ce
B.

DECENTRALIZATION AND FUNDING
ISSUE II
Given H's recommendations as to RMP mission, what should be the

extent of decentralization of authority to the local RMPs?

OPTION 1 - Complete ‘
PRO

1. Most nearly consistent with HEW philosophy of decentralization,
State responsibility and local initiative.

2. Most acceptable to the RMPs and providers.

3. Most compatible with relating to local needs, objectives, and
resources, and ‘resultant local variations in approach and
priorities as determined by CHP.

CON |

1. May not address priorities in effect set by identified RMP
mission,

2. In face of funding constraints and possible cut-backs,
unreasonable to expect rapid re-direction in line with new
mission in absence of Federal pressure,

OPTION 2 - Partial, with local RMPs having latitude to fund

Specific proposals within the broad priority areas as

established by their redefined mission and local CHP plans.

PRO

1. Still somewhat more consistent with HEW philosophy of decentrali-
zation, State responsibility and local initiative.
2. Compatible with relating to local needs, variations, and CHP

planning.
3. Helps assure that RMP activities will address broad HEW
priority areas.

CON

1. Would not be as acceptable to RMPs and providers as Option 1.

2. Would not necessarily insure that all local RMPs would
adequately address each of the several broad priority areas,
especially monitoring of quality of care.

OPTION 3 - None.

PRO.

1. Would most nearly insure that local RMPs address broad HEW
priorities.

con

1. Totally my pons istent with HEW decentralization philosophy
of local initiative to meet local problems.

2. Most unlikely that providers would be willing to actively
participate.

3. Réms counter to actual long-term trend of increasing
decentralization to local RMPs.

ISSUE III

How should funds be apportioned/distributed to the local RMPs?

OPTION 1 - Competitive project basis.

PRO

1. Improves review of individual proposals against HEW priorities.

2. Allows better coordination of related activities; and would
minimize unnecessary duplication of effort.

2
CON

1. Administratively cumbersome.

2. Unlikely to correlate funding with local needs and problems
since there would be a tendency for those RMPs and sponsoring
institutions (e.g. medical schools) most proficient in °
grantsmanship and with the greater resoruces. to obtain a
larger share of the funds.

3, Would not utilize the considerable local technical review and
decision-making capacity and structure that has been created
by the RMPs over the past 6 years.

OPTION 2 - Competitive ae basis.

1. Would provide incentives for RMPs to address HEW priorities.

2. Encourages high level of competition and, thus, qualitatively
better activities.

3. Eliminates the criticisms (CON) of Option 1.

CON

1. Reduces flexibility once programs approved; RMPs would tend not
to be as fully and rapidly responsive to possible changes in
HEW priorities. |

2. Financially rewards stronger RMPs and not weaker ones.

OPTION 3 - Competitive basis with selected earmarks.

PRO _

1. Earmarks would provide incentives needed to spur local RMPs
to engage in activities addressing priority areas (e.g., quality
of care monitoring) that many of them otherwise might be

3
extremely reluctant to undertake.

2. Closely coincides with present mode.

3. Similar to Option 2.

CON

1. Earmarking, once resorted to, sets a precedent for further
earmarkings on the one hand while at the same time it is
difficult to get rid of previous earmarks even though they
have outlined their usefulness.

2. Similar to Option 2. |

OPTION 4 - Ona formula basis.

PRO.

1. Consistent with HEW position on local initiative.

2. Provides local RMPs with significant flexibility.

3. More nearly results in an equitable distribution of funds
to all RMPs. |

on aade/

1. Little or no incentive to, funds to address HEW national
priorities,

2. Difficult to develop a formula adequately taking into account
potential resources and needs in various specific priority
areas that is applicable to all States.

— OPTION 5 - On a formula basis with selected earmarks.

‘PRO

1. Would allocate specified sums for given HEW priorities.

4
2. Would force RMPs to come up with proposals within each earmarked
area, even if that resulted in funding some weaker projects
in one given priority area at the expense of additional
stronger projects in another. |

CON

os

1. Earmarking, once resorted to, sets a precedent for further
earmarks on the one hand while at the same time it is difficult
to get rid of earlier earmarks that have outlined their usefulness.
OPTION 6 - On a combination formula-competitive basis.
PRO
1. Provides a financial base for long-term commitment to
professional staff.
2. Provides for competition.
CON
1. May have programs sending stronger projects for competition

and funding weaker non-priority projects out of formula.