ny
DEPARTMENT OF HEALTH, EDUCATION AND WELFARE
PUBLIC HEALTH SERVICE
National Advisory Council on Regional Medical Programs

Minutes of the Thirty-first Meeting 1/ 2/
November 26 - 27, 1973

The National Advisory Council on Regional Medical Programs convened for
its thirty-first meeting at 9:00 a.m. on November 26, 1973 in Conference
Room M of the Parklawn Building, Rockville, Maryland. Dr. Herbert B.
Pahl, Acting Director, Regional Medical Programs Service presided over
the meeting.

The Council members present were:

Dr. Bland W. Cannon Mr. Sewall 0. Milliken

Dr. Laurence Foye, Jr. 3/ Mrs. Mariel S. Morgan
Mr. Edwin C. Hiroto Mr. C. Robert Ogden
Mrs. Audrey M. Mars Dr. Russell B. Roth

Dr. John P. Merrill Dr. George E. Schreiner

Dr. Benjamin W. Watkins

A list of RMPS staff members and others attending the Council meeting
is appended. a .

I. CALL TO ORDER AND OPENING REMARKS

 

The meeting was called to Order at 9:00 a.m. on November 26, 1973 by
Dr. Herbert B. Pahl. Dr. Pahl called attention to the Conflict of Interest
and Confidentiality of Meetings statements in the Council's folders.

 

1/ Meetings are conducted in accordance with the Federal Advisory Committee
Act. Proceedings of the closed portions of meetings, and materials sub-
mitted for discussion during such closed portions are restricted unless
cleared by the Office of the Administrator, HRA

2/ For the record, it is noted that members absent themselves from the
meeting when the Council is discussing applications: (a)from their
respective institutions, or (b)in which a conflict of interest might
occur. This procedure does not, of course, apply to en bloc actions ~
only when the application is under individual discussion.

3/ Dr. Foye represented Dr. Mare J. Musser for the Veterans Administration.
-~2-

Dr. Pahl noted that Dr. Alexander M. McPhedran had to resign from

the Council on assuming a position with the Veterans Administration.
He then noted that the terms of four Council members expire at the
end of November 1973. Dr. Bland W. Cannon and Dr. Russell B. Roth
have served two terms on the Council. Dr. Benjamin W. Watkins and
Mr. Sewall 0. Milliken have completed one term. Dr. Pahl thanked

the retiring members personally and officially for their service on
the Council and expressed the hope that those eligible for reappoint-
ment would be reappointed.

II. PRESENTATION BY DR. KENNETH M. ENDICOTT

Dr. Pahl introduced Dr. Kenneth M. Endicott, Administrator HRA, who
discussed reorganization, legislative developments and RMP issues.

On July 1, 1973 the health functions of HEW were reorganized into six
agencies. NIH and FDA are essentially unchanged, while the former
Health Services and Mental Health Administration has been split into
four separate units: the Communicable Disease Center, Alcoholism,

Drug Abuse and Mental Health Administration, Health Services Administra-
tion and Health Resources Administration. The latter includes the
National Center for Health Statistics, National Center for Health
Services Research and Development, the former NIH manpower programs,
Hill-Burton, CHP and RMP.

Nearly all the enaviing legislation for HRA programs expires on

June 30, 1974 and Congress has yet to act on any significant piece of
legislation except for Emergency Medical Services which provides

for an ambitious implementation program which is no longer a demonstra-

tion.

Legislation for extension of NCHS and NCHSR & D which is considered to be
relatively noncontroversial. :

With respect to manpower, it is now the policy of the Federal Govern-
ment to limit higher education support to students, and phase out
support of institutions. For the current fiscal year the Administra-
tion proposes to make some exceptions to the general policy and
continue several forms of institutional aid for medical, dental and
osteopathic schools only. Capitation grants and special project
grants for nursing, optometry, podiatry and other schools presumably
would be eliminated, but this is all tentative since manpower policy
and strategy are still under consideration. Consolidation of a
number of manpower programs can apparently be expected. It also
seems likely that student loan guarantees will be emphasized over
scholarships. —
-~3-

There has been considerable discussion within the Department with
respect to consolidation of CHP, RMP and Hill-Burton. Two separate
proposals are currently being debated. One would provide for
regional health authorities made up primarily of providers and the
other would place heavy emphasis on State functions.

It appears that any proposal must take into account the functions

of CHP, RMP and Hill-Burton if it is to receive serious Congressional
consideration. While some consolidation will probably take place
eventually, what form this will take is not presently clear. In the
meantime HRA has set up a task: force to monitor the situation and
assist in developing Agency plans for administering whatever
legislation finally emerges,

The funding situation with respect to Regional Medical Programs is
still uncertain. The total amount available for Fiscal 74 us still
-unknown, and release of fiscal 1973 money is being sought through

the Courts. In considering grant applications, the Council will have
to ignore the uncertainties and assume that funds will be available
and, in addition, that project periods will be 1 year.

III. PRESENTATION BY DR. HAROLD MARGULIES

Dr. Pahl introduced Dr. Harold Margulies, Acting Deputy Administrator,
HRA who discussed the Department's position conccrning RMP priority
areas and the lifetime of local RMPs.

New understandings apparently have been reached within HEW to extend

the termination date for RMP activities beyond June 30, 1974. The
understandings, however, even though based on high level oral discussions,
are still subject to change. , ,

Another understanding within HEW concerns the use of grant funds. While
the purposes for which funds can be expended may be altered by new legis-
lation, HRA and HEW still consider the five RMP options as high priority
areas. While they should receive continuing emphasis, the options should
not be regarded as exclusive areas of grant awards. While all activities
within the scope of the Mission Statement and the Act are permissable,
the options are related to existing and potential initiatives such as
PSRO, Kidney Disease, Health Planning and Health Insurance, and as such
should receive continuing attention..

Ill. COUNCIL ACTIONS RELATING TO PRIORITIES AND OPTIONS
The Council took 2 actions in relation to the above discussions. It
was moved seconded and carried that,

1. The Council accepts the Options as priorities
and not restrictions, and
~4-

2. The Council endorses the Department's
present position that RMPs be permitted
to expend funds through December 31, 1974.

Iv. COUNCIL ACTION CONCERNING ALLOCATION OF ADDITIONAL FUNDS

Because of the lawsuit by the National Association of Regional Medical
Programs, Inc., there as a possibility that substantial additional funds
will become available for award in Fiscal 1974. Im view of that possibil-
ity, the Council adopted a resolution concerning allocation of such

funds. The Council's resolution, as passed, is shown as Attachment 1.

Vv. COUNCIL ACTION ON. CHANGES IN DISCRETIONARY FUNDING AUTHORITY

The Council voted to modify the RMPS policy entitled "Governing Prin-

ciples and Requirements: Discretionary RMP Funding and Rebudgeting
Authority," originally issued on September 20, 1972. The revision

removes the distinction formerly made between "triennial" and “Anniver-

sary Regions with respect to rebudgeting authority. The Council,

while recognizing that the difference between these categories presently

is no longer relevant, requested that the Regions be informed that the "Tri-
ennial" and "Anniversary" classifications might be reinstituted if the RMP
program is continued. The revised "Governing Principles" as approved by

the Council are shown as Attachment 2.

VI. COUNCIL ACTION ON MANAGEMENT ASSESSMENT AND REVIEW PROCESS
CERTIFICATION VISITS

RMPS plans to reinstitute Management Assessment visits and Review Process
Certification visits, since the award of Fiscal 1974 funds reduires that
the Regions have adequate capacity to allocate, award and manage funds.
The Council's action endorsing the resumption of these activities is
shown as Attachment 3. .

VIL. REPORT OF THE DIRECTOR

Dr. Pahl discussed budget matters which are summarized in the table

‘shown in Attachment 4.

VIIE. SPECIAL REPORTS

a. Overview of current status of RMPs ~- Mr. Peterson
Mr. Roland Peterson, Director, Office of Program Planning and
Evaluation, RMPS, presented statistical data on Coordinator changes,
program staff, committee activity, and categories of proposed RMP
activities. These showed, among other things, that RMPs have re-
tained about half the staff they had prior to phaseout and that about
75% of proposed activities are within the option areas. In general,
data presented indicated that the Regions have attained a surprising
b.

Cc.

—and-interim Regulations were promulgated on June 29th. “~~

degree of stability and renewed viability considering the events
of the last year.

Reports generated under Section 907 - Dr. Sloan

Dr. Margaret Sloan, Assistant to Dr. van Hoek, reported in the
outcome of RMPS' long-standing effort ‘to carry out the provisions

of Section 907 of the RMP statute. This has resulted in the
publication of a seven volume inventory of services entitled
Hospital Services for Selected Chronic Disease Patients. Copies
have been mailed to all RMPs and will be sent to Council members.

The inventory was developed through a questionnaire under a

contract with the Joint Commission of the Accreditation of Hospitals.
It, covers 92% of the Nation's hospitals. Special runs can be

made from the data contained in the inventory.

The JCAH Steering Committee felt that a list of outstanding facilities
should be published only after actual site visitations to facilities.
It was decided, therefore, that the public interest would be served
best by publishing the basic data and criteria -which could be

applied by users to develop lists suitable to their particular needs.

Four criteria documents have now been completed. The kidney and
stroke criteria acpeared in the October 1973 JAMA. The heart
disease and cancer criteria will be published in November and
December respectively. These are tentative documents and comments
and suggestions are invited. Comments should be addressed to Dr.
Sloan at the Parklawn Building.

The American Cancer Society, American Hospital Association and
JCAH are interested in keeping the data up to date and have dis~
cussed this with HRA. It is therefore possible that the inventory
will be repeated in another year.

End=Stage Kidney Disease Regulations -

Mr. Matthew Spear, who has been on detail with others developing
‘standards for the new Social Security kidney reimbursement program,
reviewed the Interim Kidney Regulations. Mr. Spear stated that

medical care has now been extended to persons with end-stage kidney
disease who are fully covered by Social Security. Reimbursement
for care under the Act was authorized to begin on July 1, 1973,

The Regulations blanket in coverage of existing end-stage renal
services and provide coverage for new services only on an exception
basis. The Regulations provide for (1) minimum utilization,

(2) medical review, (3) facility affiliation and (4) cost containment.

All RMPS kidney activities must comply with the above regulations,
and conditions to that effect were placed on all kidney activities
reviewed and approved at the present Council meeting.
IX.

XI.

XII,

Presentation by Dr. van Hoek

“Dr. Robert van Hoek, Director Bureau of Health Services Research and

Evaluation, discussed a number of matters of mutual interest to the
Bureau and RMPs.

The Emergency Medical Services program which was initially lodged
in the Bureau has now been transferred to the Health Services Administration.

There is a bill in the House (H.R. 11385) which would combine the
National Center for Health Services R&D with the National Center for

Health Statistics, but passage is not expected.

The Bureau has developed a lengthy program statement on health
service research needs which have been mailed to all RMP Coordinators.
In summary these Program needs are: ,

1. studies of planning licensure and legislation, especially certificate
of need and planning mechanisms

2. quality of health care including (a) assuring quality, (b) disseminating
findings and (c) implementing the PSRO legislation, the quality
aspects of kidney and HMOs (if legislation passes).

3. financing of medical care

4. productivity of the health care system especially in regard to

manpower
5. data systems emphasizing improved medical record systems in ambulatory

and institutional settings
6. long term care

Dr. van Hoek suggested that RMPs could assist the health service research
and development effort in disseminating BHSR&E research findings and also
in developing indices of standards of medical care and the effectiveness of
medical care processes.

Consideration of Minutes of February 7, 1973 Meeting

It was moved, seconded and carried that the Minutes of the February 7, 1973
meeting be approved.

Future Meeting Dates

 

Future meeting dates were set for January 11-12, February 12-13 and
March 12-13, 1974.

Other Business

Dr. Roth stated that the survival value of RMPs would depend on building on
categorical activities. He noted that RMP has spawned a generation of
activities that are self supporting and continuing and have some survival
value. He expressed strong disagreement, however, with the involvement of
RMP in such activities as PSROs, HMOs and strengthening of local planning.
XIII

-~ J-

Dr. Cannon expressed the opinion that the development of directives
for spending RMP money before the Council has had an opportunity to
make recommendations has been detrimental to the effectiveness of the

program.

Mr. Ogden noted that a quorum of serving Council members was present
and expressed the need to reestablish a review committee.

Dr. Donal R. Sparkman, Director Washington/Alaska RMP and Chairman of
the National Steering Committee of RMP Coordinators, noted with pleasure
that the restrictive language concerning the options had been removed
and that the June 30, 1974 termination date had been relaxed. He

called attention to the fact, however, that the current applications
were prepared under time pressure using new "options" which were viewed
as restrictions.

Dr. Sparkman also noted that Council members had expressed various
views on RMP priorities and suggested that the Council review its approved
"Mission Statement" and the "Directions Statement" developed by the

Coordinators.

Dr. J.§. Reinschmidt, Director Oregon RMP, addressed the Council in behalf
of the National Association of RMPs. He explained that the Association

is a nonprofit organization to promote the interests of and provide
information about RMPs. Two member RMPs have filed a class action suit

to secure release of funds and relief from restrictions.

Review of Applications

Approved Council actions on individual applications are shown in.
Attachment 5.

| | Cheon aK —-.

Oy Hbrbert B. Pahl. Ph.D.
Abting Director, RMP

i
i

 
ATTACHMENT 1

RESOLUTION BY THE NATIONAL ADVISORY COUNCIL ON
REGIONAL MEDICAL PROGRAMS RECOMMENDING ALLOCATION
OF ADDITIONAL RMPS FUNDS IN FISCAL YEAR 1974

»

WHEREAS:  RMPS has established a method acceptable to this
Council for allocating the funds already made available

for Fiscal Year 1974, and

WHEREAS: Substantial additional funds may become available
for obligation by RMPS in Fiscal Year 1974,

BE IT RESOLVED THAT: The National Advisory Council
recommends that;

1. the Regional Medical Programs Service allocate by
established mode the full amount of Fiscal Year 1974
funds made available, up to the maximum amount
anticipated under the HEW Gontinuing Resolution or
Appropriation, $81.9 million.

2. up to $10.0 million of any amount over $81.9 million
which the Regional Medical Programs Service may be
directed to obligate in Fiscal Year 1974, may be
distributed in a manner that the Director, Regional
Medical Programs Service, finds will make the best
possible use of funds in accordance with existing
legislation, Council, Department and RMPS policies.

All such distributions will be reported to the Council.

3. any other funds in excess of $81.9 million, not
awarded pursuant to item 2, above, shall be awarded
subject to the Council's recommendation thereon at its
next regular or special meeting after such funds shall
have become availiable for obligation.

APPROVED: National Advisory Council on Regional Medical
Programs - 11/26/73
DRART: 11/26/73 . ATTACHMENT 2

COVERNING PRINCIPLES AND REQUIREMENTS :
DISCRETIONARY RMP FUNDING AND REBUDGETING AUTHORITY

I. APPROVAL AND FUNDING AUTHORITY

An RMP, at its discretion, may fund any eligible operational or
program staff activity (including new activities) or rebudget
funds within the total direct costs awarded subject to the prin-
ciples and requirements set forth below.

Il. PRINCIPLES

The following principles shall be generally applicable in all
situations:

-A. Consonance With Federal Requirements

No activity shall be undertaken that is contrary toTitle IX of
the PHS Act and other applicable legislation, regulations,
written Departmental, HRA, and RMPS policies, and/or specific
conditions of the grant.

B. Applicability of Local RMP Procedures

Any activity undertaken pursuant to the authority conferred by this
policy shali be subject to the regular review, approval and funding
requirements of the particular RMP, the grantee (where different),
and the Regional Advisory Group, as described in NID of August 30,
1972.

:

C. Current Regional Advisory Group Approval

Any operational activity initiated by an RMP within its discretion-
ary authority must have current RAG approval. That is, it must be
approved by the RAG in the budget period during which it is initiated
or the immediately preceding one. If not, the activity must be re-

' approved by the RAG before it can be undertaken. Likewise, any pro~
gram staff activity must have current RAG approval in accordance with
the policies or normal administrative procedures of the RMP.

D. Activities Jointly Funded by Two or, More RMPs

Any activity which involves, anticipates, or requires funding by
more than one RMP during the total anticipated RMPS support period

requires prior RMPS approval for such funding (but not for the tech- —
nical design or details of the activity).

E. Obligations of Funds Derived From Grant Related Income

No grant related income may be expended without prior RMPS approval
DRAFT: 11/26/73

 

 

Peg.

F. Resolution of Questions Regarding Discretionary Funding Authority

When there are any substantive questions or doubts as to the

scope and applicability of the di
budgeting authority, the grantee
behalf shall communicate with RMP

Til. REQUIREMENTS
Because of the changing conditions th
authorities to act are identical for

status.

RMPs must obtain prior approval from
posed program staff or operational ac

scretionary funding and re-
or the Coordinator on its
S for advice and guidance.

at have prevailed, the following
all RMPs regardless of previous

the Director, RMPS for any pro-
tivity involving,

1. Alterations and renovations in excess of $25,000 total Federal

direct costs per activity, or any
of amount.

2. Research or other activities invo
(Programmatic approval by RMPS is
by NIH of an institutional plan f
welfare of human subjects.)

3, HMO related feasibility studies.

4, End-stage treatment of kidney dis

5. Other specialized activities as i
TV. NOTIFICATIONS

RMPS should be notified immediately w

which has not been funded previously.
be submitted:

new construction regardless

lving the use of human subjects.
required in addition to approval
or safeguarding the rights and

easé (e.g. dialysis, transplant-

ation and supportive facilities and services).

dentified by RMPS.

henever an activity is initiated
The following documents should

1. The budget for the new activity on RMPS 34-1, Page 16.

——-—-9- ~fievised budgets for any activity
withdrawn, again on RMPS 34-1, Pa

3. A brief description of the activi
34-1, Pages 6, 9, 11, 12, or 15,

ln all other cases, normal progedures
woeting proc

 
 

should be followed. Rebud

structions for RMPS 34-1, Tage 16.

from which funds have been--——~
ge 16.

ty on the applicable form, RMPS
as appropriate.

for notifying RMPS of rebudgets
edures are described in the in-
ATTACHMENT 3

RESOLUTION BY THE NATIONAL ADVISORY COUNCTL ON

RECLONAL MEDICAL PROGRAMS RECOMMENDING REPORT ON
STATUS OF RMPs' COMPLIANCE WITH REVIEW REQUIREMENTS

WHEREAS: Some RMPs still have not complied fully with the

BE

the "RMPS Review Process Requirements and Standards" and
administrative management requirements, then

IT THEREFORE RESOLVED:. The National Advisory Council
reiterates the necessity for all RMPs to be in compliance
with the "RMPS Review Process Requirements and Standards”
and administrative management requirements as soon as
possible, and therefore, requests the Director, RMPS, to
report the status of RMPs' compliance at the next

‘Gouncii meeting.

APPROVED: National Advisory Council on Regional Medical

Programs, November 26, 1973
. ~ .
. ’ .
i * :
: ®
i ‘ *
i ve
—

SOURCES AND STATUS OF RMPS FUNDS ANTICIPATED
TO BE AVAILABLE FOR EXPENDITURE BY RMPs IN FISCAL
YEAR 1974, AS OF NOVEMBER 1, 1973

SOURCE AND CATEGORY OF FUNDS STATUS AS OF 11/1/73
Fiscal 73 Funds

FY 73 Balance .weeereeee pew eceeeeveeeS 6.900 m . Awarded 6/30/73 But may not

be spent by RMPs.
Direct Operations(73 Supplemental)... 1.700 m . Available to RMPS
Congressional Construction Earmark

(73 Supplemental Appropriation)... 5.900 m . $ 5mawarded to North Country

Hosp., Newport, Vt. Remaining
$4.5 m earmarked by Congress
for Seattle Children's

Medical Center.

Total 73 Funds ws... cae ueneeneues 7$13.600 m $13.600 m

Fiscal 74 Funds

RMP Support...eeeeeene eee eee $41.236 m ', $17.1 awarded 10/1/73. Remaining
$24.136 m apportioned and released
- for RMP Grants.

HEW Earmark for Pediatric
Pulmonary CentersS..+.se peweeeeeese 2.000 m +, Eight centers funded in the
amount of $1,340,420. Two centers
Calif. and N.M. still to be

awarded. Georgia Pediatric >

Pulmonary application withdrawn. 3

Direct Operations ..+..eeeee see eee 2.314 m . Available to RMPS =
Other ssveee rrr a er are 1.464 m . $,.338 m set aside for HMO 5
contract extensions through 5

12/31/73. Is

Total 74 FundS .w.--eeeees see eee eee . $47.014 m $47.014 m

TOTAL ANTICIPATED AMOUNT FOR FY Theccccevevceee + $60. 614 m
Eastern Branch

Albany .....-s.
Central N.Y. ©. .
Connecticut .«...
Gr. Delaware Valley
Lakes Area... .
Maine . .. +e -
Maryland oe 8
Metro D.C. oe
Nassau/Suffolk..
New Jersey... .
New York Metro.

.

Northern New England

Puerto Rico ...
Rochester ....
Susquehanna Valley
Tri-State ....
Virginia ....
West Virginia ..
Pennsylvania ..'.

Western Branch

Arizona . +. «+. « «
California ....
Hawaii se ees
Mountain States

Oregon . . + + » «
Washington/Alaska

.

ATTACHMENT

INDEX OF APPLICATIONS

 

Page Mid-Continent Branch

 

Arkansas . . « 6 6 « e« «
Bi-State . 2. 6. 6 1 we ee
Colorado/Wyoming ....
Intermountain .....
Towa er er
Kansas . . . « «6 « «6 «© «
Louisiana ... 6 2 « »
Missouri . . . + « «© « «6
Nebraska . ... 6 2 «© 2
New Mexico . 2... . « «
North Dakota . .... .e
Cklahoma . . 2. 6 « ew
South Dakota... .-..
TexaS . 2. 6 «© « © bw

South Central Branch

 

Alabama ... 2. se ee «
Florida . . « « «6 «© »© «
Georgia . 2. 2. 2 ew oe
Illinois ....+ «see.
Indiana . ... 2. eee
Memphis .. . 56 « © « «
Michigan... 2. 2 ee «
Mississippi .....-.
North Carolina .....

° . e °
SNES SE SESE OD SI SENSE DSS DDD

anu ES

Ohio Valley .....-.
South Carolina .....
Tennessee/Mid-South ..
Wisconsin ....-. ee.

Northlands . . . «6 « «

rd
a
fe)

MENS no

WWWWSAT ODN FM NH DNF fF
November 26 - 27, 1973 Council Meeting

CONSIDERATION OF APPLICATIONS

South Dakota

Moved: Dr. Roth
Seconded: Dr. Cannon

Approval as recommended by staff in the amount of $120,680
Operational status approved (discussion pp. 48 & 49).
(Transcript p. 51, line 14.)

Colorado~Wyoming

Moved: Dr. Roth
Seconded: Dr. Cannon

Approval in the amount of $335,604. Agreed that rebudgeting could
be requested for the implementation of the genetic counseling project.
(Transcript p. 54, line 17.)

Michigan

Moved: Mrs. Morgan
Seconded: Dr. Watkins

Approval in the amount of $627,536, with the deletion of the
$2,000 requested for stipends. (Transcript p- 87, line 4.)

Alabama

Moved: Mr. Milliken
Seconded: Mr. Ogden

Approval as requested at the level of $410, 312.
(Transcript p. 88, line 24.)

Florida

Moved: Mrs. Mars
Seconded: Dr. Foye

Approval as requested in the amount of $683,048.
- (Transcript p. 91, line 16.)
Georgia

Moved: Mrs. Morgan |
Seconded: Dr. Watkins

Approval as requested in the amount of $779,592.
(Transcript p. 93, line 22.)

Illinois

Moved: Mr. Ogden-
Seconded: Dr. Foye

Approval in the amount of $806,142 with the kidney condition, and
the recommendation that staff follow up with the RMP regarding
strengthening of their staff. (Transcript p. 97, line 20.)

Indiana

Moved: Dr. Watkins
Seconded: Mrs. Morgan

Approval in the amount of $304,113 with the kidney proviso, In
light of long term aspects of activities generated, Council
advised staff to follow up in terms of future support should
IRMP terminate. (Transcript p. 103, line 21.)

Memphis

Moved: Mr. Hiroto
Seconded: Mr. Milliken

Approval as requested for $494,788 with small kidney portion being
flagged with regard to the Social Security regulations.
(Transcript p. 108, line 19.)

Mississippi

Moved: Mrs. Mars
Seconded: Mrs. Morgan

Approval as requested in the amount of $325,836 with staff
recommendation to alert the region to the provision in the
interim rules and regulations under Title, 20, Chapter 3 of
the SSA-DHEW Regulation 5, Part 405, Federal Health Insuranc
for the Aged. (Transcript p. 113, line 8.)
Ohio Valley

Moved: Mr. Hiroto
Seconded: Mrs. Morgan

Approved at the level of $497,201 with the kidney condition,
and advice that the management program be followed rather
carefully. (Transcript p. 121, line 3.)

South Carolina

Moved: Mrs. Mars -
Seconded: Mr. Milliken

Approved at the requested amount of $516,510 with the kidney
condition. (Transcript p. 125, line 17.)

Tennessee-Mid South

Moved: Mr. Ogden
Seconded: Mrs. Mars

Approved as requested in the amount of $658,912 with the

following four conditions:

1. That the general kidney condition be put on with
regard to Social Security Administration;

2. That the amounts proposed for the purchase of the
EMS communications equipment and kidney dialysis
equipment be restricted pending technical review;

3. That the staff carefully monitor the RAG review
process;

4, That the coordinator be urged to seek the advice
and assistance from his experienced peers in
other Regional Medical Programs in matters of
developing a central capability and reasonable
programmatic separateness from the grantee.

Wisconsin

Moved: Mr. Milliken
Seconded: Dr. Foye

Approved as requested in the amount of $540,646.
_Crensertpt P- 137, line 13. a
Hawail

Moved: Dr. Cannon
Seconded: Mrs. Morgan

Approval of staff recommendations to approve the Pacific Basin
for the full amount, and an amount, to be determined by staff,
of the remaining portion be restricted and not available for
expenditure until the full review at. the next Council meeting;
site visit by Council and report back to next Council meeting.
Hawaii is to be advised that no funds will go for the Waianae
Coast project until RMPS received assurance from the RAG that
it clearly understands the problem involved, and would ensure
the RMP funds and program staff activities will be used in a
coordinated manner to strengthen the capability of the Waianae
Area to effectively manage programs locatly. Also, the kidney
project will undergo its exception approval.

Six council members voted for the motion; two against.
(Transcript p. 33, line 17.)

Arizona

Moved: Dr. Cannon
Seconded: Mrs..Mars

Approval in the amount of $359,623 with the condition that the
region be visited to determine whether they really have changed
direction and responded to previous concerns. (Transcript p. 41,
line 5.)

’

California

Moved: Mr. Ogden
Seconded: Mrs. Mars

Approved as requested at the amount of $2,645,305, with the proviso
that the kidney applications be reviewed and funded in accordance
with the Social Security regulations; that the Quality Assurance,
EMS and Hypertension components not be funded by CCRMP until they
have been subjected to CCRMP's total review process including review
by technical panels; that the central staff needs augmentation; and-
that good management is a must. (Transcript p. 144, line 10.)

Mr. Hiroto absented himself during this discussion
Mountain States

Moved: Mrs. Morgan
Seconded: Mrs. Mars

Approved as requested in the amount of $470,652. °
(Transcript p. 147, line 15.)

Oregon

Moved: Mrs. Morgan
Seconded: Dr. Watkins

Approved in the amount requested for $289,560.
(Transcript p. 149, line 24.)

Washington-Alaska

Moved: Mrs. Mars
Seconded: Dr. Watkins

Approved as requested in the amount of $545,473. (Transcript p. 153,
tine 8.) Mr. Ogden absented himself during this discussion.

Loulstfana

Moved: Dr. Roth
Seconded: Dr. Cannon

Approval in the amount of $270,323, but the program should be
encouraged to recruit additional staff, particular reference to
the Program Director. Because of the marked change brought
about through planned phaseout, Staff visit to the region is
recommended prior to the March Council meeting.

(Transcript p. 47, line 6.)

Tri-State

Moved: Dr. Roth
Seconded: Dr. Cannon

Approval for the remainder of FY 1974 in the amount of $569,609.
(Transcript p. 70, line 12 and p. 80, line 7.)

Moved: Mr. Ogden
Seconded: Mrs. Morgan

Approved as requested for $325,836 with the kidney condition.
(Transcript p. 156, line 15.)

-~5-
© Connecticut
Moved: Mr. Ogden
Seconded: Mrs. Morgan

Approval in the amount requested for $482,720 with the kidney
condition. (Transcript p. 161, line 8.)

Central New York

Moved: Dr. Foye -
Seconded: Mrs. Morgan

Approval at the level requested of $200,686 and that the concerns
of the staff and Council be transmitted to the region; that there
be-more concerted monitoring of the program by RMPS staff, technical
assistance, and the region be given priority to an assessment visit,
and there be a report to Council on the progresses made in solving
some of these management problems. (Transcript p. 169, line 17.)

Greater Delaware Valley

Moved: Or. Watkins
Seconded: Dr. Foye

Approval at the requested level of $591,332 with the kidney
@ condition and the condition that written progress reports
be submitted to RMPS indicating the progress that has been
made by the task forces and the utilization of the staff in
the medical schools. Also, in the event that additional
money is forthcoming that a Council site visit be held.
(Transcript p. 176, line 11.)

Maryland

Moved: Mr. Milliken
Seconded: Mr. Hiroto

Approved as requested in the amount of $226,878 with the kidney
condition. (Transcript p. 181, line 23.)

New York Metro

Moved: Mrs. Morgan
Seconded: Mr. Ogden

Approval at the requested level of $458,584, that there be kidney

conditions not on this application but on the activities that are

ongoing, and that the Coordinator be advised that Council made

strong recommendations that he get additional staff who are competent
in the areas of program concerned. (Transcript p. 186, line 15.)

© Dr. Watkins absented himself during this discussion.

~6-
a?

Puerto Rico

Moved: Mrs. Mars

Seconded: Mr. Milliken
Counci] approved funds for staff support. No expansion is to
be made in the program until a Council site visit ts made with
Council] representation. The site visit team's assessment of
the Region's potential must be reviewed by the Council.
(Transcript p. 196, line 10.)

Lakes Area, Maine, Rochester,
Susquehanna Valley, Pennsylvania

 

 

Moved: Dr. Foye
Seconded: Mrs. Morgan.

Council approved the recommendation by staff that the above be
approved as requested. (Transcript p. 197, line 19.)

Metropolitan Washington, Nassau/Suffolk, New Jersey,
Northern New England, Virginia and West Virginia

 

 

Moved: Mrs. Morgan
Seconded: Mr. Milliken

Council approved the staff recommendations to approve the above
as requested with the kidney condition. (Transcript p. 198, line 21.)

Arkansas, Oklahoma, Bi-State, lowa, Nebraska,
New Mexico, Missouri, North Dakota and Texas

 

 

Northlands

Moved: Mr. Hiroto
Seconded: Mrs. Mars

Approved with conditions noted in the staff recommendations and
the additional comments made by Council. (Transcript p. 204, line 19.)

Intermountain

Moved: Dr. Schreiner
Seconded: Mrs. Mars

Approval of the operating funds which will be determined by staff,
have a Council site visit, and report back to the February
Counci] meeting. (Transcript p. 226, line 7.)

Moved: Mr. Ogden
Seconded: Mrs. Morgan

Approval at the level of $458,586. (Transcript p. 16, line 6.)
-~7J- ,
«?

North Carolina

Moved: Mr. Ogden
Seconded: Mr. Milliken

Approval in the amount of $586,504 with the kidney condition, and-
advice to the region regarding Council's concerns about the lack

of program cohesion and responsibility of the RAG in regionalizing
the important aspects of the program. (Transcript p. 116, line 13.)

Kansas

Moved: Mr. Ogden
Seconded: Mrs. Morgan

Approved with the condition that staff make a site visit and help
them develop a more cohesive program. (Transcript p. 202, line 19.)
RMPS STAFF

Mr.
Mr.
Mr.
Mr.
Ms.
Ms.
Mr.
Ms.
Mr.
Mr.
Mr.
Ms.

Ms.
Mr.
Dr.
Mr.
Ms.
Ms.
Ms.
Mr.
Mr.
Mr.
Dr.
Ms,
Mr.
Mr.
Mr.
Ms.
Mr.
Mr.
Ms.
Ms.
Mr.
Mr.
Mr.
Mr.
Mr.
Mr.
Ms.
Mr.

Norman Anderson
Kenneth Baum
Cleveland Chambliss
Speficer Colburn
Myrtle C. Flythe
Rita Fox

Gerald T. Gardell
Eva Handal

George Hinkle

Joe Jewell

Burt Kline
Jorraine Kyttle

Edythe Levanthal
Walter Levi
Marian Leach
Rodney Mercker
Deborah Miller
Marjorie Morrill
Mary E. Murphy
Frank Nash

Gene Nelson
Joseph J. Ott
Herbert B. Pahl
Jeanne L. Parks
Roland L. Peterson
Mike Posta
Lawrence Pullen
Leah Resnick

Abe Ringel
Richard Russell
Rebecea Sadin
Sarah J. Silsbee
Thomas Simonds
Matt Spear

Jerry Stolov

Lee Teets

Bill Torbert

Lee Van Winkle
Glenna Wilsom
Frank Zizglavsky

OTHERS ATTENDING

Dr. G.A.Courie, RCAS/OOD

Dr. Kenneth M. Endicott,
“Administrator, HRA

Mr. Roger Feinthel, Blue
Sheet

Ms. Francés Howard, NIH-NLM

Mr. Robert B. Lanman, OGC

Mr. Morton A. Lebow, HRA

Dr. Harold Margulies, Acting
Deputy Director, HRA

Mr. Alex Naimon, BHSRE&E

Mr. J.S.Reinschmiedt, Oregon
RMP

tir. Arthur E. Rickli,

Missouri RMP

Dr. Colin C. Rorrie, CHPS

Dr. Margaret H. Sloan,
BHSR&E

Dr. Donal Sparkman, Washington/
Alaska RMP

. Dr. Robert van Hoek, BHSR&E

Mr. Daniel Webster, Region VIII
PHS

Mr. Dan Zwick, OPEL/HRA

Mr. Morton A. Lebow
REVIEWER

CANNON

HIROTO

MARS

MERRILL

ASSIGNMENT SHEET

National Advisory Council on

Regional Medical Programs

November 26-27, 1973

Conference Room 'M" ~ 9:00 a.m.

eee

REGION

Arizona (SV)

Florida (SV)

Mountain States
Nassau/Suffolk

North Carolina
Northlands

South Dakota
Susquehanna Valley (SV)
West Virginia (SV)

Colorado/Wyoming
Connecticut (SV)
Jawaili (SV)

Maine

Memphis

Metropolitan D.C.
Northern New England
Ohio Valley
Tri-State

Western Pennsylvania

Arkansas (SV)

Florida

Indiana .
Intermountain (SV)
Lakes Area (SV)
Mississippi

New Jersey

Puerto Rico

South Carolina
Washington/Alaska (SV)

California

Georgia

Greater Delaware Valley
Hawaii

Louisiana

Maryland

Mississippi (SV)

New York Metropolitan
Puerto Rico
ASSIGNMENT SHEET - Page 2
REVIEWER REGION

MILLIKEN Alabama
Arizona
Iowa
Lakes Area
Maryland
Nassau/Suffolk
Nebraska
Oklahoma
Rochester (SV)
Wisconsin

MORGAN Georgia
Iowa
Kansas
Michigan
Missouri
Mountain States
New York Metropolitan
Oregon
Texas (SV)
Virginia

OGDEN Albany (SV)
California
Connecticut
Illinois
Kansas
North Carolina
Northern New England
Northlands
Oklahoma
Tennessee/Mid-South

ROTH Colorado/Wyoming
Louisiana
Memphis
Metropolitan D.C.
Michigan
Ohio Valley (SV)
South Dakota
Tri-State
Wisconsin

SCHREINER Arkansas
Central New York (SV)
Illinois
Intermountain
Missouri
New Mexico (SV)
North Dakota
South Carolina
Susquehanna Valley
Texas
ASSIGNMENT SHEET - Page 3

REVIEWER REGION

WATKINS Albany
Bi~State
Greater Delaware Valley (SV)
Indiana

New Mexico

North Dakota

Oregon

Virginia (SV)
Washington/Alaska
Western Pennsylvania

Veteran's Administration

MUSSER/FOYE Alabama
Bi-State
Central New York
Maine
Nebraska
New Jersey
Rochester
Tennessee /Mid-South
West Virginia

¥ DOD-11/16/73
ASSIGNMENT SHEET

National Advisory Council on
Regional Medical Programs

November 26-27, 1973

 

Conference Room "M" ~ 9:00 a.m.
REVIEWER REGION
CANNON Arizona (SV)

Florida (SV)

Mountain States
Nassau/Suffolk

North Carolina
Northlands

South Dakota
Susquehanna Valley (SV)
West Virginia (SV)

HIROTO Colorado/Wyoming
Connecticut (SV)
tawaii (SV)

Maine

Memphis

Metropolitan D.C.
Northern New England
Ohio Valley
Tri-State

Western Pennsylvania

MARS Arkansas (SV)
Florida
Indiana .
Intermountain (SV)
Lakes Area (SV)
Mississippi
New Jersey
Puerto Rico
South Carolina
Washington/Alaska (SV)

MERRILL California
Georgia
Greater Delaware Valley
Hawaii
Louisiana
Maryland
Mississippi (SV)
New York Metropolitan
Puerto Rico
REVIEWER

MILLIKEN

MORGAN

OGDEN

ROTH

SCHREINER

ASSIGNMENT SHEET - Page 2

Alabama
Arizona

Towa

Lakes Area
Maryland
Nassau/Suf folk
Nebraska
Oklahoma
Rochester (SV)
Wisconsin

Georgia

Towa

Kansas

Michigan

Missouri

Mountain States

New York Metropolitan
Oregon

Texas (SV)

Virginia

Albany (SV)
California
Connecticut
Tllinois

Kansas

North Carolina
Northern New England
Northlands

Oklahoma
Tennessee/Mid-South

Colorado/Wyoming
Louisiana
Memphis
Metropolitan D.C.
Michigan

Ohio Valley (SV)
South Dakota
Tri-State
Wisconsin

Arkansas

Central New York (SV)
Illinois
Intermountain
Missouri

New Mexico (SV)

North Dakota

South Carolina
Susquehanna Valley
Texas
ASSIGNMENT SHEET - Page 3

»
REVIEWER REGION
@ WATKINS Albany
. Bi-State
Greater Delaware Valley (SV)
Indiana

New Mexico

North Dakota

Oregon

Virginia (SV)
Washington/Alaska
Western Pennsylvania

Veteran's Administration

MUSSER/FOYE Alabama
Bi-State

Central New York
Maine

Nebraska

New Jersey
Rochester
Tennessee/Mid-South
West Virginia

» pDOD-11/16/73
REGION

ALABAMA
ALBANY
ARKANSAS
ARIZONA
BI-STATE

CALIFORNIA

CENTRAL NEW YORK
COLORADO /WYOMING

CONNECTICUT
FLORIDA

GEORGIA

GREATER: DELA. VALLEY

HAWATI
ILLINOTS
INDIANA

INTERMOUNTAIN
IOWA

KANSAS

LAKES. AREA
LOUISIANA

MAINE
MARYLAND
MEMPHIS

METROPOLITAN D.C.

MICHIGAN

MISSISSIPPI
MISSOURI
MOUNTAIN STATES
NASSAU /SUFFOLK
NEBRASKA

NEW JERSEY

NEW MEXICO

NEW YORK METRO.
NORTH CAROLINA
NORTH DAKOTA

ASSIGNMENT SHEET

National Advisory Council on
Regional Medical Programs

November 26-27, 1973

Conference Room "M" - 9:00 a.m.

REVIEWERS

Milliken
Ogden (SV)
Mars (SV)
Cannon (SV)
Watkins

Merrill
Musser/Foye
Hiroto
Hiroto (SV)
Cannon (SV)

Merrill
Merrill
Hiroto (SV) |
Ogden

Mars

Mars (SV)
Milliken
Morgan
Mars (SV)’
Merrill

Hiroto
Merrill
Hiroto
Hiroto
Morgan

Mars
Morgan
Cannon
Cannon
Milliken

Mars

Schreiner (SV)
Merrill
Cannon
Schreiner

Musser/Foye
Watkins
Schreiner
Milliken
Musser/Foye

Ogden
Schreiner (SV)
Roth

Ogden

Mars

Morgan
Watkins (SV)
Merrill
Schreiner
Watkins

Schreiner
Morgan
Ogden
Milliken
Roth

Musser/Foye
Milliken
Roth

Roth

Roth

Merrill (SV)
Schreiner
Morgan
Milliken
Musser/Foye

Musser/Foye
Watkins
Morgan
Ogden
Watkins

Council BOOKS

Eastern — Orange
Mid Continent - Red
South Central - Blue

Western - Gray

BRANCH

South Central
Eastern
Mid~Continent
Western
Mid-Continent

Western
Eastern

‘Mid-Continent

Eastern
South Central

South Central
Eastern
Western
South Central
South Central

Mid-Continent

Mid-Continent
Mid-Continent
Eastern

Mid-Continent

Eastern
Eastern
South Central
Eastern
South Central

South Central

Mid-~-Continent
Western
Eastern
Mid-Continent

Eastern
Mid-Continent
Eastern
South Central
Mid-Continent

STAFF

Jewell
Anderson
Posta
Sadin
Zizlavsky

Sadin
Stolov
Murphy
‘Colburn
Parks

Jewell
Colburn
Russell
Kyttle
Torbert

Murphy
Zizlavsky
Murphy
Hinkle
Zizlavsky

Colburn
Hinkle
Kyttle
Colburn
Parks

Torbert
Resnick
Sadin
Stolov
Zizlavsky

Anderson
Zizlavsky
Hinkle
Torbert
Resnick
@ REGION

N. NEW ENGLAND
NORTHLANDS
OHIO VALLEY
OKLAHOMA
OREGON

PUERTO RICO
ROCHESTER
SOUTH CAROLINA
SOUTH DAKOTA

SUSQUEHANNA VALLEY

TENNESSEE/MID-SOUTH

TEXAS
TRI-STATE
VIRGINIA

WASHINGTON / ALASKA

WEST VIRGINIA

WESTERN PENNSYLVANIA

WISCONSIN

ASSIGNMENT SHEET - Page 2

REVIEWERS

Hiroto
Cannon
Hiroto
Milliken
Morgan

Mars
Milliken (SV)
Mars

Cannon
Cannon (SV)

Ogden
Morgan (SV)
Hiroto
Morgan
Mars (SV)

Cannon (SV)
Hiroto
Milliken

Ogden
Ogden
Roth (SV)
Ogden
Watkins

Merrill
Musser/Foye
Schreiner
Roth
Schreiner

Musser/Foye
Schreiner
Roth
Watkins (SV)
Watkins

Musser/Foye
Watkins
Roth

BRANCH

Fastern

South Central

South Central
Mid—Continent
Western

Eastern
Eastern
South Central
Mid-Continent
Eastern

South Central

. Mid-Continent

Eastern
Eastern
Western

Eastern

Eastern
South Central

tt

DOD-11/20/73

STAFF

 

Colburn
Torbert
Parks

Resnick
Russell

Hinkle
Anderson
Kyttle
Resnick
Stolov

Kyttle
Murphy

. Stolov

Hinkle
Russell

Anderson
Anderson
Parks