§ 300q. Loan and loan guarantee authority

Footnotes

1. 1 So in original. The comma probably should be a semicolon.

Legislative history

Reconstructed from this section’s Code source credit and amendment notes, resolved against the local Statutes at Large. Editorial notes are evidence, not the law that made the change.

1. 1944

   National Health Planning and Resources Development Act of 1974

   Pub. L. 93–641 § 4 · 88 Stat. 2225

   Enacted · 42 U.S.C. § 300q

   July 1, 1944, ch. 373, title XVI, § 1601, formerly § 1620, as added Pub. L. 93–641, § 4, Jan. 4, 1975, 88 Stat. 2264

   Source evidence

   Code source credit
   July 1, 1944, ch. 373, title XVI, § 1601, formerly § 1620, as added Pub. L. 93–641, § 4, Jan. 4, 1975, 88 Stat. 2264

   Enacted provision · exact public law section
   Sec. 4. revision of health resources development programs under the public health service act The Public Health Service Act, as amended by section 3, is amended by adding after title XV the following new title: Ante, p. 2227. “TITLE XVI— HEALTH RESOURCES DEVELOPMENT “Part A— Purpose, State Plan, and Project Approval “Sec. 1601. “purpose It is the purpose of this title to provide assistance, 42 USC 300o. Post, p. 2262. Post, p. 2264. through allotments under part B and loans and loan guarantees and interest subsidies under part C, for projects for— “(1) modernization of medical facilities; “(2) construction of new outpatient medical facilities; “(3) construction of new inpatient medical facilities in areas which have experienced (as determined under regulations of the Secretary) recent rapid population growth; and “(4) conversion of existing medical facilities for the provision of new health services, and to provide assistance, through grants under part D, for construction and modernization projects designed to prevent or eliminate safety hazards in medical facilities or to avoid noncompliance by such facilities with licensure or accreditation standards. “Sec. 1602. “general regulations The Secretary shall by regulation— 42 USC 300o–1. “(1) prescribe the general manner in which the State Agency of each State shall determine for the State medical facilities plan under section 1603 the priority among projects within the State for which assistance is available under this title, based on the relative need of different areas within the State for such projects and giving special consideration— “(A) to projects for medical facilities serving areas with relatively small financial resources and for medical facilities serving rural communities, “(B) in the case of projects for modernization of medical facilities, to projects for facilities serving densely populated areas, “(C) in the case of projects for construction of outpatient medical facilities, to projects that will be located in, and provide services for residents of, areas determined by the Secretary to be rural or urban poverty areas, “(D) to projects designed to (i) eliminate or prevent imminent safety hazards as defined by Federal, State, or local fire, building, or life safety codes or regulations, or (ii) avoid noncompliance with State or voluntary licensure or accreditation standards, and “(E) to projects for medical facilities which, alone or in conjunction with other facilities, will provide comprehensive health care, including outpatient and preventive care as well as hospitalization; “(2) prescribe for medical facilities projects assisted under this title general standards of construction, modernization, and equipment for medical facilities of different classes and in different types of location; “(3) prescribe criteria for determining needs for medical facility beds and needs for medical facilities, and for developing plans for the distribution of such beds and facilities; “(4) prescribe criteria for determining the extent to which existing medical facilities are in need of modernization; “(5) require each State medical facilities plan under section 1503 to provide for adequate medical facilities for all persons residing in the State and adequate facilities to furnish needed health services for persons unable to pay therefor; and “(6) prescribe the general manner in which each entity which receives financial assistance under this title or has received financial assistance under this title or title VI shall be required to comply 42 USC 291. with the assurances required to be made at the time such assistance was received and the means by which such entity shall be required to demonstrate compliance with such assurances. An entity subject to the requirements prescribed pursuant to paragraph (6) respecting compliance with assurances made in connection with receipt of financial assistance shall submit periodically to the Secretary data and information which reasonably supports the entity’s compliance with such assurances. The Secretary may not waive the requirement of the preceding sentence. “Sec. 1603. “state medical facilities plan (a) Before an application for assistance under this 42 USC 300o–2. Post, p. 2268. title (other than part D) for a medical facility project described in section 1601 may be approved, the State Agency of the State in which such project is located must have submitted to the Secretary and had approved by him a State medical facilities plan. To be approved by the Secretary a State medical facilities plan for a State must— “(1) prescribe that the State Agency of the State shall administer or supervise the administration of the plan and contain evidence satisfactory to the Secretary that the State Agency has the authority to carry out the plan in conformity with this title; “(2) prescribe that the Statewide Health Coordinating Council of the State shall advise and consult with the State Agency in carrying out the plan; “(3) be approved by the Statewide Health Coordinating Council as consistent with the State health plan developed pursuant to section 1524(c)(2); “(4) set forth, in accordance with criteria established in regulations prescribed under section 1602(a) and on the basis of a statewide inventory of existing medical facilities, a survey of need, and the plans of health systems agencies within the State— “(A) the number and type of medical facility beds and medical facilities needed to provide adequate inpatient care to people residing in the State, and a plan for the distribution of such beds and facilities in health services areas throughout the State, “(B) the number and type of outpatient and other medical facilities needed to provide adequate public health services and outpatient care to people residing in the State, and a plan for the distribution of such facilities in health service areas throughout the State, and “(C) the extent to which existing medical facilities in the State are in need of modernization or conversion to new uses; “(5) set forth a program for the State for assistance under this title for projects described in section 1601, which program shall indicate the type of assistance which should be made available to each project and shall conform to the assessment of need set forth pursuant to paragraph (4) and regulations promulgated under section 1602(a); “(6) set forth (in accordance with regulations promulgated under section 1602(a)) priorities for the provision of assistance under this title for projects in the program set forth pursuant to paragraph (4); “(7) provide minimum requirements (to be fixed in the discretion of the State Agency) for the maintenance and operation of facilities which receive assistance under this title, and provide for enforcement of such standards; “(8) provide for affording to every applicant for assistance for a medical facilities project under this title an opportunity for a hearing before the State Agency; and “(9) provide that the State Agency will from time to time, but not less often than annually, review the plan and submit to the Secretary any modifications thereof which it considers necessary. “(b) The Secretary shall approve any State medical facilities plan and any modification thereof which complies with the provisions of subsection (a) if the State Agency, as determined under the review made under section 1535(d), is organized and operated in the manner prescribed by section 1522 and is carrying out its functions under section 1523 in a manner satisfactory to the Secretary. If any such plan or modification thereof shall have been disapproved by the Secretary for failure to comply with subsection (a), the Secretary shall, upon request of the State Agency, afford it an opportunity for hearing. “Sec. 1604. “approval of projects (a) For each project described in section 1601 and 42 USC 300o–3. included within a State’s State medical facilities plan approved under section 1603 there shall be submitted to the Secretary, through the State’s State Agency, an application. An application for a grant under section 1625 shall be submitted directly to the Secretary. Except as provided in section 1625, the applicant under such an application may be a State, a political subdivision of a State or any other public entity, or a private nonprofit entity. If two or more entities join in a project, an application for such project may be filed by any of such entities or by all of them. “(b) (1) Except as authorized under paragraph (2), an application Application requirements. for any project shall set forth— “(A) in the case of a modernization project for a medical facility for continuation of existing health services, a finding by the State Agency of a continued need for such services, and, in the case of any other project for a medical facility, a finding by the State Agency of the need for the new health services to be provided through the medical facility upon completion of the project; “(B) a description of the site of such project; “(C) plans and specifications therefor which meet the requirements of the regulations prescribed under section 1602(a); “(D) reasonable assurance that title to such site is or will be vested in one or more of the entities filing the application or in a public or other nonprofit entity which is to operate the facility on completion of the project; “(E) reasonable assurance that adequate financial support will be available for the completion of the project and for its maintenance and operation when completed, and, for the purpose of determining if the requirements of this subparagraph are met, Federal assistance provided directly to a medical facility which is located in an area determined by the Secretary to be an urban or rural poverty area or through benefits provided individuals served at such facility shall be considered as financial support; “(F) the type of assistance being sought under this title for the project; “(G) except in the case of a project under section 1625, a certification by the State Agency of the Federal share for the project; “(H) reasonable assurance that all laborers and mechanics employed by contractors or subcontractors in the performance of work on a project will be paid wages at rates not less than those prevailing on similar construction in the locality as determined by the Secretary of Labor in accordance with the Act of March 3, 1931 (40 U.S.C. 276a—276a–5, known as the Davis-Bacon Act), 40 USC 276a note. and the Secretary of Labor shall have with respect to such labor standards the authority and functions set forth in Reorganization Plan Numbered 14 of 1950 (15 F.R. 3176; 5 U.S.C. Appendix) and section 2 of the Act of June 13, 1934 (40 U.S.C. 276c); “(I) in the case of a project for the construction or modernization of an outpatient facility, reasonable assurance that the services of a general hospital will be available to patients at such facility who are in need of hospital care; and “(J) reasonable assurance that at all times after such application is approved, (i) the facility or portion thereof to be constructed, or modernized, or converted will be made available to all persons residing or employed in the area served by the facility, and (ii) there will be made available in the facility or portion thereof to be constructed, modernized, or converted a reasonable volume of services to persons unable to pay therefor and the Secretary, in determining the reasonableness of the volume of services provided, shall take into consideration the extent to which compliance is feasible from a financial viewpoint. “(2) (A) The Secretary may waive— Waiver. “(i) the requirements of subparagraph (C) of paragraph (1) for compliance with modernization and equipment standards prescribed pursuant to section 1602(a)(2), and “(ii) the requirement of subparagraph (D) of paragraph (1) respecting title to a project site, in the case of an application for a project described in subparagraph (B). “(B) A project referred to in subparagraph (A) is a project— “(i) for the modernization of an outpatient medical facility which will provide general purpose health services, which is not part of a hospital, and which will serve a medically underserved population as defined in section 1623 or as designated by a health systems agency, and “(ii) for which the applicant seeks (I) not more than $20,000 from the allotments made under part B to the State in which it is Post, p. 2262. Post, p. 2264. located, or (II) a loan under part C the principal amount of which does not exceed $20,000. “(c) The Secretary shall approve an application submitted under subsection (b) (other than an application for a grant under section 1625) if— “(1) in the case of a project to be assisted from an allotment made under part B, there are sufficient funds in such allotment to pay the Federal share of the project; and “(2) the Secretary finds that— “(A) the application (i) is in conformity with the State medical facilities plan approved under section 1603, (ii) has been approved and recommended by the State Agency, (iii) is for a project which is entitled to priority over other projects within the State as determined in accordance with the approved State medical facilities plan, and (iv) contains the assurances required by subsection (b); and “(B) the plans and specifications for the project meet the requirements of the regulations prescribed pursuant to section 1602(a). “(d) No application (other than an application for a grant under section 1625) shall be disapproved until the Secretary has afforded the State Agency an opportunity for a hearing. “(e) Amendment of any approved application shall be subject to approval in the same manner as an original application. “(f) Each application shall be reviewed by health systems agencies in accordance with section 1513(e). Ante, p. 2235. “Part B— Allotments “Sec. 1610. “allotments (a) For each fiscal year, the Secretary shall, in accordance 42 USC 300p. with regulations, make from sums appropriated for such fiscal year under section 1513 allotments among the States on the basis of the population, the financial need, and need for medical facilities projects described in section 1601 of the respective States. The population of the States shall be determined on the basis of the latest figures certified by the Secretary of Commerce. “(b) (1) The allotment to any State (other than Guam, American Samoa, the Virgin Islands, or the Trust Territory of the Pacific Islands) for any fiscal year shall be not less than $1,000,000; and the allotment to Guam, American Samoa, the Virgin Islands, and the Trust Territory of the Pacific Islands for any fiscal year shall be not less than $500,000 each. “(2) Notwithstanding paragraph (1), if the amount appropriated under section 1613 for any fiscal year is less than the amount required to provide allotments in accordance with paragraph (1), the amount of the allotment to any State for such fiscal year shall be an amount which bears the same ratio to the amount prescribed for such State by paragraph (1) as the amount appropriated for such fiscal year bears to the amount of appropriations needed to make allotments to all the States in accordance with paragraph (1). “(c) Any amount allotted to a State for a fiscal year under subsection (a) and remaining unobligated at the end of such year shall remain available to such State, for the purpose for which made, for the next two fiscal years (and for such years only), in addition to the amounts allotted to such State for such purposes for such next two fiscal years; except that any such amount which is unobligated at the end of the first of such next two years and which the Secretary determines will remain unobligated at the close of the second of such next two years may be reallotted by the Secretary, to be available for the purposes for which made until the close of the second of such next two years, to other States which have need therefor, on such basis as the Secretary deems equitable and consistent with the purposes of this title. Any amount so reallotted to a State shall be in addition to the amounts allotted and available to the State for the same period. “Sec. 1611. “payments from allotments (a) If with respect to any medical facility project 42 USC 300p–1. approved under section 1604 the State Agency certifies (upon the basis of inspection by it) to the Secretary that, in accordance with approved plans and specifications, work has been performed upon the project or purchases have been made for it and that payment from the applicable allotment of the State in which the project is located is due for the project, the Secretary shall, except as provided in subsection (b), make such payment to the State. “(b) The Secretary is authorized to not make payments to a State Payment restriction. pursuant to subsection (a) in the following circumstances: “(1) If such State is not authorized by law to make payments for an approved medical facility project from the payment to be made by the Secretary pursuant to subsection (a), or if the State so requests, the Secretary shall make the payment from the State allotment directly to the applicant for such project. “(2) If the Secretary, after investigation or otherwise, has reason to believe that any act (or failure to act) has occurred requiring action pursuant to section 1612, payment by the Secretary may, after he has given the State Agency notice and opportunity for hearing pursuant to such section, be withheld, in whole or in part, pending corrective action or action based on such hearing. In no event may the total of payments made under subsection (a) with respect to any project exceed an amount equal to the Federal share of such project. “(c) In case an amendment to an approved application is approved as provided in section 1604 or the estimated cost of a project is revised upward, any additional payment with respect thereto may be made from the applicable allotment of the State for the fiscal year in which such amendment or revision is approved. “(d) In any fiscal year— “(1) not more than 20 per centum of the amount of a State’s allotment available for obligation in that fiscal year may be obligated for projects in the State for construction of new facilities for the provision of inpatient health care to persons residing in areas of the State which have experienced recent rapid population growth; and “(2) not less than 25 per centum of the amount of a State’s allotment available for obligation in that fiscal year shall be obligated for projects for outpatient facilities which will serve medically underserved populations. In the administration of this part, the Secretary shall seek to assure Rural projects. that in each fiscal year at least one half of the amount obligated for projects pursuant to paragraph (2) shall be obligated for projects which will serve rural medically underserved populations. “Sec. 1612. “withholding of payments and other compliance actions (a) Whenever the Secretary, after reasonable notice and 42 USC 300p–2. opportunity for hearing to the State Agency concerned finds— “(1) that the State Agency is not complying substantially with the provisions required by section 1603 to be included in its State medical facilities plan, “(2) that any assurance required to be given in an application filed under section 1604 is not being or cannot be carried out, or “(3) that there is a substantial failure to carry out plans and specifications approved by the Secretary under section 1604, the Secretary shall take the action authorized by subsection (b) unless, in the case of compliance with assurances, the Secretary requires compliance by other means authorized by law. “(b) (1) Upon a finding described in subsection (a) and after notice to the State Agency concerned, the Secretary may— “(A) withhold from all projects within the State with respect to which the finding was made further payments from the State’s allotment under section 1610, or “(B) withhold from the specific projects with respect to which the finding was made further payments from the applicable State allotment under section 1610. “(2) Payments may be withheld, in whole or in part, under paragraph (1)— “(A) until the basis for the finding upon which the withholding was made no longer exists, or “(B) if corrective action to make such finding inapplicable cannot be made, until the State concerned repays or arranges for the repayment of Federal funds paid under this part for projects which because of the finding are not entitled to such funds. “(c) The Secretary shall investigate and ascertain, on a periodic Periodic investigations. basis, with respect to each entity which is receiving financial assistance under this title or which has received financial assistance under title VI or this title, the extent of compliance by such entity with the 42 USC 291. assurances required to be made at the time such assistance was received. If the Secretary finds that such an entity has failed to comply with any such assurance, the Secretary shall take the action authorized by subsection (b) or take any other action authorized by law (including an action for specific performance brought by the Attorney General upon request of the Secretary) which will effect compliance by the entity with such assurances. An appropriate action to effectuate compliance with any such assurance may be brought by a person other than the Secretary only if a complaint has been filed by such person with the Secretary and the Secretary has dismissed such complaint or the Attorney General has not brought a civil action for compliance with such assurance within 6 months after the date on which the complaint was filed with the Secretary. “Sec. 1613. “authorization of appropriations Except as provided in section 1625(d), there are authorized 42 USC 300p–3. to be appropriated for allotments under section 1510 $125,000,000 for the fiscal year ending June 30, 1975, $130,000,000 for the fiscal year ending June 30, 1976, and $135,000,000 for the fiscal year ending June 30, 1977. “Part C— Loans and Loan Guarantees “Sec. 1620. “authority for loans and loan guarantees (a) The Secretary, during the period beginning July 1, 42 USC 300q. 1974, and ending June 30, 1977, may, in accordance with this part, make loans from the fund established under section 1622(d) to pay the Federal share of projects approved under section 1604. “(b) (1) The Secretary, during the period beginning July 1, 1974, and ending June 30, 1977, may, in accordance with this part, guarantee to— “(i) non-Federal lenders for their loans to nonprofit private entities for medical facilities projects, and “(ii) the Federal Financing Bank for its loans to nonprofit private entities for such projects, payment of principal and interest on such loans if applications for assistance for such projects under this title have been approved under section 1604. “(2) In the case of a guarantee of any loan to a nonprofit private Interest payments. entity under this title, the Secretary shall pay, to the holder of such loan and for and on behalf of the project for which the loan was made amounts sufficient to reduce by 3 per centum per annum the net effective interest rate otherwise payable on such loan. Each holder of such a loan which is guaranteed under this title shall have a contractual right to receive from the United States interest payments required by the preceding sentence. “(c) The cumulative total of the principal of the loans outstanding Limitations. at any time with respect to which guarantees have been issued, or which have been directly made, may not exceed such limitations as may be specified in appropriation Acts. “(d) The Secretary, with the consent of the Secretary of Housing HUD assistance. and Urban Development, shall obtain from the Department of Housing and Urban Development such assistance with respect to the administration of this part as will promote efficiency and economy thereof. “Sec. 1621. “allocation among the states (a) For each fiscal year, the total amount of principal 42 USC 300q–1. of— “(1) loans to nonprofit private entities which may be guaranteed, or “(2) loans which may be directly made, under this part shall be allotted by the Secretary among the States, in accordance with regulations, on the basis of the population, financial need, and need for medical facilities projects described in section 1601 of the respective States. The population of the States shall be determined on the basis of the latest figures certified by the Secretary of Commerce. “(b) Any amount allotted to a State for a fiscal year under Unobligated funds, availability to State. subsection (a) and remaining unobligated at the end of such year shall remain available to such State, for the purpose for which made, for the next two fiscal years (and for such years only), in addition to the amounts allotted to such State for such purposes for such next two fiscal years; except that any such amount which is unobligated Reallotments. at the end of the first of such next two years and which the Secretary determines will remain unobligated at the close of the second of such next two years may be reallotted by the Secretary, to be available for the purposes for which made until the close of the second of such next two years, to other States which have need therefor, on such basis as the Secretary deems equitable and consistent with the purposes of this title. Any amount so reallotted to a State shall be in addition to the amounts allotted and available to the State for the same period. “Sec. 1622. “general provisions relating to loan guarantees and loans (a) (1) The Secretary may not approve a loan guarantee 42 USC 300q–2. for a project under this part unless he determines that (A) the terms, conditions, security (if any), and schedule and amount of repayments with respect to the loan are sufficient to protect the financial interests of the United States and are otherwise reasonable, including a determination that the rate of interest does not exceed such per centum per annum on the principal obligation outstanding as the Secretary determines to be reasonable, taking into account the range of interest rates prevailing in the private market for similar loans and the risks assumed by the United States, and (B) the loan would not be available on reasonable terms and conditions without the guarantee under this part. “(2) (A) The United States shall be entitled to recover from the Payment recovery. applicant for a loan guarantee under this part the amount of any payment made pursuant to such guarantee, unless the Secretary for good cause waives such right of recovery; and, upon making any such payment, the United States shall be subrogated to all of the rights of the recipient of the payments with respect to which the guarantee was made. “(B) To the extent permitted by subparagraph (C), any terms and Terms and conditions, modification. conditions applicable to a loan guarantee under this part (including terms and conditions imposed under subparagraph (D)) may be modified by the Secretary to the extent he determines it to be consistent with the financial interest of the United States. “(C) Any loan guarantee made by the Secretary under this part shall be incontestable (i) in the hands of an applicant on whose behalf such guarantee is made unless the applicant engaged in fraud or misrepresentation in securing such guarantee, and (ii) as to any person (or his successor in interest) who makes or contracts to make a loan to such applicant in reliance thereon unless such person (or his successor in interest) engaged in fraud or misrepresentation in making or contracting to make such loan. “(D) Guarantees of loans under this part shall be subject to such further terms and conditions as the Secretary determines to be necessary to assure that the purposes of this title will be achieved. “(b) (1) The Secretary may not approve a loan under this part Loan approval conditions. unless “(A) the Secretary is reasonably satisfied that the applicant under the project for which the loan would be made will be able to make payments of principal and interest thereon when due, and “(B) the applicant provides the Secretary with reasonable assurances that there will be available to it such additional funds as may be necessary to complete the project or undertaking with respect to which such loan is requested. “(2) Any loan made under this part shall (A) have such security, (B) have such maturity date, (C) be repayable in such installments, (D) bear interest at a rate comparable to the current rate of interest prevailing, on the date the loan is made, with respect to loans guaranteed under this part, minus 3 per centum per annum, and (E) be subject to such other terms and conditions (including provisions for recovery in case of default), as the Secretary determines to be necessary to carry out the purposes of this title while adequately protecting the financial interests of the United States. “(3) The Secretary may, for good cause but with due regard to the Waiver. financial interests of the United States, waive any right of recovery which he has by reasons of the failure of a borrower to make payments of principal of and interest on a loan made under this part, except that if such loan is sold and guaranteed, any such waiver shall have no effect upon the Secretary’s guarantee of timely payment of principal and interest. “(c) (1) The Secretary shall from time to time, but with due regard Sale of loans. to the financial interests of the United States, sell loans made under this part either on the private market or to the Federal National Mortgage Association in accordance with section 302 of the Federal National Mortgage Association Charter Act or to the Federal Financing Bank. “(2) Any loan so sold shall be sold for an amount which is equal (or approximately equal) to the amount of the unpaid principal of such loans as of time of sale. “(3) (A) The Secretary is authorized to enter into an agreement Agreements with loan purchaser. with the purchaser of any loan sold under this part under which the Secretary agrees— “(i) to guarantee to such purchaser (and any successor in interest to such purchaser) payments of the principal and interest payable under such loan, and “(ii) to pay as an interest subsidy to such purchaser (and any successor in interest of such purchaser) amounts which, when added to the amount of interest payable on such loan, are equivalent to a reasonable rate of interest on such loan as determined by the Secretary after taking into account the range of prevailing interest rates in the private market on similar loans and the risks assumed by the United States. “(B) Any agreement under subparagraph (A)— “(i) may provide that the Secretary shall act as agent of any such purchaser, for the purpose of collecting from the entity to which such loan was made and paying over to such purchaser any payments of principal and interest payable by such entity under such loan; “(ii) may provide for the repurchase by the Secretary of any such loan on such terms and conditions as may be specified in the agreement; “(iii) shall provide that, in the event of any default by the entity to which such loan was made in payment of principal or interest due on such loan, the Secretary shall, upon notification to the purchaser (or to the successor in interest of such purchaser), have the option to close out such loan (and any obligations of the Secretary with respect thereto) by paying to the purchaser (or his successor in interest) the total amount of outstanding principal and interest due thereon at the time of such notification; and “(iv) shall provide that, in the event such loan is closed out as provided in clause (iii), or in the event of any other loss incurred by the Secretary by reason of the failure of such entity to make payments of principal or interest on such loan, the Secretary shall be subrogated to all rights of such purchaser for recovery of such loss from such entity. “(4) Amounts received by the Secretary as proceeds from the sale of loans under this subsection shall be deposited in the fund established under subsection (d). “(d) (1) There is established in the Treasury a loan and loan guarantee Loan and guarantee fund. Establishment. fund (hereinafter in this subsection referred to as the ‘fund’) which shall be available to the Secretary without fiscal year limitation, in such amounts as may be specified from time to time in appropriation Acts— “(A) to enable him to make loans under this part, “(B) to enable him to discharge his responsibilities under loan guarantees issued by him under this part, “(C) for payment of interest under section 1620(b)(2) on loans guaranteed under this part, “(D) for repurchase of loans under subsection (c)(3)(B), and “(E) for payment of interest on loans which are sold and guaranteed. There are authorized to be appropriated from time to time such Appropriation. amounts as may be necessary to provide the sums required for the fund. There shall also be deposited in the fund amounts received by the Secretary in connection with loans and loan guarantees under this part and other property or assets derived by him from his operations respecting such loans and loan guarantees, including any money derived from the sale of assets. “(2) If at any time the sums in the funds are insufficient to enable the Secretary— “(A) to make payments of interest under section 1620(b)(2), “(B) to otherwise comply with guarantees under this part of loans to nonprofit private entities, “(C) in the case of a loan which was made, sold, and guaranteed under this part, to make to the purchaser of such loan payments of principal and interest on such loan after default by the entity to which the loan was made, or “(D) to repurchase loans under subsection (c)(3)(B), and “(E) to make payments of interest on loans which are sold and guaranteed, he is authorized to issue to the Secretary of the Treasury notes or Notes or other obligations. other obligations in such forms and denominations, bearing such maturities, and subject to such terms and conditions, as may be prescribed by the Secretary with the approval of the Secretary of the Treasury. Such notes or other obligations shall bear interest at a rate determined by the Secretary of the Treasury, taking into consideration the current average market yield on outstanding marketable obligations of the United States of comparable maturities during the month preceding the issuance of the notes or other obligations. The Secretary of the Treasury shall purchase any notes and other obligations issued under this paragraph and for that purpose he may use as a public debt transaction the proceeds from the sale of any securities issued under the Second Liberty Bond Act, and the purposes 31 USC 774. for which the securities may be issued under that Act are extended to include any purchase of such notes and obligations. The Secretary of the Treasury may at any time sell any of the notes or other obligations acquired by him under this paragraph. All redemptions, purchases, and sales by the Secretary of the Treasury of such notes or other obligations shall be treated as a public debt transactions of the United States. Sums borrowed under this paragraph shall be deposited in the fund and redemption of such notes and obligations shall be made by the Secretary from the fund. “(e) (1) The assets, commitments, obligations, and outstanding Transfer of funds. 42 USC 291j–6. balances of the loan guarantee and loan fund established in the Treasury by section 626 shall be transferred to the fund established by subsection (d) of this section. “(2) To provide additional capitalization for the fund established Appropriation. under subsection (d) there are authorized to be appropriated to the fund, such sums as may be necessary for the fiscal years ending June 30, 1975, June 30, 1976, and June 30, 1977. “Part D— Project Grants “Sec. 1625. “project grants (a) The Secretary may make grants for construction 42 USC 300r. or modernization projects designed to (1) eliminate or prevent imminent safety hazards as defined by Federal, State, or local fire, building, or life safety codes or regulations, or (2) avoid noncompliance with State or voluntary licensure or accreditation standards. A grant under this subsection may only be made to a State or political subdivision of a State, including any city, town, county, borough, hospital district authority, or public or quasi-public corporation, for a project described in the preceding sentence for any medical facility owned or operated by it. “(b) An application for a grant under subsection (a) may not be approved under section 1604 unless it contains assurances satisfactory to the Secretary that the applicant making the application would not be able to complete the project for which the application is submitted without the grant applied for. “(c) The amount of any grant under subsection (a) may not Cost limitation. exceed 75 per centum of the cost of the project for which the grant is made unless the project is located in an area determined by the Secretary to be an urban or rural poverty area, in which case the grant may cover up to 100 per centum of such costs. “(d) Of the sums appropriated under section 1613 for a fiscal year, there shall be made available for grants under subsection (a) for such fiscal year 22 per centum of such sums. “Part E— General Provisions “Sec. 1630. “judicial review If— 42 USC 300s. “(1) the Secretary refuses to approve an application for a project submitted under section 1604, the State Agency through which such application was submitted, or “(2) any State is dissatisfied with, or any entity will be adversely affected by, the Secretary’s action under section 1612, such State or entity, may appeal to the United States court of appeals for the circuit in which such State Agency, State, or entity is located, by filing a petition with such court within sixty days after such action. A copy of the petition shall be forthwith transmitted by the clerk of the court to the Secretary, or any officer designated by him for that purpose. The Secretary thereupon shall file in the court the record of the proceedings on which he based his action, as provided in section 2112 of title 28. United States Code. Upon the filing of such petition, the court shall have jurisdiction to affirm the action of the Secretary or to set it aside, in whole or in part, temporarily or permanently, but until the filing of the record, the Secretary may modify or set aside his order. The findings of the Secretary as to the facts, if supported by substantial evidence, shall be conclusive, but the court, for good cause shown, may remand the case to the Secretary to take further evidence, and the Secretary may thereupon make new or modified findings of fact and may modify his previous action, and shall file in the court the record of the further proceedings. Such new or modified findings of fact shall likewise be conclusive if supported by substantial evidence. The judgment of the court affirming or setting aside, in whole or in part, any action of the Secretary shall be final, subject to review by the Supreme Court of the United States upon certiorari or certification as provided in section 1254 of title 28. United States Code. The commencement of proceedings under this section shall not, unless so specifically ordered by the Court, operate as a stay of the Secretary’s action. “Sec. 1631. “recovery (a) If any facility constructed, modernized, or converted 42 USC 300s–1. with funds provided under this title is, at any time within twenty years after the completion of such construction, modernization, or conversion with such funds— “(1) sold or transferred to any person or entity (A) which is not qualified to file an application under section 1604, or (B) which is not approved as a transferee by the State Agency of the State in which such facility is located, or its successor; or “(2) not used as a medical facility, and the Secretary has not determined that there is good cause for termination of such use, the United States shall be entitled to recover from either the transferor or the transferee in the case of a sale or transfer or from the owner in the case of termination of use an amount bearing the same ratio to the then value (as determined by the agreement of the parties or by action brought in the district court of the United States for the district in which the facility is situated) of so much of such facility as constituted an approved project or projects, as the amount of the Federal participation bore to the cost of the construction, modernization, or conversion of such project or projects. Such right of recovery shall not constitute a lien upon such facility prior to judgment. “(b) The Secretary may waive the recovery rights of the United Waiver. States under subsection (a) with respect to a facility in any State— “(1) if (as determined under regulations prescribed by the Secretary) the amount which could be recovered under subsection (a) with respect to such facility is applied to the development, expansion, or support of another medical facility located in such State which has been approved by the Statewide Health Coordinating Council for such State as consistent with the State health plan established pursuant to section 1524(c); or Ante, p. 2247. “(2) if the Secretary determines, in accordance with regulations, that there is good cause for waiving such requirement with respect to such facility. If the amount which the United States is entitled to recover under subsection (a) exceeds 90 per centum of the total cost of the construction or modernization project for a facility, a waiver under this subsection shall only apply with respect to an amount which is not more than 90 per centum of such total cost. The Secretary may not waive a right of recovery which arose one year before the date of the enactment of this title. “Sec. 1632. “state control of operations Except as otherwise specifically provided, nothing in 42 USC 300s–2. this title shall be construed as conferring on any Federal officer or employee the right to exercise any supervision or control over the administration, personnel, maintenance, or operation of any facility with respect to which any funds have been or may be expended under this title. “Sec. 1633. “definitions For the purposes of this title— 42 USC 300s–3. “(1) The term ‘State’ includes the Commonwealth of Puerto Rico, Guam, American Samoa, the Trust Territory of the Pacific Islands, the Virgin Islands, and the District of Columbia. “(2) The term ‘Federal share’ means the proportion of the cost of a medical facilities project which the State Agency determines the Federal Government will provide under allotment payments or a loan or loan guarantee under this title, except that— “(A) in the case of a modernization project— “(i) described in section 1604(b)(2)(B), and “(ii) the application for which received a waiver under section 1604(b)(2)(A), the proportion of the cost of such project to be paid by the Federal Government under allotment payments or a loan may not exceed $20,000 and may not exceed 100 per centum of the first $6,000 of the cost of such project and 66⅔ per centum of the next $21,000 of such cost, “(B) in the case of a project (other than a project described in subparagraph (A)) to be assisted from an allotment made under part B, the proportion of the cost of such project to be paid by the Federal Government may not exceed 66⅔ unless the project is located in an area determined by the Secretary to be an urban or rural poverty area, in which case the proportion of the cost of such project to be paid by the Federal Government may be 100 per centum, and “(C) in the case of a project (other than a project described in subparagraph (A)) to be assisted with a loan or loan guarantee made under part C, the principal amount of the loan directly made or guaranteed for such project, when added to any other assistance provided the project under this title, may not exceed 90 per centum of the cost of such project unless the project is located in an area determined by the Secretary to be an urban or rural poverty area, in which case the principal amount, when added to other assistance under this title, may cover up to 100 per centum of the cost of the project. “(3) The term ‘hospital’ includes general, tuberculosis, and other types of hospitals, and related facilities, such as laboratories, outpatient departments, nurses’ home facilities, extended care facilities, facilities related to programs for home health services, self-care units, and central service facilities, operated in connection with hospitals, and also includes education or training facilities for health professional personnel operated as an integral part of a hospital, but does not include any hospital furnishing primarily domiciliary care. “(4) The term ‘public health center’ means a publicly owned facility for the provision of public health services, including related publicly owned facilities such as laboratories, clinics, and administrative offices operated in connection with such a facility. “(5) The term ‘nonprofit’ as applied to any facility means a facility which is owned and operated 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. “(6) The term ‘outpatient medical facility’ means a medical facility (located in or apart from a hospital) for the diagnosis or diagnosis and treatment of ambulatory patients (including ambulatory inpatients)— “(A) which is operated in connection with a hospital, “(B) in which patient care is under the professional supervision of persons licensed to practice 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 “(C) which offers to patients not requiring hospitalization the services of licensed physicians in various medical specialties, and which provides to its patients a reasonably full-range of diagnostic and treatment services. “(7) The term ‘rehabilitation facility’ means a facility which is operated for the primary purpose of assisting in the rehabilitation of disabled persons through an integrated program of— “(A) medical evaluation and services, and “(B) psychological, social, or vocational evaluation and services, under competent professional supervision, and in the case of which the major portion of the required evaluation and services is furnished within the facility; and either the facility is operated in connection with a hospital, or all medical and related health services are prescribed by, or are under the general direction of, persons licensed to practice medicine or surgery in the State. “(8) The term ‘facility for long-term care’ means a facility (including a skilled nursing or intermediate care facility) providing in-patient care for convalescent or chronic disease patients who required skilled nursing or intermediate care and related medical services— “(A) which is a hospital (other than a hospital primarily for the care and treatment of mentally ill or tuberculous patients) or is operated in connection with a hospital, or “(B) in which such care and medical services are prescribed by, or are performed under the general direction of, persons licensed to practice medicine or surgery in the State. “(9) The term ‘construction’ means construction of new buildings and initial equipment of such buildings and, in any case in which it will help to provide a service not previously 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. “(10) The term ‘cost’ as applied to construction, modernization, or conversion means the amount found by the Secretary to be necessary for construction, modernization, or conversion, respectively, under a project, except that, in the case of a modernization project or a project assisted under part D, such term does not include any amount found Ante, p. 2268. by the Secretary to be attributable to expansion of the bed capacity of any facility. “(11) The term ‘modernization’ includes the alteration, expansion, major repair (to the extent permitted by regulations), remodeling, replacement, and renovation of existing buildings (including initial equipment thereof), and the replacement of obsolete equipment of existing buildings. “(12) The term ‘title,’ when used with reference to a site for a project, means a fee simple, or such other estate or interest (including a leasehold on which the rental does not exceed 4 per centum of the value of the land) as the Secretary finds sufficient to assure for a period of not less than twenty-five years’ undisturbed use and possession for the purposes of construction, modernization, or conversion and operation of the project for a period of not less than (A) twenty years in the case of a project assisted under an allotment or grant under this title, or (B) the term of repayment of a loan made or guaranteed under this title in the case of a project assisted by a loan or loan guarantee. “(13) The term ‘medical facility’ means a hospital, public health center, outpatient medical facility, rehabilitation facility, facility for long-term care, or other facility (as may be designated by the Secretary) for the provision of health care to ambulatory patients. “(14) The term ‘State Agency’ means the State health planning and development agency of a State designated under title XIV. Ante, p. 2227. “(15) The term ‘urban or rural poverty area’ means an urban or rural geographical area (as defined by the Secretary) in which a percentage (as defined by the Secretary in accordance with the next sentence) of the residents of the area have incomes below the poverty level (as defined by the Secretary of Commerce). The percentage referred to in the preceding sentence shall be defined so that the percentage of the population of the United States residing in urban and rural poverty areas is— “(A) not more than the percentage of the total population of the United States with incomes below the poverty level (as so defined) plus five per centum, and “(B) not less than such percentage minus five per centum. “(16) The term ‘medically underserved population’ means the population of an urban or rural area designated by the Secretary as an area with a shortage of health facilities or a population group designated by the Secretary as having a shortage of such facilities. “Sec. 1634. “financial statements; records and audit (a) In the case of any facility for which an allotment 42 USC 300s–4. payment, grant, loan, or loan guarantee has been made under this title, the applicant for such payment, grant, loan, or loan guarantee (or, if appropriate, such other person as the Secretary may prescribe) shall file at least annually with the State Agency 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 “(2) the costs to the facility of providing health services in the facility and the charges made by the facility for providing such services, during the period with respect to which the statement is filed. “(b) (1) Each entity receiving Federal assistance under this title Recordkeeping. shall keep such records as the Secretary shall prescribe, including records which fully disclose the amount and disposition by such entity of the proceeds of such assistance, the total cost of the project in connection with which such assistance is given or used, the amount of that portion of the cost of the project supplied by other sources, and such other records as will facilitate an effective audit. “(2) The Secretary and the Comptroller General of the United Audit. States, or any of their duly authorized representatives, shall have access for the purpose of audit and examination to any books, documents, papers, and records of such entities which in the opinion of the Secretary or the Comptroller General may be related or pertinent to the assistance referred to in paragraph (1). “(c) Each such entity shall file at least annually with the Secretary 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 constructed or modernized with such assistance, and “(2) the costs to such facility of providing health services in such facility, and the charges made for such services, during the period with respect to which the statement is filed. “Sec. 1635. “technical assistance The Secretary shall provide (either through the Department 42 USC 300s–5. of Health, Education, and Welfare or by contract) all necessary technical and other nonfinancial assistance to any public or other nonprofit entity which is eligible to apply for assistance under this title to assist such entity in developing applications to be submitted to the Secretary under section 1604. The Secretary shall make every effort to inform eligible applicants of the availability of assistance under this title. “Part F— Area Health Services Development Funds “Sec. 1640. “development grants for area health services development funds (a) The Secretary shall make in each fiscal year a grant 42 USC 300t. to each health system agency— “(1) with which there is in effect a designation agreement under section 1515(c), Ante, p. 2239. “(2) which has in effect an HSP and AIP reviewed by the Statewide Health Coordinating Council, and “(3) which, as determined under the review made under section 1535(c), is organized and operated in the manner prescribed Ante, p. 2256. Ante, p. 2232. Ante, p. 2235. by section 1512(b) and is performing its functions under section 1513 in a manner satisfactory to the Secretary, to enable the agency to establish and maintain an Area Health Services Development Fund from which it may make grants and enter into contracts in accordance with section 1513(c)(3). “(b) (1) Except as provided in paragraph (2), the amount of any grant under subsection (a) shall be determined by the Secretary after taking into consideration the population of the health service area for which the health systems agency is designated, the average family income of the area, and the supply of health services in the area. “(2) The amount of any grant under subsection (a) to a health Limitation. systems agency for any fiscal year may not exceed the product of $1 and the population of the health service area for which such agency is designated. “(c) No grant may be made under subsection (a) unless an application therefor has been submitted to, and approved by, the Secretary. Such an application shall be submitted in such form and manner and contain such information as the Secretary may require. “(d) For the purpose of making payments pursuant to grants under Appropriations. subsection (a), there are authorized to be appropriated $25,000,000 for the fiscal year ending June 30, 1975, $75,000,000 for the fiscal year ending June 30, 1976, and $120,000,000 for the fiscal year ending June 30, 1977.”

2. 1976

   Fiscal Year Adjustment Act

   Pub. L. 94–273 § 2(21) · 90 Stat. 375

   Substituted · 42 U.S.C. § 300q(a); 42 U.S.C. § 300q(b)(1)

   Pub. L. 94–273 substituted “September” for “June”

   Source evidence

   Code amendment note
   Subsecs. (a), (b)(1). Pub. L. 94–273 substituted “September” for “June”.

   Enacted provision · exact public law section
   (21) sections 435(b), 1305(d), and 1620 of the Public Health Service Act (42 U.S.C. 289o–2(b), 300e–4(d), and 300q);

3. 1977

   Health Planning and Health Services Research and Statistics Extension Act of 1977

   Pub. L. 95–83 title I § 106(x)(1) · 91 Stat. 383

   Substituted · 42 U.S.C. § 300q(a); 42 U.S.C. § 300q(b)(1)

   Pub. L. 95–83 substituted “September 30, 1978” for “September 30, 1977”

   Source evidence

   Code amendment note
   Subsecs. (a), (b)(1). Pub. L. 95–83 substituted “September 30, 1978” for “September 30, 1977”.

   Enacted provision · exact public law section
   (1) Subsections (a) and (b)(1) of section 1620 of such Act are 42 USC 300q. each amended by striking out “September 30, 1977” and inserting in lieu thereof “September 30, 1978”.

4. 1979

   Health Planning and Resources Development Amendments of 1979

   Pub. L. 96–79 title II · 93 Stat. 592

   1. Substituted · 42 U.S.C. § 300q(a)

      Pub. L. 96–79, §§ 201(b)(1), 203(a)(2), added par. (1); substituted reference to section 1602(d) for 1622(d), set out in text as “section 300q–2(d) of this title”; incorporated in par. (2) former subsec. (b) provisions made applicable for period ending Sept. 30, 1982, previously covering period beginning July 1, 1974, and ending Sept. 30, 1978, extended provisions to public entities

   2. Struck · 42 U.S.C. § 300q(a)

      Pub. L. 96–79, §§ 201(b)(1), 203(a)(2), struck out existing condition that applications for assistance under subchapter be approved under former section 300o–3 of this title

   3. Substituted · 42 U.S.C. § 300q(a)

      Pub. L. 96–79, §§ 201(b)(1), 203(a)(2), substituted in subpar. (2)(B) provision for payment of amounts sufficient to reduce by not more than one half net effective interest otherwise payable on the loan for prior provision for amounts sufficient to reduce by 3 per centum per annum net effective interest rate on the loan

   4. Struck · 42 U.S.C. § 300q(a)

      Pub. L. 96–79, §§ 201(b)(1), 203(a)(2), struck out provision granting contractual right of holder of a guaranteed loan to receive from the United States such interest payments

   Source evidence

   Code amendment note
   Subsec. (a). Pub. L. 96–79, §§ 201(b)(1), 203(a)(2), added par. (1); substituted reference to section 1602(d) for 1622(d), set out in text as “section 300q–2(d) of this title”; incorporated in par. (2) former subsec. (b) provisions made applicable for period ending Sept. 30, 1982, previously covering period beginning July 1, 1974, and ending Sept. 30, 1978, extended provisions to public entities, struck out existing condition that applications for assistance under subchapter be approved under former section 300o–3 of this title, substituted in subpar. (2)(B) provision for payment of amounts sufficient to reduce by not more than one half net effective interest otherwise payable on the loan for prior provision for amounts sufficient to reduce by 3 per centum per annum net effective interest rate on the loan, and struck out provision granting contractual right of holder of a guaranteed loan to receive from the United States such interest payments.

   Enacted provision · exact public law
   TITLE II— REVISION OF AUTHORITY FOR HEALTH RESOURCES DEVELOPMENT Sec. 201. revision and extension of assistance (a) Part B of title XVI is repealed. (b) (1) Subsections (a) and (b) of section 1620 are amended to read as follows: “(a) (1) The Secretary, during the period ending September 30, 1982, may, in accordance with this part, make Ioans from the fund established under section 1622(d) to any public or nonprofit private entity for projects for— “(A) the discontinuance of unneeded hospital services or facilities, “(B) the conversion of unneeded hospital services and facilities to needed health services and medical facilities, including outpatient medical facilities and facilities for long-term care; “(C) the renovation and modernization of medical facilities, particularly projects for the prevention or elimination of safety hazards, projects to avoid noncompliance with licensure or accreditation standards, or projects to replace obsolete facilities; “(D) the construction of new outpatient medical facilities; and “(E) the construction of new inpatient medical facilities in areas which have experienced (as determined by the Secretary) recent rapid population growth. “(2) (A) The Secretary, during the period ending September 30, 1982, may, in accordance with this part, guarantee to— “(i) non-Federal lenders for their loans to public and nonprofit private entities for medical facilities projects described in paragraph (1), and “(ii) the Federal Financing Bank for its loans to public and nonprofit private entities for such projects, payment of principal and interest on such loans. “(B) In the case of a guarantee of any loan to a public or nonprofit Projects in urban or rural areas, loan assistance. private entity under subparagraph (A)(i) which is located in an urban or rural poverty area, the Secretary may pay, to the holder of such loan and for and on behalf of the project for which the loan was made, amounts sufficient to reduce by not more than one half the net effective interest rate otherwise payable on such loan if the Secretary finds that without such assistance the project could not be undertaken. “(b) The principal amount of a loan directly made or guaranteed Medical facilities project loan, limitation. Ante, p. 630. under subsection (a) for a medical facilities project, when added to any other assistance provided such project under part B, may not exceed 90 per centum of the cost of such project unless the project is located in an area determined by the Secretary to be an urban or rural poverty area, in which case the principal amount, when added to other assistance under part B, may cover up to 100 per centum of such costs.”. (2) Section 1622(b)(2)(D) is amended by striking out “minus 3 per 42 USC 300q–2. Post, pp. 632, 635. centum per annum” and inserting in lieu thereof the following: “minus any interest subsidy made in accordance with section 1601(a)(2)(B) with respect to a loan made for a project located in Post, p. 635. an urban or rural poverty area”. (3) Section 1622(e)(2) is amended (A) by striking out “and” after “1977,”, and (B) by inserting before the period a comma and the following: “September 30, 1979, September 30, 1980, September 30, 1981, and September 30, 1982”. (c) Section 1625 is amended to read as follows: 42 USC 300r. Post, pp. 632, 635. “Sec. 1625. “project grants (a) (1) (A) The Secretary may make grants for construction or modernization projects designed to— “(i) eliminate or prevent in medical facilities imminent safety hazards as defined by Federal, State, or local fire, building, or life safety codes or regulations, or “(ii) avoid noncompliance by medical facilities with State or voluntary licensure or accreditation standards. “(B) A grant under subparagraph (A) may only be made to— “(i) a State or political subdivision of a State, including any city, town, county, borough, hospital district authority, or public or quasi-public corporation, for any medical facility owned or operated by the State or political subdivision; and “(ii) a nonprofit private entity for any medical facility owned or operated by the entity but only if the Secretary determines— “(I) the level of community service provided by the facility and the proportion of its patients who are unable to pay for services rendered in the facility is similar to such level and proportion in a medical facility of a State or political subdivision, and “(II) that without a grant under subparagraph (A) there would be a disruption of the provision of health care to low-income individuals. “(2) The amount of any grant under paragraph (1) may not exceed 75 per centum of the cost of the project for which the grant is made unless the project is located in an area determined by the Secretary to be an urban or rural poverty area, in which case the grant may cover up to 100 per centum of such costs. “(3) There are authorized to be appropriated for grants under paragraph (1) $40,000,000 for the fiscal year ending September 30, 1980, $50,000,000 for the fiscal year ending September 30, 1981, and $50,000,000 for the fiscal year ending September 30, 1982. Funds available for obligation under this subsection (as in effect before the date of the enactment of the Health Planning and Resources Development Amendments of 1979) in the fiscal year ending September 30, 1979, shall remain available for obligation under this subsection in the succeeding fiscal year. “(b) (1) The Secretary may make grants to public and nonprofit private entities for projects for (A) construction or modernization of outpatient medical facilities which are located apart from hospitals and which will provide services for medically underserved populations, and (B) conversion of existing facilities into outpatient medical facilities or facilities for long-term care to provide services for such populations. “(2) The amount of any grant under paragraph (1) may not exceed 80 per centum of the cost of the project for which the grant is made unless the project is located in an area determined by the Secretary to be an urban or rural poverty area, in which case the grant may cover up to 100 per centum of such costs. “(3) There are authorized to be appropriated for grants under paragraph (1) $15,000,000 for the fiscal year ending September 30, 1981, and $15,000,000 for the fiscal year ending September 30, 1982.”. Sec. 202. conforming amendments (a) Part A of title XVI is repealed and parts C, D, E, and F of title XVI are redesignated as parts A, B, C, and D, respectively. (b) Part C (as so redesignated) of title XVI is amended by striking out section 1630, by redesignating section 1631 through 1635 as section 1622 through 1626, respectively, and by inserting before section 1622 (as so redesignated) the following: “Sec. 1620. “general regulations The Secretary shall by regulation— “(1) prescribe the manner in which he shall determine the priority among projects for which assistance is available under part A or B, based on the relative need of different areas for such projects and giving special consideration— “(A) to projects for medical facilities serving areas with relatively small financial resources and for medical facilities serving rural communities, “(B) in the case of projects for modernization of medical facilities, to projects for facilities serving densely populated areas, “(C) in the case of projects for construction of outpatient medical facilities, to projects that will be located in, and provide services for residents of, areas determined by the Secretary to be rural or urban poverty areas, “(D) to projects designed to (i) eliminate or prevent imminent safety hazards as defined by Federal, State, or local fire, building, or life safety codes or regulations, or (ii) avoid noncompliance with State or voluntary licensure or accreditation standards, and “(E) to projects for medical facilities which, alone or in conjunction with other facilities, will provide comprehensive health care, including outpatient and preventive care as well as hospitalization; “(2) prescribe for medical facilities projects assisted under part A or B general standards of construction, modernization, and equipment, which standards may vary on the basis of the class of facilities and their location; and “(3) prescribe the general manner in which each entity which receives financial assistance under part A or B or has received financial assistance under part A or B or title VI shall be 42 USC 300q–300q–2, 300r, 291. Ante, p. 632. required to comply with the assurances required to be made at the time such assistance was received and the means by which such entity shall be required to demonstrate compliance with such assurances. An entity subject to the requirements prescribed pursuant to paragraph (3) respecting compliance with assurances made in connection with receipt of financial assistance shall submit periodically to the Secretary data and information which reasonably supports the entity’s compliance with such assurances. The Secretary may not waive the requirement of the preceding sentence. “Sec. 1621. “applications (a) No loan, loan guarantee, or grant may be made under part A or B for a medical facilities project unless an application for such project has been submitted to and approved by the Secretary. If two or more entities join in a project, an application for such project may be filed by any of such entities or by all of them. “(b) (1) An application for a medical facilities project shall be submitted in such form and manner as the Secretary shall by regulation prescribe and shall, except as provided in paragraph (2), set forth— “(A) in the case of a modernization project for a medical facility for continuation of existing health services, a finding by the State Agency of a continued need for such services, and, in the case of any other project for a medical facility, a finding by the State Agency of the need for the new health services to be provided through the medical facility upon completion of the project; “(B) in the case of an application for a grant, assurances satisfactory to the Secretary that (i) the applicant making the application would not be able to complete the project for which the application is submitted without the grant applied for, and (ii) in the case of a project to construct a new medical facility, it would be inappropriate to convert an existing medical facility to provide the services to be provided through the new medical facility; “(C) in the case of a project for the discontinuance of a service or facility or the conversion of a service or a facility, an evaluation of the impact of such discontinuance or conversion on the provision of health care in the health service area in which such service was provided or facility located; “(D) a description of the site of such project; “(E) plans and specifications therefor which meet the requirements of the regulations prescribed under section 1620(2); Ante, p. 632. “(F) reasonable assurance that title to such site is or will be vested in one or more of the entities filing the application or in a public or other nonprofit entity which is to operate the facility on completion of the project; “(G) reasonable assurance that adequate financial support will be available for the completion of the project and for its maintenance and operation when completed, and, for the purpose of determining if the requirements of this subparagraph are met, Federal assistance provided directly to a medical facility which is located in an area determined by the Secretary to be an urban or rural poverty area or through benefits provided individuals served at such facility shall be considered as financial support; “(H) the type of assistance being sought under part A or B for the project; “(I) reasonable assurance that all laborers and mechanics employed by contractors or subcontractors in the performance of work on a project will be paid wages at rates not less than those prevailing on similar construction in the locality as determined by the Secretary of Labor in accordance with the Act of March 3, 1931 (40 U.S.C. 276a–276a–5, known as the Davis-Bacon Act), and the Secretary of Labor shall have with respect to such labor standards the authority and functions set forth in Reorganization Plan Numbered 14 of 1950 (15 FR 3176; 5 U.S.C. Appendix) and section 2 of the Act of June 13, 1934 (40 U.S.C. 276c); “(J) in the case of a project for the construction or modernization of an outpatient facility, reasonable assurance that the services of a general hospital will be available to patients at such facility who are in need of hospital care; and “(K) reasonable assurance that at all times after such application is approved (i) the facility or portion thereof to be constructed, modernized, or converted will be made available to all persons residing or employed in the area served by the facility, and (ii) there will be made available in the facility or portion thereof to be constructed, modernized, or converted a reasonable volume of services to persons unable to pay therefor and the Secretary, in determining the reasonableness of the volume of services provided, shall take into consideration the extent to which compliance is feasible from a financial viewpoint. “(2) (A) The Secretary may waive— “(i) the requirements of subparagraph (D) of paragraph (1) for compliance with modernization and equipment standards prescribed Ante, p. 632. pursuant to section 1620(2), and “(ii) the requirement of subparagraph (E) of paragraph (1) respecting title to a project site, in the case of an application for a project described in subparagraph (B) of this paragraph. “(B) A project referred to in subparagraph (A) is a project— “(i) for the modernization of an outpatient medical facility which will provide general purpose health services, which is not part of a hospital, and which will serve a medically underserved 42 USC 300s–3. Ante, p, 632, population as defined in section 1624 or as designated by a health systems agency, and “(ii) for which the applicant seeks a loan under part A the principal amount of which does not exceed $20,000.”. (c) Part C (as so redesignated) of title XVI is amended by adding at the end thereof the following new section: “Sec. 1627. “enforcement of assurances The Secretary shall investigate and ascertain, on a periodic basis, with respect to each entity which is receiving financial assistance under this title or which has received financial assistance under title VI or this title, the extent of compliance by such entity 42 USC 291. Noncompliance report. with the assurances required to be made at the time such assistance was received. If the Secretary finds that such an entity has failed to comply with any such assurance, the Secretary shall report such noncompliance to the health systems agency for the health service area in which such entity is located and the State health planning and development agency of the State in which the entity is located and shall take any action authorized by law (including an action for specific performance brought by the Attorney General upon request of the Secretary) which will effect compliance by the entity with such assurances. An action to effectuate compliance with any such assurance may be brought by a person other than the Secretary only if a complaint has been filed by such person with the Secretary and the Secretary has dismissed such complaint or the Attorney General has not brought a civil action for compliance with such assurance within six months after the date on which the complaint was filed with the Secretary.”. Sec. 203. technical amendments (a) Part A (as so redesignated) of title XVI is amended— Ante, p. 632. 42 USC 300q–1, 300q, 300q–2. 42 USC 300q. (1) by striking out section 1621 and by redesignating sections 1620 and 1622 as sections 1601 and 1602, respectively, (2) by striking out “section 1622(d)” in subsection (a)(1) of section 1601 (as so redesignated) and inserting in lieu thereof “section 1602(d)”, and (3) by striking out “section 1620(b)(2)” each place it occurs in 42 USC 300q–2. subsection (d) of section 1602 (as so redesignated) and inserting in lieu thereof “section 1601(a)(2)(B)”. (b) Section 1625 of part B (as so redesignated) is redesignated as Ante, pp, 631, 632. 42 USC 300r. 42 USC 300s–1a. section 1610. (c) Subsection (a)(1) of section 1622 (as so redesignated) is amended by striking out “section 1604” and inserting in lieu thereof “section 1621 or 1642”. (d) Section 1623 (as so redesignated) is amended by striking out 42 USC 300b–2. “state” in the heading for such section. (e) (1) Section 1624 (as so redesignated) is amended by striking out 42 USC 300s–3. paragraphs (1) and (2) and by redesignating paragraphs (3) through (16) as paragraphs (1) through (14), respectively. (2) Section 2(f) of the Public Health Service Act is amended by 42 USC 201. striking out “1531(1), and 1633(1)” and inserting in lieu thereof “and 1531(1)” (f) Section 1626 (as so redesignated) is amended (1) by striking out 42 USC 300s–5. “nonprofit”, and (2) by striking out “section 1604” and inserting in lieu thereof “section 1621 or 1642”, (g) (1) Section 1602 (as so redesignated) is amended by adding at the 42 USC 300q–2. end thereof the following: “(f) (1) The Secretary may take such action as may be necessary to Loan, default prevention. 42 USC 291. prevent a default on a loan made or guaranteed under this part or under title VI, including the waiver of regulatory conditions, deferral of loan payments, renegotiation of loans, and the expenditure of funds for technical and consultative assistance, for the temporary payment of the interest and principal on such a loan, and for other purposes. Any such expenditure made under the preceding sentence on behalf of a medical facility shall be made under such terms and conditions as the Secretary shall prescribe, including the implementation of such organizational, operational, and financial reforms as the Secretary determines are appropriate and the disclosure of such financial or other information as the Secretary may require to determine the extent of the implementation of such reforms. “(2) The Secretary may take such action, consistent with State law respecting foreclosure procedures, as he deems appropriate to protect the interest of the United States in the event or a default on a loan 42 USC 291. made or guaranteed under this part or under title VI, including for a reasonable period of time taking possession of, holding, and using real property pledged as security for such a loan or loan guarantee.”. (2) Paragraph (1) of subsection (d) of section 1602 (as so redesignated) 42 USC 300q–2. Ante, p. 635. is amended (A) by striking out “and” at the end of subparagraph (D), (B) by striking out the period at the end of subparagraph (E) and inserting in lieu thereof “, and”, and (C) by adding after subparagraph (E) the following: “(F) to enable the Secretary to take the action authorized by subsection (f).”. (3) Paragraph (2) of such subsection (d) is amended (A) by striking out “and” at the end of subparagraph (D), (B) by inserting “and” at the end of subparagraph (E), and (C) by adding after subparagraph (E) the following: “(F) to enable the Secretary to take the action authorized by subsection (f),”. Sec. 204. effective date The amendments made by this title shall take effect October 1, 1979, except that the amendments made by section 201(b) respecting the payment of an interest subsidy for a loan or Ioan guarantee made under part A of title XVI of the Public Health 42 USC 390q–300q–2. Ante, p. 632. Service Act shall apply only with respect to loans and loan guarantees made after October 1, 1979, and with respect to loans and loan guarantees made under such part before such date the Secretary shall continue to pay the interest subsidy authorized for such loans and loan guarantees before such date.

   Effective date note
   Pub. L. 96–79, title II, § 204, Oct. 4, 1979, 93 Stat. 636, provided that: “The amendments made by this title [enacting sections 300s, 300s–1, and 300s–6, amending this section and sections 201, 300q–2, 300r, 300s–1a, 300s–3, and 300s–5, and repealing sections 300o to 300o–3, 300p to 300p–3, 300q–1, and 300s of this title] shall take effect October 1, 1979, except that the amendments made by section 201(b) [amending this section and section 300q–2 of this title] respecting the payment of an interest subsidy for a loan or loan guarantee made under part A of title XVI of the Public Health Service Act [42 U.S.C. 300q et seq.] shall apply only with respect to loans and loan guarantees made after October 1, 1979, and with respect to loans and loan guarantees made under such part before such date the Secretary shall continue to pay the interest subsidy authorized for such loans and loan guarantees before such date.”

5. 1979

   Health Planning and Resources Development Amendments of 1979

   Pub. L. 96–79 § 201(b)(1) · 93 Stat. 592

   Added · 42 U.S.C. § 300q(b)

   Pub. L. 96–79, § 201(b)(1), added subsec. (b) and incorporated existing provisions of subsec. (b) relating to loan guarantee authority for payment of principal and interest on loans for approved projects, their duration, and payments for reduction of interest rate in subsec. (a)(2) of this section

   Source evidence

   Code amendment note
   Subsec. (b). Pub. L. 96–79, § 201(b)(1), added subsec. (b) and incorporated existing provisions of subsec. (b) relating to loan guarantee authority for payment of principal and interest on loans for approved projects, their duration, and payments for reduction of interest rate in subsec. (a)(2) of this section.

   Enacted provision · exact public law section
   (1) Subsections (a) and (b) of section 1620 are amended to read as follows: “(a) (1) The Secretary, during the period ending September 30, 1982, may, in accordance with this part, make Ioans from the fund established under section 1622(d) to any public or nonprofit private entity for projects for— “(A) the discontinuance of unneeded hospital services or facilities, “(B) the conversion of unneeded hospital services and facilities to needed health services and medical facilities, including outpatient medical facilities and facilities for long-term care; “(C) the renovation and modernization of medical facilities, particularly projects for the prevention or elimination of safety hazards, projects to avoid noncompliance with licensure or accreditation standards, or projects to replace obsolete facilities; “(D) the construction of new outpatient medical facilities; and “(E) the construction of new inpatient medical facilities in areas which have experienced (as determined by the Secretary) recent rapid population growth. “(2) (A) The Secretary, during the period ending September 30, 1982, may, in accordance with this part, guarantee to— “(i) non-Federal lenders for their loans to public and nonprofit private entities for medical facilities projects described in paragraph (1), and “(ii) the Federal Financing Bank for its loans to public and nonprofit private entities for such projects, payment of principal and interest on such loans. “(B) In the case of a guarantee of any loan to a public or nonprofit Projects in urban or rural areas, loan assistance. private entity under subparagraph (A)(i) which is located in an urban or rural poverty area, the Secretary may pay, to the holder of such loan and for and on behalf of the project for which the loan was made, amounts sufficient to reduce by not more than one half the net effective interest rate otherwise payable on such loan if the Secretary finds that without such assistance the project could not be undertaken. “(b) The principal amount of a loan directly made or guaranteed Medical facilities project loan, limitation. Ante, p. 630. under subsection (a) for a medical facilities project, when added to any other assistance provided such project under part B, may not exceed 90 per centum of the cost of such project unless the project is located in an area determined by the Secretary to be an urban or rural poverty area, in which case the principal amount, when added to other assistance under part B, may cover up to 100 per centum of such costs.”.

   Effective date note
   Pub. L. 96–79, title II, § 204, Oct. 4, 1979, 93 Stat. 636, provided that: “The amendments made by this title [enacting sections 300s, 300s–1, and 300s–6, amending this section and sections 201, 300q–2, 300r, 300s–1a, 300s–3, and 300s–5, and repealing sections 300o to 300o–3, 300p to 300p–3, 300q–1, and 300s of this title] shall take effect October 1, 1979, except that the amendments made by section 201(b) [amending this section and section 300q–2 of this title] respecting the payment of an interest subsidy for a loan or loan guarantee made under part A of title XVI of the Public Health Service Act [42 U.S.C. 300q et seq.] shall apply only with respect to loans and loan guarantees made after October 1, 1979, and with respect to loans and loan guarantees made under such part before such date the Secretary shall continue to pay the interest subsidy authorized for such loans and loan guarantees before such date.”

4 of 8 references resolved to an enrolled provision · 4 partial