
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: 42USC291o]

 
                 TITLE 42--THE PUBLIC HEALTH AND WELFARE
 
                    CHAPTER 6A--PUBLIC HEALTH SERVICE
 
  SUBCHAPTER IV--CONSTRUCTION AND MODERNIZATION OF HOSPITALS AND OTHER 
                           MEDICAL FACILITIES
 
                       Part D--General Provisions
 
Sec. 291o. Definitions

    For the purposes of this subchapter--
    (a) 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.
    (b)(1) The term ``Federal share'' with respect to any project means 
the proportion of the cost of such project to be paid by the Federal 
Government under this subchapter.
    (2) With respect to any project in any State for which a grant is 
made from an allotment from an appropriation under section 291a of this 
title, the Federal share shall be the amount determined by the State 
agency designated in accordance with section 291d of this title, but not 
more than 66\2/3\ per centum or the State's allotment percentage, 
whichever is the lower, except that, if the State's allotment percentage 
is lower than 50 per centum, such allotment percentage shall be deemed 
to be 50 per centum for purposes of this paragraph.
    (3) Prior to the approval of the first project in a State during any 
fiscal year the State agency designated in accordance with section 291d 
of this title shall give the Secretary written notification of the 
maximum Federal share established pursuant to paragraph (2) of this 
subsection for projects in such State to be approved by the Secretary 
during such fiscal year and the method for determining the actual 
Federal share to be paid with respect to such projects; and such maximum 
Federal share and such method of determination for projects in such 
State approved during such fiscal year shall not be changed after such 
approval.
    (4) Notwithstanding the provisions of paragraphs (2) and (3) of this 
subsection, the Federal share shall, at the option of the State agency, 
be equal to the per centum provided under such paragraphs plus an 
incentive per centum (which when combined with the per centum provided 
under such paragraphs shall not exceed 90 per centum) specified by the 
State agency in the case of (A) projects that will provide services 
primarily for persons in an area determined by the Secretary to be a 
rural or urban poverty area, and (B) projects that offer potential for 
reducing health care costs through shared services among health care 
facilities, through interfacility cooperation, or through the 
construction or modernization of free-standing outpatient facilities.
    (c) 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 professions personnel operated as an integral part of a hospital, 
but does not include any hospital furnishing primarily domiciliary care.
    (d) 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.
    (e) 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.
    (f) The term ``outpatient facility'' means a facility (located in or 
apart from a hospital) for the diagnosis or diagnosis and treatment of 
ambulatory patients (including ambulatory inpatients)--
        (1) which is operated in connection with a hospital, or
        (2) 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
        (3) 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.

    (g) 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--
        (1) medical evaluation and services, and
        (2) psychological, social, or vocational evaluation and 
    services,

under competent professional supervision, and in the case of which--
        (3) the major portion of the required evaluation and services is 
    furnished within the facility; and
        (4) either (A) the facility is operated in connection with a 
    hospital, or (B) 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.

    (h) The term ``facility for long-term care'' means a facility 
(including an extended care facility) providing in-patient care for 
convalescent or chronic disease patients who require skilled nursing 
care and related medical services--
        (1) which is a hospital (other than a hospital primarily for the 
    care and treatment of mentally ill or tuberculosis patients) or is 
    operated in connection with a hospital, or
        (2) in which such nursing care and medical services are 
    prescribed by, or are performed under the general direction of, 
    persons licensed to practice medicine or surgery in the State.

    (i) The term ``construction'' includes construction of new 
buildings, expansion, remodeling, and alteration of existing buildings, 
and initial equipment of any such buildings (including medical 
transportation facilities) 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.
    (j) The term ``cost'' as applied to construction or modernization 
means the amount found by the Surgeon General to be necessary for 
construction and modernization respectively, under a project, except 
that such term, as applied to a project for modernization of a facility 
for which a grant or loan is to be made from an allotment under section 
291b(a)(2) of this title, does not include any amount found by the 
Surgeon General to be attributable to expansion of the bed capacity of 
such facility.
    (k) The term ``modernization'' includes alteration, major repair (to 
the extent permitted by regulations), remodeling, replacement, and 
renovation of existing buildings (including initial equipment thereof), 
and replacement of obsolete, built-in (as determined in accordance with 
regulations) equipment of existing buildings.
    (l) The term ``title'', when used with reference to a site for a 
project, means a fee simple, or 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 Surgeon General finds sufficient to assure for 
a period of not less than fifty years' undisturbed use and possession 
for the purposes of construction and operation of the project.

(July 1, 1944, ch. 373, title VI, Sec. 645, formerly Sec. 625, as added 
Pub. L. 88-443, Sec. 3(a), Aug. 18, 1964, 78 Stat. 460; amended Pub. L. 
88-581, Sec. 3(b), Sept. 4, 1964, 78 Stat. 919; renumbered Sec. 645 and 
amended Pub. L. 91-296, title I, Secs. 113, 114(a), 116(f), 117, 118, 
119(d), title II, Sec. 201, June 30, 1970, 84 Stat. 340, 341, 342, 343, 
344.)


                            Prior Provisions

    A prior section 291o, act July 1, 1944, ch. 373, title VI, Sec. 641, 
as added July 12, 1954, ch. 471, Sec. 2, 68 Stat. 461, related to a 
declaration of purpose with respect to diagnostic or treatment centers, 
chronic disease hospitals, rehabilitation facilities, and nursing homes, 
prior to the general amendment of this subchapter by Pub. L. 88-443. See 
section 291 of this title.
    Provisions similar to those comprising this section were contained 
in section 291i(d) to (o), act July 1, 1944, ch. 373, title VI, 
Sec. 631, as added Aug. 13, 1946, ch. 958, Sec. 2, 60 Stat. 1041; 
amended June 19, 1948, ch. 544, Sec. 1(b), 62 Stat. 531; Oct. 25, 1949, 
ch. 722, Sec. 9, 63 Stat. 901; July 12, 1954, ch. 471, Sec. 4(c) to (f), 
68 Stat. 465, 466; Aug. 1, 1956, ch. 852, Sec. 19(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; Oct. 5, 1961, Pub. L. 87-395, 
Sec. 5, 75 Stat. 826; Sept. 25, 1962, Pub. L. 87-688, Sec. 4(a)(2), 76 
Stat. 587, prior to the general amendment of this subchapter by Pub. L. 
88-443.


                               Amendments

    1970--Subsec. (a). Pub. L. 91-296, Sec. 119(d), inserted reference 
to Trust Territory of the Pacific Islands.
    Subsec. (b). Pub. L. 91-296, Sec. 113, provided that Federal share 
of any project be in such amount, not in excess of two-thirds, as the 
State agency determined and authorized a higher Federal share of up to 
90 per centum, in case of rural or urban poverty projects, and 
facilities which might reduce health costs through shared services, 
interfacility cooperation, and free-standing ambulatory care centers.
    Subsec. (c). Pub. L. 91-296, Sec. 114(a), inserted references to 
extended care facilities, facilities related to programs for home health 
services, and self-care units operated in connection with hospitals and 
education or training facilities for health professions personnel 
operated as an integral part of a hospital.
    Subsec. (f). Pub. L. 91-296, Sec. 116(f), substituted ``outpatient 
facility'' for ``diagnostic or treatment center'', inserted ``(located 
in or apart from a hospital)'' after ``means at facility'', inserted 
``(including ambulatory inpatients)'' after ``ambulatory patients'', and 
added par. (3).
    Subsec. (h). Pub. L. 91-296, Sec. 117, inserted ``(including an 
extended care facility)'' after ``means a facility''.
    Subsec. (i). Pub. L. 91-296, Sec. 118, inserted reference to 
equipment of any buildings in cases in which such equipment will help to 
provide a service not previously provided in the community.
    1964--Subsec. (c). Pub. L. 88-581 substituted ``nurses' home 
facilities'' for ``nurses' home and training facilities''.


                    Effective Date of 1970 Amendment

    Section 113 of Pub. L. 91-296 provided that the amendment made by 
that section is effective with respect to projects approved under this 
subchapter after June 30, 1970.
    Section 114(a) of Pub. L. 91-296 provided that the amendment made by 
that section is effective with respect to applications approved under 
this subchapter after June 30, 1970.
    Section 116(g) of Pub. L. 91-296 provided that: ``The amendments 
made by subsection (e) [amending this section] and paragraphs (2) and 
(3) of subsection (f) of this section [amending section 291e of this 
title] shall apply with respect to applications approved under title VI 
of such Act [this subchapter] after June 30, 1970.''
    Section 117 of Pub. L. 91-296 provided that the amendment made by 
that section is effective with respect to applications approved under 
this subchapter after June 30, 1970.
    Section 118 of Pub. L. 91-296 provided that the amendment made by 
that section is effective with respect to projects approved under this 
subchapter after June 30, 1970.
    Amendment by section 119(d) of Pub. L. 91-296 applicable with 
respect to allotments and grants therefrom under part A of this 
subchapter for fiscal years ending after June 30, 1970, and with respect 
to loan guarantees and loans under part B of this subchapter made after 
June 30, 1970, see section 119(e) of Pub. L. 91-296, set out as a note 
under section 291b of this title.


                    Effective Date of 1964 Amendment

    Amendment by Pub. L. 88-581 effective with respect to applications 
for grants from appropriations for fiscal years beginning after June 30, 
1965, see section 3(b) of Pub. L. 88-581, set out as a note under 
section 291c of this title.

                          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.

                  Section Referred to in Other Sections

    This section is referred to in section 291e of this title; title 29 
section 731.
