collaboration with staff development personnel, as a special part of the agency's organized in-service training program.

(h) Costs of rental of space attributable to training activities.

(iii) Persons preparing for employment in public assistance. Payments made directly to an individual, or to an educational institution on behalf of such individual, for costs of education in preparing for employment in public assistance.

(iv) Education for work in public assistance. (a) Costs of field instruction in public assistance for graduate social work students, field experience for undergraduate social welfare students, and student training programs including: rental of space, salaries, travel to and from field work units, clerical assistance, teaching materials and equipment, such as books and audiovisual aids necessary for effective instruction, and salaries of persons participating in summer student training programs in social work and related professional assignments.

(b) Grants to graduate schools of social work or to undergraduate colleges offering a social welfare sequence for classroom instruction or for other purposes related to the needs of the public assistance programs including: salaries, clerical assistance, necessary travel, teaching material and equipment necessary for effective instruction, such as books, and audiovisual aids.

(v) Educational leave. (a) Direct payments to employees on educational leave in an amount not to exceed salary plus the additional costs of obtaining the education.

(1) Payment of personal services, travel, per diem, costs of education and educational expenses of persons granted full-time educational leave, and for those on work-study leave.

(2) Payment of travel, per diem, costs of education and expenses other than personal services of persons granted part-time educational leave or of persons on work-study plan with more than one-half of work load.

(b) Payments covering some or all of the items, in (a) of this subdivision (v), made directly to an educational institution on behalf of an employee on educational leave.

(vi) Training leave. (a) Payment of personal services, travel, per diem and training expenses of staff granted training leave for attendance at sessions of four or more consecutive workweeks.

(b) Payment of travel, per diem, and other training expenses of staff granted training leave for attendance at sessions of less than 4 workweeks.

(vii) Special leave. Direct payments to employees on special leave in an amount not to exceed salary, plus such additional costs of the educational program as may be agreed upon by the agency and the staff member.

(viii) Agency membership in other organizations. Payment for costs of State or local agency membership in organizations for the advancement of education or training when such membership primarily is attributable to the agency's staff development program needs.

(4) (i) For the State plan under title XIX of the Act, Federal financial participation is available at 75 percent for training and educational leave, with respect to title XIX, of skilled professional medical personnel, and staff directly supporting such personnel, of the State agency or any other public agency in the administration of the medical assistance program at the State or local level. In addition. Federal financial participation in expenditures for training personnel who are working both under title XIX and under title I, IV-A, X, XIV, or XVI may be claimed under such other title at applicable rates. Any other expenditures are matchable at 50 percent.

(ii) Costs which may be claimed as training and staff development expenditures for Federal financial participation under title XIX of the Act are those specified in subparagraph (3) of this paragraph, under subdivision (i) for State and local staff development personnel; under subdivision (ii) for agency sessions planned to train staff in content dealing with medical assistance; under subdivision (v) (a) for educational leave; under subdivision (vi) for training leave; and under subdivision (vii) for special leave; and, in addition, the costs of field instruction in medical assistance for graduate students, field experience for undergraduate students, and student training programs.

[36 F.R. 3863, Feb. 27, 1971]

PART 206-APPLICATION, DETERMINATION OF ELIGIBILITY AND FURNISHING ASSISTANCE-PUBLIC ASSISTANCE PROGRAMS

§ 206.10 Application, determination of eligibility and furnishing of assist

ance.

(a) State plan requirements. A State plan under title I, IV-A, X, XIV, XVI, or XIX of the Social Security Act must provide that:

(1) Each individual wishing to do so will have the opportunity to apply for assistance without delay. Under this requirement: (i) The agency accepts application from the applicant himself, his designated representative, or someone acting responsibly for him, in person, by mail or by telephone; (ii) an applicant may be assisted, if he so desires, by an individual(s) of his choice (who need not be a lawyer) in the various aspects of the application process and the redetermination of eligility, and may be accompanied by such individual(s) in contacts with the agency and when so accompanied may also be represented by them; (iii) individuals eligible for financial assistance are eligible for medical assistance without a separate application.

(2) Applicants will be informed about the eligibility requirements and their rights and obligations under the program. Under this requirement individuals are given information in written form, and orally as appropriate, about coverage, conditions of eligibility, scope of the program, and related services available, and the rights and responsibilities of applicants for and recipients of assistance. Specifically developed bulletins or pamphlets explaining the rules regarding eligibility and appeals in simple, understandable terms, are publicized and available in quantity.

(3) A decision will be made promptly on applications, pursuant to reasonable State-established time standards not in excess of 30 days for OAA, AFDC, and AB (and in AABD and MA as to the aged and blind) and 60 days in APTD (and in AABD and MA as to the disabled). Under this requirement, the applicant is informed of the agency's time standard in acting on applications, which covers the time from date of application to the date that the assistance check, or notification of denial of assistance or change of award, or the eligibility decision with

respect to medical assistance, is mailed to the applicant or recipient. The State's time standards apply except in unusual circumstances (e.g., where the agency cannot reach a decision because of failure or delay on the part of the applicant or an examining physician, or because of some administrative or other emergency that could not be controlled by the agency, in which instances the case record shows the cause for the delay. The agency's standards of promptness for acting on applications or redetermining eligibility may not be used as a basis for denial of an application or for terminating assistance.

(4) Written notice will be sent to applicants and recipients to indicate that assistance has been authorized (including the amount, if financial assistance) or that it has been denied or terminated for a specified reason and the agency policy on which the decision is based. Under this requirement, the notice must include the right to request a fair hearing about the decision (see section 205.10 of this chapter).

(5) Financial assistance and medical care and services included in the plan will be furnished promptly to eligible individuals without any delay attributable to the agency's administrative process, and will be continued regularly to all eligible individuals until they are found to be ineligible. Under this requirement there must be arrangements to assist applicants and recipients in obtaining medical care and services in emergency situations on a 24-hour basis, 7 days a week.

(6) Entitlement will begin as specified in the State plan, which (i) for financial assistance must be no later than the date of authorization of payment and, for purposes of Federal financial participation, may be as early as the first of the month in which an application has been received and the individual meets all the eligibility conditions, and (ii) for medical assistance must be no later than the date of application for either financial or medical assistance, and may be as early as the third month prior to the month of application if the individual was eligible in that month.

(7) In cases of any proposed action to terminate, suspend, or reduce assistance, the agency will give timely and adequate notice. See § 205.10 (a) (5) of this chapter.

(8) Each decision regarding eligibility of ineligibility will be supported by

facts in the applicant's or recipient's case record. Under this requirement each application is disposed of by a finding of eligibility or ineligibility unless:

(i) The applicant voluntarily withdraws his application, and there is an entry in the case record that a notice has been sent to confirm the applicant's notification to the agency that he does not desire to pursue his application; or (ii) There is an entry in the case record that the application has been disposed of because the applicant died or could not be located.

(9) Where an individual has been determined to be eligible, eligibility will be reconsidered or redetermined:

(i) When required on the basis of information the agency has obtained previously about anticipated changes in the individual's situation;

(ii) Promptly, within 30 days, after a report is obtained which indicates changes in the individual's circumstances may affect the amount of assistance to which he is entitled or may make him ineiigible; and

(iii) Periodically, within agencyestablished time standards, but not less frequently than every 6 months in AFDC, and every 12 months in the other categories, including medical assistance, on eligibility factors subject to change.

(10) Standards and methods for determination of eligibility will be consistent with the objectives of the programs, will respect the rights of individuals under the United States Constitution, the Social Security Act, title VI of the Civil Rights Act of 1964, and all other relevant provisions of Federal and State laws, and will not result in practices that violate the individual's privacy or personal dignity, or harass him or violate his constitutional rights. Under this requirement, the agency especially guards against violations of legal rights and common decencies in such areas as entering a home by force, or without permission, or under false pretenses; making home visits outside of working hours, and particularly making such visits during sleeping hours; and searching in the home, for example, in rooms, closets, drawers, or papers, to seek clues to possible deception.

(11) With respect to title XIX, policies and procedures will assure that eligibility for medical assistance will be determined in a manner consistent with simplicity of administration and the best interests of the applicant or recipient.

(12) In determining initial and continuing eligibility:

(i) Applicants and recipients will be relied upon as the primary source of information in making the decision about their eligibility.

(ii) The agency will help applicants and recipients provide needed information, as necessary, or will obtain the information for them if, because of physical, mental, or other difficulties, they themselves are unable to provide it.

(iii) Verification of circumstances pertaining to eligibilty will be limited to what is reasonably necessary to ensure the legality of expenditures under this program.

Under the requirements of this subparagraph:

(a) The agency takes no steps in the exploration of eligibility to which the applicant or recipient does not agree. It obtains specific consent for outside contacts, gives a clear explanation of what information is desired, why it is needed, and how it will be used;

(b) If other procedures are followed in an exceptional situation, they are consistent with subparagraph (10) of this paragraph, and the case record specifies what procedures were followed and why they were needed;

(c) When information available from the applicant or recipient is inconclusive and does not support a decision of eligibility, the agency explains to the individual what questions remain and how he can resolve or help to resolve them, what actions the agency can take to resolve them and the need for their resolution if eligibility is to be established or reconfirmed. If the individual is unwilling to have the agency seek verifying information, the agency, unable to determine that eligibility exists, denies or terminates assistance;

(d) If a simplified method is used in the determination and redetermination of eligibility, the requirements of § 205.20 of this chapter apply.

(13) The State agency will establish and maintain methods by which it will be kept currently informed about local agencies' adherence to the State plan provisions and to the State agency's procedural requirements for determining eligibility, and it will take corrective action when necessary.

(b) Definitions. For purposes of this section:

(1) "Applicant" is a person who has,

directly, or through someone acting responsibly for him, requested public assistance from the agency administering the program, and whose application has not been terminated.

(2) "Application" is an action by which an individual indicates to the agency administering public assistance his desire to receive assistance. The relative with whom a child is living or will live ordinarily makes application for the child for AFDC. An application is distinguished from an inquiry, which is simply a request for information about eligibility requirements for public assistance. Such inquiry may be followed by an application.

(Sec. 1102, 49 Stat. 647, 42 U.S.C. 1302) [36 F.R. 3864, Feb. 27, 1971, as amended at 36 F.R. 10783, June 3, 1971]

PART 208-ASSISTANCE TO AGED INDIVIDUALS IN INSTITUTIONS FOR MENTAL DISEASES

§ 208.1 Assistance to individuals 65 years of age or older in institutions for mental diseases.

(a) State plan requirements. A State plan under title I, XVI, or XIX of the Social Security Act which includes assistance to or in behalf of individuals 65 years of age or older who are patients in institutions for mental diseases must provide for:

(1) Having in effect written agreements with the State authority (or authorities) concerned with mental diseases, and with those individual institutions not under the jurisdiction of such State authorities, in which assistance is provided, which clearly set forth the respective responsibilities of the State agency and the State authorities or institutions, with respect to the individuals to whom or on whose behalf payments are made, including arrangements for: (i) Joint planning and for development of alternate methods of care;

(ii) Immediate readmittance to the institutions when needed for individuals in alternate methods of care;

(iii) Access by appropriate representatives of the State agency to the medical facility, the patient, and the patient's records as necessary for carrying out the State agency's responsibilities;

(iv) Necessary recording, reporting, exchange of medical and social information, and other procedures.

(2) A recorded individual plan of treatment and care to assure that the in

stitutional care provided serves the best interest of each patient, i.e., maintains the patient at or restores him to the greatest possible degree of health and independent functioning, including:

(i) Initial and periodic review of his medical, psychiatric and social needs. In fulfilling this requirement initial reviews shall be conducted for each patient not later than 90 days after approval of the State plan, and for each recipient-patient subsequently included, not later than 30 days after payments are initiated in his behalf;

(ii) Appropriate medical treatment within the institution;

of his

(iii) Periodic determination need for continued treatment in the institution and for alternate care arrangements. In fulfilling this requirement such determinations shall be conducted at least quarterly;

(iv) Appropriate social services.

(3) The development of alternate plans of care, making maximum utilization of available resources, for recipients 65 years of age or older who would otherwise need care in such institutions, to meet their medical, social, and financial needs.

(4) Making available social services referred to in section 3(a) (4) (A) (i) and (ii) or section 1603 (a) (4) (A) (i) and (ii) of this Act which are appropriate for such recipients.

(5) Methods of determining the reasonable cost of institutional care for such patients in compliance with § 250.30 of this chapter.

(6) Methods of administration necessary to assure that the responsibilities of the State agency under the State plan with respect to such recipients and such patients will be effectively carried out.

(7) If the State plan includes patients in public institutions for mental diseases, showing that the State is making satisfactory progress toward developing and implementing a comprehensive mental health program for all age groups, through appropriate mental health and public welfare resources, including provision for utilization of community mental health centers, nursing homes and other alternatives to care in public institutions; for arrangements for joint planning with the State authority (ies) for this purpose; and for annual reports showing the progress made. In fulfilling this requirement such annual reports are to be submitted within three months after the close of each fiscal year in

which the State has a program of assistance to individuals 65 years of age or older in public institutions for mental diseases.

(b) Federal financial participation. (1) Federal payments under this section for any quarter shall be made only to the extent that total expenditures in the State from Federal, State, and local sources for mental health services for such quarter exceed the average of the total expenditures for such services for each quarter of the fiscal year ending June 30, 1965. As a basis for determination of the proper amount of Federal payments, the State agency shall submit to the Secretary annual reports which show total expenditures from Federal, State and local sources for mental health services (including payment to or in behalf of individuals with mental health problems) under State and local public health and public welfare programs including total expenditures for each quarter of the fiscal year ending June 30, 1965, and total expenditures for each quarter in which the State has received Federal financial participation in making payments in behalf of individuals 65 years of age or over in institutions for mental diseases; and which show for each quarter all assistance payments and administrative costs incurred in behalf of individuals 65 years of age or older in institutions for mental diseases, and of Federal shares of such payments and such costs. In fulfilling this requirement such reports should be submitted not later than 3 months after the close of the fiscal year.

(2) For purposes of this section, an institution for mental diseases is one that meets the definition contained in § 249.10(b) (14) (iv) of this chapter. (Sec. 1102, 49 Stat. 647; 42 U.S.C. 1302) [36 F.R. 3865, Feb. 27, 1971]

66-100 0-72- 3

§ 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;