Grants for state and community programs on aging: notice of proposed rulemaking.
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The Administration on Aging (AoA), in the Office of Human Development Services, is issuing final regulations for a new program for older Indians authorized by Title VI of the Older Americans Act, as amended. The purpose of this program is to promote the delivery of social and nutrition services for older Indians comparable to the services provided through the State and Community Programs on Aging, under Title III of the Act. Eligible tribal organizations will be able to apply for direct funding to pay the costs of providing social and nutrition services to Indians at 60 and older, including the acquisition, alteration, or renovation of multipurpose senior centers.
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The Assistant Secretary for Health with the approval of the Secretary of Health and Human Services proposes to revise the regulations governing the Community Health Centers grant program. The Health Services and Centers Amendments of 1978 made a number of changes in the statutory requirements governing the operation of the centers. The Amendments, among other things, change pharmacy services from supplemental to primary health services, establish priority for certain supplemental health services, provide an incentive for maximized collection of fees, permit conversion of certain centers from fee for service to prepaid operations, and change the governing board requirements or public centers. The proposed revisions are intended to revise the present regulations consistent with the revised statutory provisions.
The Assistant Secretary for Health with the approval of the Secretary of Health and Human Services proposes to revise the regulations governing the Migrant Health Centers grant program. The Health Services and Centers Amendments of 1978 made a number of changes in the statutory requirements governing the operation of the centers. The Amendments, among other things, change pharmacy services from supplemental to primary health services, make former migratory agricultural workers who are disabled eligible for services, establish priority for certain supplemental health services, provide an incentive for maximized collection of fees, permit conversion for certain centers from fee for service to prepaid operations and change the governing board requirements for public centers. The proposed revisions are intended to revise the present regulations consistent with the revised statutory provisions.
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Distribution of federal funds has achieved equal status with Congressional reapportionment as a motivation and justification for the Census of Population and Housing. This article describes the effects that U.S. population redistribution during the 1970s, as measured by the 1980 Census, will have on the spatial distribution of federal grants-in-aid provided to state and local governments through programs with formula-based funding systems. The conclusion is that funding changes will not match population changes. The overall redistribution of federal grants-in-aid to state and local governments occurring in response to incorporation of 1980 Census population counts into federal funding formulas will be far less than the level of population redistribution since 1970. Use of intercensal data, formula specifications, limited geographic specificity in many formula allocations, and nonformula determinants of formula-based grants all weaken the relationship between Census-measured population change and the receipt of federal funds at the local level. Despite all the intervening factors, it is probably that in many programs there will be some redistribution of funds when the 1980 Census counts are incorporated into the allocation formulas. But the importance of measurement errors and threshold and reclassification effects may equal that of true population change in determining the funds received by local communities.
This notice announces: (1) Factors that the Health Services Administration (HSA) will use in determining which Community Health Center (CHC) projects to fund, and (2) restrictions on the type of project activities that will be eligible for Federal support under the CHC program. a reduced level of authorization of appropriations for section 30 of the Public Health Service (PHS) Act in the recently enacted Omnibus Budget Reconciliation Act of 1981 (Pub. L 97-35) is the reason for the announcement of these factors and restrictions.
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At a time when human service providers should be priming their technologies to meet the emerging needs of a new age, they appear to be fighting for their very survival. New governmental priorities have reduced the Welfare State to a new level of pauperism, where both public and private services scurry for scarce resources. In the midst of these changes, serious questions emerge regarding who is ultimately responsible. That is, for maintaining acceptable standards of human dignity and rights despite government preoccupation with budget-balancing. Traditional advocates in the form of civil rights community organizations and organized labor groups do not appear to be available for the task. And recent changes in conventional primary group systems such as the family and the neighborhood complicate the matter of identifying appropriate leaders for mobilizing any form of "grass roots" movement. Despite what appears to be a bleak future for the human services, there is little question about their survival. The issue is, in what form and at what level of quality will they survive. If current trends continue, they will most certainly be incapable of meeting even basic human needs in the future. Funding in its current form may be a moot issue. Ultimately, it may be those who are dependent upon service systems who will determine their own survival.
Section 1923 of the Public Health Service (PHS) Act (42 U.S.C. 300y-2) requires that if a State does not apply for a Primary Care Block Grant under section 1924 of the PHS Act (42 U.S.C. 300y-3), or does not qualify for such a grant, the Secretary of Health and Human Services will use those funds not allotted to States participating in the block grant to make grants under section 330 of the PHS Act (42 U.S.C. 254c) to individual community health centers (CHCs). Section 1923 also requires that the Secretary consult with the chief executive officer of the State and with appropriate local officials before making such grants for community health centers in a State. This notice describes the manner in which the Health Resources and Services Administration (HRSA) will fulfill the requirement for consultation. In addition, it solicits comments from local officials regarding CHCs in their areas.