PUBLIC LAW 93 - 641 National Health Planning and Resources Development Act of 1974 Public. Law 93-641 93rd Congress, S. 2994 January 4, 1975 @88 STAT. 2225 TO an end the Public 116tiltli Service Act to assure the develol)incii.t of a national lieallth policy and of effective State and area health' planning and resources develolimetit programs, and for other liurliost-,4. Pc, it &)tftcted by the Setiette a2id 1IOU80 of lt'el)i-e8ejitative-8 of the I,,'iiitedStatesofAmericaiitCo?'Igr688aS8einb7ed, Nationa.1 Health 8110lrr TITI,E; T.%III.E (IF ('O'@\"ITNTS PlamirAg and Resourdes Development SE:crroN 1. This Act iiiny be cited as the "National Ilea] tli Planning Aot of 1974. tiii(I IZL@sotiz-ees I)ev.elopmelit.'tct of 1974". 42 USC 300k note. 'rABI,E OF CONTENTS Sec. 1. Short title; table of contents. 2. Findings and liurl)ose. See. 3. Revision of health planning programs under the Public Ilealth Service Act. ,,TITY,li, XV-NATIO.NAT, IINAVrll PLANNI.NG AND DEVELOPBIE,14T ,,l'AitT A-NATXO'IAL GtyzDr.;Lxlqxa FOR III-,ALTH I'FANNING ",Sec. 1501. National guidelines for health planning. "Sce. 1.1)02. National health priorities. I 503. National Councii on Health Planning and Development. "rAitT 13@IIEAt:rn SYSTFI.Is AoENciEs 1511. Ilealtli service areas. 1312. Ileti Ith systems a geTicies. "See. 1513. Functions of licititli Systems agencies. ,Sec. 1514. Assistance to entities dcslrliig to be designated as health systems "Ste. 1 51 ;-). I)eSlglllltio?l Of ]teDItli SY.'Ctelll.4 agencies. ,'Set-. 151(L Illtiniilng grants. "l'AnT C-STATE IIEILTH 1'L,%NNING AND DLVELOPIIENT 15,21. Designation of State health I)Iatiiiiiii@- and devel(iplnelit agencies. "S(-e. 152'@ State administrative I)rograiiii. .4ce. 1523. State health planning and devel(YI)ni(,tit functions. ;Pc. 1524. Statewide Ileatitli Coordiiiittliig Council. "Sec. I.T-15. Cratits for State health I)Iiiiiiitig and (]Lvelopmelit. "See. (;ratit4 for rate regulation. I)-(,F,.qrltAl, llnovrstoiqs cc. 1531. I)t-iiiii(loii4. "So(!. Ir@.12. Ilrocetltir(,s and eriteria for reviews of proposed Health system "S(.C. 15". Technical a,.;slsttum- for health systems ageiicitq ntid State health planning and development agencies. "'3ee. 1534. Conterq for health planning. ,Stv. 1535. Review by the Secretary. ,Sec. 153 fnr certain States and Territories." St-c. 4. Revision of health resources development I)ro.-rnms under the Public Health Service Act. ..TITLE XVI-Ill,',,tTTll RPSOURCIVS DEVELOPlifE,'%T ,,PAitT A-PuitpoaF, STATE I'LAN, -.,qD PltOTrOT APPROVAL Sec. 1601. Ilurpose. IW2. General regiilntions. I(JO3. State medical facilities plain. January 4, 1975 3 - Pub. Law 93-641 Pub. Law 93-641 2@- January 4., 1975 d to play all uctiv(, role ill TAURP, OF' CONTENTS-Colitinued public are lackiiiz in basic kiiowl- 1,TITI,F, XVI-RIPALTII T@Z14,SOURCES DEVELOPIII,,NT-Continued itil health care @nd jactliods for "PAILT B-ALLOTMENTS services. magnitude of the problems described in (b) III rikogiiitioji of tliL llqec. 1610. Allotments. ',SL,c. lt3ll. Paytuentsfromallotments. subsection (a) and tile urgency placed on their solution, it is the IISLC. 1612. Witli)iolding of payments and other compliance actions. purpose of this Act to facilitate the development of recoinmendfttions 1613. iiithorizaLion of alil)ropriations. ' foi- a iiittional health planning policy, to augment areawide iLnd State "PAILT C-T,*A'qS AND LoAm GuAR&iqTEES plinniii- for health services, manpower, and facilities, and to author- ize iiiialiciul assistance for tile clevelopiiieiit of resources to further "Sec. I(P-10. Authority for loans and loan guarantees. "'sec. I G'-' 1. Allocation among States. that policy. "Sec. Coneril provisions relating to loan guarantees and loans. REVISION OF IIEALTIX PLANNING PROGRAMS UNDER THE "PANT D-I'WJECT GP-&IqTs lUSLIC IIEALTJI SERVICE ACT "See. i(r25. Ilroject grants. SFc. 3. The I)ublic I-Iealtli Service Act is amended by adding at "P.'.YtT T"-rENL:ItAL ruoyfsxop,rs the ejid the followiii,, new title - "See. 100. Jiititcinl review. "sm 1031. Recovery. "TITLE XV-NATIONAL IIEALTII PLANNING AN]) .iec. IW2. state control of ol)crattozis. I)EVFLOPMENT "Ste. l(M. Dednitioiis. "Sm. IU34. I'litancial statements; records and audit. "See. 16M. Irechnical assistance. "PART A-LNATIONAL GuiDF.Li@-irs FOR HFALTII "P.&RT @ F-AitF.A lIvALTiz Simviozi DEvEwiMENT PU'qDg 49 .WATIONALGUIDELINFS FOR IIE.I.LTIL I'L@iIqNING 'Stv. 1640. Area health services development funds." See. 5. Mlwdlnneoui and transitional provisions. 4(sFc. 1501. (a) The Secretary shall within eighteen niontlis ,tfter See- U. Advisory committees. the date of the'eiiactment of this title,)by regulation irqtie .,Iii(leiiiies sm 7. Agency reports. concerning national health planning policv ttnd sliill, as lie ileezn.,; Sec. & Technical amendment. RPI)T.ol)ritite. by i-egttltttioii revise such liegiiiatio!is iiiiicr FINDINGS ANT) IIIJRIROSE this stii)sectioii sliikil be promttl,-,atcd in tiecot-diiice Ni-itli section 553 of title 5, 1,TiiitLd.Stitt(@s (,@oLIc-. SEc. 2. (a) The Con 'Yrcssmakestliefollowi-nzfindin(,Ys: "(b) Tile Secretary shall include in tli6 -iiidelizie-@3 issued under t, slll (1) The achievement of equal -.iccess to (ability health care at a )Sect;oll (R) the following: iv.isoiial)]c cost is it priorit@ 6f the- r- edeml -Clove-rnniont. "(1) Staiiidii-ds respecting the appropriate supply, distribu- (2) The iziftisi-oi-L of F(,-(Ieril fluids into the exi.4ilig tion, nnd orgitiiizzitioil of li(@ailth resources. health ctre ]ills CO[Itl'il)tltA-(l to illdfttiOll.Ll'y ill tile "(2) A sititt@.iiteiit of national )i(,ititli I)Iitiiiiiii,,, go,-'Ils clevelol)e(l cost of lletlt.)i (..ti-c :111tt fitilett to 1)1'0(11ICO ITIL Supply ol, ftft(@t. colisitlei-litioii of tll(3 I)I-iol-ities, set fol-(Ik ill ',(@ctioll distribution of lie:tltli i-esotil.c(!S, and ]ills not lll:ttl(l which goals, to the maximum extt-iit I)j-tteticiibl(-. slitli b(, possible equal itce @ for evet-yt)tw to such i-Lsotire-es. expressed in qizitiitit-.itii,c terms. (3) Th6 many and increasing rt!il)otist% to these probl(-jiis by 11(c) III issuin(y guidelines under subsection (it) the Seei-etirv Shall tile public sectoi (Fe(ICMI,'St@"and-local) and the lirivate sectoi- colisitit with atiLd solicit recommendations and comments frj)iii tile have not resulted in a comprehensive, r,,ttioni-I up' reach to the health systems agencies desi,,,,iiated under part 13, tile Stitte 11(@,iltli present- p planning and development ii,,eiici(@s dt!si,-ii-,ited under 1-),ti-t C, the (A) lack of uniformly effective methods of delivering Statewide Fletltli Coor(linttitify Couiicils established under part C er Health cam; associations and specialty societies representing medical and et,, (B) malai-,tribution of health care facilities and mail- health care providers, ana the National Council on Health Plazinijity powei,and and Development estitblislied by section 1503. C) incrmijig cost of health care. (4) ln(creases in the cost of health care, Particularly of hospital 'fWATIO.WAL IIEALTII PItIOlUTIFS stay.,;, )live been uncontrollable. and inflationary, slid there- are tly inadequate incentives for the use of a@i@ropri,%te, alter- "SEC. 1502. The Coii-ress finds their the following deserve -priority levels of health care, and for the Substitution of ainbtila- consideration in the formulation of national licalih planiiiilm goals' tory and intermediate cam for inpatient hospital care. an(] in t)te development and operation of Federal, State, a I(, lit@ea (5) Since the health cam provider is one-of tile most important health pitniiiiig and resources development pro.-ritnis: participants in itnv health-care deliNTry system,.healtli policy t'(1) The provision of primary care FA-i-%,jces for medically must a7ddress t)ie I;gitimate needs and concerns of the pr6vid@r undei-sci-ved populations, especially those %vliicii are loctted in if it is to achieve n@caninoftil results; and, thus, it is iriiperative rural or economically 5 - Pub. Law 93-641 January 4, 1975 - Pub. Law, 93-641 4 January 4, 1975 health systems agencies designoteAl under part B, and not less than 11 be members of 9-tatewide Henft.ii Coordinating Councils Tl' t olitil systems foi- cool.(Ii- three slia 66 (,Y it, (levelol)iiielit of iiiiijti-ilist.ittli - two major political parties shall have equal nation or c Isoli(I'ti 11 of ilistittitiotiii lt(,,iltli ser%-i(-i-@s (iiicitidiil,r under section 1624. The ol it 0 n bei-s on the Council. tl.ie, elijej-,relicv I)IC(Iic:tl, ilitt@iisi%'(@ itil(I col-olial'Y re i-cselitittion among tile votiha mom the Council shall@be obstetric, pedin i" g members of PI (2) Tlt(s term of -oflice of vo in ellt,e, all(i ritili:ttioil tl)el':Il@y " @ - -- --f 11(3) Tile dei,(-,Iol)jiiL@iit of iii(-dic-LI (,@rolil) PI-ttetlc(.s (especially six y rs, except that- oil -diii.itetl oi@ iiit--gt-ateci o memberi3 first al)y)oiiited to the C ncil, four shall those whose services IIPI)l.ol)riattely coot 0 t itrs and four shall be appointed i d for terms, of two ye with,institutioiifl] health SL.I.Vicck@), li(I'llitli ill;liliteiiiiii(e Ol'ga?ilzl- be appo nt--, gii@d by the @retary at the tioiis, and other organized systell's- fot' tile 1)1'0%'is: 0:1 of retain for terms 0 f our years, as desi nt; and care. time of appoint-me (4) The trainin litilizit'oli of pliysiciaiii lissi-t- 64 (B) an 9 aiid-incmise(I I -y member appointed to fill a vacancy occxirriii- prior lilts, especially nurse cliniciaiis. to the exl)irati ' of [ge term for wliieli his p decessor was Oil r? "(5) The develol,)iiieiif of iiitilti-iiistittiti(,,jiitl foi- appointed shall be appoiiited,oiily for the remainder of such the slittiing of support set-vices.iiecessal-y to all health sel-vic(i term. institutions. 64 (6) The promotion of activities to achieve iieedetl iiiil)rove- A. i-ticiiiber may serve after tile expiration of his term until his sue- iiienti in the qttttlit-y of health services. including needs ide@tified cessorhastpkenoffice, 11(3) The chairman of the Council shall be selected by the voting by the; reiiew'activiti(.s of I,?.Ofe,;siolitil Staii(lii.(Is R(!vie@v Oi-gtt- members f rom among their num .her. The term of office of the chairman iiizzi.tions under part B of title XI of tile Social Security Act. or tileneriod remaining cc(7 it c of the Council shall be tile l@r of three years The development by health service inst titiops of th f the co- iicil. 11 iiy his term of office as a member o clip itv to i)rovid6 various levels of cii-e (iiielti(Iiii-w intensive 66(c) 1 Except-as provided'in paragraph 10%, the members of Carl Care, find extei@(led cni-e) oil it ,rco@&pliically int( the Oouiicil shall each 6e entitled to receive the (I equivalent of the (4 ioii of lictivitit-s fol-tlle Prevention of annual rate of basic pay in effect for grade ("@ily,8 -of the (xeiieral ilici Schedule for each dai CiiielijOing traveltim6) during which th are f nutritional and eiii,iroziiiiezitit] factors affect- engaged in the actual T)erformance of duties vested @n the @unecyil. in T)rovisio?i of preventive health care services. (2) I%Ieinbers of th@ Council who are full-time officers or employees The -adopti'on of Uniform (.0st :IC(.Otll)tilil-r. Silill)lified es shall receive'no ad(lition-.tl pay on account of of t-lie' United Stat reii,,bitrseiiieiit, and utilization reporting systems and improved their service on the Council. -iltli serV cement proced ice institii iiianaL - tires'for he. , tions. (3) While away from their homes or business m (170) The development of effective iii(-fliods'of educating the of services for the Cour the Council the performance neral public concerning pro r personate (in@ltitliil& eventive) vel expen@ iiicludi lieu of sub- a,l@l, PO shall be allowed tra re care and methods for effective it-@A 0, v.,?,rb health ently in sistence, in the same manner as persons service& the Government service are allowed exp 5701 (b) of title 5,LJiiited States Code. @4,kTlO'4AI, ('OUQCIL 0'4 .%Nl) I)I'Vk'IOPM.NT r, . I (d) The Council may appoint, fix the pay of, and prescribe the 1503. (a) There, is established in tii(, I)epiiiiiieiit of Health, emotions of sxicli.pei-soiuiel its are n ry to @rry @ut its funic- Education, and AVelfai-e all advisory: -council to be known as the tions. In addition, t)ie Council may i)rociim the services of experts and Nil-tiniial council oil IfetLltil Pliiiiiiii,;.iii(i I)t,i-clol)iiieiit (hereinafter consultants as authorized by sectijn 3109 of title 5, United States "e, but without regard to the last sentence of such section. in this section referred to as the 'Council'). The C@iincil shall advise, e) The revisions of section 14 (a) of the Federal Advisory Corn- consult with, and make recommendations to, the Secretary with p respect. to (1) tile (levelol)iii(@jit of national "nii(lelilles iiiider'sectioii mittee Act shall not apply with respe'ct'to the Council.. 1.)Ol. (2) the implementation and administration of this title and 44PA title XVI. a@ii(I (3) an evnitiatioit of tll(t ilill)liclttioils of iiciv electrical itT B-HxALTif Symms Ac-ExcrFs t(.Cllllolo.-,v foi- tile ol.(,Rllizlltioll, t@(Iiiittil)le ilistribittioii tc]]EALTII SERVICR AREAS of jacinth cRie services. ll.(b) (1) Tile Council- shall be composed 'of fifteen members. The liief Ifedi(--.)l I)ii-ector of tile Vet(-i-iiiisi "SEo. 1511. (a) There shall be established, in accordance with this section, health service areas thi-oillrhout the United States with respect for Heikltli atii(I l@,iivii-oitiii(-iit of the I)epaiijliejit of Dttfeiise, -tiiieiit of If@tli, to which health systems agencie@ shall be designated imder section *3itl the Assi@iit @retai-Y for Ilealtli of the I)el)ai 1515. Each health service area shall meet the following requirements: F,dlication, and IVelfai-P sfirtil be,.iioitvotiii4r ex oflicio iii(-iiibei-.4 of the co 11 (1) The strea shall be ageographic region the tincil. The remaining numbers Shall be al't)poijite(i by the Seci-ettiry effective Planning and development of hei:lth i tied jid quite[ be persons who as it result Of their experience, or ity :ttaiiiiiielits, 9,t-c exceptionally well qualified to assist I in Icarrying out on the bisis of factors inclu for residents the functions of the'Voiiiieif. Of tile not I(.Ss thin of resources to provide all n SC of the area. live slitill be persons w)lo iti-e ]lot I)]-Ovitlers of health Services, not 11(2) To the extent practicable, the area shall include at least titoi-t@ than theme Shall be officers or t@itiplovet-8 of tile Ft-(Iei-lit ('ovei-n- I . of highly specialized health services. ...... flinn them i4linll be nitrate .)(-t-s of _rovpl.llili4r bo:lies of one center for the provision January 4. 1975 7 - Pub. Law 93-641 Pub. Law 93-641 6 January 4, 1975 days of the (late of Lliftetmc-nt of this title, such botiiitla@,r (lesig- 91(3 I'lioallea,ill)onitsestlil)lislltlltjlt,'Jllltlllltvelti)ol)lllatioll ii-.Ctioiis to,-,ttther with coiiiinents, sttl)iiiitted by tile entities of iiot@ 'm than five Iiiin'dred thousand or iiiot-c tiltili three -111illioll; to in mLragrapli (2), w@tli respect to stit-ii (1@ignittions. except tllltt- I . I . . - (let- this to en(!Ii - tile population of all area iiity Ix- itioi-(- tariff iiii1lioll At the t iiie such notice IS give'' I'll ' file. F@eril (Zt) -the Seei-Lttit@y slinll' I)llblisil 'Is 11 "O .e III if the area includes a stttiiiliti-d iiieti-i)l)oiitiii stittisti(-iii it-eik (its IZeLyister II statement of tile givi@iz of his lioti('e. to tile Cloventor %laid determined by the, Oilice of %I-.t telit till([ with it "ell .1' - pulatioii of inore than three millilioii, and tli@crit-eris and procedures cotitit iiie(I in sucli notice. "(2) ]@,.%ch Sftite's Ciovei-nor sliall in the de%-elopi-neiit of boundaries oiigall(l if the RI.(,a com- for health service areas 'consult with and solicit tile views of lilts it, poplilfttioii of less their the chief executive officer or agency @@t@e political sxibdivisionswithiii the State, the State itLyciiey which ndministers or stipervis". be Im than- the administration of tlie'Statfes health planning functions under a (I) five hundred thousand (but not less than two hit,,- State ])]Ail ill)l)roved iiiidei- -k-etioii 314(it), each eiititv within the dr-ed thousand) in unusual circumstances (as determined State ivliicli this developed it conil.)t-eliciisi%,c regional, iiie-ti@ol)olitnn, b@tliegmt-Ltary), or or other loeftl area plan or I)Iiis i-efei-i-ed to III se(-tioii 314(l))' and each @.Lrioiial medical pro am established in tlit, State tintl(-r the '(II) two ltlijidrt-(i thousand in liiLIllv illitisiilil ell,- gr title IX. cuinstances(astletei-iiiiiiedl)yllie.@(!rLt if the Govenior of - wilit (3) (A) Within two liuii(It d and tell days after tile. (late of each State ill -II tile ui-eu is lockitel eiin(.tlll@iit' of this title, tile Secretary %]fall I)Itl;lisll -.Is a notice ill tile detei-miiies,,%vit-li the al)l)t-oviti of hire Se@i-t-ttii-y, tlitxt the area tile Health sei-%-iee I)(,- ii(iiii-v tlesi!-,iintionq. Tlit, lnftlts the other i-t-qtlirL-itittiits of t his slll)sect ioll. it "(4) To the niaximuni e..xttiit feasible, the boundaries of the boundaries for health service ti-eiis submitted I)'V the Ciovei.iiol-3 sll-.Ill, area' iliall be. appropria@ly coordinated with the botiii(]:triL@S Of exc(-I)t it,; otlit@rwise I)IIovi(le(I ill rlil)l)lllllglllpli' (B) constitute til)oii desihniLted under eCioit 1152 of the Social @ tiiei' I)til)lietttioii in the Federal Iteiristel- tile I)Otl;idaries for su(-Il areas - St, . Ili-ity Act foi- r Profemional Stan(lar(Is-lieview Orgritiizttiotis, existiji ' i-e(yional liell](Ii service are-.is. 9 planning areas, and State planning, and administrative tirefts. "(13)(i) If the Secretary deteniiiii(@s trial it @iiiidiiry submitted lr3le bouiida- IL to Iiiiii fort health sei-vi(-e area does not iiieet the i-eqiiirtiiit-iitq of stib- rles of health service a'-cit retail be established so trial, ill the planning and development of health services to be offel se(-tioii (n), lie sliitll, after continuation with ill- ('o erilor tvlio the health service area, any econ - -L4tl within e v V oiiiie or geographic barrier to the siiljiiiitte(I sti(-Ii boundary. ninice such revision in the I)onliti-,Ii-.1, for.-iiell @l of such services in nojimetrot)olitaxii art-its is ttiken into itceouiit. (1111(l It.@ lie(le@s@ii;y, i;i the i)oitiid:ti-ies for adjoining health The totiiidiries of health service areas sliall lx- established so as to as Italy be iiei-@ssiti-y to Ill(-(-t Sll(-It ie(iiiii-eiiielits hall I)III)Iigit recolmize-tlie differences in health planning aittl ]return servi(-es devel- sit(.II I)OIliidii-Y (oi- boundaries) ; and the revised botiiid.-try 0I)nlellt: iieA@ds @weeii -nonnictrol)olitaii ni@d metropolitan there-, F,,tell (or botiii(Itiri(-s) ii?;nii I)itl)lit-,ifitiii iii train Feilei--ii Ite,@ris.ter (-oil- bial 11 se VI( idard metropolitan -,tatistica-l- area shelf be. entirely within the ,titiite tilt, liniiiidii-v (oi- I)ottii(iii-ies) for !2iielt lie;tlt r -P. boundaries of one health st@i-vice area, excei)t that if tlie.(Iovernor of ((VI. areas). 'I'lic se(.i.eljll.v still] iiotify tl?e ('ovei-iif)r of enter] I e;teli State in which a stanclitid nictrol)olitwil statistical larval is located ill %V)iit-li is located 1.1 Health itaterniiiies, -with the approval of tile that ill oi-ti(ir to iTiet-t iiii(loi- this (if the I)oiili(l-,ii.v ,iild the tv.1.4ollt foi the other rt,(Iiiiivmeztts-o-f this ;Itl@ctioil it health slioll](I ilt'Nli.,ioll. contain )i,,,y ,.,i-t of tile st@itiitl:xrti ilietf-ol)olititil st:ltisti(-Ixl tlieii .&(ii) Ili Ili(, of of (lit@ Ililletl Stilit,-, )lot ill(.Itl(leil Witlliii i.ta @ such , t tic.11 area stiall not be required to be entirely warrant the (lit@ I)otilitI.Il.ies fol. l@(.1titil siil)lllitt(.(] to till, boundftties of such health service area. Ir - ,,s I-eciiieste(I iiiidei- tl,.e iintit-c (1), the "(1)) (1) Within thirty dtivs following the date of. tile ancient Al,,Ill vst:ll)li.,ll it))(] I)III)Iisll ill tile ])Chile iitle, the Secreta7ry sliall simultaneously leave to the Goi,enior of t-iii I)ollll(]:)I.i fill ill(.Ill(le %lit-II of each State written noti -cc of the initiittion of @@L-Ctliiigys to @t.,tblisli i,otirv tilt, or t,:,(.ii state ill Nviii(.ii is io(..itt@d it sel-vi(-t .health service areas throughout the lliiited Sf-ites. Each notice sliill :iiv-,. the foi- wliieli is est-.il)lislie(l- iin(lct- tljis einftqt contain the follo%vin I)f tilt, I)otlll(l:ll ics e'-t: I it (-art- - ]it of tTki! 9 I vitit, out tile i-e(iiiireiiie (A) A statement of the 1.0,"ireiiielit (ill ,iilbse(-tioll (a?) of se(.I.etii-y iiiiy shelf I-ei,isioiis in I)oiiiiiiiriesqtil)ltlitte( tl cestablishment of Learn, go,-%-ice areas throughout' tilt, I rated (A) as lit- tire ilecesq:tl-v to metal St,,ttes. tile I-('(Illil-Olllellt of stil)st-ctioti (a) foi- the estnl)lisliill(.Ilt of lieiltl "(B) A St Statee.. -element. of the ei-iteria prescrii*d bv subsection (a) IS t],,.Ollgllollt. tile ITnite(I &I ervice areas and the .for he' th procedures pi-ewi-iWd by tli is sub- (-1) I'll(i Secretary Silill Tvvivw Oil 11 containing I)II@i% and lit ties ,section for the 'designation of health service area - boundaries. request of nity Ciovirnor or (Imigii-,iteil lictitli glyiteiiiq -igen('y tlil ti(C? A request thii the Governor mcciving.tlie notice (i) desig- ilill)l.opi-iittenesq of the boundaries of tile Health service threats est-il) itate t le boundaries of health service areas within his State, tviid, ]allied under piriitri@npil (3) tilid, if lie d(.tt@i-iiiiiiei that n where app!-opri-.tte and in cooperation with the CToveriioi-s of foi- II II(..Iltll sel-vi(.c 110 ltillt"ri. illeets tilt, of adjoining §tatcs, designate the boundaries warfare) his State of note (a), III-, fliiiv revise tile @iiii(lat-ii-.4 in %with the lie- of service art-as Iatetl Wtli in' his Stttte niid ill annealing (Iiii-es I)rewi-il)e(I I)v (3) (B) (ii) foi- the Ntiblklinicitt o al oc @tat@, and (ii),submit (in such forni and treating its tile Se@l-L@ttLi-Y boundaries; of health stlr%-i(-e iiit-Iiid(. insiders ]lot lll(.111(le(i it If tll(. I)oiiiid-.irim sitl iiiitte(i 1).), tile V facts Oil Ili: Pu,,D. L,-L@v "13-641 January 4, 19'$ 5 January 4, 1975 - 9 Pub. Law 93-641 olvill @nitivitive to revise tlie'bo-.induries of any lic:t!tJi wrvico area, Ito F,li,ill conf-@,iiii, with the Governor of L-lic atl)l)i-ol)riate State or States, (i) Adiviinistritioii, (ii) the LatlierinL, i red analysis of @tati, (iii) tl-,t, A-litities referred to in pamgrap)i tile a propriate health liealtli planning, and (iv) dt@@Llol)iiiciii'a i(i use oi health resotij-cm. sysivilis agency or agencies d(!sij,,i)-,ttcd il(ll!l".Ir part @i and the nl)l)ro- Tile functions of plailllilkg and of develo )illciit of health resources ptiato Statewide Ileiltli Coor(lin'@iii,-, Coiiiicil-agtal)lislled u rt, sliiill be conducted by StdirS- Wit)L sk lls appropriate to each n'll 11 PI, A rr,(Itiest for boundary revision still bt- iiiitdo only after colsultit- function. 'tfi t)ie Governor of the 21)lirol)riat(3 State "(B) SIZEAKI)EM -,-r.-T tion i%,- 01- scates, tilt- elitities-@ i-Loyiri,@., lie.%ize of the professional staff. I 0 except that refet-tvtl to in pai-ft@rral)lt (2), desigmittecl II(-alt-li sys- ofaiyliealthaystemsal,,ejicysliall@ii tlmthaifive, if tire quotient-of the population (rounded to the next highest one agenci@. itnd tiie appropriate ei;tablislild Statewide Ifealtli hundr&l thousand) of flie health service area which @e agency "I@diii.itina Council and sfiall include tile coiiiiii(@jits cone(,,, n c in the revision by the entities coiisulted in reqiiestiji,-, the roves serves divided by @ne hundred thousand is greater than five, the ioii. g4(r)) Within @ojie year after the date of tl)e enactment of this title miniinum size ot the prof@ional staff sliall be the lesser of (i@. the Socrettii@ v sb.-tll the proeeiltii-es for I)ie iiiitiil estitl)l@@li- such quotient, five. The iiieznbers of the staff sl a u (except us 1)1'0- be wliRted, pa arLed itit,@iit of tlie'l)<) n(Ittries of 'Health service areas tvliielt in accordance with vided in section 1-035) include tile Leot-,rapliic at-ea of all the- Stitteq. such systeiii as. I @eept that the rate of pay it " ieq6ireiiieiit of this section, an for any positio rate o in (c) Notwitli%tanding any other e- fth service. iLrea for simi6r pos tioiis area- the h a or '-'(1) for Nvbic,-L It,,ts been det-elol)ed a comprehensive I-egioliul, private health service entitie& If- i-y for of met-ropolit.i-,i area or other local area plan referred to ill S-ectioll its fluictions, a health syrtenis nay e-my and 314 (b @, and "V ties c of may contract %vith in&ividuals dye'n (2@'wlileli otlier,6vise in&-,ts f-lie i-c-(Illirenients of sub@tion (a), services. Compensatidii for consultants and for shall be desialiate(i I)v the Secretary its a lie-.tltii service area unless shall be estalilished in accordance with standards estab shed by tbagovei-xioroftin Stateiii%vliielis-uclitrc,,tislocited,uponofindiiig regulation by the @cmta@y. y (3)- GovEitNixGBoD3r.- that another area is a mor-- appropriate rt-gion.for the ciTective plan- '44 (A) Ix GEx=A@-A health @ems agemcv whi ch is a public nintr .ind development of 'Aiealtli resources, ivalves such requirement. im yegionil planning body or unit of -oeneral locaf &illE.%LTII BYtril',MS AGENCIF.8 in addition to a@y oth@@ goyeriil3lLr Wdv. have for health planning, wnien is establish,;d'in a@ ,6sw. 1519. (a) DFii.NiTio-,.-For purposes of this title, the term I)aragi-apit @C cii shall have the responsibilities prescribed 3 is or--anized all(] oper- bv subparagi-a) I Wlt), and Which has excfiisive authority to per- ',lie-,iltli systems a-"ne-y means an entifly pit ( ,-tted in the, manner described in subsection (b) and-@vhich is f@rm for the agency ilie functions described in section 1513. Itny as determined by the. ,;eerettry, of I)ii-fon@iiiiL, eicli of the fitneti(-,Il., other health systems ilgency @ll have a governing body com- -Secretary sjiall .by re dewril)ed it,. Selection 1.-)13. The _nilation est4ll)li"ll posed, in accordance with subparagraph (C), of not less than tell -s slid of not more than thirty itieitib(-i-s, except tlixt the standards and criteria .or I lie rcq-,iireinents of siii)sci.iioii (b) -Lnd meTnbei tion 1513. nuniber of iyiembers may exceed tliirt@ if the governing body has 9((b) (1) IFG.KL 9,ntuc-ruity.@.4'i health systems -,i,,Cicy for -.I ',ie:iltli established another unit (referred to in this ratumpli as an 11 P@ , service -,hall bL- (,@xecutive coiiiiiiittec') composed, in accordance Wlill 'stiV@tira- "(A) a i-ionl)rofit private corporation (or slinil-ir le,@ ty-five iii(-tiibers of tile goverii- iiisiii sti(.Il -is ft public benefit corporation) watch is incorporated xillit the authority to take such in tlic, Stite in %viiicli the larLrest part of the pc)i)iilatiofi of the sliiiiciit and revisioii-of the i)laiis Health Fcrvice, ivsiul(-s, ivl;ie'h ii not a siibsi(li-;i-y of, or otlivi-- as the 4roveriiiiir body is 15 25 ,tvisecor,trolledby,anyotli,,i-priv,tte orpubliecoi-I)oi-atioii ot,otlier legal clititv, and whicli only engages in ficaltli plalininm and dcn,cl- "(B) lti.,spoxslitiT.t,rirs.-Tliegovei-iii gb(xly- ol)nlvf@t functions: 4(i) Shall be r(,-spoiisib@-fol. the internal atTiii-s of the "(B) a publ@C reLviolial plaiiiiiii,-,'oody if (i) it has a governing Health systems ll(,Mlicyl actuarial" )Hart I's "P.IItiji@o to the staff board composed of Wmzjo@t@.Y of ef@ted officials of units of rreiieral of the tile 11 i cy's biid,_,et, and procedures and cri- local government or it i-S authorized by State law (in effect before tells (developed ft,15p- )tiblislied piii-stiniit to section 15.32) the date of enactment of this subsection) to carrv 6tit lie,,tlt)i plan- applicable to its filiict oils iiiitlel- stibsecl,.-'Aoiis (e), (i), Liid ninly and review functions such Ps those described in section 1513, (k) of section 1513; and'(ii). its planiiing-area is identical to the Health service at-ea; 4(ii) shall be responsible for the establishment of the or health systems plan and annual implementation plan required ".(C) a sinzle unit of --eneral local government if the area of the b@ secti;n 1513 (b) ; ,unsdiction,if that unit7is identical t@ the health service area. '(iii) shall be responsible foi- the approval of gi-aiits and @l health s Lt&ncy may not be an educational institution or oper- contracts made and entered into ulider-siction 151@(c) (3) - system It a t "(iv) shall be responsible for the al-)ptoval of all acti' rite site n insti ons (2) STAPPI- @kell Pill-Blialit to subslctioiis (e), (f) -(g)! and (h), of sec. "(A) Exrr=isF--A health systems agen shall have a staff tion 1513; fi@ency with c "iy rn , wh;.@h'provides the xpertiscina leastth6followiiio "(v sh@l@ (I) issue an annual report coiice iii(r tile activities ot tile amency, (II) include in fl)iit report the licaltli Pub. Law 93-641 - 10 - January 4, 197.5 January 4, 1975 11 - Pub. Law 93-641 sball have designated for such I)tii-I)ose, and if the agency svsteiiis i)laii aiitl annual iiiiplejiit-ilt4itioii I)Itii (levt-lol)e(i by serves all at-ea in which there is located one or more II,-relicv's iii(@oiile. exl)eiidittii-es, qualified health maintenance organizations (within the 'i) i@ IC i-el);I.t I-e:l(lily Castello ' inberwlio I -.tke ti meaning of section 131 0), include at I me lie health s(!rvic(- a-reit itit(I (Iiii is representative of sucli @rganizutions. serving such al-ct; (iv) if, iii'tlie exercise of its f uiietioiis, a -overniiig body lit)tti-s for t)iei I- i-i asoi)oible costs or executive committee appoints a subcommittee of its meni- governing body; bei-s et- all advisory rioup, it sliall, to the extent practicable, I qaleiidii r'qttai-ter of it make its appointing 'ts to any such subcommittee or r-yrouv in year a qt I tiii)@ in u year' such a maiiiier as to provide the repr@-iitation on such iub- least tivice ill tlltit committee or Lyroup ( esci-ibed in tlii@subpitr&iEriLiDli. Car:' and (4) INDIVIT)IJAI, iiidividi: ember or "@1) coll(ILici its I)IIisill@ss' ille(.tillas ill public, employee of it lip-iltli systems agency, sliall, I perform- enhance to the public- of such Ill cetiii- aiid ance of any d ftiiictioii, or ae gs tfiity retire torized to records and dftta- available, ul)oii request, to be uzid tit ertaken by, c azency under tlils tit the pay- mciit of damtit_,-es unusually Itw of the Iji, IIDY St-ate 'The (,,tttlvLl committee political s@ibtlivision thereof) if lie has acted within the scope of lienl systems atyen (SHIl-atil oyify by vote of aniijoi-it of its tioii, or activity, has exercised due c4ire, and has ,Lcted, men rs'i)resent III voting tit at ;IIt.(.iijiLr CIllttl that performance, without malice toward any person it'l is Tioti to it] of its I libci@tijid tit Nvllit!l;,a (Itiort @ it, ane4i. ;t"quoi,iiiii foi, it goveilitij@g, body and executive Coillillittee CovTrinuno-,s.-No lietLItli systems agency may Strait be not less than oiit,-Ii-.ilf of its members. (is oi- contributions of services o- facilities r s from any .x.-The iiiejiibei-s)iip of the goveriiijil, body n v( oi- I)rivRte entity which has a financial, fiduciar , or other '@teh)eCexoexc'tiot'ilv'reloconiniittee (if any) of an a,.rc-iiey _v tin Strait iiieet dir, et iii rest in the development, expansion, or supporC6f health the following reqtxi'r@@nts - resources unless, in the case of an entity, it is tin organization described lbut not itiore than 60 per ceiitum of the in section 509 (a) of the Internal Iteveiiue Cod@ of 1954 and is not 1 residents of the health iei-vice area served directly engaged iiL the provision of health care in the hertltli service are consumers of health care and who ti-e lima of the @,olicy. Foipuil)o@ of this paragraph, tin entity sliall ie twcllvq months preceding appointment not be considered to have such an interest solely on the basis of its pro- of health care and Nvli6 are bi-on(ily represent- vid indirectly) health care foi its employees. economic, Iiitgtiistic untl rticilil populations, InFMFNTS.-E' RCII liettltli system agency sliall- an of the lictiliri'service aiva, -aiid major such reports, in such form and containing such f health care. ceriiing its striiet Once of on ure, operations, perform Attainder of'tlte.lli@-nil)ers sliatll be residents of other mattei-s its the Secretary @y from time to rvice area serv(!(l by are @)tllotvli(let-S keep such records and afford such access thereto of licaltll'c-.tre -lead wl'OrcT)rcseiit .(pit c rally as t find iwcess-try to verify such reports; -dentist other ans) health such &ml control d fund accounting licafth create 11 tictilai-ly. lios- proce( s the Secretarv mav require to assure proper disburse- are facil'ti( I maintenance c merit of, an accounting'for' am6'lliiis rece ved from the Secre- tli ea health pro- ta ry under this title and section 1610; and tied, a i t ssions. Not (C) permit the Secretary and the (comptroller General of the less than one-t vit ers I ]( I II care who are U@ited-Sta,tes, or their representatives, to have access for the members of tit oi, executive committees of a purpose of audit and extiniiiittioii to any books, documents, P;IT)Crs) health systems yeet providet-s,of health care and records pertinent to the (IiST)OSitio@l Of IIDIOUIITS received from as dow@ibed ii the Secretary under this title - d section lG40. an -CouNc-iis.-A. health systems eager (i i') The memlx-.rs (e) SLIB.%IEA Irv may establish incltt(l( ier through consumer or. pi-ovi(ler sub-tret advisory -cotincils represent" rts of the lici.Ith inei(n'@el-s) pub@ ted o'ilici;tls. and other represciita- service itrea to advise the governing bofy Pof the agency On @he perform- tives of governmental ttutliorities' in the a(,enc@'s health &nee of its functions. The composition of a stibarea itdvisory council 'service area and representatives of ptibli@ ai@d private iqhall confoi-in to the requirements of subsection (b) (3) (C). in the itrem concerned with tit, "FUNCTIO-TA OF lly,%LTIL SYSTE-DS AGFWCIXS I include a percentage of,individuals who reside in nonmetropolitan areas.within the health service area which percentage is equal to the percentage of resitlents "SEe. 1513. (a) For the purpose of- of t)iea-rcmtdio-resid'ej'nnoninctro-politati:ti-eits, and . 11 (1) improving tb-o health of residents of a health serv.ice ILI-em, "(III) if the health systems i,(,-(,,iicy serves -.tit arct in (2) increasing the accessibility (including overcoming Lee- which there is located one or more'lio-,Pitals or other graph - nd t@nspoitaiion barriers), -ameptabi ity, Cturalo' -hem, -hit' le'ar' health care fteilitim- of tlie.Veteraiis' @di)xinistmtion, cent nii iia@ty of t health services provided t it-y' a' 3 i@trai@n q the cost of providing them lietltli include, as all ex officio lyicinber, an individual whom the iiig increases in January 4i 1975 - 13 - Pub. Law 93-641 Pub. Law 93-641 - 12.- January 4, 1975 - Avill achieve tile, Cy S13 itil(I 131-iOl.ities tll(- .@(4) I)t-e%-etttii tilille(:tls@.11-Y (itil)@iCitiOll 01' IIC:L]Lll O@lis of tile 11 obje,(,Livt!s. In the -kTP, the ii,,,eiicy shall ,ive I)Vioritv eac)i Ilea ltli s@ysteiiis -,Li 111-iiiiti-V I.esl)o])Sil)ility tile the pi-vvisiujl of eirt!(, fol- its health lilltl;t to those objectives .vliiel@ will iiit-,imally improve tile li@-.iltli (@r ;iii(i tli,.- I)rojiiotioii 4 iiiiiii tile di-e-,t of lit-:Iltli the i-esi(leiiis of tile area, its tietei-iiiiiie(I o-ii the basis of the mliition of the cost of tkttiiiiini, such ol)icctives to tli(-ir bon(-fits, ajiti Avliiell v iieli iiiet-t ideittifi(-d (locuiiietited iit6fficiencies, and iiiipleiiieiit the health I)Illls of are fitted to the Sl)eeiai iieL(Is of the area. "@4) The ageii ins itnd Cy shall clovelol) -,iiid publish sliceific DI ,agency. To iiieeL its Drimary responsibility, a health systems n(,,ei s le proj@ts for a@Iiie@ing the objectives citablisliedill tlitt i@1P. 11 carry out the functi@s described in subsections (b) tliro,i,,-,@i bc,.qltli systems agency shall iiiii)lemciit its ITSP aii(I AIP, (g) of this section. find in implementing the plans it shall I)e@form it least the following -'(1)) In pro%-idiiig health plaiiiiiii,, aii(i resources devclol)ii,,eiit for I fulictiolis., its health service area, % licgtltli systeins atreiicy s)iall I)L@i-foriii Liie "(1) The ii,,,CIlcy Sllflll Seek, to the extent I)i-,ict;ci following functions: ble, to iml)le- rlic@ agency still tisseiiil)lt- Iiii itil;ll).Zt. (little (:o i(lill'illitil-Y iii-@ilt, its T[SP aiitl klll with tile of iii(lividii-,ils and public aiid I)ri%,fite entities in its Health service area. ( -t ) tile Stittis (iiiid its (I(itei-iiiiiiiijit,;) of tile I el tl@of 'd(-., in iic(.-ordince with the priorities tile i-t-sideiitsol"Itslictiltliwi-%-ice C'(2) The ii,(,rciicy may i)rovi "(Ii) the stttti-., of tliL lit-ziltli care s%-stt@ill ill tile established in the AIi?, technical agsistaiic(@ to individuals and eiii by the i-t@si(i 'its'of tile, public and private entities for t.ii(,, development of projects and area; and the use of that syst el rogranis Nibieli the a,-,ency det,,i,,,iiies are iiece-sary to achieve "(C) the effect tlc ill -P -ei-3- svsteni has t "e;l,s lieal@ii ciii . dealt t@ielicaltli systeiins de@,-ib,@.-,l in lie IISP, including Assistance in on the health of t lie residents of the area, "(1)) tile iit;iiibL@,-. t),i)e, i:i(I l(x-;ttioii of the ki-ea's ll(.@iltli ectiitg tile requirements of the x-ency prescribed antler sect-ion resources, ilielli lill(-' Health iiianpo%i-ei-, qn(i fa(.ilitic.@, 1532 (b). 't T iTlie a,(,,r(!jicy shall, in accordance with the I)i-ioriti@ "(E) the 1):Itte-iis of utilization of tile .11.("I,s )it. she n the II". make griiits to i)ttblic and nonprofit private resources, and (F) tilt' .111(i occupational exposure factors entities and enter into contracts ivit-fi iii(livi(luicls aiid public and atTi@(-tiiit, immediate -.iitd liv;iltii correlations. non7)rolit privtte entities to assist them in planning aii(i develop- III L-:iri-yin--, out this ' ' 'r ' t) e Shall to tile iiilxiilltiili in(,! @rojc@ts and pi-oaraiiis which the airencv detei-iiiiiivs are iieces- '3"' a ' " sii-v for the achievement of the lieal@ft sisteiiis described in the (.Xtttlit 1.@iical)le use (later developed iiii,l(,r -oiii t -L Fe(lel-a ins) and coortliiiati- its activities with the cool)- 119P. Such graiits and @iitracts shall ge made fi -lie iki @it el-titive ' Hettlth Services Dcvelol)in(-iit Fxiixtl of the i,.,rney esttblisliect i 11, tftk-i- tippiol)i-itttL@ consideration of the '%Vitli funds I)rovide(I under griiiits made ujider-section lG40. No -itidc)ilies fo-r lit-tiltli 1)laiiinitim policy Irr'llits or contract uiidt-@r this subsection iiiqy be. used (,k) to pay by the Sec l@licler,@ectioii 1501, the -set fol-tli till costs incurred by all etitity oi- iii(livitlx,.il in the delivery of health services (as defined in'rcgtLl,,itioiis of the SLcretary),, o@ lit section 1502, ai a dei,elol)etl I)tii-siiiiiit to (1), (B) for the cost of construction or modernization of mcuic4ii establish, annually i-evi .laid aiiiell(I its -.t fietith sys- teiiis )lei-eiiitiftei- in tlti-,, title to its the facilities. No single LyrRiit or contract made or entered into under Nvllicll sfiii I)P, t detailed structural of goals (.-k) this para,-x-,tpli sliitlY be a%-ttil-.ible for ol)li,,,.Itioii beyond the one ii@tltiiflij (.111-ii-olliov-1it itn(i health ill tile year 1)oi-i6d I;f,-giiiiiiiig oil the ditte the or contract was made wilt.II %Vill trial (liti@lity lit-ailtli will 1)(', or ciitet-ed into. If all individual or t('@iitity receives a ,rant or ill it lliltill)t!l. %vilieli Colitillitily of courtlier under this I)tit-tigriLI)II -for a I)ro]cet or program, such Carl" It 1'eiloiillL)le cost, for all ?-csi(leiits of Ili(, :irt-.t; ( l@) Wili(-]) individual or eiitity may rec(-ivtt only one inorL@ sti(-Ii gr%Lnt or I-L contract foi- such project or n,,)ollsivc to tile !iii(Itie ii(teds :tii(i i-esoiii-c(!s of tile. laid -real Nvitli tilt', national "(d) Each health systt@iiis a,rc-iicy iii:ill coordinate its Ictivities (C) wliicli tlkt itito lIt-cotiiit and is coiisis (,Uidelijies fol- lie,;tlt)i Primarily ])olicy issued I)v the Seei-(-tii-Y -%I itli- - ,(.tioii 1501 1). '(list libation, iiiiti oi-gitiliz;t- (I l@PN-iow Oi-,,,aiiiz:ition (d(,s- Trader S( r(,s ig (1) each Prof@ioiial St, tioji of health rLk-cotirwsaii(I services.' 13efoi-eest:tl)llsllillgllil 11,Sl), iiated under section 1152 of the. So(-iiil Sociii-ity kct), a Health S.).Stems oji(Iiiet a public ]treating oil tile "(2) entities referred to in pai-ii,ri-al)lis (1) .iii(I (@)) of s(tetioii proposed f[SP at tv 204(a) of the Demonstration Clities .111(l @Aletroi)olitiii Develop- to siibiyiit tiieir v I' ilient Act of 1966 and regionil and locil entities the vieivs of y days prior to suc Ct which are required to be considered under regulations prescribed two newspapers o V. un(ler sectioil' 403 of tile Iiitei-govei-iiiiieiitil Cooperation Act of ice area &- notice lie I 968 to c,,Li-i-y out section 401 (b) of such Act, time and place of the hearing, t "(3) other appropriate acimriil or special purpose re-gional sons may @oiisult the FISP in adv@ ne, of t le ear ng, all( e pace planning or administrative agL@ilcies, and and pe@iod durin- which to -submit written comments to the " (4) @y other appropriate entitv, in the health system aLL-iicy's health s;r'vice area. The a,,,ency shall, at,yeniv oil the HSP. it (3) The agenev shall establish, aiiiiiiftliy review, and amen(I its appi-ol@iiate, secure d.;ta, Train them foi- use in the a!-Tric.@'s planning as necessary an annual implementation plan (hereinafter in this and developiiilnt activities, enter into i--reeiiients Avitli them '%Yliie-li title referred to -,is tile 'AIP') which describes objectives which ivill tisstil-o that actions taken by such entities %Vjlicll altcr the arc,.t's Pub. Law 93-641 - 14 January 4, 1975 i anuary -i, 1 7 f II(-.titli Systi-ill will I)L@ ttilit-ii 'III it lilitilyiei- wilicil is %%,illi tile clittiojis to the ttl)l)i-ol)i-iate litsite pi-,tjtiiiii,,, .111(l ft,r(,.]I(!y I-CSI)Cetill@r tile lice(i foi- lit@w itistittitioii;tl liciltli services I)ro- IISI' iti@tt the All@ in eirect fot-'tlic to the extt-iit 0 I)i-ovi(le tecliiiii-,tl itssistaiiec to,;ticli entities. )Oskl(l to be ojl'el'Ctl or developed iii the li(-altli sci-viel ai-(--.i of such "(c) (1) (A) l@,xcept as provided iii stibp)Li-ftgr:tpli (11), cicli health ll('4111)1 systems Lgc-,iicy. system$ It,,,eitcy sli-,iil ievitw qll(l .11)1)t.ove 01- (lisil)l)l.ovc Proposed a@pi-ovide(I in T)-.ir!lg Ili (2), each health systems Ilse ivitliiii its health service'area 'of Fe(lci-itl fuil(is- II ,re-i sliill review oil a I)ei-iodie'basis :It IClSt every iive years) si(i) al)propriittetl under this Act, the Coinmilility Ift'lit.11 all i ittitioiiii health services oirered iii tile health service area of iTea I It.It Centers -Act, or the Coilipreli.ensive. Alcohol Abuse nnd tI.10 age, icy iiii(i sliall nial@e re(-oniryie-ii(littiojis to the State lititltli I)Ian- Alcoliolisiii Prevention, Treatiiieilt ali(I Rehabilitation Act of iiiii,-, aild'dcvelol)iiieiit agency desi(,,zittted iiii(lei- sectioii 1521 for eaen 1970 for graiits,, contracts, loans, )or loan guarantees foi-- the St,@Ce ill which tl-ic licaltlisysteiiisa,(,@clicy'sli(-,tltli sez-viceare,,tislocated develoi)l telit, expansion, or support of liealt.li rt-sotii-ces; or i,esl)cctiiigt)ie-,tppropi-iateiiess ill tile al-Li Of.,-,Il(!IISCI-ViCC.9 6 1 44 (2) j@, health systems ag,-@i sli:lll collil)](@to its Illegal] review of ftiqiltible by the State in which t-lie health service Icy - area is @located (front an iLlIotiti(,jit to the State under all Act Xisiiii(_, institutional health services ivitliiii three. years ,ifter the dite referred to.iii cla'use (i)) for gFatits or contract$ for the develop- of licy's designation retailer sectiozi i.,-il5(c). inent, expansion, or support of health resources. - - 44 ('11) liciltli svsteiiis shelf tiiiiii;iII3, rect)miiicii(I to tal I not review and aT)prove or tilo@tiite ]retail J)Iitililil@giiid :lg(.Ilt-vdesiaii-itetlforeacli its lienitli service area 6f-Fe(lel..ti State ill wili(.Il tile, lie-.tilli IS s or contracts under title IV, VII, or I)i-4)jc(-ts for ttit@ iiit)tit-i-iiiz;ttioit, contraction. :tii(I jits or coiit ricts are- to be iiinde, entered sioii ol, facilities ill III(,. I)roj(@i-is %%-ill tile ITSI) aii(i 'Hill' of tile- 111-:iltll ezit of health resources iziteiitle(i Chile (2) :iliit)ll@r sll(:Il I)).oje(.ts. fti the delivery of health -services. Intlic case of iipropo duse ivitlxiii t ic health service it-eLof a li(.Ult.ll systcins a.-ciicy of Federal funtls des @ribed in stibpai-iit,,rapli I)y '1'0 Ill an Indian tribe or inter-tribal Indian oi-,_raliiztltioii foi, tiiy I)i-ogr,.iiii or proicet.wliieh will be located -tvitil n @i -,vill spFcifically serve- ;ill necessity te(,Iiiiietil ,tiid 11(i). a fe'derally-reco,,,,iiized Ili( i.,tn resei-vatioli, other. ill(, of 1)1-0(()tNj)e -"iii) fLwv landarciLili Oklalioiiimwliich isliel(l.in triistby'tlio of 4)1-,,r:tiiiz:itioll field ol)(-I.atit)ll)Ito liolli)I-Ofit I)I.ivlttt i-liti.tit-s Uniied Stites for Iiidians or whicli:is a rt-strictl@d Iiidianoiviied (literature,,, ('unless land area, or I ioll :3II(11) (,I. title IX oi. svl;- (iii) it N-ttive village in Alask,% (as d6fined in section 3 (c) of tile ,Vl'nska Native CliLlins Settleiiieiit Act), to be .I, lie,.tltlt systems a,-,cjlcy sliill only review 'and coiikitiezit on stieli pi-OPOSeAt use. standing any other: provision of this Act or tiny. other "(2) I lit, it) filet-t (II(. Notwith of I iii 1512 Act referred to in p-,ii-,tgmpli (1), file Secretii-3, sliall tllow a'li(@.Iltli :ill,[ systeins'a,,,Liiey sixtv d-.ivs to inalce tile review re(illil-c(l by sll(:Il to ill to be to If an a,,,tjicidisitl)l)rov(,s it I)z-ol)ow(l Ilse iiL its'he:tltli Ill to iiiec-t serviel- aret),of Federal funds described in ptrii,,,i-it 11 (1), tile p t lit@, of This Jet-( rot. :t, :k 11(@.litil ,;vstelilq iiialy not inake such Federal fluids available foi- Such Ilse until lie, has .nitide, til)on request of the entity making such I)t-oposa 'a i-evienv of tlion--(,i@vdeciiioii.Initiakingaiiysticlir-e-viewofttiiy g@iicydecisioii, 11 i-isiteStat(,Iiet-ltll' ilit.t.-iiiii-st p i ti(lvelol)fllf-.Ilt literacy till o -tti iit to cojisi,.Iei- the (II cis) (),I() tile Y ,,(@)pot , )Iealtll sLvstcjlls II,-Cllcy t to sub, it to the Secretary its cojiiiiietits oil (.11:1, f,f I ill,-) (Ile St,tll'(,(:II'.%, the decision. Tlie-Seer(.tary, aftet- taking into (consideration such St-.tic :t-,,cttcy's cottitnejits il:Llcc sticli ftiiids i,,jiiit iot, or @i -IPI)I.O%.al of tile, 11(@.litli syitellis for sti(:Ii Ilse, iiotwil tiis. it-to (,finite,, Secretary to Ili, ttil(lvl. (airlines ]I(.itltii a (,]icy. I,,ttcli such ( tko faults av@i]ilble s@iall be submitted ti ill systems agency and Stitt@ fill. nitrate ;II-(-:IS oil .1 iloll(iiti,)Il;li N%.itll I view health primarily all( I Iiid Shall Contain II (let@tile(i to ilit@ii. iil)ilitn. ill iiie(.t tii(@ or statement of the real sion. (b), -.Ill([ ilit-i I- C:ll)ilt.ity 11) i)(.I.f, , 1.1 II tIli- I'liil(.tiolis by SP(-tioii 11(3) Eitcli liciltli systems al,,eiil- sti-.tll provide each Indian tribe, or iiiter-tribil Iiitliniioi-ganizatiotill@iiiciiislocttted,%Yit-Iiiiitlic ageyic3-s 11(2) I)itriiig tiiy 1)el-ioti of (.Oil(liti(iiiii (attention iii.@v licaltIL service arett information respecting tile availability 'of tile not 2-t itit)iiilis), t)it, July tilitt. till- (entity coli- Federal fluids described in the fii-qt sentence @f this subsection. tlitioiiiliv distrusted attempt ofily stl(.Ii of tlit- I.V(lllilelllelt.ts of @@tioli it (f) 'To assist State liciltli planning iii(I development 1512(b) 'field only shelf of the by section c rryinir out their functions tui(ter paragraphs (4) -and (5) of section 1513 as lie determines sit;.II entity to lit citi).tlilt- 'of int-(-tiii- ;iid Pei-- 102;f(ayeacli health systeins a(,reiicy shall review anti iiialce t-(,coitiiiicii- 'rilt! number. all(] t%.I)(. of slit-11 ry 4, 1975 17 Pub. Law 93-641 Pub. Law 93-641 - 16 - January 4, 1975 Janua (Ivsi gii:ltioll, 1)(@ oi-is J)Ol-fol-litillt,' like iiit,i-eist,(l Is tile Clitit@- Coll(litii)llklly tit@sigiiiltetl I)(.(.Olll(.g of I!Iir tile y I)!-iol-itly to all ap])IiC.L- ilay ti" I wliiel' litis been I-ecoiiiiii(.,ii(led for k)l)i-ova each C'Iitity little([ I I)ojl@il)ility So t)i:lt, by tli,- L!ll(l ofill(-Ii I)t!l-iott. tll(-. :I,,eiiey I 01 I f(ii. (It-sii,ii;tl ioll (C,). ivliic',Ii hisIdlveloi)ed iL,I)Ian referred to Ili for all or igi-et-iiitiit Iiii(ILI. Nylli(.Iltjly critics is coil(litioii:illy dt-sig- part of tliol If(-ultil service tire& WitIL rwi)ect to which tile application it.tted its 11-1 e:tltli systi@Ill-, illity be te@iiiiiiate,(l by siicti czitit), I edical proirr-,im established I I was sltl)mitti,@d, and (13) each i-egiolit in kll)Oll iiiiietv d;ivs iioli(.(- to tlte Secretary or by tile Secretary in such are,& under titf,-@ IX. e to such Clitity.. (3) Ali agreement uixtler this subsection for the designation of a t,ii-v iiiiv )lot eiitei- ilitoiii U"I,Colll(.Ilt witiltily clitity health systems &,,,reiiey may be renewed by the Secr=r for a I)erio(l y (I) foi- cojitlitioii@il tlesigitlitioil as a health systems not to exceed twelve months if upon i-eviinv (as p ded in section tli service ai-et until- 1535) of the -,ig(@ncy's oi*mtion and perfoi-maince-of its functiori& lie eiltity has sLibiiiitted ,tii application foi- sticli (Iesi,-,[I:I- determines that it has @ifilled, in a satisfactory manner, the functi.ons jitaiii,, -i.@,;tti-aiicLs satisfactory to tll(- S(@cl-Ltll-Y tlilt Of iL health sxsteins agency l@rescribvd by section 1513 and continues to III)oii coiiil)](@tioit of the pet-i(itl of coiidiiioti;tl (It'.-;igli-.Itioll t]IL@ meet the requirements of section 151 (b). . @ill be oi-,_,.iiiized ;Lnd o )erite(I !it tile iniiiiiei- on under subsection (b) or (e) of a liealtli systems Ill @L-tit)ii 1.@Y12(b) aiid will be qualified to I)erfoi-iii tile functions services area is tei@niill-.tte(I -before the date pre- ai-y sliall,.u I)I't@scril)e(I by section 151.1; SCI-I tioii, the Secret "(I@) I 1)1-,tli foi- the ot-(Iei-I.y isstitiil)tion aiid implementation of acco: oil (@) or (e) (as the lie filll(:ti -late), enter a cl(-,signtitioii agreeme 0 oils of I lic@litli s'X'stellis 11:1s I)(.ell fl'olll ttpprol)l e ity I i)y t I it" iicy fol, stlelixrea. tlic@ 1LI)I)li(.;Illtlllcl. t-obetlieteattlisysteiiis e "((,') tile Secret:ii.y.iiis coiisulteti witli the (iov(-t-iior of eacli ,Nt:iie, in which sticii lie-,tltli it-e;t is loc;tteki itii(i witli sii(,Ii it ill@%NNING GIL%NTS otlivi@ Stit(,@ ili(l loetl olliciils its lie iiity witli I'CSI)ect to stieli IISFC. 1516. (a) 'The Seci-etai-y.sliill iiialt@ in earth fiscal yc-.ir a gi-.xiit Ili ct)llsitl(.I.@ii .4licil .II) I)Iie:ttiojis. the Soci-et;ti-y ,4]iall I)i,io,,-itv lo to catch licaltli systems Nvltli Nvlliell tliert@ is in etTect iL Ciesigiia- :ill -%which -b(,(-ti foi- 11)1)i-ov;il b.N- hill t-ion a""cement under =Ccty:loll (b) of- (e) of sectioll I.-)1,5. z't -raiit (@litit),'wliicli )ill de%,eiol)cd !L 1)1'.Ill I-Cferl'L(i EO ill 1-4.1@tioii tinder tells subsection sliall be niaile oil sti(.Ili correlations its the S(,ci-etarN s fot- .111 d(@teriniiies is itl)propriate, sliall be used bv a )iealtli @vstenis agency o'r 1).tt-t or tiit-, ;11,et Nvitli respect to N@-iiieli tile :11)1)li- J)I-o"t for con agency (,:Ittoli %-:t,., slil))Iliticti, Haiti I.(",ioll.,Il II -am (!,,t:tb- ipensitioii of lei, (Collection of (vital, I)IRIIIiiii"r ]initial and the performance of the fllnctioiis of the and still] L)otviiii- "(e) ( I ) 'I'lic Secretit-y sliill cjitei- iiitoiii -,agreement with Ili (!Iltity able forobligatioii foi- it pei-ioill not to exceed the period for which its for its oil :is -,t'liealtli systvitis t,,!vjicy if, oil the basis of ttii d(%igiiat-ioii agreement is entered into oi- i-eite-,N-ed (its the case I I be) '@y :11)1)iic@itioil Tinder P:tl,;t,,rr:tl)li (2) (; iiti, in tile (-:is(, of fail eiiLity con- JIL Health systems a,,,reney may use funds under a grant. tinder this sub- (litioiizilly tl@,,igiiztted, oil the 1),tsis of its 1)(@rft)l.lllztllce I ))('I-iotl @extioii to make payments lin(loi- contracts NN-itli other eiitit@ to assist of c(ititlitioii:il-(Iesigiiittioii uiidei- stil)@tioii (b) as a health systems tile health systems agen(!V Ili the performance of its functions; but it for t health at-(it), the Sect-etii-3. (let(!I-Illilles treat SIIL-ll sliill not li@. funds uitd;r such a- Lrriint. to iiinke payment,., Iitcl(@r a -is of fillfilliiig, il' for the (lo%-elol)iiiciit 6i (@;@t t c)jiti-tict with aiiot)iet- cjitii' I -,I s:itisf;t(.tol-Y lli:iiiiit-t-, (Ile instant ot. c -Y ili(,lit$ itil(i functions of :1 lit@:lltli sv,;tk@ili@ ;i,,,Clicv. ikily Sllt!ll igi-ccfiiel)t of liviiit)i services or resources ,IV be renewer lie(,orLIiiim, 11(b) (1) 'I'lle Brilliant of falls iiii(let- falls ,:qil).,;ection water .tii ejititv Ili, V Lri.@ilit iiiidei- -,kll).@ctioll (a) to a health Nvitit 1).ti-agz-.tllll sliill Collt-.Iil@ sticfi I)IOVISLOJIS I-es ills agl@iicy (tesig@iiated iiii(lei- section 1;-)l.'j(b) sliall be determined I)Cct.illg tile syste re(litii-eiiieiits of sections 1512(b) -,iiid 1.,Jl,), ;Ili([ such (-oji(litioiis de,.ii,rlit@d I;y tli(@ S@i-etl-li-y. Tli(,- amount of any (-Fruit tinder subsection (a) to tt) olit. the of this title. :is ',Ile S(@Cl-(!t.11-V rally .iny )ieilt-ii systems ii,-eiicy desiaiiiiteil 'U'ii(ler section sliill be :iitd sli:tll be foi- a tei,iii of not to t%%-eli-e iiiol@tli,,; trial, the l@ei- of- I)i-ior to tile expiritioi) of such tt-i-iii, such it'I'VOI)ICIII lll;LN' be, k tile, ])I-Otlllet of $O..@io and tlit@ I)ol)llllltioli of tile, health which tire literacy is dvsi,,!ii-.itL@d. oi- 0 "(A) I)v the eiitity at such tiiiie aii(I upon such ll()ti(-e to the "(Ii) $,I,-, "-,O,oo()) unless tile ti,,Clicv Nvolll(l receive a trrl.elttel. amount tinder 'by t]iL I n tit stiel' time and upon Sticli notice to (2) ot- (:@). the eiitity as the Secretary i)iLY by regulation prescribe, if the t, (2) (A) If the tlpplication of a health systems a-aency for such L .,4eci-et,,ti-y determines that the exitity is not complying with oi- grant contains alsqtlllltlle(@s satisfactory to tile Secivt-ai@ trial the a_@n citc,ctively carrying out the provisions of such agreement. .vill cxi)cnd or ob]iLute in the peri@ in %,.,Iiich such graii@ will g'(2) TiioSecretarvniaynotenteriiitoinagrecinentwitliaiiy(,iitity tivaiiil)!L foi- obligation lioii-Ft!d-er,,tl fluids nicetiii,,, the iv,(Iiiii-eiiieiits tinder ptragrapli (lf for @designation as a health systems, Lgc!ilcy for a of subparagraph (13) foi- tile pui-I)osLs foi- which such rr-ijit relay be health service area unless the ejititv has 3tibmitte@l an application to (IC, tile amount of such gi-aiit-,;hall be the stiiii of- inti the Secretary for dimigiiatioii its iL health systems ,t,,,.eii6y, and tliL@ treat determined matter para,,ri-al)li (1), and Governor of 'each State in which the area is l@Ltted has been consulted a:3110tilit of such ,ioti-FL-,deral funds respecting such dc-,iLli,,ttion of such entity. Such ail application sliall trances weiv made, or (II) the contain 'Isiui-,iiiecs s;ttitsfactory to the secretary unable apl,)Iictnt latioii of t]tL, health service area foi- ilicets the reqtiii-ei-nents of section 1512(b) and is qualified to perform Pub. Law 93-641 - 18 janil,3rv 4, 1975 January 4, 1975 - 19 Pub. Law V:5-b4i tlitlt tilt, elllol fol "(Ii) '.Vile 11(311-1@'c(ier@ii ftLiltis wait I.(. c V., ;tit lii;t% it)llI(,,II Nvlli(@ IL is oil tllt@ 'y li:,s tllo ;lilt .1111 (;f the Stat and 1)0,4e of obttiili,.l;- i I,. - to ;Ltlittiiilst(,r tile 'it:ite, Itliiitiii@11-:Itive pi-o",I., the ba:,is of the foi-xjitilL 1)resci-ibeAt by (A) tk) (,;II l'Y olit ill(! lk(,Itltll (I(@%-Ciol)lliellt fillictioiis I)I.C- not ill(!IU(IC !illy flilitis coliti-ibt,!(@il to til@- igi,n(!V L)-; ',IIIY I'N.@ 01' ti lt)2;1, aiiti ill(l" ititiii oi- I)ri%.Ilt(, 'Clitity Wlti(-Ii lits a filitifici@ll. litti S(.I.l e IV i@ ((.i) ii, t III, case of it ri -,ii-rrvL@iiietit entered into iiiider ,,r direct iittert-.-t ill tile (li@velol)lliellt. exl)-,Illiloll or- Sill)l)ol,r, otliL t ( (3), tiici-e litts I)ecjl L'-,tablislic@tl for tile Stite a St,"@ewi'lc IIP,'Lltli of lictitil r@ur(:(,s, and (,Ool.d,lllltill(y (,Ollllcil illectiiii, the r(@qttit-einents of section 1524. -(ii) be ftinds wliiell "'e. 'lot Paid to tile acrellry for tli(@ m .]Ito I- of n State it vitli a (-toveriior ictllll' 'A-I'VieCi ))V it Ill(] i%liic I f t, foi-ill.,!Ilct, of I)alt (a) iiiay 1)i,ovi(le foi' tile 0 a S 'tL coiitl-ibiite(I to tli(, ; eiley witliolit coll(iitioiis :is to tlit@ii- fish, otil(@i- leliat !lie f iiii(Is sliall be ii@oti f t)t, t lie 1)11 1-1 oil :I Colltl itiolli@tl basis wit II it view than the condition for %vlticli a grant iiiii(le Initial. tilis st@L!t ioll iiizi v be or Stat(, Al,t,i!(-Y to -,I(llllillister the @taie :I(Imillistrt- "(3) The national of a ,,i-aiit un(lei-stibsv(-tioti (;I) toll liellitli sy,,tt@l:il; ti%-e I)T'Oirl'itill of tilt, @t:vt(@ find to Carry Olit tile lie.-LItli PI-,IlilliltLr ftil(i .I,ffelley dt-!zigii-itL-d iiiltlt@i s(.ctit)ii iii;iy not be le.@,; tilati $175.00(,[. I)V st@ctioil 15@-,;I. 'I'll(, (c) ( 1) I-or ill(, of ilitilcill", I):Iyill(tllt% I)III'Slitilit to gl,:Iilt:- is II (.011,11tii@lk to the into of steel all tli-it iiii(it'l- sul)st.ct@uii ('.I), ill(.I.e :ti-e Itltflol-ized' to Ill- tile ('ro%,et-jtor stii)itiit. oil belialf of tlir- agency to be (icsic,,ii@tted -i pliii I.-'.60,Ooo,000 for the 3-(-at- eiidiii,-r :)(), *."O,Ooo,000 fol. fol. tll(@, a(r(,iiey's oi-(Iei-ly assumption tried ii-nl)lemeiitttioii of Snell 'tile fiscal year ending JiiiiL@ ;@t), ll,)7t'), @iii(i $12.),Ut)U,ooo foi. the ii.,;elll 1)(-t-iotl of all (A) 11(2) Notwitlistii -t@A@tioii (Li), if ilitt it)t;il (if the Atlanta t.t) I-- )IIIL) itot (,X(.k.(.(l tN%.Cllty-foli 1. illotitli-i. sttl)., Slit-11 i)vl-io(I tile ittattle, earlier this set-tioll to lieiltli sv.4tellis fol- :tiiy fiscal 3-eitil lll;tn, tlllt till! (IL-sifril@tte(I St:lte A;-,(-j)ey perform oill.@' t,x@(Is tile total of the Nationals %)f Ill(- fiiiit-ti,)iii of :I @t;ttti @kLrt,jicv pres(,i-il)ecl by sL(!tic)ii 15-);@ for that fiseil veai-, tile aiiiottitt of the foi, tlitt lical to it is of 1)@i-fo@iTiiiig. The iiiiiiil)er -tn(l tyl)(, e,ti-li lit,,tltli systems I,,eiiev sliall be ail ;internal wliit-li tll(@ of filll(.tiolis slitill, (Illicit Stl(.fl P(.I'iOLI, be 'I tei-iiiiiie(i for tli:it 01, tlilt. I;S..;Ii -is the desicrii:it(@41 Stiittt AL be(-oiiic@s ctl):tl)lc'of added i'C'Sl)ollsi- ratio tA) the aiiiotiiit t e tinder sti@- -(,tioii (1)) its the t ot.11 of tile itilloillit-S I)ilitv. so tiiilt 1) sti(-Ii I)eriotl the designated Static 11111-ligrnl)li (I) foi @i:tt year beai-s to the t t)t-.il itinouiit i-e(litired v the end ni-.ty be foi- desi(-,n;ttio@ iinder par-i,rril-)Ii to ninke gmiits to tems I witli tile ail lietiltli Sys II itecol bfo,- provision kliy with I Govei-jioi, of L Stott% el'iterc@d into larger -.IPI)Iica of subsection (b) ex@.I)t @litt the a,,iotiiit of any (.k) iiiiiy be tei-iiiiii:tt(-(l I)v the Governor ul)oll nijicty gi-tLnt to IL li(-.ttlth systems tigeiicy for iiiiv veir sliall not be lesi than ([,Lvs' iioti(,e to the oi- by the @eretai-Y iilion riiii(@ty diys' $175,000, unless tile. -.Internal nl)pr@I)ritite(f for that fiscal -vcai- iio't to t lie (1) is less tli-.tii the iiiiottiit i,eqti sticli 11(3) If, oil the I)-,isi,, of :III all, ii-t@ti to Intake T)li(':ItiOll for dv:,i,,-iitioll q.9 ;I Yraiiitt) e@tcli liettlt.li systenis it,,,ency. kfr ll(-y (1111(l, ill ill(. ease of itn tl,@(,iicy conditionally (lesif,iiited trader (2), oil tli(- basis of it- T)c-i-foi-nl:tzi(!e tilid(,I. till iizreeill(@lit "I".%I,T C-ST.KTF kN[) s I- I -it tion-ei-iior of it viitel-t@ti ilito iiii(IL.I. li(:Il ), ill(' is of filitillill@@, ill a DFAiIGN.'%TIO.V OF .%Nl) tile, it, - -,Zltisftt-tol-Y t]IL@, of t sttt(.@ lIe ,Ii:lll (.11tel@ into itil with tile of till' StiLt(I "SEc. 1521. (a-,) For the I)tit-l)ose of till- N%-itliijl L",ICII failing tile tt,(,'Clloy :its (lie St-.ite A.@(,iicy for t;i(@ St:ite' No ,;tate of the lietiltli I)Ittiiiiiii,-, atitl de%-elol)jiit-iit ftiiit-tions I)i-eset-ibed atyreciii(.jit lately l@(@ ii)IL(I(,. analogs ail -.11-11)li(@itioll tilt'l-efol- is Sill)lliittetl ID '.v sl,.. to, and liy, tile Se(-i-(,t-,try. Billy swell sl,.:tll I,,e ft)l. bv section 1523, the Se(-i-t-titi ill eiitei- i)ito and i-enew a,-,t-e(@in(-iits (ile.scril)ed in si.ii).@ctioii (b)') foi- tile tlt-si,-tiatioii of II ;t@ItL, liciltli I t(@i-ill of not. to twc-IV(-, itiolitli-,, trial, I)rior to tli(@ of plaiiiiin(,, and de%,elol)meiit itt-ri@ii(-v foi- Sr:tte (Intel. tli:iii ,I Stitt(. ill-,tv not silbb(.(,Iioll ((I') auto. tile -,it ti, -II for w I tile S( ne , ill iij@on qiieli notict- @(1i) I)'V tile 'it such tii-,c ind iij)(;n -catch notice (b) (1) A' desigi,.:itioii iitide;. ;Ill)se(.tion (a) is ail electrical with the ('xo%-ey-iior of i St@ite for the (I(,siLii.,itioii of ill to the as tli(k @t!ct-et-iry it):iy by retaliation I)rc,.zci-ibe. if the ';(-ei-etai-y tliit tile (tesi'L-liate(i St-,ite A-@nev is itt,rency (selected by the Cyoverjiot-) of the -ovei-iinieiit of that State le -iit .tgoiicv (hereinafter not voiiil)l%liii@,-'ivitli or eil'ectinrely carryin- out tile provision; of LS ti State,liealth I)Iajiiiiiir tii(I de%,clol)iii( tD in this 1)itrt. refei-i-ed to is the 'State A@reiicyl) to administer t]iL- State am 1)i Ali qzi-e(@inent iiii(ter this par-igrql)!L shill contain such provisions -.is -,administrative pro-i- -cscril)ed by section 15:)2 iiii(i it) carry otit the State's lictltli I)Iaiiiiin-g tzid (leveiol)inent functions lires(-i-ibed by the Sc,(-i-et:try rni'v riqtiii-e. to thqt tli(, requirements of tllis section 1523. riie ';cci-etai-y may not eiitei- into sii(-Ii tii ii-i-veniciit part rcsl)ecti!ily State wine tile (loverjiorof a State "(4) kii entered into under :tgrltpli (3) for tile (I(@siLiititioii of t @tiite A,,Liicv 11 "(A) there has been stibinitte-d by the Statc-, IL State a(ltyiiiiis- - itv be the Secretary for Ft period not to tw(,]%,e tratii-e T)ro@,i-ani wliirli has been atl)pi-oved by the S(,Cl.(@t@it-yi months if lie (letemlitio-S that it II-.Is 11(13) ail nl)plie:ltioll ]ills been to the foi, sii(-Ii ftilfill6ti, iiL a -,ttisf:t(-toz-v tile responsibilities of t State '.ill(] file ill)[)Ii(-Itlitjii C-t)lltltitl.14 JISSIII-;Iiict-.i.it Ag(-iicv Ali,,i-iii,r ilit@. I)ci,iotCof tile to be I-eflc%ve(l ;Ill(l if tile January 4, 1975 - 21 - Pub. Law 93-641 Pub. Law c,3-.641 20 January 4, 19'!5 .11 11,L@tlic).(is of u(iiiiiiiisti-,ttioii itstre found t 01 1 1 (,t,t i II(, sit( :il,i)lit-iti)le @L@t[C " ( 13 tli,3) @,@lcoiveitLater rol of -;Uctioll by @y to be necessary for the I)i-ol)er aiitt (-iiicitiit (lesiL-,Illltiull @igi-et-ILIt,'Ilt@ @%'Itli tile of at stilt(3 ilciiiiiiiistratioiiofstichfttiietiolisttiidtlieSt-,ttePz-6gt-aiii,iiiellitilll", -@ I 0 b) (;@) is tet-iiiinited before iiietilo(is I.(.IlttiliLe to the est-.ibli,;Iiiiieiit -.111(l illitiliteiiiiiiet,@ of I)er- ito iiiidL,ll slil)Se@-tioll (b) III)oll Soil C'l staii(lai-tli oil at iiiet-it, b, II. I- its ]oil. I lie S(@ I'L-I;ll,y Sll:l it -isis consistent with such stand rds tliu fo ,illl)sc('tiOll (b (2) (b) as tire or iiltty be established by the Civil Service Commission 0 t detet es tipl)l.ol)l.iite - ilito itilotilel- sect-io -208(ii) of the Izitet-(,roveriiinezital Per-.;o lent n nnel Aci of N@-it It t lie (i ov'e i-iior f or t lie (,Iesi _,ii itti oil o f ii St:tt e A gL,,i ic 1970 (Public r,aiv 01-648), but the Secretary sliall exercise no y ,,((I) If, UI)Oll tile ex.ilati I of the fottrtli risen @Iciti- which be.(.,iiis authority with respect to the selection, teiiure of office, and coni- I)i Ul aftertliecalt,iid,ir3,ear Ili %which tile ',\'ittioIl.,Il Health 11olie-y'plalllli@ig, peiisitioii of tiny individual employed in accordance 'With the -elol)iri isi-@iiacted,aiit-ri,et,ilielitillide" iii(@tiio(is i-claitinly.to personnel standards on a nierit bisis estib- zill(i I)e% ciit Act of 1974 this sectic ' i-, @St;kte is not ill li.-Aied and iiitltttttiii'ed in conformity Avitil this parigr,-tpli; it for the des it-itioli of it St-ite .@g("'cY fol' , ,I I ()I. lo@tit (Street, tlt @i-et:tl,v liiay tit)t iiiitk(! tiiiy @ liotii,t@lit, lo..Ill "(5) require t)ie State A(,r@tic@ t@ perform its functions in e eco I shed t@u Illy (,-Olltl".Ict, lliiciei- this @@ct. the C,ollilllulllty ardaiice with procedures find criteria established and publi "tilliliteL@. t)l' into 1))I.eilellsi%-e .@icullol -Abuse Ilitl -I)y it, which 1)1-0,-etliires all(] criteriii sl,.-,tll t-onfoi-iii to the 1-e(luire- tei-s .\xt, or tile ('oil -eittiiielt, ,Illd l@elitl)ilitatioji ACL of 1970 f(ii- iii(-nts of sect ioii 15.'42 - .@icoliolisiii Ili @\,e,.itioii, Ti 69 ( is, such tile exl);It 1011, 01- of health I.(.s I require tile Article k,,ezicy tc) (!'t) coiiduict its business meet- State )Ill)lic, (11) gii ,,)t ice to tl,.e I)III)Iic@of such me(.t- iiitike its i-e(@oi-ds and data uvailtible, upon re(luc!,t. to tii(@ I)tiblie; "(7)-(A) provide 'for the coordination (in accordance with a) 'I st;ltk! ilenil, - ttioiis of the Secretary) -ivitli the coopent this sectioii i-efet-i-e(i to as the 'Stite is a foi- the %-iii(@(i foriizidersectioii3O6(e@ of the activitiesof ,)el fol-illaiice %vitliin the ,itate i)y its Sttte A,,Cll@y of the functions 1)re- In for tile reti,ie%,tti, analysis, reporting, 'b@l bv se(-tit)ji I;)2:@. Tli(@ Se(-i,et;tt'v ",IV ]lot l'i-o- of .;ttitistical iin(i otliet- iiifc)i-iiiition i-el,,ttNI to 1: care, @iii(i ( 11) i-e(Iiiir(,@ providers of lie:titli cii-e (loing business in ,yi-,tiii fort St@tte. Ull]VSS IL- I meats the i,e(ltli I-ellielits of Sill)S(@(-t ioll (1)) the State to iniike statistical iiid other reports of -ucli iiifornii- has I)e(@ii stibtiiitle(i to tile SCCI@et-,ti-v 1)3. the (,Io%.t.l.llor of lioll retire State iktrelicy: ,iilttli (lk!ttlil. 3131;1 (.Olltllili,.i ol. I)I@ovi(le. ill accordance with inctliod.-i and procedures re- j)llllied by' such infoi-iiiaitioil, its tile @eei-t-tai,y (teenis necessary; s(,t,it)e(t or appro%-ed by the Secretary, for the evrtliiation, at ?east y itall , of file perf6@inance by the State Agency of its functions "(3) his been submitted to the Secretary O]IIY ;tftei- tile. (Zovei-- 'til(i of their ecoiioiiiic etrectivelim; not, of the State has alroi-detl to tile 1)tiblic of tile St-,Ite a "(9) pi-o%-itILktliattlieStateA"iicvwillfroiiitiiiietotitii(,..,In(l reasonable opportunity for it of N'ie%v" 'ItL It oil tile St, iii any e%-ejit not less often iii@iittlly, review the @State Pro- 41111ini and submit. to tile 10(lific;ltiolis-, "(10) require the Stite A cli reports, in such (ii) rii() State of it ';tute I'llist- .91 .i t;lte ()Lftel, tilt@ f,)t-zii tii(I (-ontttiiiiiig such iilfl retain,, its structure, ovi(IC for tile I)CI-fol-ill;tllcc within tile -S I)r t)l)ei-@ii-ions. ii(,i-foi-iiiiii(-e of fit her niattet-s as tile (I(@.,i'l,fliltiollof,tSt:ite.kgeii(-viiiid iii li'L'(Ivsigllll- tioli el I,_IrectilLilt) Of the filli@tit I-esel.il)e(i by 1,7)2,i :tii(i Secretiry artery fi-oiii tiiiie to tinio requi keep such records )Its 1) SI)ecif@ the State @keiicv of tile. Stite is the sole aleiicv foi- the Retail :iiTord such tccess thereto as the AC( nity-fiiid necessity' a : to v(@,i-ifv ,itieli reports; I)CI-fol-riiaiiee of suef@ fililetioi@- (except S ill sill)s(-.etioli 99(il;I z-e(luire-tlie State .4k,-reiiev to )i-ovide foi- sIitch fiscal con- (b) of such section) ind foi- the ;administration of the 'file l Program; ti-ol :111(l fund a!O!Olllltilig refectories as tlit, '-cci-etary mav y satisfactory (.alliance thit require to assure arsenical of, all contain oi- be supported b I roper d Iccoiilitiiia foi. tile State @kgeiicy his uiidei- State' law the authority to carry iiiioiiiits i-(tcei%,Pd fL-oiii the Secretary under this title; out sti(-Ii functions ill(l the State Program in -ic(,oi-dince ivitil " ( 1 2) 1)(,i-iiiit t he Secretary and tli@ Coiiipti-ollei- C-teii(-.ral of tile -,ill .i ciii-i-(@zit budget for the operation of tile. failed States, el- their representatives, to litve access for. the this ]),Lrt and Coal, purpose of ati(lit and examination to' any books. documents. State Agency; el- ade(juitte colistilt.,Itioii with, and iutlioritY l@tipeils, and records of the State Agency peAinent t6 the (lisposi- (3) ovide f "Ititeli.i(le lfe-,tltli Cool.(Iillltill,- Council (prescribed by tloii of amounts received from the secretary under this title, and foi the 61 A-mency malces a decision ill section l@)4),. out such functions and the State Ilrof-ri-ii.in; r (3), S4), (.@), or fol-ti, in such (letail its tile Seei'Ltary nitv p@e- li is inconsistent set under subsection (f (g), or (It) sci-i@ tile q,,alificatiolis foi- personnel having i-E-sPolisibilit;es Ili tile 1)(',I-fOl.llillllcL Of such functions and tile @t-tte Ili-ogi-:iin, and of section 1513 by a health sv@ms a(-rcllcv within the. State- i-e(itiii-t! the State t,_rellcy to it T)t-oft-ssiuiial stafY for planning "(A) sucfi decision (and tlio"rec6rd iij.)on which it was and a professional 'Staff-for dei,clol;nit-iit, Nviliell sttirs sliall be of made) shall, ypon request of the I e-alt-h systems agency, be ivvicN'Vc(l, uji(ier all appeals mechanism c-ol@si.,;telit With Stite one), size iiieet -,itch qualifications as the S(@eretiry may Pub. Law 93-641 y 4, 1975 23 January 4, 1975 januar Pub. Law 93-641 zz lsi(lel,,,itioii of recoiiiincii(littioiis stibniitted bv it,id, after co, ti@c of lic:,Itli systems ligetiel(t.,3 iiiider sitcli ',el'Vic(!S, iiitlio I)Ublic al)l)i-ol)ritten@ of lit f tinetioit - described ijL sttl)section er- of tli(- ageii(-3, sli-ill fol- Plir- fol.l,,O.,(, bv ano her tigeiicy of tlil- StiLte Lrovernnici of agreemeiit with tf;e State A ory 'ove@nor under an title NN71 I)L tile decision the (i ltli planning tiid develol)tiiel t I,(,reiicy. to the Secretary. of t@, I cc (2 'I'lic i-c(ltiireiiicrit of paragraph (4) (B) of siib-,ection (-,I) sliall Tile sil.111 al),@rove.-any @-it:ite Ili-o!i'-,iin ntitt any iry 0 Tilo(lific,itioii f wliicli Colill) i(@s With siil)st,(-t ioiis (I ) and (b). I'lie II t I)Ply to a State Aveitcy of a Stite uiitil the exl)'ir-.itioii of tile first 1'eti-ill@ti- session of tl,ic l@,,istittiti-c of sti(-It itzite which be,riiis after sli,,ill rL,,view for coitil ii-.iiiee with the i-p(i.iii -eiiient.A of this I f -iiid . St-,tte 11ru t lit,, (lit(. of eiii.l(!tnieiit of this title. - 1), 1-t the SI)CCiacat-ioils 0 , litloiis iiilfl(.I. each 9 4( lete its ftndinrs with respect to tile .1 OP"" than 1) @'t State @@o-clicy coinp LI ,t 1) -ov(,d by Iiiiii. Such review Sillill be coil(Itictett not less oft eil 1) I appropriateness of tiny existing institutional health service within oitt,t- each ve,.tr. I)iit@ yea,- after the (late a liealtli systeins a-,,L-ticy his init(to its I-ccoiii- A%I) DFVEI.Ol'Ati..-;,r i.-LTN(@T10,48 iiiider section 1513(g) with resliect to tile appropriateness of 4.sl.. C. (lesilrilitocl iiii(It@r (e) If aL State Agency rotikes a decision in c-,ii-ryinz out t function (a) State A Cixcv of a State i@itit(irizt-(i iiii(itll' dest-i-it)(:@d in I)ztt-agi-al)li (4) (.5), (O' sectiuii -fol-iii is not colisi,,telit with tile 1-roals of tile or tile pi-ioritic'.1; I)VI it to the ty)l)rol)@i- -activities of the State of Llic al)l)lieable AIP, the State A(rt 4 health 1)1-.Ill (Trader section ;itc licalitli syst(@iiis lifrelicy a detaiii f the reasons for ,y-,teilis within tli(,@ inconsistency. the I)tljll of tile Stiitt@. ..(2 -1 iew iid "IS .(I)Ilt lit lo:ist "STATFWII)E IIIIATTll COC)ri)lll.klrlNc. COI"Iqc;lll iiai,.v St-.Ito health 1)1:111 ivliit-li slitill be ilil(lo tile t 11(@ q 'Itt@ ninz and development ttgeiiclv 111) of iealtli slsteiiis agencies within "Spc. 1524. (a) A State health plan S'lic.li I)I.elilllill.,l plan iii-ty, its found -by the -State (lesiliiatccl iiii(tei, section 1521 sititll be advised bN a Stitewide He-,tltii y ALt@iiev, coiittiin of sll(.Il IISI"s to ttcliien-e their (,o@cliiifttiiig (council (Iwreiii-,ifter in this section referred to as tile lil!l)ro@)@ilite coot.(I deal I.)()I.c with -,tttt(@- 'SIICC') Nvllicli (1) is orlraiiized in the niitiiiier described by sitlisce- Witic fit-ititli itilit-V I)IIIll Strait be ,Ill)lllitto(I to t.ion (b@ and ( i)crfo@itis the functions listed in subsection (c). 2 life I;tlltewitlc If( ttill,y. (,ollllcil of tlit- rol. (b) (1') A Sl@t,' of it State sliill be eotiil)osed in the follo%viii,-, l r or and for use III (IC%.eloi)illg the State health annular: -f--ctioii 15,')4 t,. N 14II i-eferri-tl to iii t, "(..V) (i) @V STICC sliall ]to flwt%l. than (3@ A-,-;i-,t the il(.@iltii Cool.(Iilllltlli(y ('oiill(.il of tile tivts nl)l)i)iiited by the Cioveriior of the Stite fi-oii-i lists of at State. Ili the revit@Nv or tile stitt(. iiiedi(--,tl i)l-,tii i-(-(Iiiii-Ld legal live ]retained: sxil)initted to the (taverner by each (.)f tile health under ek(-(.ioii 1(',O:I, ittitl in title I)ef.fol.lll..Illcc. of its filllk'tioii-, s stenis lit,'(-Ilcies ft)]. Health sel-vi(.e ILI,e,,ts which fall, y ili'%Vllolc or ill within tile St (4) (@'t) its tile (lesigiiiltt@(I :telling of Ili(, Stzlte 1; lio:tlt.11 systi-t@ be entitled to the for tile of ll-)2 of ti:,(. S)(.Ilti S(ICI I:ity Act ir tile, i(@j iiiiibet-of i-el)i ,aiiI -es(-iit:tt.ives Strait, ]):I.,; ili:l(le. till a.4-ri.e(!Iliellt ])III-sillitit to sit(.ii S(' -t if;lt, and (1@) "(iii) Ett(!Ii stiCil IICILlt.ll SyStV I be entitled to -,it .administer ft St;tte (-ei-tifictit(N of i,.eed NV iieli nl)l)lies to oil tile of new institutional Health @i-vices 1)1-01)ose(l to 1)(@o ()I. -.1 Health systems ]lot less iiill be iii(i@vi(ititl!z -,Hill wIli( is s %vlio site co rs of'lie:iltli 'Lil(i -,Vito Ill-C, not I)I@OVi(l(@I'S Of 01)(@d %within tile State -11 -.Iti"f..It.tol..v to the SC( iisliine ,qitcli 1)i-ograiii.sli-,ill I)rovitle foi- review and (lotel-iiiiiiitioii of lived health cire. I)rior to t)ie tiTne such s iiiaule. ii-l(ler siil)i Itilli- to the a )I.)oiiitnici,,t itere(I or or substantial CXI)Vlt(litili-e:, Cyr: after of tile @Stite ili-,ty @'li)I)Oillt Sliell persons ioll for such Oif(@i-iti(I or (le%.elol)lllelit, :Liid I)i-o@,ide tliit Z7. kir Carl,,, I)tlblic elected oili@-iils, -,Liid otlier rel)i-e- Only those. Sol ice,;, facilities. and oi-g@inizitioiis foiiiid to be sell I iiietiidl -.authorities Avit.Iiiii the Stite) to serve needed sliall be oiTered or tievelol)(@cl ill-ill(., ,3tilt(t. Ill I)CI-fO)-Illillg Oil ciiis ,IPT)I.o i-i-,tte; except tlttt (i) tile niiiiilx@r its IC -,tgi,a II the $into A4,reiicy Saint Coll- C under this subparagraph ni,,xy functions iiii(ICI- this I)al PI of persons al)poliitL,,cl to the Blab 91(ler rtconiiiieti(latioiis made by health ,ystciiis x,@eiicies iindei- of exceed 40 T)er ceiit,.im of the total nicmlvrshii; of the Si lcc,, section I.?)13 (f). n alid (ii) II majority of the 1.)Cl@solis 'IPI)Olrlted by the (,Iovel.liol- "(5) After consideration of recommezidfltioiis submitted by ;Iiall be coiisuiners'of health care W110 fire not. afso providers of hettltli systems ilocncies under section 1413(f) I-esl)cctiiig new hem it" Cft 0- institutional health Service., to be, offei-eci witllill the (0) @@t less than outlined of the providers of c-,ti-t, State. iiiak-c finding as to the need foi- ,iicit sci-%-iccs. wli@ t@e nici-abers of it SIICC sliall be direct providers of health "(6) Review oil IL periodic basis (but not le.cs often than every care (as described in section 1531 (3) ',Ill institutional ])Clean 1)(.ill" elected ill the ry 4, 1975 25 - Pub. Law 93-641 Pub. Law 93-641 24 - January 4, 1975 Jai-iua III)oll I.eq1lest, of t II(" (,XoN,el.llol. of tll(, stil)iiiiiied siicli .1 IOCIte,(l ill It Stiite, tliv, .1 I or ioii oi- :tiioilivi- a,,@(@ i(-,Y Of St'('II St,, 'eViL'W Of of the @k(lillillisti-litioii ill l) . I I it@, it I sil:tl'i, ill ii(Ittitioll to tile ill' I)OiIiteLl it.@ lilt i@x 111L@, SIICV, tilelsioll. If ilft(@i- Su(.II i-e-vic%v tli(@, Se(-i-Ltiti-y tiecides ollici,) iiiertiblr,aii iiidividii-,i] wlioiii t]iL@ (",Iiief Nfe(liciLl I)irect.or of to iiiitko, sticii iiiiids avixilitl)l(!, the decision by the Seei,ctii-y to t-110 @ktiiiiiiiistt-litit)ll iiiilil liu%-v its :I I-el)l.(!- iiiiiliL itirli iiiii(Is. tivitiltil)lc silill be stibiiiitte(I to tile niid sent.itive of sti(-Ii facilities. -'] I ('C slid] I select f L-oin an sliall contain a d(@tAxiled statement of the i-exsoiis foi- the tleeisiorL (2) The @ , -itian. long its niciiibei-s it cli-,tii tg(3) The SIICC sliill conduct fill of its-busiiit,@ iiieLtiiit,,s in I)tiblic, GIIANTS FOR EVI@ATII, IIFAYTll I'LANNI'40 AND DFVFLOPMENT tili(i -,Iiiill iiiect at Least once in cicit citleii(iir (Iti:ii-tel- of v yett-. "(c),,A SIIC(, sliall I)ei@foi-iii t]iL,, following fililctio!ls: 152! (a) The @9eci-etai-1, sliiill inalce grants to State licaltli (1) lleviciv annually tii(I cooi-(Iitittt(I the IISI' and All' of cies designated uii(ler stib ctioii @-r all (ievclol ment agen se (1)) (;I) of section 1.521 to a catcli lie-.titli systems aLrency witliiii tile @Slatt! iiii(I I-el)ol,t to the (I!) (2) ssist tlleni in inectintr tile, Costs foi- p@ti-po of-iiis reN,iew iiiidei- sect (c (" "I, station. @inv Lrraiit iiiii(le iiiitlL@,r St-ito Se ioii 15, its @i, o) this subsection to coiiiiiielit,.4 oil siich TISP and kll). :@Lren(!v sli,.ill beav,,tiltil;ie'forobligatioii only forol)criodnotto exceed ,ti-c .iii(i revic%v -,iii(i i-evis(@ as it it ep. (2 - -'I ecess:ii-y (bar it tile 1)(,I.io(l fol- which its designation is entered into or -A ctl. Tile amount of any grant niid@ under this subsection sliall a State l,eiltli wlii(@li sliall be riia(le Ill) of 1,Cll(,NV tile, IISII",., of tli(-, licitltli syswzns ,i,-eiicies within the @Stiite. Stl(,Ii Illini]IC(l by the Seel-ctxi-Y, CXC(@pt that no _-rant to a desi(,,Iiate(I (let(. plan mav, as foiind necessary by tli(@ SIICC, contain revisions of St:it(,. A(,@(@iicy Inity excetal 75 per cellular of its operation (,Osts (as Such I-T.@l)'s to Ieliicve tlieil- .11) i)i-ol)x-iate (-(i()I'LtlllZltiOll 01- tO (1(1:11 tl(,tei-iiiiiied iiiict(@r i,@rillfitiolis (;f tile Seerk@tRry) during the period for alone eir(@ctively with statewide lie:iftli ii(-eds. I-.ticli health sy,;teiii,, wlii(.@li the (,,t-aiit-is available for obligation a,,ency which i),-ii-ticip-,Ites ill the SIICC sliall iiiatl@e. [tviilttble to (1)) (ii-iijits iin(lez- ,iib,-,ection (a) shill be mftde oil such ternis valid tile, Sil('C its ]fSP foi- eacli ,ve@ii, fol. iiitc,,,I-,itioli into the St:tte exec-I)t that tll(@ @Se-cretitry coll(liti@)IIS as tile Sect@(@tii-y relay pi-e. health I)Itii and sli,,xll, as reqtiii-eci by the STICO, revise its ITS13 in:iy not in:tke a ffrant to a State At7-@i iilcss lie receives satisfactory to ,tclii(@ve ,ipproprilite cool.(Iillqtioii'Witli tile TT,@P's of tll(, ottiel, isstir,.ilices tliit t@he State Agency wil C- a"ellcies which Pat-ti(-il)ate in the q]T('C oi- to i)ioi-c (,ITt@(,tiN- rescr'bed by section 1523 diir lie ely tions with stitewide lie-,tltli needs. grant notint of faults icli "(13) Tii the preparation and revision of the State health plan, is :It s the average ai tile SIICC sliall review and coiisidei- the preliminary State ]lemur till-co ely precediiil- tt plan submitted by the State a,-eiicy iiitdet- station 152@(a) (2). is soil te. for which s and sliall coiidiicc-.t piiblic hearing on the plan ,is proposed anci nated s'for which fti u (,rrax U! slia I zive iiiterested persons all o )I)oiltiiiiti, to submit their views res of EL xionreciirrinplic.Lt-ion ,y (local-, equitable :tnd consistent Nvitli tile I)tirpowq of filttl til)(lel. 160t is 7lot 01, en as tile see?.eta ii7iot 'Ile cii-rft-(l otit, 6z- this title. Any amoiizit -,o'n,itllottetl to t State slittll be ill 11(tilitioll to -,tib.;;taiiti:ti furnace i carry otit piins and a tli6 tiniottiits Ilottt-(l and available to tile State for the s,,titie pi@i-io(l. by the Secretary uiid(@r sect;on 1604, tile @epeorcelt.,ti-v Oi:tll tal@e t]iL, action itut-I)oz-iv(,(l bv si,l).,icet;oii (1)) iiiilecs. %I,IXYr3Er,',Tg in the cqqe (if coiiil)iiiiii(-e N@-itli nss-,ii-,,tiices, the i-(-,quires com- "Sr,c. 1611. (a) If with respect to any inedicitl facility project pli.-ince by other Ltitliot-ized by ltiv. )04 the itite A-@ency certifies (upon the CC approved iin(l@@r stTtion 1C (1)) (11 Upon iL findii!z described in (a) and after notice I;-i-is of iii-peetion by it) to the Sect-et-,ii-y I la t, ill tccol.(I:lllcc i%,itli -eiicy co:icvi-iie(l, the Secretary ni;xy- S to tli(3 S,,itte A@ Lttir-L- linq nez-foi-ined ui)oii iLinuLlry 4, I,) tD 41 - Fut). Law Pub. Law 93-641 40 - January 4, 1975 "(A) %vitliliold fi-ozii all 1)i-oj(,(!ts within tile State '%"itll "es])cct (.11tit). ties title. III(! iii-y sli:ill 1),IY, to tile of to wlii'clt flit) findiii-,-, iv:is zit;tti(, ftiz-tlivi- I)IINIIIICIlt.,; front tile Stilte's :I!I(i :Iiitl ()II I)ell:tlf of tilt@ I)I.ojt,ct. fol. iviii(-Il till'. lo.111 IUIO,ot- ;Iiilt)llllt" to j-e(liicv I)t,r cetitiiiii I)t-i- :tiiiiiiiii Llie )let 11(13) wiLliliold front tht) projects Nvitli r(.,Sl)eettoNvIlicil ilitel-L-si I-ii(e oil sit(-II loan. lioltl('I. ol' tile, filling Nvits iii;itie fiirtli(k I),iyiiiezit' front tile applicable, St4tte such it lt:lli wliit,li isigttiLl-illitee(I this titit! slitll have. it col) r s allotment under section 1 610. ti-act.tial -iglit to cc %,e from the [Jiiite(I St;ltvs ilitt@i-est I),IYIIlellt@ 64 @yniejits may I)c withheld, in N%,Iiole or in pall, under piti-a- )Y tlit@, ffmph 'I lit, (-Illlllll:ltive total Of til(@ I)I'ill('iT),Il Of tile loans oittstitidin-, 2, r- is foi- tile fi,,)(Iiii upon which the witlihol(Iiii,,, :it III (iiii(@ %vital to which gll,.Ii..--iiitLcts have 1)(,cii issued, 01, I.Vas exists, or N%.Iliell leave 1)(-i"l (iii-t-(-tly iiiay not exceed such limitations a@ C( v(, action to ril,,ilce such finding iiiippli(-,.ible ililLy I)c Si)(Ti.ile(i lll)i)l-Ol)l,illtioli @kets. can,, t@il tilO St',Lt(@ coji(-(ti-iie(I rcpa s or ari-aii.-cs for "((I) I'lic 'Latin tile collsolit@ of tlil- Secretary of Iloiisiii- tll o r ii(.,zit o L-de-i-al funds piid under this part for projects sliixll obtain front the 1)opai-tiliciit of Irolls- wliie ause of tile finding are not entitled to such ftin(ts. an(i i,@'i-b:tii I)evelol)lllLllt such II-,,;istiiice with respect to tll 91(c) The Secretary sliall investigate and ascertain iL periodic administration of this 4is will promote efficiency and econoiil3. basi's,,with respect to each entity whi-cli is reetiviiig filiinc@inal assistance thereof. "U iuider this title or -%which has received financial assistance under title .%',fO., TIIE ST,'ITFS VI or this title, the extent of compliance by such entity with the -it .1.@sistance wits receive(l. L@src. 1621. (n) For each fisertl year, the total amount of principal asstimnet@s required to be ma(le at the tiiiie sit( of- If the Secretiry finds treat such an entity has failed to comply with y such assurance, the Secretary sliall t.'tke tlt(@ action authorized by loan,, to nonprofit 1)t-i%,ate entities which iiia be git.,Ii-- -iiitee(l, oi- subsection (b) or ttike aiii, other ,tetion tiit)ioi-ized by law (including an action f6r'sl)ccific y)ei-forni-,in(!e bi-ou,,,Iit by the ,it-torney General (2) loniis wlii(,Ii lately be (Iii-ectly nit(le. upon request ol the @(-i,(-t;try) in-hicli will effect coiiil)liaice by the iiii(iei- this part sli-ill be allotted by tile li,,retti,v ainoiiz-the States. entity with such @ill appropriate ,tct-ion to effectuate com- ill aceol-(Ixti(-o with i-(@glilatioiis, Oil the basis Of tiic population, filitil- ei-.tl tii(i ilee(I for ni(@(lical facilities projects described in section plianc,B Nvitli tiiy such as!ztii-.tiice mty be brought by a person ot-lidr 1601 of tile I-csi)ective, Stites. 'I'lic population of the States short be than the Seci-ctiry only if a coilipl-tilit has been rated by such person (I(-t(,i-niiiicti oil fli(@ basis of tli(, latest figures certific(i by the Secretary cret,, y -cttry has dismissed sjicli cor6plaint twain tile S@ey j and the Seci of ('omnierce. or the Atto li(-i-al has not brotiolit t civil action for compliance tt(,b) Any amount nllotted to it 'state for a fiscal year under with such assurance within 6 moiit)is after the dite on which the subsection (-I) aiiii T-(@maiiiiii,, iiiioblizited it tile end of such year slitill complaint was filed with the Seci-ettry. I i-(-initiii iivtiltble to -sti(!Ii State, f@@ the pill-pos(t for wliicli MI(LC. tc.%If'l,iloitlZ.%I'ION OF Al-l'ItollitIATIONS fol' tile next two fisci I years (and for siicfl years only), in addition to the amounts allotted to silc)i State for stlc)i purposes for sucli Sy(.,. 161:1. l@xcept its provided in sect,ioit 162.-)(d), -,ti-c Rutlior- next two fiscitl years; except that tiny such amount wIli(.Il is iiii0l)- ized to be appropriated ?or allotments uii(lei- section 1510 $125,000,000 ligatt,(l it. tli(@ (@ii(i of tile first of lit-xt t%Vt) years .111(i which for the fiscal yeiii- calling iiiiie.30. 197.7) $13o.ooo.ooo for the fisctil year determines will liiiobli-:Ite(l :it tlit@ close, of the eiidiii,r June' 30, 1.1)76, iiii(I $135,000,000 for the fiscal yeai- eiidiii- se(.Ollil of such iitxt two years iiiii )O. "(';tllotte(i by the Secretii-v. .11111c, 30, 1977. to be ivililll)lc foi- tile ])III-I)OSes fol-y'vlliicli iiia(le until the close,of tfie se(!Oll(l of sil(.)l ii(,.xt two ye.ai-s, to other 3tites which have need there- "13AIrl'C-I,O.%N.S ANI) IAO.%N' ('EIAI-A-,Tllll,.S eci-et-ai-y deenis c(luitable ind consistent for, oil such bisis its the S ' with the piii-I)os(-s of this title. Any amount so i-callotted to a Stnte ill be i :t(f(litioii to the amounts allotted and ti,itilible to the State .%ii,j,iioRi,ry Ft)ni,OAN'S A%'I) I.OAN (.IIARA%'I'I-'ES sit. 11 for t)ie suine I)ez-io(l. "SEc.. 1620. (a) The duriiiLr the period betnnin iti, tf @uly 1, 1974, and eniling Jtiiie 30, 1977 .11 a . Its part, ct OF.NFit.%I, l'it0l'ISIONS 1',I'T.ATrNC, tilake loans from the fund established tin(ler s(-,ctioii 16--)2(d) to pay the Fe(.Iei-al sl)ttre of I)i- under section 1604. "SEc. 1622. (a) (1) The Secretary may not approve a loan ar- @l(b)(1) The Secret niiin- July 1, 1974, detet-iiii I tile. a In antee for a Project under this part unless lie lies that (,% )7 Riid endin'l- June 30, 197' this part, guarantee torrrL,;, Coil(ritio-ns, sceuritv (if any), and schedule and iinouiit of to- re -,tyments'witli respect t6 the loan are sufficient to protect tile. filltn- (i) noii-Fedex-al lenders for their loans to nonprofit private Pi interests of the llnite(I States itiid are otlierwiv r(@asojial)] iTiclil cia e,ntiti'es for medical facilities projects, and in(y a determination trial. tile. rate of interest does not exceed such per (ii) the. Federal I-inancfng -Bank for its loans to nonprofit contum per aniiiiin on the principal ol)li,-m, tion otitstiii(iiii,_r Its tile private entities for such projects, Secretary determines to be reasonable. takiiiL, into account tile r,,I,-,L- pa@nicitt of principal and interest on such loans if applications for of interest rates I)rovailizi,- in the private ii-iai-ket for similar loans assistance for such projects under this title have been approved under and the risks assumed by the United States, and (B) the loan would !wctioii 1604. Pub. Llw 93-641 4Z January 4, 1975 jan,,iary 4, I'J @UL;. J-@@v (3) (i@) 'I'lic Secretary is aiitlint-iz(@4.1 to enti@r into III o!l ivitli tile, of :iiiy lo:iji sold iiii(it@r this I)ixi-t iiiide@i- Nv)licll tit, f L-olTi tlic. It.(I I o Se(@i-et;i r.), of !Illy ,tiariiiit (,e to sticlt I)tit-cliaFer (,iii(I any successor it. 'fol. tf) ])III-CIII.Isel.) L)-.LYmellts of the principal tnd interest fol' ill@tet'. iiit tile, payal)lo under such loan, aii(i Still] be to -,III of tlic-, I'it']Lt., Of "(ii) to I)ay as -,til interest subsidy to such purchaser (and .tiiv tee p I of tile I)II3 to AN-11it-11 tit(' t'lliti-itil ,;iiece,.3sor. in interest of such amounts which, ivlieii ,rallied to the, aniati tylit)le on such loans are equiv- lit of iiitel.(,@st 1), 13) I,o tilt, (,Xt(,iit. I)t-i-iiiitte(I by siti)l -,IlV teiliTI9 iiid aletit to ,t rt-asuiiiijit, rate of interest oil such loltrris (leterniiiie(I 10 .1 ee this I)Ztt-t (ill(-lltclillg I)Y tile Seel-etzti-y Iftcr tikiilgizitu ;i,,cot,.iit tli(@, riin,_,cof prevailing trll;ll;ll t I (1)) ) Italy l@L' illo(ii- Ili t)ie 1)rivate inarket oil siziiilaxr-'Ioaiis and tile I)v ilit@ -I-t-1:11-y to tilt- extent Ile. if to 1)(, (.ollslstc@iit frisks assuiiic-tl by tlic- I)'-Ilited States. - (, 1-@ '(1i) k iiy it -,t-L@eiiit-ixt titicipi- %Vill, tilt' lill:IIL( it![ t 1) f t 11(t I! it it (@tt St -.1 I I",. lli:t(lt. Ily (II(! tillklt-l. tlii,, ]),Il't @'(i) ilia), I)roi-ide tiiat t)ie Stci-(-t;ii-,v sititll tct as ag(@iit of any of ;tit .11@illit-ill't oil still for the- of c(@llf-,ctiii,., front tile. Pill ity to t ill fi-;tll(l ol. iiiis- siit.IL lo;tll \%'its ]Tilde Iiitl I)-,Iyili,, O\.el. to c !it plyil)le bv 'lily liliviiie!tis .)f I)riiieil)al :tell artery cli (-Iltit3. t I lit I", 'I ol till(! I- such li).Ili; to .I t. i ,C(ii) 1)t-ovitle for tlitt I)Y tllt- of Silly it]] Iiis slit, lil:ll@iii,r - (:Ifi'(l ill ti" 11-:tll(l ot. sit(-Ii loan oil sti(-Ii tet-itis atitl conditions Its rally 1)(, SI)( (I IL 1) sill-II I)Tlovide tliat4 in tile ei,crit of any default by the i it-., to Ile llc,cci- (@litit.V to wllicll -.IILII Total lvfts inside lit ptviiiel@t of or :IS "IC ( -etai - lit.11, iil)oii n6tificati6ii to s:tt-v It;tt t Ilk, lif I Ilia t it It, \\.i,ll lit. Intelsat (Ill(, oil ;II(.Il loitil. tll(@ Seel -y @ lilt 1111(it-i- this 1)@irt tile (ot- it) tile in ijitt@i-est of such II-,I\-C tells, oi)tif)ll (o (,-Io!:(@ olit tytv or life Seei-c-t-ii-y 'Nvitli respect thereto) by p,,iyinz t6 the i)iii-cliaqc,i- (or -,I- ill iiit -t Lo o t I11 lilt I- lilt- \V,)Illtl 1) fill It- N% 11 Ile tll)IL@ Iiis ;S( el -St) tik(i LOttl 11111OUltf it 1):il and dtiL@ thereon tit.tliL tijlie of-stieli notification; (i%-) sik;tll tllitt, in the event ,iicli loan is elwed out A.-, tli:lt t II(-? 11 11, tilt' tit' 1) -ovi(le(I ill ('11,Iiise (iii), or !II the event of nny other loss incurred fly litt@ of ilit, failure. of @ieii (iittitv to nt-.tke of I)Iti oi- iiitei-t-st oil sit(-Ii loan. the 1)(" to ill i-iL,:Itts of such I)ureliaser for recovet-v of ;tich lo.,;s front slit-II (Utility. ..II tile ti@itt- lilt- Hill ii 10 Total,,, gli-li-:iil- "(.I) killoillits ilt,C(Itlle(I I)Y tile. -IC; front the -sale of t .1 1, 11I - foi- itilkl(@i- ,Ill)sc(.tioll ((I). @t:"; tit ill lit- (d) ( I ) I'liei-e is (,stiil)l i.;Ii(,(l in the Treti-,iiry t loan and loin -ii.,ir- R71tee fine(] ill tl)is referred to is the Ifitiid!) tll to tile ill Saint :@1114)llllts :to, iil:ty Ile. Sl)i-eifletl front tiiiie to tinie lit tl)l)ropri,,t- .rely of tioii Acts- "(113 to Iiiiii to, 't" his under loan fir I I- I 4rtlfti-illitees issilett I)y li),,i ,itclLr t@ii,, ilai-t i'f - :11"y F11:111 ll:Lvt! I sill-!i ],,:Ili i,, it ((") forpiyttit,.iit of iii[erc-stiizidersection 1G--)O(b) (2) oiilo.-tiis guaranteed under this part, "(1)) for repurchase of loiiis under subsection (e) (3) (B). -tn(I 10:111.'; little "title" r foi- I)-.tyineiit of intei-(,.@t on loan,; which are sold -,tn(I oil tit(' Ili-ivtltt- ill. to tile :,,O.) or tiit.. Tliet'c- @ni-e authorized to Ile ftlil)rol)i-iit(@d from time. to time stl(.Il ki't ot. to tile -.amount.,; is relay Ile. to pi-ovi