ae HEQOOT LS # medical SPECIAL ISSUE _programs FOR LIMITED DISTRIBUTION Co 60 service e news einformation data A communication device designed to speed . the exchange of news, LEGISLATION EXTENDED AND AMENDED For Regional Medical information and data on P . ; - Public J 91-515 Regional Medical Programs rograms Je Law yirol. aod related activities. November 20, 1970 - Vol. 4, No. 51S On October 30, 1970, the President signed Public Law 91-515 which extends and amends the Regional Medical Programs legislation, as well as that of Comprehensive Health Planning and Services, the National Center for Health Services Research and Development and the National Center for Health Statistics. To reflect the details of this action, a copy of Title I of the new law (P.L. 91-515) referring to Regional Medical Programs specifically, and parts of certain other titles relevant to Regional Medical Programs, are reproduced in the first part of this issue. To indicate how the total Regional Medical Programs law now reads as part of the Public Health Service Act, all changes have been interpolated into the original law (Public Law 89-239, as amended by Public Law 90-574) on the pages that follow. Deletions in the previous law are shown in {brackets} , while the new legislative language is underscored. - Distribution: . Coordinators of Regional Medical Programs Members of National Advisory Council and . Review Committee on Regional Medical Programs — Staff of Regional Medical Programs Service Regional Health Directors and Regional Medical Programs Service Representatives of Health, Education, and Welfare Regional Offices U.S. DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE Public Health Service © Health Services and Mental Health Administration * Rockville, Maryland 20852 Public Law 91-515 91st Congress, H, R. 17570 October 30, 1970 An Act To amend titles IYI and IX of the Public Health Service Act so as to revise, extend, and improve fhe programs of research, investigalion, education, training, and demonstrations authorized thereunder, and for other purposes, Be it enacted by the Senate and House of Representatives of the United States of America in Congress assembled, TIPLE [--AMENDMENTS TO TYLLE 1X OF TILE PUBLIC HBALTH SERVICE ACT Src. LOL. This title may be cited as the “Heart Disease, Cancer, Stroke, and Kidney Disense Amendments of 1970”, Sec. 102. Section 900 of the Public Health Service Act is amended to read as follows: “PURPOSES “See. 900. The purposes of this title are— “(a) through grants and contracts, to encourage and assist in the establishment of regional cooperative arrangements among medical schools, research institutions, and hospitals for research and training (including continuing education), for medical data exchange, and for demonstrations of patient care in the fields of heart disease, cancer, stroke, and kidney disease, and other related diseases; “(b) to afford to the medical profession and the medical imsti- tutions of he Nation, through such cooperative arrangements, the opportunity of making available to their patients the Jatest advances in the prevention, diagnosis, aud treatment and reha- lilitation of persons suffering from these diseases ; “{e) fo promote and foster regional linkuges among health care institutions and providers so as to strengthen and improve primary care and the relationship between specialized and. pri- mary eure; and “(d) by these meaus, to improve generally the quality and enhance the capacity of the health manpower and_ facilities aviilable to the Nation and to improve health services for persons residing in areas with limited health services, 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, andl In cooper- ution with practicing physicians, medical center officials, hospi- tal administrators, and representatives from appropriate voluntary health agencies.” Src. 103. (a)(1) The first sentence of section 901(a) of such -\ct is amended by striking out “and” immediately after “June 30, 1969,", and by inserting immediately before“, for grants” the following: “, $125,000,000 for the fiscal year ending June 30, 1971, %150,000,000 for the fiscal year ending June 30, 1972, and $250,000,000 for the fiscal year ending June 80, 1973”. (2) Such first seutence is further amended by striking out the period after “title” and inserting in liew thereof “and for contracts to carry out the purposes of this title.” (3) Such section 901(a) is amended by striking out the second sentence nnd inserting in lieu thereof the following: “Of the sums appropriated under this section for the fiscal year ending June 30, 1971, not more than $15,000,000 shall be available for activities in the field H2-7 Public Health Service Acty amendments » Citation of title. 79 Stat, 926, 42 USC 299, G4 STAT. 1297 54 SPAT. 1298 Appropriations, 82 Stat, 10c5, 42 USC 2998. Punde, limie tation, 79 Stat, 9263 82 Stat, 1006, 42 USC 2998, 1298 1299 84 STAT. 84 STAT. 42 USC 299b, 42 USC 299¢, 42 USC 299d, National Ad-= visory Council on Regional Mediaal Prow Bramse 42 USC 299e, Pub, Law 91-515 October 30, 1970 of kidney disease, Of the sums appropriated under this section for any fiscal year ending after June 30, 1970, not more than $5,000,000 may be made available in any such fiseal year for grants for new construction.” (b) Section 901 of such Act is further amended by adding at the end thereof the following new subsection : “Ce) At the request of any recipient of a grant under this title, the payments ro such recipient inay be reduced by the fair market value of any equipment, supplies, or services furnished by the Secretary to such recipient und by the amount of the pay, allowance, traveling expenses, and any other costs tn connection with the detail of an officer or em- ployee of the Government to the recipient: when such furnishing or such derail, as the case may be, is for the convenience of and at the request of such recipient and for the purpose of carrying out the regional inedical program to which the grant under this title is made.” Src 104. Section 902(n) of such Act is amended by striking out “training, diagnosis, and treatment relating to heart disease, cancer, or stroke, and, at the option of the applicant, related disease or diseases” and inserting in lieu thereof “training, prevention, diagnosis, treatment, and rehabilitation relating to heart disease, cancer, stroke, or kidney disease and, at the option of the applicant, other related diseases”. (b) Section 902(f) is amended by striking out “inclides” and inserting in liew thereof “means new construction of facilities for demonstrations, research, and training when necessary to carry out regional medical programs”. See. 105. Section 903(b) (4) of such Act is amended— (1) by striking out “voluntary health agencies, and” and insert- ing in heu thereof “voluntary or official health agencies, health planning agencies, and”; (2) by inserting immediately after “under the program”, where it first appears therein, the following: “(including as an ex officio member, if there is located in such region one or more hospitals or other health facilities of the Veterans’ Administration, the indi- vidual whom the Administrator of Veterans’ Affairs shall have designated to serve on such advisory group as the representative of the hospitals or other health care facilities of such Admin- istration which are located in such region)”; and (3) by striking out “need for the services provided under the program” and inserting in lien thereof “need for and financing of the services provided under the program, and which advisory group shall be sufficient in number to insure adequate community orientation (as determined by the Secretary)”. Sec. 106. That part of the second sentence of section 904(b) of such Act preceding paragraph (1) is amended by striking out “section 903(b) (4) and” and inserting in liew thereof the following: “section 903(b) (4), if opportunity has been provided, prior to sueh recom- mendation, for consideration of the application by each public or non- profit. private agency or organization which has developed a compre- hensive regional, metropolitan area, or other local area plan referred to in section 314(b) covering any area in which the regional medical program for which the application is made will be located, and if the application”. Sec. 107. (a) Section 905(a) of such Act is amended to read as follows: “Sec. 905. (a) The Secretary may appoint, without regard to the civil service laws, 1 National Advisory Council on Regional Medical Programs. The Council shall consist of the Assistant Secretary of Tlealth, Rducation, and Welfare for Health and Scientific Affairs, who October 30, 1970 Pub, Law 91-515 shall be the Chairman, the Chief Medical Director of the Veterans’ Administration who shall be an ex officio member, and twenty mem- bers, not otherwise in the regular full-time employ of the United States, who are leaders in the fields of the fundamental sciences, the medical sciences, health care administration, or public affairs. At least. {wo of the appointed members shall be practicing physicians, one shill be outstanding: in the study or health eare of persons suffering from heart disease, one shall be outstanding in the study or health care of persons salfering from cancer, one shall be outstanding: in the study or health care of persons suffering from stroke, one shall be outstand- ing in the study or health care of persons suffering from kidney disense, two shall be oufstanding in the field of prevention of heart. disease, cancer, stroke, or kidney disease, wad four shall be members of the public.” (b) br the persons first appointed under section 905¢a) of the Public Tfealth Service Act to serve as the four additional members of the National Advisory Council on Regional Medical Programs autbor- wed by the amendment made by subsection (a) of this section. -. (1) one shall serve fora term of one year, (2) one shall serve fora term of two years, (3) one shall serve for a term of three years, and (4) one shall serve for a term of four years, us designated by the Secretary of Health, Education, and Welfare at the time of appointment. , (c) Members of the National Advisory Council on Regional Medical Programs (other than the Surgeon General) in office on the date of enactment of this Act shall continue in office in accordance with the term of oflice for which they were last appointed to the Council. Sec. 108. Section 907 of such Act is amended by striking out “or stroke,” and inserting in lieu thereof “stroke, or kidney disease”. Sec. 109, Section 909(a) of sueh Act is amended by inserting “or contract” after “grant” each place it appears therein. Src. 110. (a) Section 910 of such Act ts amended to read as follows: “SCULTIPROGRAM SERVICES “See. EOL (a) Po facilitate titerregional cooperation, and develop improved national capability for delivery of health services, the Secre- (ary is authorized to utilize funds appropriated under this title to make grants to public or nonprofit private agencies or institutions or com -inations (hereof and to contract. for— “(1) programs, services, and activities of substantial use to two or more regional medical programs; . “(2) development, trial, or demonstration of incthods for con- trol of heart disease, cancer, stroke, kidney disease, or other related cliseases : “(3) the collection and study of epidemiologic data related to any of the diseases referred to in paragraph (2); (4) development of training specifically related to the pre- vention, diagnosis, or treatinent of any of the diseases referred to in paragraph (2), or to the rehabilitation of persons suffering from any of such diseases; and for continuing programs of such training where shortage of trained personnel would otherwise limit application of knowledge and skills important to the control of any of such diseases; and “(5) the conduct of cooperative clinical field trials. “(b) The Secretary is authorized to assist in meeting the costs of special projects for improving or developing new means for the deliv- ery of health services concerned with the diseases with which this title ix concerned, 84 STAT. 1360 Tem of office. 79 Stet. 930, 42 USC 2992, 42 USC 2994, 82 Stat, 1006, 42 USC 29945, Pub. L ~ od 44 Star, au aw 91-515 October 30, 1970 . “(c) The Seeretary is authorized to support research, studies, Investigations, training, and demonstrations designed to maximize the utilization of manpower in the delivery of health services.” Sec. LiL. (a) The heading to title LX of such Act is arnended by striking out “STROKE, AND RELATED DISEASES” and insert- ig in Liew thereof “STROKE, KIDNEY DISEASE, AND OTHER RELATED DISEASES”, 42 USC 299b~ (b) Sections 902(a), 903(a), 903(b), 2042) 90-4 (b), 905(b), 299g, 2091, 903d), 906, 907, and 909(a) of such Act (as amended by the preceding provisions of this Act) are each further amended by striking out “Surgeon General”, each place it appears therein and inserting in Jieu thereof “Secretary”, , x x * ok * * Other New Provisions Relevant to Regional Medical Programs In P.L. 91-515 TITLE H--AMENDMENTS TO TITLE UL OF THE PUBLIC SIEALTIL SERVICE ACT * * * * * * Pary H--ApmMenisrrarion or Grants in Crrrarn Muvricran't ‘ Proseces Sec. 270. Part A of title LIT of the Public Health Service Act is 52 Stat. 691; amended by adding at the end thereof the following new section: 7 nee bane u iw “Administration of Grants in Certain Multigrant Projects e4zh, “Src, SIOA. For the purpose of facilitating the administration of, and expediting the carrying out of the. purposes of, the programs established by title EX, and sections 304, 314(a), 314(b), 314(c), Si$(d), and 314(e) of this Act in situations in which grants are sought Antes ppe 1297, or made under two or more of such programs with respect to a single 15°. project, the Secretary is authorized to promulgate regulations— _“(1) under which the administrative functions under such programs with respect to such project will be performed by a single administrative unit which is the administrative unit charged with the administration of any of such programs or is the administrative unit charged with thé supervision of two or more of such programs; “(2) designed to reduce the number of applications, reports, and other auaterinds required under such programs to be’ sub- mitted with respect. to such project, and otherwise to simplify, cotsolidute, and make uniform (to the extent. feasible), the data and information required to be contained in such applications, reports, and other materials; and : “(3) under which inconsistent or duplicative requirements im- posed by such programs will be revised! and made uniform with respect to such project; except that-nothing in this section shall be construed to authorize the Pecretary to waive or suspend, with respect to any such project, any requirement with respect to any of such programs if such requirement is posed by law or by any regulation required by law.” -4- Pub, Law 91-515 October 30, 1970 84 STAT. 1307 Parr I-—-Annvuat Rerorr, Nationa, Apvisory Councu., Ec. Sec. 280. Part A of title IIT of the Public Health Service Act. is -further amended by adding after section 310A thereof (as added by section 270 of this Act) the following new section: “Annual Report ‘310B, On or before January 1 of each year, the Secretary shall transmit to the Congress a report of the activities carried on under the provisions of title IX of this Act and sections 804, 805, 314 (a), 3L4(b), BI-A(c), 314 (d), and 314(e) of this title together with (1) an evaluation of the effectiveness of such activities in improving the effi- ciency and effectiveness of the research, planning, and delivery of health services in carrying out the purposes for which such provisions were onaeted, (2) a statement of the relationship between Federal finaneing and financing from other sources of the activities mnder- tuken pursuant to such provisions (including the possibilities for more efficient support of such activities through use of alteriate sources of financing after an initial period of support under such. provi- sions), and (3). such recommendations with respect to such provisions as he deems appropriate.” Antey pps 1207, 1304, * x ko x % * x TITLE VI—MISCELLANEOUS NATIONAL ADVISORY COUNCIL * x * * * * x (b) (1) Subsection (c) of section 208 of the Public Health Service compensation, ‘Act is amended to read : 64 Stat. 447, “(c) Members of the National Advisory Health Council and mem- 42 usc 216, hers of other national advisory or review councils or committecs estab- lished under this Act, including members of the Technical Electronic Product Radiation Safety Standards Committee and the Board of Regents of the National Library of Medicine, but excluding ex officio members, while attending conferences or meetings of their respective councils or committees or while otherwise serving at the request of the Secretary, shall be entitled to receive compensation at rates to be fixed by the Secretary, but at rates not exceeding the daily equivalont . of the rate specified at the time of such service for grade GS-18 of the “General Schedule, including traveltime; and while away from their 35 rp. -R. 6247, homes or regular places of business they may be allowed travel ex- 5 usc 5332 notes penses, ineluding per diem in lieu of subsistence, as authorized by see- OE STM a tion 5703(b) of title 5 of the United States Code for persons in the Government service employed intermittently.” (2) The second sentence of subsection (d) of section 306, the second sentence of subsection (d) of section 307, the first sentence of para- graph (2) of subsection (f) of section 358, subsection (d) of section 373, subsection (e) of section GE, subsection (d) of section 703, sub- section (d) of section 725, subsection (d) of section 774, subsection (c) of section Sf, and subsection (ce) of section 905 of such Act are deleted. BO Stat. 4993 83 Stat, 190, 42 USC 242d, 42 USC 242e, 42 usc 263f, Ante, pp. 66,344, 42° USC 292b,. 42 USC 293ey 295f-4, 298, 2998, « 3) Paragraph (2) of subsection (f) of section 358 is further 62 Stak BNI: mended hy Sorking out “under this subsection” in the second sentence thereof and by inserting in lieu thereof “to members of the Committee who are not officers or employees of the United States pursuant to subsection (c) of section 208 of this Act?” / . . 79 Stats, 929. (4) Subsection (d) of seotion 905 of such Act 18 redesignated as subsection (c). LEGISLATIVE HISTORY: HOUSE REPORTS! No, 91-1297 (Comm, on Interstate and Foreign - Commerce) and Noe 91-1590 (Comm. of Conference). SENATE REPORT No, 91-1090 acoompanying S, 3355 (Comm, on Labor and Public Welfare). CONGRESSIONAL RECORD, Vol, 116 (1970) Aug, 12, considered and passed House. Sept. 9s considered and passed Senate, amended, in lieu of S, 3355. Oct, 13, House agreed to conference report. Oot, 14, Senate agreed to conference report. Pusirc Heatta Service Act * * * ¥ x * s TITLE IX—EDUCATION, RESEARCH, TRAINING, AND DEMONSTRATIONS IN THE FIELDS OF HEART DIS- EASE, CANCER, STROKE, [AND] K/DNEY DISEASE, AND OTHER RELATED DISEASES PURPOSES Sec. 900. The purposes of this title are -- (a) through grants and contracts, to encourage and assist in the establishment of regional cooperative arrangements among medical schools, research institutions, and hospitals for research and training (including continuing education), for medical data exchange, and for [related] demonstrations of patient care 1n the Fields of heart disease, cancer, stroke, and kidney disease, and other related diseases; (b) to afford to the medical profession and the medical in- stitutions of the Nation, through such cooperative arrangements, the opportunity of making available to their patients the latest advances in the [diagnosis and treatment of these diseases] prevention, diagnosis, and treatment and rehabilitation of persons suffering from these diseases; (c) to promote and foster regional linkages among health care institutions and providers so as to strengthen and improve primary care and the relationship between specialized and primary care; and Te] (d) by these means, to improve generally the guality and enhance the capacity of the health manpower and facilities aval able to the Nation [jJ and to improve health services for persons residing in areas with limited health services, 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 center officials, hospital administrators, and representatives from appropriate voluntary health agencies. AUTHORIZATIONS 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, $200,000,000 for the fiscal year. ending June 30, 1968, $65,000,000 for the fiscal year ending June 30, 1969 , [and] $120,000,000 for the next fiscal year, $125,000,000 for the fiscal year ending June 30, 1971, $150,000,000 for the fiscal year ending June 30, 1972, and $250,000,000 for the fiscal year ending June 30, 1973, for grants to assist public or nonprofit private universities, medical schools, research institutions, and other public or nonprofit private oe, vee si institutions and agencies in planning, in conducting feasibility studies, and in operating pilot projects for the establishment, of regional medical programs of research, training, and demonstration activities for carrying out the purposes of this title and for contracts to carry out the purposes of this title. Sums appropriated 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.J Of the sums appropriated under this section for the fiscal year ending June 30, 1971, not more than $15,000,000 shall be available for activities in the field of kidney disease,Of the sums appropriated under this section for any fiscal year ending after June 30, 1970 not more than $5,000,000 may be made available in any such fiscal year for grants for new construction. For any fiscal year ending after June 30, 1969, such portion of the appropriations pursuant to this section as the Secretary may determine, but not exceeding 1 per centum thereof, shall be available to the Secretary for evaluation (directly or by grants or contracts) of the program authorized by this title. (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 with respect to construction of, or provision of built-in {as determined in accordance with regulations) equipment for, any facility may not exceed 90 per centum of the cost of such construction or equip- ment. (c) Funds appropriated pursuant to this title shall not be available to pay the cost of hospital, medical, or other care of patients except to the extent it is, as determined in accordance with regulations, incident to those research, training, or demon- stration 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 demon- stration activities carried out with funds appropriated pursuant to this title, unless he has been referred to such facility by a practicing physician or, where appropriate, a practicing dentist. (d) Grants under this title to any agency or institution, or combination thereof, for a regional medical program may be used by it to assist in meeting the cost of participation in such program by any Federal hospital. (e) At the request of any recipient of a grant under this title, the payments to such recipient may be reduced by the fair market value of any equipment, supplies, or services furnished by the Secretary to such recipient and by the amount of the pay, allowance, traveling expenses, and any other costs in connection with the detail of an officer or employee of the Government to the recipient when such furnishing or such detail, as the case may be, is for the convenience of and at the request of such recipient and for the purpose of carrying out the regional medical program to which the grant under this title 1s made. 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 insti- tutions or agencies engaged in research, [training, diagnosis, and treatment relating to heart disease, cancer, or stroke, and at the option of the applicant,. related disease or diseases] training, prevention, diagnosis, treatment, and rehabilitation relating to heart disease, cancer, stroke, or kidney disease and, at the option of the applicant, other related 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 for purposes of this title includes the District of Columbia, the Common- wealth of Puerto Rico, the Virgin Islands, Guam, American Samoa, and the Trust Territory of the Pacific Islands) , which the [Surgeon General] Secretary determines, in accordance with regulations, to be appropriate for carrying out the purposes of this title; (2) consists of one or more medical centers, one or more clinical research centers, and one or more hospitals; and (3) has in effect cooperative arrangements among its com- ponent units which the [Surgeon General] Secretary 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 post-graduate 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 treatment 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 in supported and augmented by the program established under this title. (ec) the term "nonprofit" as applied to any institution or agency means an institution or agency which is owned and operated by one or more non-profit corporations or associations no part of the net earnings of which inures, or may lawfully inure, to the benefit of any private shareholder or individual. (f) the tem "construction" [includes] means new construction of facilities for demonstrations, research, and training when necessary to carry out regional medical programs, alteration, major repair (to the extent permitted by regulations), remodeling and renovation of existing buildings (including initial equipment thereof), and replacement of obsolete, built-in (as determined in accordance with regulations) equipment of existing buildings. fo . ‘\ ee, GRANTS FOR PLANNING Sec. 903 (a) The [Surgeon General] Secretary, upon the recom- mendation of the National Advisory Council on Regional Medical Programs established by section 905 (hereafter in this title refer- red 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, and combinations thereof, to assist them in planning the development of regional medical programs. (b) Grants under this section may be made only upon application therefor approved by the {Surgeon General] Secretary. Any such ap- plication 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 will provide for such fiscal control and fund accounting procedures as are required by the [Surgeon General] Secretary to assure proper disbursement of and accounting for such Federal funds; (3) reasonable assurances that the applicant will make such reports, in such form and containing such information as the [Surgeon General] Secretary may from time to time reasonably require, and will keep such records and afford such access thereto as the [Surgeon General] Secretary 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 establishment and opera- tion of such regional medical program, which advisory group includes practicing physicians, medical center officials, hospital administrators, | representatives from appropriate medical societies, [voluntary health . agencies, andj voluntary or official health agencies, health planning agencies, and representatives of other organizations, institutions, and agencies concerned with activities of the kind to be carried on under the program (including as an ex officio member, if there is located in such region one or more hospitals or other health facilities. of the Veterans' Administration, the individual whom the Administrator of Veterans’ Affairs shall have designated to serve on such advisory group as the representative of the hospitals or other health care - facilities of such Administration which are located in such region) and members of the public familiar with the [need for the services provided under the progranfJ need for and financing of the services provided under the program, and which advisory group shall be suf- ficient in number to insure adequate commumity orientation (as determined by the Secretary.) - 10 - GRANTS FOR ESTABLISHMENT AND OPERATION OF REGIONAL MEDICAL PROGRAMS Sec. 904. (a) the (Surgeon Generalj Secretary, upon the recom- mendation of the Council is authorized to make grants to public or nonprofit private universities, medical schools, research institutions ,. and other public or non-profit private agencies and institutions. and combinations thereof, 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} Secretary: Any such application may be approved only if it is recommende by the advisory group described in [section 903(b) (4) and } section 903 (b) (4, if opportunity has been provided, prior to such recommendation, for “ons tleration of the application b each public or nonprofit private agency oF organization W, ich has developed a comprehensive regional, metropolitan area, OT other local area plan referred to in section 318 (5) covering any area in which the regional medical program for which the application is made will be located, and if the a jication contains or 1S supported by reasonable assurances t at -- (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 there- under, and (B) will not supplant funds that are otherwise avail- able 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] Secretary to assure proper disbursement of and accounting for such Federal funds; (3)the applicant will make such reports, in such form and containing such information as the (Surgeon General] Secreta may from time to time reasonably require, and will keep su records and afford such access thereto as the (Surgeon General} Secretary may find necessary to assure the correctness and Verification of such reports; and (4)any laborer or mechanic employed by any contractor or subcontractor in the performance of work 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 Davis-Bacon Act, as amended (40 U.S.C. 76a -- 276a - 5)3 and the Secretary of Labor shall have, with respect to the labor standards specified in this | paragraph, the authority and functions set forth in Reorganization — Plan Numbered 14 of 1950 (15 F.R. 3176; 5 U.S.C. 1332 - 15) 7 and section 2 of the Act of June 13, 1934, as amended (40 U.S.C. (276c)- ‘ eee -li- NATIONAL ADVISORY COUNCIL ON REGIONAL MEDIC PROGRAMS cy Sec, 905. (a) The [Surgeon General, with the approval of the Secretary ,] Secretary may appoint, without regard to the civil service laws, a National Advisory Council on Regional Medical Programs. The Council shall consist of the {Surgeon General] . ’ Assistant Secretary of Health, Education, and Welfare for Health and Scientific Affairs, whe shall be the Chairman, the Chiet Medical Director of the Veterans! Administration who shall be an ex officio member, and {sixteen} twenty members, not otherwise in the regular full-time employ of the United States, who are leaders in the fields of the fundamental sciences, the medical sciences, health care administration, OF public affairs. At least two of the appointed members shall be practicing physicians, one shall be outstanding in the study {, diagnosis, oF treatment] or health care of persons suffering from fof] heart disease, one shall be outstanding in the study {, diagnosis, or treatment} or health care of persons suffering from fof} cancer, and} one shall be outstanding in the study {, diagnosis, or treatment] or health care of persons suffering from fof] stroke, one shall be outstanding in t e.study or health care of persons suffering ron kidney disease, two shall be outstanding 1n the field of prevention of heart disease, cancer, stroke, or kidney disease, and four shall be members of the public. { Each appointed member 0 the Council shall hold office for a term of four years, except that any member appointed to fill Gy a vacancy prior to the expiration of the term for which his pre- ed ee decessor was appointed shall be appointed for the remainder of such term, and except that the terms of office of the members first taking office shall expire, as designated by the [Surgeon General] Secretary at the time of appointment, four at the end of the first year, four at the end of the second year, four at the end of the third year, and four at the end of the fourth year after the date of appointment . An appointed member shall not be eligible to serve continuously for more than two terms. [(o) Appointed members of the Council, while attending meetings or conferences thereof or otherwise serving on business of the Council, shall be entitled to receive compensation at rates fixed by the Secretary, put not exceeding $100 per day, including travel- time, 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 by section 5 of the Administrative Expenses Act of 1946 (5 U.S.C. 73b-2) for persons in the Government service employed intermittently J {(d)3_ (c) The Council shall advise and assist the [Surgeon General] Secretary in the preparation of regulations for, and as to policy matters arising with respect to the administration of this title. The Council shall consider all application for grants under this title and shall make recommendations to the [Surgeon General] Secreta with respect to approval of applications for and the amounts of grants under this. title. * See explanatory addenda page 10. | -12-) REGULATIONS Sec. 906. The [Surgeon General] Secretary, after consultation with the Council shall prescribe general regulations covering the terms and conditions 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 titles of this Act or other Acts of Congress. INFORMATION ON SPECIAL TREATMENT AND TRAINING CENTERS Sec. 907. The [Surgeon General] Secretary, 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, for stroke,] stroke, or kidney disease, 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 available to licensed practitioners and other persons requiring such information. To the end of making such list or lists and other information most useful, the FSurgeon General] Secretary shall from time to time consult with interested national pro essional organizations. REPORT Sec. 908. On or before June 30, 1967, the Surgeon General, after consultation with the Council, shall submit to the Secretary for transmission to the President and then to the Congress, a report of the activities under this title together with (1) a statement of the relationship 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. RECORDS AND AUDIT Sec. 909. (a) Each recipient of a grant or contract under this title shall keep such records as the [Surgeon GeneralJ Secreta may prescribe, including records which fully disclose the amount and disposition by such recipient of the proceeds of such grant or contract, the total cost of the project or undertaking in connection with which such grant or contract 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 effective audit. - 13- (b) The Secretary of Health, Education, and Welfare and the Comptroller General 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. (PROJECT GRANTS FOR MULTIPROGRAM SERVICES (Sec. 910. Funds appropriated under this title shall also be available for grants to any public or nonprofit private agency or institution for services needed by, or which will be of substantial use to any two or more regional medical programs .J MULTIPROGRAM SERVICES Sec. 910. (a) To facilitate interregional cooperation, and develop improved national capability for delivery of health services, the Secretary is authorized to utilize funds appropriated under this title to make grants to public or nonprofit private agencies OY institutions or combinations thereof and to contract for -- (1) programs, services, and activities of substantial use to two or more regional medical programs; (2) development, trial, or demonstration of methods for control of heart disease, cancer, stroke, kidney disease, or other related diseases; . (3) the collection and study of epidemiologic data related to any of the diseases referred to in paragraph (2); (4) development of training specifically related to the pre- vention, diagnosis, or treatment of any of the diseases referred to in paragraph (2), or to the rehabilitation of persons suf- fering from any of such diseases; and for continuing programs of such training where shortage of trained personnel would otherwise limit application of knowledge and skills important to the control of any of such diseases; and (5) the conduct of cooperative clinical field trials. ; (b) The Secretary is authorized to assist in meeting the costs of special projects for improving or developing new means for the delivery of health services concerned with the diseases with which this title is concerned. (c) The Secretary is authorized to support research, studies, investigations, training, and demonstrations designed to maximize the utilization of manpower in the delivery of health services. - 14 - OTHER NEW PROVISIONS RELEVANT TO REGIONAL MEDICAL PROGRAMS IN P.L. 91-515 TITLE II - PART H ADMINISTRATION OF GRANTS IN CERTAIN MULTIGRANT PROJECTS Sec. 310A. For the purpose of facilitating the administration of, and expediting the carrying out of the purposes of, the programs established by title IX, and sections 304,314(a), 314(b), 314(c), 314(d), and 314(e) of this Act in situations in which grants are sought or made under two or more of such programs with respect to a single project, the Secretary is authorized to promulgate regu- lations --. (1) under which the administrative functions under such programs with respect to such project will be performed by a single administrative unit which is the administrative unit charged with the administration of any of such programs or is the administrative unit charged with the supervision of two or more of such programs; (2) designed to reduce the number of applications, reports, and other materials required under such programs to be sub- mitted with respect to such project, and otherwise to simplify, consolidate, and make uniform (to the extent feasible), the data and information required to be contained in such appli- cations, reports, and other materials; and (3) under which inconsistent or duplicative requirements im- posed by such programs will be revised and made uniform with respect to such project; except that nothing in this section shall be construed to authorize the Secretary to waive or suspend, with respect to any such project, any requirement with respect to any of such programs if such require- ment is imposed by law or by any regulation required by law. TITLE II - PART I ANNUAL REPORT -310B. On or before January 1 of each year, the Secretary shall transmit to the Congress a report of the activities carried on under the provisions of title IX of this Act and sections 304, 305, 314(a), 314(b), 314(c), 314(d), and 314(e) of this title together with (1) an evaluation of the effectiveness of such activities in improving the efficiency and effectiveness of the research, planning, and delivery of health services in carrying out the purposes for which such pro- visions were enacted, (2) a statement of the relationship between Federal financing and financing from other sources of the activities undertaken pursuant to such provisions (including the possibilities © 3..' for more efficient support of such activities through use of alternate. sources of financing after an initial period of support under such 22 provisions), and (3) such recommendations with respect to such pro- visions as he deems appropriate. - 15 - TITLE VI - fo} COMPENSATION FOR NATIONAL ADVISORY COUNCILS ee Amends section 208 of the Public Health Services Act to read: "(c) Members of the National Advisory Health Council and mem- bers of other national advisory or review councils or committees estab- \ lished under this Act, including members of the Technical Electronic Product Radiation Safety Standards Committee and the Board of Regents of the National Library of Medicine, but excluding ex officio members, while attending conferences or meetings of their respective councils or committees or while otherwise serving at the request of the Secretary, shall be entitled to receive compensation at rates to be fixed by the Secretary, but at rates not exceeding the daily equivalent of the rate specified at the time of such service for grade GS-18 of the General Schedule, including traveltime; and while away from their homes or regular places of business they may be allowed travel expenses, including per diem in lieu of subsistence, as authorizéd by section 5703(b) of title 5 of the United States Code for persons in the Government service employed intermittently." * & * & x *% * Explanatory Addenda to Section 905 - National Advisory Council "Of the persons first appointed under section 905(a) of the Public Health Service Act to serve as the four additional members of the National Advisory Council on Regional Medical. Programs authorized by the amendment made by subsection (a) of this section -- (1) one shall serve for a term of one year, (2) one shall serve for a term of two years, (3) one shall serve for a term of three years, and (4) one shall serve for a term of four years, as designated by the Secretary of Health, Education, and Welfare at the time of appointment." “Members of the National Advisory Council on Regional Medical Programs (other than the Surgeon General) in office on the date of enactment of this Act shall continue in office in accordance with the term of office for which they were last appointed to the Council." - 16 -