§300e–5 — Title 42 The Public Health and Welfare | U.S. Code

Summary

A loan or loan guarantee under this law can only happen if the applicant sends an application and the Secretary approves it. The Secretary can approve an application only if the application follows the rules in section 300e–7, and if help under section 300e–4 is requested, the Secretary finds the applicant could not finish the project without that help. The application must describe many details (12 main kinds) such as who will be served, membership and enrollment rules, estimated cost per member, where professional services will come from and how services will be organized, quality assurance under section 300e(c), how services will be paid for, facilities and financing, management and finances, member roles and grievance steps, and community and professional support. The applicant must promise to enroll and keep the largest number of members its resources allow (as the Secretary’s rules say). If the project already got federal help before, the applicant must show it has the money and followed past plans and rules. The application must also include any assurances needed to meet section 300e(b)(1) and (2) about community rating payments and be in the form and with any extra information the Secretary requires. The Secretary must make rules for health systems agencies to review and comment on applications.

Title 42, §300e–5

The Public Health and Welfare — Source: USLM XML via OLRC

(a)No loan or loan guarantee may be made under this subchapter unless an application therefor has been submitted to, and approved by, the Secretary.

(b)The Secretary may not approve an application for a loan or loan guarantee under this subchapter unless—

(1)such application meets the requirements of section 300e–7 of this title;

(2)in the case of an application for assistance under section 300e–4 of this title, he determines that the applicant making the application would not be able to complete the project or undertaking for which the application is submitted without the assistance applied for;

(3)the application contains satisfactory specification of the existing or anticipated (A) population group or groups to be served by the proposed or existing health maintenance organization described in the application, (B) membership of such organization, (C) methods, terms, and periods of the enrollment of members of such organization, (D) estimated costs per member of the health and educational services to be provided by such organization and the nature of such costs, (E) sources of professional services for such organization, and organizational arrangements of such organization for providing health and educational services, (F) organizational arrangements of such organization for an ongoing quality assurance program in conformity with the requirements of section 300e(c) of this title, (G) sources of prepayment and other forms of payment for the services to be provided by such organization, (H) facilities, and additional capital investments and sources of financing therefor, available to such organization to provide the level and scope of services proposed, (I) administrative, managerial, and financial arrangements and capabilities of such organization, (J) role for members in the planning and policymaking for such organization, (K) grievance procedures for members of such organization, and (L) evaluations of the support for and acceptance of such organization by the population to be served, the sources of operating support, and the professional groups to be involved or affected thereby;

(4)contains or is supported by assurances satisfactory to the Secretary that the applicant making the application will, in accordance with such criteria as the Secretary shall by regulation prescribe, enroll, and maintain an enrollment of the maximum number of members that its available and potential resources (as determined under regulations of the Secretary) will enable it to effectively serve;

(5)in the case of an application made for a project which previously received a grant, contract, loan, or loan guarantee under this subchapter, such application contains or is supported by assurances satisfactory to the Secretary that the applicant making the application has the financial capability to adequately carry out the purposes of such project and has developed and operated such project in accordance with the requirements of this subchapter and with the plans contained in previous applications for such assistance;

(6)the application contains such assurances as the Secretary may require respecting the intent and the ability of the applicant to meet the requirements of paragraphs (1) and (2) of section 300e(b) of this title respecting the fixing of basic health services payments and supplemental health services payments under a community rating system; and

(7)the application is submitted in such form and manner, and contains such additional information, as the Secretary shall prescribe in regulations.

(c)The Secretary shall by regulation establish standards and procedures for health systems agencies to follow in reviewing and commenting on applications for loans and loan guarantees under this subchapter.

Notes & Related Subsidiaries

Editorial Notes

Amendments

1986—Subsec. (a). Pub. L. 99–660, § 803(b)(1)(A), substituted “loan” for “grant, contract, loan,”. Subsec. (b). Pub. L. 99–660, § 803(b)(1)(A), substituted “loan” for “grant, contract, loan,” in introductory text and in second sentence. Subsec. (b)(1). Pub. L. 99–660, § 803(b)(1)(B), struck out “in the case of an application for assistance under section 300e–2 or 300e–3 of this title, such application meets the application requirements of such section and in the case of an application for a loan or loan guarantee,” before “such application”. Subsec. (b)(2). Pub. L. 99–660, § 805(b), struck out reference to section 300e–4a. Pub. L. 99–660, § 803(b)(1)(C), struck out reference to section 300e–3. Subsec. (b)(5) to (8). Pub. L. 99–660, § 806, redesignated pars. (6), (7), and (8) as (5), (6), and (7), respectively, and struck out former par. (5) which read as follows: “each health systems agency designated for a health service area which covers (in whole or in part) the area to be served by the health maintenance organization for which such application is submitted;”. Subsec. (c). Pub. L. 99–660, § 803(b)(1)(D), substituted “loans” for “grants, contracts, loans,”. 1978—Subsec. (b). Pub. L. 95–559 in par. (2) inserted “in the case of an application for assistance under section 300e–3, 300e–4, or 300e–4a of this title,” before “he determines” and in provisions following par. (8) inserted provision that in determining, for purposes of par. (2), whether an applicant would be able to complete a project or undertaking without the assistance applied for, the Secretary not consider any asset of the applicant the obligation of which for such undertaking or project would jeopardize the fiscal soundness of the applicant. 1976—Subsec. (b)(5). Pub. L. 94–460, § 117(b)(5), substituted “each health systems agency designated for a health service area which covers (in whole or in part) the area to be served by the health maintenance organization for which such application is submitted;” for “the section 314(b) areawide health planning agency whose section 314(b) plan covers (in whole or in part) the area to be served by the health maintenance organization for which such application is submitted, or if there is no such agency, the section 314(a) State health planning agency whose section 314(a) plan covers (in whole or in part) such area, has, in accordance with

Regulations

of the Secretary under subsection (c) of this section, been provided an opportunity to review the application and to submit to the Secretary for his consideration its recommendations respecting approval of the application or if under applicable State law such an application may not be submitted without the approval of the section 314(b) areawide health planning agency or the section 314(a) State health planning agency, the required approval has been obtained;”. Subsec. (b)(7), (8). Pub. L. 94–460, § 105(a)(3), added par. (7) and redesignated former par. (7) as (8). Subsec. (c). Pub. L. 94–460, § 117(b)(6), substituted “health systems agencies” for “section 314(b) areawide health planning agencies and section 314(a) State health planning agencies”.

Statutory Notes and Related Subsidiaries

Effective Date

of 1986 Amendment Pub. L. 99–660, title VIII, § 803(c), Nov. 14, 1986, 100 Stat. 3800, provided that: “The

Amendments

made by this section [amending this section and section 300e–6, 300e–8, and 300e–16 of this title and repealing section 300e–2 and 300e–3 of this title] do not apply to any grant made or contract entered into under title XIII of the Public Health Service Act [42 U.S.C. 300e et seq.] before October 1, 1985.” Pub. L. 99–660, title VIII, § 805(c), Nov. 14, 1986, 100 Stat. 3800, provided that: “The

Amendments

made by this section [amending this section and repealing section 300e–4a of this title] do not apply to any loan or loan guarantee made under section 1305A of the Public Health Service Act [former 42 U.S.C. 300e–4a] before October 1, 1985.” Amendment by Pub. L. 99–660 effective Oct. 1, 1985, see section 815(a) of Pub. L. 99–660, set out as an Effective and Termination Dates of 1986 Amendment note under section 300e–1 of this title.

Effective Date

of 1976 AmendmentAmendment by Pub. L. 94–460 effective Oct. 8, 1976, see section 118 of Pub. L. 94–460, set out as a note under section 300e of this title.

§300e–5 Application requirements

Summary

Title 42, §300e–5

Notes & Related Subsidiaries

Editorial Notes

Amendments

Regulations

Statutory Notes and Related Subsidiaries

Effective Date

Amendments

Amendments

Effective Date

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