42 U.S.C. § 291d — State plans

Page 971 TITLE 42—THE PUBLIC HEALTH AND WELFARE § 291d (6) to facilities which will provide training in health or allied health professions; and (7) to facilities which will provide to a sig- nificant extent, for the treatment of alco- holism; (b) Standards of construction and equipment general standards of construction and equip- ment for facilities of different classes and in different types of location, for which assist- ance is available under this part; (c) Criteria for determining needs for beds, hospitals and other facilities; plans for dis- tribution of beds and facilities criteria for determining needs for general hospital and long-term care beds, and needs for hospitals and other facilities for which aid under this part is available, and for developing plans for the distribution of such beds and fa- cilities; (d) Criteria for determining need for mod- ernization criteria for determining the extent to which existing facilities, for which aid under this part is available, are in need of modernization; and (e) State plan requirements; assurances nec- essary for approval of application that the State plan shall provide for ade- quate hospitals, and other facilities for which aid under this part is available, for all persons residing in the State, and adequate hospitals (and such other facilities) to furnish needed services for persons unable to pay therefor. Such regulations may also require that before approval of an application for a project is rec- ommended by a State agency to the Surgeon General for approval under this part, assur- ance shall be received by the State from the applicant that (1) the facility or portion there- of to be constructed or modernized will be made available to all persons residing in the territorial area of the applicant; and (2) there will be made available in the facility or por- tion thereof to be constructed or modernized a reasonable volume of services to persons un- able to pay therefor, but an exception shall be made if such a requirement is not feasible from a financial viewpoint. (July 1, 1944, ch. 373, title VI, § 603, as added Pub. L. 88–443, § 3(a), Aug. 18, 1964, 78 Stat. 451; amend- ed Pub. L. 88–581, § 3(b), Sept. 4, 1964, 78 Stat. 919; Pub. L. 91–296, title I, § 110, June 30, 1970, 84 Stat. 339; Pub. L. 96–88, title V, § 509(b), Oct. 17, 1979, 93 Stat. 695.) Editorial Notes PRIOR PROVISIONS A prior section 291c, act July 1, 1944, ch. 373, title VI, § 613, as added Aug. 13, 1946, ch. 958, § 2, 60 Stat. 1041, re- lated to allotments to States, the determination of their amount, and the disposition of unexpended funds, prior to the general amendment of this subchapter by Pub. L. 88–443. See section 291(a), (b) and (d) of this title. Provisions similar to those comprising this section were contained in a prior section 291e, act July 1, 1944, ch. 373, title VI, § 622, as added Aug. 13, 1946, ch. 958, § 2, 60 Stat. 1041; amended 1953 Reorg. Plan No. 1, §§ 5, 8, eff. Apr. 11, 1953, 18 F.R. 2053, 67 Stat. 631, prior to the gen- eral amendment of this subchapter by Pub. L. 88–443. AMENDMENTS 1970—Subsec. (a). Pub. L. 91–296 struck out from cl. (1) provisions requiring that States give special consider- ation for projects for hospitals serving rural areas but inserted provisions making such preference optional with each State and added cls. (4) to (7). 1964—Subsec. (a)(4). Pub. L. 88–581 struck out cl. (4) relating to hospital facilities which ‘‘will include new or expanded facilities for nurse training’’. Statutory Notes and Related Subsidiaries CHANGE OF NAME ‘‘Secretary of Health and Human Services’’ sub- stituted in text for ‘‘Secretary of Health, Education, and Welfare’’ pursuant to section 509(b) of Pub. L. 96–88, which is classified to section 3508(b) of Title 20, Edu- cation. EFFECTIVE DATE OF 1970 AMENDMENT Pub. L. 91–296, title I, § 110, June 30, 1970, 84 Stat. 339, provided that the amendment made by that section is effective with respect to applications approved under this subchapter after June 30, 1970. EFFECTIVE DATE OF 1964 AMENDMENT Pub. L. 88–581, § 3(b), Sept. 4, 1964, 78 Stat. 919, pro- vided that the amendments made by such section 3(b) [amending this section and sections 291o and 293c of this title] are effective with respect to applications for grants from appropriations for fiscal years beginning after June 30, 1965. Executive Documents TRANSFER OF FUNCTIONS Office of Surgeon General abolished by section 3 of Reorg. Plan No. 3 of 1966, eff. June 25, 1966, 31 F.R. 8855, 80 Stat. 1610, and functions thereof transferred to Sec- retary of Health, Education, and Welfare by section 1 of Reorg. Plan No. 3 of 1966, set out as a note under sec- tion 202 of this title. Office of Surgeon General reestab- lished within the Office of the Assistant Secretary for Health, see Notice of Department of Health and Human Services, Office of the Assistant Secretary for Health, Mar. 30, 1987, 52 F.R. 11754. § 291d. State plans (a) Submission; requirements Any State desiring to participate in this part may submit a State plan. Such plan must— (1) designate a single State agency as the sole agency for the administration of the plan, or designate such agency as the sole agency for supervising the administration of the plan; (2) contain satisfactory evidence that the State agency designated in accordance with paragraph (1) of this subsection will have au- thority to carry out such plan in conformity with this part; (3) provide for the designation of a State ad- visory council which shall include (A) rep- resentatives of nongovernmental organiza- tions or groups, and of public agencies, con- cerned with the operation, construction, or utilization of hospital or other facilities for di- agnosis, prevention, or treatment of illness or disease, or for provision of rehabilitation serv- ices, and representatives particularly con- cerned with education or training of health professions personnel, and (B) an equal num- Page 972 TITLE 42—THE PUBLIC HEALTH AND WELFARE § 291d 1 So in original. Probably should not be capitalized. ber of representatives of consumers familiar with the need for the services provided by such facilities, to consult with the State agency in carrying out the plan, and provide, if such council does not include any representatives of nongovernmental organizations or groups, or State agencies, concerned with rehabilita- tion, for consultation with organizations, groups, and State agencies so concerned; (4) set forth, in accordance with criteria es- tablished in regulations prescribed under sec- tion 291c of this title and on the basis of a statewide inventory of existing facilities, a survey of need, and (except to the extent pro- vided by or pursuant to such regulations) com- munity, area, or regional plans— (A) the number of general hospital beds and long-term care beds, and the number and types of hospital facilities and facilities for long-term care, needed to provide adequate facilities for inpatient care of people resid- ing in the State, and a plan for the distribu- tion of such beds and facilities in service areas throughout the State; (B) the public health centers needed to provide adequate public health services for people residing in the State, and a plan for the distribution of such centers throughout the State; (C) the outpatient facilities needed to pro- vide adequate diagnostic or treatment serv- ices to ambulatory patients residing in the State, and a plan for distribution of such fa- cilities throughout the State; (D) the rehabilitation facilities needed to assure adequate rehabilitation services for disabled persons residing in the State, and a plan for distribution of such facilities throughout the State; and (E) effective January 1, 1966, the extent to which existing facilities referred to in sec- tion 291a(a) or (b) of this title in the State are in need of modernization; (5) set forth a construction and moderniza- tion program conforming to the provisions set forth pursuant to paragraph (4) of this sub- section and regulations prescribed under sec- tion 291c of this title and providing for con- struction or modernization of the hospital or long-term care facilities, public health cen- ters, outpatient facilities, and rehabilitation facilities which are needed, as determined under the provisions so set forth pursuant to paragraph (4) of this subsection; (6) set forth, with respect to each of such types of medical facilities, the relative need, determined in accordance with regulations prescribed under section 291c of this title, for projects for facilities of that type, and provide for the construction or modernization, insofar as financial resources available therefor and for maintenance and operation make possible, in the order of such relative need; (7) provide minimum standards (to be fixed in the discretion of the State) for the mainte- nance and operation of facilities providing in- patient care which receive aid under this part and, effective July 1, 1966, provide for enforce- ment of such standards with respect to projects approved by the Surgeon General under this part after June 30, 1964; (8) provide such methods of administration of the State plan, including methods relating to the establishment and maintenance of per- sonnel standards on a merit basis (except that the Surgeon General shall exercise no author- ity with respect to the selection, tenure of of- fice, or compensation of any individual em- ployed in accordance with such methods), as are found by the Surgeon General to be nec- essary for the proper and efficient operation of the plan; (9) provide for affording to every applicant for a construction or modernization project an opportunity for a hearing before the State agency; (10) provide that the State agency will make such reports, in such form and containing such information, as the Surgeon General may from time to time reasonably require, and will keep such records and afford such access thereto as the Surgeon General may find necessary to as- sure the correctness and verification of such reports; (11) provide that the Comptroller General of the United States or his duly authorized rep- resentatives shall have access for the purpose of audit and examination to the records speci- fied in paragraph (10) of this subsection; (12) provide that the State agency will from time to time, but not less often than annually, review its State plan and submit to the Sur- geon General any modifications thereof which it considers necessary; and (13) Effective 1 July 1, 1971, provide that be- fore any project for construction or mod- ernization of any general hospital is approved by the State agency there will be reasonable assurance of adequate provision for extended care services (as determined in accordance with regulations) to patients of such hospital when such services are medically appropriate for them, with such services being provided in facilities which (A) are structurally part of, physically connected with, or in immediate proximity to, such hospital, and (B) either (i) are under the supervision of the professional staff of such hospital or (ii) have organized medical staffs and have in effect transfer agreements with such hospital; except that the Secretary may, at the request of the State agency, waive compliance with clause (A) or (B), or both such clauses, as the case may be, in the case of any project if the State agency has determined that compliance with such clause or clauses in such case would be inad- visable. (b) Approval by Surgeon General; hearing after disapproval The Surgeon General shall approve any State plan and any modification thereof which com- plies with the provisions of subsection (a). If any such plan or modification thereof shall have been disapproved by the Surgeon General for failure to comply with subsection (a), the Fed- eral Hospital Council shall, upon request of the State agency, afford it an opportunity for hear- ing. If such Council determines that the plan or modification complies with the provisions of Page 973 TITLE 42—THE PUBLIC HEALTH AND WELFARE § 291e such subsection, the Surgeon General shall thereupon approve such plan or modification. (July 1, 1944, ch. 373, title VI, § 604, as added Pub. L. 88–443, § 3(a), Aug. 18, 1964, 78 Stat. 452; amend- ed Pub. L. 91–296, title I, §§ 115, 116(b), (c), 123, June 30, 1970, 84 Stat. 341, 342, 344.) Editorial Notes PRIOR PROVISIONS A prior section 291d, act July 1, 1944, ch. 373, title VI, § 621, as added Aug. 13, 1946, ch. 958, § 2, 60 Stat. 1041; amended Oct. 25, 1949, ch. 722, § 2(a), 63 Stat. 898; July 27, 1953, ch. 243, 67 Stat. 196; Aug. 2, 1956, ch. 871, title IV, § 401, 70 Stat. 929; Aug. 14, 1958, Pub. L. 85–664, § 1(a), 72 Stat. 616, authorized appropriations for construction of hospitals and related facilities, prior to the general amendment of this subchapter by Pub. L. 88–443. See section 291a of this title. Provisions similar to those comprising this section were contained in a prior section 291f(a), (b), act July 1, 1944, ch. 373, title VI, § 623, as added Aug. 13, 1946, ch. 958, § 2, 60 Stat. 1041, prior to the general amendment of this subchapter by Pub. L. 88–443. AMENDMENTS 1970—Subsec. (a)(3). Pub. L. 91–296, § 115, inserted re- quirement that State advisory councils include rep- resentatives particularly concerned with education or training of health professions personnel. Subsec. (a)(4)(C). Pub. L. 91–296, § 116(b), substituted ‘‘outpatient facilities’’ for ‘‘diagnostic or treatment centers’’ and ‘‘such facilities’’ for ‘‘such centers’’. Subsec. (a)(5). Pub. L. 91–296, § 116(c), substituted ‘‘outpatient facilities’’ for ‘‘diagnostic or treatment centers’’. Subsec. (a)(13). Pub. L. 91–296, § 123, added par. (13). Statutory Notes and Related Subsidiaries CHANGE OF NAME ‘‘Secretary of Health and Human Services’’ sub- stituted for ‘‘Secretary of Health, Education, and Wel- fare’’ in subsec. (a)(13) pursuant to section 509(b) of Pub. L. 96–88, which is classified to section 3508(b) of Title 20, Education. EFFECTIVE DATE OF 1970 AMENDMENT Pub. L. 91–296, title I, § 115, June 30, 1970, 84 Stat. 341, provided that the amendment made by that section is effective July 1, 1970. TRANSFER OF FUNCTIONS Functions, powers, and duties of Secretary of Health and Human Services under subsec. (a)(8) of this section, insofar as relates to the prescription of personnel standards on a merit basis, transferred to Office of Per- sonnel Management, see section 4728(a)(3)(C) of this title. FUNDS FOR MODERNIZATION PROJECTS; CONDITIONS TO BE MET BEFORE APPROVAL Pub. L. 88–443, § 3(b)(5), Aug. 18, 1964, 78 Stat. 462, pro- vided that no application with respect to a moderniza- tion project may be approved for purposes of receiving funds from an allotment under section 291(a)(2) of this title before July 1, 1965, or before a State plan has been approved, as well as certain other requirements. See Effective Date note under section 291 of this title. Executive Documents TRANSFER OF FUNCTIONS Office of Surgeon General abolished by section 3 of Reorg. Plan No. 3 of 1966, eff. June 25, 1966, 31 F.R. 8855, 80 Stat. 1610, and functions thereof transferred to Sec- retary of Health, Education, and Welfare by section 1 of Reorg. Plan No. 3 of 1966, set out as a note under sec- tion 202 of this title. Office of Surgeon General reestab- lished within the Office of the Assistant Secretary for Health, see Notice of Department of Health and Human Services, Office of the Assistant Secretary for Health, Mar. 30, 1987, 52 F.R. 11754. § 291e. Projects for construction or moderniza- tion (a) Application; contents For each project pursuant to a State plan ap- proved under this part, there shall be submitted to the Surgeon General, through the State agen- cy, an application by the State or a political subdivision thereof or by a public or other non- profit agency. If two or more such agencies join in the project, the application may be filed by one or more of such agencies. Such application shall set forth— (1) a description of the site for such project; (2) plans and specifications therefor, in ac- cordance with regulations prescribed under section 291c of this title; (3) reasonable assurance that title to such site is or will be vested in one or more of the agencies filing the application or in a public or other nonprofit agency which is to operate the facility on completion of the project; (4) reasonable assurance that adequate fi- nancial support will be available for the com- pletion of the project and for its maintenance and operation when completed; (5) reasonable assurance that all laborers and mechanics employed by contractors or subcontractors in the performance of con- struction or modernization on the project will be paid wages at rates not less than those pre- vailing on similar work in the locality as de- termined by the Secretary of Labor in accord- ance with sections 3141–3144, 3146, and 3147 of title 40; and the Secretary of Labor shall have with respect to the labor standards specified in this paragraph the authority and functions set forth in Reorganization Plan Numbered 14 of 1950 (15 F.R. 3176) and section 3145 of title 40; and (6) a certification by the State agency of the Federal share for the project. (b) Approval by Surgeon General; requisites; ad- ditional approval by Secretary of Health and Human Services The Surgeon General shall approve such appli- cation if sufficient funds to pay the Federal share of the cost of such project are available from the appropriate allotment to the State, and if the Surgeon General finds (1) that the ap- plication contains such reasonable assurance as to title, financial support, and payment of pre- vailing rates of wages; (2) that the plans and specifications are in accord with the regulations prescribed pursuant to section 291c of this title; (3) that the application is in conformity with the State plan approved under section 291d of this title and contains an assurance that in the operation of the project there will be compli- ance with the applicable requirements of the regulations prescribed under section 291c(e) of this title, and with State standards for oper- ation and maintenance; and (4) that the applica-