**(a) Designation by Secretary; removal from areas designated; “medical facility” defined**
(1) For purposes of this subpart the term “health professional shortage area” means (A) an area in an urban or rural area (which need not conform to the geographic boundaries of a political subdivision and which is a rational area for the delivery of health services) which the Secretary determines has a health manpower shortage and which is not reasonably accessible to an adequately served area, (B) a population group which the Secretary determines has such a shortage, or (C) a public or nonprofit private medical facility or other public facility which the Secretary determines has such a shortage. All Federally qualified health centers and rural health clinics, as defined in section 1861(aa) of the Social Security Act ([42 U.S.C. 1395x(aa)](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section1395x/aa&num=0&edition=prelim)), that meet the requirements of [section 254g of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section254g&num=0&edition=prelim) shall be automatically designated as having such a shortage. The Secretary shall not remove an area from the areas determined to be health professional shortage areas under subparagraph (A) of the preceding sentence until the Secretary has afforded interested persons and groups in such area an opportunity to provide data and information in support of the designation as a health professional shortage area or a population group described in subparagraph (B) of such sentence or a facility described in subparagraph (C) of such sentence, and has made a determination on the basis of the data and information submitted by such persons and groups and other data and information availabl
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Stable record: federal_law:legal_authorities:record_usc_58a6a38bf8ca1c35459d0aad Source file: Laws/federal/codes/united-states-code/title-42/section-254e-health-professional-shortage-areas--25e677ca6b.md Pages: Not recorded – Not recorded Passage SHA-256: 65181279af3a7861a4b962ddddc6a6fa02b7aecec9cdda25d579bad1e27d5c5d Retained source evidence SHA-256: 1c5d73729cc44b65504b30eab5357d217764136b88b292b0995da8bff0685942
Source location: Title 42, Chapter 6A, § 254e; chapter-6a-public-health-service.md
Stored source content
**(a) Designation by Secretary; removal from areas designated; “medical facility” defined**
(1) For purposes of this subpart the term “health professional shortage area” means (A) an area in an urban or rural area (which need not conform to the geographic boundaries of a political subdivision and which is a rational area for the delivery of health services) which the Secretary determines has a health manpower shortage and which is not reasonably accessible to an adequately served area, (B) a population group which the Secretary determines has such a shortage, or (C) a public or nonprofit private medical facility or other public facility which the Secretary determines has such a shortage. All Federally qualified health centers and rural health clinics, as defined in section 1861(aa) of the Social Security Act ([42 U.S.C. 1395x(aa)](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section1395x/aa&num=0&edition=prelim)), that meet the requirements of [section 254g of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section254g&num=0&edition=prelim) shall be automatically designated as having such a shortage. The Secretary shall not remove an area from the areas determined to be health professional shortage areas under subparagraph (A) of the preceding sentence until the Secretary has afforded interested persons and groups in such area an opportunity to provide data and information in support of the designation as a health professional shortage area or a population group described in subparagraph (B) of such sentence or a facility described in subparagraph (C) of such sentence, and has made a determination on the basis of the data and information submitted by such persons and groups and other data and information available to the Secretary.
(2) For purposes of this subsection, the term “medical facility” means a facility for the delivery of health services and includes—
(A) a hospital, State mental hospital, public health center, outpatient medical facility, rehabilitation facility, facility for long-term care, community mental health center, migrant health center, facility operated by a city or county health department, and community health center;
(B) such a facility of a State correctional institution or of the Indian Health Service, and a health program or facility operated by a tribe or tribal organization under the Indian Self-Determination Act [[25 U.S.C. 5321](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title25-section5321&num=0&edition=prelim) et seq.];
(C) such a facility used in connection with the delivery of health services under [section 248 of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section248&num=0&edition=prelim) (relating to hospitals), 249 of this title (relating to care and treatment of persons under quarantine and others), 250 of this title (relating to care and treatment of Federal prisoners), 251 of this title (relating to examination and treatment of certain Federal employees), 252 of this title (relating to examination of aliens), 253 of this title (relating to services to certain Federal employees), 247e of this title (relating to services for persons with Hansen’s disease), or 254b(h) of this title (relating to the provision of health services to homeless individuals); and
(D) a Federal medical facility.
(3) Homeless individuals (as defined in [section 254b(h)(5) of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section254b/h/5&num=0&edition=prelim)), seasonal agricultural workers (as defined in [section 254b(g)(3) of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section254b/g/3&num=0&edition=prelim)) and migratory agricultural workers (as so defined)), and residents of public housing (as defined in [section 1437a(b)(1) of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section1437a/b/1&num=0&edition=prelim)) may be population groups under paragraph (1).
**(b) Criteria for designation of health professional shortage areas; promulgation of regulations** The Secretary shall establish by regulation criteria for the designation of areas, population groups, medical facilities, and other public facilities, in the States, as health professional shortage areas. In establishing such criteria, the Secretary shall take into consideration the following:
(1) The ratio of available health manpower to the number of individuals in an area or population group, or served by a medical facility or other public facility under consideration for designation.
(2) Indicators of a need, notwithstanding the supply of health manpower, for health services for the individuals in an area or population group or served by a medical facility or other public facility under consideration for designation.
(3) The percentage of physicians serving an area, population group, medical facility, or other public facility under consideration for designation who are employed by hospitals and who are graduates of foreign medical schools.
**(c) Considerations in determination of designation** In determining whether to make a designation, the Secretary shall take into consideration the following:
(1) The recommendations of the Governor of each State in which the area, population group, medical facility, or other public facility under consideration for designation is in whole or part located.
(2) The extent to which individuals who are (A) residents of the area, members of the population group, or patients in the medical facility or other public facility under consideration for designation, and (B) entitled to have payment made for medical services under title XVIII, XIX, or XXI of the Social Security Act [[42 U.S.C. 1395](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section1395&num=0&edition=prelim) et seq., 1396 et seq., 1397aa et seq.], cannot obtain such services because of suspension of physicians from the programs under such titles.
**(d) Designation; publication of descriptive lists**
(1) In accordance with the criteria established under subsection (b) and the considerations listed in subsection (c), the Secretary shall designate health professional shortage areas in the States, publish a descriptive list of the areas, population groups, medical facilities, and other public facilities so designated, and at least annually review and, as necessary, revise such designations.
(2) For purposes of paragraph (1), a complete descriptive list shall be published in the Federal Register not later than July 1 of 1991 and each subsequent year.
**(e) Notice of proposed designation of areas and facilities; time for comment**
(1) Prior to the designation of a public facility, including a Federal medical facility, as a health professional shortage area, the Secretary shall give written notice of such proposed designation to the chief administrative officer of such facility and request comments within 30 days with respect to such designation.
(2) Prior to the designation of a health professional shortage area under this section, the Secretary shall, to the extent practicable, give written notice of the proposed designation of such area to appropriate public or private nonprofit entities which are located or have a demonstrated interest in such area and request comments from such entities with respect to the proposed designation of such area.
**(f) Notice of designation** The Secretary shall give written notice of the designation of a health professional shortage area, not later than 60 days from the date of such designation, to—
(1) the Governor of each State in which the area, population group, medical facility, or other public facility so designated is in whole or part located; and
(2) appropriate public or nonprofit private entities which are located or which have a demonstrated interest in the area so designated.
**(g) Recommendations to Secretary** Any person may recommend to the Secretary the designation of an area, population group, medical facility, or other public facility as a health professional shortage area.
**(h) Public information programs in designated areas** The Secretary may conduct such information programs in areas, among population groups, and in medical facilities and other public facilities designated under this section as health professional shortage areas as may be necessary to inform public and nonprofit private entities which are located or have a demonstrated interest in such areas of the assistance available under this subchapter by virtue of the designation of such areas.
**(i) Dissemination** The Administrator of the Health Resources and Services Administration shall disseminate information concerning the designation criteria described in subsection (b) to—
(1) the Governor of each State;
(2) the representative of any area, population group, or facility selected by any such Governor to receive such information;
(3) the representative of any area, population group, or facility that requests such information; and
(4) the representative of any area, population group, or facility determined by the Administrator to be likely to meet the criteria described in subsection (b).
**(j) Regulations and report**
(1) The Secretary shall submit the report described in paragraph (2) if the Secretary, acting through the Administrator of the Health Resources and Services Administration, issues—
(A) a regulation that revises the definition of a health professional shortage area for purposes of this section; or
(B) a regulation that revises the standards concerning priority of such an area under [section 254f–1 of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section254f-1&num=0&edition=prelim).
(2) On issuing a regulation described in paragraph (1), the Secretary shall prepare and submit to the Committee on Energy and Commerce of the House of Representatives and the Committee on Health, Education, Labor, and Pensions of the Senate a report that describes the regulation.
(3) Each regulation described in paragraph (1) shall take effect 180 days after the committees described in paragraph (2) receive a report referred to in such paragraph describing the regulation.
**(k) Maternity care health professional target areas**
(1) The Secretary, acting through the Administrator of the Health Resources and Services Administration, shall identify, based on the data collected under paragraph (3), maternity care health professional target areas that satisfy the criteria described in paragraph (2) for purposes of, in connection with receipt of assistance under this subchapter, assigning to such identified areas maternity care health professionals who, without application of this subsection, would otherwise be eligible for such assistance. The Secretary shall distribute maternity care health professionals within health professional shortage areas using the maternity care health professional target areas so identified.
(2) For purposes of paragraph (1), the Secretary shall establish criteria for maternity care health professional target areas that identify geographic areas within health professional shortage areas that have a shortage of maternity care health professionals.
(3) For purposes of this subsection, the Secretary shall collect and publish in the Federal Register data comparing the availability and need of maternity care health services in health professional shortage areas and in areas within such health professional shortage areas.
(4) In carrying out paragraph (1), the Secretary shall seek input from relevant provider organizations, including medical societies, organizations representing medical facilities, and other organizations with expertise in maternity care.
(5) For purposes of this subsection, the term ‘full scope maternity care health services’ includes during labor care, birthing, prenatal care, and postpartum care.
(6) Nothing in this subsection shall be construed as—
(A) requiring the identification of a maternity care health professional target area in an area not otherwise already designated as a health professional shortage area; or
(B) affecting the types of health professionals, without application of this subsection, otherwise eligible for assistance, including a loan repayment or scholarship, pursuant to the application of this section.
Cross-references
Connections may be documented source relationships, shared citations or nearby passages. Each explains its basis; a connection alone does not establish applicability to your situation.
Federal law — U.S. Code and appendices · legal_authorities
**(a) Findings respecting historical and special legal relationship, and resultant responsibilities** The Congress, after careful review of the Federal Government’s historical and special legal relationship with, and resulting responsibilities to, American Indian people, finds that—
(1) the prolonged Federal domination of Indian service programs has served to retard rather than enhance the progress of Indian people and their communities by depriving Indians of the full opportunity to develop leadership skills crucial to the realization of self-government, and has denied to the Indian people an effective voice in the planning and implementation of programs for the benefit of Indians which are responsive to the true needs of Indian communities; and
(2) the Indian people will never surrender their desire to control their relationships both among themselves and with non-Indian governments, organizations, and persons.
**(b) Further findings** The Congress further finds that—
(1) true self-determination in any society of people is dependent upon an educational process which will insure the development of qualified people to fulfill meaningful leadership roles;
(2) the Federal responsibility for and assistance to education of Indian children has not effected the desired level of educational achievement or created the diverse opportunities and personal satisfaction which education can and should provide; and
(3) parental and community control of the educational process is of crucial importance to the Indian people.
Stored review status: release_metadata_unconfirmed. The source passage cites 25 U.S.C. § 5321. This identifies an authority to review, not proof of applicability.
Federal law — U.S. Code and appendices · legal_authorities
§ 5321. Self-determination contracts
(a) Request by tribe; authorized programs
(1) The Secretary is directed, upon the request
of any Indian tribe by tribal resolution, to enter
into a self-determination contract or contracts
with a tribal organization to plan, conduct, and
administer programs or portions thereof, includ-
ing construction programs—
(A) provided for in the Act of April 16, 1934
(48 Stat. 596), as amended [25 U.S.C. 5342 et
seq.];
(B) which the Secretary is authorized to ad-
minister for the benefit of Indians under the
Act of November 2, 1921 (42 Stat. 208) [25 U.S.C.
13], and any Act subsequent thereto;
(C) provided by the Secretary of Health and
Human Services under the Act of August 5,
1954 (68 Stat. 674), as amended [42 U.S.C. 2001 et
seq.];
(D) administered by the Secretary for the
benefit of Indians for which appropriations are
made to agencies other than the Department
of Health and Human Services or the Depart-
ment of the Interior; and
(E) for the benefit of Indians because of their
status as Indians without regard to the agency
or office of the Department of Health and
Human Services or the Department of the In-
terior within which it is performed.
The programs, functions, services, or activities
that are contracted under this paragraph shall
Page 725
TITLE 25—INDIANS
§ 5321
1 So in original. Probably should be ‘‘paragraph,’’.
include administrative functions of the Depart-
ment of the Interior and the Department of
Health and Human Services (whichever is appli-
cable) that support the delivery of services to
Indians, including those administrative activi-
ties supportive of, but not included as part of,
the service delivery programs described in this
paragraph that are otherwise contractable. The
administrative
Stored review status: historical_2024_not_currentness_verified. The source passage cites 25 U.S.C. § 5321. This identifies an authority to review, not proof of applicability.
Federal law — U.S. Code and appendices · legal_authorities
**(a) Conditions of participation; protection of individual rights; notification of State entities; use of home health aides; medical equipment; individual’s plan of care; compliance with Federal, State, and local laws and regulations** The conditions of participation that a home health agency is required to meet under this subsection are as follows:
(1) The agency protects and promotes the rights of each individual under its care, including each of the following rights:
(A) The right to be fully informed in advance about the care and treatment to be provided by the agency, to be fully informed in advance of any changes in the care or treatment to be provided by the agency that may affect the individual’s well-being, and (except with respect to an individual adjudged incompetent) to participate in planning care and treatment or changes in care or treatment.
(B) The right to voice grievances with respect to treatment or care that is (or fails to be) furnished without discrimination or reprisal for voicing grievances.
(C) The right to confidentiality of the clinical records described in section 1395x(o)(3) of this title.
(D) The right to have one’s property treated with respect.
(E) The right to be fully informed orally and in writing (in advance of coming under the care of the agency) of—
(i) all items and services furnished by (or under arrangements with) the agency for which payment may be made under this subchapter,
(ii) the coverage available for such items and services under this subchapter, subchapter XIX, and any other Federal program of which the agency is reasonably aware,
(iii) any charges for items and services not covered under this subchapter and any charges the individual may have to pay with respect to items and services furn
Stored review status: release_metadata_unconfirmed. The source passage cites 42 U.S.C. § 1395. This identifies an authority to review, not proof of applicability.
Federal law — U.S. Code and appendices · legal_authorities
§ 1395. Prohibition against any Federal inter-
ference
Nothing in this subchapter shall be construed
to authorize any Federal officer or employee to
exercise any supervision or control over the
practice of medicine or the manner in which
medical services are provided, or over the selec-
tion, tenure, or compensation of any officer or
employee of any institution, agency, or person
providing health services; or to exercise any su-
pervision or control over the administration or
operation of any such institution, agency, or
person.
(Aug. 14, 1935, ch. 531, title XVIII, § 1801, as added
Pub. L. 89–97, title I, § 102(a), July 30, 1965, 79
Stat. 291.)
Statutory Notes and Related Subsidiaries
SHORT TITLE
For short title of title I of Pub. L. 89–97, which en-
acted this subchapter as the ‘‘Health Insurance for the
Aged Act’’, see section 100 of Pub. L. 89–97, set out as
a Short Title of 1965 Amendment note under section
1305 of this title.
PROTECTING AND IMPROVING GUARANTEED MEDICARE
BENEFITS
Pub. L. 111–148, title III, § 3601, Mar. 23, 2010, 124 Stat.
538, provided that:
‘‘(a) PROTECTING GUARANTEED MEDICARE BENEFITS.—
Nothing in the provisions of, or amendments made by,
this Act [see Short Title note set out under section
18001 of this title] shall result in a reduction of guaran-
teed benefits under title XVIII of the Social Security
Act [42 U.S.C. 1395 et seq.].
‘‘(b) ENSURING THAT MEDICARE SAVINGS BENEFIT THE
MEDICARE
PROGRAM
AND
MEDICARE
BENEFICIARIES.—
Savings generated for the Medicare program under title
XVIII of the Social Security Act under the provisions
of, and amendments made by, this Act shall extend the
solvency of the Medicare trust funds, reduce Medicare
premiums and other cost-sharing for beneficiaries, and
improve or expand gu
Stored review status: historical_2024_not_currentness_verified. The source passage cites 42 U.S.C. § 1395. This identifies an authority to review, not proof of applicability.
Federal law — U.S. Code and appendices · legal_authorities
**(a) Establishment** The Secretary shall establish a manufacturer discount program (in this section referred to as the “program”). Under the program, the Secretary shall enter into agreements described in subsection (b) with manufacturers and provide for the performance of the duties described in subsection (c).
**(b) Terms of agreement**
(1) **In general**
(A) *Agreement* — An agreement under this section shall require the manufacturer to provide, in accordance with this section, discounted prices for applicable drugs of the manufacturer that are dispensed to applicable beneficiaries on or after January 1, 2025.
(B) *Clarification* — Nothing in this section shall be construed as affecting—
(i) the application of a coinsurance of 25 percent of the negotiated price, as applied under paragraph (2)(A) of [section 1395w–102(b) of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section1395w–102/b&num=0&edition=prelim), for costs described in such paragraph; or
(ii) the application of the copayment amount described in paragraph (4)(A) of such section, with respect to costs described in such paragraph.
(C) *Timing of agreement*
(i) *Special rule for 2025* — In order for an agreement with a manufacturer to be in effect under this section with respect to the period beginning on January 1, 2025, and ending on December 31, 2025, the manufacturer shall enter into such agreement not later than March 1, 2024.
(ii) *2026 and subsequent years* — In order for an agreement with a manufacturer to be in effect under this section with respect to plan year 2026 or a subsequent plan year, the manufacturer shall enter into such agreement not later than a calendar quarter or semi-annual deadline established by the Secretary.
(2)
Stored review status: release_metadata_unconfirmed. The source passage cites 42 U.S.C. § 1395x. This identifies an authority to review, not proof of applicability.
Federal law — U.S. Code and appendices · legal_authorities
§ 1395x. Definitions
For purposes of this subchapter—
(a) Spell of illness
The term ‘‘spell of illness’’ with respect to any
individual means a period of consecutive days—
(1) beginning with the first day (not included
in a previous spell of illness) (A) on which such
individual is furnished inpatient hospital serv-
ices, inpatient critical access hospital services
or extended care services, and (B) which oc-
curs in a month for which he is entitled to
benefits under part A, and
(2) ending with the close of the first period
of 60 consecutive days thereafter on each of
which he is neither an inpatient of a hospital
or critical access hospital nor an inpatient of
a facility described in section 1395i–3(a)(1) of
this title or subsection (y)(1).
Page 3524
TITLE 42—THE PUBLIC HEALTH AND WELFARE
§ 1395x
(b) Inpatient hospital services
The term ‘‘inpatient hospital services’’ means
the following items and services furnished to an
inpatient of a hospital and (except as provided
in paragraph (3)) by the hospital—
(1) bed and board;
(2) such nursing services and other related
services, such use of hospital facilities, and
such medical social services as are ordinarily
furnished by the hospital for the care and
treatment of inpatients, and such drugs,
biologicals, supplies, appliances, and equip-
ment, for use in the hospital, as are ordinarily
furnished by such hospital for the care and
treatment of inpatients; and
(3) such other diagnostic or therapeutic
items or services, furnished by the hospital or
by others under arrangements with them made
by the hospital, as are ordinarily furnished to
inpatients either by such hospital or by others
under such arrangements;
excluding, however—
(4) medical or surgical services provided by a
physician, res
Stored review status: historical_2024_not_currentness_verified. The source passage cites 42 U.S.C. § 1395x. This identifies an authority to review, not proof of applicability.
Federal law — U.S. Code and appendices · legal_authorities
§ 254e. Health professional shortage areas
(a) Designation by Secretary; removal from areas
designated; ‘‘medical facility’’ defined
(1) For purposes of this subpart the term
‘‘health professional shortage area’’ means (A)
an area in an urban or rural area (which need
not conform to the geographic boundaries of a
political subdivision and which is a rational
area for the delivery of health services) which
the Secretary determines has a health man-
power shortage and which is not reasonably ac-
cessible to an adequately served area, (B) a pop-
ulation group which the Secretary determines
has such a shortage, or (C) a public or nonprofit
private medical facility or other public facility
which the Secretary determines has such a
shortage. All Federally qualified health centers
and rural health clinics, as defined in section
1861(aa) of the Social Security Act (42 U.S.C.
1395x(aa)), that meet the requirements of section
254g of this title shall be automatically des-
ignated as having such a shortage. The Sec-
retary shall not remove an area from the areas
determined to be health professional shortage
areas under subparagraph (A) of the preceding
sentence until the Secretary has afforded inter-
ested persons and groups in such area an oppor-
tunity to provide data and information in sup-
port of the designation as a health professional
shortage area or a population group described in
subparagraph (B) of such sentence or a facility
described in subparagraph (C) of such sentence,
and has made a determination on the basis of
the data and information submitted by such per-
sons and groups and other data and information
available to the Secretary.
(2) For purposes of this subsection, the term
‘‘medical facility’’ means a facility for the deliv-
ery of