E

REGLUNAL MEDILL.

LEGISLATIVE/BUDGET

AUGRANO SOV AU

i108 FOR 1972-1973 — @ -

 

Budget/Appropriations

 

uary, 1972

ust 16, 1972

sober 27, 1972

tober 27, 1972

ngary 29, 1973

a

rch 8, 1973:

 

President's Budget for FY 1973 requests
$130.3M for RMP.

First Labor-HEW Appropriation bill for
FY73 vetoed. Contained $164.5" for
RMP,

Second Labor-HEW Appropriation bill
vetoed - Again $164.5M for RMP.

“Because of the veto, a continuing

resolution (H.J. Res. 1331 signed
Oct., 26, 1972) went into effect.
Permitted appropriation at lower of
House or Senate levels in first
appropriation bill - i.e., $150M-
for RMP which was House figure.

PRESIDENT'S BUDGET FOR FY 1974 PROPOSES: .

(1) (A reduced amended level of
$55,358,000 for grants and
contracts in FY 1973, and

- House Subcommittee on Public

Health and Envionment (Rep.
Rogers, Chrmn.) holds overview
hearings on FY74 health budget,
with Sec. Weinberger testifying.

°

 

Legislation/Authorization

(2) ‘The termination of RNP in FY74.

S. 1136, proposing one-year extension of 12 PHS authori
ties due to expire 6/30/73, including RMP, introduced
by Senator Kennedy with 15 of the 16 members of the
Senate Labor and Public Welfare Committee cosponsoring.
Authorization for RMP kept at $250M.

cn ee ng at em
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ch 14, 1973

‘ch 22, 1973

ch 27, 1973

rch 27,.1973

rch 27-29, 1973

y 8, 1973

y 15, 1973.

 

Budget/Appropriations © Legislation/Authorization © .

House Appropriations Committee held

hearings on the FY74 budget relating
to RMP - Dr. Sencer, Dr. Margulies
testified.

 

H.R. 5608 introduced in the House by Rep. James

Hastings with the cosponsorship of the entire

Subcommittee on Public Health and Environment. Also *
extends 12 PHS authorities for one-year, with RMP
authorization set at a level of $250M.

Hearings were held on S. 1136 by the Senate Health

Subcommittee. Secretary Weinberger testified.

Committee ordered bill favorably reported. Report
#93-87.

Senate passed S. 1136, the PHS Extension Act, by a
vote of 72-19 with RMP authorization’ level of. $250
million for FY 1974. | | ‘ Ce

i.

Hearings were held on H.R. 5608 by the House
Subcommittee on Public Health and Environment. ;
Secretary Weinberger testified, as did RMP representa-
tives. .

Oversight hearings on Regional Medical Programs held .”-
by the Subcommittee on Public Health and Environment.: ~
Testimony by Dr. John Zapp and Dr. Margulies for
HEW; a panel of physicians involved in RMP 's 5 and

four RMP coordinators.

Representative Hastings (with all members of the
Subcommittee on Public Health and Environment co-
sponsoring) introduced H.R. 7806 = a new PHS Extension
Act bill - in lieu of H.R. 5608.. Set RMP authorization

for FY 1974 at $159 million.
‘ ©

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wa

Budget/Appropriations

Legislation/Authorization @

 

y 24, 1973

y 29, 1973

ty 31, 1973
ine 5, 1973

ine 6, 1973
ine 8, 1973

une 13, 1973

une’ 18, 1973

une 19, 1973

 

An amendment was added to the second
Supplemental Appropriations bill for
FY 1973 (H.R. 7447) in the Senate by
a vote of 59-14 which would add an
additional $20 million to the FY 1973
RMP appropriation.

s

Senate Labor-HEW Appropriation Sub- *

- committee held hearings which included

RMP in terms of the FY74 budget.

Senate Labor-HEW Appropriation Sub-

‘committee again held hearings which
— included RMP for FY 74.

?

Conferees on Second Supplemental

Appropriation bill for FY 73 (H.R.
7447) delete $20 million added by -
Senate for RMP (H. Rept. #93-295).

 

H.R. 7806 reported unanimously by the House Inter-
state and Foreign Commerce Committee. House Report
$#93-227.

House passed H.R. 7806, the PHS Extension bill by a
vote of 372-1. The bill would authorize. $159 million
for RMP in FY 1974. . v

Senate agreed to the House version of the PHS Extensior
Act by a vote of 94-0, with its level of $159 million
for RMP.

H.R. 7806 sent to the President.

'
<d

President signs S. 1136 into” Taw as P.L. 93-45, which
includes one-year extension of RMP with authorization
level of $159 M.
fE ;

Budget/Appropriations

 

ie 21, 1973

ne 26, 1973

ly 1, 1973

 

House Appropriations Committee
ordered the Labor-HEW Appropriations bill
favorably reported (H. Report #93-305).

House passed H.R. 8877, the Labor-HEW
Appropriation bill for FY74 by a vote

of 347-58. Funds were included for

RMP at a level of $81,953,000.

The President signed the continuing
resolution (H.J. Res. 636) following
compromise on the Cambodian Resolution:

- Congressional interpretation of the

“current rate" under the continuing
resolution is the more restrictive of
the FY74 House passed rate ($81.935M)
and the current rate ($150M). Thus —
Congressional interpretation of the

- continuing rate for RMP would be the

FY74 House figure of $81.935M.

 

Legislation/Authorization

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a
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a RELEVANT QUOTATIONS ON REASONS FOR TERMINATION AND CONTINUANCE OF RMP

January 29, 1973 - The President's Budget

"No extension beyond June 30, 1973, of the regional medical program
authorities is being requested.

Over a period of 8 years, the Federal Government, by means of grant awards
and direct staff activities, promoted and developed 56 RMNP's, regional
cooperative arrangements among the Nationts health care providers and
institutions. Originally established to upgrade the health care of
persons threatened by heart disease, cancer, stroke, kidney disease and
related diseases, the RMP's in recent years sought more to improve access
to and generally strengthen the health care delivery system.

Gespite Federal expenditures in excess of $500 million for these activities
however, there is little evidence that ona nationwide basis the RMP's
have materially affected the health care delivery system. Further expendit
of scarce Federal health resources on this program, therefore, cannot be
justified on the basis of available evidence." °

January 30, 1973 - Material Prepared for DHEW Presentation of President's Bu

"The greatest expenditure of RMP funds has been in the area of continuing
education and upgrading training of health personnel. It is not an
appropriate use of Federal funds to finance continuing education tor
professionals generally capable of financing his own education to improve
professional competence." -

"As a result of various legislative and.administrative decisions in recent
years, several activities for improving the quality of care previously
assigned to RMP are now being supported by other HEW organizations such as
the special NIH cancer and heart initiatives and the system of Professiona
Standards Review Organizations being set up. under the Medicare authorities.

March J, 1973 - President's Message to Congress on Human Resources

"Regional Medical Programs likewise can now be discontinued. The planning
function they have performed can better be conducted by comprehensive State
planning efforts. A second function of these programs, the continuing
education of physicians who are already licensed, is an inappropriate
burden for Federal taxpayers to bear."

Harch 22, 1973 ~ Secretary Weinberger's Testimony before the Senate Sub-
committee on- Health, Committee on Labor and Public

"We are proposing the termination of the Regional Medical Program because we
believe that it has not achiéved itspromise when it was first enacted seven
years ago, and shows no reasonable chance of doing so in the future. From
the outset, the RMP has had great difficulty in defining a clear role for
itself. oo '
@

Originally conceived as covering a limited number of major regions in the

“United States, a total of 56 regions were funded. In 34 cases, the regions

became coterminous with State boundaries. This fact alone brings RMP into
direct conflict with State-based and areawide health planning, coordinating
and service programs, such es comprehensive health planning. There is no
significant evidence that the RMP's have achieved their goal of getting
research advances rapidly into regular medical practice. The training
programs undertaken are typically of limited scope and duration, and there
is no substantial evidence that they have had an effect on actual medical
practice. Further, we believe that continuing education for physicians
should be paid for by physicians and not by the Federal Government.

A major RMP activity has been the funding of demonstration projects, but

many other HEW programs, and many different Federal, State and local agencie
similarly fund demonstration projects, thus adding to profiferation of
separate projects. In the final analysis, it has become increasingly appare
that RMP's have not succeeded in developing the efficient, rational and
regional health systems which their original purpose sought."

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March 23, 1973 - Report of the Senate Conmittee on Labor and Public Welfare
on $.1136 (Keport #93-87

‘The Committee believes that it is essential and urgent for it to upgrade,

improve and delete when necessary the provisions of the PUblic Health
Service Act and the Mental Retardation Facilities and Community Mental
Health Centers Act. In that complicated process, which is now underway,
the Committee will strive to consolidate, recodify, and rationalize those
legislative authorities in a manner consistent with the appropriate Federal
role in respect to the health needs of. the American people.

The Committee is hopeful that this major legislative undertaking will resul
in fewer but more productive health authorities. The Committee is convince
that this process cannot reasonably be completed by the time the authoritic
expire June 30, 1973. And the Committee cannot stand by while the Executiy
branch implements decisions which could effectively terminate existing
health programs before Congress has an opportunity to work its will."

May 25, 1973 - Report of the House Committee on Interstate and Foreign Comme
on H.R. 7806 (Report. # 93-227)

 

"This is another program which the’ Adminjstration has proposed to terminate,
saying that the program has failed to meet its original intents; regionaliz
health services and disseminattng -new biomedical knowledge.. Further, .they
feel that the program has waited an excessive amount of money on administra
costs. The Committee willbe reviewing the future of this program in-‘con-
junction with the Comprehensive Health Planning and the Hill-Burton pregran
but feels that in the meantime the proposed abrupt’ termination is tnappropr
Further, while some criticism of the regional medical program may be justif
it is clear that it has had many individual successes and that many people
become dependent upon it. Adequate provision has not been made for findine
alternative sources of suzport for the successful parts or the people deper
on the program. The presciit legislation would authorize $159 million for t

2
ioe

regional medical programs in fiscal year 1974.

“June 19, 1973 - Conference Report on Second Supplemental Appropriations bill

H.R. 7447 (Report #93-295)

‘Amendment No. 29. Deletes appropriations of $20,000,000 for regional medic
programs and $15,000,000 for ‘construction of outpatient facilities proposed
by the Senate.

In agreeing to delete these additional appropriations, the conferees take n
of the fact that $150,000,000 has already been appropriated for fiscal year
for regional medical programs and $70,000,000 has been appropriated for con
struction of outpatient facilities. The Congress is clearly opposed to the
termination of these programs. Legislation to extend the authorizations fo
them through June 30, 1974 has been passed by overwhelming majorities in bo
the House of Representatives and the Senate. The conferees urge that the
funds which have been appropriated for the regional medical programs and th
Hill-Burton program be released for obligation, in accordance with Congress
intent." ,

June 21, 1973 - Report of the House Appropriations Committee on FY 1974 Labo
HEW Appropriations - H.R. 8877 (Report # 93-305)

"Health services planning and development. -~ . . . This appropriation funds

_a group of programs [NCHSRED RMP, CHP, and Hill-Burton] whose common purpose
is to improve the delivery of health care and to make the most effective us
of available resources. . ."'

"The budget proposed no appropriations for regional medical programs for

fiscal year 1974. The legislative authorization for the regional medical
programs has recently been extended through fiscal year 1974 by a nearly
unanimous vote of Congress. While the Committee is aware that some of the
regional medical programs may not have been as productive as they should be
others have been highly successful. In any case, the Committee believes th
the original objectives of the regional medical programs are still valid, a
that the Department should seek to improve the operations of the programs
rather than terminating them. The Committee has included in the bill the s
of $81,953,000 to continue the funding of the regional medical programs. ‘T
Committee urges that every effort be made to strengthen and improve the
weaker prograns.'' , >

Second Supplemental Appropriations Act - P.L. 93-50-July 1, -1973
"Health Services Planning and Development - For an additional. amount for
“Health services planning and development'', for carrying out, to the extent
not otherwise provided, section 304 and title 1X of the Public Health Servi
Act, $17,000,000, to remain available until expended." , ,

The Senate Report (No. 93-160} plus floor debate indicate that these funds,
are for the following items:

(1) $12,000,000 to permit comp létion of the new Children's Hospital Nat
Medical Center in Washington, D.C.
(2)

(3)

$4,500,000 to meet the initial needs for a children's medical cente
serving the northwestern regions of the U.S. "Plans are now underwa)
to transform the Children's Orthopedic Hospital Center into a
children's regional health service center, comparable to the
Children's Medical Center in Boston. The committee recognizes that
existing facilities are hopelessly outmoded and inadequate and that
some corrective action must be taken immediately. For this reason.
the Committee recommends that $4,500,000 be provided to meet the
critical, immediate needs of this facility."

$500,000 to complete a hospital in northern Vermont ~- the North
Country Hospital and Health Center at Newport, Vermont ~- by
provding additional grants for hospital construction.