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EXCERPTS FROM REPORT BY THE COMMITTEE ON

INTERSTATE AND FOREIGN COMMERCE

TO ACCOMPANY

H.R. 16204

TO REFLECT COMMITTEE INTENT ON PROVISIONS |

TO SERVE AS A BASIS FOR POLICY OR PROCEDURES

INDEX TO PROVISIONS DISCUSSED:

Title XIV

Part A -

Part B -

Part C -

Part D -

National Council for Health Policy
Health Systems Agencies

Health Areas - Designation

Health Areas

Health Systems Agencies

Agency Legal Structure

Sub-area Councils

Agency Functions

Designation of Health System Agencies
Planning Grants

State Health Planning and Development

Designation of State Agencies

State Administrative Program

State Agency Functions

State Health Coordinating Council

Grants for State Health Planning & Development

General Provisions
Definitions

Procedures and Criteria for Reviews of
Proposed Health Systems Changes

Technical Assistance for HSAs & State Agencies

Title XV
Part A-

Part E -

Centers for Health Planning
Review by the Secretary

- Health Resources Development
Purpose

Area Health Services Development Funds

Pages

1

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11-12

11-12

12

12
13

13

13

14
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MMITTEE INTENT COMMENTS

ttle XIV
~ National Council for Health Policy

"specifies national health priorities which are intended to
provide direction to Federal, State, and areawide planning
efforts"

"policy and priorities will serve the dual purpose of indicat-
ing the direction in which our health efforts must move and
making it possible to.measure how far in that direction they

_ have progressed"

"it would be appropriate for the National Council for Health
Policy to review legislative proposals and other Federal
initiatives which are not directly concerned with the
provision of medical care about which the Council can show
will have an impact upon peoples’ health and publish
conclusions"

"that mechanisms be developed to coordinate the policy work
of the Council with the activities of these various parts of
the government so that the Council's work will constitute a
government-wide statement of National health policy"

“the Council may employ and use such staff as it deems
necessary . . . and may procure the services of experts and
consultants as necessary"

"it igs intended that the annual report required include the
results of all the various activities of the Council described

. . » even though it is recognized that . . . the report may
well be of book length"

. ~ Health Systems Agencies
Health Areas - Designation
"the Secretary is authorized to revise such designation (made

.by the Governors) only where they are inconsistent with
requirements specified in the legislation and will be

 

 

34

34

39

47

48

49

 

Intro.

Intro.

Intro.

1401 (a)

1401(d)

—1402(b)

 

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3. continued

3

i,

responsible for publishing them in the Federal Register."

"it is anticipated . . . designation by the Governors of
approximately 200 health service areas."

"Generally, the Committee is serious in specifying the
500,000 minimum and does not intend the waivers in either
“unusual” or "highly unusual" to be used frequently"

Health Areas

"the requirement for the inclusion of a center for the
provision of highly specialized health services . . . reflects
the desire that the health service areas provide a self-
contained comprehensive and complete range of health service
such that (a resident) would rarely if ever have to leave

it in order to obtain needed medical care."

"while provision is made for waiving this requirement
(SMSAs crossing state boundaries) it is anticipated that
the waiver will be granted rarely (e.g. perhaps Norfolk,

“Va. SMSA):

Health Systems Agencies

Review by Secretary

“require detailed reviews by the Secretary of the performance
of HSAs... . at least every three years, and conditioning
the availability of developmental funds for the agencies upon
their successful completion"

HSAs

Agency Legal Structure

. a assist interested public by providing such things as

ndex of available data and documents relevant fo
. aa ular concern — -@

 

 

36
32

52

52°

53

37-38

56

 

Intro.

| 1411(a)

1411(a)

1411(a) -

1411(a)

Intro.

1412 (a)

 

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(OMMITTEE INTENT COMMENTS | PAGE SECTION

 

Agency Legal Structure continued:

"the governing body . . . is responsible for the planning of
the area's health system it is particularly important that it
adequately and equitably represent the area's population and
health care provides." "it is intended .. . that in regula~ |
tions ... ., the Department take particular care to assure thak
the governing bodies are chosen and composed so as to assure
that they are not dominated by any particular part of the 57 p419CO)
areas health industry."

 

 

"An HSA should assume the costs of defending its governing
body members and employees if and when they are sued for
performing their responsibilities. Liability insurance
could also be purchased to provide protection against the
costs of such suits.” 57-58 |1412(b)

 

Sub-area Councils

"the health planning process is to be local and public and
involve as many members of the community as possible...
subarea councils could be developed for remote rural parts of
an area... to represent various communities within a large
metropolitan area . . . could be created for each county.
within a health service area." 58 . |1412(c)

 

Agency Functions

"HSA reviews including such activities as mental health
planning, health facilities planning, health manpower
planning, necessary environmental health planning, planning
for public health services, health education planning and
occupational health planning. This means that in all these
areas should be represented to the maximum possible extent
in both the HSAs staff and governing body." 40 Intro.

 

 

 

 

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Agency Functions

"no bureaucratic obstacles should be imposed . .. to the
full availability of data... it is also hoped that
non~Federal health programs will voluntarily supply requested
data .. . that maximum possible use should be made of
existing data..." 59 1413 (b)

"the active process of planning including implementation
represents the substance of the (HSA) work .. . that there
be developed and published identifiable products of the

nt

planning process ... 60 1413 (b)

 

 

 
«

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Agency Functions

"reference to a ‘healthful environmental' . . . include

the cultural, .social, occupational, family, and individual
environments in which people live and which determine their
health." ; 60 1413(b)

"the most important method available (in implementing health
plans is in) seeking the assistance of individuals and
entities in the health service area." 61 + 1413(c)

 

"money (for development) is to be used strictly as seed money
with limited commitments in terms of both money and years '
to any one activity." 7 62 1413(c)

"HSAs should . .-. coordinate their health planning activities
with other kinds of planning . . . such as transportation,
environment, and land use planning. . ." 63 1413(d)

 

"it is (also) hoped that A~95 clearing houses will coordinate
their activities with those of HSAs so that the... review
of health projects: and programs can .. . be done for the

clearing house by the HSA to the maximum extent feasible
ol 63 | 1413 (d)

"Similarly, when PSRO review activities identify deficiencies
» « « such as shortage of primary care or inappropriate use
of (care services) ... . that the PSRO will convey their
knowledge to the HSAs .. ." , 64 1413(d)

 

“it is hoped by the Committee that similar reviews (Sec.
1413(e)) of proposed Federal health activities . . . outside
the jurisdiction (of this) Committee, that similar reviews
will be undertaken" 64 1413 (e)

 

 

"the Secretary will make every effort to assist the HSAs in
this (review) requirement by informing the HSA of applications
for funds received . . . and requiring that applicants work
with HSA... in review and development of the application" 64 1413 (e)

 

 

 

 
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Functions

"the requirement that HSAs review institutional health
services is not intended... to limit their reviews to
institutional health services . . . generally desirable. . .
to review all health services available in the community

. . » priority should be given to the more expensive and

more “permanent institutional services"

"(there is) not attached to the review activity any sanction
which would be available for closing or eliminating unneeded
services. .... to the extent that those .. . providing
institutional health services which (HSAs) feel no longer
needed .. . (there is) a requirement for the HSAs...

to bring their services into conformity with the community! s
needs,"

"while the responsibility for the preparation of the State
medical facilities plan rests with the State agency, it is
the intent that the recommendations of the HSAs to the State
for health facilities construction projects be generally used
by the State to prepare the construction plan."

"the need for HSAs to recommend priorities among possible
construction projects in the context of their health plans

_ should be emphasized."

Assistance to entities desiring to be designated as HSAs

 

"Specific authority for receiving such assistance is given to
the existing CHP, RMP, and EHSDS programs"

Designation of Health Systems Agencies

"the designation agreement between the Secretary and a HSA

is the tool by which the Secretary recognizes an organization
as the official health planning agency for the area and
defines both (the agency) obligation in fulfilling planning
‘responsibility to the community, the State and the Secretary
as . as (the Secretary's) responsibility .. . to ~o-

 

65

65°

65

66

66

 

1413(g)

1413 (g)

1413 (h)

1413 (h)

1414

 

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ITTEE INTENT COMMENTS

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Designation of Health Systems Agencies continued:
financial and other forms of assistance"

"such agreements might take the form of memorandums of
agreement . . . jointly developed or in fact actual contracts
. . » for products of the planning process"

"in any given community the Secretary may initially designate
an HSA on either a conditional or final basis depending
purely upon the applicant organization's ability to meet the

requirements"

"where an HSA loses its designation and a new agreement is to
be entered into with another organization, it would be
discretionary with the Secretary whether the new agreement
would be conditional or final”

"In designating HSAs . . . maximum possible use be made of
"existing areawide CHP agencies and RMPs" (for whom a condi-
tional designation would not be required)

"where both (CHP-RMP) exist in a community that the resources
of whichever will not serve as the HSA will be assumed by
the one (agency) that will"

"4c ig not anticipated that conditional designation will

always be for a full two-year period . .. it could be for as

short a period as a few months (to determine) whether or not
an organization meets the requirements and can fill the
functions of a HSA."

“conditional designation (to) be used for the development
and evaluation of potential HSAs"

 

66

66

66

67

67

67

68

68

 

1415(a)

1415 (a)

1415(a)

1415(a)

1415(a)

1415(a)

1415(b)

1415(b)

 

 

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Planning Grants

‘hontract authority included in section 1416(a) is meant as
a limited authority for contracting for specific planning
purposes related to the activities of the HSAs."

"The Committee generally anticipates that the amount of a
grant would have the same ratio to the amount which the
organization would receive if it were finally designated"

"Matching funds are intended to be in cash and not to include

in-kind matching funds"

"(it) is not intended that agencies should not seek local

funds beyond a level of 25 cents per capita... and to the

extent that they can use such funds they are encouraged to
do so"

title XIV
3 ~ State Health Planning and Development
Designation of State Agencies

"(the) provision requires each State which does not prevent

unneeded capital expenditures outright through a certificate

of need approach to implement through its insurance laws a
requirement that all private insurors within the State deny
reimbursement for unneeded capital expenditures."

"Tf a State has failed to implement this policy after the
expiration (period following the end of the next regular

session of State legislature) then the Secretary would be
required to terminate the designation agreement .. . and
to deny to the State Government further funding under this
title and new title Xv."

 

 

.

 

69

70

70

71

73

73

 

1416(a)

1416(a)

1416(b)

1416(b)

1421(d)

| 1421(d)

 

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SITTEE INTENT COMMENTS | PAGE SECTION

 

Designation of State Agencies continued:

"the Committee has chosen to draft the legislation as
essentially a statement of policy and to leave with the
Secretary broad discretion for deciding on a State-by-State
basis whether or not the policy has been adequately complied
with... by promulgation of regulations . . . give clear
and specific indication of what will be required... and |
provide model implementing legislation." 73 1421(d)

 

State Agencies

State Administrative Program

"The requirement that the State Agency have adequate authority
under State law to carry out its functions and programs
represents the understanding .. . that the implementation .

. . - and requirement for either a certificate of need or

1122 program may require the enactment of a specific
enabling legislation in the State." 24 1422(b)

"the requirement for consultation with, and authority for,
_ the SHCC in carrying out the agency's functions and the

State program is designed to give the Secretary adequate

description of the council's role and authority . .. to
- ascertain whether requirements of section 1122 have been met."| 74 1422 (a)

"the planning staff (is understood) to be in a very real sense;
the SHCC's own staff for its activities" 75 1422(b)

"(it would be) appropriate if the Secretary chose to require
that agencies have a minimum staff . . . varied in proportion
to the population of the State." 75 1422(b)

 

"the Committee recognizes that regulations will be needed to
define the situations in which public access must be available
. » « promulgated expeditously by the Secretary." 75 1422(b) ©

. "no objection to the State Agency itself being the State's

lead oo for the cooperative data system for the “oe , @

 

 

 

 

 

 

 

 
 

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State Administrative Program continued:

", . .« not required but does anticipate that since this is
to be a single Federal, State, and local health data system
the State Agency will participate .. ; and closely coordinate

with it"

"the HSAs should have recourse for review (of an unaccepted
HSA recommendation by the State Agency) the State program
will require the Governor to designate an appropriate agency
or hearing officer to serve as an appeal body for the

decision-making."

"It is the firm intent . .. that the Secretary actually
receive and actively review modifications of State programs

on. an annual basis . . that this review (not) be a proforma

one."

State Agency Functions

"requirement(s) emphasizes that the State Agency is in fact tq
be the health planning entity of the State. This does not
-require (it) be located within the State's operational
health agency .. . intend that the State Agency act as an
agent within State Government of the HSAs. . ."

"each State Agency (is required) to apply to its review of
proposed new institutional health services one of two sanc-
tions to assure that when a service is felt not to be needed
it will not be offered (the possible two sanctions are a
State certificate of need program or praticipation in
section 1122 of the SSA)"

 

"As a general rule the Committee does wish to express a
preference for the certificate of need approach" ". .. On
reviewing a State certificate of need program the Secretary
should consider .... the sanctions to be imposed, the

- Facilities subject to review, and the procedures to be used"

 

76

77

77

77

78

78

 

1422 (b)

1422(b)

~1422(c)

1423 (a)

1423 (a)

1423(a)

 

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{MITTEE INTENT COMMENTS

' State Agency Functions continued:
. health services
“emphasize that the review of new institutional/is not simply
a regulatory activity but also a planning activity ... and
should begin as soon as State agencies are designated" 79 1423(a)

"The Committee has not. required any sanction (related to agency
review of existing institutional health services) which would
require that unneeded services be eliminated or closed ...
were a State .. . on its own initiative create such a
sanction the Committee . . . would have no objection..." 79 1423 (a)

"intent that the State health planning and development ...
and construction activities of new title XV be combined in
the one agency . . . to assure that a clear distinction is
preserved between funds available for planning purposes and
those .. . for development of health facilities, the costs
of administration . . . is to be paid through (Title XIV)
grants to the State agency .. . rather under title XV

allotmerit_earmarking." 79 1423 (a)

"The Committee does not intend that the provision...
-allowing States to have various functions of a State Agency
performed by different agencies of State government will
be used with any great frequency." , 80 | 1423(b)

 

 

 

"The agreement between the State Agency and a different State
agency which performs one of the listed functions should
specify how the budgets,staffs, and activities of the two
agencies will be related . . . and how the SHCC will be 80 1423(b)
used: to advise the separate agency."

State Health Coordinating Council

"the SHCC is to play a real and active role in the state's
health planning activities and to have specific authorities." 74 1422(a)

. "the SHCC (envisioned) as analagous to the governing body of
> the HSAs with specific authority to perform listed State

 

 

 

 

 

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Statewide Health Coordinating Council continued:

health planning functions for which it would have available
. . . staff of the State Agency. In addition the SHCC was
seen as a general advisory council to the Governor and

State Agency . . . and means by which the needs and concerns
of the Stateb consumers of health services, providers, and
HSAs would be reflected in the health planning and develop-
ment activities of the State."

Composition .
"the requirement that an equal number of representatives be

consumers and providers is not to imply that each HSA is to
appoint an even number of representatives but if an odd
number is appointed the extra person should be a consumer

WwW

 

Grants for State Health Planning and Development

"(no) required maintenance of effort for those states which
are spending more than others (on many of functions described
to the State Agency) so as not to penalize them for taking
‘the initiative."

 

"funds available under this grant may and in fact are
intended to be used for the costs of administering the
allotment program available under new title XV"

- General Provisions Definitions
"the definition of a provider is intentionally broad in that
a fiduciary position or interest includes for example all

those with positions of trust and accountabstity with respect
to the delivery of health services.'

* gS j

 

80

81

83

83

 

1424(a)

1424(b)

1425(a)

1425 (a)

1431

 

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General Provisions Definitions continued:

"In general, providers would also include all individuals
who hold degrees in the health professions or are employed
by organizations or individuais who provide health services.
-, . . this definition will require further development in |
both regualtions and policy statements."

"the term ‘institutional health services' is generally to
include the facilities and organizations which provide
such services .. . to. key the definition to the definition in
regulation of facilities and organizations reviewable under
section 1122 of the SSA... . to assure consistency . .. and
to allow a measure of flexibility in the definition of
institutional health services."

 

Procedures and Criteria for Reviews of Proposed Health

Systems Changes

"included in the legislation (are) specific requirements for
the procedures and criteria .. . not anticipated (to be) the
same for every HSA or State Agency but it is anticipated that
every individual agency will develop and publish its own

standard set of procedures and criteria which the communities
_may then be aware of and which the agency will then follow."

Technical Assistance for HSAs and State agencies

"requiring of the Department a very substantial technical
assistance program for the new planning agencies and a much
more careful and genuine review of their quality than has
previously been required."

"Technical assistance should take both the form of providing
to. agencies on a regualr mail basis or on request written
instruction and examples as to health planning and the form
of providing on-site assistance by experts in health planning
problems with the particular problems of a particular agency.

 

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83

84

84

33

i 86

 

1431

1431

1432(a)

Intro. 33.

1433(a)

 

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