---
kind: "section"
citation: "42 U.S.C. § 291d"
title: "42"
title_heading: "The Public Health and Welfare"
number: "291d"
heading: "State plans"
release: "119-102"
url: "https://uscodex.org/usc/42/291d"
units:
  - "Chapter 6A — Public Health Service"
  - "Subchapter IV — Construction and Modernization of Hospitals and Other Medical Facilities"
  - "Part A — Grants and Loans for Construction and Modernization of Hospitals and Other Medical Facilities"
---

# §291d. State plans

- (a) **Submission; requirements—** Any [State](/usc/42/291o.md?p=a) desiring to participate in this part may submit a [State](/usc/42/291o.md?p=a) plan. Such plan must—
  - (1) designate a [single](/usc/42/2304.md?p=m) [State agency](/usc/42/1396r–8.md?p=k-9) as the sole agency for the administration of the plan, or designate such agency as the sole agency for supervising the administration of the plan;
  - (2) contain satisfactory evidence that the [State agency](/usc/42/1396r–8.md?p=k-9) designated in accordance with paragraph (1) of this subsection will have authority to carry out such plan in conformity with this part;
  - (3) provide for the designation of a [State](/usc/42/291o.md?p=a) [advisory council](/usc/42/274l–1.md?p=1) which shall include (A) [representatives](/usc/42/3058f.md?p=5) of nongovernmental organizations or groups, and of [public agencies](/usc/42/11851.md?p=8), concerned with the operation, [construction](/usc/42/291o.md?p=i), or utilization of [hospital](/usc/42/291o.md?p=c) or other [facilities](/usc/42/11049.md?p=4) for diagnosis, prevention, or [treatment](/usc/42/11851.md?p=11) of illness or disease, or for provision of rehabilitation [services](/usc/42/201.md?p=a), and [representatives](/usc/42/3058f.md?p=5) particularly concerned with education or [training](/usc/42/285e–2.md?p=b-2) of health professions personnel, and (B) an equal number of [representatives](/usc/42/3058f.md?p=5) of consumers familiar with the need for the [services](/usc/42/201.md?p=a) provided by such [facilities](/usc/42/11049.md?p=4), to consult with the [State agency](/usc/42/1396r–8.md?p=k-9) in carrying out the plan, and provide, if such [council](/usc/42/300f.md?p=9) does not include any [representatives](/usc/42/3058f.md?p=5) of nongovernmental organizations or groups, or [State agencies](/usc/42/1396r–8.md?p=k-9), concerned with rehabilitation, for consultation with organizations, groups, and [State agencies](/usc/42/1396r–8.md?p=k-9) so concerned;
  - (4) set forth, in accordance with criteria established in [regulations](/usc/42/201.md?p=d) prescribed under [section 291c of this title](/usc/42/291c.md) and on the basis of a statewide [inventory](/usc/42/4370m.md?p=14) of existing [facilities](/usc/42/11049.md?p=4), a survey of need, and (except to the extent provided by or pursuant to such [regulations](/usc/42/201.md?p=d)) community, area, or regional plans—
    - (A) the number of general [hospital](/usc/42/291o.md?p=c) beds and long-term care beds, and the number and types of [hospital](/usc/42/291o.md?p=c) [facilities](/usc/42/11049.md?p=4) and [facilities](/usc/42/11049.md?p=4) for long-term care, needed to provide adequate [facilities](/usc/42/11049.md?p=4) for inpatient care of people residing in the [State](/usc/42/291o.md?p=a), and a plan for the distribution of such beds and [facilities](/usc/42/11049.md?p=4) in [service](/usc/42/201.md?p=a) areas throughout the [State](/usc/42/291o.md?p=a);
    - (B) the [public health centers](/usc/42/291o.md?p=d) needed to provide adequate public health [services](/usc/42/201.md?p=a) for people residing in the [State](/usc/42/291o.md?p=a), and a plan for the distribution of such centers throughout the [State](/usc/42/291o.md?p=a);
    - (C) the [outpatient facilities](/usc/42/291o.md?p=f) needed to provide adequate diagnostic or [treatment services](/usc/42/300x–34.md?p=7) to ambulatory patients residing in the [State](/usc/42/291o.md?p=a), and a plan for distribution of such [facilities](/usc/42/11049.md?p=4) throughout the [State](/usc/42/291o.md?p=a);
    - (D) the [rehabilitation facilities](/usc/42/291o.md?p=g) needed to assure adequate rehabilitation [services](/usc/42/201.md?p=a) for disabled [persons](/usc/42/1320a–7k.md?p=d-4-C-i) residing in the [State](/usc/42/291o.md?p=a), and a plan for distribution of such [facilities](/usc/42/11049.md?p=4) throughout the [State](/usc/42/291o.md?p=a); and
    - (E) effective January 1, 1966, the extent to which existing [facilities](/usc/42/11049.md?p=4) referred to in section [291a(a)](/usc/42/291a.md?p=a) or [(b)](/usc/42/291a.md?p=b) of this title in the [State](/usc/42/291o.md?p=a) are in need of [modernization](/usc/42/291o.md?p=k);
  - (5) set forth a [construction](/usc/42/291o.md?p=i) and [modernization](/usc/42/291o.md?p=k) [program](/usc/42/274l–1.md?p=4) conforming to the provisions set forth pursuant to paragraph (4) of this subsection and [regulations](/usc/42/201.md?p=d) prescribed under [section 291c of this title](/usc/42/291c.md) and providing for [construction](/usc/42/291o.md?p=i) or [modernization](/usc/42/291o.md?p=k) of the [hospital](/usc/42/291o.md?p=c) or long-term care [facilities](/usc/42/11049.md?p=4), [public health centers](/usc/42/291o.md?p=d), [outpatient facilities](/usc/42/291o.md?p=f), and [rehabilitation facilities](/usc/42/291o.md?p=g) which are needed, as determined under the provisions so set forth pursuant to paragraph (4) of this subsection;
  - (6) set forth, with respect to each of such types of medical [facilities](/usc/42/11049.md?p=4), the relative need, determined in accordance with [regulations](/usc/42/201.md?p=d) prescribed under [section 291c of this title](/usc/42/291c.md), for [projects](/usc/42/11360.md?p=20) for [facilities](/usc/42/11049.md?p=4) of that type, and provide for the [construction](/usc/42/291o.md?p=i) or [modernization](/usc/42/291o.md?p=k), insofar as financial resources available therefor and for maintenance and operation make possible, in the order of such relative need;
  - (7) provide minimum [standards](/usc/42/1320d.md?p=7) (to be fixed in the discretion of the [State](/usc/42/291o.md?p=a)) for the maintenance and operation of [facilities](/usc/42/11049.md?p=4) providing inpatient care which receive aid under this part and, effective July 1, 1966, provide for enforcement of such [standards](/usc/42/1320d.md?p=7) with respect to [projects](/usc/42/11360.md?p=20) approved by the [Surgeon General](/usc/42/201.md?p=b) under this part after June 30, 1964;
  - (8) provide such methods of administration of the [State](/usc/42/291o.md?p=a) plan, including methods relating to the establishment and maintenance of personnel [standards](/usc/42/1320d.md?p=7) on a merit basis (except that the [Surgeon General](/usc/42/201.md?p=b) shall exercise no authority with respect to the selection, tenure of [office](/usc/42/3058f.md?p=1), or compensation of any individual employed in accordance with such methods), as are found by the [Surgeon General](/usc/42/201.md?p=b) to be necessary for the proper and efficient operation of the plan;
  - (9) provide for affording to every applicant for a [construction](/usc/42/291o.md?p=i) or [modernization](/usc/42/291o.md?p=k) [project](/usc/42/11360.md?p=20) an opportunity for a hearing before the [State agency](/usc/42/1396r–8.md?p=k-9);
  - (10) provide that the [State agency](/usc/42/1396r–8.md?p=k-9) will make such reports, in such form and containing such information, as the [Surgeon General](/usc/42/201.md?p=b) may from time to time reasonably require, and will keep such records and afford such access thereto as the [Surgeon General](/usc/42/201.md?p=b) may find necessary to assure the correctness and verification of such reports;
  - (11) provide that the Comptroller General of the [United States](/usc/42/291b.md?p=c-4) or his duly authorized [representatives](/usc/42/3058f.md?p=5) shall have access for the purpose of audit and examination to the records specified in paragraph (10) of this subsection;
  - (12) provide that the [State agency](/usc/42/1396r–8.md?p=k-9) will from time to time, but not less often than annually, review its [State](/usc/42/291o.md?p=a) plan and submit to the [Surgeon General](/usc/42/201.md?p=b) any [modifications](/usc/42/7501.md?p=4) thereof which it considers necessary; and
  - (13) Effective[^1] July 1, 1971, provide that before any [project](/usc/42/11360.md?p=20) for [construction](/usc/42/291o.md?p=i) or [modernization](/usc/42/291o.md?p=k) of any general [hospital](/usc/42/291o.md?p=c) is approved by the [State agency](/usc/42/1396r–8.md?p=k-9) there will be reasonable assurance of adequate provision for extended care [services](/usc/42/201.md?p=a) (as determined in accordance with [regulations](/usc/42/201.md?p=d)) to patients of such [hospital](/usc/42/291o.md?p=c) when such [services](/usc/42/201.md?p=a) are medically appropriate for them, with such [services](/usc/42/201.md?p=a) being provided in [facilities](/usc/42/11049.md?p=4) which (A) are structurally part of, physically connected with, or in immediate proximity to, such [hospital](/usc/42/291o.md?p=c), and (B) either (i) are under the supervision of the professional staff of such [hospital](/usc/42/291o.md?p=c) or (ii) have organized medical staffs and have in effect transfer [agreements](/usc/42/1320b–8.md?p=a-3-A) with such [hospital](/usc/42/291o.md?p=c); except that the [Secretary](/usc/42/201.md?p=c) may, at the request of the [State agency](/usc/42/1396r–8.md?p=k-9), waive compliance with clause (A) or (B), or both such clauses, as the case may be, in the case of any [project](/usc/42/11360.md?p=20) if the [State agency](/usc/42/1396r–8.md?p=k-9) has determined that compliance with such clause or clauses in such case would be inadvisable.
- (b) **Approval by Surgeon General; hearing after disapproval—** The [Surgeon General](/usc/42/201.md?p=b) shall approve any [State](/usc/42/291o.md?p=a) plan and any [modification](/usc/42/7501.md?p=4) thereof which complies with the provisions of [subsection (a)](#a). If any such plan or [modification](/usc/42/7501.md?p=4) thereof shall have been disapproved by the [Surgeon General](/usc/42/201.md?p=b) for failure to comply with [subsection (a)](#a), the Federal [Hospital](/usc/42/291o.md?p=c) [Council](/usc/42/300f.md?p=9) shall, upon request of the [State agency](/usc/42/1396r–8.md?p=k-9), afford it an opportunity for hearing. If such [Council](/usc/42/300f.md?p=9) determines that the plan or [modification](/usc/42/7501.md?p=4) complies with the provisions of such subsection, the [Surgeon General](/usc/42/201.md?p=b) shall thereupon approve such plan or [modification](/usc/42/7501.md?p=4).

## Footnotes

[^1]: So in original. Probably should not be capitalized.

## Source credit

(July 1, 1944, ch. 373, title VI, § 604, as added Pub. L. 88–443, § 3(a), Aug. 18, 1964, 78 Stat. 452; amended Pub. L. 91–296, title I, §§ 115, 116(b), (c), 123, June 30, 1970, 84 Stat. 341, 342, 344.)

## Notes

### Editorial Notes

### Prior Provisions

A prior section 291d, act July 1, 1944, ch. 373, title VI, § 621, as added Aug. 13, 1946, ch. 958, § 2, 60 Stat. 1041; amended Oct. 25, 1949, ch. 722, § 2(a), 63 Stat. 898; July 27, 1953, ch. 243, 67 Stat. 196; Aug. 2, 1956, ch. 871, title IV, § 401, 70 Stat. 929; Aug. 14, 1958, Pub. L. 85–664, § 1(a), 72 Stat. 616, authorized appropriations for construction of hospitals and related facilities, prior to the general amendment of this subchapter by Pub. L. 88–443. See section 291a of this title.

Provisions similar to those comprising this section were contained in a prior section 291f(a), (b), act July 1, 1944, ch. 373, title VI, § 623, as added Aug. 13, 1946, ch. 958, § 2, 60 Stat. 1041, prior to the general amendment of this subchapter by Pub. L. 88–443.

### Amendments

1970—Subsec. (a)(3). Pub. L. 91–296, § 115, inserted requirement that State advisory councils include representatives particularly concerned with education or training of health professions personnel.

Subsec. (a)(4)(C). Pub. L. 91–296, § 116(b), substituted “outpatient facilities” for “diagnostic or treatment centers” and “such facilities” for “such centers”.

Subsec. (a)(5). Pub. L. 91–296, § 116(c), substituted “outpatient facilities” for “diagnostic or treatment centers”.

Subsec. (a)(13). Pub. L. 91–296, § 123, added par. (13).

### Statutory Notes and Related Subsidiaries

### Change of Name

“Secretary of Health and Human Services” substituted for “Secretary of Health, Education, and Welfare” in subsec. (a)(13) pursuant to section 509(b) of Pub. L. 96–88, which is classified to section 3508(b) of Title 20, Education.

### Effective Date of 1970 Amendment

Pub. L. 91–296, title I, § 115, June 30, 1970, 84 Stat. 341, provided that the amendment made by that section is effective July 1, 1970.

### Transfer of Functions

Functions, powers, and duties of Secretary of Health and Human Services under subsec. (a)(8) of this section, insofar as relates to the prescription of personnel standards on a merit basis, transferred to Office of Personnel Management, see section 4728(a)(3)(C) of this title.

### Funds for Modernization Projects; Conditions To Be Met Before Approval

Pub. L. 88–443, § 3(b)(5), Aug. 18, 1964, 78 Stat. 462, provided that no application with respect to a modernization project may be approved for purposes of receiving funds from an allotment under section 291(a)(2) of this title before July 1, 1965, or before a State plan has been approved, as well as certain other requirements. See Effective Date note under section 291 of this title.

### Executive Documents

### Transfer of Functions

Office of Surgeon General abolished by section 3 of Reorg. Plan No. 3 of 1966, eff. June 25, 1966, 31 F.R. 8855, 80 Stat. 1610, and functions thereof transferred to Secretary of Health, Education, and Welfare by section 1 of Reorg. Plan No. 3 of 1966, set out as a note under section 202 of this title. Office of Surgeon General reestablished within the Office of the Assistant Secretary for Health, see Notice of Department of Health and Human Services, Office of the Assistant Secretary for Health, Mar. 30, 1987, 52 F.R. 11754.