(b) The Director of the Office of Medical, Dental, and Hospital Services (hereinafter called the "Director") shall, with the approval of the Administrator, certify for each fiscal year the amount of the allotment to be paid under this title to each State that has qualified under section 304 of this title to the Secretary of the Treasury, who shall, through the fiscal service of the Treasury Department and prior to audit or settlement by the General Accounting Office, pay to the treasurer or corresponding official of such State the amount certified for such fiscal year in four installments. One such installment shall be paid as soon after the first day of each quarter as may be feasible, beginning with the first quarter of the first fiscal year for which appropriations made under the authorization of this title are available.

(c) If, in any State, the treasurer or corresponding official of such State is not permitted by law to disburse any of the funds authorized under section 301 (a) for the purpose of providing health services referred to in such section to children attending nonpublic schools, the Director shall withhold from the allotment of such State an amount which bears the same ratio to such allotment as the number of children in average daily attendance at nonpublic schools within such State bears to the total number of children in average daily attendance in all schools within such State. The Director shall, with the funds so withheld, make provision for such services to children attending the nonpublic schools within such State for the same purposes and subject to the same conditions as are authorized or required with respect to the disbursement of funds for such purposes for children attending public schools within the State.

ALLOTMENT PERCENTAGE

SEC. 303. For the purposes of this title

(a) The allotment percentage for any State shall be 100 per centum less that percentage which bears the same ratio to 50 per centum as the per capita income of such State bears to the per capita income of the continental United States (excluding Alaska), except that (1) the allotment percentage shall in no case be more than 75 per centum or less than 33% per centum and (2) the allotment percentage for Hawaii shall be 50 per centum and the allotment percentage for Alaska, Puerto Rico, the Virgin Islands, the Canal Zone, American Samoa, and Guam shall be 75 per centum.

(b) The allotment percentages shall be promulgated by the Director between July 1 and August 31 of each even-numbered year, on the basis of the average of the per capita incomes of the States and of the continental United States (excluding Alaska) for the three most recent consecutive years for which satisfactory data are available from the Department of Commerce. Such promulgation shall be conclusive for each of the two fiscal years in the period beginning July 1 next succeeding such promulgation: Provided, That the Director shall promulgate such percentages as soon as possible after the enactment of this Act, which promulgation shall be effective until June 30, 1951.

(c) The number of children between the ages of five and seventeen, inclusive, in the several States shall be determined on the basis of the latest figures certified by the Department of Commerce.

STATE ACCEPTANCE PROVISIONS

SEC. 304. (a) In order to qualify for receiving funds appropriated under this title a State shall accept the provisions of this title through its legislature, or through its chief executive until its legislature shall meet, and shall submit a plan through its chief executive to the Director for the administration of funds to be received, which plan shall be prepared by the State educational agency and State health agency jointly or, in Guam, American Samoa, or the Canal Zone, such agency as may be designated by the Governor. Such plan shall—

(1) set forth a school health program which (A) shall provide for medical and dental examinations at periodic intervals for all school children in the State, insofar as practicable at the schools which they attend, including nonpublic as well as public schools; (B) shall provide for treatment of such children for physical and mental defects and conditions shown by such examinations whenever the parents of such children are unable to provide such treatment; and (C) may provide for the prevention and treatment of such physical and mental defects and conditions for all school children. Such examinations and service shall be made available to children, on a just and

equitable basis, without regard to race, creed, color, or national origin, or the location or character of the school in which the examination is made. Such plan shall set forth the manner in which payments are to be made and examinations and treatment provided.

(2) provide the method by which the plan shall be administered and specify the State agency or agencies (which shall be the State health agency or the State educational agency, or both, except that in Guam, American Samoa, and the Canal Zone it shall be the agency or agencies designated by the Governor) which shall administer the plan and the division of powers and responsibilities between them, if there is more than one, in order to secure the most equitable provision of services provided by this title to all the school children of the State;

(3) provide that the State treasurer or corresponding official in the State shall receive the funds paid to the State under this title and shall be required to submit to the Director on or before the 1st day of November of each year, for transmission to the Congress, a detailed statement of the amount so received for the preceding fiscal year and of its disbursement;

(4) provide for an annual audit of the expenditure of funds received under this title, and for the submission of a copy thereof to the Director;

(5) provide for the expenditure of State and local funds in an amount not less than (A) the State percentage (as defined in sec. 307 (g)) of the total sum to be spent in the State, for the health services described in this title, or (B) the amount of such funds actually spent for such purposes in the fiscal year of the State ended in 1948, whichever is greater;

(6) provide that the State agency or agencies will make such reports, in such form and containing such information, as the Director may from time to time reasonably require, and give the Director, upon demand, access to the records upon which the information is based.

(7) provide for the designation of a State advisory council which shall include representatives of nongovernmental organizations or groups, and of State agencies, concerned with health, education, child welfare, and the interests of the public at large, to consult with the State agency or agencies administering the plan with respect to the operation of such plan;

(8) provide that the school health services developed in accordance with this title shall utilize and develop the qualified health, medical, dental, hospital, and other related facilities already established in the State;

(9) provide for cooperation with medical, dental, health, nursing, psychiatric, educational, and welfare groups and organizations, and, where necessary, for working agreements with State or local public agencies having authority under State law for the care of crippled or otherwise physically handicapped children, or for other necessary health services; and

(10) provide that the State shall set standards for the services to be provided under this title.

(b) The Director shall approve any State plan which complies with the provisions of subsection (a).

OPERATION OF STATE PLANS

SEC. 305. In the case of any State plan for school health services which has been approved by the Director, if the Director, after reasonable notice and opportunity for hearing to the State agency or agencies administering such plan, finds that in the administration of the plan there is a failure to comply substantially with any provision required by section 304 to be included in the plan, or finds, after October 1, 1952, that such plan is not yet in full effect, he shall notify the Secretary of the Treasury and such State agency or agencies that further payments will not be made to the State until he is satisfied that there is no longer any failure to comply. Until he is so satisfied he shall make no further certification to the Secretary of the Treasury with respect to such State.

RIGHT OF APPEAL

SEC. 306. (a) If any State is dissatisfied with the Director's action under section 304 (b) or section 305 hereof, such State may appeal to the United States court of appeals for the circuit in which such State is located. The summons and notice of appeal may be served at any place in the United States. The Director shall forthwith certify and file in the court the transcript of the proceedings and the record on which he based his action.

(b) The findings of fact by the Director, unless substantially contrary to the weight of the evidence, shall be conclusive; but the court, for good cause shown, may remand the case to the Director to take further evidence, and the Director may thereupon make new or modified findings of fact and may modify his previous action, and shall certify to the court the transcript and record of the further proceedings. Such new or modified findings of fact shall likewise be conclusive unless substantially contrary to the weight of the evidence.

(c) The court shall have jurisdiction to affirm the action of the Director or to set it aside, in whole or in part. The judgment of the court shall be subject to review by the Supreme Court of the United States upon certiorari or certification as provided in the United States Code, title 28, section 1254.

DEFINITIONS

SEC. 307. As used in this title

(a) The term "State" shall include the several States, the District of Columbia, Alaska, Hawaii, Puerto Rico, the Canal Zone, American Samoa, the Virgin Islands, and Guam.

(b) The term "legislature" means the State or Territorial legislature or other comparable body, except that in the District of Columbia it shall mean the Board of Education, and in American Samoa, the Canal Zone, and the Virgin Islands it shall mean the Governor.

(c) The term "schools" means only elementary and secondary schools, and the term "nonpublic schools" means those schools exempt under section 101 (6) of the Internal Revenue Code, as amended, which, while performing the public function of educating children in accordance with the State educational requirements, are not administered by public authorities.

(d) The term "school children" means all children between the ages of five and seventeen, inclusive, attending schools.

(e) A just and equitable basis for the provision for health services provided under this title for the benefit of children attending public schools maintained for minority races in a State which maintains by law separate public schools for minority races means a basis which provides for children attending such schools the same health services as are provided for children in other public schools in the State.

(f) The term "minority race" means any race or racial group that constitutes a minority of the population of the continental United States.

(g) The State percentage shall be that percentage which bears the same ratio to 50 per centum as the per capita income of such State bears to the per capita income of the continental United States, except that (1) the State percentage shall in no case be more than 50 per centum or less than 25 per centum, and (2) the State percentage for Hawaii shall be 50 per centum, and the State percentage for Alaska, Puerto Rico, the Virgin Islands, the Canal Zone, American Samoa, and Guam shall be 25 per centum.

The State percentages shall be promulgated by the Director between July 1 and August 31 of each even-numbered year, on the basis of the average of the per capita incomes of the States and of the continental United States (excluding Alaska) for the three most recent consecutive years for which satisfactory data are available from the Department of Commerce. Such promulgation shall be conclusive for each of the two fiscal years in the period beginning July 1 next succeeding such promulgations: Provided, That the Director shall promulgate such percentages as soon as possible after the enactment of this title, which promulgation shall be effective until June 30, 1951.

TITLE IV-AMENDMENTS TO HOSPITAL SURVEY AND CONSTRUCTION ACT

EXTENSION OF DURATION AND INCREASE IN AUTHORIZED APPROPRIATIONS FOR HOSPITAL CONSTRUCTION

SEC. 401. In order to provide greater financial assistance to the States for the construction of hosptials

(a) The first sentence of section 621 of the Public Health Service Act is amended to read as follows: "In order to assist the States in carrying out the purposes of section 601 (b), there is hereby authorized to be appropriated for the fiscal year ending June 30, 1950, and for each of the five succeeding fiscal years, the sum of $150,000,000 for the construction of public and other nonprofit hos

pitals; and there are further authorized to be appropriated for such construction the sums provided in section 624."

(b) The paragraph “Grants for hospital construction" under the heading "Public Health Service" in the Federal Security Agency Appropriation Act, 1949, is amended by striking out "$75,000,000" and inserting in lieu thereof "$150,000,000".

ADDITIONAL FEDERAL AID IN CONSTRUCTION OF HOSPITALS

SEC. 402. (a) Sections 624, 625 (a), and 625 (b) of such Act are each amended by striking out "33% per centum" and inserting in lieu thereof "the State's allotment percentage".

(b) Section 625 (e) of such Act is amended by striking out "33% per centum of the then value of such hospital, as determined by agreement of the parties or by action brought in the district court of the United States for the district in which such hospital is situated" and inserting in lieu thereof the following: "an amount bearing the same ratio to the then value (as determined by agreement of the parties or by action brought in the district court of the United States for the district in which such hospital is situated) of the hospital, or of that portion of the hospital which constituted an approved project, as the amount of the Federal participation bore to the cost of the construction of such project”.

REQUIREMENT OF ADEQUATE STATE ADMINISTRATION

SEC. 403. Section 632 (a) of such Act is amended by inserting after "under section 625" in clause (4) thereof a comma and the following: "or (5) that adequate State funds are not being provided annually for the direct administration of the State plan (which shall be not less than $15,000 or 1 per centum of the total funds proposed to be expended during the year under the plan, whichever is the higher)".

STUDIES AND DEMONSTRATIONS RELATING TO COORDINATED USE OF HOSPITAL

FACILITIES

SEC. 404. Such Act is further amended by adding after section 635 the following new section:

"STUDIES AND DEMONSTRATIONS RELATING TO COORDINATED USE OF HOSPITAL

FACILITIES

"SEC. 636. In carrying out the purposes of section 301 with respect to hospital facilities, the Surgeon General is authorized to conduct research, experiments, and demonstrations relating to the effective development and utilization of hospital services, facilities, and resources, and, after consultation with the Federal Hospital Council, to make grants-in-aid to States, political subdivisions, universities, hospitals, and other public and private nonprofit institutions or organizations for projects for the conduct of research, experiments, or demonstrations relating to the development, utilization, and coordination of hospital services, facilities, and resources. Any award made under this section for any such project in any fiscal year may include amounts for not to exceed the four succeeding fiscal years, and such amounts for such succeeding fiscal years shall constitute contractual obligations of the Federal Government: Provided, That the total of such obligations for all such projects to be paid in any such succeeding fiscal year may not exceed $1,200,000."

PURPOSE OF ACT

SEC. 405. Section 601 of such Act is amended to read as follows: "SEC. 601. The purpose of this title is

"(a) to assist the several States to inventory their existing hospitals (as defined in section 631 (e)), to survey the need for construction of hospitals, and to develop programs for construction of such public and other nonprofit hospitals as will, in conjunction with existing facilities, afford the necessary physical facilities for furnishing adequate hospital, clinic, and similar services to all their people;

"(b) to assist in the construction of public and other nonprofit hospitals in accordance with such programs; and

"(c) to authorize the Surgeon General to conduct, and make grants for the conduct of, research, experiments, and demonstrations relating to the effective development and utilization of hospital services, facilities, and resources, and to promote the coordination of such experiments and demonstrations and the useful application of their results."

EFFECTIVE DATE

SEC. 406. This title shall take effect upon the date of its enactment except that (1) the amendments made by section 402 (a) shall be effective with respect to projects approved under section 625 of the Public Health Service Act on and after January 1, 1949, and (2) section 404 shall take effect July 1, 1949.

TITLE V-LOCAL PUBLIC HEALTH UNITS

AMENDMENTS TO PUBLIC HEALTH SERVICE ACT

SEC. 501. In order to assist the States in the development and maintenance of local public health units

(a) section 315 of the Public Health Service Act, as amended, is amended by redesignating such section as section 304; and

(b) part B of title III of such Act is amended by adding at the end thereof the following new section:

"GRANTS TO STATES FOR LOCAL PUBLIC HEALTH UNITS

"SEC 315. (a) For the purposes of this section

"(1) the term 'local public health unit' means the governmental authority of a local area authorized to provide in such area the basic public health services for which funds are made available under this section (including a unit of a State government specifically assigned responsibility for the provision of basic public health services in a local area), or a combination of the governmental authorities of two or more contiguous local areas authorized to provide such services in such combined area;

"(2) the term 'population' (A), as applied to a State, means the population thereof according to the latest estimates available from the Department of Commerce on August 31 of the year preceding the fiscal year (or portion thereof) for which a determination with respect to such population is made under this section, and (B), as applied to less than State-wide areas, means the population of such areas according to the most recent decennial census figures certified by the Department of Commerce that are available on August 31 of the year preceding the fiscal year (or portion thereof) for which a determination with respect to such population is made under this section, increased or decreased in proportion to the increase or decrease since such census of the population of the State as estimated in accordance with clause (A) hereof;

'(3) the average per capita income of the United States or the average per capita income of a State, as the case may be, means its average per capita income for the three most recent consecutive years for which satisfactory data are available from the Department of Commerce on August 31 of the year preceding the fiscal year for which the determination is made, except that the average per capita income of Hawaii shall be deemed to be equal to that of the continental United States (excluding Alaska) and the average per capita income of Alaska, Puerto Rico, and the Virgin Islands shall be deemed to be equal to one-half of that of the continental United States (excluding Alaska). "(b) To enable the Surgeon General to assist the States and their subdivisions in establishing and maintaining adequately staffed and equipped local public health units for the provision of basic public health services, there are hereby authorized to be appropriated such sums as may be necessary to carry out the purposes of this section. The sums appropriated pursuant to this section shall be used for making payments to States which have submitted, and had approved by the Surgeon General, State plans for carrying out the purposes of this section.

"(c) Within six months after the enactment of this section, the Surgeon General shall by regulation prescribe—

66

'(1) criteria for determining the minimum population and financial resources which various types of areas must have, and the minimum number