
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: 42USC291b]

 
                 TITLE 42--THE PUBLIC HEALTH AND WELFARE
 
                    CHAPTER 6A--PUBLIC HEALTH SERVICE
 
  SUBCHAPTER IV--CONSTRUCTION AND MODERNIZATION OF HOSPITALS AND OTHER 
                           MEDICAL FACILITIES
 
Part A--Grants and Loans for Construction and Modernization of Hospitals 
                      and Other Medical Facilities
 
Sec. 291b. State allotments


(a) Computation for individual States; formulas for both new 
        construction and modernization

    (1) Each State shall be entitled for each fiscal year to an 
allotment bearing the same ratio to the sums appropriated for such year 
pursuant to subparagraphs (1), (2), and (3), respectively, of section 
291a(a) of this title, and to an allotment bearing the same ratio to the 
sums appropriated for such year pursuant to section 291a(b) of this 
title, as the product of--
        (A) the population of such State, and
        (B) the square of its allotment percentage,

bears to the sum of the corresponding products for all of the States.
    (2) For each fiscal year, the Secretary shall, in accordance with 
regulations, make allotments among the States, from the sums 
appropriated for such year under section 291a(c) of this title, on the 
basis of the population, the financial need, and the extent of the need 
for modernization of the facilities referred to in paragraphs (a) and 
(b) of section 291a of this title, of the respective States.

(b) Minimum allotments

    (1) The allotment to any State under subsection (a) of this section 
for any fiscal year which is less than--
        (A) $50,000 for the Virgin Islands, American Samoa, the Trust 
    Territory of the Pacific Islands, or Guam and $100,000 for any other 
    State, in the case of an allotment for grants for the construction 
    of public or other nonprofit rehabilitation facilities,
        (B) $100,000 for the Virgin Islands, American Samoa, the Trust 
    Territory of the Pacific Islands, or Guam and $200,000 for any other 
    State in the case of an allotment for grants for the construction of 
    public or other nonprofit outpatient facilities,
        (C) $200,000 for the Virgin Islands, American Samoa, the Trust 
    Territory of the Pacific Islands, or Guam and $300,000 for any other 
    State in the case of an allotment for grants for the construction of 
    public or other nonprofit facilities for long-term care or for the 
    construction of public or other nonprofit hospitals and public 
    health centers, or for the modernization of facilities referred to 
    in paragraph (a) or (b) of section 291a of this title, or
        (D) $200,000 for the Virgin Islands, American Samoa, the Trust 
    Territory of the Pacific Islands, or Guam and $300,000 for any other 
    State in the case of an allotment for grants for the modernization 
    of facilities referred to in paragraphs (a) and (b) of section 291a 
    of this title,

shall be increased to that amount, the total of the increases thereby 
required being derived by proportionately reducing the allotment from 
appropriations under such subparagraph or paragraph to each of the 
remaining States under subsection (a) of this section, but with such 
adjustments as may be necessary to prevent the allotment of any of such 
remaining States from appropriations under such subparagraph or 
paragraph from being thereby reduced to less than that amount.
    (2) An allotment of the Virgin Islands, American Samoa, the Trust 
Territory of the Pacific Islands, or Guam for any fiscal year may be 
increased as provided in paragraph (1) only to the extent it satisfies 
the Surgeon General, at such time prior to the beginning of such year as 
the Surgeon General may designate, that such increase will be used for 
payments under and in accordance with the provisions of this part.

(c) Allotment percentages; definitions; determination

    For the purposes of this part--
    (1) The ``allotment percentage'' for any State shall be 100 per 
centum less that percentage which bears the same ratio to 50 per centum 
as the per capita income of such State bears to the per capita income of 
the United States, except that (A) the allotment percentage shall in no 
case be more than 75 per centum or less than 33\1/3\ per centum, and (B) 
the allotment percentage for the Commonwealth of Puerto Rico, Guam, 
American Samoa, the Trust Territory of the Pacific Islands, and the 
Virgin Islands shall be 75 per centum.
    (2) The allotment percentages shall be determined by the Surgeon 
General between July 1 and September 30 of each even-numbered year, on 
the basis of the average of the per capita incomes of each of the States 
and of the United States for the three most recent consecutive years for 
which satisfactory data are available from the Department of Commerce, 
and the States shall be notified promptly thereof. Such determination 
shall be conclusive for each of the two fiscal years in the period 
beginning July 1 next succeeding such determination.
    (3) The population of the several States shall be determined on the 
basis of the latest figures certified by the Department of Commerce.
    (4) The term ``United States'' means (but only for purposes of 
paragraphs (1) and (2)) the fifty States and the District of Columbia.

(d) Availability of allotments in subsequent years

    (1) Any sum allotted to a State, other than the Virgin Islands, 
American Samoa, the Trust Territory of the Pacific Islands, and Guam for 
a fiscal year under this section 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 sums allotted to such State for such purposes for such 
next two fiscal years.
    (2) Any sum allotted to the Virgin Islands, American Samoa, the 
Trust Territory of the Pacific Islands, or Guam for a fiscal year under 
this section and remaining unobligated at the end of such year shall 
remain available to it, for the purpose for which made, for the next two 
fiscal years (and for such years only), in addition to the sums allotted 
to it for such purpose for each of such next two fiscal years.

(e) Transfer of allotments

    (1) Upon the request of any State that a specified portion of any 
allotment of such State under subsection (a) of this section for any 
fiscal year be added to any other allotment or allotments of such State 
under such subsection for such year, the Secretary shall promptly (but 
after application of subsection (b) of this section) adjust the 
allotments of such State in accordance with such request and shall 
notify the State agency; except that the aggregate of the portions so 
transferred from an allotment for a fiscal year pursuant to this 
paragraph may not exceed the amount specified with respect to such 
allotment in clause (A), (B), (C), or (D), as the case may be, of 
subsection (b)(1) of this section which is applicable to such State.
    (2) In addition to the transfer of portions of allotments under 
paragraph (1), upon the request of any State that a specified portion of 
any allotment of such State under subsection (a) of this section, other 
than an allotment for grants for the construction of public or other 
nonprofit rehabilitation facilities, be added to another allotment of 
such State under such subsection, other than an allotment for grants for 
the construction of public or other nonprofit hospitals and public 
health centers, and upon simultaneous certification to the Secretary by 
the State agency in such State to the effect that--
        (A) it has afforded a reasonable opportunity to make 
    applications for the portion so specified and there have been no 
    approvable applications for such portion, or
        (B) in the case of a request to transfer a portion of an 
    allotment for grants for the construction of public or other 
    nonprofit hospitals and public health centers, use of such portion 
    as requested by such State agency will better carry out the purposes 
    of this subchapter,

the Secretary shall promptly (but after application of subsection (b) of 
this section) adjust the allotments of such State in accordance with 
such request and shall notify the State agency.
    (3) In addition to the transfer of portions of allotments under 
paragraph (1) or (2), upon the request of any State that a specified 
portion of an allotment of such State under paragraph (2) of subsection 
(a) of this section be added to an allotment of such State under 
paragraph (1) of such subsection for grants for the construction of 
public or other nonprofit hospitals and public health centers, and upon 
simultaneous certification by the State agency in such State to the 
effect that the need for new public or other nonprofit hospitals and 
public health centers is substantially greater than the need for 
modernization of facilities referred to in paragraph (a) or (b) of 
section 291a of this title, the Secretary shall promptly (but after 
application of subsection (b) of this section) adjust the allotments of 
such State in accordance with such request and shall notify the State 
agency.
    (4) After adjustment of allotments of any State, as provided in 
paragraph (1), (2), or (3) of this subsection, the allotments as so 
adjusted shall be deemed to be the State's allotments under this 
section.

(f) Request by State to transfer portion of allotment

    In accordance with regulations, any State may file with the Surgeon 
General a request that a specified portion of an allotment to it under 
this part for grants for construction of any type of facility, or for 
modernization of facilities, be added to the corresponding allotment of 
another State for the purpose of meeting a portion of the Federal share 
of the cost of a project for the construction of a facility of that type 
in such other State, or for modernization of a facility in such other 
State, as the case may be. If it is found by the Surgeon General (or, in 
the case of a rehabilitation facility, by the Surgeon General and the 
Secretary) that construction or modernization of the facility with 
respect to which the request is made would meet needs of the State 
making the request and that use of the specified portion of such State's 
allotment, as requested by it, would assist in carrying out the purposes 
of this subchapter, such portion of such State's allotment shall be 
added to the corresponding allotment of the other State, to be used for 
the purpose referred to above.

(July 1, 1944, ch. 373, title VI, Sec. 602, as added Pub. L. 88-443, 
Sec. 3(a), Aug. 18, 1964, 78 Stat. 448; amended Pub. L. 90-574, title 
IV, Sec. 402(b), Oct. 15, 1968, 82 Stat. 1011; Pub. L. 91-296, title I, 
Secs. 103(a), (b), 104, 116(a), 119(a)-(c), 122, June 30, 1970, 84 Stat. 
338, 341, 343, 344.)


                            Prior Provisions

    A prior section 291b, act July 1, 1944, ch. 373, title VI, Sec. 612, 
as added Aug. 13, 1946, ch. 958, Sec. 2, 60 Stat. 1041, related to a 
State application for funds, its requirements and its approval, prior to 
the general amendment of this subchapter by Pub. L. 88-443.
    A prior section 291c, act July 1, 1944, ch. 373, title VI, Sec. 624, 
as added Aug. 13, 1946, ch. 958, Sec. 2, 60 Stat. 1941, related to 
subject matter similar to this section, prior to the general amendment 
of this subchapter by Pub. L. 88-443.
    A prior section 291g, act July 1, 1944, ch. 373, title VI, Sec. 624, 
as added Aug. 13, 1946, ch. 958, Sec. 2, 60 Stat. 1041; amended June 29, 
1948, ch. 728, Sec. 1, 62 Stat. 1103; Oct. 25, 1949, ch. 722, 
Secs. 3(b), 7, 63 Stat. 899, 901; Aug. 1, 1956, ch. 852, Sec. 19(c), 70 
Stat. 911; Sept. 25, 1962, Pub. L. 87-688, Sec. 4(a)(3), 76 Stat. 587, 
related to subject matter similar to this section, prior to the general 
amendment of this subchapter by Pub. L. 88-443.
    A prior section 291i(a) to (d), act July 1, 1944, ch. 373, title VI, 
Sec. 631, as added Aug. 13, 1946, ch. 958, Sec. 2, 60 Stat. 1041; 
amended June 19, 1948, ch. 544, 62 Stat. 531; Aug. 1, 1956, ch. 852, 
Sec. 19(a), (b), 70 Stat. 911; June 25, 1959, Pub. L. 86-70, Sec. 31(c), 
73 Stat. 149; July 12, 1960, Pub. L. 86-624, Sec. 29(d), 74 Stat. 419; 
Sept. 25, 1962, Pub. L. 87-688, Sec. 4(a)(2), 76 Stat. 587, related to 
subject matter similar to this section, prior to the general amendment 
of this subchapter by Pub. L. 88-443.
    A prior section 291n-1, act July 1, 1944, ch. 373, title VI, 
Sec. 637, formerly Sec. 654(c), as added July 12, 1954, ch. 471, Sec. 3, 
68 Stat. 463, renumbered and amended Aug. 14, 1959, Pub. L. 86-158, 
title II, Sec. 201, 73 Stat. 349, related to subject matter similar to 
this section, prior to the general amendment of this subchapter by Pub. 
L. 88-443.
    A prior section 291r, act July 1, 1944, ch. 373, title VI, Sec. 648, 
as added July 12, 1954, ch. 471, Sec. 2, 68 Stat. 462, related to 
subject matter similar to this section, prior to the general amendment 
of this subchapter by Pub. L. 88-443.
    A prior section 291t, act July 1, 1944, ch. 373, title VI, Sec. 652, 
as added July 12, 1954, ch. 471, Sec. 3, 68 Stat. 462; amended Aug. 1, 
1956, ch. 852, Sec. 19(c), 70 Stat. 911; Oct. 5, 1961, Pub. L. 87-395, 
Sec. 3(b), 75 Stat. 825; Sept. 25, 1962, Pub. L. 87-688, Sec. 4(a)(3), 
76 Stat. 587, related to subject matter similar to this section, prior 
to the general amendment of this subchapter by Pub. L. 88-443.
    A prior section 291v(b), act July 1, 1944, ch. 373, title VI, 
Sec. 654, as added July 12, 1954, ch. 471, Sec. 3, 68 Stat. 463, related 
to subject matter similar to this section, prior to the general 
amendment of this subchapter by Pub. L. 88-443.


                               Amendments

    1970--Subsec. (a)(1). Pub. L. 91-296, Sec. 103(a), substituted 
``sums appropriated for such year'' for ``new hospital portion of the 
sums appropriated for such year'' and struck out provision setting out a 
formula for determining new hospital portion of sums appropriated 
pursuant to section 291a(b) of this title.
    Subsec. (a)(2). Pub. L. 91-296, Sec. 103(a), substituted 
``Secretary'' for ``Surgeon General'', and substituted reference to sums 
appropriated for such year under section 291a(c) of this title for 
reference to remainder of sums appropriated pursuant to section 291a(b) 
of this title (which portion was to be available for grants for 
modernization of facilities referred to in paragraphs (a) and (b) of 
section 291a of this title).
    Subsec. (b)(1)(A). Pub. L. 91-296, Secs. 103(b)(1), 119(a)(1), 
substituted ``$50,000'' and ``$100,000'' for ``$25,000'' and 
``$50,000'', respectively, and inserted reference to Trust Territory of 
the Pacific Islands.
    Subsec. (b)(1)(B). Pub. L. 91-296, Secs. 103(b)(2), 116(a), 
119(a)(1), substituted ``$100,000'' and ``$200,000'' for ``$50,000'' and 
``$100,000'', respectively, substituted ``outpatient facilities'' for 
``diagnostic or treatment centers'', and inserted reference to Trust 
Territory of the Pacific Islands.
    Subsec. (b)(1)(C). Pub. L. 91-296, Secs. 103(b)(3), 119(a)(1), 
substituted ``$200,000'' and ``$300,000'' for ``$100,000'' and 
``$200,000'', respectively, and inserted reference to Trust Territory of 
the Pacific Islands.
    Subsec. (b)(1)(D). Pub. L. 91-296, Sec. 103(b)(4), added subpar. 
(D).
    Subsecs. (b)(2), (c)(1). Pub. L. 91-296, Sec. 119(a)(2), (b), 
inserted reference to Trust Territory of the Pacific Islands.
    Subsec. (d)(1). Pub. L. 91-296, Secs. 119(c), 122, inserted 
reference to Trust Territory of the Pacific Islands and substituted two 
years for one year as the time span following a year in which allotted 
sums remaining unobligated at the end thereof during which such 
unobligated funds remain available.
    Subsec. (d)(2). Pub. L. 91-296, Sec. 119(c), inserted references to 
Trust Territory of the Pacific Islands.
    Subsec. (e). Pub. L. 91-296, Sec. 104, authorized any State to make 
transfers of any amount up to the minimum amount allotted to any state 
for a particular category and authorized all amounts above such minimums 
to be transferred from one category of assistance to another without 
restriction on the amounts with the exception that no funds could be 
transferred from rehabilitation facilities category or to new hospital 
construction category and that all transfers be justified on the basis 
that either there are no approvable applications in the category from 
which funds are transferred or, in case of transfers from new hospital 
construction category, the purposes of the program would be better 
served by the transfer, and authorized transfers to new hospital 
construction from modernization category if need is greater.
    1968--Subsec. (a)(1). Pub. L. 90-574, Sec. 402(b)(1), inserted 
provision for two-thirds of the sums appropriated in the case of the 
fifth fiscal year thereafter.
    Subsec. (e)(2)(E). Pub. L. 90-574, Sec. 402(b)(2), added subpar. 
(E).


                    Effective Date of 1970 Amendment

    Section 103(a) of Pub. L. 91-296 provided that the amendment made by 
that section is effective with respect to appropriations made pursuant 
to section 291a of this title for fiscal years beginning after June 30, 
1970.
    Section 103(b) of Pub. L. 91-296 provided that the amendment made by 
that section is effective with respect to allotments from appropriations 
made pursuant to section 291a of this title for fiscal years beginning 
after June 30, 1970.
    Section 104 of Pub. L. 91-296 provided that the amendment made by 
that section is effective with respect to allotments made pursuant to 
section 291a of this title for fiscal years beginning after June 30, 
1970.
    Section 119(e) of Pub. L. 91-296 provided that: ``The amendments 
made by this section [amending this section and section 291o of this 
title] shall apply with respect to allotments (and grants therefrom) 
under part A of title VI of the Public Health Service Act [this part] 
for fiscal years ending after June 30, 1970, and with respect to loan 
guarantees and loans under part B of such title [part B of this 
subchapter] made after June 30, 1970.''
    Section 122 of Pub. L. 91-296 provided that the amendment made by 
that section is effective with respect to allotments made from 
appropriations under section 291a of this title for fiscal years 
beginning after June 30, 1970.

                          Transfer of Functions

    Office of Surgeon General abolished by section 3 of Reorg. Plan No. 
3 of 1966, eff. June 25, 1966, 31 F.R. 8855, 80 Stat. 1610, and 
functions thereof transferred to Secretary of Health, Education, and 
Welfare by section 1 of Reorg. Plan No. 3 of 1966, set out as a note 
under section 202 of this title. Secretary of Health, Education, and 
Welfare redesignated Secretary of Health and Human Services by section 
509(b) of Pub. L. 96-88 which is classified to section 3508(b) of Title 
20, Education.

          Termination of Trust Territory of the Pacific Islands

    For termination of Trust Territory of the Pacific Islands, see note 
set out preceding section 1681 of Title 48, Territories and Insular 
Possessions.


 Availability of Funds for Obligation From Allotment for Administration 
                                 of Plan

    Pub. L. 93-641, Sec. 5(b), Jan. 4, 1975, 88 Stat. 2274, provided 
that any State having in the fiscal year ending June 30, 1975 or the 
next fiscal year funds available for obligation from its allotments 
under section 291a et seq. of this title, may in such fiscal year use 
for the proper and efficient administration during such year of its 
State plan an amount of such funds not exceeding 4 percentum of such 
funds or $100,000, whichever is less.


                   Allotment Study; Report to Congress

    Section 103(c) of Pub. L. 91-296 directed Secretary to study effects 
of the formula specified in subsec. (a)(1) of this section for allotment 
among the States for construction of health facilities, with results of 
such study together with recommendations for change to be reported to 
Congress on May 15, 1972.


  Approval of Application for Modernization Prior to July 1, 1965, or 
                     Before Approval of a State Plan

    Section 3(b)(5) of Pub. L. 88-443, providing that no application for 
modernization of any facility may be approved for purposes of receiving 
funds before the approval of a State plan, as well as other 
requirements, is set out as an Effective Date note under section 291 of 
this title.

                  Section Referred to in Other Sections

    This section is referred to in section 291o of this title.
