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42 U.S.C. § 300e–5Application requirements

submitted 82 years ago by Pub. L. 93-222 to r/title-42-THE-PUBLIC-HEALTH-AND-WELFARE · 704 words · no verdicts yet

in plain englishAI-generated · not legal advice

No HMO can get a loan or loan guarantee under this subchapter without an approved application. That application must satisfy section 300e-7 and show real need for the funds. It must also detail the HMO's population, services, finances, and governance. It must also include assurances about enrollment, community rating, and, for repeat applicants, past performance.

(a) Submission to and approval by Secretary required for making loans and loan guarantees No loan or loan guarantee under this subchapter may be made unless an application has been submitted to, and approved by, the Secretary. (b) Application contents The Secretary can't approve a loan or loan-guarantee application unless: (1) it meets the requirements of section 300e-7; (2) -- for a section 300e-4 application -- the Secretary decides the applicant couldn't complete the project without this assistance; (3) the application gives satisfactory details about the existing or planned HMO's: (A) population group(s) to be served, (B) membership, (C) enrollment methods, terms, and periods, (D) estimated per-member costs of health and education services and what drives those costs, (E) sources of professional services and how services will be organized, (F) organizational arrangements for an ongoing quality-assurance program that meets section 300e(c), (G) sources of prepayment and other payment for its services, (H) available facilities and capital investment (plus funding sources) for the level and scope of services planned, (I) its administrative, managerial, and financial arrangements and capabilities, (J) how members will take part in planning and policy-making, (K) its grievance procedures for members, and (L) evaluations of community support and acceptance, sources of operating support, and the professional groups involved or affected; (4) it includes assurances, satisfying Secretary-set criteria, that the applicant will enroll and maintain the maximum membership its available and potential resources (as the Secretary determines) can effectively serve; (5) for an application tied to a project that already got a previous grant, contract, loan, or loan guarantee under this subchapter, it includes assurances that the applicant can financially carry out the project's purposes and has run the project consistent with this subchapter and with what earlier applications said; (6) it includes assurances the Secretary requires about the applicant's intent and ability to meet section 300e(b)(1) and (2) -- setting basic and supplemental payments under a community rating system; and (7) it's submitted in whatever form and manner, and contains whatever additional information, the Secretary prescribes by regulation. An organization submitting multiple applications for more than one loan or loan guarantee doesn't have to duplicate information already given -- it only has to update the paragraph (3) specifications as often, and in whatever manner, the Secretary's regulations require. When deciding, under paragraph (2), whether an applicant could complete a project without this assistance, the Secretary can't count any asset whose use for the project would threaten the applicant's fiscal soundness. (c) Regulations The Secretary must set standards and procedures, by regulation, for health systems agencies to follow when reviewing and commenting on loan and loan-guarantee applications under this subchapter.
the actual law source: uscode.house.gov ↗public domain
(a) Submission to and approval by Secretary required for making loans and loan guarantees

No loan or loan guarantee may be made under this subchapter unless an application therefor has been submitted to, and approved by, the Secretary.

(b) Application contents

The Secretary may not approve an application for a loan or loan guarantee under this subchapter unless—

(1)

such application meets the requirements of section 300e–7 of this title;

(2)

in the case of an application for assistance under section 300e–4 of this title, he determines that the applicant making the application would not be able to complete the project or undertaking for which the application is submitted without the assistance applied for;

(3)

the application contains satisfactory specification of the existing or anticipated (A) population group or groups to be served by the proposed or existing health maintenance organization described in the application, (B) membership of such organization, (C) methods, terms, and periods of the enrollment of members of such organization, (D) estimated costs per member of the health and educational services to be provided by such organization and the nature of such costs, (E) sources of professional services for such organization, and organizational arrangements of such organization for providing health and educational services, (F) organizational arrangements of such organization for an ongoing quality assurance program in conformity with the requirements of section 300e(c) of this title, (G) sources of prepayment and other forms of payment for the services to be provided by such organization, (H) facilities, and additional capital investments and sources of financing therefor, available to such organization to provide the level and scope of services proposed, (I) administrative, managerial, and financial arrangements and capabilities of such organization, (J) role for members in the planning and policymaking for such organization, (K) grievance procedures for members of such organization, and (L) evaluations of the support for and acceptance of such organization by the population to be served, the sources of operating support, and the professional groups to be involved or affected thereby;

(4)

contains or is supported by assurances satisfactory to the Secretary that the applicant making the application will, in accordance with such criteria as the Secretary shall by regulation prescribe, enroll, and maintain an enrollment of the maximum number of members that its available and potential resources (as determined under regulations of the Secretary) will enable it to effectively serve;

(5)

in the case of an application made for a project which previously received a grant, contract, loan, or loan guarantee under this subchapter, such application contains or is supported by assurances satisfactory to the Secretary that the applicant making the application has the financial capability to adequately carry out the purposes of such project and has developed and operated such project in accordance with the requirements of this subchapter and with the plans contained in previous applications for such assistance;

(6)

the application contains such assurances as the Secretary may require respecting the intent and the ability of the applicant to meet the requirements of paragraphs (1) and (2) of section 300e(b) of this title respecting the fixing of basic health services payments and supplemental health services payments under a community rating system; and

(7)

the application is submitted in such form and manner, and contains such additional information, as the Secretary shall prescribe in regulations.

An organization making multiple applications for more than one loan or loan guarantee under this subchapter, simultaneously or over the course of time, shall not be required to submit duplicate or redundant information but shall be required to update the specifications (required by paragraph (3)) respecting the existing or proposed health maintenance organization in such manner and with such frequency as the Secretary may by regulation prescribe. In determining, for purposes of paragraph (2), whether an applicant would be able to complete a project or undertaking without the assistance applied for, the Secretary shall not consider any asset of the applicant the obligation of which for such undertaking or project would jeopardize the fiscal soundness of the applicant.

(c) Regulations

The Secretary shall by regulation establish standards and procedures for health systems agencies to follow in reviewing and commenting on applications for loans and loan guarantees under this subchapter.

Source credit: (July 1, 1944, ch. 373, title XIII, § 1306, as added Pub. L. 93–222, § 2, Dec. 29, 1973, 87 Stat. 925; amended Pub. L. 94–460, title I, §§ 105(a)(3), 117(b)(5), (6), Oct. 8, 1976, 90 Stat. 1948, 1955; Pub. L. 95–559, § 12(b), (c), Nov. 1, 1978, 92 Stat. 2140; Pub. L. 99–660, title VIII, §§ 803(b)(1), 805(b), 806, Nov. 14, 1986, 100 Stat. 3799, 3800.)

history & why it existsrecord from the source credit
  • 1944Enacted · Pub. L. 93-222 · 87 Stat. 925
  • 1976Amended · Pub. L. 94-460 · 90 Stat. 1948, 1955
  • 1978Amended · Pub. L. 95-559 · 92 Stat. 2140
  • 1986Amended · Pub. L. 99-660 · 100 Stat. 3799, 3800

A history note hasn’t been published yet. The record shows enactment by Pub. L. 93-222 on 1944-07-01.

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