42 U.S.C. § 291o — Definitions

(a) "State" "State" includes Puerto Rico, Guam, American Samoa, the Trust Territory of the Pacific Islands, the Virgin Islands, and the District of Columbia — not just the 50 states. (b) "Federal share" (1) The "Federal share" of a project is the part of the cost the federal government pays. (2) For a project funded through a state's allotment, the state agency decides the federal share. But it can't be more than 66⅔ percent or the state's allotment percentage, whichever is lower. If the state's allotment percentage is below 50 percent, the law treats it as 50 percent for this purpose. (3) Before approving a state's first project each fiscal year, the state agency must tell the Secretary in writing the maximum federal share it will use that year and how it will calculate the actual share. Once set for that fiscal year, this can't be changed. (4) The state agency can add an extra "incentive" percentage on top of the amounts above — but the combined federal share can never go over 90 percent. This bonus applies to (A) projects that mainly serve people in a rural or urban poverty area, or (B) projects that could lower health costs by sharing services between facilities, cooperating between facilities, or building or upgrading standalone outpatient facilities. (c) "Hospital" "Hospital" covers general hospitals, tuberculosis hospitals, and other kinds of hospitals, plus related facilities like labs, outpatient departments, nurses' housing, extended care facilities, home health service facilities, self-care units, and central service facilities connected to hospitals. It also includes education or training facilities for health workers that are part of a hospital. It does NOT include a hospital that mainly provides just room and board (domiciliary care). (d) "Public health center" A "public health center" is a publicly owned facility that provides public health services, including related publicly owned labs, clinics, and offices connected to it. (e) "Nonprofit" A facility is "nonprofit" if it's owned and run by one or more nonprofit corporations or associations, and none of its profits can legally go to any private owner or individual. (f) "Outpatient facility" An "outpatient facility" diagnoses, or diagnoses and treats, patients who don't need to stay overnight (including ambulatory inpatients). It must be one of these: (1) run in connection with a hospital, or (2) have care supervised by a state-licensed doctor or surgeon (or, for dental care, a state-licensed dentist), or (3) offer patients who don't need hospitalization access to licensed physicians across various specialties, with a fairly full range of diagnosis and treatment services. (g) "Rehabilitation facility" A "rehabilitation facility" mainly helps disabled people through a combined program of (1) medical evaluation and services and (2) psychological, social, or vocational evaluation and services, all under qualified professional supervision. It must also meet these conditions: (3) most of the required evaluation and services happen at the facility itself; and (4) either (A) it's run in connection with a hospital, or (B) all its medical and related health services are ordered by, or generally directed by, a state-licensed doctor or surgeon. (h) "Facility for long-term care" This means a facility (including an extended care facility) that provides inpatient care for convalescent or chronic-disease patients who need skilled nursing and related medical care. It must be either: (1) a hospital (other than one mainly for mentally ill or tuberculosis patients) or run in connection with a hospital, or (2) a place where the nursing and medical care is ordered by, or generally directed by, a state-licensed doctor or surgeon. (i) "Construction" "Construction" includes building new buildings, expanding, remodeling, and altering existing buildings, and providing their initial equipment (including medical transportation facilities). If a project will bring a service the community didn't have before, it also includes equipping any buildings for that. Architects' fees count too. It does NOT include off-site improvements, and — except for public health centers — it does not include the cost of buying land. (j) "Cost" "Cost," for construction or modernization, is the amount the Surgeon General finds necessary for that construction or modernization. Exception: for a project modernizing a facility funded from a particular allotment (section 291b(a)(2)), "cost" excludes any amount the Surgeon General finds is for expanding the facility's bed capacity. (k) "Modernization" "Modernization" includes altering, major repairs (as far as regulations allow), remodeling, replacing, and renovating existing buildings (including their initial equipment), and replacing worn-out, built-in equipment as defined by regulation. (l) "Title" When talking about a project site, "title" means full ownership, or another kind of interest (including a lease where rent is no more than 4 percent of the land's value) that the Surgeon General finds is enough to guarantee undisturbed use and possession of the site for at least 50 years, for building and running the project.