Title 42, The Public Health and WelfareRelease 119-110
§291i Recovery of Expenditures Under Certain Conditions
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 › § 291i
Summary
The United States can require repayment if a facility that got federal money for construction or modernization is sold, transferred to an unapproved or ineligible owner, or stops being a public or nonprofit health facility within 20 years after construction or modernization is finished. The seller or owner must tell the Secretary in writing within 10 days after the sale, transfer, or change of use. The amount to be repaid is based on the federal share of the original project compared to the current value of that part of the facility. Interest is added after certain waiting periods: generally 180 days after the sale/transfer/change for actions after July 18, 1984; for actions before that date there is a rule that starts interest either 30 days after July 18, 1984 or 180 days after the sale, whichever is later. If notice is given, the interest period starts after 180 days from the Secretary’s receipt of the notice; if no notice is given, it starts on the date of the sale/transfer/change. The interest rate is set by the Secretary using an average of the bond equivalent of the weekly 90-day Treasury bill auction rate. The Secretary may waive recovery in some cases: for transfers if the buyer sets up an irrevocable trust meeting specified funding and care conditions tied to clauses in section 291c(e), or for changes of use for good cause. The United States’ right to recover is not a lien on the facility.
Full Legal Text
Title 42, §291i
The Public Health and Welfare, Source: USLM XML via OLRC
(a)Persons liable
If any facility with respect to which funds have been paid under section 291f of this title shall, at any time within 20 years after the completion of construction or modernization—
(1)be sold or transferred to any entity (A) which is not qualified to file an application under section 291e of this title, or (B) which is not approved as a transferee by the State agency designated pursuant to section 291d of this title, or its successor, or
(2)cease to be a public health center or a public or other nonprofit hospital, outpatient facility, facility for long-term care, or rehabilitation facility,
the United States shall be entitled to recover, whether from the transferor or the transferee (or, in the case of a facility which has ceased to be public or nonprofit, from the owners thereof) an amount determined under subsection (c).
(b)Notice to Secretary
The transferor of a facility which is sold or transferred as described in subsection (a)(1), or the owner of a facility the use of which is changed as described in subsection (a)(2), shall provide the Secretary written notice of such sale, transfer, or change not later than the expiration of 10 days from the date on which such sale, transfer, or change occurs.
(c)Amount of recovery; interest; interest period
(1)Except as provided in paragraph (2), the amount the United States shall be entitled to recover under subsection (a) is an amount bearing the same ratio to the then value (as determined by the agreement of the parties or in an action brought in the district court of the United States for the district for which the facility involved is situated) of so much of the facility as constituted an approved project or projects as the amount of the Federal participation bore to the cost of the construction or modernization of such project or projects.
(2)(A)After the expiration of—
(i)180 days after the date of the sale, transfer, or change of use for which a notice is required by subsection (b), in the case of a facility which is sold or transferred or the use of which changes after July 18, 1984, or
(ii)thirty days after July 18, 1984, or if later 180 days after the date of the sale, transfer, or change of use for which a notice is required by subsection (b), in the case of a facility which was sold or transferred or the use of which changed before July 18, 1984.
the amount which the United States is entitled to recover under paragraph (1) with respect to a facility shall be the amount prescribed by paragraph (1) plus interest, during the period described in subparagraph (B), at a rate (determined by the Secretary) based on the average of the bond equivalent of the weekly ninety-day Treasury bill auction rate.
(B)The period referred to in subparagraph (A) is the period beginning—
(i)in the case of a facility which was sold or transferred or the use of which changed before July 18, 1984, thirty days after such date or if later 180 days after the date of the sale, transfer, or change of use for which a notice is required by subsection (b),
(ii)in the case of a facility with respect to which notice is provided in accordance with subsection (b), upon the expiration of 180 days after the receipt of such notice, or
(iii)in the case of a facility with respect to which such notice is not provided as prescribed by subsection (b), on the date of the sale, transfer, or change of use for which such notice was to be provided,
and ending on the date the amount the United States is entitled to under paragraph (1) is collected.
(d)Waiver
(1)The Secretary may waive the recovery rights of the United States under subsection (a)(1) with respect to a facility in any State if the Secretary determines, in accordance with regulations, that the entity to which the facility was sold or transferred—
(A)has established an irrevocable trust—
(i)in an amount equal to the greater of twice the cost of the remaining obligation of the facility under clause (2) of section 291c(e) of this title or the amount, determined under subsection (c), that the United States is entitled to recover, and
(ii)which will only be used by the entity to provide the care required by clause (2) of section 291c(e) of this title; and
(B)will meet the obligation of the facility under clause (1) of section 291c(e) of this title.
(2)The Secretary may waive the recovery rights of the United States under subsection (a)(2) with respect to a facility in any State if the Secretary determines, in accordance with regulations, that there is good cause for waiving such rights with respect to such facility.
(e)Lien
The right of recovery of the United States under subsection (a) shall not constitute a lien on any facility with respect to which funds have been paid under section 291f of this title.
Legislative History
Notes & Related Subsidiaries
Editorial Notes
Prior Provisions
A prior section 291i, act
July 1, 1944, ch. 373, title VI, § 631, as added Aug. 13, 1946, ch. 958, § 2, 60 Stat. 1041; amended
June 19, 1948, ch. 544, 62 Stat. 531; Oct. 25, 1949, ch. 722, § 9, 63 Stat. 901;
July 12, 1954, ch. 471, § 4(c)–(f), 68 Stat. 465, 466; Aug. 1, 1956, ch. 852, § 19(a), (b), 70 Stat. 911;
June 25, 1959, Pub. L. 86–70, § 31(c), 73 Stat. 149;
July 12, 1960, Pub. L. 86–624, § 29(d), 74 Stat. 419; Oct. 5, 1961, Pub. L. 87–395, § 5, 75 Stat. 826; Sept. 25, 1962, Pub. L. 87–688, § 4(a)(2), 76 Stat. 587, related to allotment percentages, and contained various definitions, prior to the general amendment of this subchapter by Pub. L. 88–443. See section 291b of this title. Provisions similar to those comprising this section were contained in section 291h(e) of this title, act
July 1, 1944, ch. 373, title VI, § 625, as added Aug. 13, 1946, ch. 958, § 2, 60 Stat. 1041; amended Oct. 25, 1949, ch. 722, § 3(c), 63 Stat. 899, 901;
July 12, 1954, ch. 471, § 4(b), 68 Stat. 464, prior to the general amendment of this subchapter by Pub. L. 88–443.
Amendments
1984—Pub. L. 98–369 amended section generally. Prior to amendment, section read as follows: “If any facility with respect to which funds have been paid under section 291f of this title shall, at any time within twenty years after the completion of
Construction
— “(a) be sold or transferred to any person, agency, or organization (1) which is not qualified to file an application under section 291e of this title, or (2) which is not approved as a transferee by the State agency designated pursuant to section 291d of this title, or its successor, or “(b) cease to be a public health center or a public or other nonprofit hospital, outpatient facility, facility for long-term care, or rehabilitation facility, unless the Surgeon General determines, in accordance with
Regulations
, that there is good cause for releasing the applicant or other owner from this obligation, the United States shall be entitled to recover from either the transferor or the transferee (or, in the case of a facility which has ceased to be public or nonprofit, from the owners thereof) an amount bearing the same ratio to the then value (as determined by the agreement of the parties or by action brought in the district court of the United States for the district in which the facility is situated) of so much of the facility as constituted an approved project or projects, as the amount of the Federal participation bore to the cost of the
Construction
or modernization under such project or projects. Such right of recovery shall not constitute a lien upon said facility prior to judgment.” 1970—Cl. (b). Pub. L. 91–296 substituted “outpatient facility” for “diagnostic or treatment center”.
Statutory Notes and Related Subsidiaries
Change of Name
“Secretary of Health and Human Services” substituted for “Secretary of Health, Education, and Welfare” in subsecs. (b), (c), and (d) pursuant to section 509(b) of Pub. L. 96–88, which is classified to section 3508(b) of Title 20, Education.
Regulations
and Personnel Pub. L. 98–369, div. B, title III, § 2381(c),
July 18, 1984, 98 Stat. 1116, provided that: “Not later than the expiration of the one-hundred-and-eighty-day period beginning on the date of the enactment of this section [
July 18, 1984], the Secretary shall have in effect
Regulations
and personnel to place in effect the
Amendments
made by this section [amending section 291i and 300s–1a of this title].”
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. § 291i
Title 42, The Public Health and Welfare
Last Updated
Sep 23, 2026
Release point: 119-110