U.S. Code » Title 42 » Chapter CHAPTER 6A— PUBLIC HEALTH SERVICE › Subchapter SUBCHAPTER IV— CONSTRUCTION AND MODERNIZATION OF HOSPITALS AND OTHER MEDICAL FACILITIES › Part Part A— Grants and Loans for Construction and Modernization of Hospitals and Other Medical Facilities

42 U.S.C. § 291c

General regulations

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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; determinationthe 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.

(July 1, 1944, ch. 373, title VI, § 603, as added Pub. L. 88–443, § 3(a), Aug. 18, 1964, 78 Stat. 451; amended Pub. L. 88–581, § 3(b), Sept. 4, 1964, 78 Stat. 919; Pub. L. 91–296, title I, § 110, June 30, 1970, 84 Stat. 339; Pub. L. 96–88, title V, § 509(b), Oct. 17, 1979, 93 Stat. 695.)Editorial NotesPrior 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 SubsidiariesChange 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 sections 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 DocumentsTransfer 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.

Notes of Decisions
Cited in 80 cases, 1970–2011 · leading case: Nat'l Ass'n of Neighborhood Health Centers v. David Mathews, 551 F.2d 321 (D.C. Cir. 1976).
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Nat'l Ass'n of Neighborhood Health Centers v. David Mathews, 551 F.2d 321 (D.C. Cir. 1976). · cites it 9× “42 U.S.C. § 291c. 14 . 42 U.S.C. § 291d(b).”
Wyoming Hosp. Ass'n v. Harris, 527 F. Supp. 551 (D. Wyo. 1981). · cites it 12× “Yet, such speculation on the intent of Congress in passing the original version of the Hill-Burton Act fails to surmount the unambiguous and unqualified language of 42 U.S.C. § 291c(e), which requires that: (An) assurance shall be received by the State from the applicant that…”
City of Revere v. Massachusetts Gen. Hosp., 463 U.S. 239 (1983). · cites it 2× “See 42 U. S. C. § 291c(e). In the Commonwealth of Massachusetts now, any hospital with an emergency facility must provide emergency services regardless of the patient's ability to pay.”
Am. Hosp. Ass'n v. Richard S. Schweiker, 721 F.2d 170 (7th Cir. 1983). · cites it 6× “He was required to issue general regulations to ensure that the various state plans provide that the facilities established with the aid of federal funds be made available to all residents of the community and that they furnish services to persons unable to pay, 42 U.S.C. §…”
Gordon v. Forsyth Cnty. Hosp. Auth., Inc., 409 F. Supp. 708 (M.D.N.C. 1976). · cites it 4× “Pursuant to this section, which implements the phrase “persons unable to pay” found in 42 U.S.C. § 291c(e), Forsyth normally postpones determination of a person’s inability to pay until after the services are rendered and sometimes until after a bill has been sent and has…”
Florida ex rel. Attorney Gen. v. United States Dep't of Health & Human Servs., 648 F.3d 1235 (11th Cir. 2011). · cites it 2× “The Hill-Burton Act required hospitals receiving federal construction or renovation funds to provide care to "all persons residing in the territorial area" and to provide a "reasonable volume" of free care to indigent patients.”
League of United Latin Am. Citizens v. Wilson, 908 F. Supp. 755 (C.D. Cal. 1995). · cites it 3× “See 42 U.S.C. § 291c. In an application for funds under the Act, the applicant state and institution must make assurances 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…”
Braun v. Ada Cnty., 643 P.2d 1071 (Idaho 1982). · cites it 4× “Luke's Hospital's uncompensated services obligation under the federal Hill-Burton Act, 42 U.S.C. § 291c(e)(2). Consequently, appellant's application for assistance was again denied.”
Mem'l Hosp. v. Margaret M. Heckler, 706 F.2d 1130 (11th Cir. 1983). · cites it 2× “42 U.S.C.A. § 291c(e)(2). A hospital may satisfy this obligation to provide uncompensated care to indigents for a 20-year period in one of two ways: (1) it may budget for free care to indigents at a level not less than the lesser of 3 percent of its operating costs or 10 percent…”
Lugo v. Simon, 453 F. Supp. 677 (N.D. Ohio 1978). · cites it 3× “” 42 U.S.C. § 291c(e) (hereafter this assurance will be referred to as the “reasonable volume” assurance.”
Lugo v. Simon, 426 F. Supp. 28 (N.D. Ohio 1976). · cites it 3× “The defendant secretary, in his motion, argues that he has fulfilled his responsibility to ensure that state plans which have been submitted to him for approval fully comply with the statutory and regulatory scheme of the Hill-Burton Act and that he has thus fulfilled his…”
Corum v. Beth Israel Med. Ctr., 359 F. Supp. 909 (S.D.N.Y. 1973). · cites it 3× “” 42 U.S.C. § 291c (emphasis added). On July 22, 1972, 1 HEW 2 issued an interim regulation implementing the statute’s “reasonable volume” requirement, which was approved, without substantial modification, as a final regulation by the Federal Hospital Council on March 13, 1973.”
Show all 80 citing cases →
42 U.S.C. § 291c(a)(4): 1 case
Nat'l Ass'n of Neighborhood Health Centers v. David Mathews, 551 F.2d 321 (D.C. Cir. 1976). “42 U.S.C. § 291c. 14 . 42 U.S.C. § 291d(b).”
42 U.S.C. § 291c(d): 1 case
Am. Hosp. Ass'n v. Schweiker, 529 F. Supp. 1283 (N.D. Ill. 1982).
42 U.S.C. § 291c(e): 44 cases
Wyoming Hosp. Ass'n v. Harris, 527 F. Supp. 551 (D. Wyo. 1981). “Yet, such speculation on the intent of Congress in passing the original version of the Hill-Burton Act fails to surmount the unambiguous and unqualified language of 42 U.S.C. § 291c(e), which requires that: (An) assurance shall be received by the State from the applicant that…”
City of Revere v. Massachusetts Gen. Hosp., 463 U.S. 239 (1983). “See 42 U. S. C. § 291c(e). In the Commonwealth of Massachusetts now, any hospital with an emergency facility must provide emergency services regardless of the patient's ability to pay.”
Am. Hosp. Ass'n v. Richard S. Schweiker, 721 F.2d 170 (7th Cir. 1983). “He was required to issue general regulations to ensure that the various state plans provide that the facilities established with the aid of federal funds be made available to all residents of the community and that they furnish services to persons unable to pay, 42 U.S.C. §…”
Florida ex rel. Attorney Gen. v. United States Dep't of Health & Human Servs., 648 F.3d 1235 (11th Cir. 2011). “The Hill-Burton Act required hospitals receiving federal construction or renovation funds to provide care to "all persons residing in the territorial area" and to provide a "reasonable volume" of free care to indigent patients.”
Gordon v. Forsyth Cnty. Hosp. Auth., Inc., 409 F. Supp. 708 (M.D.N.C. 1976). “Pursuant to this section, which implements the phrase “persons unable to pay” found in 42 U.S.C. § 291c(e), Forsyth normally postpones determination of a person’s inability to pay until after the services are rendered and sometimes until after a bill has been sent and has…”
42 U.S.C. § 291c(e)(2): 28 cases
Gordon v. Forsyth Cnty. Hosp. Auth., Inc., 409 F. Supp. 708 (M.D.N.C. 1976). “Pursuant to this section, which implements the phrase “persons unable to pay” found in 42 U.S.C. § 291c(e), Forsyth normally postpones determination of a person’s inability to pay until after the services are rendered and sometimes until after a bill has been sent and has…”
Mem'l Hosp. v. Margaret M. Heckler, 706 F.2d 1130 (11th Cir. 1983). “42 U.S.C.A. § 291c(e)(2). A hospital may satisfy this obligation to provide uncompensated care to indigents for a 20-year period in one of two ways: (1) it may budget for free care to indigents at a level not less than the lesser of 3 percent of its operating costs or 10 percent…”
IHC Hospitals, Inc. v. Bd. of Commissioners, 697 P.2d 1150 (Idaho 1985).
Braun v. Ada Cnty., 643 P.2d 1071 (Idaho 1982). “Luke's Hospital's uncompensated services obligation under the federal Hill-Burton Act, 42 U.S.C. § 291c(e)(2). Consequently, appellant's application for assistance was again denied.”
Nat'l Ass'n of Neighborhood Health Centers v. David Mathews, 551 F.2d 321 (D.C. Cir. 1976). “42 U.S.C. § 291c. 14 . 42 U.S.C. § 291d(b).”
42 U.S.C. § 291c(e)(l): 6 cases
Lugo v. Simon, 426 F. Supp. 28 (N.D. Ohio 1976). “The defendant secretary, in his motion, argues that he has fulfilled his responsibility to ensure that state plans which have been submitted to him for approval fully comply with the statutory and regulatory scheme of the Hill-Burton Act and that he has thus fulfilled his…”
Flagstaff Med. Ctr., Inc. v. Sullivan, 773 F. Supp. 1325 (D. Ariz. 1991).
Barlow v. Marion Cnty. Hosp. Dist., 495 F. Supp. 682 (M.D. Fla. 1980).
Metro. Med. Ctr. v. Harris, 524 F. Supp. 630 (D. Minn. 1981).
Dallas Gay All., Inc. v. Dallas Cnty. Hosp. Dist., 719 F. Supp. 1380 (N.D. Tex. 1989).
42 U.S.C. § 291c(eX2): 2 cases
Braun v. Ada Cnty., 643 P.2d 1071 (Idaho 1982). “Luke's Hospital's uncompensated services obligation under the federal Hill-Burton Act, 42 U.S.C. § 291c(e)(2). Consequently, appellant's application for assistance was again denied.”
Newsom v. Vanderbilt Univ., 653 F.2d 1100 (6th Cir. 1981).
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