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PROGRAMOBJECTIVES   GrantsforSupportiveServicesandSeniorCenters  8  TheobjectiveofthisgrantprogramistoassistStatesindevelopingandimplementing,througha 6  networkofpublicandprivateagenciesandserviceproviders,comprehensiveandcoordinated   communitybasedservicedeliverysystemsforolderAmericans,whichwillassistthemin   leadingindependent,meaningfulanddignifiedlivesintheirownhomesandcommunitiesas   longaspossible.Thetargetpopulationforthesesupportiveservices,whichincludeinhome ~  servicesforfrailelderlyaswellasthoseprovidedinmultipurposeseniorcenters,isindividuals d aged60andolderwithemphasisonthosewiththegreatestsocialandeconomicneed, J particularlylowincomeminorities;however,proofofageisnotrequiredasaconditionof 0 receivingservices. f Astheprogramitselfmatures,programfundingisincreasinglybeingtargetedtoservethose  elderlywho,becauseoftheirincomeorage,maynotbeeligibleforMedicaidorMedicare,and  recipientsarecoordinatingwithotherFederalandStateprogramsinensuringtheavailabilityof  thebroadestrangeofservicesfortheelderly.Asaresult,manyoftheorganizationsfunded v underthisprogramandthenutritionservicesprogram(seebelow)alsoreceivefundsfromother \ FederalsourcesaswellasfromnonFederalsources. B Supportiveservicesmayincludeafullrangeofeconomicandsocialservices,includingaccess @ services(transportation,outreach,informationandreferral,andlanguagetranslationservices), & legalassistanceandothercounselingservices,casemanagementservices,healthscreening   services,servicesdesignedtoensuresafeandappropriatehousing,preretirementplanningand ! assessmentofpostretirementneeds,ombudsmanservices,andservicestofamiliesofelderly " victimsofAlzheimersdiseaseandrelateddisorderswithneurologicalandorganicbrain n# dysfunction.Nutritionservicesareprovidedunderaseparateauthorizationasdescribedbelow. T$  GrantsforNutritionServices  &R! Theobjectiveofthisgrantprogramistoprovideindividualsaged60orolderwithnutrition '#  services,includingmealsandnutritioneducation,eitherinthehomeorinacongregatesetting. (#! Thisprogramisclusteredwiththegrantsforsupportiveservicesandseniorcentersforpurposes |)$" ofthisprogramsupplementsincetheseservices,althoughseparatelyearmarked,fallunderthe b*%#  overallStateplanningprocessandprocessforallocationoffunds. H+&$ _& T  NutritionServicesIncentiveProgram   Theobjectiveofthisgrantprogramistoprovideresourceincentivestoencourageandreward ^ effectiveandefficientperformanceinthedeliveryofnutritiousmealstoolderindividuals.The D AdministrationonAging(AoA)isresponsibleforthisprogram(previouslyincludedinthe *z SupplementastheDepartmentofAgricultures(USDA)NutritionServicesIncentiveProgram  ` (CFDA10.570))asdescribedinII, ProgramProceduresAdministrationandServices.This  F programisincludedaspartofthisclusterbecauseofitsdirectrelationshiptothenutrition  , servicesprogram.    II.  PROGRAMPROCEDURES  p   AdministrationandServices 'T  n  TheAoA,acomponentoftheDepartmentofHealthandHumanServices,administersthe   supportiveservicesandseniorcentersprogramandthenutritionservicesprogramincooperation   withStates,subStateagencies,andotherserviceproviders.TheStatesreceiveaformulagrant   fromAoA,whichisusedbytheStateUnitonAging(StateAgency)bothforitsplanning, ~  administration,andevaluationoftheseprogramsaswellastopassthroughtootherentities. d PlanningandServiceAreas(PSAs)aredesignatedbytheStateAgencyinaccordancewithAoA b guidelinesafterconsideringthegeographicaldistributionoftheservicepopulations,locationof H availableservices,availableresources,otherserviceareaboundaries,locationofunitsof . generalpurposelocalgovernment,andotherfactors.AnAreaAgencyonAging(AreaAgency)  isthendesignatedbytheStateforeachPSAafterconsideringtheviewsofaffectedlocal  governments(Statesthathadasinglestatewideplanningandserviceareainplacepriortofiscal  year(FY)1981hadtheoptiontocontinuethatmethodofoperation;therearecurrentlyeight v Statesinthiscategory).AsingleAreaAgencymayservemorethanonePSA.TheArea \ Agencies,whichmaybepublicorprivatenonprofitagenciesororganizations,developand B administercounterpartareaagingplans,asapprovedbytheStateAgency,and,inturn,provide (x subgrantstoorcontractwithpublicorprivateserviceprovidersfortheprovisionofservices. ^ Withlimitedexceptions(e.g.ombudsmanservices,outreach),theStateAgencyandtheArea   Agenciesareprecludedfromthedirectprovisionofservices,unlessprovidingtheservicesis ! necessarytoensureanadequatesupplyofservices,theservicesarerelatedtotheagencys " administrativefunctions,orwhereservicesofcomparablequalitycanbeprovidedmore n# economicallybytheagency.Federalfundsmaypayforonlyaportionofthecostsof T$ administrationandserviceswiththeStateandsubrecipientsrequiredtoprovideamatchingshare :%  fromothersources.  &p!  AoAadministersNSIPincooperationwithStates,subStateagencies,andotherservice '#! providers.UnderSection311(b)(1)and(d)(1)oftheOAA,Statesreceiveacashgrantfrom ($" AoA,basedontheformulaintheOAA.TheamountofaStatesgrantisdeterminedbydividing )$# thenumberofmealsservedtoeligiblepersonsintheStateduringtheprecedingFederalfiscal *%$ yearbythenumberofsuchmealsservedinallStates,andapplyingtheresultingratiotothe f+&% amountoffundsavailable.UnderSection311(d)(1),aStatemaychoosetoreceivepartofits L,'& grantascommoditiesdistributedbytheUSDAthroughStateDistributingAgencies.The 2-(' amountaStatechoosestoreceiveincommoditiesisdeductedfromtheStatesgrantfromAoA,  andAoAreimbursesUSDAforthecommodities.USDAremainsresponsiblefortheoverall  mangementofthecommoditiesprogram,includingordering,purchase,anddeliveryofthe | requestedcommodities.(Alsosee IV.OtherInformation.) b  StatePlanandAreaPlans  `  AStateplan,approvedbyAoA,isaprerequisitetofundingofthesupportiveservicesand   nutritionprograms;however,theStatePlancoversthetotalityofAoAprogramsforwhichthe   StateistherecipientundertheOlderAmericansAct.TheStatePlanisdevelopedonthebasisof   inputfromtheAreaAgenciesaswellasinputfromtheaffectedpopulationsasaresultofpublic p  hearings.TheStatePlanaddresseshowtheStateintendstocomplywiththevarious V  requirementsoftheOlderAmericansActand,specificallyforTitleIII,itsprogramobjectives, <  designationofPlanningandServiceAreas(PSAs),andspecificationoftheintrastateallocation "r  formulafordistributionoffundstoeachPSA.TheStatePlanalsocontainsassurancesrequired X  bytheActandimplementingregulations. >  UnlessaStateisnotincompliancewithTitleIIIrequirements,theStatePlanmaybesubmitted  onatwo,three,orfouryearcycle,attheoptionoftheState,withannualamendments,as  appropriate;however,AoAfundingisprovidedannually.Statesfoundtobeinnoncompliance h mayberequiredtosubmittheirStatePlansannuallyuntiltheyaredeterminedtobein N compliance.AreaplansarepreparedandsubmittedtotheStateforapprovalforeithertwo, 4 three,orfouryears,withannualadjustments,asnecessary. j  SourceofGoverningRequirements   TheseprogramsareauthorizedunderPartsBandC,respectively,ofTitleIIIoftheOlder v AmericansAct,asamended,whichiscodifiedat42USC30213030.Theseprogramsmayalso \ bereferredtoasPartB(supportiveservicesandseniorcenters)andPartC1(congregatenutrition B services)andC2(homedeliverednutritionservices).GrantstoIndiantribesforsimilar (x purposesareauthorizedunderanothertitleoftheOlderAmericansActandarenotincludedin ^ thisSupplement.Implementingregulationsarepublishedat45CFRpart1321. D  TheNutritionServicesIncentiveProgram(NSIP)isauthorizedinTitleIIIoftheOlder ! AmericansAct(OAA),whichiscodifiedat42USC3030a.TheConsolidated " AppropriationsResolution,2003,Pub.L.1087,transferredresponsibilityforthe n# administrationofthecashprogramfromUSDAtoAoA.Therearenoimplementing T$ regulationsatthistime. :%  AvailabilityofOtherProgramInformation &8"   AdditionalinformationaboutnutritionandsupportiveservicesisavailableattheAoAwebsite (#! at4` s;O  5  +  http://www.aoa.gov/prof% a %a/% b /aoaprog%b/% c %c0% d %d!0% e %e?0% f %f]0% g /aoa_programs.asp+w/edi  6+/;?/the  7sem/_Ԁand |)$"  4hse;O  5  +  http://www.aoa.%g{0% i gov/ab%i1% j out/l%j2% k egbudg/oaa/legbudg_oaa_faq.asp+1edi  _6V1;j1the  7se1._ b*%# &   III.  COMPLIANCEREQUIREMENTS    IndevelopingtheauditprocedurestotestcompliancewiththerequirementsforaFederal ^ program,theauditorshouldfirstlooktoPart2,MatrixofComplianceRequirements,to D identifywhichofthe14typesofcompliancerequirementsdescribedinPart3are *z applicableandthenlooktoParts3and4forthedetailsoftherequirements.   `  A.  ActivitiesAllowedorUnallowed     XE.` hp x (#X(#E1. ` StateAgency'%3 l    XE. ` hp x (#X(#E a. StateAgenciesmayuseanyamountofTitleIIIB(supportiveservices) j  fundingnecessarytoconductaneffectiveombudsmanprogram(42USC P  3024(d)(1)(B)). 6  b. GrantfundsmaybeusedforStateplanadministration,includingState   Planpreparation,evaluationofactivitiescarriedoutunderthePlan,the z  collectionofdataandtheconductofanalysesrelatedtotheneedfor `  services,disseminationofinformation,shorttermtraining,and F  demonstrationprojects(42USC3028(a)). ,| c. Nosupportiveservices,nutritionservices,orinhomeservicesmaybe * provideddirectlybytheStateAgencyunlesstheStateAgencydetermines  thatdirectprovisionofservicesisnecessarytoensureanadequatesupply  ofservices,wheresuchservicesarerelatedtotheagencysadministrative  functions,orwheresuchservicesofcomparablequalitycanbeprovided r moreeconomicallybytheStateAgency(42USC3027(a)(8)(A)).  X  P 2. ` AreaAgency V  P E.` ` hp x (# X(#E SupportiveServicesandSeniorCentersandNutritionServices    E. ` hp x (#` X(#E& d a. Fundsmaybeusedforplanadministration,operationofanadvisory b  council,activitiesrelatedtoadvocacy,planning,informationsharing,and H! otheractivitiesleadingtodevelopmentorenhancementwithinthe ."~ designatedservicearea(s)ofcomprehensiveandcoordinatedcommunity #d basedsystemsofservicedeliverytoolderpersons(45CFRsection #J 1321.53).'db < $0  b. IfapprovedbytheStateAgency,anAreaAgencymayuseservicefunds &! forprogramdevelopmentandcoordinationactivities(42USC3024 t'" (d)(1)(D);45CFRsection1321.17(f)(14)(i)). Z(#  l (03B/ /""  ,E.` hp x (# X(#E   ,B+ hp x (#X(#B`@2  c  .3     Nosupportiveservices,nutritionservices,orinhomeservicesmaybe *X%  provideddirectlybyanAreaAgencyexceptif,inthejudgmentofthe *>&! StateAgency,directprovisionofservicesisnecessarytoensurean +$'" adequatesupplyofservices,wheresuchservicesarerelatedtothe , (# agencysadministrativefunctions,orwheresuchservicesofcomparable -($ qualitycanbeprovidedmoreeconomicallybytheagency(42USC3027  (a)(10)).`@LA݌  Ќ -  X(#  ,hX(#-    XE.` hp x (# X(#ENSIP󀄀Recipientagenciesmayusethecashreceivedinlieuofcommoditiesonlyto D purchaseU.S.agriculturalcommoditiesandotherfoodfortheirnutritionprojects(42 *z USC3030a(d)(2)).  `  X XE.` hp x (#X(#E3.  ` ServiceProviders     X E. ` hp x (#X(#ESupportiveServicesandSeniorCentersandNutritionServices l  a. Fundsmaybeusedtoassistintheoperationofmultipurposesenior j  centersandtomeetallorpartofthecostsofcompensatingprofessional P  andtechnicalpersonnelrequiredforcenteroperation(42USC3030d 6  (b)(2)).   b. Fundsmaybeusedfornutritionservicesandsupportiveservices z  consistentwiththetermsoftheagreementbetweentheAreaAgencyand `  theserviceprovider(42USC3026(a)(1),3030d(a),and3030e). F  c. Fundsmaybeusedforservicesassociatedwithaccesstosupportive D servicesforinhomeservices,andforlegalassistance(42USC3026 * (a)(2)).  d. Nutritionservicesmaybeprovidedtoolderindividualsspouses,who n maynotbeeligiblefortheseservicesintheirownright,onthesamebasis T astheyareprovidedtoolderindividuals,andmaybemadeavailableto : handicappedordisabledindividualswhoarelessthan60yearsoldbut  p whoresideinhousingfacilitiesoccupiedprimarilybyolderindividualsat V whichcongregatenutritionservicesareprovided(42USC3030g < 21(2)(I)). " e. InaccordancewithproceduresestablishedbytheAreaAgencies,nutrition   projectadministratorsmayoffermealstoindividualsprovidingvolunteer f! servicesduringthemealhoursandtoindividualswithdisabilitieswho L" resideathomewithandaccompanyeligibleindividuals(42USC3030g 2# 21(2)(H)). $h f. Fundsmaybeusedforprovisionofhomedeliveredmealstoolder %! individuals(42USC3030f). &! / /""  ,E.` hp x (# X(#E   ,B+ hp x (#X(#BN2  g  .3     Fundsmaybeusedtoacquire(infeesimpleorbyleasefor10yearsor Z(# more),alter,orrenovateexistingfacilitiesortoconstructnewfacilitiesto @)$  serveasmultipurposeseniorcentersfornotlessthan10yearsafter &*v%! acquisition,or20yearsaftercompletionofconstruction,unlesswaivedby  +\&"  theAssistantSecretaryforAging(42USC3030b).NO݌ +B'# Ќ -  X(#  ,hX(#-    XE.` hp x (# X(#ENSIP󀄀Cashreceivedinlieuofcommoditiesmaybeusedonlytopurchase   U.S.agriculturalcommoditiesandotherfoodfortheirnutritionprojects(42USC  3030a(d)(2)). |  XE.` hp x (#X(#E& ( E.  Eligibility *z  XE.` hp x (#X(#E1. ` EligibilityforIndividuals 󀄀NotApplicable  (  n (00l / /""  ,XE.` hp x (#X(#E   ,B+` ` hp x (#X(#B U2  2  .3   `   EligibilityforGroupofIndividualsorAreaofServiceDelivery 󀄀Not   Applicable'(*TUV݌ l  Ќ X* X(#` ` ,X(#*   ""  ,XE.` hp x (#X(#E  | ,B+ ` hp x (#X(#B W2  3  .3   `   EligibilityforSubrecipientsWX݌ j  Ќ X* X(# ` ,X(#* |  XE.` ` hp x (#X(#EServiceprovidersmayincludeprofitmakingorganizationsexceptthatproviders   ofcasemanagementservicesmustbepublicornonprofitagencies(42USC   3026(a)(8)(C)).    E.` hp x (#` X(#E G.  Matching,LevelofEffort,Earmarking B   X1. ` Matching  @   X E. ` hp x (#X(#Ea. State    ` E.` hp x (# X(#E(1)  StatesmustcontributefromStateorlocalsourcesatleast25 L percentofthecostofStatePlanadministrationastheirmatching 2 share.ThismayincludecashorinkindcontributionsbytheState h orthirdparties(42USC3028(a)(1)and42USC3029(b);45CFR N section1321.47). 4 (2)  Allservices,whetherprovidedbytheStateAgency,anArea  Agencyorotherserviceprovider(includinganyombudsman x servicesprovidedundertheauthorityof42USC3024(d)(1)(D)) ^ mustbefundedwithanonFederalmatchofatleast15percent. D  Thispercentagemustbemetonastatewidebasis.Fundsfor *!z ombudsmanservicesprovidedundertheauthorityof42USC3024 "` (d)(1)(B)arenotrequiredtobematched(42USC3024(d)(1)(D); "F 45CFRsection1321.47). #,  ` E. ` hp x (#X(#E& ` b. StateandAreaAgencies %   AreaAgencies,intheaggregate,mustcontributeatleast25percentofthe 8'" costsofadministrationofareaplans(42USC3024(d)(1)(A);45CFR (n# section1321.47).'`%a )T$   ` E.` hp x (# X(#E(1)  State󀄀Sincethismatchiscomputedbasedontheaggregateofall *& AreaAgenciesintheState,theauditorstestingoftheamountof +&  thismatchisperformedattheStateAgency. ~,'! &  (2)  AreaAgencies󀄀Theauditorstestingoftheallowabilityofthe  matching(e.g.,fromanallowablesourceandincompliancewith  theadministrativerequirementsandallowablecosts/costprinciples | requirements)shouldbeperformedattheAreaAgencies. b  X ` E.` hp x (#X(#E 2.1 ` LevelofEffort MaintenanceofEffort  `  X E.` ` hp x (#X(#EState󀄀TheStateAgencymustspendforbothservicesandadministrationatleast   theaverageamountofStatefundsitspentundertheStateplanfortheseactivities   forthethreepreviousfiscalyears.IftheStateAgencyspendslessthanthis   amount,theAssistantSecretaryforAgingreducestheStatesallotmentsfor p  supportiveandnutritionservicesunderthispartbyapercentageequaltothe V  percentagebywhichtheStatereduceditsexpenditures(42USC3029(c);45 <  CFRsection1321.49).SeeIII.L.1, ReportingFinancialReportingforthe "r  reportingrequirementregardingmaintenanceofeffort. X   X E.` hp x (#` X(#E 2.2 ` LevelofEffort SupplementNotSupplantNotApplicable'c    X 3.  Earmarking  d   E. ` hp x (#X(#Ea. State b  ` E.` hp x (# X(#E(1)  Overallexpendituresforadministrationarelimitedtothegreater  offivepercent(or$300,000or$500,000dependingonthe  aggregateamountappropriatedoralesseramountfortheU.S.  territories)oftheoverallallotmenttoaStateunderTitleIIIunless r awaiverisgrantedbytheAssistantSecretaryonAging(42USC X 3028(b)(1),(2),and(3)). > (2)  AfteraStatedeterminestheamounttobeappliedtoStateplan < administrationunder42USC3028(b),theStatemay: "   ` E.h` hp x (#X(#E(a) h Makeupto(andincluding)10percentofthatamount   availablefortheadministrationofAreaPlans.TheState f! mayeithercalculatethe10percentbasedonthetotal L" allotmentfromAoAorontheamountremainingafter 2# deductingtheamounttobeappliedtoStatePlan $h administration(42USC3024(d)(1)(A));and $N  (b) h UseanyamountsavailabletotheStateforStateplan &! administrationwhichtheStatedeterminesarenotneeded '" forthatpurposetosupplementtheamountavailablefor x(#   administrationofAreaPlans(42USC3028(a)(2)). ^)$!  ` E.` hp x (#hX(#E& F  (3)  AnyStatewhichhasbeendesignatedasasingleplanningand  serviceareamayelecttobesubjecttotheStatePlan  administrationlimit(fivepercent)ortheAreaPlanadministration | (10percent)limit(42USC3028(a)(3)). b (4)  AStatemaytransfer:'Fq  `   ` E.h` hp x (#X(#E(a) h Upto40percentofaStatesseparateallotmentsfor   congregateandhomedeliverednutritionservicesbetween   thosetwoallotmentswithoutAoAapproval(42USC3028   (b)). p  (b) h Notmorethan30percentbetweenprogramsunderPartB n  andPartC(PartsC1and/orC2)foruseastheState T  considersappropriate(42USC3028(b)). :  (c) h Anadditional10percentmaybetransferredbetweenC1   andC2withanAoAwaiver(42USC3028(b)). ~  (d) h Awaivermayberequestedtotransferanamountwhichis ,| abovetheallowable30percentbetweenPartsBandC(42 b USC3030c3(b)(4)). H   ` E.` hp x (#hX(#EAStateAgencymaynotdelegatetoanAreaAgencyoranyother  entitytheauthoritytomakesuchtransfers(42USC3028(b)(6)).   (5)  TheStateagencywillnotfundprogramdevelopmentand : coordinatedactivitiesasacostofsupportiveservicesforthe  p administrationofareaplansuntilithasfirstspent10percentofthe V totalofitscombinedallotmentsunderthisprogramonthe < administrationofareaplans(45CFRsection1321.17(f)(14)). "   ` E.` ` hp x (#X(#E& n b. AreaAgency    E. ` hp x (#` X(#EAsprovidedinagreementswiththeStateAgency,AreaAgenciesearmark ."~ portionsoftheirallotment.Thetypicalearmarksare: #d   ` E.` hp x (# X(#E(1)  Amaximumamountorpercentageforprogramdevelopmentand $  coordinationactivitiesbythatagency(42USC3024(d)(1)(D);45 %  CFRsection1321.17(f)(14)(i)). &! (2)  Aminimumamountorpercentageforservicesrelatedtoaccess, <(# inhomeservices,andlegalassistance(42USC3026(a)(2)and ")r$  (b)).'n  !z *X%    ` E.` hp x (#X(#E& >  H.  PeriodofAvailabilityofFederalFunds    XE.` hp x (#X(#EFundsaremadeavailabletotheStateannuallyandmustbeobligatedbytheStatebythe ^ endoftheFederalfiscalyearinwhichtheywereawarded.TheStatehastwoyearsto D liquidateallobligationsforitsadministrationoftheStatePlanandforawardstotheArea *z Agenciesconsistentwithitsintrastateallocationformula.Therefore,inanygivenyear,  ` multipleyearsoffundingarebeingusedtoprovideservicesstatewide.  F WhenevertheAssistantSecretaryonAgingdeterminesthatanyamountallottedtoa   StateunderPartsBorCforafiscalyearwillnotbeusedtocarryoutthepurposefor   whichtheallotmentwasmade,thefundsmaybereallottedtooneormoreotherStates. p  AnyamountmadeavailabletoaStateastheresultofareallotmentshallberegardedas V  partoftheStatesallotmentforthesamefiscalyearinwhichthefundswere <  appropriated,butshallremainavailableforobligationbytheStateuntiltheendofthe "r  succeedingfiscalyear(42USC3024(b)).'> } X   XE.` hp x (#X(#E J.  ProgramIncome      E.` ` hp x (#X(#E1. ` Serviceprovidersarerequiredtoprovideanopportunitytoindividualsbeing d servedunderallPartBandCservicesprogramtomakevoluntarycontributions J forservicesreceived.Thesevoluntarycontributionsaretobeaddedtothe 0 amountsmadeavailablebytheStateorAreaAgencyandmustbeusedtoexpand f theservicefromwhichtheyarecollected(42USC3030c2(b)). L 2. ` CostsharingfeesmaybecollectedfromTitleIIIBservicesexceptinformation  andassistance,outreach,benefitscounseling,orcasemanagementservices.Cost  sharingisnotallowedforTitleIIICservicesorTitleVIIElderRightsServices v (Ombudsman,legalservices,elderabusepreventionorotherconsumerprotection \ services)(42USC3030c2(a)(2)). B   E.` hp x (#` X(#E& ( L.  Reporting  @  X 1. ` FinancialReporting    X E. ` hp x (#X(#E a. SF269,FinancialStatusReport,andAoASupplementalForm(OMBNo. L" 09850004)Applicable(requiredsemiannually)'( 2# b. SF270,RequestforAdvanceorReimbursement󀄀NotApplicable $0  c. SF271,OutlayReportandRequestforReimbursementforConstruction &! Programs󀄀NotApplicable t'" d. SF272,FederalCashTransactionsReport󀄀Paymentsunderthisprogram ")r$ aremadebytheHHSPaymentManagementSystem.Reporting *X%  equivalenttotheSF272isaccomplishedthroughthePayment *>&! ManagementSystemandisevidencedbythePSC272seriesofreports. +$'"  E.` ` hp x (# X(#E 2. ` PerformanceReporting 󀄀NotApplicable -(#  X E.` hp x (#` X(#E 3. ` SpecialReporting NotApplicable   X M.  SubrecipientMonitoring ^   E.` ` hp x (#X(#E 1. ` StateAgency  \  TheStateAgencyisrequiredtodeveloppoliciesgoverningallaspectsof   programsoperatedundertheStatePlanandtomonitortheirimplementation,   includingassessingperformanceforqualityandeffectivenessandspecifyingdata   systemrequirementstocollectnecessaryandappropriatedata(45CFRsections l  1321.11and1321.17(f)(9)). R   2. ` AreaAgencies P   AreaAgenciesarerequiredtooverseetheactivitiesofserviceproviderswith   respecttoprovisionofservices,reporting,voluntarycontributions,and   coordinationofservices(45CFRsection1321.65). z   B+ ` hp x (#` X(#B N.  SpecialTestsandProvisions (x    E.` ` hp x (#X(#E1. ` DistributionofCash &    XE.` hp x (#` X(#EComplianceRequirement 󀄀Statesarerequiredtopromptlyandequitablydistributecash  receivedinlieuofcommoditiestorecipientsofgrantsorcontractsunderOAATitleC1 j andC2(42USC3030a(d)(2)). P  AuditObjective 󀄀DeterminewhetherStatesaredistributingcashpromptlyand N equitably. 4  SuggestedAuditProcedures    XE.` ` hp x (#X(#E a. ` ReviewtheStatesproceduresforhandlingcashreceivedinlieuofcommodities @ todeterminewhetherthereisadocumentedprocessfordistributingcash, & v includingestablishedtimeframes.  !\ b. ` ReviewasampleoftransactionsduringtheauditperiodinwhichtheState "  receivedcashinlieuofcommoditiesanddeterminewhethertheStatecomplied #  withitsestablishedprocess,includingtimeframes. $   E.` hp x (#` X(#E&   IV.  OTHERINFORMATION   XE.` hp x (#X(#E TheAoANSIPprogramreplacestheNSIPadministeredbyUSDAunderCFDA10.570. ^ ResponsibilitywastransferredtoAoAasofOctober10,2002.Theprogrammayinclude D bothcashpaymentsandcommoditiesinlieuofcash.Assistanceintheformof *z commoditiesinlieuofcashisconsideredFederalawardsexpendedinaccordancewith  ` theOMBCircularA133,___.105,definitionofFederalfinancialassistanceandshould  F bevaluedinaccordancewith___.205(g).Therefore,bothcashexpendituresforthe  , purchaseoffoodandthevalueofcommoditiesreceivedfromtheStateDistribution   Agenciesshouldbe(1)usedwhendeterminingTypeAprogramsand(2)includedinthe   ScheduleofExpendituresofFederalAwardsinaccordancewith__.310(b).' I     _pY_q]  X  DEPARTMENTOFHEALTHANDHUMANSERVICES    $   ?( hp x (#X(#? _CFDA_Ԁ93.210 TRIBALSELFGOVERNANCEDEMONSTRATIONPROGRAM: ^ PLANNINGANDNEGOTIATIONCOOPERATIVEAGREEMENTS D AND_IHS_ԀCOMPACTS  *z  $ H.` hp x (#  X(#H I.  PROGRAMOBJECTIVES   ( TheobjectiveofthisprogramistomakefinancialassistanceawardstoIndiantribestoenable   themtoassumeprograms,services,andfunctionsoftheIndianHealthService(_IHS_), l  DepartmentofHealthandHumanServices(_HHS_)thatareotherwiseavailabletoIndiantribes R  (tribes)orIndians. 8   II.  PROGRAMPROCEDURES  6  TitleIIIoftheIndianSelfDeterminationandEducationAssistanceAct,asamended(25_USC_   450etseq.),authorizedademonstrationprogramforselfgovernancecompactswithtribes.Title z  VoftheIndianSelfDeterminationandEducationActwassignedintolawAugust18,2000 `  (Pub.L.106260),closingthedemonstrationprojectandprovidingpermanentstatusforthis F  program.TitleVallowstribestoretaintheirTitleIIICompactsandAnnualFunding ,| Agreements(_AFA_),totheextentthattheirprovisionsarenotdirectlycontrarytoanyexpress b provisioninTitleV,ortribesmaynegotiatenewCompactsandFundingAgreements(FA)under H TitleV(25_USC_Ԁ458aaa3(c)and458aaa4(f)). . Planningcooperativegrantsaremadebythe_IHS_Ԁtoanyfederallyrecognizedtribeorits  designatethatmeetsspecificrequirements,andareawardedonaonetimebasistoallowtribes r toprepareforcompactawards.Thisgrantallowsatribetogatherinformationtodeterminethe X currenttypesandextentofprograms,services,andfundingavailablewithinitsserviceareaand > toplanforthetypesandextentofprograms,services,andfundingtobemadeavailabletothe $t tribeunderaCompactand_AFA_Ԁ(TitleIII)orFA(TitleV),whichidentifiesthehealthprograms  Z assumedandmoniesavailabletothetribefortheseprograms.The_IHS_Ԁmayalsoawardfunding @ fornegotiatingtheCompactsand_AFAs_Ԁor_FAs_.Uponcompletionoftheplanningand & negotiationphase,fundingawardedunder_AFAs_Ԁor_FAs_Ԁmaybemultiyearagreements.Atribe   maycompactwiththe_IHS_Ԁtoberesponsiblefortheprovisionofcertainhealthservices,enter ! intoacontractwiththe_IHS_Ԁtoprovideotherhealthservices,andhaveotherservicesbedirectly " providedbythe_IHS_.Inaddition,atribemayusefundsreceivedfrom_IHS_Ԁtocontractwithother n# entitiesinordertoprovidespecifiedhealthservices. T$ Tribalcompactorsmayprovidehealthcareservicesdirectlyatfacilitiesoperatedbythe &R! compactororbyoperatingacontracthealthservicesprogramaspartofthe_AFA_ԀorFA. &8"  Contracthealthservicesareservicesprovidedto_IHS_Ԅeligiblebeneficiariesbyprivatesector '#!  healthcareproviders,suchashospitalsandphysicians,undercontractwiththetribalcompactor. ($" & >  SourceofGoverningRequirements   TheDemonstrationProgramwasauthorizedbyTitleIIIoftheIndianSelfDeterminationand ^ EducationAssistanceAct,asamended,andiscodifiedat25_USC_Ԁ450fnote.TitleVofthe D IndianSelfDeterminationandEducationAssistanceAct(_ISDA_),asamended,(Pub.L.106260) *z whichwassignedintolawonAugust18,2000,andiscodifiedat25_USC_Ԁ458aaa.  ` RegulationsconcerningthegeneraladministrationofIndianhealthprogramsmaybefoundat42   _CFR_Ԁpart36.TheseregulationsarenotcodifiedintheCodeofFederalRegulations,butmaybe   foundintheOctober28,1999,FederalRegister(64FR5831858322).Theregulations   currentlycodifiedat42_CFR_Ԁpart36havebeenunderacongressionalmoratoriumsince1988 p  andhavenotbeenimplemented,andpursuantto64FR58318havebeendesignated42_CFR_Ԁpart V  36a.Accordingly,allreferencesreferringtoregulatoryrequirementsinthissupplementcite <  thoserequirementsfoundat42_CFR_Ԁpart36aspublishedonOctober28,1999intheFederal "r  Register,andnotthosecodifiedintheCodeofFederalRegulations.'> 1 X   III.  COMPLIANCEREQUIREMENTS   IndevelopingtheauditprocedurestotestcompliancewiththerequirementsforaFederal d program,theauditorshouldfirstlooktoPart2,MatrixofComplianceRequirements,to J identifywhichofthe14typesofcompliancerequirementsdescribedinPart3are 0 applicableandthenlooktoParts3and4forthedetailsoftherequirements . f  A.  ActivitiesAllowedorUnallowed     E.` ` hp x (#X(#E1. ` PlanningCooperativeGrants󀄀Theseonetimefundsmaybeusedfor r determinationandplanningfortheassumptionofhealthservices(25_USC_Ԁ450f X noteforTitleIIIand25_USC_Ԁ458aaa2forTitleV). > 2. ` NegotiationGrants󀄀Fundsmaybeusedforthenegotiationofthehealthservices < program(25_USC_Ԁ450fnoteforTitleIIIand25_USC_Ԁ458aaa2forTitleV). " 3. ` Compacts󀄀Fundsmaybeusedtocarryoutanddeliverthehealthservices   program.Thespecificservicesallowedwillbeindicatedinthe_AFA_ԀorFA f! betweenthetribalorganizationandtheSecretaryofHealthandHumanServices. L" Whilelatitudeinredesigningprogramsandactivitiesisprovided,suchredesignis 2# limitedtoprogramscoveredbythe_AFA_ԀorFA(25_USC_Ԁ450fnoteforTitleIII $h and25_USC_Ԁ458aaa2forTitleV). $N    B+ ` hp x (#` X(#B B.  AllowableCosts/CostPrinciples  &!  XE.` hp x (#X(#EForcontracthealthservices,thetribalcompactoristhe_payor_Ԁoflastresort.Thecontract Z(# providermustfirstseekpaymentfromallalternateresources,suchashealthcare @)$  providersandinstitutions,healthcareprogramsincluding,butnotlimitedto,programs &*v%! underSocialSecurityAct(i.e.,Medicare,Medicaid),Stateorlocalhealthcareprograms  +\&" orlocalhealthcareprograms,and,privateinsurancebeforeseekingpaymentfromthe +B'# tribalcompactor.Whereathirdpartyliabilityisestablishedaftertheclaimispaid, ,(($ reimbursementfromthethirdpartyshouldbesought(42_CFR_Ԁsection36.61). -)%  XE.` hp x (#X(#E&  E.  Eligibility     E.` ` hp x (#X(#E 1. ` EligibilityforIndividuals  ^  E. ` hp x (#` X(#Ea. Eligibilityforserviceswithinfacilitiesoperatedbythe_IHS_Ԁ(whichare  \ billedby_IHS_Ԁtothetribe)orrunbyatribalorganizationfortheFederal B Government:'  (  ` E.` hp x (# X(#E(1)  IndividualsofIndiandescentbelongingtotheIndiancommunity   servedbythelocalfacilitiesandprogramareeligibletoreceive l  services.Anindividualmayberegardedaswithinthescopeofthe R  Indianhealthandmedicalserviceifhe/sheisregardedasanIndian 8  bythecommunityinwhichhe/shelivesasevidencedbysuch n  factorsastribalmembership,enrollment,residenceontaxexempt T  land,ownershipofrestrictedproperty,activeparticipationin :  Indianaffairs,orotherrelevantfactorsinkeepingwiththegeneral   BureauofIndianAffairspracticesinthejurisdiction(42_CFR_   section36.12).  (2)  NonIndianwomenpregnantwithaneligibleIndianschildare J eligibleforservices.Incaseswherethewomanisnotmarriedto 0 theeligibleIndianunderapplicablestateortriballaw,paternity f mustbeacknowledgedinwritingbytheIndianordeterminedby L orderofacourtofcompetentjurisdiction.Servicesmaybe 2 providedonlyduringtheperiodofherpregnancythrough  postpartum(generallysixweeksafterdelivery)(42_CFR_Ԁsection  36.12).  (3)  ServicesmaybeprovidedtononIndianmembersofaneligible B Indianshouseholdifamedicalofficerinchargedeterminesthat (x suchservicesareneededtocontrolanacuteinfectiousdiseaseora ^ publichealthhazard(42_CFR_Ԁsection36.12). D (4)  Otherwiseineligibleindividualsmayreceivetemporarycareand ! treatmentincaseofanemergency,asanactofhumanity(42_CFR_ " section36.14). n# (5)  Servicesmaybeprovidedonacostbasistootherwiseineligible %l  personsinaccordancewiththecriteriainSection813oftheIndian &R!  HealthCareImprovementAct(25_USC_Ԁ1680c(b)(1)(B)). &8"   ` E. ` hp x (#X(#E& :  b. EligibilityforservicesintheContractHealthServicescomponentofthe  _IHS_:   ` E.` hp x (# X(#E(1)  InordertoqualifyfortheContractHealthServicescomponentof D _IHS_: *z   ` E.h` hp x (#X(#E(a) h Anindividualmustmeettherequirementsoutlinedabove  ( (42_CFR_Ԁsection36.23);and   (b) h MusteitherresideintheUnitedStatesandonareservation l  locatedwithinaContractHealthServiceDeliveryArea R  (_CHSDA_)asdefinedunder42_CFR_Ԁsection36.22;or,if 8  he/shedoesnotresideonareservation,residewithina n  _CHSDA_;and': m T  (c) h Beamemberofthetribeortribeslocatedonthat   reservationorofthetribesortribesforwhichthe   reservationwasestablished;ormaintaincloseeconomic ~  andsocialtieswithsaidtribeortribes(42_CFR_Ԁsection d 36.23). J  ` E.` hp x (#hX(#E(2)  Students󀄀Studentscontinuetobeeligibleforcontracthealth H servicesduringtheirfulltimeattendanceatprogramsof . vocational,technical,oracademiceducation,includingnormal  schoolbreaksandforaperiodnottoexceed180daysafterthe  completionoftheirstudies(42_CFR_Ԁsection36.23).  (3)  Transients󀄀Transientpersons,suchasthosewhoareintravelor > aretemporarilyemployed,remaineligibleforcontracthealth $t servicesduringtheirabsence(42_CFR_Ԁsection36.23).  Z (4)  OtherPersons󀄀Otherpersonswholeavethe_CHSDA_Ԁinwhich  theyareeligibleandareneithertransientsnorstudentsremain   eligibleforcontracthealthservicesforaperiodnottoexceed180 ! daysfromsuchdeparture(42_CFR_Ԁsection36.23). j" (5)  FosterChildren󀄀Indianchildrenwhoareplacedinfostercare $h outsidea_CHSDA_Ԁbyorderofacourtofcompetentjurisdictionand $N  whowereeligibleforcontracthealthservicesatthetimeofthe %4! courtordershallcontinuetobeeligibleforcontracthealthservices &" whileinfostercare(42_CFR_Ԁsection36.23). '#   ` E.` ` hp x (#X(#E& z 2. ` EligibilityforGroupofIndividualsorAreaofServiceDelivery 󀄀Not ^)$! Applicable D*%"  3. ` Eligibilityfor_Subrecipients_ 󀄀NotApplicable'z^)} +B'#   E.` hp x (#` X(#E& r  H.  PeriodofAvailabilityofFederalFunds    XE.` hp x (#X(#EForeachfiscalyearduringwhichaSelfDeterminationFAor_AFA_Ԁisineffect,the ^ carryoveroffundsispermittedwithoutafiscalyearlimitation.Theannualfunding D continuesunderthesamecontractnumberforthelengthoftheprogram(Pub.L.106 *z 113,DivisionB,section1000(a)(3)(DepartmentoftheInteriorandRelatedAgencies  ` AppropriationsAct,TitleII,AdministrativeProvisions,IndianHealthService)).  F Allfundspaidtoatribeinaccordancewithacompactorfundingagreementshallremain   availableuntilexpended.Intheeventthatatribeelectstocarryoverfundingfromone   yeartothenext,suchcarryovershallnotdiminishtheamountoffundsthetribeis p  authorizedtoreceiveunderitsfundingagreementinthatoranysubsequentfiscalyear V  (25_USC_Ԁ458_aaa_Ԅ7(I)).'r   <   XE.` hp x (#X(#E J.  ProgramIncome  :    E.` ` hp x (#X(#E1. ` Fordirectcareservicesthetribalcompactorpursuescostreimbursementfromall   applicablesources(25_USC_Ԁ1621e,42_USC_Ԁ1395qq,and42_USC_Ԁ1396j). ~  2. ` AllMedicare,Medicaid,orotherprogramincomeearnedbyatribeshallbe ,| treatedassupplementalfundingtothatnegotiatedinthefundingagreement.The b tribemayretainallsuchincomeandexpendsuchfundsinthecurrentyearorin H futureyearsexcepttotheextentthatIndianHealthCareImprovementAct . (25_USC_Ԁ1601etseq.)providesotherwiseforMedicareandMedicaidreceipts  (25_USC_Ԁ450j1and25_USC_Ԁ458_aaa_Ԅ7(j)).  3. ` UseofFundsDirectBillingMedicareandMedicaid󀄀Tribeselectingtodirectly X billforMedicareandMedicaidshallfirstusesuchincomeforthepurposeof > makinganyimprovementsinthehospitalorclinicthatmaybenecessaryto $t achieveormaintaincompliancewiththeconditionsandrequirementsapplicable  Z generallytofacilitiesofsuchtypeunderMedicareorMedicaidprograms.Any @ fundssoreimbursedwhichareinexcessoftheamountnecessarytoachieveor & maintainsuchconditionsshallbeusedsolelyforimprovinghealthresources   deficiencylevelofthetribe(Pub.L.106417;25_USC_Ԁ1645). ! 4. ` UseofFundsCollectedthrough_HHS_󀄀TribeselectingtoreceiveMedicareand P# Medicaidreimbursementthrough_HHS_Ԁshallusesuchincomeforachieving 6$ compliancewiththeapplicableconditionsandrequirementsofMedicareand %l  Medicaid(exclusiveofplanning,design,andconstructionofnewfacilities)(Pub. &R! L.106291114Stat.978,42_USC_Ԁ1395qq,and25_USC_Ԁ1642). &8"   XE.` hp x (#` X(#E  (#! _rp