42 U.S.C. § 291o — Definitions

Page 985 TITLE 42—THE PUBLIC HEALTH AND WELFARE § 291o 1 See References in Text note below. 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. § 291m. State control of operations Except as otherwise specifically provided, nothing in this subchapter shall be construed as conferring on any Federal officer or employee the right to exercise any supervision or control over the administration, personnel, mainte- nance, or operation of any facility with respect to which any funds have been or may be ex- pended under this subchapter. (July 1, 1944, ch. 373, title VI, § 643, formerly § 623, as added Pub. L. 88–443, § 3(a), Aug. 18, 1964, 78 Stat. 458, and renumbered § 643, Pub. L. 91–296, title II, § 201, June 30, 1970, 84 Stat. 344.) Editorial Notes PRIOR PROVISIONS A prior section 291m, act July 1, 1944, ch. 373, title VI, § 635, as added Aug. 13, 1946, ch. 958, § 2, 60 Stat. 1041; amended July 12, 1954, ch. 471, § 4(h), 68 Stat. 467, con- tained provisions similar to this section, prior to the general amendment of this subchapter by Pub. L. 88–443. § 291m–1. Loans for certain hospital experimen- tation projects (a) Other public or private sources unavailable for alleviation of hardship due to increased construction costs In order to alleviate hardship on any recipient of a grant under section 291n 1 of this title (as in effect immediately before August 18, 1964) for a project for the construction of an experimental or demonstration facility having as its specific purpose the application of novel means for the reduction of hospital costs with respect to which there has been a substantial increase in the cost of such construction (over the estimated cost of such project on the basis of which such grant was made) through no fault of such recipient, the Secretary is authorized to make a loan to such recipient not exceeding 662⁄3 per centum of such increased costs, as determined by the Sec- retary, if the Secretary determines that such re- cipient is unable to obtain such an amount for such purpose from other public or private sources. (b) Application; form; information Any such loan shall be made only on the basis of an application submitted to the Secretary in such form and containing such information and assurances as he may prescribe. (c) Interest; repayment period Each such loan shall bear interest at the rate of 21⁄2 per centum per annum on the unpaid bal- ance thereof and shall be repayable over a period determined by the Secretary to be appropriate, but not exceeding fifty years. (d) Authorization of appropriation There are hereby authorized to be appro- priated $3,500,000 to carry out the provisions of this section. (July 1, 1944, ch. 373, title VI, § 643A, formerly § 623A, as added Pub. L. 90–174, § 11, Dec. 5, 1967, 81 Stat. 541, and renumbered § 643A, Pub. L. 91–296, title II, § 201, June 30, 1970, 84 Stat. 344.) Editorial Notes REFERENCES IN TEXT Section 291n of this title, referred to in subsec. (a), was repealed by Pub. L. 90–174, § 3(b)(1), Dec. 5, 1967, 81 Stat. 535. § 291n. Repealed. Pub. L. 90–174, § 3(b)(1), Dec. 5, 1967, 81 Stat. 535 Section, act July 1, 1944, ch. 373, title VI, § 644, for- merly § 624, as added Aug. 18, 1964, Pub. L. 88–443, § 3(a), 78 Stat. 459, and renumbered § 644, June 30, 1970, Pub. L. 91–296, title II, § 201, 84 Stat. 344, provided for research, experiments and demonstrations in utilization of med- ical facilities, authorization, grants-in-aid, amounts, payment, conditions, authorization of appropriations, and right of recovery of United States Government. See section 242b of this title. Provisions similar to those comprising this section were contained in a prior section 291n, act July 1, 1944, ch. 373, title VI, § 636, as added Oct. 25, 1949, ch. 722, § 5, 63 Stat. 900; amended Oct. 6, 1961, Pub. L. 87–395, § 4, 75 Stat. 825, prior to the general amendment of this sub- chapter by Pub. L. 88–443. Statutory Notes and Related Subsidiaries EFFECTIVE DATE OF REPEAL Repeal effective with respect to appropriations for fiscal year ending after June 30, 1967, see section 3(b) of Pub. L. 90–174, set out as an Effective Date of 1967 Amendment note under section 246 of this title. § 291n–1. Omitted Editorial Notes CODIFICATION Section, act July 1, 1944, ch. 373, title VI, § 637, for- merly § 654(c), as added July 12, 1954, ch. 471, § 3, 68 Stat. 463; renumbered § 637 and amended Aug. 14, 1959, Pub. L. 86–158, title II, § 201, 73 Stat. 349, related to transfers of allotments between States, prior to the general amend- ment of this subchapter by Pub. L. 88–443, Aug. 18, 1964, 78 Stat. 447. See section 291b of this title. § 291o. Definitions For the purposes of this subchapter— (a) The term ‘‘State’’ includes the Common- wealth of Puerto Rico, Guam, American Samoa, the Trust Territory of the Pacific Islands, the Virgin Islands, and the District of Columbia. (b)(1) The term ‘‘Federal share’’ with respect to any project means the proportion of the cost of such project to be paid by the Federal Gov- ernment under this subchapter. (2) With respect to any project in any State for which a grant is made from an allotment from an appropriation under section 291a of this title, the Federal share shall be the amount deter- mined by the State agency designated in accord- ance with section 291d of this title, but not more than 662⁄3 per centum or the State’s allotment percentage, whichever is the lower, except that, Page 986 TITLE 42—THE PUBLIC HEALTH AND WELFARE § 291o if the State’s allotment percentage is lower than 50 per centum, such allotment percentage shall be deemed to be 50 per centum for purposes of this paragraph. (3) Prior to the approval of the first project in a State during any fiscal year the State agency designated in accordance with section 291d of this title shall give the Secretary written notifi- cation of the maximum Federal share estab- lished pursuant to paragraph (2) of this sub- section for projects in such State to be approved by the Secretary during such fiscal year and the method for determining the actual Federal share to be paid with respect to such projects; and such maximum Federal share and such method of determination for projects in such State approved during such fiscal year shall not be changed after such approval. (4) Notwithstanding the provisions of para- graphs (2) and (3) of this subsection, the Federal share shall, at the option of the State agency, be equal to the per centum provided under such paragraphs plus an incentive per centum (which when combined with the per centum provided under such paragraphs shall not exceed 90 per centum) specified by the State agency in the case of (A) projects that will provide services primarily for persons in an area determined by the Secretary to be a rural or urban poverty area, and (B) projects that offer potential for re- ducing health care costs through shared services among health care facilities, through inter- facility cooperation, or through the construc- tion or modernization of free-standing out- patient facilities. (c) The term ‘‘hospital’’ includes general, tu- berculosis, and other types of hospitals, and re- lated facilities, such as laboratories, outpatient departments, nurses’ home facilities, extended care facilities, facilities related to programs for home health services, self-care units, and cen- tral service facilities, operated in connection with hospitals, and also includes education or training facilities for health professions per- sonnel operated as an integral part of a hospital, but does not include any hospital furnishing pri- marily domiciliary care. (d) The term ‘‘public health center’’ means a publicly owned facility for the provision of pub- lic health services, including related publicly owned facilities such as laboratories, clinics, and administrative offices operated in connec- tion with such a facility. (e) The term ‘‘nonprofit’’ as applied to any fa- cility means a facility which is owned and oper- ated by one or more nonprofit corporations or associations no part of the net earnings of which inures, or may lawfully inure, to the benefit of any private shareholder or individual. (f) The term ‘‘outpatient facility’’ means a fa- cility (located in or apart from a hospital) for the diagnosis or diagnosis and treatment of am- bulatory patients (including ambulatory inpa- tients)— (1) which is operated in connection with a hospital, or (2) in which patient care is under the profes- sional supervision of persons licensed to prac- tice medicine or surgery in the State, or, in the case of dental diagnosis or treatment, under the professional supervision of persons licensed to practice dentistry in the State; or (3) which offers to patients not requiring hospitalization the services of licensed physi- cians in various medical specialties, and which provides to its patients a reasonably full-range of diagnostic and treatment services. (g) The term ‘‘rehabilitation facility’’ means a facility which is operated for the primary pur- pose of assisting in the rehabilitation of disabled persons through an integrated program of— (1) medical evaluation and services, and (2) psychological, social, or vocational eval- uation and services, under competent professional supervision, and in the case of which— (3) the major portion of the required evalua- tion and services is furnished within the facil- ity; and (4) either (A) the facility is operated in con- nection with a hospital, or (B) all medical and related health services are prescribed by, or are under the general direction of, persons li- censed to practice medicine or surgery in the State. (h) The term ‘‘facility for long-term care’’ means a facility (including an extended care fa- cility) providing in-patient care for convales- cent or chronic disease patients who require skilled nursing care and related medical serv- ices— (1) which is a hospital (other than a hospital primarily for the care and treatment of men- tally ill or tuberculosis patients) or is oper- ated in connection with a hospital, or (2) in which such nursing care and medical services are prescribed by, or are performed under the general direction of, persons li- censed to practice medicine or surgery in the State. (i) The term ‘‘construction’’ includes construc- tion of new buildings, expansion, remodeling, and alteration of existing buildings, and initial equipment of any such buildings (including med- ical transportation facilities) and, in any case in which it will help to provide a service not pre- viously provided in the community, equipment of any buildings; including architects’ fees, but excluding the cost of off-site improvements and, except with respect to public health centers, the cost of the acquisition of land. (j) The term ‘‘cost’’ as applied to construction or modernization means the amount found by the Surgeon General to be necessary for con- struction and modernization respectively, under a project, except that such term, as applied to a project for modernization of a facility for which a grant or loan is to be made from an allotment under section 291b(a)(2) of this title, does not in- clude any amount found by the Surgeon General to be attributable to expansion of the bed capac- ity of such facility. (k) The term ‘‘modernization’’ includes alter- ation, major repair (to the extent permitted by regulations), remodeling, replacement, and ren- ovation of existing buildings (including initial equipment thereof), and replacement of obso- lete, built-in (as determined in accordance with regulations) equipment of existing buildings. (l) The term ‘‘title’’, when used with reference to a site for a project, means a fee simple, or Page 987 TITLE 42—THE PUBLIC HEALTH AND WELFARE § 291o–1 such other estate or interest (including a lease- hold on which the rental does not exceed 4 per centum of the value of the land) as the Surgeon General finds sufficient to assure for a period of not less than fifty years’ undisturbed use and possession for the purposes of construction and operation of the project. (July 1, 1944, ch. 373, title VI, § 645, formerly § 625, as added Pub. L. 88–443, § 3(a), Aug. 18, 1964, 78 Stat. 460; amended Pub. L. 88–581, § 3(b), Sept. 4, 1964, 78 Stat. 919; renumbered § 645 and amended Pub. L. 91–296, title I, §§ 113, 114(a), 116(f), 117, 118, 119(d), title II, § 201, June 30, 1970, 84 Stat. 340, 341, 342, 343, 344.) Editorial Notes PRIOR PROVISIONS A prior section 291o, act July 1, 1944, ch. 373, title VI, § 641, as added July 12, 1954, ch. 471, § 2, 68 Stat. 461, re- lated to a declaration of purpose with respect to diag- nostic or treatment centers, chronic disease hospitals, rehabilitation facilities, and nursing homes, prior to the general amendment of this subchapter by Pub. L. 88–443. See section 291 of this title. Provisions similar to those comprising this section were contained in section 291i(d) to (o), act July 1, 1944, ch. 373, title VI, § 631, as added Aug. 13, 1946, ch. 958, § 2, 60 Stat. 1041; amended June 19, 1948, ch. 544, § 1(b), 62 Stat. 531; Oct. 25, 1949, ch. 722, § 9, 63 Stat. 901; July 12, 1954, ch. 471, § 4(c) to (f), 68 Stat. 465, 466; Aug. 1, 1956, ch. 852, § 19(b), 70 Stat. 911; June 25, 1959, Pub. L. 86–70, § 31(c), 73 Stat. 149; July 12, 1960, Pub. L. 86–624, § 29(d), 74 Stat. 419; Oct. 5, 1961, Pub. L. 87–395, § 5, 75 Stat. 826; Sept. 25, 1962, Pub. L. 87–688, § 4(a)(2), 76 Stat. 587, prior to the general amendment of this subchapter by Pub. L. 88–443. AMENDMENTS 1970—Subsec. (a). Pub. L. 91–296, § 119(d), inserted ref- erence to Trust Territory of the Pacific Islands. Subsec. (b). Pub. L. 91–296, § 113, provided that Federal share of any project be in such amount, not in excess of two-thirds, as the State agency determined and au- thorized a higher Federal share of up to 90 per centum, in case of rural or urban poverty projects, and facilities which might reduce health costs through shared serv- ices, interfacility cooperation, and free-standing ambu- latory care centers. Subsec. (c). Pub. L. 91–296, § 114(a), inserted references to extended care facilities, facilities related to pro- grams for home health services, and self-care units op- erated in connection with hospitals and education or training facilities for health professions personnel op- erated as an integral part of a hospital. Subsec. (f). Pub. L. 91–296, § 116(f), substituted ‘‘out- patient facility’’ for ‘‘diagnostic or treatment center’’, inserted ‘‘(located in or apart from a hospital)’’ after ‘‘means at facility’’, inserted ‘‘(including ambulatory inpatients)’’ after ‘‘ambulatory patients’’, and added par. (3). Subsec. (h). Pub. L. 91–296, § 117, inserted ‘‘(including an extended care facility)’’ after ‘‘means a facility’’. Subsec. (i). Pub. L. 91–296, § 118, inserted reference to equipment of any buildings in cases in which such equipment will help to provide a service not previously provided in the community. 1964—Subsec. (c). Pub. L. 88–581 substituted ‘‘nurses’ home facilities’’ for ‘‘nurses’ home and training facili- ties’’. 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. (b) 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, § 113, June 30, 1970, 84 Stat. 340, provided that the amendment made by that section is effective with respect to projects approved under this subchapter after June 30, 1970. Pub. L. 91–296, title I, § 114(a), June 30, 1970, 84 Stat. 341, provided that the amendment made by that section is effective with respect to applications approved under this subchapter after June 30, 1970. Pub. L. 91–296, title I, § 116(g), June 30, 1970, 84 Stat. 342, provided that: ‘‘The amendments made by sub- section (e) [amending this section] and paragraphs (2) and (3) of subsection (f) of this section [amending sec- tion 291e of this title] shall apply with respect to appli- cations approved under title VI of such Act [42 U.S.C. 291 et seq.] after June 30, 1970.’’ Pub. L. 91–296, title I, § 117, June 30, 1970, 84 Stat. 342, provided that the amendment made by that section is effective with respect to applications approved under this subchapter after June 30, 1970. Pub. L. 91–296, title I, § 118, June 30, 1970, 84 Stat. 342, provided that the amendment made by that section is effective with respect to projects approved under this subchapter after June 30, 1970. Amendment by section 119(d) of Pub. L. 91–296 appli- cable with respect to allotments and grants therefrom under part A of this subchapter for fiscal years ending after June 30, 1970, and with respect to loan guarantees and loans under part B of this subchapter made after June 30, 1970, see section 119(e) of Pub. L. 91–296, set out as a note under section 291b of this title. EFFECTIVE DATE OF 1964 AMENDMENT Amendment by Pub. L. 88–581 effective with respect to applications for grants from appropriations for fiscal years beginning after June 30, 1965, see section 3(b) of Pub. L. 88–581, set out as a note under section 291c 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. TERMINATION OF TRUST TERRITORY OF THE PACIFIC ISLANDS For termination of Trust Territory of the Pacific Is- lands, see note set out preceding section 1681 of Title 48, Territories and Insular Possessions. § 291o–1. Financial statements In the case of any facility for which a grant, loan, or loan guarantee has been made under this subchapter, the applicant for such grant, loan, or loan guarantee (or, if appropriate, such other person as the Secretary may prescribe) shall file at least annually with the State agen- cy for the State in which the facility is located a statement which shall be in such form, and contain such information, as the Secretary may require to accurately show— (1) the financial operations of the facility, and