* 00 297*





                                                               April. 1969


                                      OTHER POSSIBLR,, LEGISLATIVE ISSUES


                  There are a number of other possible legislative issues which, of
             perhaps leSSEir import or not quite so pressing, also warrant mention

             And some consideration.



             Authorization for       Construction
                  This issue, wj,j-ch was considered to be  of  major  importance  during  the
             early days of the program and was treated accordi.nS,-l-y in the "Repo3-t on  PZFP
             to the President and the Coiig.Less," now appears to be dead.     There is
             littJ.e or no indication from the Regions that th(-,. need  for  or  desirability
             of such authority is critical or great.     Current efforts  by  the  AdniinistrA-
             tiori to reduce inflation and the anticipated budget pressures  @,7oulcl  Seem  to

             make any efforts in this direction quixotic.


             Cost          or intatchi
                  There presently are no formal RIMP cost sharing or matching require-
             ments for either planning or operational- activities except for renovation
             (90% Federal- - 10% local.). The Reaul-al--ions state that  when  approving  pro-
             jects, the potential. ut-.Lli-zot-4--on of noiifecle-ral resources in carrying out
             proc,ram activities must be taken into account, but to date this has not
             been a majoi: pr@ictical- consideration.  Some Regions 'nave adopted proce-
             dures regarding the vracli.,al pliasino out of pro@ects or  the  transference  of
             their su,,)poi:t to community resources, but no specific  policy  in  this  regard

             has yet been adopted and applied nationally.








                                                         2--


                   One of the strengths of MIP has been the ability to full-fund

             prooi-am activities without having to worry about obtaining continued

             local support.  However,  some  persons  have  argued  that  if  matching  money

             were re(Iiiired, it would bri.rio increased local  involvement  to  the  procram.

             Given tli(2, current financial status of  most  medical  schools,  cost  sharing

             potei-iti@tl-],y might increase. the outreach of the program by  forcing  @T  to

             look to the community for financial support.       In addition, cost sharing

             also lqotil.d multiply the impact of the available R@iT funds.    The  basis  for

             cost sharing or matching in a program dealing with and composed of multiple

             institutions and organizations would pose subs     taiitial administrative prob-

             lems, bo,,!ever.

                  One very practical  consideration  is  that  a  program  with  an  authori-

             zati.on l(@vel (or appropriations) of even  $2--300  million  might  well  elicit

             Congressi,onal pressures for  local  matching,  even  though  that  same  program

             at a $65--120 million level had not.


             l@ o,@ial-L7atic)il

                  An @Liicreased. emphasis on regional- cooperative arrangements or   region-

             ,alizatio-,l of lica-l-tl-i resources and services, could raise. questions with

             respe ct to the present prohibition against interference with              the

             patterns. or methods of financing, of patient care or professional practice,

             or wit',, fire administration of hospitals".   Strict  interpretation  of   this

             provisic,-.i in the Act coul.@l limit severely the opportunities for  Regioi-lal








                                                   -3-


            Medical PrograTps to contribute to the regiotializati.on of health  resources

            and services. However, to date this prohibition  has  not  appeared  to  have

            caused any riiajor difficulties; and in all. probability any attempt to change

            or to clarify it woul.d raise more problems than it would solve.


            Broader Involvement in the Pr

                 Although medical schools and centers, community hospitals, practicing

            physicians, and by extension ffiedical- societies, make up the  primary  con-
            stitueiicy of I?!.iT, the ir@ix and relative influence of these groups varies

            considerably aiiioii,- Regions. Community hospital interests in particular,

            have been concerned about their limited involvement in the @'4P decision-

            uiakilig and planp.-.i-n- processes and operational projc-@cts. There has also
            been implied criticism from certain Congressmen about P@IP funds not getting
            beyond the medical- school (or "deai-@'s office")
                 Perhaps some consideration needs to be given to means by which broader
            participation by community hospitals and other provider groups, as wel-I as
            community and consumer interests mi.ghL: be insured.  Cost  sharing,  redefi-

            nition of the function of Reclo-ial Advisory Groups, and  increase(!  cooper-

            atiop with both state and areawide C@iP efforts liak7e been suggested as
            possible ways to accomplish this purpose.  The recent AIIA position with
            respect to hospital pl.anning and financial requirements may provide an
            impetus Ezqd opportunity for greater W@,@T support of individual hospital
            pl.anning efforts and cooperation and collaboration with CIIP areav7ide plan-

            ni.iig agencies.









             @a @@p   c@
                  The present explicit emphasis of  Pd,!P is on iiiTrovi.iig the quality of
             care -- "To afford to the Ttiedica.3- profession and the riedi-cal institutions
             of the Nation        the opportunity of i,.ial-,ing avail-able to their patients
             the latest advances in the diagnosis and treatment of these diseases."
             Consideration perhaps should be given to including within the procarqm's
             broad purposes an explicit reference to increasing or improving the
             capacity of the professions and hospitals for providing care through

             regi.onalizat:Lon.