---
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"
date: "2026-07-12"
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/42/201.md?p=f) desiring to participate in this part may submit a [State plan](/usc/42/300d–31.md?p=2). Such plan must—
  - (1) designate a single [State agency](/usc/42/300s–3.md?p=12) as the sole [agency](/usc/42/8262.md?p=1) for the administration of the plan, or designate such [agency](/usc/42/8262.md?p=1) as the sole [agency](/usc/42/8262.md?p=1) for supervising the administration of the plan;
  - (2) contain satisfactory evidence that the [State agency](/usc/42/300s–3.md?p=12) 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/42/201.md?p=f) [advisory council](/usc/42/274l–1.md?p=1) which shall include (A) representatives of nongovernmental organizations or groups, and of [public agencies](/usc/42/11851.md?p=8), concerned with the operation, [construction](/usc/42/300s–3.md?p=7), or utilization of [hospital](/usc/42/300s–3.md?p=1) or other facilities 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 particularly concerned with education or training of health professions personnel, and (B) an equal number of representatives of consumers familiar with the need for the [services](/usc/42/201.md?p=a) provided by such facilities, to consult with the [State agency](/usc/42/300s–3.md?p=12) in carrying out the plan, and provide, if such council does not include any representatives of nongovernmental organizations or groups, or [State agencies](/usc/42/300s–3.md?p=12), concerned with rehabilitation, for consultation with organizations, groups, and [State agencies](/usc/42/300s–3.md?p=12) 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 of existing facilities, 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/42/300s–3.md?p=1) beds and long-term care beds, and the number and types of [hospital](/usc/42/300s–3.md?p=1) facilities and facilities for long-term care, needed to provide adequate facilities for inpatient care of people residing in the [State](/usc/42/201.md?p=f), and a plan for the distribution of such beds and facilities in [service](/usc/42/201.md?p=a) areas throughout the [State](/usc/42/201.md?p=f);
    - (B) the [public health centers](/usc/42/300s–3.md?p=2) needed to provide adequate public health [services](/usc/42/201.md?p=a) for people residing in the [State](/usc/42/201.md?p=f), and a plan for the distribution of such centers throughout the [State](/usc/42/201.md?p=f);
    - (C) the outpatient facilities needed to provide adequate diagnostic or [treatment](/usc/42/11851.md?p=11) [services](/usc/42/201.md?p=a) to ambulatory patients residing in the [State](/usc/42/201.md?p=f), and a plan for distribution of such facilities throughout the [State](/usc/42/201.md?p=f);
    - (D) the [rehabilitation facilities](/usc/42/300s–3.md?p=5) needed to assure adequate rehabilitation [services](/usc/42/201.md?p=a) for disabled persons residing in the [State](/usc/42/201.md?p=f), and a plan for distribution of such facilities throughout the [State](/usc/42/201.md?p=f); and
    - (E) effective January 1, 1966, the extent to which existing facilities referred to in [section 291a(a)](/usc/42/291a.md?p=a) or (b) of this title in the [State](/usc/42/201.md?p=f) are in need of [modernization](/usc/42/300s–3.md?p=9);
  - (5) set forth a [construction](/usc/42/300s–3.md?p=7) and [modernization](/usc/42/300s–3.md?p=9) [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/42/300s–3.md?p=7) or [modernization](/usc/42/300s–3.md?p=9) of the [hospital](/usc/42/300s–3.md?p=1) or long-term care facilities, [public health centers](/usc/42/300s–3.md?p=2), outpatient facilities, and [rehabilitation facilities](/usc/42/300s–3.md?p=5) 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/42/300s–3.md?p=11), 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/42/13641.md?p=2) for facilities of that type, and provide for the [construction](/usc/42/300s–3.md?p=7) or [modernization](/usc/42/300s–3.md?p=9), insofar as financial resources available therefor and for maintenance and operation make possible, in the order of such relative need;
  - (7) provide minimum standards (to be fixed in the discretion of the [State](/usc/42/201.md?p=f)) for the maintenance and operation of facilities providing inpatient care which receive aid under this part and, effective July 1, 1966, provide for enforcement of such standards with respect to [projects](/usc/42/13641.md?p=2) 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 plan](/usc/42/300d–31.md?p=2), including methods relating to the establishment and maintenance of personnel standards 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, 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/42/300s–3.md?p=7) or [modernization](/usc/42/300s–3.md?p=9) [project](/usc/42/13641.md?p=2) an opportunity for a hearing before the [State agency](/usc/42/300s–3.md?p=12);
  - (10) provide that the [State agency](/usc/42/300s–3.md?p=12) 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](/usc/42/300x–64.md?p=b-1) of the United States or his duly authorized representatives 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/42/300s–3.md?p=12) will from time to time, but not less often than annually, review its [State plan](/usc/42/300d–31.md?p=2) and submit to the [Surgeon General](/usc/42/201.md?p=b) any modifications thereof which it considers necessary; and
  - (13) Effective[^1] July 1, 1971, provide that before any [project](/usc/42/13641.md?p=2) for [construction](/usc/42/300s–3.md?p=7) or [modernization](/usc/42/300s–3.md?p=9) of any general [hospital](/usc/42/300s–3.md?p=1) is approved by the [State agency](/usc/42/300s–3.md?p=12) there will be reasonable assurance of adequate provision for extended [care services](/usc/42/300z–1.md?p=a-7) (as determined in accordance with [regulations](/usc/42/201.md?p=d)) to patients of such [hospital](/usc/42/300s–3.md?p=1) 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 which (A) are structurally part of, physically connected with, or in immediate proximity to, such [hospital](/usc/42/300s–3.md?p=1), and (B) either (i) are under the supervision of the professional staff of such [hospital](/usc/42/300s–3.md?p=1) or (ii) have organized medical staffs and have in effect transfer agreements with such [hospital](/usc/42/300s–3.md?p=1); except that the [Secretary](/usc/42/201.md?p=c) may, at the request of the [State agency](/usc/42/300s–3.md?p=12), waive compliance with clause (A) or (B), or both such clauses, as the case may be, in the case of any [project](/usc/42/13641.md?p=2) if the [State agency](/usc/42/300s–3.md?p=12) 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 plan](/usc/42/300d–31.md?p=2) and any modification thereof which complies with the provisions of [subsection (a)](#a). If any such plan or modification 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/42/300s–3.md?p=1) Council shall, upon request of the [State agency](/usc/42/300s–3.md?p=12), afford it an opportunity for hearing. If such Council determines that the plan or modification complies with the provisions of such subsection, the [Surgeon General](/usc/42/201.md?p=b) shall thereupon approve such plan or modification.

## 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.