SUBCOMMITTEE ON LABOR AND HEALTH, EDUCATION, AND WELFARE, AND RELATED AGENCIES — ” COMMITTEE ON APPROPRIATIONS 92ND CONGRESS U.S. SENATE DEMOCRATS Warren G. Magnuson, Washington, Chairman John C. Stennis, Mississippi Alan Bible, Nevada Robert C. Byrd, West Virginia William W. Proxmire, Wisconsin Joseph M. Montoya, New Mexico Ernest F. Hollings, South Carolina REPUBLICANS Norris Cotton, New Hampshire Clifford P. Case, New Jersey Hiram L. Fong, Hawaii James C. Boggs, Delaware Edward W. Brooke, Massachusetts Ted Stevens, Alaska Ex officio members: Allen J. Ellender, Louisiana Milton R. Young, North Dakota Harley M. Dirks, Professional Staff “ember W. Proctor Jones, Professional Staff Member Robert Clark, Professional Staff Member Sen, Warren G. ug of Seattle, Washington Psoraue LABOR AND HEALTH, EDUCATION, AND WELFARE SUBCOMMITTEE OF THE SENATE APPROPRIATIONS COMMITTEE si ee fet ACCRA ais cia i catieadinmaisbongdet omits Santee bh Democrat-~Dec. 14, 1944 Sen . John St es of De Kalb, hres: Demecrat—Nov. 5, 1947 92ND CONGRESS Warren G,. Magnuson (Democrat) of Seattle, Washington. Born in vinnesota, 1905, Entered University of Washington, graduating from the law school in 1929; served as special prosecuting attorney of King County, 1931; elected to the Washington State Legislature, served in the regular and special sessions of 1933; chairman of the Judiciary Committee; assistant United States district attorney, 1934; elected prosecuting attorney of King County, November 1934; member of American Legion and Veterans of Foreign Wars; served as lieutenant commander in U.S.N.R. in Pacific Fleet; married Mrs. Jermaine Elliott Peralta on October 4, 1964; elected to the 75th through the 78th Congresses; elected to the Senate November, 1944 and re-elected for all subsequent terns. Chairman of Committee on Commerce. Member of Committee on Aeronautical and Space Sciences. John Cornelius Stennis (Democrat) of De Kalb, Mississippi. Born in Kemper County, Mississippi, August 3, 1901. Married, two children; attended the county schools and graduated from Kemper County Agricultural High School, Scooba, 1919; B.S. degree, Mississippi State College, 1923; LL.B. degree, University of Virginia Law School, 1928, member of Phi Beta Kappa, Phi Alpha Delta (legal), and Alpha Chi Bho Fraternities; Presbyterian, Mason, Lion, member of Farm Bureau, Mississippi, and American Bar Associations; past president, State 4-H Club Advisory Council; elected Mississippi House of Representatives from Kemper County, 1928-32: elected district prosecuting attorney, 16th Judicial District, 1931 and 1935; appointed circuit judge, 16th Judicial District, 1937, and elected 1938, 1942, 1946; elected United States Senator November 4, 1947, to fill unexpired term of the late T.G, Bilbo; sworn in November 17, 1947; re-elected 1952; 1958, 1964, and 1970. Chairman of Armed Services Committee. Member of Aeronautical and Space Sciences Committee. Alan Bible (Democrat) of Reno, Nevada; born in Lovelock, Nevada, November. 20, 1909; married Loucile Jacks; children--one daughter and three sons; A.B. University of Nevada, 1930; LL.B, Georgetown University School of Law, 1934; admitted to the Nevada State Bar, 1935; asso- ciate law partner of late United States a Senator Pat McCarran, Reno, 1935~38; appointed we then elected district attorney of Storey County : an (Virginia City), 1935; appointed deputy ‘ ~ + attorney general of Nevada in 1938; elected attorney general of Nevada in 1942 at age of 32 years, becoming youngest attorney general in United States; re-elected attorney general in 1946 without opposition; served as president and vice president of National Association of Attorneys General; private practice of law under pemedine sth egremmerstag Whe Ube eteatlen Sak a ea fa a meee: Eadie secant. deanta vga Sent Abt | aman EAL Sh Sen, Alan Bible firm name of Bible & McDonald, Reno, from January 1951; of Reno, Nevada member of American Bar Association, chairman of , Democrat--Dec. 2, 1954 State delegation of Committee on Improvement of Judicial Administration, National, Safety Council, Nevada State Bar Association, University of Nevada Alumni Association, Lambda Chi Alpha social fraternity, Masons, and Eagles; elected to the United States Senate November 2, 1954, to fill the unexpired term of late Senator Pat McCarran; re-elected for all subsequent terms, Member of Committees on Interior and “Insular Affairs and Committee on District of Columbia. Robert C. Byrd (Democrat) of Sophia, West Virginia; ee born in North Wilkesboro, North Carolina, January 15, ae *., 1918; student - Beckley College; Concord College; Morris Harvey College, 1950-51; Marshall College, 1951-52; LL.B. cum laude, American University; married Erma Ora James, May 29, 1937, two daughters; elected to the West Virginia House of Delegates in a 1946 and re-elected in 1948; elected to the West oy : Virginia Senate in 1950 and elected to the U.S. 2 ou House of Representatives in 1952, 1954 and 1956; “3 elected to the U.S. Senate in 1958; re-elected to the U.S. Senate in 1964 and 1970 by the greatest vote ever accorded a West Virginia candidate. He was elected secretary of the Senate Democratic “a Seo Conference in January 1967 and reelected by Sen. Robert C. Byrd unanimous vote in January 1969; elected Senate of Sophia, Weat Virginia i, . ; . " Democratic Majority Whip in January 1971. Democrat--Jan, 3, 1959 Member of Committees on Judiciary and Rules and Administration. a . : oe 3 eat Tier Soi a ee ee poms Sen. William W. Proxire of Madison, Wisconsin Democrat~~August, 1957 seeppennemans ile ame Sen. doseph M. Montoya of Santa Fe, New Mexico Democrat~--Nov. 3, 1964 William W. Proxmire (Democrat) of Wisconsin; born in Lake Forest, Illinois, November 11, 1915. He earned his undergraduate degree from Yale and two graduate degrees from Harvard University; taught government at Harvard, worked for J.P, Morgan and Company on Wall Street: nine months before Pearl Harbor, he enlisted as a private in the U.S, Army to serve in the counter- intelligence corps, leaving active duty in 1946 as a first lieutenant; he has been in politics since 1950, when he was elected to the Wisconsin State Assembly. He was elected to the United States Senate in 1957 to fill the seat left vacant by the death of Senator Joe McCarthy. He was re-elected the following year to a full 6 year term and again re-elected in 1964 and 1970. He is married to Ellen. Hodges Sawall. Mr. Proxmire is Chairman of the Joint Economic Committee; ranking Democrat on the Banking, Housing and Urban Affairs Committee, and member of the Joint Committee on Defense Production. Joseph M, Montoya (Democrat) of Santa Fe, New Mexico; born in Sandoval County, New Mexico, September 24, 1915; attended Regis College in Denver, Colorado, and Georgetown University Law School in Washington, D.C., receiving LL.B. in 1938; a lawyer by profession; actively engaged in various business enterprises; elected to New Mexico House of Representatives in 1936 at age 21 while still in college: re-elected in 1938 and named majority floor leader; elected as youngest member of State senate in 1940 and named majority whip; reelected to State senate in 1944 and named chairman, Senate Judiciary Committee; was elected Lieutenant Governor in 1946 and re-elected in 1948; in 1952 again was elected to the State senate; in 1954 was returned to the office of Lieutenant Governor, and re-elected in 1956; married Della Romero and they have three children--Joseph II, Patrick, and Lynda; delegate, Mexico-United States Interparliamentary Conference, 1961-65; official United States observer, Latin American Parliamentary Conference, Lima, Peru, 1965; elected to the 85th Congress in special election kana tt 1 tangy ~ £a2tt 1. een pas ney 1 April 9, 1957, to fili the vacancy caused by the death of Antonio M. Fernandez; re-elected to the 86th, and 88th Congresses; elected to the United States Senate in 1964 and 1970. Member of Committee on Public Works and Select Committee on Small Business, oe a & cee Fos - A, The *y : 4 wes j a z f r q 4 # ad i Sen. Erneat P. Hollings of Charleston, South Carolina Democrat--Nov. 8, 1966 ee penne tne ge ip rn NSA TE er SAR ey inn ei an 3 Soe tela weit ot AM Paco nes oe on Sen. Norris Cotton . of Lebanon, Nev Kampehire Republican--Nov. 8, 1954 pole Seetad ards terecveed ott anit git Ernest F. Hollings (Democrat) of Charleston, $.C.; born in Charleston, $.C., January 1, 1922; son of Wilhelmine Meyer and Adolph G. Hollings; attended public schools, Charleston, $.C.: graduate, The Citadel, B.A., 1942; the University of South Carolina, LL.B., 19475 LLD. conferred by The Citadel, June 1959; married Patricia Salley of Coluabia, S.C., March 30, 1946; four children; member of Charleston County, South Carolina, and American Bar Associations; admitted to practice before South Carolina Supreme Court, U.S. District Court; U.S. Circuit Court of Appeals; U.S. Tax Court, U.S. Customs Court and U.S. Supreme Courts Armed Forces, 1942-45, served overseas from Africa to Austria; elected to South Carolina General Assembly from Charleston County, 1948, 1950, and 1952; chairman, Charleston County Legislative delegation; speaker pro tempore, South Carolina ~ House of Representatives; elected twice by unanimous vote, 1951, 1953; elected Lieutenant Governor, November 2, 1954; elected Governor, November 4, 1958; served as Governor, 1959-63; appointed to Hoover Commission May 15, 1955; appointed by President Risenhower to Advisory Commission on Intergovernmental Relations, December 1959; re-appointed by President Kennedy February 1962; chairman, Regional Advisory Council on Nuclear Energy; elected November 8, 1966, to complete the unexpired term of the late Senator Olin D, Johnston; re-elected to full 6-year term November 5, 1968, Chairman of Appropriations Subcommittee on Legislative Branch; member of Subcommittees on District of Columbia; Military Construction; State, Justice, and Commerce, the Judiciary, and Related Agencies. Norris Cotton (Republican) of Lebanon, New Hampshire; born Warren, New Hampshire, May il, 1900. Educated Tilton School, Phillips Exeter Academy, Wesleyan University, George Washington University Law School; lawyer, firm of Cotton, Tesreau & Stebbins, Lebanon, New Hampshire. Married. Secretary of United States Senator George Moses, 1924-28; prosecuting attorney from Grafton County, 1933-39; justice, municipal Court of Lebanon, 1939-43; majority leader and later speaker New Hampshire House of Representatives; elected to the 80th Congress on November 5, 1946; re-elected to the 8lst, 82nd, and 83rd Congresses; elected to the United States Senate November 2, 1954; to complete the term of the late-Senator Charles W. Tobey ending January 3, 1957; re-elected to all subsequent terms, . Member of Committee on Commerce and Joint Committee on Atomic Energy. | oe em OE f t 2 “a d e + $ a Lego dotendin pants Lh. = setedadle Sen. Clifford P. Case of Rahway, New Jersey Republican-—Jan, 3, 1955 POT Rg me cneget mre ens ne gti magn conn inl a ig 4 ey Prepomeneenetns on Maki Eh en and ane Wace eb ateab ge ERLE oe a : at felceederlees ERR Lote ela lis Sen, Hiran L, Fong of Honolulu, Hawatt Republican-~Aug. 21, 1959 Clifford P. Case (Republican) of Rahway, N.J.; born in Franklin Park, N. J., April 16, 1904. “Married with three children, Attended public schools in Poughkeepsie, N.Y., and was graduated from Rutgers University with A.B. degree in 1925, and from Columbia University with LL.B. degree in 1928; received honorary LL.D, from Rutgers University, Middlebury College, Rollins College, Rider College, Bloomfield College, Princeton University, and Columbia University; was admitted to the New York bar in 1928 and practiced in New York City from 1928 to 1953; member of the Rahway Common Council, 1938-42 and of the New Jersey House of Assembly, 1943-1944; served as a Member of the House of Representatives, 1945-53; trustee of Rutgers University from 1945 to 1959; trustee of New Jersey Society for Crippled Children and Adults; director, N.J. Chapter, Arthritis and Rheumatism Foundation; director, American Institute for Retarded Children; trustee, Rahway (N.J.) Chapter, American Red Cross; member of various civic and fraternal organizations; Presbyterian; elected to the United States Senate on November 2, 1954; was re~- elected for all subsequent terms. Member of Committee on Foreign Relations. Hiram Leong Fong (Republican) of Honolulu, Hawaii; born in Honolulu, October 1, 1907; attorney and businessman; corporation president of several business firms; operates banana farm in Honolulu; attended Kalihiwaena Grammar School, McKinley High School and St. Louis- College: University of Hawaii, B.A., LL.D. (Honorary); member Phi Beta Kappa; Harvard Law School, LL.B.; Tufts University, LL.D, (Honorary); Lafayette College, LL.D. (Honorary), Director, Hall of Fame for Great Americans; 14 years in Legislature of the Territory of Hawali; 6 years as speaker and 4 years as vice speaker; delegate to the Republican National Conventions 1952, 1956, 1960, 1964 and 1968; vice president of Territorial Constitutional Convention, 1950; judge advocate of the Seventh Fighter Command of the Seventh Air Force with rank of major in World War II; presently colonel, U.S, Air Force Reserve; married to Ellyn Lo; 4 children; elected to the United States Senate July 28, 1959, for the term beginning August 21, 1959; re-elected 1964 and 1970. Member of Committees on Judiciary and Post Office and Civil Service. ccnp. GLE ad Sen, Jd. Caleb Boggs of Wilmington, Delaware Republican--Jan, 3, 1961 poem ee oo Sen, Edward W. Brooke of Newton Centre, Massachusetts Repub)ican--Nov, 8, 1966 Ba yeas WT Lacie ann Be oe James Caleb Boggs (Republican) of Wilmington, Delaware; -born Kent County, Delaware, May 15, 1909; educated in the public schools’ of Delaware; A.B. degree, University of Delaware; LL.B, degree, Delaware State College; married Elizabeth Muir; two children; member of the bar of the State of Delaware and the United States Supreme Court; former judge of the Family Court of New Castle County, Delaware; elected as U.S. Representative at Large from Delaware to the 80th, @lst, and 82d Congresses; elected Governor of the State of Delaware for two 4-year terms, 1952 and 1956; chairman of the National Governors Conference, 1959; president of the Council of State Governments, 1960; enlisted as private in Delaware National Guard, 1926; colonel USAR, ret.; brigadier general, ret., Delaware National Guard; five campaigns in the European Theater of Operations during World War IT; Legion of Merit, Bronze Star with cluster, French Croix de Guerre with Palm; elected to the United States Senate November 8, 1960, for the term ending January 3, 1972. Member of Committees on Public Works and Post Office and Civil Service. Edward W. Brooke (Republican) of Newton Centre, attended public schools of Washington, D.C.; , B.S. degree, Howard University, 1941; master of laws, Boston University Law School, 1950 (editor of Law Review, 1946-48); honorary degrees: Doctor of Jurisprudence, Portia Law School Boston, 1963; Doctor of Public Administration, Northeasterm University, Boston, 1964; Doctor of Science, Worcester Polytechnic Institute, 1965; Doctor of Laws, American International College, Springfield, 1965; Doctor of Laws, Emerson College, Boston, 1965; Captain, U.S. Army, Infantry; 5 years’ active service, European theater of operations; recipient of Bronze Star and Combat Infantryman's badge; served with "Partisans" in Italy; chairman of Finance Commission, city of Boston, April 1961 to September 1962; member of President Johnson's Commission for Civil Rights under law; the Republican Club of Massachusetts; National Association of Attorneys General; National Association of District Attorneys; American Massachusetts, and Boston Bar Associations; married Remigia Ferrari Scacco, two children; elected Attorney General of the Commonwealth of Massachusetts, 1962; re-elected 1965; elected to the U.S, Senate November 8, 19665. Member of Appropriations Subcommittees on Foreign Operations; Legislative Branch; Military Construction; and State, Justice, and Commerce, the Judiciary, and Related Agencies. TED STEVENS, Republican, of Anchorage, Alaska; born in Indianapolis, Ind., November 18, 1923; graduated from high school, Redondo Beach, Calif.; attended Oregon State College, Montana State College; graduated from U.C.L.A., 1947, Harvard Law School, 1950; served in the Air Force in World War II in China, 1943-46, first Lieutenant (pilot), 14th Air Force; awarded two Distinguished Flying Crosses, two Air Medals, and the Yuan Hai Medal (by Chinese Nationalist Government) ; practiced law in office of Northeutt Ely, Washington, D.C., 1950-52; member, law firm of Collins & Clasby, Fairbanks, Alaska, 1953; appointed U.S. Attorney, Fairbanks, Alaska, September 1953; transferred to Department of the Interior, Washington, D.C., as legislative counsel, 1956; appointed assistant to the Secretary of the Interior (Fred Seaton), 1958; appointed solicitor of the Department of the Interior by President Eisenhower, 1960; returned to Alaska, 1961, opened law office in Anchorage; president Anchorage Republican Club, 1962-63; elected to the State House of Representatives, 1964, reelected 1966, served as Q@ ieee: pro tem and majority leader; member American, Federal, California, Alaska, and District of Columbia Bar Associations; admitted to practice before the United States Supreme Court, 1954; member, Rotary, American Legion, Veterans of Foreign Wars; Republican Club, Petroleum Club, Anchorage Press Club, and Alaska Press Club; married Ann Mary Cherrington, of Denver, Colo., 1952; five children: Susan, Beth, Walter, Ted, Jr., and Ben; appointed December 23, 1968, by Governor Walter J. Hickel to fill the U.S. Senate vacancy created by the death of Senator E.L. Bartlett; reelected November 3, 1970, for the term ending January 3, 1973. eel a AMM rag IR ETE, Sen. Theodore F, Stevens of Anchorage, Alaska Republican--Dec. 24, 1968 ore Sen, Allen J, Ellender of Houma, Louisiana Democrar-~Jan. 3, 1937 “Bete yon Wht ate ee oe uw oe ees Sen. Milton R, Young . of Latfoure, North Dakota \ i Rlboatine ant geen ean cote actors oe “etal tesa Republican~-March 12, 1945 ‘Allen Joseph Ellender (Democrat) of Houma, La.; born in Montegut, Terrebonne Parish, La., September 24, 1890; lawyer and farmer; graduate of St. Aloysius College, New Orleans, La., and Tulane University of Louisiana, at New Orleans, with degrees of M.A. and LL.B.; married to Miss Helen Calhoun Donnelly (died September 30, 1949); one son, Allen J., Jxv.3; served in World War I; city attorney of Houma, 1913-15; district attorney, Terrebonne Parish, 1915-16; delegate to Constitutional Convention of Louisiana in 1921; member of the house of representatives of Louisiana, 1924-36; floor leader, 1928-32, during administration of the late Huey P. Long, Governor; speaker of the house of representatives, 1932-36; Democratic nominee for United States Senator from Louisiana, and elected without opposition in the general election held on November 3, 1936, for the term ending January 3, 1943; reelected November 3, 1942, in the general election, without opposition, for the term ending January 3, 1949; reelected without opposition in the general election held on November 2, 1948, for the term ending January 3, 1955; again re-elected without opposition in the general election held on November 2, 1954, for the term ending January 3, 1961; re-elected November 8, 1960, for the term ending January 3, 1967; re-elected November 8, 1966, for the term ending January 3, 1973; Democratic national committeeman from Louisiana, 1939-40, Chairman of Committee on Appropriations. Member of Committee on Agriculture and Forestry and Joint Committee on Nonessential Federal Expenditures. Milton R. Young (Republican) of LaMoure, North Dakota; born December 6, 1897 in Berlin, North Dakota; attended the LaMoure County public schools and was graduated from LaMoure High School in 1915; attended North Dakota State Agricultural College and Graceland College at Lamoni, Iowa. Married Malinda V. Benson of LaMoure, N. Dak., July 7, 1919; three sons, Member of school, township, and county AAA boards; elected to House of Representatives of ‘North Dakota State Legislature in 1932; elected to State Senate of North Dakota in 1934 and served continuously until his resignation March 14, 1945; elected president pro tempore 1941; majority floor leader 1943. Was actively engaged in the operation of his farm near Berlin, N. Dak., until his appointment to the U.S. Senate. Appointed to the U.S. Senate March 12, 1945; elected at special election June 25, 1946 for term ending January 3, 1951; re-elected to successive terms; served as secretary to the Senate Republican Conference Committee since 1948. Member of Committee on Agriculture and Forestry and ranking Republican on the 9 Appropriations Committée. LABOR-WELFARE SUBCOMMITTEE OF THE HOUSE APPROPRIATIONS COMMITTEE 92ND CONGRESS DANIEL J. FLOOD (Democrat) of Wilkes-Barre Pennsylvania. Bor in Hazleton, Pennsylvania, November 26, 1903. Received early education in public schools of Wilkes-Barre, Pennsylvania, and St. Augustine, Florida. Graduate of Syrecuse University, A.B. and M.A. degrees, and sater attended Harvard Law School and Dickinson School of Law, Carlisle, Pensylvania, 7 2 graduating in 1929 with L.L.B. degree, Admitted ee to the bar of various State and Federal Courts in 1930, Attorney 2*r Home Owners' Loan Corpor- ation 1934-35, Deputy Attorney General for Pennsylvania and Counsel for Pennsylvania Liquor Control card, 1935-39; Director, Bureau of Public Assistance Disbursements, State Treasury, and Executive Assistant to State Treasurer, hacen Bee ae tint Bosal, ao i aie ats on intl F Pe.nsylvania, 1941-44; married Catherine H. Daniel J. Flood . Swank on September 24, 1949; member of many of iar (11th Dist.) local civic, fraternal, beneficial, and social emocrat - > societies. Elected to 79th, 8lst, 82nd, 84th Congress and re-elected to succeeding Congresses. Former Vice Chairman of Special Committee to investigate Katyn Massacre (murder of Polish officers by Russians). Also member of Subcom- mittee cn Defense, Committee on Appropriations. WILLIAM H, NALCHER (Democrat) of Bowling Green, Warren County, Kentucky; born in Bowling Green, Kentucky, educated in the public schools of Bowling Green, Kentucky, and high school at Ogden Preparatory Department; A.B. degree, Western Kentucky State College, Bowling Green, Kentucky; L.L.B. degree, Ohio State University, Columbus, Ohio; married to Miss Virginia Reardon, of Bowling Green, Kentucky, on June 17, 1937; two daughters: Celeste White, 26, and Louise Lewter, 22; practicing attorney, Bowling Green, Kentucky, since March 18, 1934; Federal concili- ation commissioner 1936~37 for Western District of Kentucky; elected county attorney of Warren County in 1937 and served three four~year terms, William H. Natcher elected Commonwealth attorney of the 8th Judicial Bowling Green (2d Dist.) District, composed of Allen and Warren Countries, Democrat - 10th term . . . . in 1951 and served until August 15, 1953, having been elected to Congress; Baptist; member of Kiwanis club, Odd Fellows, Americal Legion Post 23, and 40 and 8 Mammoth Cave Voiture 1146; past president of the Bowling Green Bar Association; past president of the Young Democratic Clubs of Kentucky, 1941-46; during World War Il served in the United States Navy from October 1942 to December 1945; elected to the 83d and succeeding Congresses, Also member of Subcommittee on Agriculture, and Subcommittee on District of Columbia (Chairman), Committee on Appropriations, & z ‘ L : gE F. 2 sili RA RTE ee ye a e Buia NEAL SMITH (Democrat) of Altoona, Lowa; born March 23, 1920, at Hedrick, Towa; married Beatrix Havens, two children, Douglas and Sharon; farmer and lives on farm near Altoona, Iowa; engaged in the practice of law in Des Moines, Iowa; graduated Drake University Law School; attended Missouri University College of Liberal Arts and Syracuse University Schools of Public and Business Adminis- : De . tration; 4-H Club member and leader for : es wo ten years, farm operator since 1937 Bd “ except for time and armed services and i some of the time in college; spent four years in World War II, citations include Neal Smith ; nine battle stars, Air Medal, 4 Oak Leaf of Altoona (Sth Dist.) Democrat -?th term Clusters, and Order of the Purple Heart; elected National President Young Demo- cratic Clubs of America 1953--served usual two-year term 1953 to 1955; former chairman, Polk County Board of Social Welfare (a nonpaying civic board which distributed several million dollars per year to needy families and elder citizens); former assistant county attorney for Polk County, Iowa; member of Disabled American Veterans, Masonic Order, and various farm, school, and service organizations; elected to 86th and succeed- ing Congresses. Also member of Subcommittee on State, Justice, Commerce, and . the Judiciary, Committee on Appropriations; and Select Committee on Small Business. it Seen arate Biter oa W.R. HULL, JR. (Democrat) of Weston, ses Missouri; born in Weston, Platte County, ’ . Missouri, April 17, 1906; widower; my children, Mrs. Susan Hudson and W. R. , coo . Hull 3d; elected to the 84th Congress ‘ and succeeding Congresses. Also member of Subcommittee on Agriculture, Con- mittee on Appropriations. W. R. Hull, Jew of Weston (€th Dist.) Democrat - 9th term ROBERT (BOB)RANDOLPH CASEY (Democrat) of Houston, Texas; born in Joplin, Missouri, July 27, 1915, moved to Houston, Texas, in 1930, and graduated from San Jacinto High School; attended the University of Houston and the South Texas School of Law at night: was admitted to the State bar of Texas in 1940; opended law office in Alvin, Texas, and served as city attorney and also a member of the school board; assistant district attorney in Harris County, in charge of the civil department; in 1948 was elected to the State house of representatives and served in the regular and special sessions of the 5lst Legislature; elected county judge of Bob. Casey . Harris County in 1950 for a two-year Fonocnat piap acid term; re-elected in 1952 and again in 1954 for a four-year term; member, First Christian Church; married Hazel Marian Brann on August 13, 1935, and have ten children; elected from the newly created 22d district to the 86th Congress and succeeding Congresses. Also member of Subcommittee on Legislation, Committee on Appropriations. pores ayreongiennee marge or, * beeen ae. Edward J. Patten of Perth Anboy (15th Dist.) Democrat - 5th term EDWARD JAMES PATTEN (Democrat),of Perth Amboy, N.J.; born in Perth Amboy, August 22, 1905; graduated from Newark State College, Rutgers Law School, L.L.B., and Rutgers University, B.S. ED.; member of Eagles, Moose, Elks, Kiwanis, Knights of Columbus, National Conference of Christians and Jews, Chamber of Commerce, and NAACP; lawyer, 1927; teacher public schools, 1927-34; mayor of the city of Perth Amboy, 1934-40; county clerk of Middlesex County, 1940-54; campaign manager for Robert B. Meyner, 1953 and 1957; secretary of state of the State of New Jersey, 1954-62; president, Salvation Army Board; past president of the Middlesex Bar Association; chairman of the Middlesex County Democratic Committee, 1934-36; member of the Democratic State Committee and member of American Judicature Society; recipient of "Outstanding Citizenship" award from American Heritage Foundation and B'nai Birith's "Brotherhood" award; married February 22, 1936, to Anna Quigg of South Amboy, N.J.; one daughter, Catherine M.; elected to the 88th Congress November 6, 1962; reelected to the 89th, and succeeding Congresses. Also member of Subcommittee on Military -Construction pec trait nacantii bE ae Shins ad ah ails Robert H. Michel of Peoria (18th Dist.) Republican - 8th term Garner E. Shriver of Wichita (4th. Dist.) Republican: - 6th term ROBERT H, MICHEL (Republican) of Peoria, Illinois. Born March 2, 1923, in Peoria, Illinois. Graduate of Peoria Public Schools and Bradley University, B.S. 1948, business administration. Served in the enlisted ranks during World War IT; awarded the Bronze Star, Purple Heart, and four battle stars. Married, four children. Elected to the 85th and succeeding Congresses. Also member of Subcommittee on Agriculture, Committee on Appropriations. GARNER E, SHRIVER (Republican) of Wichita, Kansas. Born July 6, 1912, in Towanda, Kansas; married in 1941, three children. Attended public schools of Towanda and Wichita; graduate of University of. Wichita in 1934 (post-graduate study at University of Southern California in 1936) and Washburn Law School, L.L.B. degree, in 1940, Engaged in law practice since 1940; served for three years in the U.S. Navy as an enlisted man and officer during World War IT; State representative 1947-51 and State Senator 1953-60; member of American, Kansas and Wichita bar associations, Veterans of Foreign Wars, American Legion, National Sojourners, Albert Pike Masonic Lodge, Wichita Consistory, De Molay Legion of Honor, and College Hill Methodist Church; elected to the 87th Congress November 8, 1960 and succeeding Congresses, Also member of Subcommittee on Foreign Operations, Committee on Appropriations. TiS suaekd New at eketingy oda a Sit dai bedle® £48 Silvio 0, Conte ‘of Pittsfield (1st Dist.) Republican - 7th term J. Kenneth Robinson of Wincheater (7th Dist.) Republican. ~ 1st tern ‘SILVIO O. CONTE (Republican) of Pittsfield, Mass.; born in Pittsfield November 9, 1921, son of Mr. and Mrs. Ottavio Conte; attended public. schools in Pittsfield and the Pittsfield Vocational High School, graduating in 1940; machinist at General Electric Co. in Pittsfield before joining the Seabees in World War II; served in Southwest Pacific; attended Boston College and Boston College Law School, graduating in 1949; admitted to the bar same year; in November 1950 elected to the Massachusetts State Senate; served as Senator from Berkshire District 1951-58; Massachusetts Bar Association, Federal Bar Associations married to the former Corinne Duval, four children, elected to the 86th and succeeding Congresses; delegate to Republican National Convention; 1968, member of Platform Committee; member of Appropriations Conmittee; Subcommittees on Lcasury~Post Office; Foreign Operations and Transportation; Select Committee on Small Business; Joint Commission on the Coinage; Migratory Bird Conservation Commission. J. KENNETH ROBINSON (Republican) of Winchester, Va.; born in Frederick County, Va. on May 14, 1916; attended public schools in Winchester; received B.S. in Horticulture from Virginia Polytechnic Institute, Blacksburg, Va., in 1937; entered family fruit growing and packing business; served four years in U.S. Infantry, retiring as Major; married Kathryn Rankin of Richmond, Va., anc they have seven children; member aad officer of numerous local civic, fraternal, social and business organizations, lifelong member of the Society of Friends; elected to Virginia Stete Senate for 2lst Senatorial District in 1965, was re-elected in 1967, and resigned upon election to Congress; committee assignments: General Laws, Agriculture and Mining, Welfare, Enrolled Bills, and Nominations and Confirmations; served as chairman of Republican Delegation to 1968 and 1969 General Assemblies; J, Kenneth Robinson was elected to the 92nd Congress November 3, 1970. Also member of Subcommittee on Foreign Operations, Committee on Appropriations. SUBCOMMITTEE ON LABOR AND HEALTH, EDUCATION AND WELFARE, AND RELATED AGENCIES COMMITTEE ON APPROPRIATIONS 92ND CONGRESS Democrats Daniel J. Flood (Pennsylvania) - Chairman William H. Natcher (Kentucky) Neal Smith (Iowa) W.R. Hull, Jr. (Missouri) Robert (Bob) Randolph Casey (Texas) Edward J. Patten (New Jersey) . Republicans Robert H. Michel (Illinois) Garner E. Shriver (Kansas) Silvio 0. Conte (Massachusetts) J. Kenneth Robinson (Virginia) Robert M. Moyer, Professional Staff Assistant Henry A. Neil, Professional Staff Assistant ®@ WASHINGTON/ALASKA: Ted Stevens (R.~-: Alaska) os I, BACKGROUND Grantee or Sponsor: University of Washington School’ of Medicine Coordinator: Donal R. Sparknan, M.D. Boundaries: coterminous with those of the two states History 1. Initial planning grant: September 1966 2. Operational status: February 1968 wOb> ’ TI. FUNDING A. Support through FY71: $6,999,000 B. FY72 award: 1,868 ,000 C.. Total support to date: § ,867 ,000 IIT. ORGANIZATION A. Regional Advisory Group 1. Chairman: C. Robert Ogden, President, North Coast Life Insurance Company . 2. Composition (43 members) a. Practicing physicians 11 b. Medical center officials 3 @ c. Hospital administrators 5 d. Voluntary health agency representatives 2 e. Other health workers 5 f. Public health officials | . 3 g. Members of the public 12 h. Other 2 TOTAL 43 _-B. Program staff: 33.8 Full-time equivalents IV. PROGRAM PRIORITIES . Improve the availability of care Improve the accessibility of care Improve the acceptability of care Maintain and improve the quality of care . Assist in the containment of costs.of care HOD > V. OPERATIONAL ACTIVITIES a Taye The region currently supports 20 operational activitics at a level of 1,003,000. These include an emphasis on the coordination of health services and manpower developnent and training. Kidney disease is given emphasis with five components funded at a level of $125,000. Vil. 2 SELECTED , REGIONAL CHARACTERISTICS A. ‘population: 3.7 million -- 59% urban, 8% minority B. Health resources 1. University of Washington School of Medicine 2. 121 short-term, non-Federal hospitals with 11,863 beds. (Alaska - 13 hospitals, Washington - 108 hospitals). 3.‘ Alaska - 183 physicians (MD's and DO's) Washington 4,208 physicians (MD's and DO's) 4. Alaska - 590 active registered nurses Washington 11, 361 active registered nurses ILLUSTRATIONS OF ACTIVITY One illustration of Washington/Alaska RMP's efforts to improve health services coordination is the development of an unusual cooperative arrangement between the 39-bed Willapa Harbor Hospital, located in a remote lumbering community on the West coast of Washington, and the 300-bed Virginia Mason medical center in Seattle., - In 1969 the small community was serviced by one physician nearing retirement and a failing hospital for a population of 9,000 people. Two years later, through the aid of Washington/Alaska RMP's Com- munity Health Services Program, the town now has two resident physicians, an elected health board, a Comprehensive Health Planning agency, an emergency military helicopter service which flies patients to a specialized service center, as well as a cooperative arrange- ment between the two hospitals. The latter has produced a "hot- line'' for consultation between the hospitals, air and land transpor- tation, arrangements for continuity of patient care, a drug inventory and formulary (resulting in a savings of $5,000 in one year), as well as continuing staff education for the smaller hospital. The success of this program has prompted Virginia Mason to request Washington/Alaska RMP to help in identifying other communities for similar arrangements. , ’ GREATER DELAWARE VALLEY RMP*: James C. Boggs (R.-Delaware) I. II. Iil. IV. 7 BACKGROUND A. Grantee or Sponsor: University City Science Center, Philadelphia B. Coordinator: Martin Wollmann, M.D. , C. Boundaries: Region encompasses the State of Delaware and a number of counties in eastern Pennsylvania and southern New Jersey (Delaware River basin area). D. History 1. Initial planning grant: April 1967 2. Operational status achieved: April 1969 FUNDING A. Support through FY71: $8 ,838 ,000 B. FY72 award (projected): 2,433,000 . C. Total support to date: $11,271,000 ORGANIZATION A. Regional Advisory Group 1. Chairman: Leonard Wolf, Ph.D.;-Vice President for Planning, University of Scranton, Scranton, Pennsylvania 2. Composition (61 members) Practicing physicians 14 Medical center officials 10 Hospital administrators Voluntary health agency representatives ao gp « e. Other health workers f£. Public health officials g. Members of the public h. Others nN — RMD RO bd ow co TOTAL B. Program Staff: 46.08 Full-time equivalents PROGRAM PRIORITIES Improving the quality, quantity, and accessibility of health care. OPERATIONAL ACTIVITIES The Region currently has 16 ongoing operational activities with a total funding level of $796,667. Approximately 19% of funds are related to training of nurses for coronary care unit operations. The large majority of remaining funds are devoted to manpower developrent, including contimiing education and training. Activities are being reoriented in line with changing priorities, and include recruitment and reactivation of health care personnel, special training for respiratory disease care, etc. VI. Vil. 2 SELECTED REGIONAL CHARACTERISTICS A. Population: 6,200,000 -- 72% urban, 97% white B. Health resources 1. 6 medical schools 2. 165 short-term, non-Federal hospitals with 40,000 beds 3. 13,300 practicing physicians (MD's and DO's) 28,500 registered nurses ILLUSTRATIONS OF ACTIVITY Ten participating hospitals have joined in a 3 phase program of improving patient care through a deliberately planned process of pinpointing patient care deficiencies, determining the causes, and then developing training processes which will overcome those deficiencies in the future. This is a group approach to self- evaluation by physicians. Current year funding is supporting development and adoption of care criteria for at least three conditions. As that progresses other conditions will be assimi- lated into the process. *NOTE: As of May 1, 1972, the Greater Delaware Valley RMP will become two separate RMPs, with the splitting off of the state of Delaware. The new Delaware RMP will attain planning status as of May 1, with an initial funding of $200,000 for the first year. Details of organizational structure and staffing for the new Region have not yet been completed. HAWATI RMP: Hiram L. Fong (R.) I. Il. Iif. IV. BACKGROUND A. Grantee or sponsor: Research Corporation of the University of Hawaii B. Coordinator: Masato M. Hasegawa, M.D. C. Regional boundaries: The entire state of Hawaii, including American Samoa, Guam and the Trust Territory of the Pacific Islands (Micronesia). D. History: 1. Initial planning grant: July 1966 2. Operational status achieved: October 1968 FUNDING A. Support through FY71: $2,963,000 B. FY72 award: - 937,000 C. Total support to date: $3,900,000 ORGANIZATION | A. Regional Advisory Group 1. Chairman: Eugene Helbush, Member Public Health Committee of Chamber of Commerce - Hawaii 2. Composition (32 members) Practicing physicians Medical center officials Hospital administrators Other health workers Public health officials Members of the public Voluntary health agency representatives h. Other Tm ho BO TB No OM em UINWN © : TOTAL B. Program Staff: 17 Full-time equivalents PROGRAM PRIORITIES A. Assist in improvement of- health care delivery system by improving equity of access; quality of care and influence cost reduction B. Improve organization patterns, develop cooperation, arrangements and serve in catalytic role C. Improve quality controls in health services. OPERATIONAL ACTIVITIES The Hawaii RMP currently has 6 ongoing activities funded at a level of $393,828. Fifty-three percent of their money is aimed at projects for improving health manpower recrutiment. The major shift in VII. 2 emphasis is directed toward improved and expanded services by existing physicians, nurses and other allied health personnel; increased utilization of new types of allied health personnel; new and specific mechanism; that provides quality control and improved standards and decreased costs of care in hospitals. SELECTED REGIONAL CHARACTERISTICS A. Population: 1.0 million -- 81% urban, 62% minority B. Health Resources “1, Medical School - University of Hawaii School of Medicine 2. Hospital and beds - 22 short-term, non-Federal hospitals with 2,453 beds; 86% involved with RMP 3. Physicians and nurses - 949 physicians (MD's and DO's), 2,334 nurses . ILLUSTRATIONS OF ACTIVITY The Hawaii Regional Medical Program is assisting in improvement of the health care system of Hawaii by improving equity of access; improving quality of care; and influencing constraints in health care costs. In general the heart program satisfied basic needs in Hawaii by establishing coronary care units throughout the Islands and training ample numbers of physicians and nurses to staff units. The Hawaii RMP is currently working toward improving the overall health care delivery system in general, rather than specific cate- gorical diseases. TRI-STATE RMP: Edward W. Brooke (R.-Massachusetts) . . I. Il. Iil. BACKGROUND A. Grantee or Sponsor: Medical Care and Education Foundation, Inc., Boston B. Coordinator: Leona Baumgartner, M.D. C.. Boundaries: States of Massachusetts, New Hampshire, and Rhode Island (some western counties of Massachusetts are also served by the Albany RMP). D. History 1. Initial planning grant: December 1967 2. Operational status achieved: February 1969 FUNDING A. Support through FY71: $5,336,000 B. FY72 award: 2,461,000 C. Total support to date: $7,797,000 ORGANIZATION A. Regional Advisory Group 1. Chairman: Louis A. Leone, M.D., Director, Department of Oncology, Rhode Island Hospital, Providence 2. Composition (62 members) a. Practicing physicians 27 b. Medical center officials 3 c. Hospital administrators 4 d. Voluntary health agency representatives 5 e. Public health officials 4 f. Other health workers 5 _g. Members of the Public 10 . h. Others 4 TOTAL “62 B. Program staff: 43.0 Full-time equivalents PROGRAM PRIORITIES A. Supply distribution and education of health/manpower B. Institutional cooperation and regionalization C. Geographic gap filling D. Medical care financing OPERATIONAL ACTIVITIES Tri-State RMP currently has 6 ongoing operational components with a funding level of $613,500. About 60% of that sum supports activities in the area of intensive coronary care. Better manpower utilization is the major focus of programs which are supported by approximately VI. Vil. 2 half of the available funds, the remainder supporting various types of patient care demonstrations. Approximately 59% of funds ($365 ,000) go to activities directed against health problems of the black popu- lation in the three state area. SELECTED REGIONAL CHARACTERISTICS A. Population: 7,374,000 -- 89% urban, 5% minority B. Health resources 1. 5 medical schools; 1 two-year medical sciences school 2. 188 short-term, ‘non-Federal hospitals with 33,075 beds, 20% of these are participating in RMP planning bodies and operational activities . 3. 11,200 active physicians; 35,800 active nurses ILLUSTRATIONS OF ACTIVITY The major thrust of the Tri-State RMP is undergoing change in accord with changing emphasis of the national program. Greater emphasis is being placed on actions which affect the delivery of health care services, and changing the system, while attacks on individual disease problems are being de-emphasized. Existing disease control activities are being reoriented as the transition process indicates. There has also been an increased emphasis on awarding of contracts to ' meet specific needs of the program, while awarding of grants for marginally related activities has been de-emphasized. The end point has been a greater reliance on program expertise in meeting the Region's needs through priority programming. During the past year the Tri-State Region instituted a $300,000 program "To assure that no patient with end-stage kidney disease will die from lack of necessary services." New England states other than those of the Tri-State Region are involved. The short-range objective is to develop a method of procuring donor organs and to identify problems of funding. The long-range objective is to furnish an adequate supply of cadaver organs to satisfy patients needs in various transplant units. ® MISSISSIPPI: John C. Stennis (D.) I. BACKGRO A. Grantee or sponsor: University of Mississippi Medical Center, Jackson B. Coordinator: Theodore D. Lampton, M.D. C. Boundaries: Coterminous with State (a few northern counties are also served by Memphis RMP). D. History : 1. Initial planning grant: January 1967 2. Operational status: July 1969 TI. FUNDING A. Support through FY71: $4,599,000 B. FY72 award: 1,053,000 C. Total support to date: $5,652,000 TII. ORGANIZATION A. Regional Advisory Group 1. Chairman: Lewis Nobles, Ph.D., President, Mississippi College 2. Composition: (30 members) Practicing physicians Medical center officials Hospital administrators Other health workers Public health officials Members of the public Voluntary health agency representatives Others Pomme no ge os | a Pp Pk TOTAL B. Program staff: 22 Full-time equivalents IV. PROGRAM PRIORITIES A. Remolding the program structure to respond to new initiatives and expanded opportunities -in planning for the state's health needs B. Improving both quality and quantity of health manpower by up- grading abilities -in the field and attracting new personnel to the field . V. OPERATIONAL ACTIVITIES The region is currently supporting nine operational components at a funding level of $920,000. The major emphasis is on improved health manpower training and utilization. Vil. 2 SELECTED FECIONAL CHARACTERISTICS A. Population: 2.2 million -- 17% urban, 37% minority B. Health resources 1. One medical school 2. 97 short-term, non-Federal hospitals with 8,698 beds 3. +1,610 physicians (MD's and DO's; 3,670 active registered nurses ILLUSTRATIONS OF ACTIVITY ~ A stroke intensive care unit serves as a learning center to upgrade skills of physicians, nurses and allied health professionals. Additionally, it serves the poor who are obtaining care where none was previously available. The skills of the following groups have been upgraded by assignment to, or rotation through the unit: 89 medical students 18 nursing students 33 practical nurses 2 nurses aides 8 house staff physicians. MOUNTAIN STATES RMP: Alan Bible (D. - Nevada) I, Il. III. IV. BACKGROUND A. Grantee or Sponsor: - WICHE, P.O. Drawer "P'', Boulder, Colorado B. Coordinator: John W. Gerdes, Ph.D. C. Boundaries: Including the States of Idaho, Montana, Nevada, and Wyoming D. History 1. Initial planning grant: November 1966 2. Operational status achieved: March 1968 FUNDING A. Support through FY71: $7,676,000 B. FY72 award (projected): 1,764,000 C. Total support to date: 440, ORGANIZATION | A. Regional Advisory Group . 1. Chairman: Arthur R. Abbey, Executive Director, Wyoming Hospital Medical Service , 2. Composition (26 members) Practicing physicians Medical center officials Hospital administrators Other heaith workers Public health officials Members of the public Voluntary health agency repre- sentatives h. Others 2 TOTAL 26 B, Program staff: 27 Full-time equivalents oa rho aa oe WDof>nm > PROGRAM PRIORITIES A. Assist in subregional centers for continuing education B. Improve health centers for rural residents C. Stimulate health manpower development and utilization D. Provide specialized centers development OPERATIONAL ACTIVITIES The Mountain States RMP currently has 11 ongoing activities funded at a level of $784,200. At present a great deal of money (56 per cent) goes to continuing education and training. Most projects are aimed at provider groups. New and expanded roles for existing health professionals who will serve the disadvantaged rural and poor are being explored throughout the Region. While stimulating the improvement of existing resources, MS/PMP works cooperatively to create greatcr awareness of health manpower opportunities. @ VI. VII. SELECTED REGIONAL CHARACTERISTICS A. Population: 2.2 million 30% urban and 5% minority B. Health Resources 1. Medical schools - none 2. Hospitals and beds a. Mountain States - 131 short-term, non-Federal hospitals with 8,517 beds; 29% involved with RMP b. Nevada - 17 short-term, non-Federal hospitals with 1,967 beds 3. Physicians and nurses a. Mountain States - 1,536 physicians (MD's and DO's) 5,646 nurses b. Nevada - 463 physicians (MD's and DO's) 1,060 nurses ILLUSTRATIONS OF ACTIVITY The Mountain States Regional Medical Program as a whole is faced with the problems of providing quality health care in sparsely populated areas. The Region can never get enough physicians to Cover the vast rural areas or to serve the populace in every small community, therefore, emphasis is placed on assisting subregional centers for continuing edu- cation to seek solutions so that health practitioners will be better trained to help meet the needs in their surrounding communities. In summary, through continuing education offerings and such outreach programs as the Community Teams in Nevada and off-campus nursing work- shops a new rapport has become manifest among ‘the urban and rural health workers. . TRI-STATE RMP: Norris Cotton (R.-New Hampshire) I, Ii. Ill. BACKGROUND A. Grantee or Sponsor: Medical Care and Education Foundation, Inc., Boston B. Coordinator: Leona Baumgartner, M.D. C. Boundaries: Statesof Massachusetts, New Hampshire, and Rhode Island (some western counties of Massachusetts are also served by the Albany RMP). D. History 1. Initial planning grant: December 1967 2. Operational status achieved: February 1969 FUNDING A. Support through FY71: $5,336,000 B. FY72 award: 2,461,000 C. Total support to date: $7,797,000 ORGANIZATION A. Regional Advisory Group ‘ 1. Chairman: Louis A. Leone, M.D., Director, Department of Oncology, Rhode Island Hospital, Providence 2. Composition (62 members) a. Practicing physicians 27 b. Medical center officials 3 c. Hospital administrators 4 d. Voluntary health agency representatives 5 e. Public health officials 4 f. Other health workers 5 g. Members of the public 10 h. Others 4 TOTAL 62 B. Program staff: 43.0 Full-time equivalents PROGRAM PRIORITIES A. Supply distribution and education of health/manpower B. Institutional cooperation and regionalization C. Geographic gap filling , D. Medical care financing OPERATIONAL ACTIVITIES Tri-State RMP currently has 6 ongoing operational components with a funding level of $613,500. About 60% of that sum supports activities in the area of intensive coronary care. Better manpower utilization is the major focus of programs which are supported by approximately Vil. are being reoriented as the transition process indicates. 2 half of the available funds, the remainder supporting various types of patient care demonstrations. Approximately 59% of funds ($365,000) go to activities directed against health problems of the black popu- Jation in the three state area. SELECTED REGIONAL CHARACTERISTICS A. Population: 7,374,000 -- 89% urban, 5% minority B. Health resources 1. 5 medical schools; 1 two-year medical sciences school 2. 188 short-term, non-Federal hospitals with 33,075 beds, 20% of these are participating in RMP planning bodies and operational activities . 3, 11,200 active physicians, 35,800 active nurses ILLUSTRATIONS OF ACTIVITY — The major thrust of the Tri-State RMP is undergoing change in accord with changing emphasis of the national program. Greater emphasis is being placed on actions which affect the delivery of health care services, and changing the system, while attacks on individual disease problems are being de-emphasized. Existing disease control activities There has also been an increased emphasis on awarding of contracts to meet specific needs of the program, while awarding of grants for marginally related activities has. been de-emphasized. The end point has been a greater reliance on program expertise in meeting the Region's needs through priority programming. . During the past year the Tri-State Region instituted a $300,000 program "To assure that no patient with end-stage kidney disease will die from lack of necessary services.'' New England states other than those of the Tri-State Region are involved. The short-range objective is to develop a method of procuring donor organs and to identify problems of funding. The long-range objective is to furnish an adequate supply of cadaver organs to satisfy patients needs in various transplant units. NEW JERSEY RMP: Clifford P. Case (R.) @ I. BACKGROUND : A. Grantee or Sponsor: New Jersey Joint Committee for Implementation of P.L. 89-239. B. Coordinator: Alvin A. Florin, M.D. C. History 1. Initial planning grant: July 1967 2. Operational status: April 1969 II. FUNDING A. Support through FY71: $4,684,000 B. FY72 award (projected): 1,400,000 C. Total support to date: $6,084,000 III. ORGANIZATION A. Regional Advisory Group 1. Chairman: Richard J. Cross, M.D., Professor of Medicine, Rutgers Medical School 2. Composition (27 members) a. Practicing physicians 6 b. Medical center officials 3 c. Hospital administrators 5 d. Voluntary health agency @ representatives 2 e. Public health officials 3 f. Other health workers 2 g. members of the public -6— . TOTAL 7 B. Program staff: 20.5 Full-time equivalents TV. . PROGRAM PRIORITIES A. Improvement of services to urban poor B. Health manpower education C. Regionalization of health service resources V. OPERATIONAL ACTIVITIES ~ The region currently has twelve ongoing-operational activities with direct cost fumding of $814,000. Approximately one half of the projects are directed towards categorical diseases (heart, cancer and stroke) and the other half are muiti-categorical disease programs. In terms of primary focus, the New Jersey Program is directed rather evenly in three areas -- continuing education, patient care delivery and coordin- ation of health services. Close to half of the NJRMP's operational monies support inner city programs for blacks and spanish surname populations. VII. 2 SELECTED REGIONAL CHARACTERISTICS A. Population: 7.2 million -- 89% urban, 18¢ minority B. Health resources 1. 2 medical schools 2. 107 short-term, non-Federal hospitals with 25,247 beds; 58% (62) of these hospitals are involved in RMP planning and activities 3. 9,176 physicians (MD's and DO's); 24,900 active nurses (42,400 total) ILLUSTRATIONS OF ACTIVITY With more than 85% of New Jersey cancer patients being treated in community or general hospitals of 500 beds or less, it is the aim of the New Jersey RMP - Tumor Conference Boards to bring the most up-to- date medical information to the practicing physician responsible for cancer patient care. Thus, four agreements of affiliation have been executed with eighteen hospitals and negotiations are currently under- way with six additional hospitals. More than 10,000 patients have been brought under team review of the status of their disease, treat- ment modes, and rehabilitation plan. By March 1972, it is anticipated that 43 hospitals will be totaling an estimated 15,000 annual admissions for cancer. . , An objective of the project is to establish joint tumor conference boards for two or more hospitals. In Middlesex County, a demonstration of a joint conference board is planned for St. Peter's General Hospital (ongoing) and Middlesex Hospital. The encouraging factor in support of a joint program for these two institutions is the recent program amal- gamation of radiation therapy services in St. Peter's Hospital to serve ‘both hospitals. New Jersey RMP has provided staff and technical assistance to six Federally- designated Model Cities Programs through the assignment of full-time Urban Health Coordinators. In each city the Urban Health Coordinator helps plan and organize facilities and manpower resources to increase the effectiveness of local health care delivery systems. This project, now _in its second year of operation, serves a population of 200,000 dis- advantaged residents and has secured or applied for more than five million dollars from sources outside the RMP for funding health programs in these cities. Plans call for expanding the project to include 367,000 residents of the 14 newly approved State Community Development cities. A project has been developed to organize providers of services and health care facilities into a comprehensive care program especially directed at serving the disadvantaged and others without regular sources of medical care. The project, at Middlesex General Hospital, is designed - to serve a patient population of 4,000 persons with a program of pre- ventive medicine and treatment utilizing a full-time family health care team. ‘The project includes multiple funding from Medicaid, Medicare, hospital resources, and the RMP. wt nate, NEW MEXICO: Joseph M. Montoya (D.) © I. BACKGROUND A. Grantee or sponsor: : The University of New Mexico B. Coordinator: James R. Gay, M.D. C. Boundaries: Covers the entire State of New Mexico D. History 1. Initial Planning grant: October 1966 2. Operational status: July 1968 II. FUNDING A. Support through FY71: $4,331,000 B. FY72 award: 1,033,000 C. Total support to date: $5,364,000 III. ORGANIZATION A. Regional Advisory Group 1. Chairman: Hugh B. Woodward, M.D., Medical, Director, Mountain Bell Telephone Company 2. Composition (41 members) a. Practicing physicians 13 b. Medical center officials 2 c. Hospital administrators 4 d. Voluntary health agency representatives 2 ©} e. Public health officials 4 f. Other health workers 1 g. Members of the public 13 h. Other 2 TOTAL ~41— B. Program staff: 15 Full-time equivalents IV. PROGRAM PRIORITIES A. Manpower B. Prevention/health maintenance C. Availability of care -D. Quality of care V. OPERATIONAL ACTIVITIES . The region is currently supporting 12 operational activities in the amount of $461,317. Monies are divided among the following disease categories: heart 11%, cancer 7%, stroke 24%, and multicategorical 58%. Over 60% of the funds support training existing health personnel in new skills. 2 VI. SELECTED REGIONAL CHARACTERISTICS Vil. A. Population: 1.0 million -- 29% urban, 52% white B. Health resources 1. 1 medical school 2. 39 short-term general, non-Federal hospitals with 3,351 beds. 47% of hospitals participating in RMP 3. 969 physicians (MD's and DO's); 2,511 active registered nurses ILLUSTRATIONS OF ACTIVITY "Coronary Care Nurses Training Project'' - the project emphasizes the relationship between training of personnel in cardiovascular care and their functions in the Central monitoring units and remote stations. It will continue the four-week course to prepare nurses to work in a Central Monitoring Unit, and accelerate the teaching of personnel who will be working in the Remote Stations (one-week courses). The Remote Monitoring Project will establish eight Central Monitoring Units and 23 Remote Units to provide quality care to myocardial infarction victims in local facilities. The plan encompasses ap- proximately one-half of the small hospitals in New Mexico. Forty-seven registered nurses and two licensed practical nurses completed a training program "Nursing in the Coronary Care Unit." Three continuing education programs for CCU nurses have been planned. In conjunction with the remote monitoring project, approximately 30 nurses and other paramedical personnel received a one-week training program. This program will provide the nurses in smaller hospitals (remote units) with the knowledge and skills necessary for the nursing management of patients with coronary heart disease. SOUTH CAROLINA: Ernest F. Hollings (D.) . I. Il. Il. BACKGROUND A. Grantee or sponsor: Medical University of South Carolina, Charleston B. Coordinator: Vincent Moseley, M.D. C. Boundaries: Coterminous with State D. History 1. Initial planning grant: January 1967 2. Initial operational period: August 1968 FUNDING A. Support through FY71: $4,184,000 B. FY72 award: 1,341,000 C. Total support to date: $5,525,000 ORGANIZATION A. Regional Advisory Group 1. Chairman: James W. Colbert, M.D., Vice President, Academic Affairs, M.U.S.C. 2. Composition (70 members) a. Practicing physicians 37 b. Medical center officials 2 c. Hospital administrators 6 d. Voluntary health agency representatives 6 e. Public health officials . 3 £. Other health workers 3 g. Members of the public 10 -h. Other 3 TOTAL 70 BA Program staff: 30 Full-time equivalents PROGRAM PRIORITIES A. Redirection of program efforts to identify with emerging Federal and State initiatives in planning and delivery of health services. B. Continue to upgrade patient care by upgrading skills and abilities of health practitioners. OPERATIONAL ACTIVITIES South Carolina RMP currently has 13 operational activities underway at a cost of $724,000. The major emphasis of these activities are health manpower training and utilization and improved coordination of health services. SELECTED REGIONAL CHARACTERISTICS A. Population: 2.6 million -- 38% urban, 31% minority VII. B. Health resources 1. One medical school 2. 70 short-term, non-Federal hospitals with 9,213 beds. Sixty percent of hospitals participate with the South Carolina RMP 3. 1,955 physicians (MD's and DO's); 5,625 active registered nurses ILLUSTRATIONS OF ACTIVITY Noteworthy among continuing projects is one which is designed to improve and expand existing continuing education opportunities in the health sciences at the community level. It's efforts are directed to professional, technical, and allied health personnel. A kidney disease education and service program is aimed at expanding facilities to provide additional patient-training and provide equipment and professional support for home dialysis of the renal patient. WASHINGTON/ALASKA: | Warren G. Magnuson. (D.-Washington) I. Il. Tit. Iv e BACKGROUND A. Grantee or Sponsor: University of Washington School of Medicine B. Coordinator: Donal R. Sparkman, M.D. C. Boundaries: coterminous with those of the two states D. History 1. Initial planning grant: September 1966 2. Operational status: February 1968 FUNDING A. Support through FY71: $6,999 ,000 B. FY72 award: 1,868 ,000 C. Total support to date: 8,867,000 ORGANIZATION A. Regional Advisory Group 1. Chairman: C. Robert Ogden, President, North Coast Life - Insurance Company 2. Composition (43 members) Practicing physicians Medical center officials Hospital administrators Voluntary health agency representatives Other health workers Public health officials Members of the public ‘1 Other TOTAL a a anon UIW ee Pea tho DO DO GW UT bo -B, Program staff: 33.8 Full-time equivalents PROGRAM PRIORITIES . Improve the availability of care Improve the accessibility of care Improve the acceptability of care Maintain and improve the quality of care Assist in the containment of costs cf care e Maw > OPERATIONAL ACTIVITIES The region currently supports 20 operational activities at a level of 1,003,000. These include an emphasis on the coordination of health services and manpower development and training. Kidney disease is given emphasis with five components funded at a level of $125,000. VII. 2 SELECTED REGIONAL CHARACTERISTICS A. Population: 3.7 million -- 59% urban, 8% minority B. Health resources 1. University of Washington School of Medicine 2. 121 short-term, non-Federal hospitals with 11,863 beds. (Alaska - 13 hospitals, Washington - 108 hospitals). 3. Alaska - 183 physicians (MD's and DO's) Washington 4,208 physicians (MD's and DO's) 4. Alaska - 590 active registered nurses Washington 11, 361 active registered nurses ILLUSTRATIONS OF ACTIVITY One illustration of Washington/Alaska RMP's efforts to improve health services coordination is the development of an unusual cooperative arrangement between the 39-bed Willapa Harbor Hospital, located in a remote lumbering community on the West coast of Washington, and the 300-bed Virginia Mason medical center in Seattle. In 1969 the small community was serviced by one physician nearing retirement and a failing hospital for a population of 9,000 people. Two years later, through the aid of Washington/Alaska RMP's Com- munity Health Services Program, the town now has two resident physicians, an elected health board, a Comprehensive Health Planning agency, an emergency military helicopter service which flies patients to a specialized service center, as well as a cooperative arrange- ment between the two hospitals. The latter has produced a "hot- line" for consultation between the hospitals, air and land transpor- tation, arrangements for continuity of patient care, a drug inventory and formulary (resulting in a savings of $5,000 in one year), as well as continuing staff education for the smaller hospital. The success of this program has prompted Virginia Mason to request Washington/Alaska RMP to help in identifying other communities for similar arrangements. WEST VIRGINIA RMP: ‘Robert C. Byrd (D.) . ~ I. , Il.. Ill. BACKGROUND A. Grantee: West Virginia University Medical Center B. Coordinator: Charles D. Holland C. Boundaries: Coterminous with state D. History 1. Initial planing grant: January 1967 2. Operational status achieved: January 1970 FUNDING A. Support through FY71: — $1,716,000 B. FY72 award: 609 ,000 C. Total support to date: $2,325,000 ORGANIZATION A. Regional Advisory Group 1. Chairman: Charles E. Andrews, M.D., Provost, WVU Medical Center . 2. Composition (36 members) a. Practicing physicians 9 b. Medical center officials 3 c. Hospital administrators 6 d. Voluntary health agency representatives 7 e. Public health officials 2 f. Other health workers 3 g. Members of the public 5 h. Other 1 TOTAL 36 B. Program staff: 19.25 Full-time equivalents PROGRAM PRIORITIES A. Rural health care B. Delivery of primary health care services C. Preventive Services OPERATIONAL ACTIVITIES West Virginia RMP currently supports 5 operational activities in the amount of nearly $190,000. Only one of these programs is directed toward the control of a specific disease entity (i.e., stroke); the remainder are for the most part broadly based in the areas of cooper- ative delivery of health care services, communication networks, emergency medical systems, and general continuing education. Over half of the Region's operational funds ($100,000) go for the conduct VI. Vit. 2 of continuing education programs for physicians, primarily in the form of one project aimed at improving care through the use of physician|self-audit review. Another noteworthy effort (20% of funds) is directed toward improving primary care delivery to children in rural and remote areas of the State. SELECTED REGIONAL CHARACTERISTICS A. Population: 1.8 million -- 95% white, 62% rural B. Health resources , 1. 1 medical school; 11 schools of nursing; 7 schools of medical technology . 2. 74 short-term, non-Federal hospitals with 9,286 beds. 3. 1,500 active MD's, 111 active DO's; 5,001 active RN's. ILLUSTRATIONS OF ACTIVITY A. Rural School Health Program: This activity has been underway in West Virginia RMP since July 1971 and has as its major objectives the identification, implementation and evaluation of a prototype school health program which can be replicated in rural areas throughout the Nation. Program emphasis is on the prevention of health problems, particu- larly chronic diseases, and the more efficient usc of primary health care services. Having completed preliminary planning activities (e.g., collection of baseline data, rando sampling of health status of elementary school children, modification of school health record form), the program this year will begin the development of a new type of health manpower, the ''school health assistant; test the feasibility of employing various types of health personnel, including pediatric nurse practitioners and physicians' assistants; and initiate screening and referral services for children as well as educational programs for their parents. ¢ WISCONSIN: William Proxmire (D.) , a ~ I. II... Tif. BACKGROUND A. Grantee or sponsor: Wisconsin Regional Medical Program, Inc. B. Coordinator: John S. Hirschboeck, M.D. C. Boundaries: coterminous with state D. History 1. Initial planning grant: September 1966 2. Operational status: September 1967 FUNDING A. Support through FY71: $5,115,000 B. FY72 award: 1,764 ,000 C. Total support to date: $6,879,000 | ORGANIZATION A. Regional Advisory Group , 1. Chairman: Rodney Lee Young, J.D., County Judge - Lady Smith, Wisconsin : 2. Composition (45 members) a. Practicing physicians 9 b. Medical center officials 4 c. Hospital administrators $ d. Voluntary health agency representatives 2 e, Other health workers 6 f. Public health officials 2 g. Members of the public ll -h. Other 3 TOTAL 5 B. Program staff: 24.0 Full-time equivalents OPERATIONAL ACTIVITIES The region is currently supporting nine (9) operational activities in the amount of approximately $450,000. A majority of the funds are expended in the area of training existing health personnel in new skills, although significant portions of their budget are also directed towards patient care delivery and coordination of health services. The projects being carried out in the region are under ~ the aegis of a variety of institutions. For example, two smaller projects are directed from the medical school, two from hospitals, one from a voluntary health agency, another from a public health agency, etc. SELECTED REGIONAL CHARACTERISTICS A. Population: 4.4 million -- 493 urban, 95% white B. Health resources 1. two (2) medical schools 2 2. 154 short-term, ‘non~Federal hospitals with 22,385 beds 3. 44605 physicians (MD's and DO's); 14,084 active registered nurses ILLUSTRATIONS OF ACTIVITY A project recently funded by the Wisconsin RMP proposes to demonstrate the capability of the nurse associate in performing some tasks which are now performed by physicians. The project will ultimately prepare 68 physician-registered nurse teams. The initial focus will be on child health care because of the amount of work already done in this area. Because of the rural nature of Wisconsin, the project will then move into the area of family health or general practice, followed by the application of the concept to geriatrics practice. These teams will practice in various settings (single office, group practice, health center and outpatient department-community setting). Perfor- mance, role acceptance and cost effectiveness will be continually evaluated in order to anticipate problems and suggest modifications. Another activity recently funded -- "North Central Wisconsin Outreach"-- will hopefully serve as a prototype to be replicated elsewhere in the state. Addressing the problem of "no doctor towns ," in which there is little likelihood of recruiting a physician, this project hopes to develop Satellite Clinics. The clinics would be staffed only 2 and , one half days per week by a physician; the remainder of the time by a trained physician assistant. e. ; GREATER DELAWARE VALLEY RMP: Daniel Flood (D) Wilkes-Barre, Pennsylvania (District 11) a .I. BACKGROUND co A. . Grantee or Sponsor: University ‘City Science Center, Philadelphia B. Coordinator: Martin Wollmann, M.D. C. Boundaries: Region encompasses a mmber of counties in eastern Pennsylvania and southern New Jersey, and the state of Delaware, In general it covers the Delaware River basin area. D. History: 1, Initial planning grant: ‘April 1967 2. Operational status achieved: April 1969 ~ II. FUNDING . | A. Support through FY71: $ 8,837,753 © B. FY72 award (projected): 2,433,217 | C. Total support to date: $11,270,970 . III. ORGANIZATION oo , A. Regional Advisory Group , 1... Chairman: Leonard Wolf, Ph.D.; Vice President for Planning, University of Scranton, Scranton, Pennsylvania 2. Composition (61 members) a. Practicing physicians 14 b. Medical center officials 10 c. Hospital administrators , 8 d. Voluntary health agency representatives 5 e. Other health workers 2 . ff. Public health officials 9 _g. Members of the public 11 “h. Others. 12 TOTAL 61 B. Core staff: 46.08 full-time equivalents IV. PROGRAM PRIORITIES: Improving the (quality, quantity, and accessi-' bility of health care. V. OPERATIONAL ACTIVITIES: The Region currently has 16 ongoing operational activities with a total funding level of $796,667. Approximately 19% of funds are related to training of nurses for coronary care unit - operations. The large majority of remaining funds are devoted-to man- power development, including continuing education and training. ‘Activities are being reoriented in line with changing priorities, and include recruitment and reactivation of health care personnel, special training for respiratory disease care, etc. VI e VII SELECTED REGIONAL CHARACTERISTICS. fk. Population: 6,200,000 -- 72% urban, 97% white B.- Health Resources 1. 6 medical schools o : 2. 165 short-term, non-Federal hospitals with 40,000 beds 3. 13,300 practicing physicians (MD's and DO's) 28,500 registered nurses _ . ILLUSTRATIONS OF ACTIVITY Ten participating hospitals have joined in a 3 phase program of improving patient care through a deliberately planned process of pinpointing patient care deficiencies, determining the causes, and then developing training processes which will overcome those deficiencies in the future. This is‘a group approach to self- evaluation by physicians. Current year funding is supporting development and adoption of care criteria for at least three conditions. As that progresses other conditions will be assimi- lated into’ the process. wif II. Ill. IOWA RMP: Neal. i. Smith (D); Altoona (Fifth District) A to BACKGROUND A. Grantee or sponsor: University. of Iowa, College of Medicine B. Coordinator: Mr. Charles Caldwell (Acting) - C. Regional boundaries: coterminous with state . D. History: 1. Initial planning grant: December 1966 2. Operational status achieved: July 1968 FUNDING . . A. Support through FY71: $2,876,860 B. FY72 award 889 ,998 C. Total support to date: $3,766,858 ‘ORGANIZATION A. Regional Advisory Group . 1. Chairman: George Hegstrom, M.D.; practicing physician, McFarland Clinic, Ames | 2. Composition: (40 members) av a. Practicing physicians 8 b. Medical center officials 2 c. Hospital administrators 6 d. Other health workers 6 e. Public health officials 3 f. Members of the public 10 g. Voluntary health agency . representatives 1 h. Others 4 40 a TOTAL | B. Core staff: 17 full- time equivalents PROGRAM PRIORITIES — A. Assist in the development and testing of new and voluntary ways to deliver comprehensive quality care. B. Foster improved manpower utilization and distribution. C. Foster cooperative relationships, appropriate training and adequate data collection. OPERATIONAL ACTIVITIES: The-IRMP currently has 7 ongoing activities funded at a level of $352,700. Last year a large majority of that sum was devoted to continuing education and training. Planning for FY72 however, alters that picture and indicates a spending level of about $210, 000 for purposes. The current application requests funds for planning of a renal care program, an emergency medical services program, and a neo-natal care program. Vil. 1 Le . SELECTED REGIONAL CHARACTERISTICS A. Population: 2,825,000 -- 57% urban, 99% white B. Health resources | 1. University of Iowa College of Medicine \ 2. College of Osteopathic Medicine and Surgery . 3, 133 short-term, non-Federal hospitals with 15,333 beds; 62% involved with RMP . 4, 5,900 practicing physicians 17,000 active registered nurses ILLUSTRATIONS OF ACTIVITY In the Mason City area, emergency ambulance services are being offered ‘to rural residents with acute Myocardial Infarction. Upon being alerted, the emergency vehicle will pick up trained personnel, who will administer care enroute to the hospital where intensive care is available. An ancillary purpose is to reduce the need for a full range of emergency cardiac care services in isolated rural hospitals. Less emphasis is being given to operational component activities. Skills of core staff are being increased with a view toward assisting in development of Health Maintenance Organizations, increasing quality of care, cost reduction etc. In brief, project activities are giving way to planning and evaluation in regard to total program priorities and to related national priorities. _e e . I. Il. Ill, TV. ORGANIZATION r. ILLINOIS: Robert Michel (R), Peoria (District 18) i - NOTE: “Representative Michel's district falls into both the Illinois and the Bi-State RMP's. - . ’ BACKGROUND i A. Grantee or sponsor: Illinois Regional Medical Program, Inc. B. Coordinator: Morton C. Creditor, M.D. C. Boundaries: in general, coterminous with state; some overlap with Bi-State RMP in southern Illinois. D. History : 1. Initial planning grant: July 1967 2. Operational status: February 1970 FUNDING A. Support through FY71: $4,942,754 B. =FY72 award: - 2,000 , 000 - . . C. Total support to date: $6,942,754 A. Regional Advisory Group 1. Chairman: Dexter Nelson, M.D., practicing physician, - Princeton, Illinois 2. Composition (55 members) a. Practicing physicians 9 b. Medical center officials 12 c. hospital administrators 12 d. Voluntary health agency representatives 3 e. Other-health workers 4 . f£. Public health officials 3 g: members of the public 12 - TOTAL 55 B. Core staff -- 22.5 full-time equivalents OPERATIONAL ACTIVITIES: The region is currently supporting 9 , operational activities in the amount of approximately 758,000 direct costs. Monies are fairly evenly divided among heart, cancer, and stroke activities. Interestingly, no activities have continuing education and training as a major emphasis, while patient care demonstrations and coordination of health services account for almost 3/4 of available funds. Qver 50% of the funds support activities sponsored by voluntary health agencies. SELECTED REGIONAL CHARACTERISTICS A. Population: 11:1 million -- 83% urban, 87% white B. Health resources 1. 5 medical schools; 1 coliege of osteopathy 2. 256 short-term, non-Federal hospitals with 51,267 beds; 6% (16) of these are involved in RMP planning and activities. 13,100 physicians (MD's and 10's) . 35,500 active registered nurses. VI. ILLUSTRATIONS OF ACTIVITY ’ Helping to solve the manpower problem is a key program of the Bi- Staté Region. In this connection, the Bi-State RMP (Missouri and - Tilinois) obtained a waiver from the Missouri Council on Higher Education so as to make it possible for non-high school graduates to enter junior colleges for training as aide-level health workers. This is a part of Bi-State's larger effort of getting all neighbor- hood health personnel in the Region to work together in assessing their manpower needs and taking steps to meet them. In terms of direct patient care, the Bi-State RMP has established an intensive care facility at St. Louis City Hospital to serve an estimated 400 medically indigent stroke victims from the imner city each year. There has also been established, as an integral part of the project, a much-needed training unit for the purpose of instructing approximately 100 nurses from the Bi-State Region, in the critical early management of acute stroke. In’addition, this project has created cooperative arrangements among existing long-term care centers for stroke and set up a practical teaching program for therapists concerned with rehabilitation and, when necessary, custodial care of _ stroke victims throughout the Bi-State area. The Illinois RMP is supporting a demonstration project in Chicago in a low income community area to test the usefulness of an automated — medical history system in a Community Health Clinic. If the system is successful it will be incorporated into the regular funding schedule for the Valley Clinic. . — a oe TI. III. ‘ [ , , , KANSAS: Garner E. Shriver (R), Wichita (First District) ‘ - BACKGROUND A. Grantee or Sponsor: University, of Kansas Medical Center’ B. Coordinator: Robert Brown, M.D. C. Boundaries: coterminous with state D. History 1. Initial planning grant: July 1966 : 2. Operational status: June 1967 FUNDING ae A. Support through FY71: $5,961,663 B. FY72 award: 1,603,419 C. Total support to date: $7,565,082 ORGANIZATION : , . A. Regional Advisory Group i 1. Chairman: Robert Polson, M.D., practicing physician, Great Bend, Kansas 2. Composition (19 members) a. Practicing physicians 7 b. Medical center officials 3 c. Hospital administrators 3 d. Voluntary health agency representatives 1 e. Other health workers 1 f. Public health official — id g. Members of the Public 3 TOTAL Is” B. Core staff: 60.0 full-time equivalents OPERATIONAL ACTIVITIES: Kansas RMP currently has 9 funded operational activities. The level of support for these in direct costs is about _ $520,000 -- 85% of which supports activities in continuing education and manpower utilization and over 10% in the coordination of health services. Most of the programs do not support specific disease-related activities but programs of a more general nature, such as a medical library system, various training programs (including one designed to recruit health professionals from a Model Cities neighborhood). SELECTED REGIONAL CHARACTERISTICS A. Population: 2,250,000 -- 66% urban, 95% white B. Health resources ‘ oo 1. 1 medical school 2. 146 short-term, non-Federal hospitals with 11,805 total beds; 14% (21) are involved with RMP planning and activities. | °3. 2,333 active physicians (MD's and DO's) 6,895 active registered nurses (10,532 total) ILLUSTRATIONS OF ACTIVITY A unique attempt to alleviate the shortage of health manpower is being carried out by the Kansas Regional Medical Program. “Many registered ' nurses for one reason or another were not working and the KR\P established a program to promote the re-entry of registered nurses into the Region's health care system. For the past two years, the Kansas program has offered six three-week training courses. One hundred and thirty-three nurses have been trained and are employed in the 17 hospitals in Kansas City. Over 100 of the 133 nurses are employed on a full-time basis and 33 of this number hold supervisory positions. ; The Kansas Program is also supporting a project designed to provide and promote employment in the health fields and entry into the health professions for model neighborhood residents. The methodology employed in this project will center around the development of the health aide as a category of health personnel. The general purpose of this! project is to raise the level of knowledge and understanding among indigent residents about good health practices and to provide a means of entry of these citizens into health care professions. / @ a / / o i" II. Ill. ‘C. Total support to date $5,099 ,994 ‘Be Core Staff: 18.12 full-time equivalents . . a _ KENTUCKY (OHIO VALLEY RMP) : William Natcher (D) Bowling Green (Second District) J inn BACKGROUND 7 | os, A. Grantee or Sponsor: University of Kentucky Research Foufhdation, Lexington co . B. Coordinator: William McBeath, M.D., M.P.H. ee . C. Boundaries: Region encompasses the State of Kentucky and parts of southern Indiana and southwestern Ohio D. History —_ 1. Initial planning grant: January 1967 2. Operational status achieved: January 1969 FUNDING ‘ A. Support through FY71 . $3,594,092 B. FY72 support (projected) 1,505,902 (projected) © ORGANIZATION A. Regional Advisory Group . 1. Chairman: Donald I. Lowry, B.S., Technical Staff Director, Proctor and Gamble, Cincinnati, Ohio . 2. Composition (41 members) a. Practicing physicians 9 b. Medical center officials 7 c. Hospital administrators 5 d. Other health workers 3 e. Public health officials 2 f.- Members of the public 11 g. Voluntary health agency '“"* -yepresentatives 2 h. Others 2 TOTAL 41 PROGRAM PRIORITIES oo A. Development of health manpower’. - B. Improved delivery of ambulatory care OPERATIONAL ACTIVITIES: OVRXP currently has seven funded activities in the amount of $768,000. Slightly less than half that sum ($351,000) supports patient care demonstration activities. A somewhat smaller amount ($330,000) is devoted to continuing education and training type activities. Two components dealing with multiphasic screening: and home health care . are oriented toward control in the indigent population. VIl. - SELECTED REGIONAL CHARACTERISTICS 2 A. Population: 5,300,000 -- 52% urban, 90% white B. Health Resources ° t. 3 medical schools : 2. 157 short-term, non-Federal hospitals with 22,679 béds; 12% of these are involved with RMP activities - 3. 5,900 physicians (MD's and DO's) 17,188 registered nurses. ILLUSTRATIONS OF ACTIVITY Within the past year, the major thrust of the program has been delineated as "manpower development.'' To that end, a project has been proposed for initiation in 1972 which will train a new type _ health professional, the clinical associate. He will function under the general auspices of a physician and will perform specific activities designed to free the physician from routine duties, so he can concentrate on more critical needs. The training includes a preceptorship so the trainee can move into various segments of the medical care spectrum in accord with his abilities and desires. “ae II. Ill. VI. ’ MISSOURI (Mo.RMP): W. R. Hull, Jr. (D), Weston, Missouri (District 6) A 3 , ~ BACKGROUND . , A. Grantee or Sponsor: Curators of the University of Missouri, Columbia , - B. Coordinator: Arthur Rikli, M.D. oS C. Boundaries: coterminous with state but excluding the.St. Louis - © area ot , D. History oo 1, Initial planning grant: July 1966 2. Operational status achieved: .April 1967 FUNDING A. Support through FY71: $20,916,311 B. FY72 award (projected): 2,282,096 . - | Total $23,198,407 ORGANIZATION A. Regional Advisory Group , ; 1. Chairman: Robert E. Frank, Hospital Administrator 2. Composition (12 members) a. Practicing physicians b. Hospital administrators c. Members of the public d. Others’ fon TOTAL — B. Core staff: 48.57 full-time equivalents “PROGRAM PRIORITIES: Activities which relate to the program's mission, d.e., to serve as a "catalyst for changes which will provide the best health for residents of the region." OPERATIONAL ACTIVITIES ‘The region currently has underway 24 operational activities with a funding level of $1,231,641. Nearly half the funds support activities related to continuing education and/or patient services. Strong emphasis is placed on coordination. between health care service providers. Last year 40% of funds were expended for activities of that nature. Under RMP leadership, for example, 12 hospitals in the Green Hills area of Missouri'have banded together to discuss and act on mutual problems, including administrative practices, personnel needs and practices, etc. SELECTED REGIONAL CHARACTERISTICS A. Population: 4,677,400 -- 45% urban, 63% white B. Health resources: — a! Lo 1. 2 medical schools; 2 schools of osteopathy 2. 121 short-term non-Federal hospitals with 21,480 beds; 67% of these are involved with RMP. - — VII. A “.3.. 5,900 physicians (MD's and DO's) 11,200 active registered nurses “ILLUSTRATIONS OF ACTIVITY Sikeston Intensive Care -- A seven bed Intensive Care Unit has been established and become operational since initial funding in mid-1970. Through June 1971, 218 patients had been admitted, half of whom were categorized as cardiacs. During that period twelve pacemakers were installed and 36 defribrillations performed. The unit is currently operating at 75% capacity. High praise for the program and its training component has been received from participating institutions. he *” Il. II” BOw> r . . . NEW JERSEY: Edward J. Patten (D), Perth Amboy (District 15) 8 : , . BACKGROUND . Grantee or Sponsor: New Jersey Joint Committee for implementation Coordinator: Alvin A. Florin, M.D. ' - of P.L, 89-239. Boundaries:: coterminous with state History "1. Initial planning grant: July 1967 2. Operational status: April 1969 FUNDING A. Support through FY71: $4,684,186 B. FY72 award (projected): _1,400,000 C. Total support to date: $6,084,186 ORGANI ZATION A. Regional Advisory Group 1. Chairman: Richard J. Cross, M.D., Professor of Medicine, Rutgers Medical School . 2. Composition (27 members) a. practicing physicians 6 b. medical center officials 3 c. hospital administrators 5 d. voluntary health agency representatives 2 e. public health officials 3 f£. other health workers 2 g. members of the public 6 TOTAL 27~ B. . Core staff: 20.5 Full-time equivalents OPERATIONAL ACTIVITIES: The region currently has twelve ongoing operational activities with direct cost funding of $814,000. Ap- proximately one half of the projects’ are directed towards categorical diseases (heart, cancer and stroke) and the other half are multi- categorical disease programs. In terms of primary focus, the New Jersey Program is directed rather evenly in three areas -- continuing education, patient care delivery and coordination of health services. Close to half of the NJRMP's operational monies support inner city programs for blacks and spanish surname populations. SELECTED REGIONAL CHARACTERISTICS A. Population: 7.2 million -- 89% urban, 89% white B.. Health resources 1. 2 medical schools , 2. 107 short-term, non-Federal hospitals with 25,247 beds; 58% (62) of these hospitals are, involved in RMP planning and activities. ‘ 3. 9,176 physicians (MD's and DO's) 24,900 active nurses (42,400 total) V : VI. ILLUSTRATIONS OF ACTIVITY “With more than 85% of New Jersey cancer patients being treated in “community or general hospitals of 500 beds or less, it is the aim of the New Jersey RMP - Tumor Conference Boards to bring the most up-to- ’ date medical information to the practicing physician responsible for cancer patient care. Thus, four agreements of affiliation have been executed with eighteen hospitals and negotiations are currently under- way with six additional hospitals.’ More than 10,000 patients have -been brought under team review of the status of their disease, treatment modes, and rehabilitation plan. By March 1972, it is anticipated that 43 hospitals will be totaling an estimated 15,000 annual admissions for cancer. An objective of the project is to establish joint tumor conferente boards for two or more hospitals. In Middlesex County, a demonstration of a joint conference board is planned for St. Peter's General Hospital (ongoing) and Middlesex Hospital. The encouraging factor in support of a joint program for these two institutions is the recent program amalgamation of radiation therapy services in St. Peter's Hospital to serve both hospitals. New Jersey RMP has provided staff and technical assistance to six Federally-designated Model Cities Programs through the assign- ment of full-time Urban Health Coordinators. In each city the Urban Health Coordinator helps plan and organize facilities and manpower resources to increase the effectiveness of local health care delivery systems. This project, now in its second year of operation, serves a population of 200,000 disadvantaged residents and has secured or applied for more than five million dollars from sources outside the RMP for funding health programs in these cities. Plans call for - expanding the project to include 367,000 residents of the 14 newly approved State Community Development cities. A project has been developed to organize providers of service and health care facilities into a comprehensive care program especially ' directed at serving the disadvantaged and others without regular sources of medical care. The project, at Middlesex General Hospital, is designed to serve a patierft population of 4,000 persons with a - program of preventive medicine and treatment utilizing a full-time family health care team. The project includes multiple funding from Medicaid, Medicare, hospital resources, and the RP. Il. ITI. ‘ TEXAS: Robert R. Casey (D), Houston, (District 22) x a . BACKGROUND A. Grantee or Sponsor: ‘University of Texas System B. Coordinator: Charles McCall, M.D. C. Boundaries:. coterminous with state D. History 1. Initial planning grant: January 1966 2. Operational status: July 1968 FUNDING A. Support through FY71 $ 8,190,302 B. FY72 award: 1,650,386 C. - Total support to date: $ 9,840,688 | ORGANI ZATION , | * A. Regional Advisory Group 1, Chairman: N. C. Hightower, M.D., Scott and White Hospital and Clinic, Temple 2. Composition (50 members) a.. practicing physicians 12 b. medical center officials 13 c. hospital administrators 9. d. voluntary health agency representatives 3 e. other health workers 2 f. public health officials 3 g. members of the public 8 — ‘TOTAL wT) B. Core staff: 24.0 Full-time equivalents OPERATIONAL ACTIVITIES: The region is currently conducting 19 operational activities with $945,000 in direct costs. Approximately 60% of the TRMP activities are in the area of general continuing education and 30% of their monies are directed towards patient care delivery problems. Categorically speaking, (36%) of their projects ° are for. stroke-related diseases and (26%) are in the area of cancer. Texas is supporting two projects directed towards blacks and chicanos ~—e (one of which is coordinated with Model Cities). SELECTED REGIONAL CHARACTERISTICS A. Population: 11.2 million -- 80% urban, 87% white B. Health resources 1. 4 medical schools 2. 492 short-term, non-Federal hospitals with 46,149 total beds; 14% (67) of these are involved in the RMP oo 3. 11,700 physicians (MD's and DO's). 20,000 active registered nurses, (30,000 total) . ILLUSTRATIONS OF ACTIVITY One of the more significant projects in the Texas region has been the implementation of a program aimed at the prevention of morbidity and mortality from cervical cancer. Application of exfoliative cy tology screening is taking place at 109 satellite clinics under the aegis of the Southwestern Medical School at San Antonio. Approximately 3,700 smears are being performed each month with 40,000 women tested each year. Preliminary findings indicate that the program is finding more and earlier lesions with more favorable outlook than expected,. | | \ re. TRI-STATE RMP: Silvio Conte (R) Pittsfield, Massachusetts (District 1) NOTE: . Representative Conte's district includes territory served by both ,the Tri-State and the Albany. Regional Medical Programs. I. BACKGROUND A, Grantee or Sponsor: Medical Care and Education Foundation, Inc., Boston B. Coordinator: Leona Baumgartner, M.D. C. Boundaries: States of Massachusetts, New Hampshire, and Rhode’ Island (some western counties of Massachusetts are also served by the Albany RMP). . D. History 1. Initial planning grant: December 1967 2. Operational status achieved: February 1969 -II, FUNDING A. Support through FY71: $5,459,941, - B. FY72 award: 2,461,425 C. Total support to date: 7,921,566 III. ORGANIZATION © A. Regional Advisory Group 1. Chairman: Louis A. Leone, M.D., Director, Department of Oncology, Rhode Island Hospital, Providence 2. Composition (62 members) ; a. Practicing physicians 27 s . b. Medical center officials 3 c. Hospital administrators 4 to. d; Voluntary health agency representatives . 5: e. Public health officials 4 f. Other health workers 5 . g. Members of the public 10 “h. Others 4 4 TOTAL 2 B. Core Staff: 43.0 Full time equivalents IV. OPERATIONAL ACTIVITIES ‘Tri-State RMP currently has 6 ongoing operational components with a funding level of $613,500. About 60% of that sum supports activities in the area of intensive coronary care. Better manpower utilization is the major focus of programs which are supported by approximately half of the available funds, the remainder supporting various types of patient care demonstrations. Approximately 59% of funds ($365,000) © go to activities directed against health problems of the black popu- Jation in the three state area. - SELECTED REGIONAL CHARACTERISTICS A. Population: 7,374,000 -- 82% urban, 97% white B. Health resources a es 1. 5 medical schools; 1 two-year medical sciences school - 2. 188 short-term, non+Federal hospitals with 33,075 beds , 20% of these are participating in RMP planning bodies and — operational activities 3, 11,200 active physicians; 35,800 active nurses ILLUSTRATIONS OF ACTIVITY The major thrust of the Tri-State RMP is undergoing change in accord with changing emphasis of the national program. Greater emphasis is being placed on actions which affect the delivery of health care services, and changing the system, while attacks on individual disease problems are being de-emphasized. Existing disease control activities are being reoriented as the transition process indicates. There has also been an increased emphasis on avarding of contracts to meet specific needs of the program, while awarding of grants for marginally related activities has been de-emphasized. The end point has been a greater reliance on program expertise in meeting the Regions’ needs through priority programming. An intensive coronary care demonstration project of the Albany RMP is: located at Bershire Medical Center in Pittsfield, Massachusetts. To date it has trained 190 mrses from 29 hospitals. These hospitals © account for 68% of general:hospital admissions in the Albany Region. During the past year the Tri-State Region instituted a program ''to assure that no patient with end-stage kidney disease will die from. “Jack of necessary services." New England states other than those of the Tri-State Region are involved. . The short-range objective is to - develop a method of procuring donor organs and to identify problems of funding. The long-range objective is to furnish an adequate supply of cadaver organs to. satisfy patients needs in various transplant units. ~ ? II. Ill. v.- paw> A VIRGINIA RMP: J. Kenneth Robinson (R) Winchester (Seventh District) . . BACKGROUND ‘Grantee or Sponsor: Virginia Regional Medical Program, Inc. Coordinator: Eugene R. Perez, M.D. Boundaries: coterminous. with state ‘History a ‘ 1. Initial planning grant: January 1967 2. Operational status achieved: January 1970 - FUNDING A. Support through FY71: $2,445,755 B. FY72 support: 789 ,488 C. Total support to date: $3,235,243 ORGANIZATION — . A. Regional Advisory Group 1. Chairman: Mack I. Shanholtz, M.D., Commissioner of State Health Department ° 2. Composition (36 members) Practicing physicians 1 Medical center officials Hospital administrators Voluntary health agency Public health officials Other health workers Members of the public TOTAL 36 B. Core staff: 20.3 full-time equivalents . wT tho an op NIU BST OPERATIONAL ACTIVITIES: VRMP currently has 7 funded operational activities. The level of support for. these in direct costs. is about $372,000, 85% of which supports activities in continuing education for health professionals. Approximately 40% of the funds are. being expended in the area of heart disease, over 10% for stroke-related activities and about 5% in the area of cancer. SELECTED REGIONAL CHARACTERISTICS A. Population: 4,648,000 --.63% urban, 81% white B. Health resources , J. 2 medical schools 2. 102 short-term, non-Federal hospitals with 16,385 beds; 15% . of these are involved in RMP activities 3. 4,631 physicians (MD's and DO's) 11,500 active registered nurses “ILLUSTRATIONS OF ACTIVITY The VRMP is. supporting a program to (1) educate and train nurses and physicians in the treatment of patients with myocardial’ infarction a (2) provide consultative assistance to coronary care units. Over 50 health professionals, representing 19 hospitals, have been trained . to date, and the project director has provided consultation to six .conmunity hospitals either planning or operating CCU's. | ‘The Medical College of Virginia, under the sponsorship of the VRMP, has undertaken a project to demonstrate that the case of stroke patients in rural communities can be improved by up-grading the. knowledge and skills of physicians and other health personnel through a relationship with a medical center. The incidence and management of stroke is being studied in five small rural communities; (6) ° general practitioners, (105) nurses and nursing. assistants and a number of family members are participating in educational programs related to care and rehabilitation of stroke patients. ‘le I. IT. Regional Medical Programs Budget Summary 1971 1972 1973 Estimate Estimate Estimate Activity or Subactivity Pos. Amount Pos. Amount Pos. Amount Regional Medical Programs Grants and contracts.... 56 1/ 74,735 56 1/ 139,300 56 1/ 125,10C Direct operations....... 178: 4,025 169 4,602 194 5,051 Program direction and management services..... 67 1,394 68 1,117 68 1,136€ 245 80,154 237 145,019 262 131,287 1973 Program Summary FY'72 ADD OR SUBTRACT FY'73 56 RMP's 98.2 0 98.3 CONTRACTS 4.3 0 4.3 CANCER CONSTRUCTTON 5.0 -5.0 0 HMOS 16.2 -16.2 0 EMERGENCY MEDICAL .. - SERVICE 8.0 +7.0 15.0 AHEC 72.5 0 7.5 139.3% -14.2 125.1 Grants & *Smoking and Health Contracts taken out, print shows 140,656 1/ Represents regions. Contracts ~ 5.1 Direct Ops. ‘1.1 Direction & Management 131.3 Regional Medical Programs } ‘Budget Summary (Dollars in thousands) 1971: 1972 1973 Estimate Estimate Estimate Activity or Subactivity Pos. Amount Pos. Amount Pos. Amount Regional Medical Programs: Grants and contracts.... 56 1/ 74,735 56 1/ 139,300 56 1/ 125,100 Direct operations....... 178 4,025 169 4,602 194 5,051 Il. 1973 Program Summary Funds will be needed for programs to enable existing health manpower to provide more and better care and training and more effective utilization of new kinds of health manpower. New funds will be used to plan and develop Area Health Education Cent7°rs, which will be major sources of manpower for Health Maintenance Organizations, Experimental Health Service Delivery Systems and other comprehensive health care systems. Activities 2imed at improvi: . the accessibility, efficiency, and quality of health care will provide opportunities to increase the rate of implementa- tion of systems, innovations and new technology. Rural health care systems will be develuped that are compatable with needs of rural areas. Development o emergency healin care systems will bring tog-ther better transportation © . rvices, communication which would tie hospitals, transportation facilities and other emergency organizations into rapid response systems, and emergency medical centers with specially trainc ’ doctors and nurses. The provider- initiatea activities leadiug to a greater sharing of health facilities, manpower, and other resources will provide the opportunity to show how scarce resources can be linked together efficiencly. Further Regional Medical Prugrams wiil be strengthened so it will be possible for all to accomplish their objectives and goals. Regional Medical Programs, particulzrly the weaker ones, will be provided the strong leadership required by the expansion and redirection of Regional dedical Program activities. The rapid expansion of Regional Medical Program activity and the movement into new areas of emphasis will require additional development of policy guidance and criteria for project development. - Increased technical assistance will be needed for new projects in areas involving new techniques and innovative delivery patterns, more effective use of new kiuds of health manpower, and th2 quality of care guidelines. 1/ Represents regions. i Regional Medical Programs I. Budget Summary (Dollars in thousands) 1971 1972 1973 Estimate Estimate Estimate Activity or Subactivity Pos. Amount Pos. Amount Pos. Amount Program direction and ; management services.... 67 1,394 68 1,117 68 1,136 Il. 1973 Program Summary This activity provides for a central staff'needed in planning, directing, and evaluating the broad scope +f program activities in the RMPS; maintains effective communications and information links with the 56 local regional medical programs and the general public, and provides administrative Management services. DEPARTHENT OF HEALTH, EDUCATION, AND WELIARE HEALTH SERVICES AND MENTAL UEALTH ADMINISTRAT ION © Regional Medical Prograns Amounts Available for Obligation 1972 1973 Appropriations ccccsccascccccscceeces $102, 771,000 $131,287,000 Real transfer to: | “Operating expenses, Public Buildings Service, " General | Services Administration, sete e eee - 1,000 | Comparative transfers to: . a | “Departmental management," OS...... ~ 27,000 oe "Preventive health services"... .eee ~— 2,189,000 © : --- | Subtotal, budget authority....sseeee 100,554, 000 131, 287,000 Un ier’ 4d balance, start of year.. ’ 44,500,000 _-- eo. balance, lapsing....eee. ~35,000 --- Total, obligationS.s.sicesecceceee, $145,019, 000 $131, 287,000 8 , Obligations by Activity oe °s 1972 1973 _Increase or Page Estimate Estimate | ._: Decrease ' Ref. Pos. Amount Pos. Amount Pos, ‘ Amount - ‘ ’ Regional medical programs: (a) Grants and contracts... --- $139,300,000 --- $125,100,000 ~~~ ~$14 ,200 ,000 (b) Direct . F057 oO LLG OCD operations.. 169 4,602,000 194 55403;000 +25 + -501-5000 Program direction ‘ and management 4 (3b, O° 7 SG, ¢°O SErViceSss...sees 68 1,117,000 68 __—*4084;000_- --~ —~—33000 Total obligations... 237 $145,019,000 262 $131,287,000 +25 -$13,732,000 Obligations by Object 1972 1973 “Increase or _ Estimate Estimate Decrease Total number of permanent ; POSELELONS. . ee eee eee ee eeeees 237 262 . + 25 Full-time equivalent of all — other positions..........65 51 51 -- Average number of all Ginployees...... pee eeeeceet . 260 277 + 17 Personnel compensation! ' Permanent positions........ $3,465,000 ' $3,788,000 + $323,000 Positions other than ; PELMANENE.. cc ceceeeccvees 309 ,000 809 ,000 --- Other personnel compen- Sation...csees eect ene eeas 57,000 57,000 --- Subtotal, personnel compensation... ..reeee 3,831,000 4,154,000 + 323,000 &.. DeneLits....eceeaes 378,000 © 412,000 + ~ 34,000 Fravel and transportation of persons..... teen eeeeeeaee 289,000 314,000 + 25,000 fransportation of things..... 35,000 - 35,000 --- Rent, communications and ULLLITICS. cc ce cece eee ee eens 367,000 368,000 + -1,000 Printing and reproduction.... 87,000 87,000 . -— = Jther services. ..escsceeseess 634,000 716 ,000 + 82,000 \ . ; Project contractS.......e6. ‘ 4,300,000 4,300,000 --- Supplies and materials....... 59,000 62,000 + "3,000 Equipment ...sseeeee se aeees see 39 ,000 39 ,000 “= Srants, subsidies and . contributions...eses. soeeee 135,000,000 120, 800 ,000 ~ 14,200,000 @:: obligations by ODJOCE ccc eee ececcanes . $131,287,000 -$13, 732,000 §145 ,019,000 Summary of Changes Dresses cvrigationssccccccescssvcsccscesseesessesveee $145,019 ,000 1973 estimated obligationS..s.eseeceeeas seas see eee eee ene ceeeee 131,287,000 fe Net Change. .ccecceecesccsececevesessensres eee e eee -13,732 ,000 i ______ Base Change from Base Pos. Amount Pos. Amount _ Increases: : | A. Built-in: 1. Working capital fund _ FP58 000 CHALECS ccc ccc ene ecceeeenee | 2. Within-grade pay increase..., 4133,000 3. Military Pay Bill (P.L. 92-129) + 9,000 B. Program: 1. Upward mobility....... arr ; + 28,000 2. Emergency medical services... +25 +350 ,000 Total, increases...... . 4:25 +578 ,000 Decreases: A. Built-in: 1. Two-days less payerssseeeees ~27 ,000 B. Program: 4. Savings realized from cuts in positions . in 1972 and reduction. in. average grade -83,000 . 9. Grants and - CONELACES CL ec cece cece eee 139, 300,000 -14,200,000 | \ _ -14,310,000 Total, decreaseS......% Total, net change....cececserccuees +25 -13,732,000 Summary of Changes ©... authority.....6. Cece c ete eect e ee eee eee et eeneeeetne $100 ,554°,000 1973 budget authority......... eee e weenie Cee eee e eee | 131,287,000 Net chanpe..scccsseecees Lc cveceeveveueeenseveseseceeeees $30,733,000 Base Change from Base Pos. Amount Pos. Amount Increases: A. - Built-in: 1. Working capital fund . Charges. .csceceerenees . +$58 ,000 2. Within-grade pay - Increases. sseeeeee wean _ +133 ,000 3. Military Pay Bill (P.L. 92-129) . 4 + 9,000 B. Program: 1. Upward Mobility......... , . + 28,000. 2. Emergency medical services. oy a +25 +350 ,000 3. Grants and contracts.... 94,800,000 +30, 300 ,000 © Total, increases..... . +25 +30,878,000 Decreases? A. Built-in: - 27,000 1. ‘Two-days less paye-sceee- b. Program: . -1. Savings realized from cuts in positions in 1972 and reduction in average grade -118 ,000 Total, decreases....++ -145,000 Total, net change.....+.4...-. ~ +25 +30,733,000 © Explanation of Changes Increases: A. B. Built-in: “An increase of $58,000 is included for working capital fund charges. $133,000 is included for within-grade pay. increases. $9,000 is included for Military Pay Bill increase. (P.L. 92-129) 0 y Pay ' Program: $28,000 is included for Upward Mobility. 25 positions and $350,000 are incluited for the new Emergency Medical Services Program. These resources will be used to provide planning and evaluation, professinnal and technic ’ assistance, standard setting, project review, project grants and contracts management, data systems development, and program direction and management services. @: A. B. Built-in’ $27,000 is excluded for two days less pay. Program: $83,000 is excluded because of savings realized from cuts in positions in 1972 and reduction in average grade. The decrease of $14,200,000 in 1973 reflects adjustments for two non- recv~ring items in 1972 of $21,200,00C and an increase of $7,000,000 for a new program of grants and contracts for emergency medical services. These c funds will t used to support 5 projects in addition to the 5 funded in 1972. . \ © Explanation of Transfers Real transfer to: "Operating expenses, Pubiic Buildings Service," General Services Administration Comparative transfers to: "Departmental management" - “Preventive health services" 1972 Estimate ~$1,000 ~27,000 -2,189 ,000 Purpose Transfer to GSA for rental of space. Transfer of Public Affairs function to Office of the Secretary. Transfer of National Clearinghouse for Smoking and Health. ew aaAaenc Ean cae Significant Tien _ Approprigtions. [t 1972 House _ Report Zosearch and dc mons tra tion grants . Committee directed that the Pediatric Pulu sohary Program be con- tinved.in 1972 at not less than the 1971 level. (page 16 of the report). 1972 Senate Report Research and demonstration grants 1.- Committee expressed keen interest in a long-range plan to develop interrelated kidney pro- grams aimed at providing therapy for the 8,000 to 10,000 Americans who fell victim to kidney disease oe” (page 25 of the report). 2. Committee directed that a portion of RMP. increases be used to prove out HNO programs. (page 25 of the report). 3. Committee concurred with the Nouse and further directed that all pediatric pulmonary projects ongoing -in 1971 were to be funded in 1972. (page 26 of the report). 3 in House avd Senate Committee Reports. Action token or to be taken Eight Pediatric Pulmonary proj-- ects were funded at a $1,000,009 evel in 1971. It is anticipated that the 1972 and 1973 levels will be approximately the.same. 1. Recent studies have bepun to develop long-range plans for combat- ing end-stage kidney disease. There will be much greater emphasis on placing each project in the context of both regional and national needs. In keeping with expanded plans, funds invested in these activities will increase from $4,800,000 in 1971. to an estimated $8,500,000 in 1972. 2. °° Up to $16,200,000 will be used to fund the planning and development of HMC's in 1972. 3. All projects ongoing in 1971 which have been included in their applications by the RMP's affected have been approved for 1972. At the same time, final funding decisions have been left to the individual regions within their own systems of priorities. * Loo Sisnificant Items {fn House and Senate __ Appropriations Comaittce Reports = (Cont'd) af “ . 1972 Senate Report (Cont'd) 4. Comittee directed HSMHA and the National Advisory Council to _ address themselves to guestions _; ‘surrounding ihe flexibility and individuality. allowed RMP's which could. impair their effectiveness. (page 25 of the report). 5. Committee directed that increased funds be targeted to a review of the availabi” ity of and access to special surgical teams in open~heart and coronary artery surgery, especially in cl. District ; of Colur ia. (page 25 of the report). | @ i Beitehienneats sing sean erences ! ae 1972 Conference Report . ‘Research and demonstration grants Q Committee agreed that no exist- i ing regional. medica] program is to jreceive a lesser amount in FY 1972 than’ it received in 1971. (page 6 -of the report). a | ol 4 @ | Ae Over the past year specific cri- teria and policy have been developed and issued to the RMNP's. There has been a marked increase in efforts of staff to meet with Regional Advisory, Groups. In January, 1972, a National Coordinators Conference was held. it brought together all coordinators, RAG members from every region and Council members to discuss with staff issues, policy, etc. 5. A new survey of cardiovascular surgery facilities-in the District of Columbia is currently in progress ‘under the auspices of the Metropoli-. tan Washington RMP. A report will be available before 6/30/72. In addition, gional Medical Programs Service, in order to carry out Sec. S07 of the Public Health Service Act; Contracted with the Joint Comnission on Accreditation of Hospitals to develop the Secretary's Lists. One of the criteria which will be used in identifying eligible institutions for those lists will be their par-- ticipation in a regional plan for the optimal development and utiliza- tion of specialized facilities and services. All RMP‘'s will, where consis— tent with National Advisory Council approved funding levels, be funded at or above the FY 1971 level. Authorizing Legislation 1973 ; Appropriation I lation so Authorized requested _ Public Health Service Act Title IX -- Education, Research, Training, and Demonstrations in the Ficlds of Heart Disease, Cancer, Stroke, Kidney Disease, and. other Related Diseases..... . $250 ,000,000 $120,800,000 PUBLIC HEALTH SERVICE ACT The Public Health Service Act, Title IX, Education, Research, Training dna Demonstrations in the Fields of Heart Disease, Cancer, Stroke, Kidney Disease, and other Related Diseases. : "Sec. 900. The purposes of this title are-- "(a) through grants and contracts, to encourage and assist in the establish- ment of regional cooperative arrangements among medical schools, research insti- tutions, and hospitals for research and training (including continuing education), for medical data exchange, and for demonstrations of patient care in the fields of heart discase, cancer, stroke, and kidney disease, and other related diseases; "(b) to afford to the medical profession and the medical institutions of. the n through such cooperative arrangements, the opportunity of making availabie to their patients the latest advances in the prevention, diagnosis, and treatment and rehabilitation of persons suffering from these discases; "(c) to promete and foster regional linkages amcng health care institutions and providers so as to strengthen and improve primary care and the relationship between specialized and primary care; and "(d) by these means, to improve generally the quality and enhance the capacity of the health manpower and facilities available 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, and in cooperation with practicing physicians, medical center officials, hospital administrators, and representatives from appropriate voluntary health agencies.' 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, $120,000,000 for the next fiseal 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 30, 1973, for grants lo assist public or nonprofit private universities, cal schools, research institutions, and other public or nonprofit private institutions and agencics 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. Of the sums appropriated under this section for the fiscal year ending June 30,1971, nosgmore than $15,000,000 shall be available for activities in the field of k disease. Of the suns appropriated under this section for any fiscal year er 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 portions of the appropriations pursuant to this. section as the Secretary may determine, but not exceeding 1 per centun thereof, shall be available to the Secretary for evaluation (directly or by grants or contracts) » | of the program authorized by this title." an "MULT LP ROGRAM SERVICES Nooe, 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 non- profit private agencies or 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 prevention, nosis, or treatment 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 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." Public Law 91-515 9lst Congress, H. R. 17570 October 30, 1970 Ain Set To amend titles JW and 1X of the Public Health Service Act so as {o revise, extend, and improve the prograns of research, investigation, education, training, aud 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, TITLE I-AMENDMENTS TO TITLE IX OF THE PUBLIC JIEALTH SERVICE ACT. . Src. 101. This title may be cited as the “IIeart Disease, Cancer, Stroke, and Kidney Disease Amendments of 1970”. Src. 102. Section 900 of the Public lIealth Service Act is amended to read as follows: “PURPOSES : «Src, 906. 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 insti{utions, and hospitals for research and training (including continuing education), for medica] 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 medica) insti fntions of the Nation, through such cooperative arrangements, the opportunity of making available to their patients the latest advances in the prevention, diagnosis, and treatment and relia- bilitation 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 pri- mary care; and “(d) by these means, to improve generally the quality and enhance the capacity of the health manpower and facilities available to the Nation and to improve health services for persons vesiding in areas with limited health, services, and to accomplish ihese 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 cooper- ation with practicing physicians, medical center officials, hospi- tal administrators, and representatives ‘from appropriate _ vYoluntary health agencies.” “Src. 103. (a) (1) ‘Phe first sentence of section 901(a) of such Act 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 80, 1971, $150,000,000 for the fiscal year ending June 80, 1972, and $250,000,000 for the fiseal year ending June 30, 1972”, (2) Such first sentence is further amended by striking out the period after “title” and inserting in lier 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 and inserting in lieu thereof the following: “Of the sums appropriated under this section for the fiscal year ending June 80, 1971, not more than $15,000,000 shall be available for activities in tho field 52-067 © Public Health Service Act, amendments. Citation of title. 79 Stat, 926, 42 USC 299, 84 SPAT. 1297 84 STAT. 1298 Appropriations. 82 Stat, 1005, 42 USC 299a,. Fumds, limi~ tation, 79 Stat. 9263 82 Stat. 1006. 42 USC 29984 84 STAT. 1298 84 SPAT. 1299 42 USC 299b. 42 USC 299¢.° 42 USC 299d. National Ad~ visory Council on Regional Medical Pro» Erense 42 USC 299e,. Pub, Law 91-515 2 .. 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 fiscal year for grants for new construction.” (b) Section $01 of such Act is further amended by adding at the end thereof the following new subsection: , “(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, supphes, 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 em- ployee 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 yequest. of such recipient and for the purpose of carrying out the regional medical program fo which the grant under this title 1s made.” Src. 104. Section 962(a) of such Act is nmended 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 “t raining, 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 ‘“Gnecludes? and inserting in lieu thereof “means new construction of facilities for demonstrations, research, and training when necessary to carry out regional medical programs”. Src, 105. Section 903(b) (4) of such Act is amended— (1) by striking out “voluntary health agencies, and” and insert- ing in lien 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 Vetcrans’ 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 “eed for the services provided under the program” and inserting in lieu 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 Seerctary)”. 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_lieu thereof the following: “section 903(b) (4), if opportunity has been provided, prior to such 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”. Src. 107. (a) Section 905(a) of such Act ig amended to read as follows: “Spc. 905. (a) ‘The Seerctary may appoint, without regard to the civil service laws, a National Advisory Council on Regional Medical Programs. The Council shal} consist of the Assistant Secretary of Health, Education, and Welfare for Health and Scientific Affairs, who October 30, 1970 -3- Pub, Law 91-515 shall be the Chairman, the Chief Medical Director of the Veterans’ Administration who shall -be an ex oflicio 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 eare administration, or public affairs. At least. tavo of the appointed members shall be practicing physicians, one shall be outstanding in the siudy or health care of persons swifering from heart disease, one shall he outstanding in the study or health care of persons saffering from cancer, one shall he outstanding in the study 84 STAT. 1300 or health care of persons suffering from stroke, one shal] be outstand- . ing in the stndy or health care of persons suffering from kidney disease, two shall be oulsfanding in the field of prevention of heart disease, cancer, stroke, or kidney disease, and four shall be members of the public.” (b) Of the persons first appointed under section 905(a) of the Public Heaith Service Act to serve as the four additional members of the National Advisory Council on Regional Medical Prograins author- ized 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 appointinent. ‘ (c) Members of the National Advisory Council on Regional Medical Programs (other than the Surgeon General) in oflice on the date of enactment of this Act shall continne in office in accordance with the term of office for which they weve Jast appointed to the Council, Src. 108, Section 907 of ‘such Act is amended by striking out “or stroke,” and inserting in lien thereof “stroke, or kidney disease,”. Src. 109. Section 909(a) of sueh Act is amended by inserting “or contract” afler “grant”? each place it appears therein. Sec. 110, (a) Section 910 of such Act is amended to read as follows: “sp ULTIPROGRAM. SERVICES Seo, 910, (a) To facilitate interregional cooperation, and develop improved national capability for delivery of health services, the Seere- tary is authorized to utilize funds appropriated wider this title to make grants to public or nonprofit private agencics or institutions or com- binations thereof and to contract for— “(4) programs, services, and activities of substantial use to two or nore regional medical programs; . “(2) development, trial, or demonstration of methods for con- trol of heart discase, cancer, stroke, kidney disease, or other related diseases: ; “(3) the collection and study of epidemiologic data related to any of ihe diseases referred to in paragraph (2) ; . “(4) development of training specifically related to the pre- _ vention, dingnosis, or treatment 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 devcloping new means for the deliv- ery of health services concerncd with the diseases with which this title is concerned. Tern of office. 79 Stat, 930, 42 USC 2992. 42 USC 2993, 82 Stat, 1006, 42 USC 299]. 84 SPAT. 1301 42 USC 299b» 299g, 2991. Pub, Law 91-515 -4- October 30, 1970 “(c) The Seerctary is authorized to support research, studies, investigations, training, and demonstrations designed to maximize the utilization of manpower in the delivery of health Services.” Src. 111. (a) The heading to title 1S. of such Act is amended by striking out “STROKE, AND RELATED DISEASES” and insert- ing im heu thereof “STROKE, KIDNISY DI SEASE, AND OTHER RELATED DISEASES”. (b) Sections 902(a), 908(a), 903(b), 904(a), 904(b), 905(b), 903 (d), 966, 907, and 909(a) of such Act (as amended by the preceding provisions of this Act) are cach further amended by striking out “Surgeon General”, each place it appears therein and inserting in lieu thercof “Secretary”, _ 4 TITLE II—A AENDMENTS TO TITLE UI OF THE PUBLJC 81 Stat, 534, 42 USC 242b, Report to Congress. WEALTIL SERVICE ACT Paunr A—Resrarcn: anp Desonsrnarions Revarme to HEavrz JPaciniyes AND SYRVICES Seckerl. (a) (1) Section 304 (a) of the Public Health Service Act is amended— (A) by inserting “(1)” immediately after “Seo, BOL (a)”3 (B)\by redesionating clauses (1) and (2) as clauses (A) and (B), respectives, ; and (Cc) by, redesignating clauses (A), (33), afd (C) as clauses Gi), (1 and (iii), respectively. (2) Section 80£(b) of such Act is amended— , (A) by striking out “(b)” and inserting’in lieu thereof “ (2)”; and ‘ (B) by striking out “this section” each place it appears therein and inserung in 1 su thereof “this subsection”. (3) Section 804(c) ofsuch Act is amented— (A) by striking oh, *(c)” and inserting in lieu thereof “(3)”; and (B) by striking out “this section” each place it appears therein and inserting in Heu thercuf “this subsection”. (b) Section 304 of such Act js further amended by adding after the provision thereof redesi gmatedas paragraph (8) by subsection (a) (3) (A) of this scction the following new subsection : _ 7 . : “Systems Analysis’ of Natidnal Health Care Plans F “(b) (1) (A) The Secretary shall develop, through utilization of the systems analysis method, plans for Hvalth care systems designed adequately to meet the health needs of the American people. For purposes of the preceding sentence, the systems analysis method ineans the analytical method by which varioug means of obtaining a desired result or goal is associated with “he costsand benefits involved. “(B) The Secretary shall complete the development of the plans referred to in Subparazraph (A), within such period as may be neces- sary to enable him to submit to the Congress not later than Septem- ber 30, 1971, a report thereon which shall describe each plan so developed in terms of— aN 4 the number of p ople who would be _— the plan; “(ii) the kind and type of health care which would be covered under the plan; “ (iii) the cost involved in carrying out the plan and how such costs would be financed; Year 1966 1967 1968 1969 1970 71 6. 1973 - 1/ Not considered. ° 2/ Includes programs previously supported under the appropriation for comparability. [po ee, De ~— diseases," Budget Estimate | to Congress $25,000,000 45,024,000 64,314,000 68,922,000 100,000,000 96,502,600 52,771,000 131,287,000 4 House Allowance N.C. 1/ $45,004,000. 54,314,000 N.C. 1/ 76,000,000 96,502,000 82,771,000 Regional Medical Programs Senate Allowance © $25,000,000 ~ 45,004,000 64, 314,000 . 68,922,000 100,000,000 115,000,000 122,771,000 Appropriation $25,000,000 45,004 ,000 58,814 ,000 61,907,000 100,000,000 116,990,000 102,771,000 "Chronic Budget History - Grants (In Thousands) February 28, 1972 © FY 1972 FY 1966 FY 1967 FY 1968 FY_1969 FY 1970 FY 1971 FY 1973 Authorization.......seee. $50,000 $90,000 $200,000 $65,000 $120,000 $125,000 $150,000 $250,000 Appropriation..... eeeeeee 24,000 43,000 53,900 56, 200 73,500 99,500 90,500 120,800 a/ Add: Balance brought forward ‘ from previous year..... ~—- 21,934 b/ 25,900 36,165 20,000 15,298 44,500 --- ‘Less: * Amounts held in reserve by BOB.......-. --~ 21,000 30,900 20,000 15,000 44,500 --- --- Amount available for - . : . obligation........see0- 24,000 43,934 48,900 72,365 78,500 70,298 135,000 120, 800 Less: , { Amount obligated....... 2,066 . 27,052 43,635 72,365 78,202 70,298 135,000 120, 800 LAPSC.ssccereccccccecsees --- 11,982 c/ --- --- --- ——— -—- -— Balance carried forward.. 21,934 4,900 5,265 -——- 298 -——- --- --- al Appropriation request. b/ Available through December 31, 1966. c/ These funds were appropriated for fiscal year 1966, available for obligation until December 31, 1966. They lapsed on that date. I DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE Health Services and Mental Health Administration History of 1973 Estimate Department OMB reduction Estimate Department’ : reduction © from 1972 to Estimate President's from agency | Department - - Appropriation Department to OMB Budget request Submission ; Posi- Appropriation (a) (b) (C) (d) (e)- (£) Explanation tions | Amount gional Medical . Programs $100 ,554 ,000 $152,815 ,000 $140,616 ,000 $131,287,000 {$12,199,000 $9,329,000 | Department Reductions: . : Grants: : p : Construction <.. --- | $5,000,000 — : Regional medical . . programs. . -—- 5,813,000 Direct operations: 1 i Technical assistance : . : . and disease control] 48 656 ,000 Program direction and : management services| 62 730 ,000 , Total, Department . Reduction...--seseeee | 210 12,199 ,000 ~ OMB Reduction: Grants: ’ Health maintenance organizations o— 16,200,000 Emergency medical j . services -—— +7 ,000 ,000 Direct operations: : . Employment reduction ‘8 - 129 ,G00 Total, OMB reduction ° 8 9,329,000 « gee ‘ ——