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Title 42, The Public Health and WelfareRelease 119-110

§291c General Regulations

Title 42 › 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 › § 291c

Last updated Sep 22, 2026|Official source

Summary

The Surgeon General, with approval from the Federal Hospital Council and the Secretary of Health and Human Services, must make rules that tell state agencies how to decide which health facility projects get priority and how the program must work. The rules must say how to rank projects by need and must favor certain kinds of projects, such as hospitals serving areas with low money or rural places, rehab centers tied to university teaching hospitals with integrated services, modernization in densely populated areas, outpatient centers in rural or urban poverty areas, projects that offer comprehensive care (outpatient, preventive, and hospital), sites that train health workers, and places that treat alcoholism. The rules must also set building and equipment standards for different facility types and locations, explain how to count needed hospital and long-term care beds and where to place them, and describe how to judge if a facility needs updating. States must have plans to provide enough covered facilities for everyone in the state and to provide needed care for people who cannot pay. Before a state recommends a project for approval, the state can require the applicant to promise the new or updated part will serve local residents and will provide a reasonable amount of care to people who cannot pay, unless that is financially impossible.

Full Legal Text

Title 42, §291c

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

The Surgeon General, with the approval of the Federal Hospital Council and the Secretary of Health and Human Services shall by general regulations prescribe—
(a)Priority of projects; determination
the general manner in which the State agency shall determine the priority of projects based on the relative need of different areas lacking adequate facilities of various types for which assistance is available under this part, giving special consideration—
(1)in the case of projects for the construction of hospitals, to facilities serving areas with relatively small financial resources and, at the option of the State, rural communities;
(2)in the case of projects for the construction of rehabilitation facilities, to facilities operated in connection with a university teaching hospital which will provide an integrated program of medical, psychological, social, and vocational evaluation and services under competent supervision;
(3)in the case of projects for modernization of facilities, to facilities serving densely populated areas;
(4)in the case of projects for construction or modernization of outpatient facilities, to any outpatient facility that will be located in, and provide services for residents of, an area determined by the Secretary to be a rural or urban poverty area;
(5)to projects for facilities which, alone or in conjunction with other facilities, will provide comprehensive health care, including outpatient and preventive care as well as hospitalization;
(6)to facilities which will provide training in health or allied health professions; and
(7)to facilities which will provide to a significant extent, for the treatment of alcoholism;
(b)Standards of construction and equipment
general standards of construction and equipment for facilities of different classes and in different types of location, for which assistance is available under this part;
(c)Criteria for determining needs for beds, hospitals and other facilities; plans for distribution of beds and facilities
criteria for determining needs for general hospital and long-term care beds, and needs for hospitals and other facilities for which aid under this part is available, and for developing plans for the distribution of such beds and facilities;
(d)Criteria for determining need for modernization
criteria for determining the extent to which existing facilities, for which aid under this part is available, are in need of modernization; and
(e)State plan requirements; assurances necessary for approval of application
that the State plan shall provide for adequate hospitals, and other facilities for which aid under this part is available, for all persons residing in the State, and adequate hospitals (and such other facilities) to furnish needed services for persons unable to pay therefor. Such regulations may also require that before approval of an application for a project is recommended by a State agency to the Surgeon General for approval under this part, assurance shall be received by the State from the applicant that (1) the facility or portion thereof to be constructed or modernized will be made available to all persons residing in the territorial area of the applicant; and (2) there will be made available in the facility or portion thereof to be constructed or modernized a reasonable volume of services to persons unable to pay therefor, but an exception shall be made if such a requirement is not feasible from a financial viewpoint.

Legislative History

Notes & Related Subsidiaries

Editorial Notes

Prior Provisions

A prior section 291c, act
July 1, 1944, ch. 373, title VI, § 613, as added Aug. 13, 1946, ch. 958, § 2, 60 Stat. 1041, related to allotments to States, the determination of their amount, and the disposition of unexpended funds, prior to the general amendment of this subchapter by Pub. L. 88–443. See section 291(a), (b) and (d) of this title. Provisions similar to those comprising this section were contained in a prior section 291e, act
July 1, 1944, ch. 373, title VI, § 622, as added Aug. 13, 1946, ch. 958, § 2, 60 Stat. 1041; amended 1953 Reorg. Plan No. 1, §§ 5, 8, eff. Apr. 11, 1953, 18 F.R. 2053, 67 Stat. 631, prior to the general amendment of this subchapter by Pub. L. 88–443.

Amendments

1970—Subsec. (a). Pub. L. 91–296 struck out from cl. (1) provisions requiring that States give special consideration for projects for hospitals serving rural areas but inserted provisions making such preference optional with each State and added cls. (4) to (7). 1964—Subsec. (a)(4). Pub. L. 88–581 struck out cl. (4) relating to hospital facilities which “will include new or expanded facilities for nurse training”.

Statutory Notes and Related Subsidiaries

Change of Name

“Secretary of Health and Human Services” substituted in text for “Secretary of Health, Education, and Welfare” pursuant to section 509(b) of Pub. L. 96–88, which is classified to section 3508(b) of Title 20, Education.

Effective Date

of 1970 Amendment Pub. L. 91–296, title I, § 110,
June 30, 1970, 84 Stat. 339, provided that the amendment made by that section is effective with respect to applications approved under this subchapter after
June 30, 1970.

Effective Date

of 1964 Amendment Pub. L. 88–581, § 3(b), Sept. 4, 1964, 78 Stat. 919, provided that the

Amendments

made by such section 3(b) [amending this section and section 291o and 293c of this title] are effective with respect to applications for grants from appropriations for fiscal years beginning after June 30, 1965.

Executive Documents

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. Office of Surgeon General reestablished within the Office of the Assistant Secretary for Health, see Notice of Department of Health and Human Services, Office of the Assistant Secretary for Health, Mar. 30, 1987, 52 F.R. 11754.

Reference

Citations & Metadata

Citation

42 U.S.C. § 291c

Title 42, The Public Health and Welfare

Last Updated

Sep 22, 2026

Release point: 119-110