ung # regional U.S. DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE Public Health Service * Health Services and Mental Health Administration ° Bethesda, Maryland 20014 | 2 COL | v i medical CC”! | SPECIAL ISSUE . programs FOR LIMITED DISTRIBUTION - RS service : erews ° information Oo ° data A communication device designed to speed , the exchange of news, COMPARATIVE ANALYSIS OF PENDING LEGISLATION information and data on To Extend and Modify: Regional Medical Programs Regional Medical Programs and related activities. March 6, 1970 - Vol. 4, No. 115 The comparative analysis of all currently filed legislative proposals to extend and modify Regional Medical Programs, prepared by the Office of Planning and Evaluation, has been adapted and reproduced for this Special Issue - News, Information and Data. The material included summarizes the actual bills reproduced and distributed as- be Public Law 89-239 News , Information and ~ as amended by Data, December 9, 1968 - Public Law 90-574. Vol. 2, No. 48 H.R. 14284 filed Special Issue - News, by Mr. Staggers Information and Data, and H.R. 15135 ctober 27, 1 - (identical Bill) Vol. 3, No. 31S filed by Mr. Cramer H.R. 14486 filed Special Issue - News, by Mr. Rogers Tafomation and Data, November 6, 1969 - Vol. 3, No. 345. S. 3355 filed by Special Issue - News, Senator Yarborough Information and Data, February 9, 1970 - Vol. 4, No. 5S Administration Bill: Special Issue - News, S. 3443 filed by Information and Data, Senator Javits and February 26, 1970 - H.R. 15960 filed by Vol. 4, No. 9S . Mr. Staggers ‘ou CURRENT AND PROPOSED _ LEGISLATION Present Legislation P.L. 89-239 as amended _and extended . by P.L. 90-574 SETTING Separate legislative authorization for Regional Medical Programs. CATEGORICAL EMPHASIS “Heart disease, cancer, stroke and related diseases. Retains separate legislative Closer ‘coordination of all programs to attack health problems, especially CHP and RMP. Experimentation "in the integration and coordina- tion of the programs auth- orized...leading to the development of improved systems..." H.R. 14284 No change. (Staggers) authorization for Regional and Medical Programs but also H.R. 15135 adds a separate sub-authoriza- (Cramer) tion for chronic disease Programs. H.R. 14486 Retains separate legislative Adds "other major (Rogers) authorization for Regional diseases." Medical Programs. ” S.. 3355 Retains separate legislative Adds "kidney disease, and (Yarborough) authorization for Regional — other major diseases and oe Medical Programs. conditions. ". ‘Administration]|] Places CHP, NCHSR&D, and RMP Complete decategorization. Bill: in one title (IX) with a _ Broadened to encompass S. 3443 . single general statement of 'all "diseases and (Javits) purpose, separate statements impairments of man..." and of specific program purpose, H.R. 15960 and separate sub-authoriza- (Staggers) tions. Emphasis on: St eB Tape Te ete mee eee eee, wT ne ars a ADDITIONAL EMPHASES CONSTRUCTION AUTHORITY went Emphasis on making available the latest advances in diagnosis and treatment, and on cooperative arrangements for research, training and related demonstra- tions of patient care. Limited to "alteration, major repair, remodeling and renovation of existing buildings...and re- placement of obsolete built-in... equipment of existing buildings ," up to 90% of cost. New emphasis given. to optimum utilization of manpower and on improving health services for persons residing in areas with limited health services. : No change. Adds prevention and rehabilitation. 2.3 No change. Adds prevention and rehabilitation. New emphasis on regionalization so as to improve primary care and its relationship to specialized care. New emphasis on improving the quality and enhancing the capacity of available health manpower and facilities, and on improving health services for persons residing in areas with limited health services. | Adds authority to include "new construction of facilities for demonstrations, research, and training when necessary to carry out regional medical programs." Major emphasis on improving the quality, distribution and efficiency of health services. In addition to a broad combination of planning, research, training, and demonstra- tions also includes...''developing and demonstrating systems for delivering medical care..." Adds prevention and rehabilitation. New emphasis on cooperative planning and experimentation, including closer coordination or integration of RMP and CHP planning activities. No change. CURRENT AND PROPOSED LECISLATION NON- INTERFERENCE CLAUSE RELATIONSHIPS TO COMPREHENSIVE HEALTH PLANNING Present Legislation P.L. 89-239 as amended and extended _ by P.L. 90-574 To accomplish the goals of the program "without inter- fering with the patterns, or the methods of financing,| — of patient care or profes- sional practice, or with the administration of hos- None specified in law. pitals..." H.R. 14284 No change. For application to be approved, (Staggers) it requires that Regions must and take into consideration the H.R. 15135 plans of relevant Areawide and (Cramer) State Health and other planning agencies. Specific review and approval of such agencies is not required, however. H.R. 14486 No change. Before a RAG may recommend ap- (Rogers) proval of an operational grant, opportunity must be provided for applications to be considered by the appropriate Areawide 314(b) Comprehensive Health Planning agency. S. 3355 No change. ~' Same as H.R. 14486 (above) (Yarborough ) Administration |] Omits present clause Applicant must provide reason- Bill: , entirely, but does pro- able opportunity, prior to S. 3443 vide for protection of submission of an application, (Javits) the..."integrity of the for review and comment by the and doctor-patient relation- appropriate State and relevant H.R. 15960 ship and the confiden- areawide comprehensive health (Staggers ) tiality of information planning agencies. disclosed during the course thereof." i poe Pe int By DURATION- AUTHORIZATION LEVELS (IN MILLIONS) FUNDING MECHANISM Grants, with two-year availability of funds. Three-year extension. Chronic RMP Diseases Total FY 71$125 $ 50 $175 FY 72 150 50 200 FY 73 175 50 225 $450 $150 $600 Grants for RMP with only one-year availability of funds. . Grants and contracts for the new auth- orization of the Chronic Disease Programs. Would permit Regions to obtain services-in-kind from Federal agencies. Three-year extension. FY 71 $ 150 FY 72 200 FY 73 | 250 $ 600 Grants , with two-year availability of funds. Would permit Regions to obtain services-in-kind from Federal agencies. Five-year extension. FY 71 $150 FY 72 200 FY 73 250 FY 74 250 FY 75 250 $1100 Includes stipulation that no more than 15 million shall be available for kidney disease activities in FY 71. Provides specific contract and sepa- rate training grant authority, with only one-year availability of funds. Would permit Regions to obtain ser- vices-in-kind. Three-year authorization with separate sub-authorizations, ",..such sums as may be neces- sary,'' for (a) RMP as well as (b) CHP and (c) the remaining purposes of the title. Provides specific contract authority as well as RMP grant authority. (See also Multiprogram Services.) Maintains two-year availability of grant and contract funds. Would permit Regions to obtain services-in-kind. Must be reasonable assurances that Regions will seek "to obtain financing from non- Federal sources, and from Federal sources providing reimbursement for medical care for eligible beneficia- ries.."' after a period of initial support of the operational activities undertaken with grant support. 5. CURRENT AND PROPOSED LEGISLATION REGIONAL ADVISORY GROUPS | Composition Procedures Present Requirement there must include Has responsibility Legislation "practicing physicians, medical for approval of op- P.L. 89-239 center officials, hospital ad- erational grants at as amended ministrators, representatives from regional level. and extended by P.L. 90-574 appropriate medical societies, vol- untary health...'' and other health- related agencies...'' and members of the public..." familiar with health needs. poor and minority groups. H.R. 14284 Adds a provision that the pro- Provides an appeal (Staggers) cedures of the RAG must provide a mechanism to national and reasonable opportunity for member- level for proposals H.R. 15135 ship on the group to a representa- disapproved by the (Cramer) tive of any health related insti- Regional Advisory tution which meets certain criteria.| Group. re BS H.R. 14486 Specifically includes representa- No change. (Rogers) tives of state and local health . and health planning agencies. one S. 3355 Specifically includes representa- No change. e (Yarborough) tives of official health and ic planning agencies, and members of i, the public familiar with the need ‘ for and financing of the services provided under the program. Pro- vides that such public members be sufficient in number to ensure adequate community orientation. Administration] Specifically includes representa- No change. Bill: tives of public or nonprofit pri- S. 3443 vate health agencies and areawide ; (Javits) health planning agency represen- oO . and tation, as well as health finan- _ H.R. 15960 cing interests, and representa- . o (Staggers) tives of consumers, including the NATIONAL ADVISORY COUNCIL Advisory Council responsible solely for RMP matters. Sixteen members - leaders in fields of fundamental sciences, medi- cal sciences, or public affairs. At least 2 practicing physicians, one ex- pert each for heart disease, cancer, and stroke. SECTION 907 - LISTING OF ADVANCED FACILITIES Lists of facilities equipped and staffed to provide the most advanced methods of diagnosis and treat- ment in heart disease, cancer and stroke are to be established. No. change. No change. wg Ate Provides for representation on ths — National Advisory Council of: (1) leaders in health care admini- stration, or community or other public affairs, (2) persons, outstanding in the study,’ diagnosis or treatment of other major diseases. Provides for representation on the National Advisory Council of: (1) leaders in health care admini- stration, — (2) one member outstanding in the study or care of kidney disease, (3) three members of the public. No change. Adds kidney disease. Single National Advisory Council responsible for assisting in pre- paring regulations and general policy advice on all programs under this title; also would annually review grants made under this title to determine their effectiveness. Membership of 24 to include leaders in fields of fundamental sciences, medical sciences, the organi- zation, delivery and financing of health care, or who are State or local officials, persons active in consumer affairs, or representatives of minority groups. Provides authorization, either directly or through grants or contracts, to establish and maintain such lists. Listing expanded to cover disease and impairments of man in general. Also includes national pro- portions and trends in equip- ment, staffing and services. Rate pidpmen tina aston: CURRENT AND PROPOSED TECISLATION ~MULTIPROGRAM SERVICES Present Legislation P.L. 89-239 as amended and extended by P.L. 90-57 CHRONIC DISEASE FOCUS SECTION 910 Provides for grants for services needed by, or which will be of sub- - stantial use to, any two or more regional medical programs. None specified in law. Co eens oft hibit e H.R. 14284 No change. Provides a separate part of (Staggers) Title IX for Chronic Disease and Programs, concentrating upon H.R. 15135 training and clinical demon- (Cramer) stration programs in pre- vention, diagnosis and treat- ment. In addition to heart disease, cancer and stroke, this covers diabetes, emphy- sema, kidney disease and other related diseases. Provides specific three-year authority . and annual authorization of $50 million for these purposes. ok : : Lp H.R. 14486 No change. No change. . Lb (Rogers) S. 3355 Provides for both grants |No change. a coe (Yarborough) and contracts for a broad we Bill variety of activities including: activities of use to two or more regional programs, devel- opment or demonstration projects, collection of epidemiologic data, de- velopment of training, . and conduct of coopera- tive clinical field 4. trials. _ _ Administration} Provides new contract No change. Bill: authority for the con- i S. 3443 duct of cooperative - (Javits) clinical and field and studies, and demonstra- f H.R. 15960 tions of systems for . (Staggers ) delivering medical fo care. By : i. : i GENERAL AUTHORITIES JOINT FUNDING TRANSFER OF FUNDS All authorities and determinations under Title IX, including the awarding of grants to Regional Medical Programs, are exercised by the Surgeon General of the Public Health Sérvice. None specified in law. None specified in law. Authorities and deter- minations exercised by Secretary rather than Surgeon General. None specified. None specified. Same as H.R. 14284 and 15135 above. None specified. None specified. Same as H.R. 14284 and 15135 above. None specified. None specified. - Same as H.R. 14284 and 15135 above Authorizes the desig- nation of one admini- strative mit within. the Department (or one Federal agency) to act for all in adminis- tering the funds ad- vanced when a single project receives funds from more than one source within the Department (or from more than one agency). Authorizes the transfer of up to 10% of the amount appropriated for any program (except for state planning and formula grants) for the — purpose of carrying out any other such program or activity under this title, although no transfer may increase the amounts avail- able for another program by more than 10%.