An Act to amend the Public Health Service Act to assist in combating heart disease, cancer, and stroke, and other major diseases
PL 89-239 (S.596), enacted 10/06/1965

926 
PU BLIC LAW 89-239-OCT. 6, 1965 
[79 STAT. 
Public Law 89-239 
October 6, 1965 
A N A C T 
C^' ^^^] 
To amend the Public Health Service Act to assist in combating heart disease, 
cancer, stroke, and related diseases. 
Be it enacted hy the Senate and House of Representatives 
of the 
c^jce'r Td*s r^ke ^^'^^^^^ States of Amevica in Congress assembled^ That this Act may 
Amendments of° " be cited as the "Heart Disease, Cancer, and Stroke Amendments of 
1965. 
1965". 
^2 use 2ofriote 
^^^' ^' ^^^ 
Public Health Service Act (42 U.S.C., ch. 6A) is 
amended by adding at the end thereof tlie following new title: 
"TITLE IX—EDUCATION, RESEARCH, TRAINING, AND 
DEMONSTRATIONS IN T H E F I E L D S OF H E A R T DIS-
EASE, CANCER, STROKE, AND RELATED DISEASES 
((. 
PURPOSES 
"SEC. 900. The purposes of this title are— 
"(a) Through grants, to encourage and assist in the establishment 
of regional cooperative arrangements among medical schools, research 
institutions, and hospitals for research and training (including con-
tinuing education) and for related demonstrations of patient care in 
the fields of heart disease, cancer, stroke, and related diseases; 
"(b) To afford to the medical profession and the medical institu-
tions of the Nation, through such cooperative arrangements, the oppor-
tunity of making available to their patients the latest advances in the 
diagnosis and treatment of these diseases; and 
"(c) By these means, to improve generally the health manpower 
and facilities available to the Nation, and to accomplish these ends 
without interfering with the patterns, or the methods of financing, of 
patient care or professional practice, or with the administration of 
hospitals, and in cooperation with practicing physicians, medical cen-
ter officials, hospital administrators, and representatives from appro-
priate voluntary health agencies. 
(( 
AUTHORIZATION OF APPROPRIATIONS 
"SEC. 901. (a) There are authorized to be appropriated $50,000,000 
for the fiscal year ending June 30, 1966, $90,000,000 for the fiscal year 
ending June 30,1967, and $200,000,000 for the fiscal year ending June 
30, 1968, for grants to assist public or nonprofit private universities, 
medical schools, research institutions, and other public or nonprofit 
private institutions and agencies in planning, in conducting feasibility 
studies, and in operating pilot projects for the establishment, of re-
gional medical programs of research, training, and demonstration 
activities for carrying out the purposes of this title. 
Sums appro-
priated under this section for any fiscal year shall remain available 
for making such grants until the end of the fiscal year following the 
fiscal year for which the appropriation is made. 
"(b) A grant under this title shall be for part or all of the cost of 
the planning or other activities with respect to which the application 
is made, except that any such grant w^ith respect to construction of, 
or provision of built-in (as determined in accordance with regula-
tions) equipment for, any facility may not exceed 90 per centum of 
the cost of such construction or equipment. 
"(c) Funds appropriated pursuant to this title shall not be avail-
able to pay the cost of hospital, medical, or other care of patients 
79 STAT. ] 
PUBLIC LAW 89-239-OCT. 6, 1965 
927 
except to the extent it is, as determined in accordance with regula-
tions, incident to those research, training, or demonstration activities 
which are encompassed by the purposes of this title. No patient shall 
be furnished hospital, medical, or other care at any facility incident 
to research, training, or demonstration activities carried out with 
funds appropriated pursuant to this title, unless he has been referred 
to such facility by a practicing physician. 
"DEFINITIONS 
"SEC. 902. For the purposes of this title— 
"(a) The term 'regional medical program' means a cooperative 
arrangement among a group of public or nonprofit private institu-
tions or agencies engaged in research, training, diagnosis, and treat-
ment relating to heart disease, cancer, or stroke, and, at the option 
of the applicant, related disease or diseases; but only if such group— 
"(1) is situated within a geographic area, composed of any 
part or parts of any one or more States, which the Surgeon Gen-
eral determines, in accordance with regulations, to be appropri-
ate for carrying out the purposes of this title; 
"(2) consists of one or more medical centers, one or more clin-
ical research centers, and one or more hospitals; and 
"(3) has in effect cooperative arrangements among its com-
ponent units which the Surgeon General finds will be adequate 
for effectively carrying out the purposes of this title. 
"(b) The term 'medical center' means a medical school or other 
medical institution involved in postgraduate medical training and 
one or more hospitals affiliated therewith for teaching, research, and 
demonstration purposes. 
"(c) The term 'clinical research center' means an institution (or 
part of an institution) the primary function of which is research, 
training of specialists, and demonstrations and which, in connection 
therewith, provides specialized, high-quality diagnostic and treat-
ment services for inpatients and outpatients. 
"(d) The term 'hospital' means a hospital as defined in section 
625(c) or other health facility in which local capability for diagnosis 
and treatment is supported and augmented by the program established 
under this title. 
"(e) The term 'nonprofit' as applied to any institution or agency 
means an institution or agency which is owned and operated by one 
or more nonprofit corporations or associations no part of the net earn-
ings of which inures, or may lawfully inure, to the benefit of any 
private shareholder or individual. 
"(f) The term 'construction' includes alteration, major repair (to 
the extent permitted by regulations), remodeling and renovation of 
existing buildings (including initial equipment thereof), and replace-
ment of obsolete, built-in (as determined in accordance with regula-
tions) equipment of existing buildings. 
"GRANTS FOR PLANNING 
"SEC. 903. (a) The Surgeon General, upon the recommendation of 
the National Advisory Council on Regional Medical Programs estalD-
lished by section 905 (hereafter in this title referred to as the 
'Council'), is authorized to make grants to public or nonprofit private 
universities, medical schools, research institutions, and other public or 
nonprofit private agencies and institutions to assist them in planning 
the development of regional medical programs. 
928 
PUBLIC LAW 89-239-OCT. 6, 1965 
[79 STAT. 
"(b) Grants under this section may be made only upon application 
therefor approved by the Surgeon General. Any such application 
may be approved only if it contains or is supported by— 
"(1) reasonable assurances that Federal funds paid pursuant 
to any such grant will be used only for the purposes for which 
paid and in accordance with the applicable provisions of this 
title and the regulations thereunder; 
"(2) reasonable assurances that the applicant w^ill provide for 
such fiscal control and fund accounting procedures as are required 
by the Surgeon General to assure proper disbursement of and 
accounting for such Federal funds; 
"(3) reasonable assurances that the applicant wnll make such 
reports, in such form and containing such information as the 
Surgeon General may from time to time reasonably require, and 
will keep such records and afford such access thereto as the Sur-
geon General may find necessary to assure the correctness and 
verification of such reports; and 
"(4) a satisfactory showing that the applicant has designated 
an advisory group, to advise the applicant (and the institutions 
and agencies participating in the resulting regional medical 
program) in formulating and carrying out the plan for the estab-
lishment and operation of such regional medical program, which 
advisory group includes practicing physicians, medical center 
officials, hospital administrators, representatives from appropri-
ate medical societies, voluntary health agencies, and representa-
tives of other organizations, institutions, and agencies concerned 
with activities of the kind to be carried on under the program 
and members of the public familiar with the need for the services 
provided under the program. 
"GRANTS FOR ESTABLISHMENT AND OPERATION OF REGIONAL MEDICAL 
PROGRAMS 
"SEC. 904. (a) The Surgeon General, upon the recommendation 
of the Council, is authorized to make grants to public or nonprofit 
private universities, medical schools, research institutions, and other 
public or nonprofit private agencies and institutions to assist in 
establishment and operation of regional medical programs, including 
construction and equipment of facilities in connection therewith. 
"(b) Grants under this section may be made only upon application 
therefor approved by the Surgeon General. 
Any such application 
may be approved only if it is recommended by the advisory group 
described in section 903(b) (4) and contains or is supported by reason-
able assurances that— 
"(1) Federal funds paid pursuant to any such grant (A) will 
be used only for the purposes for which paid and in accordance 
with the applicable provisions of this title and the regulations 
thereunder, and (B) will not supplant funds that are otherwise 
available for establishment or operation of the regional medical 
program with respect to which the grant is made; 
"(2) the applicant will provide for such fiscal control and fund 
accounting procedures as are required by the Surgeon General to 
assure proper disbursement of and accounting for such Federal 
funds; 
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"(3) the applicant will make such reports, in such form and 
containing such information as the Surgeon General may from 
time to time reasonably require, and w^ill keep such records and 
79 STAT. ] 
PUBLIC LAW 89-239-OCT. 6, 1965 
929 
afford sucli access thereto as the Surgeon General may find neces-
sary to assure the correctness and verification of sucli repoi-ts; and 
"(4) any laborer or meclianic employed by any contractor or 
subcontractor in the performance of Avork on any construction 
aided by payments pursuant to any grant under this section will 
be paid wages at rates not less than those prevailing on similar 
construction in the locality as determined by the Secretary of 
Labor in accordance with the I)avis-]-5acon Act, as amended (40 
U.S.C. 27()a—2T6a-5) ; and the Secretary of Labor shall have, 78'*sta!^*23ir^' 
with res})ect to the labor standards sj^ecified in this paragraph, 
the authoritv and functions set forth in Keorganization Plan 
Numbered 14 of 1950 (15 F.R. 817(5; 5 U.S.C. 18nz-15) and sec- 
^^ stat. i267. 
tion 2 of the Act of June V% 1934, as amended (40 U.S.C. 27r)c). 
" stat. los. 
" N A T I O N A L ADVISORY C O U N C I L O N 
REOIONAL MKDICAL l'I?fM}RAMS 
"SEC. 905. (a) The Surgeon General, with the approval of the ^f'Pg°Jf ""'"* °^ 
Secretary, may a])point, without regard to the civil service laws, a 
National Advisory Council on Regional Medical Programs. The 
Council shall consist of the Surgeon General, who shall be tlie chair-
man, and twelve members, not otherwise in the regular full-time 
emjiloy of the I'nited States, who are leaders in the fields of the 
fundamental sciences, the medical sciences, or public affairs. 
At least 
two of the appointed members shall be practicing ])hysicians, one 
shall be outstanding in the study, diagnosis, or treatment of heart 
disease, one shall be outstanding in the study, diagnosis, or treatment 
of cancer, and one shall be oustanding in the study, diagnosis, or 
treatment of stroke. 
"(b) Each appointed member of the Council shall hold office for Term o
f oifice, 
a term of four years, except that any member appointed to fill a 
vacancy prior to the expiration of the term for which his j^redecessor 
was api^ointed shall be appointed for the remainder of such term, and 
except that the terms of office of the members first takhig office shall 
expire, as designated by the Surgeon General at the time of appoint-
ment, four at the end of the first year, four at the end of the second 
year, and four at the end of the third year after the date of appoint-
ment. An appointed member shall not be eligible to serve contijiu-
ously for more than two terms, 
"(c) Appointed memhers of the Council, while attending meet- 
compensation. 
ings or conferences thereof or otherwise serving on business of the 
Council, shall be entitled to receive compensation at rates fixed by 
the Secretary, but not exceeding $100 per day, including traveltime, 
and while so serving away from their homes or regular places of 
business they may be allowed travel expenses, including per diem in 
lieu of subsistence, as authorized bv section 5 of the Administrative 
Expenses Act of 1946 /5 U.S.C. 73b-2) for persons in the Govern- 
ys%^'%fXo 
inent service employed intermittently. 
"(d) The Council shall advise and assist the Surgeon General in the 
Applications for 
jn-eparation of regulations for, and as to policy matters arising with mTndations!'"' 
respect to, the administration of this title. The Council shall consider 
all applications for grants under this title and shall make recommen-
dations to the Surgeon General with respect to approval of applica-
tions for and the amounts of orants under this title. 
930 
PUBLIC LAW 89-239-OCT. 6, 1965 
[79 STAT. 
''REGULATIONS 
"SEC. 906. The Surgeon General, after consultation with the Coun-
cil, shall prescribe general regulations covering the terms and con-
ditions for approving applications for grants under this title and the 
coordination of programs assisted under this title with programs for 
training, research, and demonstrations relating to the same diseases 
assisted or authorized under other titles of this Act or other Acts of 
Congress. 
"INFORMATION ON SPECIAL TREATMENT AND niAlNlNG CENTERS 
"SEC. 907. The Surgeon General shall establish, and maintain on a 
current basis, a list or lists of facilities in the United States equipped 
and staffed to provide the most advanced methods and techniques 
in the diagnosis and treatment of heart disease, cancer, or stroke, 
together with such related information, including the availability of 
advanced specialty training in such facilities, as he deems useful, 
and shall make such list or lists and related information readily avail-
able to licensed practitioners and other persons requiring such infor-
mation. To the end of making such list or lists and other informa-
tion most useful, the Surgeon General shall from time to time consult 
with interested national professional organizations. 
Report to Presi-
dent and Con-
58 Stat. 682. 
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298b. 
"REPORT 
"SEC. 908. On or before June 30, 1967, the Surgeon General, after 
consultation with the Council, shall submit to the Secretary for trans-
mission to the President and then to the Congress, a report of the 
activities under this title together with (1) a statement of the relation-
ship between Federal financing and financing from other sources of 
the activities undertaken pursuant to this title, (2) an appraisal of 
the activities assisted under this title in the light of their effectiveness 
in carrying out the purposes of this title, and (3) recommendations 
with respect to extension or modification of this title in the light 
thereof. 
a RECORDS AND AUDIT 
"SEC. 909. (a) Each recipient of a grant under this title shall keep 
such records as the Surgeon General may prescribe, including records 
which fully disclose the amount and disposition by such recipient of 
the proceeds of such grant, the total cost of the project or under-
taking in connection with which such grant is made or used, and 
the amount of that portion of the cost of the project or undertaking 
supplied by other sources, and such records as will facilitate an effec-
tive audit. 
"(b) The Secretary of Health, Education, and Welfare and the 
Comptroller Greneral of the United States, or any of their duly author-
ized representatives, shall have access for the purpose of audit and 
examination to any books, documents, papers, and records of the 
recipient of any grant under this title which are pertinent to any 
such grant." 
SEC. 3. (a) Section 1 of the Public Health Service Act is amended 
to read as follows: 
"SECTION 1. Titles I to I X , inclusive, of this Act may be cited as 
the 'Public Health Service Act'." 
79 STAT. ] 
PUBLIC LAW 89-240-OCT. 7, 1965 
931 
42 u s e :20lnote. 
(b) The Act of July 1, 1944 (58 Stat. 682), as amended, is further 
amended by renumbernig title I X (as in effect prior to the enactment 
of this Act) as title X, and by renumbering sections 901 through 914 
(as in effect prior to the enactment of this Act), and references thereto, 
as sections 1001 through 1014, respectively. 
Approved October 6, 1965, 10:15 a.m. 
Public Law 89-240 
AN A C T 
October 7, 1965 
To amend the Consolidated Farmers Home Administration Act of 1961 to 
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authorize the Secretary of Agriculture to make or insure loans to public and 
quasi-public agencies and corporations not operated for profit with respect to 
water supply, water systems, and waste disposal systems serving rural areas 
and to make grants to aid in rural community development planning and in 
connection with the construction of such community facilities, to increase the 
annual aggregate of insured loans thereunder, and for other purposes. 
Be it enacted hy the Senate and House of Representatives 
of the 
United States of America in Congress assembled^ That section 306(a) p^mers^HlTme'^ 
of the Consolidated Farmers Home Administration Act is amended to Administration 
r e a d as follows : 
amendments 
"(1) The Secretary is also authorized to make or insure loans to ^'75"st'^r."3o'8. 
associations, including corporations not operated for profit, and public 
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and quasi-public agencies to provide for the application or establish- citt°ons *co«orL 
ment of soil conservation practices, shifts in land use, the conservation, tions, etc. 
development, use, and control of water, and the installation or im-
provement of drainage or waste disposal facilities, and recreational 
developments, all primarily serving farmers, ranchers, farm tenants, 
farm laborers, and other rural residents, and to furnish financial assist-
ance or other aid in planning projects for such purposes. 
"(2) The Secretarj^ is authorized to make grants aggregating not 
Limitation, 
to exceed $50,000,000 in any fiscal year to such associations to finance 
specific projects tor works for the development, storage, treatment, 
purification, or distribution of water or the collection, treatment, or 
disposal of waste in rural areas. The amount of any grant made 
under the authority of this paragraph shall not exceed 50 per centum 
of the development cost of the project to serve the area which the 
association determines can be feasibly served by the facility and to 
adequately serve the reasonably foreseeable growth needs of the area. 
"(3) No grant shall be made under paragraph 2 of this subsection 
conditions, 
in connection with any facility unless the Secretary determines that 
the project (i) will serve a rural area which is not likely to decline 
in population below that for which the facility was designed, (ii) is 
designed and constructed so that adequate capacity will be or can be 
made available to serve the present population of the area to the 
extent feasible and to serve the reasonably foreseeable growth needs 
of the area, or (iii) is necessary for orderly community development 
consistent with a comprehensive community water or sewer develop-
ment plan of the rural area and not inconsistent with any planned 
development under State, countyj or municipal plans approved as 
official plans by competent authority for the area in which the rural 
community is located and the Secretary shall establish regulations 
requiring the submission of all applications for financial assistance 
under this Act to the county or municipal government in which the 
proposed project is to be located for review and comment by such 
agency within a designated period of time. Until October 1, 1968, 
the Secretary may make grants prior to the completion of the com-
prehensive plan, if the preparation of such plan has been undertaken 
for the area.