42 U.S.C. 300n-4 REVIEW BY THE SECRETARY SEC. 1535. (a) The Secretary shall review and approve or disapprove the annual budget of each designated health systems agency and State Agency. In making such review and approval or disapproval the Secretary shall consider the comments of Statewide Health Coordinating Councils submitted under section 1524 (c) (3). Information submitted to the Secretary by a health systems agency or a State Agency in connection with the Secretary's review under this subsection shall be made available by the Secretary, upon request, to the appropriate committees (and their subcommittees) of the Congress. (b) The Secretary shall prescribe performance standards covering the structure, operation, and performance of the functions of each designated health systems agency and State Agency, and he shall establish a reporting system based on the performance standards that allows for continuous review of the structure, operation, and performance of the functions of such agencies. (c) The Secretary shall review in detail at least every three years the structure, operation, and performance of the functions of each designated health systems agency to determine (1) the adequacy of the HSP of the agency for meeting the needs of the residents of the area for a healthful environment and for accessible, acceptable and continuous quality health care at reasonable costs, and the effectiveness of the AIP in achieving the system described in the HSP; (2) if the structure, operation, and performance of the functions of the agency meet the requirements of sections 1512(b) and 1513; (3) the extent to which the agency's governing body (and executive committee (if any)) represents the residents of the health service area for which the agency is designated; (4) the professional credentials and competence of the staff of the agency; (5) the appropriateness of the data assembled pursuant to section 1513 (b) (1) and the quality of the analyses of such data; (6) the extent to which technical and financial assistance from the agency have been utilized in an effective manner to achieve goals and objectives of the HSP and the AIP; and (7) the extent to which it may be demonstrated that (A) the health of the residents in the agency's health service area has been improved; (B) the accessibility, acceptability, continuity, and quality of health care in such area has been improved; and (C) increases in costs of the provision of health care have been restrained. (d) The Secretary shall review in detail at least every three years the structure, operation, and performance of the functions of each designated State Agency to determine (1) the adequacy of the State health plan of the Statewide Health Coordinating Council prepared under section 1524 (c) (2) in meeting the needs of the residents of the State for a healthful environment and for accessible, acceptable, and continuous quality health care at reasonable costs; (2) if the structure, operation, and performance of the functions of the State Agency meet the requirements of sections 1522 and 1523; (3) the extent to which the Statewide Health Coordinating Council has a membership meeting, and has performed in a manner consistent with, the requirements of section 1524; (4) the professional credentials and competence of (5) the extent to which financial assistance pro- (A) the health of the residents of the State has (B) the accessibility, acceptability, continuity, and quality of health care in the State has been improved; and (C) increases in costs of the provision of health care have been restrained. SPECIAL PROVISIONS FOR CERTAIN STATES AND TERRITORIES SEC. 1536. (a) Any State which 42 U.S.C. (1) has no county or municipal public health in- 300-5 stitution or department, and (2) has, prior to the date of enactment of this title, maintained a health planning system which substantially complies with the purposes of this title, and the Virgin Islands, Guam, the Trust Territories in the Pacific Islands, and American Samoa shall each be considered in accordance with subsection (b) to be a State for purposes of this title. (b) In the case of an entity which under subsection (a) is to be considered a State for purposes of this title (1) no health service area shall be established within it, (2) no health systems agency shall be designated for it, (3) the State Agency designated for it under section 1521 may, in addition to the functions prescribed by section 1523, perform the functions prescribed by section 1513 and shall be eligible to receive grants authorized by sections 1516 and 1640, and (4) the chief executive office shall appoint the Statewide Health Coordinating Council prescribed by section 1524 in accordance with the regulation of the Secretary. 1 TITLE XVI-HEALTH RESOURCES DEVELOPMENT PART A-PURPOSE, STATE PLAN, AND PROJECT APPROVAL PURPOSE SEC. 1601. It is the purpose of this title to provide as- 42 U.S.C. 3000 sistance, through allotments under part B and loans and loan guarantees and interest subsidies under part C, for projects for (1) modernization of medical facilities; (2) construction of new outpatient medical facilities; (3) construction of new inpatient medical facilities in areas which have experienced (as determined under regulations of the Secretary) recent rapid population growth; and (4) conversion of existing medical facilities for the provision of new health services, and to provide assistance, through grants under part D, for construction and modernization projects designed to prevent or eliminate safety hazards in medical facilities or to avoid noncompliance by such facilities with licensure or accreditation standards. GENERAL REGULATIONS SEC. 1602. The Secretary shall by regulation— (1) prescribe the general manner in which the State Agency of each State shall determine for the State medical facilities plan under section 1603 the priority among projects within the State for which assistance is available under this title, based on the relative need of different areas within the State for such projects and giving special consideration— (A) to projects for medical facilities serving areas with relatively small financial resources and for medical facilities serving rural communities, (B) in the case of projects for modernization of medical facilities, to projects for facilities serving densely populated areas, (C) in the case of projects for construction of outpatient medical facilities, to projects that will be located in, and provide services for residents of, areas determined by the Secretary to be rural or urban poverty areas, 1 For transitional provision see section 5(b) of Public Law 93-641, Appendix, Vol. I. 42 U.S.C. 3000-1 42 U.S.C. 3000-2 (D) to projects designed to (i) eliminate or prevent imminent safety hazards as defined by Federal, State, or local fire, building, or life safety codes or regulations, or (ii) avoid noncompliance with State or voluntary licensure or accreditation standards, and (E) to projects for medical facilities which, alone or in conjunction with other facilities, will provide comprehensive health care, including outpatient and preventive care as well as hospitalization; (2) prescribe for medical facilities projects assisted under this title general standards of construction, modernization, and equipment for medical facilities of different classes and in different types of location; (3) prescribe criteria for determining needs for medical facility beds and needs for medical facilities, and for developing plans for the distribution of such beds and facilities; (4) prescribe criteria for determining the extent to which existing medical facilities are in need of modernization; (5) require each State medical facilities plan under section 1503 to provide for adequate medical facilities for all persons residing in the State and adequate facilities to furnish needed health services. for persons unable to pay therefor; and (6) prescribe the general manner in which each entity which receives financial assistance under this title or has received financial assistance under this title or title VI shall be required to comply with the assurances required to be made at the time such assistance was received and the means by which such entity shall be required to demonstrate compliance with such assurances. An entity subject to the requirements prescribed pursuant to paragraph (6) respecting compliance with assurances made in connection with receipt of financial assistance shall submit periodically to the Secretary data and information which reasonably supports the entity's compliance with such assurances. The Secretary may not waive the requirement of the preceding sentence. STATE MEDICAL FACILITIES PLAN SEC. 1603. (a) Before an application for assistance under this title (other than part D) for a medical facility project described in section 1601 may be approved, the State Agency of the State in which such project is located must have submitted to the Secretary and had approved by him a State medical facilities plan. To be approved by the Secretary a State medical facilities plan for a State must |