
From the U.S. Code Online via GPO Access
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[Laws in effect as of January 23, 2000]
[Document not affected by Public Laws enacted between
  January 23, 2000 and December 4, 2001]
[CITE: 42USC254e]

 
                 TITLE 42--THE PUBLIC HEALTH AND WELFARE
 
                    CHAPTER 6A--PUBLIC HEALTH SERVICE
 
                SUBCHAPTER II--GENERAL POWERS AND DUTIES
 
                       Part D--Primary Health Care
 
            subpart ii--national health service corps program
 
Sec. 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 manpower shortage and which is not 
reasonably accessible to an adequately served area, (B) a population 
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. The Secretary 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 interested persons and groups in such area an 
opportunity to provide data and information in support 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 persons 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 delivery of health services and includes--
        (A) a hospital, State mental hospital, public health center, 
    outpatient medical facility, rehabilitation facility, facility for 
    long-term care, community mental health center, migrant health 
    center, facility operated by a city or county health department, and 
    community health center;
        (B) such a facility of a State correctional institution 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. 450f 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 examination 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 256 \1\ of this title (relating to the 
    provision of health services to homeless individuals); and
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    \1\ See References in Text note below.
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        (D) a Federal medical facility.

    (3) Homeless individuals (as defined in section 256(r) \1\ of this 
title) may be a population group under paragraph (1).

(b) Criteria for designation of health professional shortage areas; 
        promulgation of regulations

    The Secretary shall establish by regulation criteria for the 
designation of areas, population groups, medical facilities, and other 
public facilities, in the States, as health professional shortage areas. 
In establishing such criteria, the Secretary shall take into 
consideration the following:
        (1) The ratio of available health manpower to the number of 
    individuals in an area or population 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 designation, with special 
    consideration to indicators of--
            (A) infant mortality,
            (B) access to health services,
            (C) health status, and
            (D) ability to pay for health services.

        (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 designation

    In determining whether to make a designation, 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 
    facility 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 population group, or patients in the medical 
    facility or other public facility under consideration for 
    designation, and (B) entitled to have payment made for medical 
    services under title XVIII or XIX of the Social Security Act [42 
    U.S.C. 1395 et seq., 1396 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) 
of this section and the considerations listed in subsection (c) of this 
section the Secretary shall designate 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 annually review and, as necessary, revise such 
designations.
    (2) For purposes of paragraph (1), a complete descriptive list shall 
be published in the Federal Register not later than July 1 of 1991 and 
each subsequent year.

(e) Notice of proposed designation of areas and facilities; time for 
        comment

    (1) Prior to the designation of a public facility, including a 
Federal medical facility, as a health professional shortage area, the 
Secretary shall give written notice of such proposed designation to the 
chief administrative officer of such facility and request comments 
within 30 days with respect to such designation.
    (2) Prior to the designation of a health professional shortage area 
under this section, the Secretary shall, to the extent practicable, give 
written notice of the proposed designation of such area to appropriate 
public or private nonprofit entities which are located or have a 
demonstrated interest in such area and request comments from such 
entities with respect to the proposed designation of such area.

(f) Notice of designation

    The Secretary shall give written notice of the designation of a 
health professional shortage area, not later than 60 days from the date 
of such designation, to--
        (1) the Governor of each State in which the area, population 
    group, medical facility, or other public facility so designated is 
    in whole or part located; and
        (2) appropriate public or nonprofit private entities which are 
    located or which have a demonstrated interest in the area so 
    designated.

(g) Recommendations to Secretary

    Any person may recommend to the Secretary the designation of an 
area, population group, medical facility, or other public facility as a 
health professional shortage area.

(h) Public information programs in designated areas

    The Secretary may conduct such information programs in areas, among 
population groups, and in medical facilities and other public facilities 
designated under this section as health professional shortage areas as 
may be necessary to inform public and nonprofit private entities which 
are located or have a demonstrated interest in such areas of the 
assistance available under this subchapter by virtue of the designation 
of such areas.

(July 1, 1944, ch. 373, title III, Sec. 332, as added Pub. L. 94-484, 
title IV, Sec. 407(b)(3), Oct. 12, 1976, 90 Stat. 2270; amended Pub. L. 
95-142, Sec. 7(d), Oct. 25, 1977, 91 Stat. 1193; Pub. L. 96-32, 
Sec. 7(d), July 10, 1979, 93 Stat. 84; Pub. L. 97-35, title IX, 
Sec. 986(b)(4), title XXVII, Sec. 2702(a), (b), (c), Aug. 13, 1981, 95 
Stat. 603, 903, 904; Pub. L. 100-77, title VI, Sec. 602, July 22, 1987, 
101 Stat. 515; Pub. L. 100-177, title III, Sec. 302, Dec. 1, 1987, 101 
Stat. 1003; Pub. L. 100-607, title VIII, Sec. 802(b)(2), Nov. 4, 1988, 
102 Stat. 3169; Pub. L. 100-628, title VI, Sec. 602(b)(2), Nov. 7, 1988, 
102 Stat. 3242; Pub. L. 101-597, title I, Sec. 102, title IV, 
Sec. 401(b)[(a)], Nov. 16, 1990, 104 Stat. 3014, 3035.)

                       References in Text

    The Indian Self-Determination Act, referred to in subsec. (a)(2)(B), 
is title I of Pub. L. 93-638, Jan. 4, 1975, 88 Stat. 2206, which is 
classified principally to part A (Sec. 450f et seq.) of subchapter II of 
chapter 14 of Title 25, Indians. For complete classification of this Act 
to the Code, see Short Title note set out under section 450 of Title 25 
and Tables.
    Section 256 of this title, referred to in subsec. (a)(2)(C), (3), 
was repealed by Pub. L. 104-299, Sec. 4(a)(3), Oct. 11, 1996, 110 Stat. 
3645.
    The Social Security Act, referred to in subsec. (c)(2), is act Aug. 
14, 1935, ch. 531, 49 Stat. 620, as amended. Titles XVIII and XIX of the 
Social Security Act are classified generally to subchapters XVIII 
(Sec. 1395 et seq.) and XIX (Sec. 1396 et seq.), respectively, of 
chapter 7 of this title. For complete classification of this Act to the 
Code, see section 1305 of this title and Tables.


                            Prior Provisions

    A prior section 332 of act July 1, 1944, was renumbered section 340, 
and was classified to section 256 of this title prior to repeal by Pub. 
L. 95-626.


                               Amendments

    1990--Subsec. (a)(1). Pub. L. 101-597, Sec. 401(b)[(a)], substituted 
reference to health professional shortage area for reference to health 
manpower shortage area wherever appearing.
    Subsec. (a)(2)(A). Pub. L. 101-597, Sec. 102(b)(1), inserted 
``facility operated by a city or county health department,'' before 
``and community health center''.
    Subsec. (a)(2)(B). Pub. L. 101-597, Sec. 102(b)(2), inserted before 
semicolon ``, and a health program or facility operated by a tribe or 
tribal organization under the Indian Self-Determination Act''.
    Subsec. (a)(2)(C). Pub. L. 101-597, Sec. 102(b)(3), substituted 
``section'' for ``sections'' before ``248'', struck out ``or'' before 
``253'' and ``or section'' before ``247e'', and inserted before 
semicolon ``, or 256 of this title (relating to the provision of health 
services to homeless individuals)''.
    Subsec. (b). Pub. L. 101-597, Sec. 401(b)[(a)], substituted 
reference to health professional shortage area for reference to health 
manpower shortage area.
    Pub. L. 101-597, Sec. 102(c)(1), struck out ``, promulgated not 
later than May 1, 1977,'' after ``establish by regulation''.
    Subsec. (c). Pub. L. 101-597, Sec. 102(c)(2), redesignated pars. (2) 
and (3) as (1) and (2), respectively, and struck out former par. (1) 
which read as follows:
    ``(A) The recommendations of each health systems agency (designated 
under section 300l-4 of this title) for a health service area which 
includes all or any part of the area, population group, medical 
facility, or other public facility under consideration for designation.
    ``(B) The recommendations of the State health planning and 
development agency (designated under section 300m of this title) if such 
area, population group, medical facility, or other public facility is 
within a health service area for which no health systems agency has been 
designated.''
    Subsec. (d). Pub. L. 101-597, Sec. 401(b)[(a)], substituted 
reference to health professional shortage area for reference to health 
manpower shortage area in par. (1).
    Pub. L. 101-597, Sec. 102(a), (c)(3), designated existing provision 
as par. (1), struck out ``, not later than November 1, 1977,'' after 
``Secretary shall designate'', and added par. (2).
    Subsec. (e). Pub. L. 101-597, Sec. 401(b)[(a)], substituted 
reference to health professional shortage area for reference to health 
manpower shortage area wherever appearing.
    Subsec. (f). Pub. L. 101-597, Sec. 401(b)[(a)], substituted 
reference to health professional shortage area for reference to health 
manpower shortage area.
    Pub. L. 101-597, Sec. 102(c)(4), redesignated par. (3) as (2) and 
struck out former par. (2) which read as follows:
    ``(A) each health systems agency (designated under section 300l-4 of 
this title) for a health service area which includes all or any part of 
the area, population group, medical facility, or other public facility 
so designated; or
    ``(B) the State health planning and development agency of the State 
(designated under section 300m of this title) if there is a part of such 
area, population group, medical facility, or other public facility 
within a health service area for which no health systems agency has been 
designated; and''.
    Subsecs. (g), (h). Pub. L. 101-597, Sec. 401(b)[(a)], substituted 
reference to health professional shortage area for reference to health 
manpower shortage area.
    1988--Subsec. (a)(3). Pub. L. 100-607 and Pub. L. 100-628 made 
identical amendments, substituting ``section 256(r)'' for ``section 
256(q)(2)''.
    1987--Subsec. (a)(1). Pub. L. 100-177, Sec. 302(1), inserted 
sentence at end relating to removal of an area from areas determined to 
be health manpower shortage areas.
    Subsec. (a)(3). Pub. L. 100-77 added par. (3).
    Subsec. (b)(2)(D). Pub. L. 100-177, Sec. 302(2), added subpar. (D).
    1981--Subsec. (a)(1)(A). Pub. L. 97-35, Sec. 2702(a), inserted 
provisions respecting reasonable accessibility to adequately served 
area.
    Subsec. (a)(2)(C). Pub. L. 97-35, Sec. 986(b)(4), substituted 
``persons under quarantine'' for ``seamen''.
    Subsec. (e). Pub. L. 97-35, Sec. 2702(c), designated existing 
provisions as par. (1) and added par. (2).
    Subsec. (h). Pub. L. 97-35, Sec. 2702(b), substituted ``may'' for 
``shall''.
    1979--Subsec. (a)(2)(C). Pub. L. 96-32 substituted ``section 247e of 
this title'' for ``part D of subchapter II of this chapter''.
    1977--Subsec. (c)(3). Pub. L. 95-142 added par. (3).


                    Effective Date of 1988 Amendments

    Section 631 of title VI of Pub. L. 100-628 provided that: ``The 
amendments made by subsection (a) of section 601 [amending section 256 
of this title] shall take effect in accordance with subsection (b) of 
such section [formerly set out as a note under section 256 of this 
title]. The amendments otherwise made by this title [amending this 
section and sections 256, 290bb-2, 290cc-21, 290cc-28, 290cc-29, 290cc-
35, 290cc-36, 290dd, 290ee, and 290ee-1 of this title and amending 
provisions set out as a note under section 290aa-3 of this title] shall 
take effect October 1, 1988, or upon the date of the enactment of this 
Act [Nov. 7, 1988], whichever occurs later.''
    Section 831 of title VIII of Pub. L. 100-607 provided that: ``The 
amendments made by subsection (a) of section 801 [amending section 256 
of this title] shall take effect in accordance with subsection (b) of 
such section [formerly set out as a note under section 256 of this 
title]. The amendments otherwise made by this title [amending this 
section and sections 256, 290bb-2, 290cc-21, 290cc-28, 290cc-29, 290cc-
35, 290cc-36, 290dd, 290ee, and 290ee-1 of this title and amending 
provisions set out as a note under section 290aa-3 of this title] shall 
take effect October 1, 1988, or upon the date of the enactment of this 
Act [Nov. 4, 1988], whichever occurs later.''


                    Effective Date of 1981 Amendment

    Amendment by section 986(b)(4) of Pub. L. 97-35 effective Oct. 1, 
1981, see section 986(c) of Pub. L. 97-35, set out as a note under 
section 249 of this title.


                    Effective Date of 1977 Amendment

    Section 7(e)(1) of Pub. L. 95-142 provided that: ``The amendment 
made by subsection (d) [amending this section] shall apply with respect 
to determinations and designations made on and after the date of the 
enactment of this Act [Oct. 25, 1977].''


  Reference to Community, Migrant, Public Housing, or Homeless Health 
              Center Considered Reference to Health Center

    Reference to community health center, migrant health center, public 
housing health center, or homeless health center, considered reference 
to health center, see section 4(c) of Pub. L. 104-299, set out as a note 
under section 254b of this title.


Evaluation of Criteria Used To Designate Health Manpower Shortage Areas; 
                           Report to Congress

    Section 2702(c) of Pub. L. 97-35 directed the Secretary of Health 
and Human Services, effective Oct. 1, 1981, to evaluate the criteria 
used under section 254e(b) of this title to determine if the use of the 
criteria resulted in areas which did not have a shortage of health 
professions personnel being designated as health manpower shortage 
areas, and to consider different criteria (including the actual use of 
health professions personnel in an area by the residents, taking into 
account their health status and indicators of unmet demand and 
likelihood that such demand would not be met in two years) which might 
be used to designate health manpower shortage areas. The Secretary was 
to report the results of his activities to Congress not later than Nov. 
30, 1982.

                  Section Referred to in Other Sections

    This section is referred to in sections 254d, 254f, 254g, 254k, 
254l, 254l-1, 254m, 254n, 254p, 295p, 296j, 297q, 1395l, 1395x, 9840, 
11709 of this title; title 5 section 8902; title 8 section 1182.
