April J-969 PPOGI.,LA-M, ll\.ELAI'I'ONSHIP WITFT@ 11.1-@'AI,Tll I'LAiNiN]'NG Issue and Back@@,rouiad The relationship bc-tx.,eei). Coitiprelic@i.).f-,ive Ilealtli Planriii-ig and the Regional inledical- Pro-rarti has been a constant issue at both the Federal and local. level-s since the er)actiii(@n.t of the-- programs. Moreover, i.@- is one that: has legislative and adln:LDi.Strative iRipli-catioiis which have been raised both by Con,@req@neii. such as T@el). Ro,,c,@rs (Deli,,ocrat - Flor@t@de,) @ind leaders of special interest groups including AIIA. and I,,@1A. Ptblic Lax-7 89--749, the Pa2-tiierslij.p for Health Act of 1966 (-and its 1967 anie-@idTqents) gives the States additional pro@,)-ciiii flexibility by removing aJ-ipo,.t all. of the c@Ltegor-ic,-,[- I.i.Tti Stations N,)Iiicli bid o-,7cr the years gradually accrued in Federal heal.th g).-aiits administered by thc@r..i. More importantly the Act pro-,z-'-Ctc-.cl funds for the support of both State -tiicl local ccpiprehc@,ii-,ive health pli, L an improved Eeaii-, iic, as for determining health Heads and establishing priorities. A stated ptir- pose of the program is to encourage broader consumer participation in health r.,-Ian.ni-,i@, by i-eqLiiri.n@, @ajorit@y cortsu-nic-r reprcseiit,-Ation on al.l. CIIP advisory council.s a,-id boards. 'J"iie projrivi has a stroii@ public b@isc-. both at the St@te-I.evel and in local plarning w'll:are by Act and Regulatioii city. and county goverriy,.iert!,; are required pai-tic-i.pints. -2- From the very early clays, CIIP was held by some persons (both in the Federal government and outside) to be the primary coordinating mechanism for all Federally assisted health prog3--ains. This position coupled with a lack of operating experience on the part of both @IP and CUP led to some predictions that the two programs were on a ficollisioii course.11 Although a really clear Federal policy position was never taken on the question, conflict between them has generally been avoided. In many areas of the country informal working relationships have been estab- li.shed to coordinate them. Interlocking board and advisory council membership are common and in a few areas both programs are working through the same local action groups. So!i,.e joint funding of projects has been undertaken. At its February meeting, the National Advisory Council on Regional Medical Pro-rains issued a policy directive which required that where applications for projects -i.iicludc-,. requests for purchase of major patient care equipment adequate evidence must be included that the project plan has been reviewed and if necessary approved by the appropriate local planning agency. The issue of the between the programs may have entered a new phase. Last month the Governor of South Dakota wrote to Secretarv Finch requesting permission to merge the two programs there under the. direction of MQ. At a recent -taff meeting Dr. John Cashman, Director, Coii,,@TPLi;.-iity Hei:ilLli Service, a-aiii raised the suggestion that -3- Comprehensive Heiltli Planning should encompass all Federal. health efforts. Recently a statement by Eugene I.Icl\lcriic@,y urged administration of both CHP and @NIP be placed in the same division. At the time CHP was Intended, medical- schools and their teaching hospitals were excluded from CITP planning through action takei-i on the floor of the House and Senate. Now more persons are saying that the service aspects of these teaching institution-- should be coordinated under community planning efforts. Indicative of current Congressional concern for the coordination of Federal health programs are provisions in the Staggers and Rogers bills to extend the Ilill-Burton Proci-@-in which require either review or approval of health facilities construction projects by the appropriate are,ii%,iete comprehensive health plaiaiiiii,@ a-ency or the State CHP agency. C, L> Since both P@4P and CHP come up for renewal in 1970,si.ii,.ilar Congressional questions about relationships can certainly be expected. .gpt.-o@ns Alternatives Perhaps the issue becomes one of how to demonstrate the unique'aspects of each pro-rwn and also IC..LP's willingness to maximize appropriate coordination. Possible approaches range from not dealing directly with the issue (as a viatter of strategy i.-espoiictiiig onl-,, when the question is sp-ecificall raised by .1 y Cortc,,,ress) to including in the Act a provision rc@quiriri- review of all R@IP projects by comprehensive area-@@i(ic--, health planiiin(- igencies. C> -4- Considerations (1) Inclusion in the Act of a provision for project review by area@.,,icle CIIP agencies would ensure closer coordination at the local- level bet-,;,,een RiNiP and CIIP. (2) Inclusion of a review provision in the INIP proposal might head off a provision by Congress reqtiiri-i-i- project p a@l. (3) Closer coordination with CII.P would bring additional needed consumer input into RMP. (4) It may not be necessary to handle this issue in the legislation. Rather it should continue to be dealt with on an administrative basis, allowing more pro-rain flexibility. (5) A review rbquirement could prove to be essentially pro forma, add nothing and entail still- further delays in the R@IP review process at the local level. (6) Since R@fll has a strong medical school - teaching hospital component, inclusion of a review or approval provision in the proposed legislation may be in violation of the intent of Congress shown in the floor action taken at the time of the last CHP exteiisi.or@. (7) The grass roots decision i-,iakin- aspects of RMP and CHP perhaps would be better served by continuing to allow the relationship between the pi.-o@-,_-aiiis to be worked out at the local level.