Field Administration of the Department to determine that the agency has properly reported its accountability for grants of Federal funds for public assistance; the amounts granted as assistance payments were actually disbursed to or on behalf of individuals who had been determined by the agency to be entitled to public assistance

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, Å, 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.

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 eli.

gible 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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PART 202-MEDICAL ASSISTANCE TO

STATE RESIDENTS Sec. 202.1 Condition of plan approval; prohibi

tion 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.O. 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 resi.

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

PART 211-CARE AND TREATMENT

OF MENTALLY ILL NATIONALS OF
THE UNITED STATES, RETURNED

FROM FOREIGN COUNTRIES Sec. 211.1 General definitions. 211.2 General. 211.3 Certificates. 211.4 Notification to legal guardian,

spouse, next of kin, or interested

persons. 211.5 Action under State law; appointment

of guardian. 211.6 Reception; temporary care, treat

ment, and assistance. 211.7 Transfer and release of eligible per

son. 211.8 Continuing hospitalization. 211.9 Examination and reexamination. 211.10 Termination of hospitalization. 211.11 Request for release from hospitaliza

tion,

Sec.

· (j) The term "legal guardian" means 211.12 Federal payments.

& guardian, appointed by a court, whose 211.13 Financial responsibility of the eligi

powers, duties, and responsibilities inble person; collections, compromise, or waiver of payment.

clude the powers, duties, and responsi211.14 Disclosure of information.

bilities of guardianship of the person. 211.15 Nondiscrimination.

8 211.2 General. AUTHORITY: The provisions of this Part 211

The Director shall make suitable arIssued under sections 1-11, 74 Stat. 308-310; 24 U.S.C. 321-329.

rangements with agencies to the end

that any eligible person will be received, SOURCE: The provisions of this part 211

upon request of the Secretary of State, appear at 29 F.R. 19252, Dec. 31, 1964, unless

at the port of entry or debarkation upon otherwise noted.

arrival in the United States from a for§ 211.1 General definitions.

eign country and be provided, to the exWhen used in this part:

tent necessary, with temporary care, (a) “Act" means Public Law 86_571,

treatment, and assistance, pending approved July 5, 1960, 74 Stat. 308, en

transfer and release or hospitalization titled “An Act to provide for the hos

pursuant to the Act. The Director shall pitalization, at Saint Elizabeths Hospital

also make suitable arrangements with in the District of Columbia or elsewhere,

appropriate divisions of the Public of certain nationals of the United States

Health Service, Bureau of Medical Servadjudged insane or otherwise found

ices, with Saint Elizabeths Hospital in mentally ill in foreign countries, and for

the District of Columbia, with Federal other purposes”;

hospitals outside of the Department, or (b) The term "Secretary" means the

with other public or private hospitals to Secretary of Health, Education, and

provide the eligible person with care and Welfare;

treatment in a hospital. The Director (c) The term “Department” means

shall maintain a roster setting forth the the Department of Health, Education,

name and address of each eligible person and Welfare;

currently receiving care and treatment, (d) The term “Director" means the

or assistance, pursuant to the Act. Director of the Bureau of Family Sery- & 211.3 Certificates. ices of the Welfare Administration, De

The following certificates are necespartment of Health, Education, and Welfare;

sary to establish that an individual is (e) The term “eligible person" means

ån eligible person:

(a) Certificates as to nationality. A an individual with respect to whom the certificates referred to in section 211.3

certificate issued by an authorized official are furnished to the Director in connec

of the Department of State, stating that tion with the reception of an individual

the individual is a national of the arriving from a foreign country;

United States. (f) The term "Public Health Service"

(b) Certificate as to mental condition. means the Public Health Service in the

Either (1) a certificate obtained or Department of Health, Education, and

transmitted by an authorized official of Welfare;

the Department of State that the indi(g) The term "agency" means an ap

vidual has been legally adjudged insane propriate State or local public or non

in a named foreign country; or (2) a cerprofit agency with which the Director has

tificate of an appropriate authority or entered into arrangements for the pro

person stating that at the time of such vision of care, treatment, and assistance

certification the individual was in a pursuant to the Act;

named foreign country and was in need (h) The term “State" means a State of care and treatment in a mental hospior Territory of the United States, the

tal. A statement shall, if possible, be Commonwealth of Puerto Rico, or the

incorporated into or attached to the cerDistrict of Columbia;

tificate furnished under this paragraph (i) The term “residence" means resi

setting forth all available medical and dence as determined under the applicable other pertinent information concerning law or regulations of a State or political the individual. subdivision for the purpose of determin (c) Appropriate authority of person. ing the eligibility of an individual for For the purpose of paragraph (b) (2) of hospitalization in a public mental hos this section a medical officer of the Pubpital;

lic Health Service or of another agency

of the United States, or a medical practi temporary care, treatment, and assisttioner legally authorized to provide care ance, as reasonably required for the or treatment of mentally ill persons in health and welfare of the eligible person. the foreign country, is an "appropriate Such care, treatment, and assistance may authority or person," and shall be so be provided in the form of hospitalizaidentified in his execution of the certifi tion and other medical and remedial care cate. If such a medical officer or prac (including services of necessary attendtitioner is unavailable, an authorized offi ants), food and lodging, money paycial of the Department of State may ments, transportation, or other goods and serve as an "appropriate authority or services. The agency will utilize the person," and shall, in the execution of Public Health Service General Hospital the certificate, identify himself as serv nearest to the port of entry or debarkaing as such person due to the unavalla tion or any other suitable public or pribility of a suitable medical oficer or vate hospital, in providing hospitalizapractitioner.

tion and medical care, including diag& 211.4 Notification to legal guardian,

nostic service as needed, pending other spouse, next of kin, or interested

appropriate arrangements for serving

the eligible person. persons. (a) Whenever an eligible person ar

8 211.7 Transfer and release of eligible rives in the United States from a foreign

person. country, or when such person is trans (a) Transfer and release to relative. ferred from one State to another, the If at the time of arrival from a foreign Director shall, upon such arrival or country or any time during temporary or transfer (or in advance thereof, if pos continuing care and treatment the Disible), provide for notification of his rector finds that the best interests of the legal guardian, or in the absence of such eligible person will be served thereby, and a guardian, of his spouse or next of kin, a relative, having been fully informed of or in the absence of any of these, of one his condition, agrees in writing to asor more interested persons, if known. sume responsibility for his care and

(b) Whenever an eligible person is treatment, the Director shall transfer admitted to a hospital pursuant to the and release him to such relative. In deAct, the Director shall provide for im termining whether his best interest will mediate notification of his legal guard be served by such transfer and release, ian, spouse, or next of kin, if known. due weight shall be given to the relation§ 211.5 Action under State law; ap

ship of the individuals involved, the fipointment of guardian.

nancial ability of the relative to provide

for such person, and the accessibility to Whenever an eligible person is inca necessary medical facilities. pable of giving his consent to care and

(b) Transfer and release to appropri. treatment in a hospital, either because of ate State authorities, or agency of the his mental condition or because he is a United States. If appropriate arrangeminor, the agency will take appropriate

ments cannot be accomplished under action under State law, including, 11

paragraph (a) of this section, and if no necessary, procuring the appointment of

other agency of the United States is a legal guardian, to ensure the proper responsible for the care and treatment planning for and provision of such care of the eligible person, the Director shall and treatment.

endeavor to arrange with the appropri§ 211.6 Reception; temporary care,

ate State mental health authorities of treatment, and assistance.

the eligible person's State of residence or (a) Reception. The agency will meet

legal domicile, if any, for the assumption the eligible person at the port of entry

of responsibility for the care and treator debarkation, will arrange for appro

ment of the eligible person by such aupriate medical examination, and will

thorities and shall, upon the making of plan with him, in cooperation with his such arrangements in writing, transfer legal guardian, or, in the absence of such and release him to such authorities. II a guardian, with other interested per any other agency of the United States sons, if any, for needed temporary care is responsible for the care and treatment and treatment.

of the eligible person, the Director shall (b) Temporary care, treatment, and make arrangements for his transfer and assistance. The agency will provide for 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. $ 211.9 Examination and reexamina

tion. Following admission of an eligible person to a hospital for temporary or continuing care and treatment, he shall be examined by qualified members of the medical staff as soon as practicable, but not later that the fifth day after his admission. Each such person shall be reexamined at least once within each six month period beginning with the month following the month in which he was first examined. & 211.10 Termination of hospitaliza

tion. (a) Discharge or conditional release. If, following an examination, the head of the hospital finds that the eligible person hospitalized for mental illness (whether or not pursuant to a judicial commitment) is not in need of such hospitaliza

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 hospital 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 hos

pitalization. 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 carry. ing 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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