42 U.S.C. § 254d — National Health Service Corps

Page 384 TITLE 42—THE PUBLIC HEALTH AND WELFARE § 254d 1 See Change of Name note below. ties (including such disparities associated with racial and ethnic minority populations), and, as appropriate, by addressing issues researched under subsection (b)(2) of section 247b–12 of this title. (b) Integrated services for pregnant and postpartum women (1) Eligibility To be eligible to receive a grant under sub- section (a), a State, Indian Tribe, or Tribal or- ganization (as such terms are defined in sec- tion 5304 of title 25) shall work with relevant stakeholders that coordinate care to develop and carry out the program, including— (A) State, Tribal, and local agencies re- sponsible for Medicaid, public health, social services, mental health, and substance use disorder treatment and services; (B) health care providers who serve preg- nant and postpartum women; and (C) community-based health organizations and health workers, including providers of home visiting services and individuals rep- resenting communities with disproportion- ately high rates of maternal mortality and severe maternal morbidity, and including those representing racial and ethnic minor- ity populations. (2) Terms (A) Period A grant awarded under subsection (a) shall be made for a period of 5 years. Any supple- mental award made to a grantee under sub- section (a) may be made for a period of less than 5 years. (B) Priorities In awarding grants under subsection (a), the Secretary shall— (i) give priority to States, Indian Tribes, and Tribal organizations that have the highest rates of maternal mortality and severe maternal morbidity relative to other such States, Indian Tribes, or Tribal organizations, respectively; and (ii) shall consider health disparities re- lated to maternal mortality and severe maternal morbidity, including such dis- parities associated with racial and ethnic minority populations. (C) Evaluation The Secretary shall require grantees to evaluate the outcomes of the programs sup- ported under the grant. (c) Authorization of appropriations There are authorized to be appropriated to carry out this section $10,000,000 for each of fis- cal years 2023 through 2027. (July 1, 1944, ch. 373, title III, § 330P, as added Pub. L. 117–103, div. P, title I, § 134(a), Mar. 15, 2022, 136 Stat. 796.) Statutory Notes and Related Subsidiaries DISSEMINATION OF BEST PRACTICES Pub. L. 117–103, div. P, title I, § 134(b)(2), Mar. 15, 2022, 136 Stat. 797, provided that: ‘‘Not later than August 1, 2027, the Secretary of Health and Human Services shall disseminate information on best practices and models of care used by recipients of grants under the amend- ments made by this section [enacting this section] (in- cluding best practices and models of care relating to the reduction of health disparities, including such dis- parities associated with racial and ethnic minority populations, in rates of maternal mortality and severe maternal morbidity) to relevant stakeholders, which may include health providers, medical schools, nursing schools, relevant State, Tribal, and local agencies, and the general public.’’ SUBPART II—NATIONAL HEALTH SERVICE CORPS PROGRAM Editorial Notes CODIFICATION Pub. L. 94–484, title IV, § 407(b)(3), Oct. 12, 1976, 90 Stat. 2268, added heading ‘‘Subpart II—National Health Service Corps Program’’. § 254d. National Health Service Corps (a) Establishment; composition; purpose; defini- tions (1) For the purpose of eliminating health man- power shortages in health professional shortage areas, there is established, within the Service, the National Health Service Corps, which shall consist of— (A) such officers of the Regular and Reserve Corps 1 of the Service as the Secretary may designate, (B) such civilian employees of the United States as the Secretary may appoint, and (C) such other individuals who are not em- ployees of the United States. (2) The Corps shall be utilized by the Sec- retary to provide primary health services in health professional shortage areas. (3) For purposes of this subpart and subpart III: (A) The term ‘‘Corps’’ means the National Health Service Corps. (B) The term ‘‘Corps member’’ means each of the officers, employees, and individuals of which the Corps consists pursuant to para- graph (1). (C) The term ‘‘health professional shortage area’’ has the meaning given such term in sec- tion 254e(a) of this title. (D) The term ‘‘primary health services’’ means health services regarding family medi- cine, internal medicine, pediatrics, obstetrics and gynecology, dentistry, or mental health, that are provided by physicians or other health professionals. (E)(i) The term ‘‘behavioral and mental health professionals’’ means health service psychologists, licensed clinical social workers, licensed professional counselors, marriage and family therapists, psychiatric nurse special- ists, and psychiatrists. (ii) The term ‘‘graduate program of behav- ioral and mental health’’ means a program that trains behavioral and mental health pro- fessionals. (b) Recruitment and fellowship programs (1) The Secretary may conduct at schools of medicine, osteopathic medicine, dentistry, and, Page 385 TITLE 42—THE PUBLIC HEALTH AND WELFARE § 254d 2 See References in Text note below. as appropriate, nursing and other schools of the health professions, including schools at which graduate programs of behavioral and mental health are offered, and at entities which train allied health personnel, recruiting programs for the Corps, the Scholarship Program, and the Loan Repayment Program. Such recruiting pro- grams shall include efforts to recruit individuals who will serve in the Corps other than pursuant to obligated service under the Scholarship or Loan Repayment Program. (2) In the case of physicians, dentists, behav- ioral and mental health professionals, certified nurse midwives, certified nurse practitioners, and physician assistants who have an interest and a commitment to providing primary health care, the Secretary may establish fellowship programs to enable such health professionals to gain exposure to and expertise in the delivery of primary health services in health professional shortage areas. To the maximum extent prac- ticable, the Secretary shall ensure that any such programs are established in conjunction with accredited residency programs, and other train- ing programs, regarding such health professions. (c) Travel and moving expenses; persons enti- tled; reimbursement; limitation (1) The Secretary may reimburse an applicant for a position in the Corps (including an indi- vidual considering entering into a written agree- ment pursuant to section 254n of this title) for the actual and reasonable expenses incurred in traveling to and from the applicant’s place of residence to an eligible site to which the appli- cant may be assigned under section 254f of this title for the purpose of evaluating such site with regard to being assigned at such site. The Sec- retary may establish a maximum total amount that may be paid to an individual as reimburse- ment for such expenses. (2) The Secretary may also reimburse the ap- plicant for the actual and reasonable expenses incurred for the travel of 1 family member to ac- company the applicant to such site. The Sec- retary may establish a maximum total amount that may be paid to an individual as reimburse- ment for such expenses. (3) In the case of an individual who has en- tered into a contract for obligated service under the Scholarship Program or under the Loan Re- payment Program, the Secretary may reimburse such individual for all or part of the actual and reasonable expenses incurred in transporting the individual, the individual’s family, and the fam- ily’s possessions to the site of the individual’s assignment under section 254f of this title. The Secretary may establish a maximum total amount that may be paid to an individual as re- imbursement for such expenses. (d) Monthly pay adjustments of members directly engaged in delivery of health services in health professional shortage area; ‘‘monthly pay’’ defined; monthly pay adjustment of member with service obligation incurred under Scholarship Program or Loan Repay- ment Program; personnel system applicable (1) The Secretary may, under regulations pro- mulgated by the Secretary, adjust the monthly pay of each member of the Corps (other than a member described in subsection (a)(1)(C)) who is directly engaged in the delivery of health serv- ices in a health professional shortage area as follows: (A) During the first 36 months in which such a member is so engaged in the delivery of health services, his monthly pay may be in- creased by an amount which when added to the member’s monthly pay and allowances will provide a monthly income competitive with the average monthly income from a prac- tice of an individual who is a member of the profession of the Corps member, who has equivalent training, and who has been in prac- tice for a period equivalent to the period dur- ing which the Corps member has been in prac- tice. (B) During the period beginning upon the ex- piration of the 36 months referred to in sub- paragraph (A) and ending with the month in which the member’s monthly pay and allow- ances are equal to or exceed the monthly in- come he received for the last of such 36 months, the member may receive in addition to his monthly pay and allowances an amount which when added to such monthly pay and al- lowances equals the monthly income he re- ceived for such last month. (C) For each month in which a member is di- rectly engaged in the delivery of health serv- ices in a health professional shortage area in accordance with an agreement with the Sec- retary entered into under section 294n(f)(1)(C) 2 of this title, under which the Secretary is obli- gated to make payments in accordance with section 294n(f)(2) 2 of this title, the amount of any monthly increase under subparagraph (A) or (B) with respect to such member shall be decreased by an amount equal to one-twelfth of the amount which the Secretary is obli- gated to pay upon the completion of the year of practice in which such month occurs. For purposes of subparagraphs (A) and (B), the term ‘‘monthly pay’’ includes special pay re- ceived under chapter 5 of title 37. (2) In the case of a member of the Corps who is directly engaged in the delivery of health services in a health professional shortage area in accordance with a service obligation incurred under the Scholarship Program or the Loan Re- payment Program, the adjustment in pay au- thorized by paragraph (1) may be made for such a member only upon satisfactory completion of such service obligation, and the first 36 months of such member’s being so engaged in the deliv- ery of health services shall, for purposes of para- graph (1)(A), be deemed to begin upon such satis- factory completion. (3) A member of the Corps described in sub- paragraph (C) of subsection (a)(1) shall when as- signed to an entity under section 254f of this title be subject to the personnel system of such entity, except that such member shall receive during the period of assignment the income that the member would receive if the member was a member of the Corps described in subparagraph (B) of such subsection. Page 386 TITLE 42—THE PUBLIC HEALTH AND WELFARE § 254d 3 So in original. The word ‘‘the’’ probably should appear. 4 So in original. (e) Employment ceiling of Department not af- fected by Corps members Corps members assigned under section 254f of this title to provide health services in health professional shortage areas shall not be counted against any employment ceiling affecting the Department. (f) Assignment of personnel provisions inappli- cable to members whose service obligation incurred under Scholarship Program or Loan Repayment Program Sections 215 and 217 of this title shall not apply to members of the National Health Serv- ice Corps during their period of obligated service under the Scholarship Program or the Loan Re- payment Program, except when such members are Commissioned Corps officers who entered into a contract with 3 Secretary under section 254l or 254l–1 of this title after December 31, 2006 and when the Secretary determines that exer- cising the authority provided under section 215 or 217 of this title with respect to any such offi- cer to 4 would not cause unreasonable disruption to health care services provided in the commu- nity in which such officer is providing health care services. (g) Conversion from Corps member to commis- sioned officer; retirement credits (1) The Secretary shall, by rule, prescribe con- version provisions applicable to any individual who, within a year after completion of service as a member of the Corps described in subsection (a)(1)(C), becomes a commissioned officer in the Regular or Reserve Corps 1 of the Service. (2) The rules prescribed under paragraph (1) shall provide that in applying the appropriate provisions of this chapter which relate to retire- ment, any individual who becomes such an offi- cer shall be entitled to have credit for any pe- riod of service as a member of the Corps de- scribed in subsection (a)(1)(C). (h) Effective administration of program The Secretary shall ensure that adequate staff is provided to the Service with respect to effec- tively administering the program for the Corps. (i) Demonstration projects; waivers (1) In carrying out subpart III, the Secretary may, in accordance with this subsection, issue waivers to individuals who have entered into a contract for obligated service under the Scholar- ship Program or the Loan Repayment Program under which the individuals are authorized to satisfy the requirement of obligated service through providing clinical practice that is half time. (2) A waiver described in paragraph (1) may be provided by the Secretary only if— (A) the entity for which the service is to be performed— (i) has been approved under section 254f–1 of this title for assignment of a Corps mem- ber; and (ii) has requested in writing assignment of a health professional who would serve half time; (B) the Secretary has determined that as- signment of a health professional who would serve half time would be appropriate for the area where the entity is located; (C) a Corps member who is required to per- form obligated service has agreed in writing to be assigned for half-time service to an entity described in subparagraph (A); (D) the entity and the Corps member agree in writing that the Corps member will perform half-time clinical practice; (E) the Corps member agrees in writing to fulfill all of the service obligations under sec- tion 254m of this title through half-time clin- ical practice and either— (i) double the period of obligated service that would otherwise be required; or (ii) in the case of contracts entered into under section 254l–1 of this title, accept a minimum service obligation of 2 years with an award amount equal to 50 percent of the amount that would otherwise be payable for full-time service; and (F) the Corps member agrees in writing that if the Corps member begins providing half- time service but fails to begin or complete the period of obligated service, the method stated in 254o(c) of this title for determining the damages for breach of the individual’s written contract will be used after converting periods of obligated service or of service performed into their full-time equivalents. (3) In evaluating waivers issued under para- graph (1), the Secretary shall examine the effect of multidisciplinary teams. (j) Definitions For the purposes of this subpart and subpart III: (1) The term ‘‘Department’’ means the De- partment of Health and Human Services. (2) The term ‘‘Loan Repayment Program’’ means the National Health Service Corps Loan Repayment Program established under section 254l–1 of this title. (3) The term ‘‘Scholarship Program’’ means the National Health Service Corps Scholarship Program established under section 254l of this title. (4) The term ‘‘State’’ includes, in addition to the several States, only the District of Colum- bia, the Commonwealth of Puerto Rico, the Commonwealth of the Northern Mariana Is- lands, the Virgin Islands, Guam, American Samoa, and the Trust Territory of the Pacific Islands. (5) The terms ‘‘full time’’ and ‘‘full-time’’ mean a minimum of 40 hours per week in a clinical practice, for a minimum of 45 weeks per year. (6) The terms ‘‘half time’’ and ‘‘half-time’’ mean a minimum of 20 hours per week (not to exceed 39 hours per week) in a clinical prac- tice, for a minimum of 45 weeks per year. (July 1, 1944, ch. 373, title III, § 331, as added Pub. L. 94–484, title IV, § 407(b)(3), Oct. 12, 1976, 90 Stat. 2268; amended Pub. L. 97–35, title XXVII, § 2701, Aug. 13, 1981, 95 Stat. 902; Pub. L. 100–177, title II, § 202(b), title III, § 301, Dec. 1, 1987, 101 Stat. 996, 1003; Pub. L. 100–607, title VI, Page 387 TITLE 42—THE PUBLIC HEALTH AND WELFARE § 254d § 629(a)(2), Nov. 4, 1988, 102 Stat. 3146; Pub. L. 101–597, title I, § 101, title IV, § 401(b)[(a)], Nov. 16, 1990, 104 Stat. 3013, 3035; Pub. L. 107–251, title III, § 301, Oct. 26, 2002, 116 Stat. 1642; Pub. L. 109–417, title II, § 206(c)(2), Dec. 19, 2006, 120 Stat. 2853; Pub. L. 111–148, title X, § 10501(n)(1), (2), Mar. 23, 2010, 124 Stat. 1002, 1003.) Editorial Notes REFERENCES IN TEXT Section 294n of this title, referred to in subsec. (d)(1)(C), was in the original a reference to section 741 of act July 1, 1944. Section 741 of that Act was omitted in the general revision of subchapter V of this chapter by Pub. L. 102–408, title I, § 102, Oct. 13, 1992, 106 Stat. 1994. Pub. L. 102–408 enacted a new section 776 of act July 1, 1944, relating to acquired immune deficiency syndrome, which was classified to section 294n of this title, and subsequently renumbered section 2692 and transferred to section 300ff–111 of this title. AMENDMENTS 2010—Subsec. (i)(1). Pub. L. 111–148, § 10501(n)(1)(A), substituted ‘‘issue waivers to individuals who have en- tered into a contract for obligated service under the Scholarship Program or the Loan Repayment Program under which the individuals are authorized to satisfy the requirement of obligated service through providing clinical practice that is half time’’ for ‘‘carry out dem- onstration projects in which individuals who have en- tered into a contract for obligated service under the Loan Repayment Program receive waivers under which the individuals are authorized to satisfy the require- ment of obligated service through providing clinical service that is not full-time’’. Subsec. (i)(2)(A)(ii), (B). Pub. L. 111–148, § 10501(n)(1)(B)(i), substituted ‘‘half time’’ for ‘‘less than full time’’. Subsec. (i)(2)(C). Pub. L. 111–148, § 10501(n)(1)(B)(ii), substituted ‘‘half-time service’’ for ‘‘less than full-time service’’. Subsec. (i)(2)(D), (E). Pub. L. 111–148, § 10501(n)(1)(B)(iii), amended subpars. (D) and (E) gen- erally. Prior to amendment, subpars. (D) and (E) read as follows: ‘‘(D) the entity and the Corps member agree in writ- ing that the less than full-time service provided by the Corps member will not be less than 16 hours of clinical service per week; ‘‘(E) the Corps member agrees in writing that the pe- riod of obligated service pursuant to section 254l–1 of this title will be extended so that the aggregate amount of less than full-time service performed will equal the amount of service that would be performed through full-time service under section 254m of this title; and’’. Subsec. (i)(2)(F). Pub. L. 111–148, § 10501(n)(1)(B)(ii), substituted ‘‘half-time service’’ for ‘‘less than full-time service’’. Subsec. (i)(3). Pub. L. 111–148, § 10501(n)(1)(C), sub- stituted ‘‘In evaluating waivers issued under paragraph (1)’’ for ‘‘In evaluating a demonstration project de- scribed in paragraph (1)’’. Subsec. (j)(5), (6). Pub. L. 111–148, § 10501(n)(2), added pars. (5) and (6). 2006—Subsec. (f). Pub. L. 109–417 inserted before pe- riod at end ‘‘, except when such members are Commis- sioned Corps officers who entered into a contract with Secretary under section 254l or 254l–1 of this title after December 31, 2006 and when the Secretary determines that exercising the authority provided under section 215 or 217 of this title with respect to any such officer to would not cause unreasonable disruption to health care services provided in the community in which such officer is providing health care services’’. 2002—Subsec. (a)(3)(E). Pub. L. 107–251, § 301(a)(1), added subpar. (E). Subsec. (b)(1). Pub. L. 107–251, § 301(a)(2)(A), sub- stituted ‘‘health professions, including schools at which graduate programs of behavioral and mental health are offered,’’ for ‘‘health professions’’. Subsec. (b)(2). Pub. L. 107–251, § 301(a)(2)(B), inserted ‘‘behavioral and mental health professionals,’’ after ‘‘dentists,’’. Subsec. (c). Pub. L. 107–251, § 301(a)(3), added subsec. (c) and struck out former subsec. (c) which read as fol- lows: ‘‘The Secretary may reimburse applicants for po- sitions in the Corps (including individuals considering entering into a written agreement pursuant to section 254n of this title) for actual and reasonable expenses in- curred in traveling to and from their places of resi- dence to a health professional shortage area (des- ignated under section 254e of this title) in which they may be assigned for the purpose of evaluating such area with regard to being assigned in such area. The Sec- retary shall not reimburse an applicant for more than one such trip.’’ Subsecs. (i), (j). Pub. L. 107–251, § 301(b), added subsec. (i) and redesignated former subsec. (i) as (j). 1990—Subsec. (a). Pub. L. 101–597, § 401(b)[(a)], sub- stituted reference to health professional shortage area for reference to health manpower shortage area in pars. (1), (2), and (3)(C). Pub. L. 101–597, § 101(a), designated existing provisions as par. (1), substituted ‘‘For the purpose of eliminating health manpower shortages in health manpower short- age areas, there is established, within the Service, the National Health Service Corps, which shall consist of— ’’ for ‘‘There is established, within the Service, the Na- tional Health Service Corps (hereinafter in this subpart referred to as the ‘Corps’) which (1) shall consist of—’’, substituted ‘‘States.’’ for ‘‘States,’’ at end of subpar. (C), struck out closing provisions which read ‘‘(such of- ficers, employees, and individuals hereinafter in this subpart referred to as ‘Corps members’), and (2) shall be utilized by the Secretary to improve the delivery of health services in health manpower shortage areas as defined in section 254e(a) of this title.’’, and added pars. (2) and (3). Subsec. (b). Pub. L. 101–597, § 401(b)[(a)], substituted reference to health professional shortage area for ref- erence to health manpower shortage area in par. (2). Pub. L. 101–597, § 101(b), designated existing provision as par. (1), inserted at end ‘‘Such recruiting programs shall include efforts to recruit individuals who will serve in the Corps other than pursuant to obligated service under the Scholarship or Loan Repayment Pro- gram.’’, and added par. (2). Subsec. (c). Pub. L. 101–597, § 401(b)[(a)], substituted reference to health professional shortage area for ref- erence to health manpower shortage area. Subsec. (d)(1). Pub. L. 101–597, § 401(b)[(a)], substituted reference to health professional shortage area for ref- erence to health manpower shortage area in introduc- tory provisions and in subpar. (C). Subsec. (d)(1)(A). Pub. L. 101–597, § 101(c), struck out ‘‘(not to exceed $1,000)’’ after ‘‘by an amount’’. Subsecs. (d)(2), (e). Pub. L. 101–597, § 401(b)[(a)], sub- stituted reference to health professional shortage area for reference to health manpower shortage area. Subsec. (h). Pub. L. 101–597, § 101(d), added subsec. (h) and struck out former subsec. (h) which read as follows: ‘‘In assigning members of the Corps to health man- power shortage areas, to the extent practicable, the Secretary shall— ‘‘(1) give priority to meeting the needs of the Indian Health Service and the needs of health programs or facilities operated by tribes or tribal organizations under the Indian Self-Determination Act (25 U.S.C. 450f et seq.); and ‘‘(2) provide special consideration to the homeless populations who do not have access to primary health care services.’’ Subsec. (i). Pub. L. 101–597, § 101(e), substituted ‘‘of this subpart and subpart III’’ for ‘‘of this subpart’’. 1988—Subsec. (b). Pub. L. 100–607 substituted ‘‘osteo- pathic medicine’’ for ‘‘osteopathy’’. Page 388 TITLE 42—THE PUBLIC HEALTH AND WELFARE § 254d 1987—Subsec. (b). Pub. L. 100–177, § 202(b)(1), inserted reference to Loan Repayment Program. Subsec. (c). Pub. L. 100–177, § 202(b)(2), made technical amendment to reference to section 254n of this title to reflect renumbering of corresponding section of origi- nal act. Subsecs. (d)(2), (f). Pub. L. 100–177, § 202(b)(3), (4), in- serted reference to Loan Repayment Program. Subsec. (h). Pub. L. 100–177, § 301(2), added subsec. (h). Former subsec. (h) redesignated (i). Subsec. (i). Pub. L. 100–177, §§ 202(b)(5), 301(1), redesig- nated subsec. (h) as (i), added par. (2), and redesignated former pars. (2) and (3) as (3) and (4), respectively. 1981—Subsec. (a)(1). Pub. L. 97–35, § 2701(a), revised provisions and, as so revised, set out existing provi- sions in cls. (A) and (B), and added cl. (C). Subsec. (b). Pub. L. 97–35, § 2701(b), substituted ‘‘may’’ for ‘‘shall’’. Subsec. (c). Pub. L. 97–35, § 2701(c), inserted provisions respecting a written agreement under section 254n of this title. Subsec. (d). Pub. L. 97–35, § 2701(d), in par. (1) inserted reference to member described in subsec. (a)(1)(C) of this section, in subpars. (1)(A) and (B) substituted ‘‘may’’ for ‘‘shall’’, and added par. (3). Subsec. (g). Pub. L. 97–35, § 2701(e), substituted provi- sions relating to conversion from Corps member to commissioned officer and retirement credits, for provi- sions relating to school participation in development of administrative guidelines. Subsec. (h). Pub. L. 97–35, § 2701(f), in par. (1) sub- stituted ‘‘Health and Human Services’’ for ‘‘Health, Education, and Welfare’’, in par. (2) substituted ‘‘254l’’ for ‘‘294t’’, and in par. (3) inserted reference to Com- monwealth with respect to the Northern Mariana Is- lands. Statutory Notes and Related Subsidiaries CHANGE OF NAME Reference to Reserve Corps of the Public Health Serv- ice deemed to be a reference to the Ready Reserve Corps, see section 204(c)(3) of this title. EFFECTIVE DATE OF 1990 AMENDMENT Pub. L. 101–597, title V, § 501, Nov. 16, 1990, 104 Stat. 3036, provided that: ‘‘This Act and the amendments made by this Act [enacting sections 254f–1, 254o–1, and 254r of this title, amending this section, sections 242a, 254e to 254i, 254k, 254l to 254q–1, 254s, 294h, 294n, 294aa, 295g–1, 296m, 1320c–5, 1395l, 1395u, 1395x, 3505d, and 9840 of this title, and section 2123 of Title 10, Armed Forces, and enacting provisions set out as notes under sections 201, 254l–1, and 254o of this title] shall take effect Octo- ber 1, 1990, or upon the date of the enactment of this Act [Nov. 16, 1990], whichever occurs later.’’ SPECIAL REPORT ON PRESENT AND FUTURE DIRECTION OF NATIONAL HEALTH SERVICE CORPS; SUBMISSION TO CONGRESS NOT LATER THAN FEBRUARY 1, 1979 Pub. L. 95–626, title I, § 116(c), Nov. 10, 1978, 92 Stat. 3569, directed Secretary, not later than Feb. 1, 1979, in consultation with National Advisory Council of Na- tional Health Service Corps and National Advisory Council on Health Professions Education, to submit to Congress a report on the direction of the National Health Service Corps, particularly its role as a health manpower program and as a health services delivery program, the use of members of the Corps in health manpower shortage areas to meet urban and rural health needs, the types of health professions needed to meet urban and rural health needs, and the projected size, composition, and use of the Corps through 1985. EFFECTIVE DATE; OTHER PROVISIONS: HEALTH MAN- POWER SHORTAGE AREA; APPROVAL OF APPLICATIONS FOR ASSIGNMENT OF CORPS PERSONNEL; ASSIGNMENT PERIOD, COMMENCEMENT; CREDIT FOR MONTHS OF PRIOR HEALTH CARE AND SERVICES FOR ADDITIONAL PAY BENEFIT; NATIONAL ADVISORY COUNCIL ON THE NATIONAL HEALTH SERVICE CORPS, CONTINUATION OF COUNCIL AND APPOINTMENT OF MEMBERS Pub. L. 94–484, title IV, § 407(c), Oct. 12, 1976, 90 Stat. 2278, provided that: ‘‘(1) The amendment made by subsections (a) and (b) [enacting this subpart and repealing section 254b of this title] shall apply only with respect to fiscal years be- ginning after September 30, 1977, except that the Sec- retary of Health, Education, and Welfare [now Health and Human Services] shall carry out the activities de- scribed in section 332 of the Public Health Service Act (as added by such amendment) [42 U.S.C. 254e] after the date of enactment of this Act [Oct. 12, 1976]. ‘‘(2)(A) Any area for which a designation under sec- tion 329(b) of the Public Health Service Act (as in effect on September 30, 1977) [former 42 U.S.C. 254b(b)] was in effect on such date and in which National Health Serv- ice Corps personnel were, on such date, providing, under an assignment made under such section (as so in effect), health care and services for persons residing in such area shall, effective October 1, 1977, be considered under subpart II of part C of title III of such Act (as added by subsection (b) of this section) [42 U.S.C. 254d et seq.] to (i) be designated a health manpower shortage area (as defined by section 332 of such Act (as so added)) [42 U.S.C. 254e], and (ii) have had an application ap- proved under section 333 of such Act (as so added)) [42 U.S.C. 254f] for the assignment of Corps personnel un- less, as determined under subparagraph (B) of this para- graph, the assignment period applicable to such area (within the meaning of section 334 (as so added)) [former 42 U.S.C. 254g] has expired. ‘‘(B) The assignment period (within the meaning of such section 334) [former 42 U.S.C. 254g] applicable to an area described in subparagraph (A) of this paragraph shall be considered to have begun on the date Corps personnel were first assigned to such area under section 329 of such Act (as in effect on September 30, 1977) [former 42 U.S.C. 254b]. ‘‘(C) In the case of any physician or dentist member of the Corps who was providing health care and services on September 30, 1977, under an assignment made under section 329(b) of such Act (as in effect on September 30, 1977) [former 42 U.S.C. 254b(b)], the number of the months during which such member provided such care and services before October 1, 1977, shall be counted in determining the application of the additional pay pro- visions of section 331(d) of such Act (as added by sub- section (b) of this section) [42 U.S.C. 254d(d)] to such number. ‘‘(3) The amendment made by subsection (b) which es- tablished an Advisory Council previously established under section 329 of the Public Health Service Act [former 42 U.S.C. 254b] shall not be construed as requir- ing the establishment of a new Advisory Council under such section 337 [42 U.S.C. 254j], and the amendment made by such subsection with respect to the composi- tion of such Advisory Council shall apply with respect to appointments made to the Advisory Council after October 1, 1977, and the Secretary of Health, Education, and Welfare [now Health and Human Services] shall make appointments to the Advisory Council after such date in a manner which will bring about, at the earliest feasible time, the Advisory Council composition pre- scribed by the amendment.’’ Page 389 TITLE 42—THE PUBLIC HEALTH AND WELFARE § 254e Executive Documents 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. § 254e. Health professional shortage areas (a) Designation by Secretary; removal from areas designated; ‘‘medical facility’’ defined (1) For purposes of this subpart the term ‘‘health professional shortage area’’ means (A) an area in an urban or rural area (which need not conform to the geographic boundaries of a political subdivision and which is a rational area for the delivery of health services) which the Secretary determines has a health man- power shortage and which is not reasonably ac- cessible to an adequately served area, (B) a pop- ulation group which the Secretary determines has such a shortage, or (C) a public or nonprofit private medical facility or other public facility which the Secretary determines has such a shortage. All Federally qualified health centers and rural health clinics, as defined in section 1861(aa) of the Social Security Act (42 U.S.C. 1395x(aa)), that meet the requirements of section 254g of this title shall be automatically des- ignated as having such a shortage. The Sec- retary shall not remove an area from the areas determined to be health professional shortage areas under subparagraph (A) of the preceding sentence until the Secretary has afforded inter- ested persons and groups in such area an oppor- tunity to provide data and information in sup- port of the designation as a health professional shortage area or a population group described in subparagraph (B) of such sentence or a facility described in subparagraph (C) of such sentence, and has made a determination on the basis of the data and information submitted by such per- sons and groups and other data and information available to the Secretary. (2) For purposes of this subsection, the term ‘‘medical facility’’ means a facility for the deliv- ery of health services and includes— (A) a hospital, State mental hospital, public health center, outpatient medical facility, re- habilitation facility, facility for long-term care, community mental health center, mi- grant health center, facility operated by a city or county health department, and community health center; (B) such a facility of a State correctional in- stitution or of the Indian Health Service, and a health program or facility operated by a tribe or tribal organization under the Indian Self-Determination Act [25 U.S.C. 5321 et seq.]; (C) such a facility used in connection with the delivery of health services under section 248 of this title (relating to hospitals), 249 of this title (relating to care and treatment of persons under quarantine and others), 250 of this title (relating to care and treatment of Federal prisoners), 251 of this title (relating to examination and treatment of certain Federal employees), 252 of this title (relating to exam- ination of aliens), 253 of this title (relating to services to certain Federal employees), 247e of this title (relating to services for persons with Hansen’s disease), or 254b(h) of this title (re- lating to the provision of health services to homeless individuals); and (D) a Federal medical facility. (3) Homeless individuals (as defined in section 254b(h)(5) of this title), seasonal agricultural workers (as defined in section 254b(g)(3) of this title) and migratory agricultural workers (as so defined)), and residents of public housing (as de- fined in section 1437a(b)(1) of this title) may be population groups under paragraph (1). (b) Criteria for designation of health profes- sional shortage areas; promulgation of regu- lations The Secretary shall establish by regulation criteria for the designation of areas, population groups, medical facilities, and other public fa- cilities, in the States, as health professional shortage areas. In establishing such criteria, the Secretary shall take into consideration the fol- lowing: (1) The ratio of available health manpower to the number of individuals in an area or pop- ulation group, or served by a medical facility or other public facility under consideration for designation. (2) Indicators of a need, notwithstanding the supply of health manpower, for health services for the individuals in an area or population group or served by a medical facility or other public facility under consideration for des- ignation. (3) The percentage of physicians serving an area, population group, medical facility, or other public facility under consideration for designation who are employed by hospitals and who are graduates of foreign medical schools. (c) Considerations in determination of designa- tion In determining whether to make a designa- tion, the Secretary shall take into consideration the following: (1) The recommendations of the Governor of each State in which the area, population group, medical facility, or other public facil- ity under consideration for designation is in whole or part located. (2) The extent to which individuals who are (A) residents of the area, members of the popu- lation group, or patients in the medical facil- ity or other public facility under consider- ation for designation, and (B) entitled to have payment made for medical services under title XVIII, XIX, or XXI of the Social Security Act [42 U.S.C. 1395 et seq., 1396 et seq., 1397aa et seq.], cannot obtain such services because of suspension of physicians from the programs under such titles. (d) Designation; publication of descriptive lists (1) In accordance with the criteria established under subsection (b) and the considerations list- ed in subsection (c), the Secretary shall des- ignate health professional shortage areas in the States, publish a descriptive list of the areas, population groups, medical facilities, and other public facilities so designated, and at least an- nually review and, as necessary, revise such des- ignations.