---
kind: "section"
citation: "42 U.S.C. § 1395hhh"
title: "42"
title_heading: "The Public Health and Welfare"
number: "1395hhh"
heading: "Health care infrastructure improvement program"
release: "119-102"
date: "2026-07-12"
url: "https://uscodex.org/usc/42/1395hhh"
units:
  - "Chapter 7 — Social Security"
  - "Subchapter XVIII — Health Insurance for Aged and Disabled"
  - "Part E — Miscellaneous Provisions"
---

# §1395hhh. Health care infrastructure improvement program

- (a) **Establishment—** The [Secretary](/usc/42/1301.md?p=a-6) shall establish a loan program that provides loans to qualifying [hospitals](/usc/42/1395x.md?p=e) for payment of the capital costs of [projects](/usc/42/13641.md?p=2) described in [subsection (d)](#d).
- (b) **Application—** No loan may be provided under this section to a qualifying [hospital](/usc/42/1395x.md?p=e) except pursuant to an application that is submitted and approved in a time, manner, and form specified by the [Secretary](/usc/42/1301.md?p=a-6). A loan under this section shall be on such terms and conditions and meet such requirements as the [Secretary](/usc/42/1301.md?p=a-6) determines appropriate.
- (c) **Selection criteria—**
  - (1) **In general—** The [Secretary](/usc/42/1301.md?p=a-6) shall establish criteria for selecting among qualifying [hospitals](/usc/42/1395x.md?p=e) that apply for a loan under this section. Such criteria shall consider the extent to which the [project](/usc/42/13641.md?p=2) for which loan is sought is nationally or regionally significant, in terms of expanding or improving the health care infrastructure of the [United States](/usc/42/1395x.md?p=x) or the region or in terms of the medical benefit that the [project](/usc/42/13641.md?p=2) will have.
  - (2) **Qualifying hospital defined—** For purposes of this section, the term “qualifying [hospital](/usc/42/1395x.md?p=e)” means a [hospital](/usc/42/1395x.md?p=e) or an entity described in [paragraph (3)](#c-3) that—
    - (A) is engaged in research in the causes, prevention, and [treatment](/usc/42/11851.md?p=11) of cancer; and
    - (B) is designated as a cancer center for the National Cancer Institute or is designated by the [State](/usc/42/1395x.md?p=x) legislature as the official cancer institute of the [State](/usc/42/1395x.md?p=x) and such designation by the [State](/usc/42/1395x.md?p=x) legislature occurred prior to December 8, 2003.
  - (3) **Entity described—** An entity described in this paragraph is an entity that—
    - (A) is described in section 501(c)(3) of the Internal Revenue Code of 1986 and exempt from tax under [section 501(a)](/usc/42/501.md) of such Code;
    - (B) has at least 1 existing memorandum of understanding or affiliation agreement with a [hospital](/usc/42/1395x.md?p=e) located in the [State](/usc/42/1395x.md?p=x) in which the entity is located; and
    - (C) retains clinical outpatient [treatment](/usc/42/11851.md?p=11) for cancer on site as well as lab research and education and outreach for cancer in the same [facility](/usc/42/1320a–3.md?p=c-5-B).
- (d) **Projects—** A [project](/usc/42/13641.md?p=2) described in this subsection is a [project](/usc/42/13641.md?p=2) of a qualifying [hospital](/usc/42/1395x.md?p=e) that is designed to improve the health care infrastructure of the [hospital](/usc/42/1395x.md?p=e), [including](/usc/42/1301.md?p=b) [construction](/usc/42/300s–3.md?p=7), renovation, or other capital improvements.
- (e) **State and local permits—** The provision of a loan under this section with respect to a [project](/usc/42/13641.md?p=2) shall not—
  - (1) relieve any recipient of the loan of any obligation to obtain any required [State](/usc/42/1395x.md?p=x) or local permit or approval with respect to the [project](/usc/42/13641.md?p=2);
  - (2) limit the right of any unit of [State](/usc/42/1395x.md?p=x) or local government to approve or regulate any rate of return on private equity invested in the [project](/usc/42/13641.md?p=2); or
  - (3) otherwise supersede any [State](/usc/42/1395x.md?p=x) or local law ([including](/usc/42/1301.md?p=b) any regulation) applicable to the [construction](/usc/42/300s–3.md?p=7) or operation of the [project](/usc/42/13641.md?p=2).
- (f) **Forgiveness of indebtedness—** The [Secretary](/usc/42/1301.md?p=a-6) may forgive a loan provided to a qualifying [hospital](/usc/42/1395x.md?p=e) under this section under terms and conditions that are analogous to the loan forgiveness provision for student loans under part D of title IV of the Higher Education Act of 1965 ([20 U.S.C. 1087a](/usc/20/1087a.md) et seq.), except that the [Secretary](/usc/42/1301.md?p=a-6) shall condition such forgiveness on the establishment by the [hospital](/usc/42/1395x.md?p=e) of—
  - (A) an outreach program for cancer prevention, early diagnosis, and [treatment](/usc/42/11851.md?p=11) that provides services to a substantial majority of the residents of a [State](/usc/42/1395x.md?p=x) or region, [including](/usc/42/1301.md?p=b) residents of rural areas;
  - (B) an outreach program for cancer prevention, early diagnosis, and [treatment](/usc/42/11851.md?p=11) that provides services to multiple [Indian tribes](/usc/42/619.md?p=4-A); and
  - (C)
    - (i) unique research resources (such as population databases); or
    - (ii) an affiliation with an entity that has unique research resources.
- (g) **Funding—**
  - (1) **In general—** There are appropriated, out of amounts in the Treasury not otherwise appropriated, to carry out this section, $200,000,000, to remain available during the period beginning on July 1, 2004, and ending on September 30, 2008.
  - (2) **Administrative costs—** From funds made available under [paragraph (1)](#g-1), the [Secretary](/usc/42/1301.md?p=a-6) may use, for the [administration](/usc/42/1301.md?p=a-10) of this section, not more than $2,000,000 for each of [fiscal years](/usc/42/619.md?p=3) 2004 through 2008.
  - (3) **Availability—** Amounts appropriated under this section shall be available for obligation on July 1, 2004.
- (h) **Report to Congress—** Not later than 4 years after December 8, 2003, the [Secretary](/usc/42/1301.md?p=a-6) shall submit to Congress a report on the [projects](/usc/42/13641.md?p=2) for which loans are provided under this section and a recommendation as to whether the Congress should authorize the [Secretary](/usc/42/1301.md?p=a-6) to continue loans under this section beyond [fiscal year](/usc/42/619.md?p=3) 2008.
- (i) **Limitation on review—** There shall be no administrative or judicial review of any determination made by the [Secretary](/usc/42/1301.md?p=a-6) under this section.

## Source credit

(Aug. 14, 1935, ch. 531, title XVIII, § 1897, as added Pub. L. 108–173, title X, § 1016, Dec. 8, 2003, 117 Stat. 2447; amended Pub. L. 109–13, div. A, title VI, § 6045(a), (b), May 11, 2005, 119 Stat. 294.)

## Notes

### Editorial Notes

### References in Text

The Internal Revenue Code of 1986, referred to in subsec. (c)(3)(A), is classified generally to Title 26, Internal Revenue Code.

The Higher Education Act of 1965, referred to in subsec. (f), is Pub. L. 89–329, Nov. 8, 1965, 79 Stat. 1219. Part D of title IV of the Act is classified generally to part D (§ 1087a et seq.) of subchapter IV of chapter 28 of Title 20, Education. For complete classification of this Act to the Code, see section 1 of Pub. L. 89–329, set out as a Short Title note under section 1001 of Title 20 and Tables.

### Amendments

2005—Subsec. (c)(2). Pub. L. 109–13, § 6045(a)(1)(A), inserted “or an entity described in paragraph (3)” after “means a hospital” in introductory provisions.

Subsec. (c)(2)(B). Pub. L. 109–13, § 6045(a)(1)(B), inserted “legislature” after “designated by the State” and “and such designation by the State legislature occurred prior to December 8, 2003” before period at end.

Subsec. (c)(3). Pub. L. 109–13, § 6045(a)(2), added par. (3).

Subsec. (i). Pub. L. 109–13, § 6045(b), added subsec. (i).

### Statutory Notes and Related Subsidiaries

### Effective Date of 2005 Amendment

Pub. L. 109–13, div. A, title VI, § 6045(c), May 11, 2005, 119 Stat. 295, provided that: “The amendments made by this section [amending this section] shall take effect as if included in the enactment of section 1016 of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (Public Law 108–173; 117 Stat. 2447).”