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Draft: K,

JULY 12,

 

 

 

  
 

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ig

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C.

. DRAFT REGULATIONS

paca,
FOR dys GNATION OF HEALTH SERVICE AREAS
FOR DISCUSSION. ONLY
BASED ON HOUSE R FT BILL "fCcLintre

M\\

BAUM
1974

 
 

een

A.

 

¢
serenity,

5. The notice to each Governor required by 3

Such bqurtda

DRAFT: 7/12/74

ANNOUNCEMENT OF AREA DESIGNATION PROCDURES

 

1. No later than 180 days following approval of the Act, the

yréetary shall establish Health Service Areas throughout the

  
 

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n¥@ted States, and, thereafter al] areas of every State shall
all times be included in a Health Service Area so established

for the purposes of the Act. !

2. Th &niiBG OSS ary shall establish Health Service Areas, or

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revise Buc } as, through publication of the boundaries (or

revised

 
 

 

   
  

n@aries) of such areas in the Federal Register.
(or revised boundaries) shall. be effective
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upon the’ date of publication in the Federal Register. |

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3. Not later than 30 days following approval of the Act,

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the Secretary shall provige Udivicual written notice to the
to the Governor of each fa Aelgnnouncing proceedings to desig-

nate the initial Healt AETV Areas. All such notices to

ioemmasesi? o

each Governor shall be transmitted by registered mail and,

in accordance with the requirements of the Act shall be deposited

Tp

h, Simultaneously with the mailing of threswptices required

in the mail simultaneously.

  
     

 

by A,2 , or immediately thereafter, th ecretary shall publish
a Statement in the Pegeral Register that the required notices
have been provided. The statement shall include the general

criteria and procedures applicable to all States uy

in such notices.

 

, shall canforn

“to. the requirements of Section Vail Cb) (1) of the Act: and;
~ in addition, shall include or be accompained by the following:

 

A copy of the Act.

A specific citation of all requirements of the
Act relating to the definition and designation
of Health Service Areas.

A list of those agencies or organizations in, or

ying, the State or any portian thereof which must

He c nulted concerning the designation of Health

 

i €e Agencies pursuant to Section G,5
ed ve toal date by which the Governors! proposals

must be received by the Secretary.

The information that must be submitted to the

   
 

Secretary, and, a he option of the Secretary,

the format theres if

Special requiref 3 Or the designation of interstate
eee fy

Health servicé reas cougsuant to Section H.
Where applicable, a list of interstate Standard
Metropolitan Statistical Areas, Lats hsd,, as determined

fucoe’, concerning

which the Governors of the affdc tates are required

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by the Office of Management an

 
    

to consult pursuant to SectionjHu
The criteria to be considered by the Secretary in
determining the suitability of Health Service Areas

proposed by the Governor, which shall includes

 
 

criteria set forth in Sections C,]l and 2.
A copy of these Regulations

The name, address and telephone nunber of the
 

Fs, f
5 rceenes ee aa neartt

. Sennett "

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official who may be called upon for advice and
technical assistance with respect to the design
nation of Health Service Areas, i

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Specific notification that the Secretary jis re-

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Se ag

quired to and shall designate Health Service
Areas for the entire territory of each State in
any case where the Governor falls to act with |

{ to designation of areas for all or a portion

  

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INFORM TON MATERIALS TO BE SUBMITTED

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I. Wig6hi ays of the date on which the notice described

in A,3 is postmarked, the Governor of each state receiving

such notice shal] submit the following materials and inform-
t

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ation to the Secretary In s ugh Format as the Secretary may

A\\

te s\of maps showing the boundaries
Eom ont
of each Health Service Rrea Proposed by the Governor

Prescribe,

 

a. A legible map

to be included in whole or in part within the State

Such map or maps shall in additiag ow the Counties
Si ganako
or equivalent political subdiv ifs ong: included in each

  
 
 

area and, where applicable, any taWdard Metropolitan

Statistical Area included in or in part
b. A distinctive numerical designation and name for each

Proposed Health Service Area comprising a Portion of |

     
  

any State including an agreed upon designatih
Proposed interstate Health Service Areas. Such]
nations and names shall be indicated on the map

submitted pursuant to B,l,a

eer Se

c. The population of the Proposed Area.

 
d.

 

ao

 
 
  

A list of major Health Care Facilities in: the Area.
An interstate compact or agreement with respect to
the designation and boundaries of any proposed
interstate area. Such agreement may take the form

of a joint declaration by the Governors of the States
involved, or separate concurrence with respect to

the agreed upon boundaries of the interstate Pealth

MW Service Area(s) in question.

proposed Health Service Area includes a portion
got all) of a Standard Metropolitan Statistical
ppropriate justification for dividing the SMSA
among different Health Service Areas.

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A summary descriptjon of the procedures followed by the

  
  
   

Governor in propofi areas and obtaining consultation

thereon pursuany Action G.
A list of all RNS, agencies, organizations
and ‘government officials formally requested to comment

on the designation of Health Service Areas.

   
  
  
 

A summary of substantive comme
from any source concerning the
Service Areas or the final areas|to be proposed to the
Secretary, and also including ° Emmary of any action

taken with respect to such comments.

Maps or narrative descriptions showing the

 
  
  

which proposed health Service Areas submitted b
Governor are coterminous. with or differ from (1
designated for Professional Standards Review Or hz-

ations under Section 1152 of the Social Security Act,

 
 

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(2) existing planning areas, including those served
by Comprehensive Health Planning Agencies established
Pursuant to P.L. 89-749, as amended and Regional Medical
Programs established pursuant to PLL. 89-239, as amended.
(3) other appropriate State Planning or administrative

areas.

APPROVAL OF HEALTH SERVICE AREAS BY THE SECRETARY
a UE

I. Prib ; Proving any Health Service Area Proposed by a

  
 

ecretary shall take into consideration the Follow-
determine to his satisfaction that all applic-
able requirements of the Act and Regulations ‘have been met:

a. That the the Population for such areas is within the

minimum and maxim

 
   
  
   

Specified by the Act, and that

adequate justificf has been provided For any pro-

posed Health Se AXea with a population of less

than 500,000.
b. That required consultation between the Governor and
G,5

State and Loca] officials PurSuant to has taken

     
   

 

Place, and that any comments an tions received

 

have been taken into consideratfo,

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c. That there has been adequate co siltation and agree-
ment among the Governors concerned with respect to
any proposed interstate Health Service Area.

d. That adequate Justification has been provided

   
 

istical Area into two or more Health Service Are§

e. That all areas of the State re included withing,

 
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~@ Health Service Area

Ff. That all Proposed Health Service Areas are mutually
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exclusive.
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9. That each Proposed Health Service Area includes one
Or more major health care Facilities or institutions
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Providing general and Specialized health care services

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available to the general public residing in such Area,

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each proposed Health Service Area constitutes
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al region, in accordance with the criteria in

er the planning and development of health services
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"and resources serving the residents of such Area,
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In determining whether a Proposed Health Service Area

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constitutes a rationa egion for planning pursuant to

  
 
 
 

C,1,h

» the Secretary take into consideration the
Following factors: .
a. ‘The extent of ithin the State and the
Area among affected and concerned public and profess-
ional groups and institutions and agencies, with

respect to the Suitability of i for Planning.

    
   

b. The extent to which the Area in the maximum

feasible Population consistent th the Act and
these Regulations.

c. Availability for the Area of the data needed for

Planning.

  

plans and Health Maintenance Organizations.

e. Congruence with areas established for Professiaqh
os,
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-The capabilities of the area for supporting thef

Standards Review Organizations and for existing
or planned Emergency Medical Service Systems.
For the initial designation of Health Service .

Areas under the Act, congruence with the areas

served by predecessor Regional Medical Programs,

local Areawide Comprehensive Health Planning Agencies,

Service Area, or areas containing a central
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city close to the minimum population for a Standard

‘ical Area).

 
  
 

Metropolitan Statj|

     

The extent to whif nterstate Health Service Areas
have been develgp in\connection with Standard
Metropolitan

Boundaries.

The extent to which area boundaries will promote

    
  

appropriate planning for the di ged or other

special population groups. (e. inartly, it
would be considered desirable keep an indian
reservation within a single Health Service Area.)

The extent to which high quality services can be

  

primary and specialized care, and appropriate p fentive

and educational programs within’ the area.

 
 

fullest possible range of general inpatient, ambulatory,
long term care and home health services, and specialized
services such as those relating to mental health,

drug abuse, alcoholism, developmental disabilities, and

physical and vocational rehabilitation.

1. Conflict with any Health Service Areas to be designated

_by the Secretary pursuant to C,4 ;

 

“nm. Division of any Standard Metropolitan Statistical Area

into two or more proposed Health Service Areas.

  

edd pursuant to A,3 was deposited
tin the mails, the Secretary shall publish in the Federal Register

the Health Service Area Boundary desi submitted by the

  
    
  
 

Governors which upon their publicatio constitute the

boundaries for such Health Service Are

oe

 

4, If the Secretary determines that aJb
him for a Health Service Area does not meet the requirements
of Section 1411 (a) of the Act, of Sections C,1! and C,2 of

these Regulations, he shall make such revision in the

 
  
  

for such area ( and as necessary, in the boundaries forfaBjoin-
ing Health Service Areas) as may be necessary to meet s§

quirements; and the revised boundary (or boundaries) sf

 
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upon publication in the Federal Register, constitute the bound-

ry (or boundaries) for such Health Service Area (or Areas).

The Secretary shall notify the Governor of each State
of the boundaries established for the Health Service Areas

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for such State (including interstate areas lying partly within
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a State). Such notice may take the form of a copy or citation

of the s) published in the Federal Register pursuant to

     
  

Sectio

 

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gd C,4. In the case of any Health Service Area
the Secretary,pursuant to Section C,4, the noti-

ad by this Section shall include a full explana-

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tion of the reasons for the Secretary's action, citing the

specific provisions of the Act and/or these Regulations.
6. In designating any H@aNth Service Area pursuant to Sec-

tion C,4 , the Secretary Kely on information from any

    

appropriate source incl information and materials

submitted by the Governor pursuant ot Section B,!? , (b) inform-

ation in the records of the Department of Health, Education and

   
  

the staff of

a fe sources.

Welfare, (c) The Department's staff, i

the HEW Regional Offices, and (d) othe

BASIS FOR DETERMINING POPULATION

 

 

1. For the purpose of defining Health Service Areas and allocat-

ing funds pursuant to the Act, the population of (a) each State,

  
 

(b) each Standard Metropolitan Statistical Area, and
County or equivalent political subdivision within a Sta shall
be the most recent Current Population Estimate prepared the

Bureau of the Census which is available for all States.
 

. a {
-10-  ° . i

Nae\essary for the purposes of the Act, the population of any

anea within a State smaller than a County shall be determined
he State in accordance with accepted statistical practice,

and shall be consistent with the Census Bureau's Current

Population Estimates for the State and related Counties and

Standar gutiiiemQpolitan Statistical Areas therein. The approp-

POPULAT® REQWEAMEMENTS FOR HEALTH SERVICE AREAS

    
 

Tl. At the time of its initial establishment, no Health Service

Af more than three million, unless

 
  
 
 

such Area contains a Stangaf\ Netropolitan Statistical Area
with a population of morg thg Mhree million. To the extent
practical, areas of thé Ypopulation, or close to that

figure, that are likely to substantially exceed three miltion

   
 
 
 

population due to short term growth ord§ hould not be

 

established.

 

2. After initial establishment, if the population of a Healt-

Service Area increases substantially bet three million pop-

ulation, the Secretary shall notify the Governor(s) of the

State(s) involved of the need to consider revision of

 
  
 

3. No Health Service Are& may have a population of less
five hundred thousand unless (a) such Area comprises the F
population of a State which has a population of tess tha TVEe

hundred thousand, or (b) has a population of at least two

 
  
  
 

 

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hundred thousand and is deemed by the Governor(s) of the

te(s) in which such Area is located (with the approval of
ecretary) to comply with all other requirements of Section
(a) of the Act. Publication of the boundaries of such

ea by the Secretary in the Federal Register constitutes the
Secretary's approval for the lower population limit for the

Area.

 
  
  
  

4, In ofd promote economies of scale in Planning for

 

health sé€r and resources, Governors are encouraged to

propose vice Areas with the largest practical pop-

ulation subject to the requirements of the Act and Regulations.

4

Where the population of a State exceeds Five hundréd thousand,

the designation of smaller Mekith service Areas ordinarily

 
 
 
   
  

will not be approved by t etary. Accordingly, Health

Service Areas of less th undred thousand population

will be approved only on request by the governor(s) involved

and only on the basis of -(a) rapid potential population growth

to five hundred thousand or more, or (b) tpeeeeqbstantial need

 

fully documented and justified in such f i) the Secretary

may prescribe.

 

5. Once established, Health Service Areas may be subdivided

into areas of smaller population for the administrative con-

 
  
 

venience of the Health Systems Agency serving such Ar
All such subdivisions of a Health Service Area establishe
any purpose shall be reflected in the Health Systems plan quired

pursuant to Section 1413 (b) of the Act. Approval by th

 

 
“T retary is not required for such sub-areas.

F. SPEMIAL REQUIREMENTS FOR STANDARD METROPOLITAN STATISTICAL
AREAS JAND INTERSTATE AREAS

_/. nm accordance with Section 1411 (a)(4) of the Act, no Health

Service Area boundaric: shall cross the boundaries of a Standard

 

 

Metropolitan Statistic | Area which Standard Metropolitan Stat-

   
 
  
  
  

istical A cated entirely within a single State, unless

 

the Govern r sch State submits a request for an exception

and the rebsbn herefor including patient origin data and other
factual 5 orting the division of the Standard Metro-
politan Statistical Area among two or more Health Service Areas.

The Secretary shall approve sych request only if, in his opinion,

    
  
  

a the division of the Standard leQropolitan Statistical Area is

   
   

justified on the basis of a ptterns of care as reflected

in the supporting data or ilable information.

2. A Health Service Area encompassing all, or part of a Stand-

    
 
 

ard Metropolitan Statistical Area may als e contiguous

territory not defined as Part of the Standhrp Metropolitan Stat-

 

istical Area by the Office of Management ahd get. Contig-

uous areas which appear likely to be incl as part of a
Standard Metropolitan Statistical Area (in accordance with the
Office of Management and Budget's definition of such areas) in
the forseeable future should receive consideration for Cc °

in the Same Health Service Area as ‘the Standard Metropolita

_~. Statistical Area in question.

3. Governors of adjoining States may agree (as specified in

 

 

 
1]

   
  

Ty

G

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Section B,].c_ ) on the designation of interstate Health Serv-
ice Area. [In the case of interstate Standard Metropolitan
tical Areas, the Governors of the States concerned are

i
d to consult in order to gain agreement on inclusion of

terstate Standard Metropolitan Statistical Area in a

nnn de

single Health Service Area [fn accordance with Section 1411 (a) (4)
of the Act and Section F,1 of these Regulations. Such agreement,

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with respect to including any interstate Stand-

 
  
 

ytatistical Area in a single Health Service Area

shall be rEpp to the Secretary in accordance with Sections

of the Governors concerned to agree on a

 

single Health Service Area for any interstate Standard Metropol-

ea

itan Statistical Area shall be considered by the Secretary who, in

accordance with Section C,4 ,] gall establish appropriate Health

 
 
 
  
 

Service Area boundaries.

CONSULTATIGN BY GOVERNORS ION WITH THE DESIGNATION

 

 

OF HEALTH SERVICE AREAS

 

T. tn considering Health Service Area boundaries to be proposed to

   
  
    
 

the Secretary, either for initial establisf for subsequent

revision, the Governor of each State is reh to consult with
government and private agencies and organik ions, elected officials
and consumers for the purpose of either (a soliciting initial

suggestions concerning such Health Service Area boundaries, and
(b) affording an opportunity to comment on such Areas

atively selected by the Governor.

  

2. The method ot consultation required by G,1 may be speci

by the Governor and may include, among other things, (a) public

 
   
 
   

 

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Mizations, (c) expressions of the views of concerned
indavitduals or appropriate experts, (d) formal resolutions by
legfsfative bodies or actions by elected officials, or (e)

combination of these.

3. Consultation required by. Section G,5 must be requested
from the propriate individuals and/or organizations in

   

writing.

 

received pursuent and records of hearings or
other for@a geroceedings concerning the designation of
Health Service Areas pursuant to the Act and these Regulations
shall be filed in a single place and shall be available for

tneral public or HEW officials.

  
  
   

inspection and copying by thg
Copies of such materials shf A furnished to the Secretary
on request and summaries sXall be provided to the

Secretary pursuant to Section B,1,9

5. In carrying out the requirements of § i » the Governor
shall consult with the following, where th exPSt.
a. State Agencies including,
(1) The State Health Planning cy established
pursuant to Section 314 (a) of the Public
Health Service Aet.
(2) State Health Facilities Construction Age
(citation) .
(3) State Mental Health Agencies (citation)

(4) State Mental Retardation Agencies (citation

 

 
 

 

(5)
(6)
(7)

Voluntary Agencies including,

(1)

    
  

 

(3)
(4)

Elected Officials of Bodies, inc]u

(1)

(2)

(3)

Service Act.

Security ActhZ

State Vocational Rehabilitation Agencies .
State Alcoholism Agencies

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State Drug Abuse Agencies |
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Agency that carries out areawide comprehensive
regtonal, metropolitan, or other local area

planning pursuant to Section 314 (b) of the
lic Health Service Act.

ional Medical Programs established in

 

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Experimental Health Service Delivery Systems

   
  

Professional

designated ung

Appropriatg€ i. Pegs iynal and consumer groups
deemed by the Governor to have a significant
interest a or to be tikely_to be affected by

decisions concerning the de n of Health

 
 
  

 

Service Areas

Mayors of incorporated cities ot fifty thousand
or more population

Chief Executive Officers of Counties (orfe

   

alent political subdivisions) of fifty thous
or more populations

Elected otficials of representative (as det

 

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by the Governor) of incorporated places and Counties
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of less than five hundred thousand population within
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the State
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Other appropriate groups or individuals, at the dis-
i
cretion of the Governor
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6. Organizations enumerated in Section G,5, (1) through (4)

rtion of a State must be consulted by the

    
 
 

Acca: |
ection ftrrespective of whether the principal

office of ganization is, or is not, located in the
State in

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7. With respect to the designation of interstate Healt

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Service Areas, the consultatipmrequired with the organizations

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of the political subdivisions of such State. Governors are urged

agencies and officials enum in G,5 shall be required of

  
 

each governor concerned, o WK respect to those organizations

and agencies serving tha particular State and ofticials

to exchange comments received for their r portions of

  
   
  
 

 

proposed interstate Health Service Areas p o reaching a

decision on whether to recommend such Area he Secretary.

CONSULTATION BY GOVERNORS ON DESIGNATION

NTERSTATE HEALTH
SERVICE AREAS

Consultation among Governors regarding designation ot Hf

  
  

Service Areas for Interstate Standard Metropolitan Statistifa

Areas, or any other proposed interstate Health Service Area

 

may take place in any manner agreeable to the respective G

 

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within a State or States

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oncerned. such consultation may be carried out through negotia-
yetween representatives as authorized by Section J ;
and ie rough written or oral communication. The latter may: be

fr in person or by phone. Al] consultation among Governors

their delegates, representatives, or staff concerning the desig-

nation of interstate Health Service Areas, shall be evidenced

by a writ

   
  
 

d maintained by each State and showing al]

communicat een the respective States concerning such

matters.

REVISICN OF HEALTH SERVICE AREA BOUNDARIES

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1. The Governor of a State ma

   
 

at any time after consultation

with the entities specified in\Section G,5, and in the case of

interstate Health Service A

 
  

he Governor(s) of the adjoin-

   

Secretary revised boundaries for one or more Health Service Areas

ing State(s) concerned purg o\Section H, submit to the

(previously established in accordance with the Act and Regulations)

 

2. The Governor of a State shall seek thelc Itation required

by Section &, and in the case ot an inters ate Health Service

Area, Section H, and shall Propose necessary revisions in the

Boundaries of established Health Service Areas in the following
cases:
a. Establishment of « new Standard Metropolitan Stat ical
Area by the Otfice ot Management and Budget

b. Addition of a County or Counties to an establish

 

 
 

 

Standard Metropolitan Statistical Area.

Population growth of a Health Service Area substan-
tially above three million (untess the Area contains
a Standard Metropolitan Statistical Area of more
than three million pooulation).

Population loss below five hundred thousand for any
Health Service Area not previously approved by the

ary for such lesser population pursuant to

   
 

 

t

ion loss of any Health Service Aréa to less

Msiundred thousand.

3. If any of the circumstances described in 1,2, a through d

 

occur, the Secretary shall nq@@\fy the Governor(s) of the State(s)

  
   

involved as soon thereafter Wssible by registered mail, and

the Governor (s) in questip submit proposed revisions

4, tf the Governor(s) fail to submit proposed Health Service

    
  
 

Area revisions in accordance with 1,3, thé tary shall

make appropriate revisions in such boundar] mthin 150 days
of the notice described in Section 1,3 and| publish such
Boundaries in the Federal Register as the daries for such

Health Service Area(s).
DELEGATION OF THE GOVERNOR'S RESPONSIBILITIES

1. The term Governor shall mean the Governor or Chief Exec

utive Officer of any State as defined in the Act.

 
- 2. The duties and responsibilities of the Governor under the

  
  
 
  

nd Regulations may be performed by any State employee
talily designated to carry out such responsibilities through
ogeration of State Law, or formal delegation or other

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ten executive action by the Governor.

wh oh ale oh ob ot.
WN A

 

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