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some impacts, for example impacts of COVID-19 itself that are addressed by providing <br />prevention and mitigation services, such a class could reasonably include the general public. <br />Second, the program, service, or other intervention must address or respond to the <br />identified impact or harm. The final rule maintains the interim final rule requirement that eligible <br />uses under this category must be in response to the disease itself or other public health harms that <br />it caused.19 <br />Responses must be reasonably designed to benefit the individual or class that experienced <br />the public health impact or harm. Uses of funds should be assessed based on their responsiveness <br />to their intended beneficiaries and the ability of the response to address the impact or harm <br />experienced by those beneficiaries. <br />Responses must also be related and reasonably proportional to the extent and type of <br />public health impact or harm experienced. Uses that bear no relation or are grossly <br />disproportionate to the type or extent of harm experienced would not be eligible uses. <br />Reasonably proportional refers to the scale of the response compared to the scale of the harm. It <br />also refers to the targeting of the response to beneficiaries compared to the amount of harm they <br />experienced. In evaluating whether a use is reasonably proportional, recipients should consider <br />relevant factors about the harm identified and the response. For example, recipients may consider <br />the size of the population impacted and the severity, type, and duration of the impact. Recipients <br />may also consider the efficacy, cost, cost-effectiveness, and time to delivery of the response. <br />19 In designing an intervention to mitigate COVID-19, the recipient should consider guidance from public health <br />authorities, particularly the Centers for Disease Control and Prevention (CDC), in assessing appropriate COVID-19 <br />mitigation and prevention strategies (see Centers for Disease Control and Prevention, COVID-19, <br />https://www.cdc.gov/coronavirus/2019-ncov/index.html). A program or service that imposes conditions on <br />participation in or acceptance of the service that would undermine efforts to stop the spread of COVID-19 or <br />discourage compliance with practices in line with CDC guidance for stopping the spread of COVID-19 is not a <br />permissible use of funds. <br />22 <br />