B&B INF13Rmikreom IMAa3iE M-ANAMEMENT 300 @emoc nw,-*=L"n Rau Upsomest MARLnosto, Ma *40 Z077Z 11 USA6 1) 249-01 1 0 HEALTH SERVICES & MENTAL liZ@ALTH ADIaNIc,TPATIOiN r\.EGIOI\'AL @IEDICAL PROGRAMS SERVICE OPRRATTI't'C HANDBOOK POLICIES AND PROCEDURES FORE14ORD (A statement on content and plan @-o'r posting and updating of information. (Include appropriate address to whom inquiries should be forwarded.) TAPILE OF CONTENTS Chapter I HISTORY AND PURPOSES OF REGIONAL MEDICAL PROGRAMS On October 6, 1965, the President signed Public world. The effect of this activity is i-ntensified by Law 89-239. It authorizes the establishment and tile swiftness of, its creation: at tile beginning of maintenance of Regional Aledical Programs to AVorld IVar 11 the national expenditure foi- me(li- assist the Nation's health resources in making avail- cal research totaled $45 million; by 1947 it was $87 able the best possible patient care for heart dis- million; and in 1967 the, total was $2.257 billion-a ease, cancer,'stroke and relateddiseases. This legis- 5,000 percent increase in 27 years. The most sig- lation, ivliicli will be referred to in ihese. 'Guide- nificaiit characteristic of this research effort is the lincs as The Act, was shaped b@, tll,;i-nteraction of tremendous rate it is producing new knowledge four antecedents: the historical tlirbst toward re- in the medical sciences, an outpouring which only gionalization of health resources; the development recently began and which shows no signs of de- of a national biomedical research community of cline. As a result, changes in health c:tre have been unprecedented size and productivity; the cliangina dramatic. 'I'oday, there are cLires i%,Iiere none ex- needs of society; and finally, the particular legis- isted before, a number of diseases lia%,e all but lative process leading to The Act itself. disappeared with the application of new vaccines, The concept of rcgionalization as a means to and patient care generally is far more effective meet health needs effectively and economically is than even a decade ago. It has become apparent not new. During the 1930's, Assistant Surgeon Gen- in the last few years, lioivever, (despite substantial eral Joseph IN'. Alountin was one of the earliest acliieN,ements), that new and better means must pioneers urging this approach for the delivery of also be found to convey the ever-increasing volume health sei-N,ices. The national Committee on the of research results to the practicing physician and Costs of @ledical Care tlso focused attention in to meet growing complexities in medical and lios- 1932 on the potential benefits of regionalization. pital care, including specialization, increasiii-ly In that same year, the Bingliam Associates Fund ititricate and expensive types of diagnosis and initiated the first comprehensive regional effort to treatment, and the distribution of scarce man- improve @ patient care in the United States. This power, facilities, and other resources. The degree program linked the hospitals and programs for of urgency attached to the need to col)e %vitli- continuing education of physicians in the State these issues is heightened by an increasing public of Nfaine with the university centers of Boston. demand- that the latest an(] best health care be Advocates of regioiialization next gained national made available to everyone. This public demand, attention more than a decade later in the report in turn, is largely in expression of expectations of the Commission on Hospital Care and in the- aroused by awareness of 'the results Ind promise Hospital Survey and Construction (Hill-Burton) of biomedical research. Act of 1946. Other proposals and attempts to In a sense, the national commitment to I)io- introduce regionalization of health resources can medical inve stigation is one manifestation of the be chronicled, but a strong national movement third factor which contributed to the creation of toivard regionalization had to aivait the conver- Regional Medicil Programs: the changing needs gence of other factors ivllicli occurred in 1964 and of society-in this case, lie;tltli needs. The deci- 1965. sions by %various private and public institutions to One of these factors was the creation of a support biomedical research @ere responses to this national biomedical research effort unprecedented societal need perceived and interpreted by these in history and unequalled anywhere else in the institutions. In addition to the support of research, (INTRODUCTORY MATERIAL) the same interpi-etin,e process led the Federal Gov- A creative partnership must be forged ernment to de@,elol) a I)i-oa(i range of otlxer pro- among the Nation's medical scientists, practicing grams to improve the quality and availability physicians, and all of the Nation's other health of health care in the Nation. The Hill-Burton resources so that new knowledge can be trins- ProgTam which began with the passage of the late(i more rapidly into better patient care. This I)rcviotisly-mentionecl Hospital Stii-%,e), and Con- par'uiersliip should make it possible for every corn- structioii Act of 19-16, t(ygetlier with the National munity's practicing pli),sicians to share in the diag- A,Iental Health Act of 1946, A,as the first in a series nostic, tlieral>eutic and constiltati%,c resources of of post-v@7orld X%'ar 11 legislative actions having major medical institutions. They should similarly majz)i- impact on health aff-.Airs. IA'Iien the 89th be provided the opportunity to participate in the Con- academic environment of reseal@cii, reaching and ,,ress adjourned in 1966, 25 liealtli-related bills had been enacted into law. Among these were patient care which stimulates and support!, medical Nfedicare and Nledicaid to pay for hospital and practice of the highest quality. physician services for the Nation's aged and poor; 0 Institutions with high quality resear@l-i pro- the Comprehensive Health Planning Act to pro- grams in heart disease, cancer, stroke, and related vide funds to each state for non-catecrorical health diseases are too few, given the magnitude of the planning'anci to support services,rendered through problems, and are not uniformly distributed state and other liealtli activities; and., Public Law throughout the country. 89-239 authorizing Regional Mcdi'cal Programs. 1, 0 There is a need to educate the public re- The report of the Presi(len@s Coffimission on garding health affairs. Education in many cases will Heart Disease, Cancer, -ind Stroke, issued in Decem- permit people to extend their own lives by chang- 1).-r 196-1, focused attention on @ocietal needs and ing personal habits to prevent heart disease, cancer, led directly to introduction of the legislation ktroke and related diseases. Such education will authorizing Regional Nlectical Pro,@rams. 'Nfany of enable individuals to recognize the need for dia@ the Commission's recoi-nmen(lations were si&,mifi- nostic, therapeutic or reliabilitatin,e services, and cantlv altered by the (fongress in the legislative to know where to find these services, and it will process, but The Act was clearly passed to meet motivate them to seek such services when needed. ind given national During the Congressional hearings on this bill, needs and problems identified , recognition in the Commission's report and in the representatives of major groups and institutions' Congressional hearings preceding 1)assa-e of The with an interest in the American health system Act. Some of these. needs and problems were ex- were heard, particularly spokesmen for practicing 1)i-esse(I as folloivs: A program is needed to focus the Nation's physicians and community hospitals of the Nation. The Act which emerged turned away from the health resources for research, teaching and pati ent idea of a detailed Federal blueprint for action. care on heart disease, cancer, stroke and related diseases, because together they cause 70 percent specifically, the network of "regional centers" rec- ommended earlier by the President's Commission of the deaths in the United States. 0 A significant number of Americans with was replaced by a concept of "regional cooperative these diseases die or are disabled because the bene- arrangements" among existing health resources. fits of present knowledge in the medical sciences The Act establishes a system of grants to enable are not uniformly a%,ailal)le throughout the coun- representatives of health resources to exercise ini- try. tiative to identify and meet local needs within the 0 There is not enough trained manpower to area of the categorical diseases through a broadly meet the health needs of 'the American people defined process. Recognition of geographical and within the lirescnt system for the delivery of societal diversities within the United States was health services. the main reason for this approach, and spokesmen Pressures threatening the Nation's health for the Nation's health resources who testified dur- resources are building because demands for health ing the hearings strengthened the case for local services are rapidly increasing at a time when in- initiative. Thus the degree to which the various creasing costs are posing obstacles for many who Regional Medical Progra;ns meet the objectives of require these I)re%-cntive, diagnostic, therapeutic the Act will provide a measure of how well local and reliabilitatin,c services. health resources can take the initiative and work 2 CHAPTER I (It,'TRODUCTORY @!!.T."RIAL) to iml)ron,e patient care for heart disease, together planning comniiltees, categorical disease task cancer, sti-oke and related diseases at tile local level. forces, and community and otliei- types of stib- The Act is intended to provide the means for regional advisory committees. conve),ing to the medical institutions and profes- Regions first may receive planning grints from sions of the Nation the latest advances in medical the Dix-ision of Regional Medical Programs, and science for diagnosis, treatment, and rehabilitation then may be awarded operational grants to fund of patients afflicted with heart disease, cancer, activities planned with initial and subsequent plan- stroke, or related diseases-and to prevent these ning grants. 'I'liese operational pro(,i-.tms are the diseases. The grants authorized by The Act are to direct means for Regional Medical Ilroarams to r3 encourage and assist in the establishcment of re- accomplish their objectives. Planning moN-es'-,i Re- gional cooperative arrangements among medical gion toward operational activity and is a con- schools, research institutions, hospitals, and other tinuing means for assuring the rele-,,anc@ and medical institutions and agencies to achieve these al)pronriateness of olxrational activity. It is the ends by research, education, and demonstrations effects of,tl@e operational activities, however, which of patient care. Through these means, the pro- will produce results by ivliicli Regional Medical grams authorized by The Act are also intended to Programs will be judged. improve, generally the health manpower and facil- On November 9, 1967, the President sent the ities of the Nation. Congress the Report on Regional Afcdical Pro- In the two years -since t@e President signed The granis prepared by the Surgeon General of the Act, broadly representative grcqlps lia,%,e organii@d Public Health Service, and submitted to the Pres- tliei-nsel-,,es to conduct Regional Medical Programs ident through the Secretary of Health, Education, in more than 50 Regions which they themselves and Welfare, in compliance with the Act. The have defined. These Recions encompass the Na- Report details the pi-ogress of Regional Medical tion's population. They have been formed by the Programs and recommends continuation of the organizing groups using functional as well as Programs beyond the June 30, 1968, limit set fortli apliic criteria. These Regions include corn- in The Act. The President's letter transmitting the geogr binaLioliS of entire states (e.g. the NVasliington- Report to the Congress was at once encouraging Alaska Region), portions of several states (e.g. the and exhortative when it said, in part: "Because the Intermountain Region includes Utah and sections Iiw and the idea behind it are new, and the prob- -of Colorado, Idaho, Montana, Nevada and Wyo- lem is so vast, the program is just emerging from ming), single states (e.g. Georgia), and portions the planning state. But this report gives encourag- of states around a metropolitan center (e.g. the ing evidence of progrcss-and it promises great Rochester Region which includes the city and 11 advances in speeding research knowledge to the surrounding counties). XN'itliin these Regional Pro- patient's bedside." Thus in the final seven words grams, a wide variety of organization structures of the P)-esident's message, the objective of Re- have been developed, including executive and gional Medical Programs is clearly emphasized. CHAPTER I REVISED GUIDELINES Page 3 (INTRODUCTORY MATERIAL) ChaDter 11 THE NATURE AND POTENTIAL OF REGIONAL MEDICAL PROGRAMS Goal-Improved Patient Care Cliaj)tei- I I)Iices the Goal of Regional iNfectical gional Medical Program. It is facilitated by N,olun- Programs in its historical context and gives a fuller tary agreements to serve, systematically, the needs ,perspective -to Section 90f) of the Act (see.Al)pen- of the public as regards the categorical diseases dix 1), which defines the Goal 'in cletiFil. In tbbre- on a regional rather than some more narrow basis. viated form, the Goal is described in the Surgeon Regionalization, or a regional cooperative ar- General's Report as clear and-unequivocal. rangement, within the context of Regional Aledi- The focus is on the I)atiei-it. Tlie-object is to in- cal Programs has several other important facets: fluence the present arrangements for health sel-v- 0 It is both functional and geographic in ices in a manner that will permit the best@ in 'character. Functionally, regionalization is the modern medical care for heart disease, cancer, mechanism for linking patient care with health stroke, and related diseases to be available to all." research and education within the entire region to provide a mutually beneficial interaction. This in- Mean,5-The Process of Regionalization teraction should occur ,vitliin the operational activ- ities as well as in the total program. Tile geo- Note: Regionalization can connote more than a graphic boundaries of a region serve to define the regional cooperative arrangement, but for the population for ivliicli each regional progrini ivill purpose of Giiiclclincs, the two terms will be be concerned and responsible. This concern and used interciiino-eal)l),. 'riie Act uses "regional responsibility should be matclied by responsiveness, cooperative arrangement," but "regionaliza- which is effected by providing tli e population ivitli tion" has become a more convenient synonym. a significant voice in the regional prograiii's deci- A regional cooperative arrangement among the sion-making process. full array of available health resources is a neces- 0 It provides a means for sharing limited sary stel) in bringing the benefits of scientific ad- health manpower and facilities to maximize the vances in medicine to people wherever they live in qtialit), and quantity of care and service available a Region they themselves lia%,e (lefinecl. It enables to the region's population, and to do this as eco- patients to benefit from the inevitable sl>ecializa- nomicilly as possible. In some instances, this may tion tnd (IiN,ision of labor ,@,iiicli accompany the require inter-regional cooperation between two or expansion of medical knowledge because it pro- among several regional programs. %-i(tes t system of ivoi-king relationships among 0 Finally, it also constitutes a mechanism for health personnel tti(i the institutions and orgaiiiza- coordinating its categorical program with other tions in i@,iiicli they work. 'I'Iiis requires a commit- health programs in the region so that their com- ment of individual and institutional spirit and bined effect may be increased and so that they con- resources which must be worked out by each Rc- tribute to the creation and maintenance of a sys- 4 CHAPTER II - REVISED GUIDELINTES - Page 4 (INTRODUCTr)RYMATERIAL) tem of comprehensive health care within the L-ntire been diverted from their objectives because there @region.1 ivas not this voluntary involvement and commit- Ber(iiisc the advance of @?2ozvledgc changes the ment by the necessary indin,iduils, institutions and organizations. The Act is quite specific to issure nature of nzedical care, regionalization can best be this necessary invoIN,cnient in Regionil Nledical viewed as a continuous process rather than a plan Programs: it defines, for example, the minimum which it totally developed and then implemented. comi-)ositioii of Regionil Advisory (;rotil)s. This process of re,,-ioiialization, or cooperative arrangements, contists of at least the folloiving'ele- Tile Act states these Regional A(l@-isoi-), Groups ments: inv,ol-,,crnent, identification of needs and must include "practicing physicians, medical center opportunities, assessment of resources, definition officials, hospital .tdmiiiistratoi-s, rel)t-csentatiN-es of objectives, setting of priorities, implementa- from appropriate medical societies, N,oltintary tion, and evaluation. lVhile these seven elements health agencies, and rel)rcsciititi%cs of other orga- in the process will be described and discussed sep- nization8,,iiistittitions, and agencies concerned with arately, in practice they are interrelated, contin- activities of the kind to be carried oil trader the 7uous;ind often occur simultaneously. program and members of tlle_I)Liblic f-,iniiliai- ivitli the need for the services provided under the pro- In,%,olvement-Tlie iii%,bl%,eiiient and comi-nitment gram." To ensure a i-naxinitim opportunity for of individuals, organizations and, institutions success, the coi-ni)ositioii of the' Regional Advisory iviiicli will engage in t@ acti@,ity of a Regi@nal' GroLil) also should be reflective of the total S13ec- Medical Program, as well as @iose -;vllicii ivill' be ti-tim of health interests and resources of 'the affected by this activity, must underlie a Reaioiial entire Region. And it should be I)ro@iclly i-cl)resei'ltii- 0 Program. By involving in the steps of study and ti%,e of the geographic ireas iii(I all of the socio- decision all those in a Region who are essential i economic groups %vliicli Nvill be served b), the Re- to implementation and ultimate success, better gional Program.' solutions may be found, the ol)porttinit), for i%pider acceptance of decisions is impi-oN-e(l, and imple- Identification of Needs and Oppoi-ttinities-A mentation of decisions is achieved more rapidly. Regional AIcdicii Ili-ogram must identify the needs Other attempts to organize health resources on a regarding heart disease, cancer, stroke and related regional basis lit%,c experienced difficult), or have diseases within the entire Region. Fui,tliei-, these ,it is not tire intent of a Regional Nle(lical Ili-ogram grant to supplant either l,'e(ici-iii (ii- iioii-Ft,(Iei-al sources of support for various activities related to achieving its purpose. Rather, the Regional Nfcdical Program provides an opportunity to introduce actuaries which draw upon and cffccti,,-cl@- link ac- ti,6-ities alica(li, supported, or supportable in tire future, through other sources. Current examples of other Federal programs that 1)ro%-i(le essential inputs into the health re- sources of the Region ir.c: other activities of t)ic National institutes of Health, particularly the National Heart Insti- ttitc, Natioiial Caiicei@ Institute, ;tiid Nationii Institute of Netirologic.ii I)i'seises an(] 13iiiidiiess; other constituents of the I)cpai-ttiiciit of ITetitli, E(itic:ttioti. and N@'elfare particti- larl)- the (oiiil)i-clictisiN-c Health Planning @ti(i Services Pro- gram in the Office of the Surgeon (;eiiei,al. the Bureau of I)iscasc llrc%,eiltic)ii aii(i Eti%-ii-oii-mental Control, the Bureau of Health Nlaiipowcr, the BtireiLi of Health Services, the Social Security Administration. the Office of E(Iti(4itiott. and the Social and Relitl)ilitatioii and otlici- (;o%,eriiiiicnt agencies, 1)@it-tictilarl%- the Oiri(,c of Economic ol)l)orttiiiitN-, the ),rodcl Cities Ilrogi-am of the I)eparttiiciit of I-lotising and Ilri):Iil I)et@cloi)lllcllt, :ill(l the N'etci-@ilis k(tillillistratioll. @Nciv sc)urc(.-s of stil)l)(Pit foi- i(@tiN-ities related to a Regional Ntc(lical %Iloiii(I I)c considered during I)otli tire plan- riiiig ;tti(i operational 1)liises. GRAFTER II - REVISED GUIDF@LINES - Page 5 (INTRODUCTORY MATERIALS) needs must be stated in terms which offer oppor- Definition of Objcctives-A Regional Procn'am ttinities for soFution. must be continuously involved in the process of This process of identification of needs and setting operational objectives to meet identified opportunities for solution requires a continuing needs 'and opportunities. OI)jecitives are interim analysis of the problems in (leliN,ei-ing the best steps toward the Goal (refined at the beginning of medical care for the target diseases on a regional this (;Iiaj)tei-, and achievement of these objectives basis, and it must go beyond a generalized state- should leave an effect in the -Region felt far ment to definitions which can be translated into beyond the focal points of the individual activ- operational activity. Pai-tictilii- opportunities may ities. This can be one of the greatest contributions be (lefincd by: iolcis at-i(I ,tl)l)roaclies generated of ]Zegiotial inlecticil Programs. The completion within the Region, extension of activities already of a new project to train nurses to care for can(-cr present within the Region, and approaches and patients undergoing new combinations of (Irucy activities developed elseivliei-c iviiicJi might be al)- and radiation tliei-al)),, for example, should benefit I)Iied with the Region. cancer patients iiid should provide additional Among N,ai-iotis identified iiee(_6- tliei-e',ilso arc trained t-daiil)oivei- for many hospitals in the Re- often relationships which, when perceived, offer gion. Iltit the project also should have challenged even greater opportunities foi- solutions. The daii- the Regioii's nursing anct liosl)it-@ils communities to ger of "I)i-piect %,ision," ivliicli is ikin to tunnel iinl)i-o%,c the continuing and in-ser-,,ice education vision, Must be guarded a-! ,,'iinst, opportunities for iiiii-ses ivitilin the Region. In examining the 1)rgl)leui of -coronary care, Settin of Priorities-Becitise of limited inin- units tlirott(@liotit its Re'rioii, for example, t,.Re- 9 ?I 9 power, facilities, financing and other resources, a gional Program may recogniz@ that @lie more effcc- Region must assign some order of priority to its tive approach would be to consider the total I)rob- ol)jectin-es tn(I to the steps to aciiieN-c them. Besides lem of the treatment of myocardial infai-ction -s to consider patients within the Region. This broadened' al)- the limitations on resources, factoi 1)i-oacli on a regioiitl basis enables the Regional include: 1) balance beti@,eeii ivli2it should be (lone Program to consider, the total ti-ray of resources first to meet the Regioii's needs, in ;tl)solute terms, and i%,Iiat can be clone using existing resources and ivitliin its Region in relationsliij) to a co.iiil)i-elien- competence; 2) the I)oteiitiils foi- rapid in(i !or six,e i-)r@gi@am for the care of the mvocai-(Ii,.tl in- farction patient. Thus, what was a' concern of substantial progress toward the Goal of Regional individual lio%sl)itals -,tbotit how to introduce coro- Nfe(lical Ilrogranis tnd progress toward regionaliza- nary care units his been transformed into a project tion of health resources and sci-N-ices; and 3) Pro- or group of related 1)i-oje(,ts with much greatei- gram balance in terms of disease categories and potential for effective and efficient utilization of in terms of emphasis on patient care, education the Region's resources to imi)i-ox,e patient care. - and research. Assessment of Resources-As part of the process of i,egioiializatioti, it Region must have contin- tiotisly updated inn-eiitoi-y of cxistin@,- resources and capabilities in terms of function, size, number and quality. EN,ei-), effort should be mt(le to i(len- tify iii(i use existing inventories, filling in the g,,tl)s as needed, ritlier than setting out on t long, exl)en- si%-e process of creating ;in entirely net%, in%,entoz-@,: Information sources include state in(I locil health planning ;igeii(@ies, liosl)it@il and meLlical associ;t- -tions, ;iii(i %-oltiiitat@y ;igeti(-ies. The in%-entory pro- %-i(les :t basis for. informed judgments and priority setting oil Icti%,ities )i-ol)osc(i foi, (IeN-elol)nient I tin(lei- the lzcgioiiil Program. It can also be used to identify I-lissilig i-esotii,(es-%-oi(Is requiring iienv inN,estnieiit-,iii(I to (lex,clal) new configurations of to meet needs. 6 CffAFTER rf - REVISED GUIDELINES - Page 6 (INTROD'UCTORY MATERIAL) CPI4 A SYSTE74 C-F NAT@N,,AJ. PRIOR-TTT-ES BE REFLE= T-N REGIOMAL @IEDICAL PROGRP24S? en@-the discussion, Doctor Hogness suggested that primary consideration OP would have to be given -iot only to identification of the broad national goals ii,for Regional Medical Programs, but to some consensus am@o- national experts /as to the best ways of accomplishing the goals. This would enable the Council !to assign the highest priorities to the activities within individual -Regioral Medical Programs which move Programs along those lines. Grant applications would then be considered to reflect entire PaNIPs and judgements on them based on the'%,iliole Program's ability to (1) affect the system of patient care, (2) improve the renderin- of primary carc,' (3) be concerned with prevention of disease, (4) contribute to the continuing education of existing mnpowep and the training of new manpower, etc." There was agreement @mng the members of the Council that any priority system designed for Re-ional I-led@al Dr@ams should have its primary emphasis on' methods rather than aims,- ivhi6h are "easily stated and rhetorical" and in the -last analysis corwon_to all effovts in radical care the aller-atio@-i of the effects of disease. Council also recognized that in beg -,to look to priorities based on the suggestions of Doctor-Ho@ess an(! others,- it ,Voul-d be necessary immediately for them to recognize these priorities in their review and analysis and final recomri@ndation on the funding of Regional Medical Program grants.. Progress i,-i priority development viould then need to be shared with the Review Committee, site visitors, panel @Te@ers, and other consultants Arho participate in the review process; and the guidelines Trade known to the staffs and Regional Advisory Groups of the 55 Regional iNl6dical Programs, (MORE) ...August 26-27, 1969 Council Minutes There was essential ap7eerr.--nt that reallocation could have a' favorable effect'onl-y if priorities can be agreed upon for administration of the program. Doctor Pellegrino suggested the following five steps to-,v@ accoitplisl,,ing these ends: (1) Each new initial reques@U should be examined carefully to determine whether or not it -A,-ill LTprove cooperative arrangements in the Region. (2) Careful attention should be given to the progress of RegionaL, i@ledical Programs ard their component projects when they-are reviewed for renewal. (3) Requests for purchase of mjor. hardware should be clo'sely examined, eliminating all but those which are absolutely essential and for which no other source of funding is available. (4) Atte,@,,-@l- should be made to increase, @enever possible, the concentration of program ef.Lort on the specifically related categorical disease. (5) Care should be taken to identify project activities which can serve as models and to avoid unnecessary duplication of these models a-wng and individual- Regic)ns. ..,December 16-17,.1969 Council Minutes (INTRODUCTORY MATERIAL) @re is agree@nt on.the part of all m@ers that the Council rmst continue to accept responsibility forgetting broad National priorities for the program. They recognize the growing importance of the development of an arrangement by which they can assess the progress of individual Regions in @ lamenting these priorities and in actually affecting the patterns of delivery of care in the areas they serve. Doctor Llrennan expressed a-notHer approach to the matter of prouam- pi-iorities. He viewed the mst successful -Regions as being those which have developed effective core staff and operational mechanisms .,kiich are bringing about change whether or not the changes are thosO authorized in the law.@ He suggests that two kinds.of "technology" must be enmlo@ed: (1) the translation of "r-ew advances in-health care" into ":L@.ovpd reso@ces for health care;" and (2) the use of those resource* -to bring about,actual in,-orovement in c@e. He used as an ex@le the control,,of cervical- cancer a-n a certain geogra-,ohic area. -He stated that by the application of new advances we know "how" to control the disease, but that we still do not know exactly what are the costs and effects of various approaches to the use of this knowledge. Itis Iiis opinion that the development of this second "technology" is an important RIQ function. As a possible point of departure for the deliberations of this group, Doctor Everist offered a series of four priorities which he follows in considering Regional Yiedical Programs: (1) The quality of the core program - the personal qualification f@the staff members; their capability of developing and handling infoi-ffation between and among the core staff, the cooperating agencies in the Region, and the national level; (2) the effectiveness of the core program - which he believes can be judged @ost solely on the extent, effectiveness, and pe, ence of tlle cooperative arrangements which are developed and developing; (3) the accessibility of the core program - its responsiveness to needs for services and the degree of regionalization of services by Tneans of Fd'IP project mnies and otherwise; and (4) the ca-oacity of the core pro= --,to be judged by the continuing enlargement of the system of both care and inforrmtion in the Region. '/'NOTE: Above are exerpts from December 16-17, 1969 Council Meeting Minutes (INTROZUCTOEr7 MATERIALS) sible within the state of the art and appropriate for the activity being e%,aluate(l. Tlitis, evaluation can range in complexity from simply counting numbers of people at meetings to the most in- I voli-ed determination of beliit%-ioral changes in patient management. 'As ;t first step, liowen,er, e%,altiation entails a realistic attempt to design activities so tliat, as they are implemented and finally concluded, some data will result ivllicil will be useful in detcri-niiiing the dearee of success attained by tile activity. Criteria-Evaluation of Regional INfedical Pro- grams-Tlie criterion for judging tile success of a Evaluation-Eacli planning and operational Region in iml)lemeiiting the process of regionalize. A, activity of a Region, as well is the overall Re- tion is the degree to ivllich it can be demoiistrated gion,il Pi-ogrim, should r ei%,.q continuous, quan- that the Regional Program lias implemented the I u titati%,e tnd qualitative eza ation iviierever pos- seven essential elements discussed in this Cliaptcl,: sible. EN,altiation should be in -terms 8f attainment involvement, identification of needs and ol)l)or- of interim objectives, the process of regionaliza- tunitics, a@ssnient of resources, definition of ob- tion, and the Goal of Regional i\lcdical Programs. . . setting of priorities, implementation, and ,JectiN,es, Objective evaluation is simply a reasonable basis en,altiation. upon wlii(:Ii to determine ivlietlier an activity Ultimately, the success of any Regiontl Nfe(lical should be continued or altered, and ultimately, Program Must be judged by the extent to ivliicli it wlietlier it acliie-,,cd its purposes. Also, the e%,alua- can be demonstrated that the Region@il Program tion of one activity may suggest modifications lias assisted the providers of 11(@i.Itli scl-l,i(:es in of another activity wliicli would increase its effec- developing a system ivliicli makes available to tiveness. let,ei-yone in tile Region impron,e(i care for fieart Evaluation implies carrying out ikliatever is fea- disease, cancei-, stroke, in(i related diseases. CHAPTER II REVISED GUIDELINES Page 7 (INTRODUCTOR@ MATERIAL) Council, by voice vote, idopte(4 t-1--r-' motiop.: ca, Pi:cl,r:qrs Tiie National.Itlldv4-sory to the P@e.,lioiial will interest itself in policy ro@vtiliti-,ln for all liS','@'LiA health senTice pro-ra@,.s -,.ii-thoti'L. altorin@ its primary concern for L'ile Re-i-,)ri@il iiod2Lcal -Pro,-rarCs. ... November 9-10, 1970 Counc8l Minutes Council passed by voice Vote, @.litll three abstc,,itions and dissent, the motion: Council requests the Peiy,-;onal. 1-feclical Pro-i7ams ScrvicL,. to coirijun- icata Lo Coorc!4-i-,,-,tors and Adviso'y Croul)sook Reizionztl r Pro@rzr..Is assurance of @puncill'@, continued int:Lr'est in in%provin@ L> the quality of. 'c'are,. 'delivered by all health personnels Noverp'-,er 9-10, 1970 -Council Minutes General Principle-- opl.-2 and Veii,,'iors zof- c--re: Regio'nal 'Medical Nceds of the Pf L Proc,rz,m.s do not !Have autlior--ty or fi:,n.-..s to all fci'L't for health services,to ',Ile pcop@e or .'or susta@@ned s-srvices to the of health care I)v direct interveiitio,,l. Itci!,ioral- @ed-Lcal ProrrIIT,,s are to conccrtrate I C> oti those needs for x.,,Iiich voluntary participat--on by t,ie- in re-ionali- zatio-,i can affect iniprover@,ent. Priority rankin@ of projects in a lle-ional liedical Prograia is to be influenced most importantly by the ariount of benefit obtainable for the service population par dollar of Re,,,ion,.-tl "-I(:tdi.cal rro&ra;7, ""C("icill Pros c'tii, nr)t. hzi@,o o i::L T-. y o r ii L@ i o r o r L o'-- c@ r%@ a. cs r-,,@.c;i c-I)critic)iizil pro"c!tt is to be dcs.L-i,.:2d Lo ")L@ t!)O. I-LualLh svste-i oL' i.Ls to be -f -,:O,!l it tlici end of its r i C,,l 0 t I I -r c C! y c ci I.- E; 0 i- e. s 5 ;:(-)jocts in cp.,iritio7i Lli,,.t a,ce fLilill@ to P,, e -il sti-.)I-)o t by t, f 3: Ciic)ii, OE t-.,,iL2 4. r i I v o r,@ r:: b t a 1 1. o, c-- d o t (? a s c, ia,@ 1,@ p c- r i o d i 1 I i,; i -L c 1 I t o It) e -, c-,,- (,r be Cotiiicil no tliaii .1.3 to 2/f W-C)"Lii@, as a lc-, pc -d" btit: @r@oEii SL-1@tin< a i!ia@.ii-,iurq nii-O'lit tciid to L-,cco,tic a cLlsl,-.o:-,.Liry pcr4oci. .21:1 0)@ si;17,-Iiort-d from other graiit ftilids: (:oui-icil .,I funds are re a f f i r 6 i @lecic,-Ll Pr' r. t, not in,:(-,need t@, ,,r;ii;ts lof;t tlircl-!Z-,h or r--,Itictic)ii of otl,-r @rant pro!;ra,.!,,s. Sc:i.-vicc oft t:rniilirr J- -- projects -'Pitit--ted unc'c!r OL.licr pro-rams t)@ l'or l,c@,j.o,,ial .ntlic@il sup!)C-cr O.-ily to tlle c test toy: tL c- n, c r I o a, r o i -ate t Li L t' I a r c c r O- t:.i. ilito t'l"c. di,@ of a short tiliic!. .,Ill Above Iran A"ovenb--r 9-10, 1970 Couticil If,-nt-,tes STATU.A.TORY t-TITHORITY ....legislative History ... Copy of current legislation,(PL 91-515) ... Regulations ... Eligible Applicant 'Types of Grants ...The Regional Advisory Group RECUL.ATIONS REGULATIONS REGIONAL MEDICAL PROGRAMS March'18, 1967 Division of Regional Medical Programs National Institutes of Health Public Health Service Department of Health, Education and Welfare ik-0 Ir r - T- -,4 I 1: I q STATUATORY A TJTHORITY 1. Eligible Applicant Public or nonprofit private universities, medical schools, i-eseircii institutions and other public or nonprofit pi-in,atc agencies tnd institutions are eligi- ble to apply for a grant to plan aii(l/ot- operate a Regional Nle(lical Progr,im. Eicii applicant must be authorized to represent the agencies and in- stitiitioiis which propose to cooperate in I)Itiiiiing for ;tii(i development of the Regional Program. A(lditioiiilly, eacli applicant must be tl)le to exer- cise program coordiiiition an([ fiscal responsibility (see agreement of affiliation Cli;tl)ter III, 1). 14). Finally, eatli'al)l)licazit in order to be eligible must have designated a Regional A(lx-isot-y Group to advise the applicant (Fired those agencies and in- StitLItions ivliicli propose to cooperate iii' the Re- gional 'i%le(lical Program) in the 1)1@innitig and operation of the Pi-o,-,r@im. It may be necessai-), foi- the agencies and in- stitittions proposing to cooperate in the Program to create-,t nonprofit corporation to act foi- them its tlle applicants to maximize the extent to %which ekecti%,e I)i-ogi@,ini and fiscal coordination can be exercised in the implementation of the Regionlil III-ogi-,im. CHAPTER III rtEVISED CUIDELINES Page 8 Single Crantee-Iii order to iiistirc @gional c@ operation. there can be only a single grantee or--,t- nization for each Regional Nledical Program. CHAPTER III REVISED GUIDELI:ES Page 13 Up-date per PL 91-515 STATUATORY RESPONSIBILITY RANTS) (TYPES OF G II. Types of Grants -t @ititlioi-izes the Planniiig-Sectioti 90.1 of The A( Stii-geon General, til)oii ilecoiiilylcll(fation of the National A([%-isoi-), Cotincil on Reo-ioiiil 'i\le(iicil Pi-ogi-ziiiis, to nitkc gi-itiltS LO Issist in the I)Iinriiii@@ an(l-(IeN-elol)i-nent of Regional Nle(lical Pro--i-ziiiis. r) Operational-Sectioii 904 of The Act @ititliori/.es the Surgeon Ceiiei-.il, til)oii i-ecomi-neii(l@itioii of both the Regional A(I%,isor), C;i-oiij) @iiid the Ni- tional Ad%,isor), Cotincil on Rcgio6,il Nfc(licil Pro- grams, to niike gi-ants to tssist in the est@iblisl'fi-iient and operation of Regional I\fc(lical Pi-oc)-rams. The I)Iiiniiing activities ivliicli are initially fLinded Liiidei- the 1)ro,,,isioiis of Section 903 iiity -in(ted as an integral part of be continued and exl), the operational ;activities of etcli Re-ioii and as stioli may become a part of the Re-ion's opcr- ri ational grant Lin(ler Section 90-1. HoNveN,er, ol)er- ational activities may not be SLII)I)Ol-tC(l from plan- nin- grant f un(is. Rec@giiiziiio- the necessity foi- each Rc(,ioii to plan ahead, the @,ariotis Regional iqe(lical Pro- graiiis are encotirige(I to consider their 1)liasing accoi-din- to ;the natiti-e and extent of the activ- ities iii%-ol%,ed all) to a nizixiiiiLiin of fi%-e )-cars. The Commitment for SLII)I)ort be),oii(I Ititi(! 30, 1969, is based Upon iiiticil),itect i-eneivtl of the Regional '.,\Iedical Pi-oo-i-@tin's authorizing legislation and is predicated on the annual @ipl-)rol)ri@itioli Of ftincls by the Coiici-ess. Commitments I)e)-on(I the teni-linal dates of legislatioii-botli appropriations and authorizing legislation-arc delimited 1)@, the phrase, "@vitliin the limits of aN-ailtl)le fiiiids," written into the regulations and on the iwtrd statements isstic(i by the Di-,-ision. CHAPTER III - REVISED GUID-MINES Page 8 NOTE: Up-date per PL 91-515 S-TATUATORY AUTIIORITY TYPES OF GP ",q'CS Project Grants for Multip-rogram Services Section 910 of th e Act authorizes that funds appropriated under this title shall also be available for grants to any public or nonprofit agency or institution for services- needed by, or which will be of substantial use to, any two or more Regional Nledical Programs . Grant applications submitted under this section may be received from any Regional Medical Program or eligible institution or agency. If the application is-for activities to be carried out in specific Regions, the-approval of Regional Advisory Groups of all Regions covered by the proposed activity is required by the Division. If the application is from an-institution or agency seeking to provide services which may be utilized by two or more Regional Medical Programs , without a specific regional focus, Regional Advis6ry Group approval is not necessary. The applYcat'lo-n must includeevidence documenting the need for the activity by two or more Regions, or show how the proposed service may be of use to two or more Programs. If a Regional -roposes to carry out such activity, the (7 Medical Program p application must be approved by its Regional Advisory Group. coininunicattoii tievice (14@signetl to speed titf- (-xcii-iii,-,e of news,- GUIDELINES for Multi-Program Services Project Grants tift)riiiitioii and data o Regional @ledical @ogram Service n iolial -Ile(lical 1'rot,raill Gk r, aii(I relatetl activities. September 8, 1970 Vol. 4, N'O. 36,' A copy of GUIDELINFS For @fulti-PrograTn Services Project Grants Regional Medical Programs Service is attac e . As noted in ection T ... "The addition of Section 910 to Public Law 90-574, the first extension of Public Law 89-239 which established,Regional Medical Programs, provided a new grmt authority designed to promote interregional cooperation and facilitate the funding of services needed by, or of substantial use to, any two or more Rearional Medical Programs." cv Since both the legislation for extension of Regional Medical Prog@-ams and the aDpropr4Lations legislation for FY 19'/'l are still under consideration I)y the it is not possible to Imoiq the extent to iqhich it ivill be possible to allocate grant funds for Ailti-Prograin Services Project Grants; nor to specifically identify the "areas of national concerns, needs, and priorities" discussed under @oses on page 2 in the Guidelines. STATUAXORY AUTHORIT'F Ill. The Regional Advisory Group The Act specifies that an applicant for i pl;iii- ning grant must designate t Regional Advisory Group. The Act ilso specifies that the Advisory Grotil) must al)l)ro@-e an ;application for tii ol)er- lltioii@tl grant tinder Section 90-1. The A(I%-isoi-y Grotil) Unit inC] LI (IC practicing I)li),sici;tiis, i-neclical center officials, Hospital ;i(Iiiiinisti-.itoi-s, ti%,es from appropriate medical societies, other health I)I-OfCSSiOlIS, N'O]Lllltar), Health agencies, and representatives of other organizations, institutions, ;Ill(l Igeiicies, and Deniers of the public f;tiiiiliai- with the need foi- the services pi-o.N,icled tinder the Program. I't should also be broadly rel)reseri@ati%-e of the geographic arei and of the %ociitl groups who will be scri,e-(l by the Regionil i@le(licil Pro- gr@illi. The Regional AdN,isoi-), Gi-otil) should I)roN,i(le ,overall advice ;tn(i (@Lli(I.IIICC to tile grantee in the I)I@iniiiii(r ;tiicl Operational program from the initial steps oniv;ij-(I. It Should be acti%,cly iiiN-ol@,e(I in the (le-t,elol>ment of the Regional ol)jectiN-es, as well as the review, guidance, and coordinated evaluation of the ongoitig planning and ol)er, functions. It should be constituted to encourage cooperation 2TIic Regional Advisoi-y Gi-olip S)IoLild 1)rovi(le overall ad- vice and guidance in the planning and opei-@itiosial Pi-ogram, among the institutions, organizations, health p,-'i-- fi-oin the initial stel)s oitivai-d. IL sliotild be actiN-ely itivol%-cd sonnel, state and locil health agencies. It should .in tl)e i-c%,icw tiid guidance and in the coordinated evalu- be concerned with continuing reN,ieNv of the degree ation of tile ongoing planning and operating functions. of rele%,ante of the planning and ol)ei-@itionil It sliotild be constituted to enc(-tii-.igc cooperation among activities to the objectives of the Regional the institutions, oi-ganiza(ions, licaltli personnel, arid state Program and particularly ivitli the effecti%,etiess of arid local fic;iltll agencies sticii as the liealtli planning I)odies being established tinder the Cotiil)i,elictisi%-c I-lealtli maturing these activities ill atttining the objecti%,e of im- Ili-ogi@aiii, Pttl)lic Laiv 89-749 :is Lnicii(ic(l. It slioul(i be con- pton,ed patient care. Tliercforei. AdN:isoi-), Gi-otil) cerile(i A-itil Containing 1-c%-icw of the degree of i-cle.@ance of members should be chosen who will I)roN,ide a the pl@illitilig arid operational Icti%,ities to tile ol)jcctii-es of broad background of knowledge, tttitudes and tile regional @Nic(lical Pi-ogi-ani tiict pai@tictilii-l)- witii the cf- experience. fecti%elless of ticst- activities in attaiiiiiig tile goal of To sen,e these purposes, the A(I%,isor@, Croup improved patient cii-e. I'lic A(I%isoi,i- Gi-otip does not lia%,e should operate under establislie(I procedures Nvl)icli direct a' "esi)(@lisil)ilit)- fol- tile l'i-ogi-aiii, I)tlt tile instire continuity and appropriate independence clear it@teiit of tile Congress was treat the (,roiip of function and adN,ice. It should formally consider wotil(i 'iiistire that the Regional \fc(lical Ili-ograiii is planned arid (le%('Iol)c(l ivitil tile Containing t(lvi(-c arid assistance of i@hat its specific duties and responsibilities sli@,ill be, " gl-(jtli) @vilicit is I)i-oi(li@, i@epi-esetitatix@c of the again, ilite,@- including such things as the frequency of its i-neet- c-sts of tile l@egion. The A(I%isoi-N Gi-otip is expecte(i to pre. ings and il)l)i-opriate methods for tile replacing of p.ire an union stateiricit gi%itig its exaltation of effective- retiring members. itess of the regional cooi)et@ati%-e arrangements established The Advisory Crotil), through the grantee, must iiii(lei- tile Regioi)al l'i@ograiii. submit to the Division of Regional rvfe(lical Pro- CHAPTER 11 - REVISED GUIDELINES - p 5 grams -,in annual statement gi%,ing its independent evaluation of effectiveness of tile regional cool)era- -tl)lislic(l tiN,c arrangements (i-egioiialization) est, under the Re-ioii;tl Nfe(lical Pi-o,,i-ain. m e) CHAPTER III - REVISED GUIDELINES - Pgs 8-9 GRANTEE RESPONP'"ILITIES ... General Responsibilities ... Accountability ... Discrimination ... Change in Approved Program ... Cbange of Program Coordinator ... Change of Grantee Organization ... Early Termination of Grant ... Protection of Individual as Research Subject ...Animal Care GRANTEE'RESPO." --BILITIES General Pcs]Foiisibilities-Tlie grantee is o@bli- to ;isstire proper disbursement of and account- gated, both for itself and eicli affiliated insti'tu- ing for such Federal funds; tion, to tdministei, the gi,.tnt 'in -accordance Nvitli 0 reasonable assurances that the grantee will regulations (Appendix 2) and policies of the make such reports in such form itid coi-itiinitig Di%,isioi-i of Regiont] Afe(lical Programs. IA'here a such information as the Stii-geon General way policy is not stated or where tile institutional from time to time reasonably r@quire, and will .polic), is more restricti%,c than the Regional Mc(li- keel) such records and afford such ,iccess tiiei-eto cal Program policy, in.,,titLitiontl policy pre%,ails as the Surgeon General may find necessary to aSSLire in that institution. the correctness ind N,erification of such reports; General Assurances-SI)ecific ittention is directed and to the requirement to lionor the assurances pro- 0 a satisfactory shelving ttiit the applicant x,i(led ii-i tile Act. has designated an adN-isor@, grOL11) to :t(l\-ise the Tile recipient of a planning grant must comply al.)plican.t (an(i the institutions. and agencies pai-- ivitli the assurances in Section 903 (b)-, namely: ticil)ating in the resulting Re-ional Aledijail Pro- reasonable assurances that Fedcril funds gram) in formulating and carrying out the I)Iin paid I)tii-stiint to any such grant will be used only for the establishment and ol).er@itioti of such Re- for the purposes for ivliiclirawai-de(I in(I in accord- gioiial Medical Pro-ram, wl)icli adN,isory group ance ivitli the applicable I)ro%,i@ioiis of @ic Act includes practicing physicians, medical center offi- and the regulations tllcreiin4er; cials, hospital idniinistrators, rel)i-eseiitzitiN,es front reasonable assurances tlia@tlie tpl)licant will appropriate medical societies, N-oltiiitai-y health 13ro,.,ide for such fiscal control- and fund tccotint-' agencies, and representatives from other oi-gaiiila- ing procedures as ire required by the tions, institutions and agencies concerned ivitli activities of the kind to be carried oil under the Program -,ind members of the public familiar ivitli tile- needs for tile sei-N,ices provided tinder the Pro,-,ram. eA The recipient of an operational grant must com- ply with tile assurances tinder Section 90,1 (b) namely: * Federal funds paid I)tirstiant to any such grant (A) will be used only for the purposes for ivliicli paid ;tn(I in accordance ivitli tile applicable provisions of this title and the actuations there- tinder, and (B) will iioL stiplylarit funds that are otlierivise available for establishment or ol)ei-- ation of the Regional Medical Program ivitli respect to ivliicii the grant is made; the applicant will pro%,ide for such fiscal control and fund accounting prc>ce(lures is are required by the -(4eTreillil to assure I)rol)ei- disbursement of and accounting fol- such Federal funds; * the applicant will make such reports, ill such form and containing such information is the Surgeon General may from time to time 1-cisoii- zil)l), require, and will keel) su(-Ii i-e(or(is and afford such access tliei,eto is the Stii-geon General may find necessity Lo assiire the correctness and N-er- ificition of such i-el@rts; and ;iny litl)oi-cr or nieclittiic employed I)NI an-% contractor oi, stil)coiiti-@ictor in the I)ei-forniance of work on anv construction aided by 1).i),iiients I)ur- I CHAPTER III - REVISED GUIDELINES 9 GRANTEE PES"-NSIBILITIES suant to any grant under this section will be 1)aid wages at rates not less tliaii tlios@e prevailing on similir construction in the locality is (letei-iniiic@(I by the Secretary of Libor in accordance Nkitli the Davis-Bacon Act, as iii-ien(le(i (40 U.S.C. 276.i- 276a-5) ; and tlle Secretary of Labor sliall lia-N,e, witli respect to the labor standards sl)ccifie(i in this paragi-al)li, the authority and functions set fortli in Reorg@inization Plan Ntinil)ci-c(l 14 of 1950 (15 F.R. 3176; 5 U.S.C. 133z-15) and section 2 of tlle Act of .June 13, 1934, as amended (40 U.S.C. 276c) . p 10 (Continued from CHAPTER III REVI.IIED GUIDELI@'V'!,:S pg 9) Jr General Responsibilities--The grantee institution is respon- sib grant in accordance with regul- ati olicies of the Division of Regional Med ponsibility applies both to itself and stitution. When an affiliating institution does.not have an officially stated or an applic- able policy, then the grantee institution policy prevails. For example, if an affiliates commity hospital does not have salaried physicians who serve on a fulltime basis and thus has no applicable-sald-ry policy, then compliance with Division of Regional @L-dical Program guidelil'-ies on salaries, as found in Chapter III, Section VII., page 14 (Allowable Direct Costs - A. Personnel Costs), would require use of the salary policies of the grantee institution. Similarly, if an affiliating institution does not have an established travel policy, then the travel policies of the grantee prevail and, in any case, the general'restrictions on travel policy apply, in accordance with Chapter III, Section VII, page 16 (Allowable Direct Costs L. Travel). ADDENDUM TO REVISED GUID-PLINES dtd 2/70 - Page /'-4 (Reference to Financial t'@nagement) GRANTEE RESPOiNTSTnTLITIES "It is the'fmdamental responsibility of the Regional Medical Program grantee institutions to be responsible and primarily liable for the fiscal and administrative aspects of managing a Regional Medical Program. 'fliis means that grantees are held accountable for all funds awarded to them and the Federal Government will continue to hbld that party fully accountable and responsible.,, The Regional Medical Programs Serviceendorses the foregoing statement of policy, and urges the individual Regional Medical Program and its grantee institution to safeguard its own interest and rights of subrogation against affiliates either by a written contract or an#agreemnt of affiliation between itself and affiliates. Depa@ent of-Health, Edu@@tion, and IVelfare attorneys have ruled that no authority currently exists whereby Regional Medical Programs Service or the Regional Medical Programs can vest title to equipment in affiliates at the tirie purchases are made. This decision was based on the principle that no privity exists between the Federal Gove=ent and institutions affiliated with grantees. Therefore,'the option to vest title in these institutions is unavailable. The Regional @-ledical Programs Service stands ready to assist Regional Medical Programs or grantee institutions in their Lmder- standing of the responsibilities under this policy. HoArever, each Regional @ledical Program and grantee is jointly responsible for insuring that its affiliated institution or organization is cognizant of the policies and procedures with respect to the'- expenditure of Federal funds. NID 7-10-70 NOTE: Cross reference to Program Mnnage.-.ient @Ceneral Requirements) - GRANTEE RESPONSIBILITIES Discrimination Prohibited-Section 601 of Title I VI of the Civil Rights Act of 1964, 42 U.S.C. 2000d, provides that no person in the United States sliall, on the ground of race, color, or national origin, be excluded from participation in, be denied the benefits of, or be subjected to discrimination under any program or activity receiving Federal financial assistance. Regulations implementing the statute have been issued as Part 80 of Title 45, Cod@ of Federal Regulations. The Regional Medi- cal Programs provide Federal fiiiin(-iiil assistance subject to the Civil Rights Act and the i-cgtil@itioiis. It is the responsibility of the grantee to insure that each affiliated agency (institution) Nvliicli pro- poses to cooperate in the Regional Medical Pro- 'f Title VI gram is in compliance with Section 601 0 of the Civil Rights Act of 1964. The grantee sliall mountain a copy of the form which insures that @cii affiliated agency (institution) is in coml)li- e ance. Each grant for construction (alterations and renovation) is subject to the condition that the z: gratitee stiall comply with the requirements of tl-ie Executive Order 112-46, 30 F.R. 12319 and the applicable rules, regulations, in(i procedures as prescribed by the Secretary of Labor. CRAPLRER III -REVISED GLYIDELINES - Pg 'i-I designed to speed the exchange of news, STA OF POLICY Re aformation and data on gs Supported w4i-@ Regional Medical Program Funds Tonal Medical Programs :I and related activities. March 11, 1970 Vol. 4, No. 12S STATBIENIT OF POLICY Sponsors of educational activities funded by Regional Medical Programs may not permit discrimination against applicants on the basis of race, religion, place of employment, or origin of professional qualifications. Applicants to stich activities should be selected, invited, or accepted only on the basis of academic or other objective qualifications set by the institution or organization responsible for the program. 'Heart Disease, Cancer, and Stroke Ojtc6 of th6 Exmugv6 Director 122 Soutli Michigan Avenue - Roorn 9S91CIzica-go, Illi@ 6060SITekphone S12-989-7SO7 ili,io 'Gliu@ll April 15, 1970 Mr. Edward M. Friedlander Assistant to the Di-rector Communications and Public Information Regional Medical Programs Service Parklawn Building 5600 Fishers Lane Rockville, Maryland 20852 Dear Ed: Regarding the "Statement of Policy re Meetings Supported with Regional Medical Program .Funds," (Special Issue, Vol. 4, No.2S), our Nursing Committee was quick to p6i out that the statement makes no reference to discrimination on the bas'lt of age or sex. Since these are two particularly touchy areas for certain groups, it would be wise to include these categories in the poli;cy statement. We would appreciate your attention to this matter. Yours truly, Marilyn J. Voss Public Information Assistant MJV:bd GRANTEE RESPONSIBILITY Change in Approved Prograin-Tlie Di%-isioii of Change in Program Period-Tlie Progr,-itii .Regional Nledicitt Pr(Tgriiiis does not intend to Period may be extended tip to 12 months without interfere i%,itli tdiiiinistrati%,c or program flexibil- additional funds, if requested by the on-i--intee ity which sei-i-es the ol)je(-.tiN,es of the Regional before the end of the Pro,-ram period. Medical Pi-@(,rr;tins. If, lioNve%,ei-, a change is deter- iiiiiic(i I))- the griiitee to be desirable, and if that Change of Program Coordinator-A clian(@e of Change IVOIIICI constitute a substantial change in Pi-o-raii-i Coordinator or other key official (lircctin-, the nature of the Program originally tpl)roN-ed, the Pro-i-am requires the written al)l)i-oN,,tl bNt the the grantee must coiistilt N%,itli the I)ivision of Re- Division of Regional Nle(lical Pro-rai-ns. \otifica- gional i\lcdical Pro-i-ams, staff. No substantial tion to the Division of Regional Nfe(lical Pro--Ir,-Ini.-, cli,iii(,-c in the il)l)i-o%-e(i Proo-ral-n can be made of such t proposed change must be signed by at %%'iLliolit the ,;I)ecific ivi-itten al)l)i-o%-al of the DiN-i- least one of the two persons who signed the ori-l- si,oti of Regional '%Iedical Reque.sts for inil application oi- their Successors. A curriculum ,,itie for the newly -ippoiiite(I offi(-iil should ac- coml)@inv tlien6tification of change. such approval must be submitted in an Application I for Rez)ision (page 21). Change of Grantee O@ganization-If foi, an% reason the grantee organization lirol)oscs to reliii- qtiisli its i-el)onsibility for a Regional i\ledicztl Pro- grtm grant, IL Must immedi@ttely potify the Di\-i- sion of Regional Medical Programs. For example, a region may wish to create a non-I)i-ofit corl)ora- tion especially foi- the purpose of becoming the grantee organization. Any change of grantee o@ga- nization requires that a terminal progress report, an expenditures report, and an invention statement (PI-IS-3945) be submitted to the Division of Re- gionil Medical Pro%@anis. If the grantee terminates its responsibility for the Regional Nleclical Program, the new institu- tion/corl)oi-,ition 111LISt submit t new grant applica- tion for the remainder of the program I)ei-icK]. The application should include the i@e@isons for transferring the Program and the probable effe(.t of the move on the Regionil Progriiii. A(Iiiiinisti-@i- tive approval mav be given by the I)i%-isioii of Re- gional Tvfedic,,il Progral-ns to continue the Pi-ograii-i with a new rantee. Applications, lio@veN,cr, tliit 9 reflect major Pi-ogriiii changes will be referred to the National Advisory Council on ]Regional Nledi- cal Prop ,rams for recommendation. Early Termination of Grant- (1) By the Gi-antee-A grint i-na@, be terminated or cancelled at any time by the grantee upon i%-i-itten notifica- tion to the Division of Regional 1%,Iedical Programs staLiiig the reason foi- termination. (2) By the Public Healtli Sei-%,i(-e-A g-riiit in x%,Iiole or in part, may be i-e%,oked or terminated by the Surgeon General at iny time ivitliin the I)i-o- ,grain period ivlieiie@,er it is determined tllat the. grantee has failed in a mtte'riil respect to comply Nvitti the terins an(t (-on(litioiis of the giant. CHAPTER III REVISED GUIDELINES - Pg 13 GRAl\'TE9 RES,-' I-BILITIES PROTECTION OF INDIVIDUALS AS RESEARCH SUBJECTS "Nothing in the institutional assurance mechanism should inhibit PHS staff, advisory groups, or consultants from (1) identifying concern for the welfare of human subjects, and communicating this concern to the grantee institutions, or (2) recommending disapproval of the application if the gravity of the hazards and risks so indicate. This provision applies-even if the application or contract in question has been reviewed.and approved by a mechanism at the grantee institution which has been accepted by the PHS." (Above quote from a memo to Directors of NIH, HS@M , and CPE'HS., and discussed in a memo, dated 7/25/69 from-'beputy Director., RMPS, to All Staff) Institutional Assurance Involving Human Sub- z: jects-FAn application foi- t Regional infedic;tl Pro- gram grant wliicli includes investigations in\-olx-ing human subjects will not be accepted foi- re\-ieNv unless the Public health Sen-ice has al)l)ro@-ed a plan (kiioivn as Institutional Assurance On ln\,es- -tigations ln\,ol@,iiig 14iiinan Subjects, Iiiclti(fina Clinical Research tnd Investigations in the Ilcliax,- ioral and Social Sciences) for iiistiriiig that tiie institution conducting the research lias coml)liecl with the Public Health Ser@-icc policy concerning research inN,olN,ing human stil)jccts. it will be the resl)oiisibilit), of the grantee to insure that tIlC individual ;tffiliateci institutions) which will be inN,oIN,ecl in these in%,esti(@aLiOTIS secure the appro%,.il from the Public He;tltli SC]-%,- ice and to 1)i-oN,ide a copy of the al)l)i-oN,@il to the DiN-ision of Regionil inledicil Programs. A copy of Llie Instructions for obtaining Public He,iltli Sei-N-ice al)l)i-o%,.tl iiity be ol)tiiiic(i I)N- iviit- in- the Grants Re@,iei%, Braiicli, DiN,ision of Re- gional I\,fc(lical Pi-ogi-aiiii, Nitioii;il Institutes Of Health, 9000 Ro(@k%,ille Pike, BCLIICS(I;I, Nf'.Iryl.111(l 20014. * REVISED GUIDELINES - CIUPTER III - Pg 11 NOTE: Wording and address up-date GIU@l@iTFT-' RESPO,KSIBILITY Stin-c)-s or Questioiinaii-es-Stii-xc)s o-,- (itie.@tioii- iiaii,es fi-oiii ,tii(i 11'ateiit,,, and Irii-entions-'I'Iic Dejjiti-tnict,t of 1-iealtli, ELIticatioti, ;iii(i I-el-LilZitiOlIS (0-15 slioill(I iiiclll(le @t I)O"iti@e sttteiiieiit cleii-I), setting fortli tli-,tt the contents Eric in no @viN- the i-esl)onsi- F.R., Piti-t 6 iiicl 8) I)i-o%,i(le is ;v condition tliiit all iii%,ciitioiis ai-isino, out of tile activities tssistect bilit@- of the Public I-Ieiltli Sen,ice. Tlie@- sliould I)N, Ptiblic Hc@iltli Sci-%-ice Gi-aiits IIILIST be 1.)i-oiiil)tl% cojifoi-ni ivitli Bureau of the Ilti(Iget, Circular @A- I -ijicl fill]), i-el)oi-te(i to the Ptibli(@ Ileiltli Sei-x-icc. 40 Any 1)rocess, art oi- iiictlio(l, iiiiciiine i-iiaiitif'@icture PLibIications-(;r:tiitees iiiid/oi- tlieii- ;tffili@tteci iii- or ii-iii)i-oN-ci-nent Llici-col, ni;iN, constitute an iii%-eii- StiLlItiOlIS I)L)I)IiSil materials I'el;LtillO to tIlCil' tion if it is near, and tiseftil iiiiLl x%,otil(I not lia-,-e Regional Nledic@il Pro(,-rini %N,itliotit I)i-ior I-e\'ieNN, been ol)\-ic)tts to i 1)ei-.soii lia\-iii(,- skill in the @ii-t to 1)i-oi,i(ic(l that sticli I)til)lications carry a footnote iviii(@li'it i-clates. ;tcknoit,ledgin- assistance froi-n tile Pul)li(: Heiltli In oi@(ler foi- the I)Liblic Heiltli S ei-\-ice to cari-N I I Ser%,ice, and iiidic;tLiii(- til@it fiiidin(,s and conclti- Out its i-esl)oii@ibilit) tin(lei- these I)aterit i-e"tila- sioiis (lo not necesstril), represent the \-iews of- tions, it'is essential tint tile Sci-N,i(-e be ad\-ise(I tile Sci@%,ice. before iiNvtr(Iiii(@ Go%,einiiieiit funds of '@'Illy (.Om- 0 iiiitiiieiits oi- ol)lio-atioiis made 1)), the institutions CHA'-PTER III REVISED GUIDELINES p 11 b oi- by the I)i-ofession;il personnel to be ;issociited ivitli the tcti\,ities c@ii-i-ic(l on under the grant ivliicli ivould be in conflict \vitli the ii)@,cntionb ;t(,,i,cemenL. N%'IICII SLII)Illittill(l@ III .11)1)li(';ItiOll foi- a Re-ioiial '\Ie(liczil Pi-o,)i-,tiii, the @,-i-aiitee must I)I,o- \.ide in lettei- form citlici-: a. a statement indicating no 1)j-e\,iotis commit- merits oi- obligations lit%-e been made, or b. a detailed exl)l;iii@itioii Of SLI(:IL Commit- merits or obligations x%'Iiei-e tile), do exist. One SIICII leltei- will sitffice for the named grantee tii(I all -,tffiliate(I institutions receiving stil)- I)ort under the grant. It is the i-esl)oiisil)iiit), of the institution named as t]'ic grantee on the al)l)lication to ascertain the facts i-elitting to 1)atents and to I-el)ol-L tliesc oil belitif of ;ill affiliated organiza- tions in the Regional i\le(licil Pi-ooi-am ;is well as to illf0l'Ill ;Iffiili,'ILC(I institutions of tileSC responsi- I)ilities. In subsequent years an annual invention state- nicnt foi-iii PHS-3915 must be filed iviietlier or not --in-inx,ention li-is occurred. N@'llei-e there are no in@-eiitiotis to i-cl)ort, i single form PHS-39-15 is all that is required for the institution named on the tl)l)li(:,ition IS tile gi-;tjitee tiid foi- @ill affiliated institutions. A\'Iiei-e tlie)-e are iii\-entioiis to rel)ort, a separate annual iii%,eiitioii Statement must be filed f'oi, cii(,Ii one. I-lei-c igiiii, it is the i-esl)otisi- I)ility of the grantee to i-el)ot-t on I)elialf of itself and all otlici- ;affiliated organizations in the Re- gioi-i:il Nfe(lic;tl I"i-ocri-.iiii. 'I'lie Rcgionil Medical Program grant foi- the next ),eti- %vill not be issued until the in\,eiitioii statement form PI-IS-3945 lias been i-ecei%-e(l by the Di\-ision of Regional Medical Programs. Ani.mal Care-Et(-Ii 1)ci-son tssigne(i or ap- 12 CHAPTER III REVISED GUIDELINES (MORE) PROGRAM IIANAGEIIENT SECTION I ... INTRODUCTION SECTION II ... GENERAL REQUIREMENTS (Responsibilities of Proaram Coordinator, Regional Advisory Group, By-Laws.,,Relationships to Grantee,@to DHEI-.' Regional Offices and other Federal agencies and programs; Reports Required; Public Announcements of Approved Grants, etc.) SECTION III- ... ELIGIBLE ACTIVITIES Definitions. Specific Requirements Cent-?al Administration Research Demonstrations of Patient Care Cate-orical Relevance Continuing Education, Training and ManpoN,7er Multiprogram Services Exclusions SECTION IV ... FINANCII-,L N!ANAGElrIE14T (List) 'D SUBMISSION OF GRANT SECTION V ... PREPARATION AN APPLICATIOI;S (List) PROGRAM MANAr-@iTNT SECTION II (C-ener3l RcqL-@@'r.,cntc-) 'sc-urvice xvs 0 AM 0 Ea L 0 r_i (lesi"llt.tl to Regional @ledicaj Programs Service l@eprosentati.ves tl%4. 4@f II(.Ws, Department of ficaltli, Education, and Ilel fare if4)1.tllttti4)11 Offi.cos ioji,il October 30, 1970 Vol. 4, N'O'. 4@)@ Regional Medic@l 1).r6graTi'is Ser@,icc,has named eight Representatives, and expects to nutie'tho remaining ti.;;) in the near future, to the I)cpartment of Ilealth, Education, Laid We-If.-ire Regional Offices. -(I,isting on Pages 2 and 3.) It is expected t@-t they will. represent IZegi.o'nal Medical Programs Service, provide assistance to the individual Regional Medical Progrims, participate in site visits for Prog-fam rLvieiv, furnish information to l@e-ional @ledical Programs Service, and act as liaison with other Federal agencies. In order to (fevelop the best possible operating relationships, each Regional Medical Program is encouraged to provide its Representative with. . . * A copy of each Program application, for @eviei-i and comment, at the time it is submitted to the Grants Review liranch of Regional Medical Programs Service. * Copi.cs OF correspondence I)etiveen the Regional Medical Program and the staff of Regional Nledical Progrims Service. * An iniitation to attend the lZcgiojiil Advisory (,roup meetings, as well as meetings of speci@il and standing committees and selected staff meetings. The stirf of- Rcgioi-ial Nlcdicil Programs Service is asked to provide the appropriate Regional Office Representative with A copy of each grant award at the time it is mailed to the Ili-ogram. . Copies of correspondence concerning cicii Regional @le(licil Ilrograiii for ivliich fie is responsible. t 'NOTE: Reference to DI-IEW Regional Offices. PROdRA,4 YAziAr-IIENT SECTION II (Relationshii.-'with DITE@4 Regional Offices) (Exerpted from letter to Members of the National Advisory Council on-Regional Medical Programs, dated November 4, 19701, signed by Vernon E. Wilson, M.D., Adhiinistrator, HS@FHA) @-.1 of 17-IL-11 tot 1, vc-,--y C.% f tt,a r,f t-.o r c t of- l.'@ C-):,@l l@.C.@ll,:,'L PROGRAM MANAGE,',kIENT SECTIO-'4 II (Rr-LATIOIZSPIP@- TO OTHER FEDLPA-U VETEP,ANS ADMINISTRATION DEPARTMENT OF MEDICINE AND SURGERY WASHINGTON, D.C. 20420 March 28, 1968 YQUR FILE R@RENCF-: IN REPL'F REFERro: 15 CHIEF MEDICAL DIRECTOR'S LETTER NO. 68-18 TO: Directors of Hospitals, Domiciliary, and VA Outpatient Clinics, and Managers of Regional Offices with Outpatient ciiyiics @SUW: Veterans A@in"istration Pa@icipation in the Regi6nal Medical Programs (RMP) of the Public Health Service 1. Purpose The purpose of this letter is to clarify relationships between the Veterans Administration and the Regional Medical Programs (RMP) of the Public Health Service, and to provide implementing guidelines. 2. Background The General Counsells office of the Department of Health, Education and Welfare has recently offered an opinion regarding the degree of participation of Federal facilities in Regional Medical Programs which now allows clarification of potential VA involvement in those programs. Title IX of the Public Health Service Act, "Education, Research, Training and Demonstrations in the fields of Heart Disease, Cancer, Stroke, and Related Diseases," (PL 89-239),. is the basis for the establishment of the RMP. The purposes of the RMP will be effected via the grant mechanism. @IP grants are to encourage and assist in the establishment of regional cooperative arrangements among medical schools, research institutions, hospitals, and other medical institutions and agencies--to make available the latest advances in the diagnosis and treatment of these diseases. Grant funds will support, through these cooperative arrangements, research, training (including continuing medical education) and related demonstrations of the highest standards of patient care. Through these means the Programs are intended to improve generally the health manpower and facilities o f the Nation. (See Guidelines, Regional Medical Programs, DHEN, PI-.TS, NIH, J-une 1967.) PROGRAM @IAI-lAr-17@,FENT SECTION TI Reports-All reports required to be submitted to the Public Flealtli Service should be sent to the Division of Rerional Medicil Programs, Public Healtil Service, Betliescii, Maryland 20014. A. Pro-i-ess Rel)orts-Tlie g-i-aiitee is required to submit tii annual progress report for eacii grant. This report (s) sliotilcl contain sufficient (le- tail to infoi-iii the reaclei- of the accoinplislii-iients witli particular respect to the objectives and must be submitted ivitli the application for Continued support. In addition, grantees may be required to stil)l)ly otlier information needed foi- guidance and development of the national I)i-ograi-n and are --iged -t eiicotii. to repoi significant -clex,elol)i)ieiits ])ronil)tly at 'ai@y time. A terminal progress i-cl@.ort i-iitist be submitted to the Division of Re-ional Medical Programs ivitliin tlii-ee i-iiotitlis of the termination of the program period. Spe(7ifically, the report i-ntist describe the ivays in wliicli the process of regioriali7,-ttion as described in Cli:il)ter 11 li@is iiio%,cd the Regional Program tc)%%,,ti-d its goal of iml)t-ox-e(I patient cii-e for all those within the Region stiffei@iii- from lieirt diseases cancer, sti-oke, oi- rqlzttc(l diseiscs..The report must @ilso include: (1) I)i-iiicil).il stiff nienii)ers-nimes @in(I positions -g, (2) oi tiiiz;ttion of the Rcgioiiil i%fe(lic;tl (3) iiieii-il)ei-sliij) ,tn(i functions of' t[ic Re- gioii;tl A(IN-isoi-y Gi-oul) (,I) names of all cooperating agenciesiiii- stitutioiis and tliei'r rclationsliii) to the Re-iotiii Ale(lic;tl Program (5) description of I)Iiiiiiiiig ;i(,ti%,ities (6) description of operational] if any (7) description of iiitei-i-c-ionil activities, if all), (8) the extent to xt,lii(-Ii the 1)1,tiiniiic,- ;tiid operational a(-ti%'iLiCS Of the I)i-o(,i,,ti-n ire sttl)- ti I)oi-te(I 1)@. iioii-Fe(lei-;tl f(in(is. B. i@egionil k(l%-isoi-), Gi-otil) Rel)oi,ts.-I'lic Re(,-ioiial A(t%-isoi-y Gi-oiii) is exl)e(-te(I to prepare ;in tnlltL@tl statement Oil the effecti%-ciiess of the regional cool)ei,,iti,,,e arrangements (regioii;iliz;t- tion) established iiii(ler the Regional Nleclic;tl Pro- gi-;ini. The report, signed by the Cliaii-iiiiii of the Regional Advisory Group, signifying its approval, should be submitted to tile Division of Regional Nfcdical Programs by the grantee along Nvitli the annual 1)rofri-ess i@el)ort. Per'iodic revieivs of -rints by the staff of the Division and the Advisory Coun- cil N@,ill include consideration of the effectiveness of the Advisory CtoLip. CHAPTER III ' REVISED GUIDELINES - Pg 13-14 P@,GCR.4@@' MANAGEME,4T SECTION II (Gtineral P iirenients) SUBJRCT: Grant kmuncements to Regional Medical Programs In an effort to work out a better method for announcing grants to Regional Medical Programs that would be more mutually effective for both the appropriate Congressmen and Senators on the one hand, and the Regional Medical Programs on the other, Mrs. Dale Kohn of my staff and I met with Mr. Jerry Poole, Deputy Assistant Secretary for Congressional Liaison of the Department of Health, Education, and lVelfare in his office on-Wedne8day, April 16. Mr. Poole demonstrated a very clear and sympathetic understanding of the problems reflected by the recent examples detailed in our memorandum to him of April 10. He agreed,that a better system could and should be developed to meet the particular needs of the Division of Regional Medical Programs that would also help him fulfill his responsibility of helping to develop relationships between the Department and the members of Congress. As a re6ul-r,-we have worked out the following new policies and procedures which include c@C.es from the current method, painfully evolved over the past three years from the old National Institutes of Health-Public Health Service practice: . Following establishment of the grant figures for an award to a Program by the Division, this office will contact the Coordinator and his authorized staff person in the office of the Regional Medical Program receiving the grant. In addition to providing them with the figures, we will encourage and work with them to develop appropriate releases and other informational materials in preparation for the announcement that will be made by the Congressional representatives of that Region, and to ins,-ire and safeguard that Congressional prerogative. . For Regional Medical Programs purposes, the rule that requires only new grants to be reported to the Congressional Elaison Office will be ignored. In its place will be a judgment made by this office of which grants in terms of dollars and/or political significance are to be forwarded to the Department for reporting to the Congressional delegations. MINATE WASTE COST REDUCTION PROGRAM 1-41 D 6 PRO C@ @Ptl'i IL.@ILACE@fENT SECTIO@\' TI (Gcneral jire,-,ients) ISSUES fiM PROCF-DURE: Re Public Announcement of Approved but Unfunded Projects July 18, 1969 Vol. 3 No. 28S The following are the issues raised: * * Can these pr'(Yj'ects 96 publicly announced by the Program--/as'a'pproved'? * How should the ultimate funding of these projects be annouiiced,'be it from reallocation of funds already announced from new funds to be granted, or from funds from other sources? * IVI-iat limitations or requirements are there on such announcements as related to members of Congressional delegations? Because these types of notification can:be e-xpected to continue and these issues continue with them the following procedure has been established: Announce-.nents to special interested or involved Regional-Medical Program publics, or to the general lay public of the Region, of the "coi-iditional approval" of projects "favorably acted upon by the I\Tati-onal Advisory Council" and 11 authorized for implementation" may be made by the Regional Medical Programs receiving such notification. Hoi%ever, these Programs are encouraged to use the foregoing quoted phrases (without quotes) along with the fact that no immediate funding is being made to support their projects, -unding will be dependent upon the availability of and future f sufficient funds. If appropriate, Program officials may detail their plans for either implementing these projects by rearranging other Regional Medical Program funds with Division of Regional Medical Program approval, or involving other funds to got these activities underway. Such announcements, regardless of the form or forms they may take, may be communicated to the appropriate Congressional delegations by the Program officials as a normal part of the total effort to keep the various publics -rned with the Regional Medical Program informed. conce PROGRAM 14-ANAGr'@'AENT SECTION II (General Requ3:reirents) Miscellaneous- Safety Prccautions-Tlie Public Ilealtli Ser-%,ice assumes no responsibility witli respect to accident, claims or illness arising out of any work tindert-@iken Nvitli the assistance of i Public I-Icaltli Ser,,,ice gr,-tnt. The grantee institution .is expected to take necessary stel)s to ensure or I)rotect itself and its I)ersonnel. (2) Federal Income T,,ix-Deteiminatioti of a tax status of an individual receiving coml)en- satioii in any form from the Public Heziltli Service grant is the responsibility of the Internal ReN,etitie Sei-%,ice. (3) Military Service-Tlie Public Ilcaltli Service will not intercede on I)elialf of an indi- ,%,idu,il in relation to military status. CHAPTER III REVISED GUIDELINES Pg 18 PiROCt?,AM MAI\7AGEMEI\'T SECTION III ELIGIBLE -.,,VI'L"IES (Definitions) V. Eligible Activities Categorical Empliasis-Tlie focus of Regional. Af!2(lical Prporims iiii(.Iei- the atitlioi@izing legisla- ti6ii is on 1)'i-obleiiis of heart disease, cancer, stroke and related.cliseaseg. This broad. categorical al)- 1)roacli must be a consideration in the development /.,of specific Program elements under a Regional Tqedical Pr@,rani. Bectuse of the broad scope of fieiii-t diseases cancer, an([ stroke, it Nvotil(I be (liffi-- cult and perhaps detrimental to 'Some types of riiedical services and educational activities if a rigi(II), categorical -,tl)l)i-oacli were t(lol)ted for all relevant Program elements. The emphasis of the -L Prf)grri-n does require target the component ele- ents be slionvn,to 1).tN,e significance for combatting M hVart diseag6, cancer, stroke and related diseases through a regional effort intended to @'nil)ro-v,e the care of all those persons i%,itliin the Region suffering from one of these diseases. HoiveN-cr, in some instan ces, activities which leave t.more gen-. eral impact extendin- beyond the specific 1)i-ol)-. lems of lie-trt, cancer, stroke and related diseases may need to be supported because tlie'y are essen- tial to the achievement of the purposes of Regional Nfe(fical Programs. The (>bjectiN,e of improved patient care for. those suffering from these c-@ttegorical diseases will require the full (teN,elol)mciit of the process of i-egionalization, 1).ti-ti(-tiltrly in the Pi-ogi,am's opera ational I)Iiases. Therefore,' in(liN-icltial, categorical.. activities should be designed and implemented in ways which will ilISLli@e tlieii- rcaioti-,il rather than organizational or institutional identity. Core Supl)ort-Tlie central @1(tininistration -ind coordination of a Re,)-ional infedical Program re- ti presents the a(Iministi-ittlx-e heart of the Program, and its such is an activity eligible for grant sul)- port. The salaries of the Program Coordinator and his staff as well as other Costs incident to the central administration and coordination of the Program may be charged to the grant. Researcii-Researcli activities ii-Iiicli are integral to the 1)tirl>o.,k-s and objectives of the Regional Nfedic;tl Pi-ogriiii are eligible for Support ;tnd their costs lil;int be paid 1)@- grant f-oii(is. Su(-Ii research activities in order Lo be cli(,'ii)le i-oust contribute to the process of regionilization and the goal of iml.)roi,ed patient care the Progrim seeks to icliieN,e. cIl.1,FfER TTT - RE'@!-IED Pc- Ir) T'- ELIGIBLE ACTIVITIES SECTION III (De f in,.,: ions) Demonstrations of Patient Care@Demonstrations of patient care may be supported when related to the objectives of the Regional Nledical Program. The Act provides that the costs of patient care may be supported only -vvlien such circ is incident to research, training, or demonstration activities encompassed by the 1.)tirl)oses of the Program and only if the patient has been referred by a I)ractic- ing physician. Documentation must be provided (,lee Clial.)ter 111, page 15). @ucli demonstrations must contribute to the process of rcgionalization .and the goal of improved patient care ivhicli the Regional Progrim is seeking to acliie%-e. Grant funds may be used to pay tlie'otlier costs incident- to the demonstration activity, including staff and eqtiipment. d Training an Continuing E(lucation-Continu- ing education and training programs for medical, all'ied health lxrsonnel and associated professions which are part off integr@ttcd comprehensive a@ preaches of enhancing regional capability for the diagnosis and treatment of heart disease, cancer, stroke, in(I related diseases are eligible for support. HoweN-er, it should be emphasized that the I)rimai@y intent of the legislation in this area is the support of those activities that are beyond those normally accepted as basic preparation for ivork in the health field. If one is to make assessment of needs for educational programs, this assessment must be based on the system of health care, the role of the leariier, and his needs. In medical education, attention nrust be focused directly on the questions: "N%Iill this effort to change belia%,ior result, in fact, in the patient receiving the max- imum benefit of modern knowled(re?". Grant funds may be used for innovative training a@ I)roaclies and the development of iiciv types of health personnel or i-ieiv arrangements of health personnel to meet the Re-ion's goal of iml)ron-ed patient care for those suffering from heart disease, cancer, stroke, or related diseases. CIMP-LER III REVISED CUID"-Llt'VES - Pg 10 NOTE.- Up-clar-e PROCr,-A@f 1,LANAGEMENT SECTION III ELIGIBLE AC@'TVITIES (Co tinuin@@,,ducation, Training & Manpower) in ... The Council agreed that tr ' ' was one of the most vital objectives of the Regional Medical Programs, and that there needed to be close collaboration with other programs in meeting the over- all manpower problem. Also considered were the support of.full- time staff in the hospital for education and service purposes, the training of new types of medical manpower, the attraction of personnel to be trained... Council Minutes 2/24-25/66 p r, o P, A, Ml M, rt r4 A G IPT SECTION III (@-Pecific Requirements) (concern for Special Porule,t-'Lon3) Therefore the Council suggested that Regional Medical Programs ... . Actively work with metropolitan planning agencies and programs, . Undertake appropriate patient care demonstration or other projects in inner-city areas, and that the Division of R@gional.Me.dical Programs of the National Institutes of Health:.. . Encourage,,, dLdvblop, publish &nd promote a series of pertinent papers on subjects concerning relationships between Regional Medical Progrems and urban problems, . Name and call together appropriate national leaders to consider how the attention of Regional Medical Programs can best be focused on the urban health issues in metropolitan areas and their inner-cities. Targeted for Specific Population Groups "The Council, recognizing the diverse problems of medically disadvantaged consumer groups, both urban and rural, urges that specific planning to meet the health needs of such groups be a function of Regional Medical Programs. "NOTE: In discussing this matter, the Council expressed its int6rest in further discussion of the special problem and appropriate role of Pbgional Ntdical Programs in metropolitan co ities, especially in high density population areas served by many centers of medical excellence. Such an item will be placed on the agenda for the next meeting." February 20-21, 1969 Council Meeting PROGIL-IM MA@IAG@iiEhT SECTIOI%' !II, @3pecific Requirc.ments) (Concern for Special '4Dopulations) VII, DIRECTED EFFC,"TS l@T RECTO@@'-AL 'rIFDIC&L PiloC@,IS The,, "Role of Regional Iledical Programs in Urban Poverty Areas and 1-10del Cities" @-7a8 discussed. A request to eai-marlc.-1 fonds for Fiscal Year 1970 for i!iod@-1 I-Tc-i-Liborhoo(I-s derives iro-@i the strategy adopted to relate liodel Cities Pro-rams not only to the funds directly available from the D,2par tricnt, of Cousin and Urbiii Developi,.ent but to C> identifiable funds fro,-n otner Federal programs as well. The strate,,y adopted for PD,IP has been to encoura"e local Generation of projects which strengthen cooperative'-arran-ements. We-recornize the Departr,,.cnt's wish to identify funds for Ilei-hborhood @iodel Cities, but believe the request to car-,Ilarlc thC requested amount of $5-million from Regional Iledical Pro,,r@-,-is incomputable with the basic method of L-@nking grant award,s in thispro@r,-m.- 11168 Counc-'l Moc-. L:-Lnfy ... Novi@mber-25-2( PROGP,AM MAN-,,NGEikIETNT SECTION III ij.'ments) (Specific Requ e @del Cities Program @lodel Cities is a major Federal response to the problems of the urban areas. It was established and is being implemented as a demon- st@ation program to identify new ways in which Federal resources can be used more effectively. Nbdel Cities.is also viewed as a mans of reforming Federal, state and local administrative systems through a partnership between government and priva@e citizens from both t,ie city involved and tl-,e affected neighborhoods. The legislation iih-i-ch established the concept requires that eacl-i city involved develop a -u L program of sufficient innovation and magnitude to make a sbs-;%itial impact on the physical and social problems of that city. Regional @le4.icai,-Proaram Involvement and Commitment Since good health services are a basic societal need the Health Services and Mental-liealth Administration has expressed its desire to coordinate its health planning and program 3.evelopment functions as represented by its agencies directly involved in this concern with the @lodel Cities programs. 'I'his action reflects the continued emphasis the Depd@ent of Health, Education, and 1,Velfa-re is placina during fiscal year 1971 on the developj,.i--Tit and funding of new activities which will fa,,Forabl-y affect. Tiorsoris- living in @.-Iodel Cities demonstration areas. Az,--Oraincly" "' -$!-,9 ini- 1. C> I R@oio'ri'al Progrmiis gfart furd--,-w-;@ll be ea=..:-;rked forICity re'l--ted -,.c4.LOS as part of regalar-Regional-Mied4caf Progiar.,s -a'nriual- xvTard-,3 during ----iscall ye4r,..-1971. New Certification Requirement and Process 'In order to insure adequate participation by the offices of the mayors of the Nlodel Cities and the Nlbdel City Demonstration Agencies (CnA) of these cities in the development of appropriate plans and activities, and to coordinate all such activity within tl,.e HealtJi, Education and 'il.'elfare Regions involved, process his been dei,elo-Ded, @d 'Ls applicable to f.@-a!tJi, Education, a-ii@- 4 grant a,-; Lstance proc-rab@, i-ncludi;ig, those,_.of Regional itedical Pro Service. The neivly.establishect process requires written certification an a special form completed by each Di-rector of a @iodel City Demonstration Agency certifying that each of the proposed activities or projects has involved acceptable citizen participation, is adequately linked with the total @iodel Cities Program, and that the sponsor has consulted on the project with a representative of the city's chief executive. The Health, Education, -.nd IVolfi-re Pegioiial Director i:,-ost also si@-i the certification -e his kiiNTledge and -approval of tfie activity. document to indica4L PROGRA',14 @IANAGEMENT SECTIOil III (ELIGIBLE ACTlviTIES) (Specific Requirements) Radiation and Dosimetry Services " In accordance with the recommendation of the Council in its February meeting, an Ad floc Committee on Radiotherapy Dosimetry Services-was con- vened on April 8 to discuss the general subject of radiotherapy consultation and dosimeti), services in Regional @ledical Proarams and to provide guidance to the Council for the review of proposals in this area. The following are the Condittee's recommendations-, which were approved by the Council, of what should be included in proposals asking support of radiotherapy consultation and dosimetry services: Indication of the applicant's intention to participate with representatives of other specialties involved, in a multi-disciplinary approach to the treatment of cancer patients. Assuyanc6-that the radiologists who are to receive the dosimetry service are 'adequately trained in radiotherapy or are willing to accept clinical consultation and assistance from the Radiotherapy Department providing the dosimetry service.. Indication of measures to be taken to assure accurate record keeping, careful followi.ip of each patient, con- tinuity of care, and feedback of information on length and quality of survival. Assurance that-there.will be regular monitoring of all -radiotherapy equipment, including calibration of the calibration instruments themselves. Indication of plans to make the dosimetry and cali-b-ra- tion services self-supporting within a relatively sh6-rt period of time." May 26-27, 1969 Council @eting -27 ... Addendum to Revised Guidelines@ /'-/70, Pg 26 P,ROCRA@T MANACEI-U--,NT S E C T.r -v !TIES (Soc-cific Req-,i,;remet@ts) ELIGIBLE ACTI RegiSILric.,-,: To date-, only gyrtcm,,iti&ally oparited ca,,icer rc,,,.-Lsti-ies f have yicldeci 157on(@f its' that JLstifi-ed their Tho. beiicf it, registries of stro'@,,c- 1:,,iticnts, for zre h-!,,I,.Iv suspect di.-,-nos,-s is z-irl-! 'or other ftincl,c. ccLtl.(', yicld if invc@,@,t(!(i in civ ct!-, IL: i v,,! or in of and factor;. -CIt?,;ICE!I- for tiiiuinc, c--l-iicz@itioii "o'Llow-u,,i b,-,,i .o'Lici@-,l to I)aticiits. rec,istri.c.,,s also ofi'Lor si.d(@ ben,@@Lit@ to ',:Iii:cu,-Ii the nc-t,p,o'k-liatic)-i @iiicl coopLritioii J-iivoJ.v in tlicii- r,),n@raL@ior) encl (.Iis- tribtit-'-oi-i of-inEorn.@@z@'Lici. Pe,,-,istr-j5.cs gcrcrally, 'Lil.-,e. hospital tc.@l---s and C'@-.,imiiiiitioiis, iiiu' forms of data Cozirci.1 can I . I'I - for perfunc,-cry, O@- tli't? other it is felt til@,-- sl'-icNuie@ be ciiiijar.,cj-iic, of modr--3:n de..L'-- tg ci-:c -ii pi-ojc@cts i-,icL,L otier T@',eF@ioral ivlc-dic,il Pro,,r-li:i Council. decided that c@ncer an,,! ot-1),@-r' re is@r-l-es, wfiere tf,.e st@ite- o h e - a i: t rely quality for when: (,a) Tiiey ii-;;pc)rtan+@- contributions @-c) rc-c"@-Lortali".Ld of patient care; (b) to L3isL-nf,L,.-e @,o-ra,.,i fu,.i@-'Ls pi.-or,@ptly and (c) 'Liet4.4-cal Pro-j.-c@,7i is cor@E41 c-' to or, zatior., plc..-i-i-iing 0-@ of doc,,- not: suppo.-,r majo-- -bquipl@.L-zit purchased or operation. Couicil sees i:),-,Itipliasic as cL spcc:CCL@L C:ata' acquisition tiiFt lias not 'yet dc@@i@l.:)r:stratc,-cl its value. Ilypotheti-cilly, it cotil.d contribute 4riil,,ort@.itl.y to aiice i,-d other x;ic'lr-,Iy pub'Lic4-zed COILCC?,Dt--s iii -,:,cd4-cal care, and to il:lr)rovecl P,@l),S..;.c4-a-is and of personal Couticil re@0C, Izes tlill@-L- i:,,-Tiy CD ocinc, pressed to supl-o-r.- rftu-ltiphasi- scrc@e.-,inc,. It is rctco-@--,I-;-ze,@ 'al.,;o tl-i;--t t",(! failure of r!,.ultiphasic scr.@eniil,-, projecL:F, to a 1)c-,siLive -,-of-t,ic@-,irt prc-.bJ.c!-,--,s as t.o cost-bciief4A-t ratio i-..ay bL- due to stitL Problems of plaiiii-i-r@- zinc, execut4-on' . Co-,i,@i@,-.l -Ic-L!erre'e, act4-,)n on t@@7o lro4 pliasic screerii-nz-, r-ct ap,,).I-ic,,',i-ons -Iii-a '-.z-tv 1.971 -i-iill :be i rel,)ort on Llic t(D It i-yas rc-cc-@:@-!@' i s c 011 ; t o E. C o u, i c i 1 b a o -J. i-i v c, to tc obtii,,i exiic-rt test:. o n v tli Itself O,-l t:)-,c 4, of -s t -1 t c -'o f0 - a r Itiplia,@ic scrc.,e,,,-n- and forr.,is of patient data ncq.uis@Ltio-,i. Coril)utc,r ;iss4stc(l dosiziatrv. Council reiterated' its'carl er finding witli rec,")i-!ct to cl C) r,, Svs Le-.-.s it was 1-iol-cl a dosi,),,@-trv. f-ler,.7icc siiotil(": (a) slip.),,);:t i -tst?lf, inclt,,,,Iin,-, costs. (b) provide 4'Ot CO',':;Illtal-loll !!)Otit the patient between ti-Lc pli%sicicin rc,.s,.)ori- sible for do.,;-Li;i et:rv irLd. tile pll,,,si.cian(s) the @erv L ice-; (c) that it tile particip,2tiii',, trezitirc,-Lit t,,,itioiis t)e tested a,,,.d cali- bratcd re-,alarly funds cril@Y if it ricets.-a need for re-ionzilizitic)ii-, Pnd (e)'coli- fine e,.,pcildittlrc of- ful)(,- 0 r,,tiprort of pl aniline and organizcitioii. NOJIP: All above from 9-IO.: 1970 Cotincil Miniites "I E SECTION' III (CATEGORICAL-RELEVANCE) Disease Categorical Versus Comprehensive "The Council reaffi= its- endorsemnt of the policies in this regard as set forth in the Regional Medical Programs Guidelines Chapter III, Section V. liowever- in so doing, it emphasizes that full consideration will be given to applications for activities which pertain to problem in heart disbase, cancer,,stroke, and related diseases but which alsg-have an impact on the diagnosis and treatment of other diseases, and/or fulfill a specified objective of the Region." February 20-21, 1969 Councii Meeting In considering the matter of the Itpele@ancell of --omponent activities of any Regional -,qedical Dmgram, the Council generally agreed with Doctor Millikan's statement that rather t@ being a Tratter of its direct relationship to one of the disease entities mentioned in Title IX, a project should be reviewed according to five basic considerations: (1) is it a valid scientific exper@-nt; (2) is it a imdel for educational experience; (3) is it some-thing other than a direct patient service; (4) will it open com,-@cations 4- channels for improved local and Regional arrangements tha,, will help to reach the long range goal of the Regional Medical Program; and (5) is it something that should be replicated in this or another Region? These questions were applied to the specific proposals and recommendations were arrived at accordingly. Council Minutes 12/16-17/69 ELIGIBLE A("RTVITIES SECTION III REASM4S FOR t;EPARATION OF-BASIC AI\TD-CONTINUING EDUCATION WITILIN REGIONAL MEDICAL PrOGRA14S AND alpHASIS ON CO',ITINUING EDUCATION Regional Medical Programs has emphasized in the past and continues to emphasize continuing education and training rather than basic education as a means of providing the opportunity "of making avail- able to their patients the latest advances in the diagnosis and treatment of these diseases" for the following reasons: The@e still exists a lack of emphasis on continuing education as an important facet in the total educational development of health personnel. RMP provides a meaningful regional framework of cooperative activity into which continuing education programs can be incorporated. Continuing education can play a role in develop- ing cooperative arrangements and, conversely, regional cooperative arrangements are essential to the development of continuing ed@tat@ programs. RMP, because-of it-s focus on the practitioner and his effect on patient care as well as through its mechanism of "demon- strations of patient care," provides the ideal setting for the connection between acquisition and utilization of knowledge that is the key to the learning process in continuing education. It is the health care needs of his patients that dictate the continuing education needs of the health practitioner and it is his utilization of this continuing education that sets the quality level of his practice. RMr, therefore, has the opportunity to make continuing education relevant to its real purpose--that of improving the health care of people with heart disease, cancer, stroke and related diseases. As a result of specialization sub specialization and the development of new technologies, the health establishment has proliferated so that there.are now many different kinds of health professionals. A variety of medical care teams has resulted but continuing education remains largely unidisciplinary. The cooperative arrangements of regional medical programs can provide an excellent base for multidisciplinary inter- professional continuing education with its primary focus-- the care of the patient with heart disease, cancer, stroke and related diseases. Generally speaking, other agencies exist whose primary efforts are aimed at supporting supply and training of health manpower at the basic and postgraduate level. ... A(ldendtin@ to Revised Cuidtlinc-s, 2/70 P-- 144-15 @,TOTE: Definitions? PROGRAM@ ',MA@%IACE@IENT SECTION.III ELIGIBLE ACWIVITT (Continuing Educatibn, Training & Manpower) II. Continuing Education and Training - Def-initioT-is Section 900a of P.L. 89-239 authorizes Regional Medical Programs to use, as means of accomplishing its purposes, research and training (including continuing education) and related demonstrations of patient care. l@ile the wording of the law is quite general, it is clear from 6e legislative history and other sources that the primary educational interest of Regiongl @ledical Programs is in continuing education and training activities. As an operational definition of continuing education, the following has been accepted:- "Those educational endeavors which are above and beyond those normally considered appropriate for qualification or entrance into a health profession.or an occupation in the health related fields." Generally, activities should,not be designed principally to qualify one for a degree, diploma, or board certification. In general, standard internship and residency programs would not qualify as "continuing education." Continuing education and training activities should lead to,,the assumption of new responsibilities in the already chosen career field;.up@te,knowledge and skill in the chosen career field, or add kpowledg,-"and skill in a different but basically'related health field. 'Add-endunz to Revi-sed Luidelires, 11/70, Pg 6 CONTINUING EDUCATION AND TRAINING - DEFINITIONS The primary educational intent of Regional Medical Programs is in continuing education and training. As an operational definition of continuing education, the following has been accepted: "Those educa- tional endeavors which are above and beyond those normally considered appropriate for qualification or entrance into a health profession or an occupation in a health related field." Continuing education activities must not be designed principally to qualify one for a degree, diploma or certification; therefore, internship and residency programs have been excluded from primary consideration. Training designed principally to prepare one for a research career in the biomedical sciences has also been excluded. Continuing education and training activities should lead to the assumption of new responsibility in the already chosen career field, update knowledge and skills in the chosen career or add knowledge and skill in a different but basically related health field but not provide for career change. In general, therefore, interest is in task-oriented training- (Addendum to Re,7'Lsed Guidelines, 2/70, Pg 1:')) @ELTOIBLE ACTIVITIES III. Criteria din 'tg Edu@a'"iL)n I-rl i ii i p We have further specified conditions which should be met by the continuing education.or training activity submitted for funding: (1) The activity must be s@UA% to met documented Regional needs. (2) Evidence should be presented to show that such activities do not already exist or do not exist in sufficient nt.inber. (3) An operational activity must leave been approved by ti,@e regional advisory group. (4) In accordance with the provisions of Section 904(b)(1)(B) of P.L. 89-239, the availability of other sources of funding must have been fully explored.. (5) TAe goal of the activity should be to maintain or ii,-,prove the quality of practice of health professionals. Ii, general, activities will fall into one of three categories: Ca) Maintaining the level of practice of the health professional (e.g., refresher courses, seminars conferences, etc.). (b) Improving the level of practice of the health .*professional (e.g., special training courses in coroiiary.pare, cancer therapy, etc.). (c) Peve-loping new areas'of interest for the health professional (e.g., training leading to the assumption of new responsibilities in a chosen career field,, obtaining knowledge and skills in a different but basically related.heal@h field, the'de,,relon,@nt of new types of health professionals, including,, for example, the medical planner and administrator. It is recognized, as stated in the revised Guidellin(,,s that "grant funds may be used for innovative training approa es an t,,c deveic-@)m--nt of new types of health personnel....I' Such activities and others Pay require investment in basic training 6r education. Such activities will be judged on their merit and on the document ation by the Region of t]-ie need for such an activity. Exclusions: It should be emphasized that Regional Nt-dical Prograri funds are not to be used to "supplant funds that are otherwise available for establish- ment or operation ...... (Sec. 904(b) 1, P.L. 89-239)-. Therefore, generally excluded from funding is training designed specifically to prepare one for a research career in the biomedical sciences. We urge Regional @dical Programs to become familiar with all available'sources of support for education and training, including private as well as other Federal sources, e.g., -the National Institutes of Health, the National Science Foundation, and the Depart,-nent of Defense. It is to b'e expected that Regional @dical Program will seek support or help cooperating agencies or institutions seek support for a wide variety of training and education activities, basic and continuing, from several different sources. In many instances, shared funding by a number of cooperating agencies will be appropriate. The Division of Regional Ntedical Programs may be of help in such cases. ... Addendum to Revised C,uidelines - 2/70 Pg 6-7 PROGRAM SECTION !II ELIGIBLE -4CTIVf@--ES (Continuing Education, Training & @lanpower) CRITERIA FOR FUNDING The following criteria have been adopted for determining those continuing education activities most suitable for funding: The activity must be shown to meet documented Regional needs. evidence should be presented to show that such activities do not already exist or do-not exist in sufficient numbers. . The goal of thd continuing education activity must be to main- tain or update knowledge and skill in,order to improve'the level of prac-tice of the already qualified health professional.' . The activity must relate to the categorical nature of the program and be part of a comprehensive plan to enhance regional cdpability"'in the care of patients with heart disease, cancerf stroke and related,diseases. RMP funding is not to be used to replace existing sources of support for educational activities. ... Addendum to RevIised Guidelines, 2/70 Pg 13-14 'NOTE: See Pgs 6-7, Addendum to Revised Guidelines, 2/70 - - - - - - - - - - - - - SECTION III ELICILLE ACTIVIT@T (Continuing Education, Training & Ilanpower) BASIC TRAINING OF ESTABLISHED ALLIED HEALTH PROFESSIONS Definition A health.profession will be considered established if a Board 6f Schools AMA Council in Medical Education, or some similarly recognized mechanism, has been set up. to approve schools, outline standards for admission, curricu;lum--reqttirements and certification procedures and/or if definitive formal educational programs in the particular health occupation have a.1-teed.%j Im zTA @rai-ning syscems oi 'nos- pitals, technical schools,. ju-nior and senior colleges. Council recommends that no RMP grant funds-be used for the cost of providing basic education and training in established allied health -professions'as defined above. Ro-gions arelencouraged, however, to use professional staff assistance as well as direce support of special planning studies to encourage educa- tional institutibris in conjunction with clinical resources.to provide new "tunities in established allied health educational andtraining oppor disciplines and.to add new disciplines. Addpnduri to Revined Guidelines, 21/ 6, BASIC TP-KINING As has been stated previously, support of basic education and training programs in the medical, allied and associated professions is not the primary "target" of PifP and is not, therefore, normally anticipated. The supply and basic training of manpower is more logically the "target" of other Federal agencies such as the Bureau of Health Professions Education and Manpower Training, Office of Education, and Department of Labor. However, because of the number of applications received by DMT requesting basic training support in the allied health professions, Division staff divided these pro- posals into three categories, - health careers recruitment, basic training in "established" allied health professions and basic training for the development of new types of health personnel. The February, May and August Councils have taken these under consideration and made the following recommendations: * ... Adde-idum to Revi,,;cd Cuidelinf2s, 2/70 Pg 15 NOTE: Item continues. (Definitions)- PROGRAM SECTION III ELIGIBLE ACTIV-. @S (Continuing Education, Training & Regional -rogr port of Rec @ledical P @ Sup ruitment and Basic Training of Health Per-sonnel,as Distinct i-rom Continuing Education -mid Refresher Training 'Ihe Council reaffirms its position on this matter and offers the following criteria for interpretation of the definitions set forth in the current Regional lledical Programs Guidel4-nes: Certain criteria have been adopted for deciding whether or not an activity is to be considered as continuing education a-,id training, e.g., activities must in general not be those designed principally to qualify.one for a degree, diploma, or Board certifica- tion; therefore, internship and residency program have been excluded from primary consideration. The education and/or training activity should lead to the assumption of new responsibility in the already chosen career field, or update knowledge and sKill in a different but related health field. In general, therefore, interest is in@,task-o-.riented training. Trai-ning designed principally as preparation for aresearch career in the biomedical sciences have been excluded. It has been stated that Regional @dical Program funding is not to be used to -replace existing s.ourcqs of support for educational The activity must satisfy a doc@nted nee(-' ol a Regional i%ledical Program, and must be shown to have a relatively high priority for funding. . Otheravenues of funding must have been explored and found inadequate either by the @gion or by the Continuing Education and Training Branch of the Division of Regional Nledical Proar@ . In many cases, funding is requested for projects because of a lack of available funds by other agencies such as the Bureau of Health Nianpower. . The Division of Regional @tdical Programs or the Region itself must also explore the possibility of phasing out the Regional ,'vertical Program funding as money becomes available from other sources. Other-Federal agencies such as the Office of Education and the Department of Labor are beginning to support parts of -recruitment and training activities' affecting the health field. The Region or the Continuing Education and Training Branch of the Division of Regional @,L-dical Programs must have explored the possibility of joint funding with other interested agencies. If the education and trai)iina activity has been slioivii to be necessary to achieving the purposes of a Regional NIP-dical Program, and the above criteria have been met, then the proposed project may be approved for funding. PROGRAM @IANAG7-'@l-,NT SECTION III ETICIBLE ACTI@-..CIES (Continuing Education, Training & Manpower) Basic Training of Allied Health Personnel The Council reco@nds that Regional radical Programs grant funds for basic training-L/ o allied health personnel be limited as follows: . For projects which meet the critqria for funding which are set forth in the Guidelines/-/ and discussed further in the Council recomendations of February 19693/; and . For training related to newly developed technologies or new modalities_of diagnosis and treatment for which no standard curriculum is yet recognized and no minimum national standards for'certification or licensure a-re yet established; and which is not generally part of the regular offerings of the health-related educational and traini@g system of hospitals and/or technical schools, junior and senior @olleges. This restf-icii'on on use of R@gional @ledical Prograris funds will be limited to the actual costs of provision of the training and for payment of student support and assistance. Regions are encouraged to use,both professional staff assistance and direct support of special planning studies to encourage educational institutions (technical institutes, public adult education resources, extension programs, junior and senior colleges, and hospitals) in conjunction with the resources for clinical experience, to provide new educational and training opportunities in the established allied health disciplines and to add new disciplines; but only after they are fully identified as essential to the provision of a recognized service to patients. At the National level, the Division fu @ er proposes to encourage the incorporation of these disciplines into the various training and education systems, such as those whi6 set standards, approve curricula, and aid in counselling and recruitment; as well as those which assist in the financing (Federal and non-Federal) of allied health career programs In implementing this recommendation, the Division will ask the Council to consider the various disciplines separately and will b@-e specific limitations on their judgment whether a discipline falls into the catcaory described. .1/ Defined for purposes o@ Regional Ntedical Program grants as' training required for a certificate, diploma, or degree, or which otherwise leads to the fulfillment of the experience and education requirements for initial entry into a health career. 2/ Guidelines, Supplement #1 - Expanded Statement on Education & Training, Au t 19 8. 3/ News, Information and Data, Volume 3, Number 17S, @lay 13. 1969, Natio:ftal Advisory Council Speaks to Six Issues Re Components of Program Activities. I,-- - I 11 PROGRA@I I-TA@@qAGEi%f--T SECTION III ELIGIBLE ACTIVI-.,-.--'S (Covitinuing Education, Training & K-ii)pcwe@-) 2. Identification of "Established" allied health disciplines. Folloiiing the-sug'gestion of the Council at the flay meeting, the staff proposed some further guidelines for development of projec'us to train allied health personnel. The Council reaffirmed its previous-position that use of Regional lledical Pro@am funds for the actual'costs of basic training and for student support be l@ted to "newly developed technologies or new r@--odali-ies of diagnosi& a,-id treatment for-i,,Thich no standard curriculum is yet recognized and no mi-rd= national standards for certification or licensure are yet established and vihich is'not generally part of the regul@ offerin s of the health-related educational and 9 LL,,-ior training sygtem..(jf @spitals ard/or technical schools, and se@r Colleges.'' j@@ guideline was made more spLcif4c to accept the staff's reco.@-nd@- ion by the Co@illsdecision that an allied health profession will be considered established if a'Board of Schools, American l@ed:Lcal A-,soci,4-tion Council on P4edical Education, has been set up to approve schools, define st@dards for adndssion, curriculum requirements and certification cedures. pr(S The three disciplines presented for specific consideration were Inhalation Therapy, Nuclear ?@edicine Technology, and Radiation Therapy Technology and it was agreed that all these would fall into the group for which basic training support would be denied. ... Au-ust 26-27, 1969 Council Minutes PROGP\-A,'L%f ?-!A!,,ICT, i\,@ SECTY.Olt' III ELICIELE ACTIVI- S (Continuing Education, Training & @laiipo,,ier) NEW TYPES OF HEALTH PERSOhliNEL Both the original and revised Guidelines state that "Grant funds may be used for innovative training approaches and the development of new -types of health personnel or new arrangements of health personnel to meet the Region's goal of improved patient care for those suffering from heart disease, cancer, stroke or related diseas-es," Some of these activities may fall into the category of basic education.,.. Definition The definition accepted by Council for the training of new types of health personnel is that training-which relates to newly developing technologies or ne@ modalities.of diagnosis and treatment for which no standard curriculum is yet recognized and no minimum national standards for certification or licensure are yet established and which is not generally part of the regular offerings of the health-related educational and trainin"g system of hospitals and/or technical schools, junior and senior colleges. Criteria for Funding- The training activity must satisfy a documented need of a Regional Medical Program, and must be,shown to have a relatively high priority for funding. ... Addendum to Revised Guidelines, 2/'70, Pg 16 Traini@2, of Physician Assistants After consideration of the background materials which were requested by them and pr@oared and submitted by staff, the Council agreed that Drojects rel-ati,@- to the development of nonprofessional rian-,ower to assist physicians in the direct care of patients (generally referred to as "ph,,tsician's assista,-its") -- i-ncludirc. the direct Cos'-Us-of providing trai@-ino- and student support -- my be eligible for funding as part of Regional I;Iedical P,-o@a,,@. In makin- this r-ecomendation, the Council emphasized that this action implied no relative priority for projects of this kind in the spectrum of -Regional @7v@cal Program activities., nor the priority of one approach to the training as related to another. ...August 26-27, 1969 Council Minutes PROG@NI ltA@NAGE@IEN' SECTION III ELIGIBLE ACTIVITI'l@@ (Conti ziuing Education, Training & @lan-oower) HEALTH CAREERS RECRUITMENT The Council recognized the need for additional health manpower but because of the time span between recruitment and improved patient care, it recommended that further support of health careers recruit- ment projects with Regional Medical Program funds be granted only when a project is related to a clearly focused (specialized) short-range approach to the critical needs of a region, and * 'Has the documented committed support.not only of the sponsoring agencies, but of the Region's hospitals, schools, and colleges whose cooperation is essential for the success of the immediate project and its continuation after Regional Medical Programs support can no longer be made available; * Includes a plan for evaluation of the impact of the program on the rate of production of trained health manpower; * Is direct6d at -.pe"'cial population groups, especially those who d6 nd't'usually seek, or have available, opportunities for trainidg @.,educatlon beyocA secondary school;" * other sources of funding have been explored-,--,,"- *Sub-para graph expanded by correction to Addendum to Revised Guide!-4.tes 2/-i Health \Ianpoi,:er Rec-iu@-@-.@-.nt In recognition of the nationwide need for more and more competent allied health personnel, the Council reaffirm its policy of support ror effective Regional Medical Programs activities directed toward meeting those needs. Houever, a direct relationship between specific recruit- ment efforts at the high school level and increases in qualified Ileal'ch personnel is difficult to demonstrate; and the real impact of a recruitment project on &.e care of patients is often remote or obscure. The Council, therefore, recommends that further support of such projects with Regional Medical Programs funds be granted only when a project is related to a clearly focused (specialized) short-range approach to the critical needs of a region, and Has the docLmented committed support not only of the sponsoring agencies, but of the Region's hospitals, schools, and colleges whose cooperation is essential for the success of the immediate project and its continuation aftelc Regional Medical Programs support can no longer be made available; Includes a plan for evaluation of the impact of the program on the rate of production of trained health manpower; . Is directed at special population groups, especially those who do not usually seek, or have available, . .. Opportunities for training or education beyond secondary school. ELIGIBLE ACTI"-TIES SECTION III (Continuing EL.--,Ction, Trainin" and @lanpower) 13, ca@O'Qullronarv Resuscitation Trai ro aIns The Council discussion was based on the material presented by staff and on its accUrCulated experience in reviei,,Tin- Fe@ional C) Medical Progra,-,, applications ,ihich contain Cardiopul@,mnary .Resuscitation training projects. 'Ihere was general @ee@@@u an the appropriateness and value of projects to pro-Tide training for selected groups of professional and a-lied health personnel in the techniques of cardiopulmonary L resuscitation, as co@-r@-oonents oL' Regional l,ledical Programs, as detenr,ined by the level of priority assigned to such projects by individual Regional ',@cal Programs and their Regional Advisory Groups. They were, h(3wever, unable to arr@ve at any consensus as to the :peal- value of t@e'a@,st 1-mlimi@ed extension of "-Uch t rairiLig Progra,,ns to n.Dn@.,ed-l-cal personnel, particularly i@n;-,n relatirZ the tcost of Such trair@ (in dollars, facilities, and Manpower) to the presently limited funds available for Seats to carr-yout the purposes of Public Law 89-239 ( ,Educat4-on, Pesearch, T-- and De,-mnstrations in the Fields of Heart Disease, Cancer, Strol-,e, and Related Diseases). icil '!it, At-,gu.@t: /^6-27, 1969 Cili-, ititeE. Regional 1,1--dical Program grant funding for projects in cardiovascular resuscitation training is to be limited to tr activities which are directed principally to medical and allied health personnel who are employed in hospitals and in other in-patient facilities, or in out- patient or @rgency facilities operated by or directly related to institutions in which follow-up care is @diately available Council Minutes 12/17-17/69) TI.IE FOLLOIVING.POLICY GUIDE-LINIE was restated by the National Advisory Council, Regional Medical Programs Service, at the December 16-17, 1969 meeting. It had been adopted at the August 1969 meeting in regard to a group of pending projects: Cardiopulmonary Resuscitation Training "Regional @dical Program grant funding for projects in cardiovasc- ular resuscitation training must be limited to activities which are directed principally to medical and allied health personnel. Such personnel riust be @lo),ed in hospitals and other inpatient faci.litic@s, or in outpatient or emergency facilities operated by or directly related to institutions.uhich can provide immediate followup career (Printed in Addendum to Revised Coijol-'nes, '-/70) @linutes of Meeting of National Adiisory SECTIO@', III ELIC,J"-",E ACTL'@ ont4nu4ng Television Production and T\"eti@ork Facilities " Council recommends that all new operational projects -requesting major investments or funds for equipment and activities in television be thoroughly studied by Division @taff and ex-port consultants for consideration for funding under the new authority for @,@-ilti-program Services provided under Section 910. It further recommends that applic- ations for continuation and renewal of prdiriously funded major television activities be reviewed by the same group of expert consultants on the basis of the pro(,ress being made in the applicant Region to-,@ard its tolelision objectives, and how those activities might be related or expanded to a @lulti-p-rogram Service." February 20-21, 1969 Council P4eeting to i-@,-,visf-d Goi-clelinez,, '-7/70, Dial Access Audiotape "The technique of direct telephone access to pre-recorded tapes on selected topics of interest to physicians and allied health personnel is becoming increasingly popular in Regional @ledical Programs. The Council recommends that -proposals for projects of this kind meet7t-he following cr t ria before being referred @or review as part of a Regional @4edical Programs application: The application should contain an explanation of the way in which the project fits into the total regional e ducation effort for physicians and other health professionals. Proposed evaluation of the serve -ce must involve its receptivity and value to the professionals in their practice. The mere measurement of numbers of the incoming calls is insufficient. lVhen the request includes the establishment of an independent network (in contrast to sharing tLn already established facility), the statement of justification for the hardware investment should include the rationale for a new network as well as a plan for long-term use of the network. There must be a plan (both long and short range) for the development of the tape library, justifying any decision to make rather than share or purchase tapes; for the selection of subject matter; and for identification of target groups (i.e., physicians, nurses, etc.). May 26-27, 1969 Council @eting 4A@linne I /7i) Pcr ELIGIBLE @,TIVITIES (Contin@,,4ing 'Educat it-in V. Other Training Provisions A. Citizenship: The Division of Regional @tedical Programs adheres to the poliqy which provides that only United States citizens and those foreign na- tionals having in their possession a visa permitting permanent residence in the United States ma@ be appointed as trainees on trainina grants. B. Long-Term Training Appointments-: A "Statement of Appointment of Trainee" (Form PHS 2271, PHS73190-5) .or PHS-4885-2 as appropriate) will continue to be'required for each appointment or reappointment of a trainee receiving stipend, dependency allowance, tuition costs, or travel from a program supported by the Division of Regional Medical Programs I funds. For each appointment, or rea@pointment,'the statement,.must be submitted at the time the training period of the'individual begins. No obligation for trainee support may be made ajainst grant @d@ until this statement is submitted. If there are changes in the terms of the appointment (e.g., support period, stipend, supplementation, dependency allowance, tuition) an amended Statement of Appointment,.is required. C. Reporting of Short-Tem Training Programs: aort-te-rm training supported by the DivBi6n of Regional @ledical Programs' funds will be reported in the aggregate on a regional basis. To be included in such a report are the number of trainees who participated, ocFTational categories represented, and the grouping of levels of academic preparation of the trainees. August 1968 ELIGIBI- ACTIVITIES SECTIO,'I III (MULT-LPRC'@RMA SERVICES) POLICY ON KIDNH-Y DISL"KSE ACrIlITIES T E,i'\TDOfZSED BY NA:FIONAL tVArISO.TZY --COUNCIL aN RF@G-LO@LAL @E-DICAL PROGRA,',!S July 28 - 29, 1970 -In recognition of the importance of clirojiic reiial. disease as one of the impairments of m@moessentially related 'Lo heart disease, cancer, ar,,d stroke, the Regional Me-dical,@P-fbgrams Service, with the advice Qf the National Advisory Cpi-L-iei-1 and a numl)er, of recognized experts in the field of nephrology, offc-rs,tlie foli(mving guidelines to Regional i'@,ledical Programs for the pluming and development of kidney disease activities as components of individual regional program or as cooperative enter- prises of two or more neighboring Regio@l @,ledical Programs Recognizing the competition for both funds and manpower in the ,@-urther development of,conprehensive kidney disease capabilities within the health care system, the Regional @ledical Programs Service and -.:,ie National Advisory Council will exer@ their best judgement in allocating the limited amount of f-wids available for this purpose in F-Y 1971 and 1972 to Regional @l,edical Programs which propose the i-iivestme-.it of grant funds --- . To encourage wider and more effective cooperative arrangements arioiig selected institutions and re- sotirces iNIii-ch together can form comprehensive systems of care; and . To strengthen existing institutional resources competent and willing to reach beyaid the con- fines of the medical centers within ivl-ii-cl-i they exist for development of systems of services and training. k!MORE) .$*NID 11-27-70 PIIOCRJ%M ',i,AGEME@iL" SECTION III (ML-LTIPROGF,@M SERVICES) regional medical programs service L Communication device designed to speed ANNOUNC Senior Clinical Traineeships the exchan,-e of news, in Cancer for Post-Residency Physicians aforinatiozi and data on iotial medical Pro,,rains and related activities. -August 24, 1970 Vol. 4, '@,'O. 19 The Senior Clinical Traineeship Program is now the responsibility of the Regional @ledical Programs Service, as explained on Page 2 of this issue. The center spread announces the latest information on this post-residen,cy training program for physicians and provides the information for candidates who ivish to apply for aivards. Please post, route or forward this publication for those who may be interested. PRO@@,f @IANA(F?@L-'iN,T SECTION Tll ELIC-IBLE AG-, -TIES (Exclusions) 711E FOLLOIIIING RE-CO@MNDATION was made by the Natioial Advisory Council, Regional Medical Programs Service, at its May 26-27, 1969 meeting. It supplements the preceding paper on Background Information and Amended Statements Concerning Continuing Education and Training: Traini,ng of Cytotechnologists 'Upon recommendation of the Council, the Division has identified Cytotechnology as an established allied health discipline. Its training programs are approved by the American tledical Association Council on Education when properly recommended by the,p-rofession, and graduates a-re certified for practice by a nationally recognized examination administered by the profession. The techniques of exfoliatiiye cytology are nor' Of universally recognized value in screening and diagnosis of pathologi.c states. 'Iherefc)re,-in line with general policy relative to support of established programs and in 'keeping with above policy guidelines on training, the Councii recomends that Regional Medical Programs grant funds not be used ding the basic education and training of cytote a grant for an independent project or as part ating the application of ex- foliative cytologic techniques to patient care." ... NID 5-13-69 NOTE: Cross reference to Eligible Activities (C.E.Tng & I-,npTqr) @T funds should not be used to establish or otherwise support centers for the evaluation of methods of 'r--atir@u of stroke patients, since u sixteen such centers are funded undei, careful study by the Natioral Institute of Neurological Disease and Stroke. -s -Apr ... March 31 ii 1, 1970 Council Minute NOTE: Cross-reference to Demonstrations of Patient Carc FINAIICI,@L ',,L@,----@MFI@T SECTION IV (General Req,-,,,,"i-@ments) include provision which will insure that the grantee ciii carry out the assurances required by tile Act in Sections 903(b) -iiid 904(b) iiid that the grant funds provided to each affiliitecl tgency ivill be administered by tl)at agency in iccordiice with the Act, the regulations an(f tl)plica',-)Ie poli- cies of the Division of Re--ioniil i%ledical 1'rogTams (see exaniple-.rkppenclix 3). VII. Financial Nlanagement The Division also encourages the Regic@iial imcdi- General Requirements-Fedei-al funds awarded c-,il Program to include in such il,i-ccment an), provisions relatin- to the conduct ptirstiant to either t planning oi- operational grant 0 and deN@clol)jii(:iit of the Rc@gional Medical Programs as ina), be are to be used only for the purposes for which awarded and in accordance with the pi-on,isions of appropriate @ind desir@ible for the achievement of the purl)&es of tile Program as outliiiecl in tl-xse the Act (Appendix 1), its regtjlxtioiis (Appendix Ciiidelines. The advice and counsel of "tile Re- 2), and these C-iiiti(@lities. Additionally, Federal funds aivar(le(i pursuant to an operational grant gioiial Advisory Group should be sought in devel- may not be used to supplant funds that are other- oping such provisions. ivise available for the establishmentor '6peration of the Regional iNIcdicaItPi-o-r-,im @itli respect to, which the grant is made. Funds granted may be used only for services, materials and other items required Lo carry out the al)l),roN,e(l program. (circular A-21 of the Bureau of the Budget should be used to the extent prac- tic:ll)le in determining allowable costs related to the grants for Regibrt,-il Medical Programs. A-%'Iiere the Division of Regional infe(licitl I)rogrims re- (litires prior approval for items not listed in the approved budget, i written request must be made by the grantee to the Division of Regional, Medical Pr%", ins in advance of the act which requires the obligating or expenditure of funds. Agreement of Affiliatioii-B), :accepting a Re- gion@il Nfedical Program grant, the grantee has accepted certain responsibilities enumerated on p:iges 9-10 of this Cliil)ter. I-loweN,er, the Re- gioiial Medical Program activities will necessitate tlie-exl)cnditure of grant funds. by a number of different institutions, organizations, and agencies in addition to tile grantee. In order to assure a@ prol)i-i'tte tCCOL111tability for the expenditure of grant funds by these additional agencies, an Agree- ment of Affiliation must be signed by the respon- sible official of each affiliating institution (or dgcncy) and by the grantee A,Iio represents the Regional %Ie(licitl Program. Such an agreement will not be required nor appropriate in the con- duct of business with (1) a I)rofit-making orga- nizatioii by subcontract, or, (2) ivliere direct pay- nient is to i)e made for tile use of facilities or for services ren(lei-ed on 1)(-.Italf of the Re<,ion-,il Nledi- cal Program. This agreement, at a minimum, must CI-L@PTER III, REVISED GUIDELIIIES, Pg 14 -'AC FTL,NAT@ -.,L il SECT-TOF IV STATEMENT OF THE NATIONAL ADVISORY COUNCIL ON REGIONAL MEDICAL PROGRAMS ON SALARIES FOR KEY STAFF MEMBERS The National Advisory Council on Regional Medical Programs has expressed concern about the possibility that salary levels being requested for the key staff of Regional Medical Programs may lead to escalation of salary levels among the Programs and may create difficulties in relationships within and among par-L-i- cipating institutions in a region. This possibility is increased through competition for'highly qualified individuals to occupy leadership posts in th@ staffs of the Regional Medical Programs. The Council believes t@at a general salary escalation for Pro@., gram staff would do harm to the achievement of effective cooper- ation with the medical institutions and medical personnel within the region and might.stimulate competition between regions in- stead of interregion4X cooperation. The Council would stress, therefore, that applicants and grantees are required to give careful consideration to-the sa,,Iary structure for personnel engaged in the Regional Medical Program to insure a salary scale consistent with that established for similar professional or administrative responsibilities in the applicant institu- tion. If the applicant institution or organization has not t previously carribd these types of responsibilities the salarv scale should bear reasonable and specific comparability to prevailing rates in medical centers or other appropriate in- stitutions in the proposed region. The Council will expect the applications to contain specific justification for salary rates proposed, and the application should define as precisely as possible the relation- .ships in terms of the responsibilities of the program coor- dinator and other key officials to the established major me- dical professional or administrative officers in the region. No unusual or extraordinary salary level should be established for personnel engaged in the Regional Medical Program acti- vities solely by reason of the institutions participation in the program unless specific justification has been supplied and approval received from the Division of Regional Medical Programs at the time of the award of the grant or subsequently. The Council has asked the staff of the Division of Regional Medical Programs to pay very careful attention to proposed salaries and the justification for these salaries during staff review of applications, negotiations with grantees, and during regular review of the grantees' progress in implementing the program. ...NID 5-15-67 PROGPAM FINANCIAL @fANAG'-,."ITT SEC@LIO,@'t IV (Alloiqable Direct Costs) Allowable Direct Costs- A. Personnel Costs-Salaries tn(I i%-ages of I)er- sonnel in I)rol)ortion to the time or effort cxpencle(i on activities of the Region,-ti Medical l'i-ogrim nia@- be cliai-ed to the grant. These costs Must be ill accor(l@iiice ivitli applicable institutional I)Olicies, -ind adequate LIMC and effort records must be maintained in order to substantiate these costs. Salaries Of Personnel XN'IIOSC full time is CICN-Ote(I '%fcdic, Should not to the Regional i -il Program exceed the saliries of full-time @iciniini-.,ti-aLi%-e pei,sonn(-I'in I)o!,itioiis of conil).ii-,tble i-e,@I)oiisibilitv in niajoi- medical institutions in the R@,,-ion. 51)e- cificallN,,, if a nei@, corporation is organized to as the grantee, it IDLIST establish silary poli(ics the al)o@'C xvliicii zil)l)l), to its personnel Linder policies :ixid iN-Iiicli do not exceed equivalent sal- aries in the major medical institutions in the Re- gion. Any question concerning the al)l-)rol)i-iatetiess of I)artiCLIIlr salaries or cxcel)Li(-.)zis to these policies Sliotil(I be discussed with the DiN,ision St!iff. B. Consultant Sei-N,ice-s-Rcgional '@leclical 1'ro- grani grant funds ma), be used to pay consultant fees and SIIPPOI-Lill,@' Costs such as tilde], -inci per them in J-)ayziiet)t foi- set-N-ices relited to an), Pro- grani element of a Region2il Nledical Program, proN,i(Iiiig that these services are the most effectiN-e means of accomplishing a particular, purpose. 0 If COII@LiltltiOll is obt@titied fi-(-)ni a aried staff iiiei-nl)er of the grantee or -,in affiliated institution, tIlZit institution mry be reimbursed for a 1?i-ol>ortiotiate amount of his regular salirv from grant funds. Pi-o,,-ram records i-niist indicate tjle total cost and include a statement of activities. ... CHAPTER III, REVISED GUIDELINES, PGs 14-15, 7CIAL NGEI,!E@4T FINA@, SECTION IV i,i rect IV. Allowable Direct Costs for Education and Training Activities The following statements amplify those made in Chapter III, Section VII-C of the revised Guidelines: A. Categories of Training: (1) Training Conferences and Seminats: Presentations ivhich a-re planned for full-time par icipation for periods from one full day to five consecutive days, or intermittently on a regular basis. (2) Short-Term Training: Activities which,are planned fo-r full-time participation for more than five consecutive days, but not more than a single academic session (quarter or semester). (3) Long-Term Training: Activities requiring full-tim-- participation more than a single academic session (quarter or f5emes@er)-. 4( B. Levels of Traiiiing: Determination of the level of stipend is to be based upon the general level of training to be presented. In the case of training designed specifically for teams of physicians and'ancillary personnel, an appropriate stipend level for each general level of participant may be selected, based on educational level attained, experience and current salary level. (1) Post-Higl-i School/PN'onacademic: Training ivhich requires completion of a seconda@e ucation or having'ai-i appropriate equivalent background and experience. . (2) Baccalaureate: Traini ng requiring at least some relevant colle ate preparation, but not more than the baccalaureate degree. (3) Graduate: Training i@,]-iich requires at least some relevant po@t-@accalaureate academic preparation but not more th'a'n a doctoral degree. Training creditable toward the degrees of M.D., D.D.S., D.O., D.V.M., or similar medical degrees is excluded from support. (4) Postdoctoral: Training program designed for holders of a doctoral degree, or who have had equivalent training. C. Stipends: Stipends are not authorized for training conferences and seminars, but stipends may be paid for short-term and long-term training programs in accordance ivith the folloiving general policies: If the trainee is employed by an affiliated institution, a stipend may be paid directly. A maintenance of income principle can be used to determine the amount of stipend. If desired, the trainee's employer can be reimbursed for the amount of the trainee's salary, including the personnel share of benefits paid by the employer at the time the trainee enrolls in the training being conducted. ... AddenduTn to Revised Cuideli-nes, -9/70, Pg 8 FINANCIIE @"'@'AGE'@,LiNT SECTION IV ('Ilolqp-"Ile ;iirc-@t costs) (Contd from Pg 8,. Addendum to Revised Guideli-@ies, 2/70, Pg 9) Payments of stipends (fellowships, scholarships, etc.) should not exceed the amounts presented in the appended schedule. In no case should such payments exceed the amount set by the policy of the training C, -r pre institution for similar trainina or training requiring siinila requisite education. Stipends for short-term training are based on a daily rate and are to be paid only for actual training days (weekends, holiday, etc... excluded) Stipends for long-term training which is less than a full twelve months are to be -calculated on a pro-rata basis, and leave and holiday policies of the training institution are to be followed. Stipend rates for full-time, long-term postdoctoral training a-re to be paid according to the,.c@rent policy of the training institution. The Division of Rggional @lbdical Programs will not undertake reimbursement at private practi@e levels. D. Dependency Allowances- Dependency allowances for those 16ng-.term trainees at the Baccalaureate level and higher, who are in trainina for a f@ll academic year, may be awarded in the amount of $500 (per year) for a dependent spouse, each d6gendent child, and each dependent relative, provided that during the trainee appointment the dependent receives more than one-half of total support from the trainee. A dependency allowance may not be claimed for any person who during thetrainee's appointment period will be receiving a fellowship or traineeship stipend under Federal educational assistance program (other than loans), or for whom an allowance will be made as a dependent of any other person during that period. The Division of Regional Medical Programs has adopted the following dependency schedule and a dependent may now be defined as any of the 'following individuals over half of whose support, during the period of appointment, is received from the trainee or student: (1) A spouse, (2) A son or daughter of the student, or a descendant of either, (3) A stepson or stepdaughter of the student, (4) A brother, sister, a stepbrother, or stepsister of the student,, (S) The father or mother of the student, or an ancestor of either, (6) A stepfather or'stepmother of the student, (7) A son or daughter of a brother or sister of the student, (8) A brother or sister of the father or mother of the student, @(9) A son-in-law, daughter-in-law, father-in-law, mother-in-law, brother-in-law, or sister-in-laiv of the student, (10) An individual who, for the school year has as his principal place of abode the home of the student and is a member of the student's household, or SEC@LION 7LV (11) An individual who (a) is a descendant of a brother or sister of the father or mother of the student,, (b) for the school year of the student receives institu- tional care required by reason of a physical or mental disability, and (c) before receiving such institutional care, was a member of the.same household as the student. E. Travel Alloi@ance: The cost of the trainee's travel to the training institution 'may be allowed only for the purpose of, and.at the time of, entering and leaving the training program. The allowance is payable only once to any one trainee from any one training project. If private transportation is used, a travel alloivance"of 8,cents per mile, as computed by standard mileage charts', may be paid.from'arailt funds for travel to the training institution from the trainee's last place of residence and return. Payment of travel allowance is limited to-part-icipants who must travel more than 50 miles round trip between tl-ie-ir residence and the training site. In general, travel policies of the training institution will apply, or in the event no such policies eX4 st, Government Travel,Regulations will apply. I\lo allowance can be made for transportation of dependents, or for shipment of household goods or personal effects. F. Per Diem Alloivance: An allowance of $16 per day may be paid to participants in training conferences and seminars and in short-term training programs (see schedule) who must travel more than 50 miles round trip between their place of residence and the training site. G. Supplementation: As used in all Public Health Service policy statements and procedural guides dealing with training stipends, the term "supplementation" means the provision of funds by a grantee to a trainee in addition to his grant-supported stipend, in a combination which then exceeds established Public Health Service stipend ceilings. Trainees in full-time, long-and short-term programs funded by the Division of Regional @ledical Program are required to devote their entire professional effort in the pursuit of the training objectives. 'Ihe source of funds for supplementation must be non-Federal. S@",CTIO@ l@c-- s,@ H. Schedule of Stipends: Grant funds used for the payment of -;tipends and related benefits to eligible persons undertaking an edtication-or trainin(T actility approved as ec-d the foliating part of a Regional Nk-dical Program grant may not exco schedule: Dependency Per StiT)end Allmvance Diem TraiTel e ior Year Day 'I. Training Conferences & Sela- None None one inars II. Short-term Trainina C, 1. Post high scli861 $10 None Yes Yes 2. Baccalaur6at6" $20 None Yes Yes 3. Graduate $30 None Yes Yes 4. Post doctoral $50 None Yesi Yes III. Long-term Training2 1. Post high school $1500 - Yes No Yes 2. Baccalaureate $2400 Yes No Yes 3. Graduate a. Cfirst post-baccal- aureate ),ear) $2400 Yes No Yes b. (years between first and terminal year) $2600 Yes No Yes c. (terminal year) $2800 Yes No Yes 4. Post doctoral a. Board creditable Yes No Yes b. Special Yes No Yes Per Diem can be paid in lieu of (not in addition to) a stipend. 2 The following DIIEIV stipend policy is applicable,: "The purpose of the the student support is to provide for a level sufficient to enable the- student to continue his studies without delaying the attainment of the degree or causing him to seek outside sources.of financial aid." 3Stipend may be negotiated on the basis of trainee's education, experience and current salary level, and then must be approved by the Division of Regional @ledical Programs. F i 1 tj@ El@;-7 T SECTIO'L@ IT@' of ',t,-,ve @c-c-ircC- clc.,,ir ii.-Iicy @l t c rCL",@:-act tc, tlio rc@y-i-@crt cf Jr ?!@Ce OF to Z!s "ir C to t C;i t'n -i err,, S. a t Ci., 7j.u. 0 rZ F., to -ire ti-,,& t ii<@@ t-,c. -L n c r r 'L L-'t I coF@- - 0j. coiiit no r:ay t r a, I J,- 1.1-tS i 4 iol t--C.] JC C" 2c-z7lA,.-q i:,-ly 1)(@ ti t C O:-,- In C)f Po"-.,2e, @,v t'-,c or a c,@,,:t rf -o@' f -LscLil it to I-,-'7 @lor a But, o-.,i tlic. ior :Lf i of -!Cj I,-.,cal ti o' to a or for pn,, lir,til a is Oi I 0 @l I rliii:t to coiit@.-,tto. t,'Ic stibjc -c--t to i:-y you T _)N IV REPLACE Cl-iaDter III, Section VII. Financial Iv@a,@ement, Allowable Direct osts, B. Consultant Services (page 14) with: B. Consultant Services Regional Medical Program grant funds may be used to pay consultant fees and supporting costs such as tratel and per diemin payn, ent for services related to any program element of a Regional @ledical Program. Cofisulta,-its may be selected from both within and outside the grantee or affiliated organization, providing that these services are the most effective means of accomplishing a particular,,purpose. It is expecte@ that grantee organizations will normally have their own policies with respect to use of con- sultant se@ices,' that those policies will apply equally to the use@of consultants paid for by grant funds and that they will include, as a minimum, the standards for documentation described below. However, in the absence of such policies, the following documentation in support of the use of consultants must be provided: the services to be performed and A statement ol- evidence that they cannot be provided by payment of direct salaries to staff members of the grantee or an affiliated institution; A brief description of the process of selection of the individuals most qualified to provide the re quired services; Evidence that the fee is appropriate considering the qualifications of the individmls, the nature of the services performed, and the amount normally paid for such services from sources other than Regional Medical Programs. As a general rule,,v,,hen services of a salaried staff member of the grantee@or-an affiliated institution are to be provided fulltime for periods of two weeks or more, or on a regularly occurring basis through- out the year, the individual should be compensated on a part-time salary basis rather than as consultation. Grant funds may not be usedto pay fees and supporting costs to U.S. Government employees regardless of their employment or pay status. ... Addendum to Revised Gui@lines, 2/70, Pg 3 N,.ITE: See N-ID 10-13-70. NOTE: Reference to Program Management (Personnel Practices) @iEY,,T sr@cIrIL01V TV Direct (,osts Not Allo@,ect-'I'Ilc follo@vin, cli.-ect costs oi- cliai-(,res are IIOL allowable: (1) flor)oi-,ii-ia is distiii(,-tiislied from con- sultant fees (2) Entertainment (cost of tiiitiseiiicnt, social -,ictivit;@..--s, entertainment itici(iciit,,.tl costs thereto, sucli -.is meals, lod-,ii,,, rentals, traiisj)orta- tioii and -,i-attiities) (3) P;iN.iileiit to Fe(lei-al eml)lo),ecs (4) Pett)- cisli funds (5) Sti@grantin(r (a stil)gr-,ttit is an,,. tlloca- r) tiozi of grant funds by the (,i-aiitee to otlier iiidi- N,i(Itials or or-aiiiz-.ttions for 1)tti-1)()scs on,ei- i@,liicli A tl)e C,'T;IIILCC IIIStItLItioti niniecl on the al)l)lic@itioii (lo,,s not maintain ,cietitific an(I Financial i-Lsl)oiisi- b;lit),. A gi-.ititee may cotitrict for sei-N-iccs. but iiity not ;tii)gi-aiit) ... @PTZR III, REVISED GUIDELINES, Pg 16 A. of shor--ten-- r,,,, t-,, the ir, the ria@ter of @l,? Kronor, Colincil considered th 1.10'V i-d--d. 'c @', i and a nLL-rLer oP s?Dec,@"@ic pro-c, i c@@s -ao -,@cati@-, T- -)C, P-l .3 e T-, rev@Lei-,, at 'his .rieet-'u @. Tr,-jey be[ -e@re t_a-L, U,- -;,OS' u c @. c -L l,Ti sar c e s-it is not necessary or ao ropr:,.a'ue T\Ied)lcal Pro@aLris grart - @ p -L Or, -Lurids to be used to cover the full-cos@L's 0 LI-l the pi-esei-i,-,a-Lio'n of s, or'L-, - L@ e,- i@, r a i projects arid O' s-iperds and expei-@es oL- 'Llbe ants. LI T'i-ie @-jority of p--@ojec-us in this catet7oiy pi7ovi -de or)POrt'@-iities for up@ F.radinR_: and develo,@Tpent c)-.r nevT Skills n special teci-,n4Loues or procedures and are directed individuals presently e,-iiployerd in health care, institutions. Urde--r s ances these LI tl,-,e circu-,n t institutions should, and ;n ii-ost cases do, @-e regular provisi'on-for th-is kind oi- training for their staffs. I 7rie Caonc4-l there I-ore reto,=L, e@-ja the f ollow4-no., chances 1 n policy @d defines ents to articipan-,s in co@,inuin, education P. I C) nircr projects (as ae-*'ined -Ln"-Uhe Guidelines Adderdum, February and tra-L 1970., page 13) which are sunDorted by Regional @ledical @ogram grant funds. Regional Medcal P--ogr@l grant @ds- rray not be used for the Pa -,@nt. Of stipends, either di-rec,"Uly -or on the 11,@',@ue.@ce of @i,,Ic@ple'll -0 part ncore P- ui u C. ants in shor--tem, continuer, p education and L'raini@o- projec-'Us. Th-;_s does not include training new c eers for new types -of health Personnel. O@her allowable costs ol participants sun _port may be calcula-L@led according to the ex4Lsting Guidelines. Regional Medical u LI @@IL, fari'ds.m@7 be requested and a:viarded for per them and a-,m tra@el to 'Vhe extent of 50% of the total Around. so derived. @,e avia-rded funds Fiay then be paid to.the enrolled trainees as considered appropriate.by the project -oersoiin@@l, de-o@ndi,-ao- on the participants c; ability -c provide these costs for themselves and/or -the willingness of their ei@mloyers to provide IL-,hem. iio single individual may receive per diem or travel allowance at a rate higher than that prescribed by the nresent Guidelines. "c.'iP funds Tray not be rebudge-ed, frc),-@l within or without the L ,o-r,ojecL@ budget, to increase the total amount awarded for per them and travel above the 50% level. ...jul' y 28-29, 1970 C.ouncil Minutes -NOTE: See wording of exerpts printed in NID 10-13-70. Cross-reference to Eligible Attivities (Manpoi.;er and Training) -------------- l@@r@ C T A C-'o ]IC i.oll xL t @iu-"@7 4- C;@ L Council backg-T@i--qd for tile L jic,,@r poli@, -regarding tile LLse of gra,-it Eui(2'S for trainee stipends.- t'In tl-..e matter of FOIP sup,@ort of sho--r-@@-ter.-ii 'training project--,, the Co,,mcil considered the history p-roi,,ided 'D@' -staff, and a i-iu.,TL)er al' specific projects. 'lliev belie@:--e 'Li-,at I,r.,)s -LI ci--,-CU,@tarices it is not i-ieccssai-@, or I"c,,,Tio-ii.al @cal P3-ogruiG grant to be used to COAT-R the full costs of both P---esf-,rita-IL- i-on. of short-t,--ii-P, ,q4 tr A-,iing pTo-ccts and the costs of stip@-,i-id-@ qn-(a' expenses of the participants. Ilie majority of projects i-n this ca.tonoi-y provide o7ppor- tu-iities for i-,T,)gradiiig ind development of new skills in special tediniqu-,as or procodi-ires, and are directed to iiicli.ATi,Ouals pr--seritl.v en)loycd in, health care institutions. tki(Jer the circu-,,-,,-@E6icos these institutions should, ljid in most c@es -do, i,,-toke re.,F@i-ar provisio,-i for this kind of training for their staffs. 'nie Council considered the present.Guiclelines regarding P,e-gional Medical Progra,-n funding of projects of long-tern@ post-do--+.-oral traininc-, it -die senior resident and post- resident levels., particularly in the clinical si,,b- spdcialties of iiim, ortance in patient management in the diseases tarbeted bv Regional I,,iedi-cal Programs. As has, bee,-i pointed out by botJi tlic- Revi-r-iv Committee and the Council, requests for sLq,)Port for training of this kind a-re appearing more and more frequently in Regional Medical Programs applications; because of the increasingly critical shortage of individuals trained in these fields, but also because of the drastic reduction in NIII fundi-ng which has previously been available for this purpose. 'nie Council tLrianiiiiotL-,Iy acrces on tl-ie i=ortance of maintaining the training programs in these fields in the major teaching centers throughout the nation. They also agree that ftmding through IZeg@onal @ledical Programs would serve to strengthen -the essential involvement of these centers of clinical excellence into the framework of cooperative arrangements which form tl-ie basis of the Region of ivhicii they are a part. It is rec,ognized, however, that the allocation of an amount of funds large enough to make a significant impact, if provided from the present @IP appropriation, would create a seri.ous and inappropriate imbalance in the PZT effort to meet their more varied and (tiORE) JL.V L LIL O(, "L'Il "I ... NID 10-13-70 ..NOTE: Reference to Eligible Activities (Training). 'R T t@ 1 V t IlayT,-,ei).I. of stil),@, ids amid costs Those cha,.iges. a2venci the Exi),ii-ided Statement of Edtication -.Md Training Guidelines for Re@2ioTial @@,le&-cal Progra;@,s @d t 1968 and 1970, oi-i pd,-Yes S-12, an' pl@lisi@ CL relate speci icn-rjy to items C, D, E, F, and H of Section IV. The changes be effective in 7r..k,,qrds relate on the basis of @il-1 nei@, and rep-ei@al appli@dtio.-is s,,).bfliitted on or a L@e-r Fel)r-Lr-i-ry 1 1971. In connection ivi-th short-ter-,i training projects . . . Grant funds may not I)e used for the payment of stipends, ei er directly or on this "maintenance of income principle," to participants in short-term continuiiip- education --Tid t-ra iiuic3 PrO3Cc-Ls. raininf nc-iv types of health perso-@uic. Other :illDi-iable costs'-,of support of participants may be calc-L;I.ated according to the existin2 Giiidelines. Grant fLmds may be requested and aiva-r@ or per cent of the total amount b-udgetpd for per them and travel of the trainees. The Lq,,varded funds may then be paid to the enrolled trainees as considered appropriate by the project personnel, depending m the participants ability to provide these costs for themselves, and/or the willingness of their employers to provide them. No single individual may receive per them or travel -ribed by allowance at a rate higher than that presc the present Guidelines. Grant funds may not be rebudgeted, from witliin or without the project budg6t, to increase the total amomt awarded for per them and travel above the 50 per cent level. In connection with long-term training projects . . . Payment of stipends and dependency allmvances to partici- pants in lonR-term,,post-doctoral training may not be made from operational grant funds awarded under Section 904 of Title IX of the Public Health 6 Servi.ce Act. However, grant funds for the planning or conduct of such training and educational projects may be used for the payment of trainee travel as provided in the present Guidelines. ...NID 10-13-70 NOTE: Reference to Eligible Actitities (Training) SECTIO",.' !V (Allowal-le 1-1@'i -Ct COC;LS) I. Tuition and Fees: Tuition and fees for training activities may be paid from grant funds providing no other charges for the cost of that trainina are C, C, made against the grant. llqien allowable, o-ilN, the same reside--it or non-resident tuition and fees char re -rolled non-Fe&-rally ,e d to gularl), cr, supported students may be charged for trainees. Tuition and fees for courses which satisfy requirements related exclusively to the M.D., D.D.S., D.O., D.V.M., or similar degrees may not be charged to a grant. lVhen the courses are creditable to satisfying P'ii.D. requirements in combination with any of the aforementioned degree, -requirements, however, tuition and fees may be charged for those courses within the combined degree program that are required specifically for the attainment of the Ph.D. degree. The training must be relevant to the purposes of the grant. (I d e n d i i z,7. tl,e -v I @-;c, d @'u i dI L n i@ s , 'ihe Council has reconrendedapolicy which precludes the use of I:UYIP funds for basic training in certain established allied health fields, including nuclear medicine technology (see Section X A2 of @,@ute s ... Aiigist 26-Z'7, 1969 Couticil Minutes r T @'A 1 G E @'@:7 @ECTICI,\' I@,@ (Dirc-ct Costs ',N'of- i%llowed) Rc,ijrj)t.,I-@@c@n2nt for -Lnl riti,,cr .,c-la-Leci --cists for Federal c,. ovces k . 7 - - ii--@ @ 3c Li - -r iis coiisul,tai-.,Ts to on L.'@-cal l-@rog ariL@ . . . 'fliis change aa,.i--nds the C,,a:'(Ieliries -regarding the use of L grant f-uncL,; for direct costs of consuitL,,jiz scn,ices as it currently appears in the Adcl--ndix-n-(3,lii-deliEes is3tied iii Fcb-ruaiy 1970, p,-ige 3@ so that . . . e- SWPO@T4--ODsts s ioftrI w4. @-on for their participation in the planning or conduct of Regional @lic,,dical Progran, activities. 'niis change is made to proi:iote the cooperation and participation of I.ocal Fed,--ral Goveliment agencies in P,,-,gi&.al I\iedical Ilrograms in instances where an indi,id.dtAl agency cannot provide for this expense. NOTE: Reference to Pro-ram l@'@-nagemonL. (FolloWilIg 4S a statement dtd 6-25-70 frorti G@IB regarding reimbursement of costs incurred by Federal employees participating in training activities: 1. A ca-@l?,@ot I)aid to a ac@.mncy. 2. dic!-.i L-.@e pai@. to E., Fc-,(It-i-al 1-trovic,!i)@g he elcc'L-s not to receive, do,-4s iiot C(li)CL.,ri, ii-L, Ti-avc@l costs b,2 R-,id a Fc@Oeral El@]@'ricy c@o-@-S ll,,)t travcl Cos 4L-,s ILA.Nti 'ENT SECIL"IOINT IV (Direct Costs Not Allowed) Consultant Services: Ltr, dated 10-1@0-70, from Pro-ram Coordinator, Tennessee @iid-Soutti R,'T, permission to use grant funds to reimburse members of their RAG at $100 per day of attendance at regular l@',@G meetings. Ltr, dated 11-12-70, signed by the Acting Director, Harold @Mar,-,ulies, M.D., to Dr. Paul E. Tesclian in.response states: ... we liz,.ve adv,'---ed tl-@c various RI-,T-, th,,it of- cclit,-.t;ltant fees or other rc@mtircrat-4,on@ to itliC siou'tc! 'De avoided. it is felt that such service should be freely offered in the spirit of- a Voluntary contribution to the coTmiti-nitv and region which are being serxyed. 'It is ent4@r appropriate, for example, to reimburse members .Lor travel expe-,iscs either on a per diem, actual and necessary, or a mileage basis when such costs are incurred. I would be remiss if I failed to point out that on occasion there have been exceptions to the ab.ove stated policy, iqhen consultant's funds were earmarked for salary reimbursement to nonprofessional members of the P@iC who sustained a loss of'@alai-v due to the absentee from their place of employment. Weedonbt feel, howev6r, ,-hat this exception should be extended to professional personnel...". L@ORTH DA!-,OTA REGIOITAL L@ICAL PRg,'F,@M -al of core Approval in the t:L-e 8/69.1 - L-@Lial or q 1 and renew ,eration- and ainow-its a-rid .,with @,he cor@l the site visitors and the Review Co,-ani@.tee; and with the added contingency that no funds budgeted for "in-State Consultants" bep--.id to mergers of the -her Co@ttees for their se,-vices as Planning Co@ttee and oL, members of those groups. AuL@u@t 26-27, 1969 Council Minutes -'P'TIOT@ 'T-V octol@,er 16, 19J'O MI-00046 I--!r G. Fiscal 0.@L.'L:,'-ccr Pro,-,rar-, 9')8 Peichl-rce test Atlanta, Ccc,r.-i-a 303C)@l, Dear @i'r. P,4-ams: P.,e@ion-i'L Service. li I r, Po. Cy provides t 1 i a t'd s-.,a r Lid from a Re-i6nal rrograri r,rLnt i--ot I)e users for of si--ipcnu's and is -Pt: liberty to Dr. P@'r'sor-s for ttit ttic fuT,-,:.s 7re r.,ct fro@ I-,y T@'e-ioiial ',ed-@Ical Pr,@--ra;-s SC--vice or the of '.'.c-all:h. Sincerel@, yours, @L'-: LHPullen:k-ef IU,T..Orant -wile DP'ID File Mr. Gilmer La-@ire-nce IT@. Pullen Mrs. Silsbee - lap -r Crants 1 t O@Lfic(- lir. Pullen Crar4ts 'rianagenicut Brirc!i Board/File ltidit-(@cr Costs-Iii(lirc(-t costs i,elztt(,cl to tll(, (,Oil- ('ILICL Of Elie I-',Ctyioiiiii I-eilil- btii,,,c,ii)lc. To be foi- tii indirect cost I)I.ol)oSll must be (]ex.elol)ecl bN. tile pei-fo)-iiiiri(,- institution in cotifoi-iiiit), x%-itli its est,iblislic(i tccoiiiitiii,, ,.N,.steii) and submitted to tile DiN,isioii of Regional l'i-ogi-aiiis. Tile I)ro- I)OSill 11111',L- ideiitif@. those tdniiiii!,ti-.ttix-c sci-N,ices I)i,oN-i(le(i to die tll(' ill,@titLItion's I ) eit) LI IC costs oi , t II e @lll(,L t II c I)ztsis or iiietlio(Is lot- :11)1)01-tiOllill('- tIlOSe (:OSLS to tile Itec)-ioiiil infedicil ti III(! otlier activities of the institution. A iien%, 1)rol)osil must be !,tibmitte(I at the end of each fisctl year. The Department of Heiltli, Education, and I\'elfare has published sel)@tr@tte gLiicies for estal)- lisliing indirect cost rates applicable to educational institutions, hospitals, Stite and local co,,,ci-nment aaencies, iii(i otlier jiozi-I)i-oFit institutions which i)i-ox-i(16 (Guidelines ii-id criteria for the i(lentifica- tion of indirect costs reinibursl-ablc under research grants and contract, and for apportionment of a(Iministi-itti\,e costs to the mtjor oper@iting activ- ities of Elie institution. The booklets contain cost pi-i ncil)les which (tcfiiie direct and indirect costs and 1)ro\,i(le information on the allo@vability of specific items of cost. They describe methods of cost al)l>ortioiiineiits and allocations, instructions on the development of indirect cost rates and sample indirect cost proposals. Although oriented primarily toxvard the research activity, the policies -rein are relevant to the and criteria contained the Regional Medical Program and should be used as a guide. institutions performing under Regional Medi- cal Program grants may also be the recipient of grants or contracts under Other Federal programs._ It is essential that consistent procedures for deter- mining rcimburseable costs for similar services be cml)lo),e(I without regard to program differences. @Addition,il information and assistance in-,i), be ob- tained from the Division of Region@il Medical Pro- grams, National InstiiLites of Health, Betliesd-.i, Maryland 20014. Tile Department of Health, Education, and IVelfare cost giiides may be ob- tained from the Government Printing Office, Nortli Capital betNvecn G ?, H Streets, N.NV., A@lasliington, D,C. 20402. ... CHAPTER III, REVISED GUIDELINES, Pg 16 (It,'DIPE-@T CO@-TS) c) v c r )Iicy called, cos'L, P, Div3.sion o'L 69 iri rec-ard to tlii s Rei@Crciicc d,@- to i-,y A-,;rll 2-c;, 1.9 z, r") r il!-, t-,, ra a o,-i 7, i,@ 0 - cost,-,, vo 'L-or -@es -: c@ D. C-1 iT.2i:e for yo,,ir To So not 1, cii ti-L-a T@-ni7,,,2ssce ..7:zs no"-. C' !SS -1@r x,,-Dt -ti-Y c@l.).c-i: c i? it i3 IIo,L-.,-, et t s,, -It "y 13 o-.- for ti.@!n las b2ci,. r c; c t c o E,,'L- 'Che hLis L,--tcli for it s c t r, L) 1: I-rC,,,-@ on 0 .;,I It:.- ACCor(:..'!I@] -!.s u-,--an',:Iy 1)@cr2 ecl ii, or Six\cc.. 11--I,3 rrcre,@c-nt li,-,.,3 I)ccn pro-@.-fLo@,.onal.ly to ti 1,@ t'-!-s in futvrc C-4@,,arc!s, as in C- Z;ory I e,, cc:- C-irint: File F I,%@ C T G, i T 11 c,, SUPPLBENT Chapter III, Section VII. Indirect Costs (page 16) with: I. Negotiation of Indirect Cost Rates f-dr Grantee Institutions A. The Division of Grants Administration Policy (MAP) - Department of Health, Education, and l@lelfare will establish -rates for each grantee institution which requests indirpct cost. B. These rates will be based on proposals submitted by the grantee institution as follows: 1. If the uantee is @e recipient of awards under other DI-DV progrps ;,ihich- reimburse indirect cost, it will submit a singlb annual submission to I)GAP proposing rates for all DI-IEIV pro@ranz.- A @ rate will be established at the time the rate(s) for the other program are negotiated. In most instances the MT rate will be identical to the Tate used for research and development awards. 2. If the grantee is not the recipient of awards under other 11@IV programs, it must submit a rate proposal for the RMP award together with supporting financial statements. This proposal will be requested by and submitted to the Grants @bnageinent Branch - Division of Regional Medical Programs which will review it for completeness and, if adequate, forward it to DGAP for processing. C. l@hen a rate has been established by DGAP, it will be incorporated in arate agreement and identified as being applicable to the R4P grants. D. The D@IP had established a number of rates for provisional use before the rate setting function w@ assumed by the DGAP. These rates will continue to be utilized until revised by DGAP in the normal course of business. E. The DPNIP will advise the DCAP immediately of any grantee institution under cate ory I.A. for which rates are required 9 but not now available. The D@IP will immediately procure proposals from those institutions' under category I.B. for which rates are required but not now available. F. If D@ makes an award to a new grantee which has an established -research rate with DGAP, it may, with the concurrence of the grantee institution, utilize the research -rate as a-provisional rate in the initial award in order to fund the grant. ...Addendum to Revised Guidelines, 2/70, Pg 21 - I - . II @- '@ -'@7 -",,-;-@ -. -'T 7 0 P 2 II. Negotiation of Indirect Costs for Affiliate InstitL)@-ions A. It will be the responsibility of the @rartee institution to establish indirect cost rates i@ith-itg affiliat d institutions. 'Aff-ilic.ted institutions generall), will not cor,--UTou-iicat-- directi), with the Division of Grants Administration Policy-EiiU.@ regarding the establishment of indirect cost rates for Regional I%Iedical Program grants. 'flee Division of Grants Administration Policy will provide technical advice to the grantee institution upon request. B@ Some grantee institutions do not now possess the resources to establish indirect cost rates with their affiliates. Such grantee institutions are expected to develop-the necessary resources. We-appreciate that these resources cannot be developed immediatel and-are amenable to an interim short term arrangement i,jhereby L@ will, upon request, and the condition that all parties are agreeable' establish rates with the affiliates on behalf of the grantee. D@T will advise DGO of such instances and the grantee will instruct the affiliate institution to forward its proposal and supporting financial statements'to the Grants Management Branci-i - Division of Regional Nledical Programs. - DRNU) will review the proposal for completeness and, if adequate, forward it to DRAP. DGAP ivfll conduct its negotiation directly with the affiliates. C. Some institutions participating in the Regional @ledical Program as affiliates are the direct recipients of grants or contracts under other 111-DV programs. In such situations DGAP will establish rates for the R@ grant ,vhen it establishes rates for the other program awards. It is understood tJiat this is an arrangement of administrative convenience for all parties involved. If the grantee institution desires to conduct direct negotiations with its affiliate, it may do so DGAP will be advised however, of the grantee's option, in order that the R@IP award may be considered in DGAP's negotiation for the other programs performed by the grantee institution. The Division of Grants Administration Polic y-DliBV has developed cost principles applicable to educational institutions,.hospitals, state and local goverment auencies and other non-profit institutions. 'flie following brochures a-re enclosed to assist you in developing the required indirect cost rate proposals: OASC - 1 A Guide for Educational Institutions OASC - 3 A Guide for hospitals OASC - 4 A Guide for State and Local Government Agencies OASC - 5 A Guide,for Non-profit Institutions SPIC@--ION IV Rebtt(]- i.iiic- of Funds-I'lie gi-.iiitee or institutions iN,Itli full knoN@,le(Ic@e and tpl)ro@,zil of the @-rtiiiee iiii)- (lep!ti,t frc)i-n the bLI(I@t and use ilic f@iii(is foi- otlici- items i-etluireci foi- the project, except the follo@vin- restrictions: -(I) GI-"lllt fall ilizIN- not be IISC(I foi- piirl)o.@ to the i-egiil@itioii@ and policies of the Di%-ision of Re-iotial i'\Ie(li(itl l'i-o<,i-aiiis or the gi--,iiiiec oi- the @iffiliate(I institutions. (2) Grant fui)cls may be transferred be- t%\,ecii btid-et categories \vitliin projects or ;IctlN,- itics only to the extent tliiit no subsLtriti,,il cli;tn-e in any sticli project is iiiicle by the ti-ansfei- (see changes in page 12) . Iiii(lqct changes beti%,ecn projects or otlier identified zict@iN,- ities liowe\,ei-, require i\,i-itten al)l)i@o@-al of the DiN,ision of Regional ivcclical RcbLidg- et Iincr sliould not be done x%,itliin the period be- tiveen stil)ii-iission of a confirmation il)l)licition and receipt of the aNviii-(I, -.in(I required special justification and i%,ritten al)l)ro@,al from the Di-,,i- siory of Reo-ional Aledical I)i-ogi,ams under excel)- tioiial circumstances. -II, REVISED GUIDELINES, Pg 17 CHAPTER .. 1. . ., ; ' I @ @i , 7 4 I . APPLIC.KTION FOR PROGPkAl Mc, TISION (,rZEBUL@ETING OF -M,,\TDS) Under the authority of the Recy-i-o@,ial i@ledical Pro gr,-.nis I.e@@i.s ition, a single grant, based officially -upon a sin(,Tle budloc-t, is 'to each P--gional Program. Although ,-hi.s 11-r,.insaccion is basccl upon the financial requirements of a 7co,@, Y@n,-mv I)ro,-ram components, each justified and ap-pro@,ed separately, its purpose is the -;uppor-L of a total Reaio,@ial ef.rOr-L. In attairiin(- operational status each Region accepts the obligation to eiraluate,the progress of each of the components and assess the total proaram they comprise. It al@b periodically roassignin,,a its available resources has the option o. in accordance ivi-L]i emergiii(, plans and priorities. At this crucial 4 time when tile amounts of,iei@ fi-iiid-L 1-1 (T -t-re uncertain and at least L- -LP. to understand teniporaril,., limited,.i4 is 1MPOrtant for the Proar, c- fully the @)i-6c@s'ol' rebudgetin@--both the opportunities it provides and its ljjnitations.- Based upon its own assessment a Regional @ledical Program may propose reallocation of its grant'resources among (1) the direction, planning, and professional service -tcti-vities of its central staff; (2) furidod operational projocts;-and (3) projects or staff activities which lic@.Ve' -,been approved by the @V'ationa'!L Advisory Council. Such reallocation requires T)rior approval of the Diiision of Regional @ledical Programs and is usually applied for as part of tile Type V (iion-com,)eting continuation) a- lication. Transfer of funds I-P between budget categories within component budaets may continue to 0 be made without prior approval but only to the extent that it makes no substantial change in the approved activity. -mds A Region may propose rebtidgeting of f committed for the continuation year and carryo,,;-er ot f-&,ds Lu-ie-p@ended in the vear ending. In applying o@r program revision a Region must fully under- -stand the provisions under which approval of its plans may be granted. The program components involved in the reallocation--tl-iose from which, as well as those into i@,iiich, the funds are to be transferred--may not be subs antially altered in their purposes, goals, or methodologies. A decision to discontinue a project, short of the time for which it was initially approved and for which funds were committed, must be explained. Rebudgeting of funds among projects may not serve to increase the general level of funding of tfie- entire program in the current or future years., (e.g. the size of a project staff may not be increased so that the annualized payroll is.in excess of the approved budget). ...NID 1-2-70 SECTIOI,L !V (PITJ'-CliAS@ OF @,lajor In-kTestmerits ill l@laclical Equipiien+ "The Council agreed that, in order to be considered for final reconnic-iidation by it, ali applications iihich include requests for purchase of major items of fixed and Moveable therapeutic and diagnostic equipment must include.... A statement of the rationale for charaing any or all C, of purchase price of the equ'pn-ent to the grant, and of the justification for the proportioning of the shared costs among those involved in the purchase; A proposed plan for accounting and fiscal control of the revenues accruing to the project (see HI-,W Grants Administration'@klanual Issuance, Related Income); Adequate ev'ldenc4 that the project plan, including the acq4uir:r.,ik of the equipment, has been reviewed, and if necessaiT, approved b the appropriate local planning agencies.' February 20-21, 1969 Council Nlee.ting After re-studying the project, the Counc4l.further recont-..@nded that L the E/,T contribution to the acquisition of fixed equipire-it be limited i- L'o not more th@ half of the total equiiDment budget o' 'he facility; the portion befall roughly equivalent to the amunt of use ol' the equip for teac@o, and demonstration. Atigtist 26-27, 1969 Council Meet g *-TAlthough the Council persists in its Unwillingness to further specify its present policy guidelines on exDe@,iture of grant funds for equipment., there was general agreement that each of these tv@,o projects has as itS ID@iii-,ary objective the es@abl-'s@ffrent of a service facility for one institution and does not in---L@ude a satisfactory plan for teac@-, patient de@ponstratd:ons and/or exL-,-nsil-In o- services to a population not now well served. The Council recontme@,ided that in +,-he context of these projects the- purchase of equipment (and thereby the projects themselves) be disapproved. ... Agust 26--27, 1969 Council Meeting I\IOTE: Cross-reference to Program Management Eligil)le Activities 11 F. .@klteritio.,is iiid Reiioi-,itioii.@--'Fo tile ex- teilt ol!ici- source.,, of Feclei-;tl -iii(I ii(.)ii-Fe(icr-il ftiil(l.s iii-c not ai-ail;ti)lc t@) the al)plicint fol- sticli purpose"" iiiiietn- Pei.(:Cllt of the Cost', of construction, i.e., @iltei-,ition, i-eniocleliii,-,- and i-ciio- N'.'Itioll Of CXiSLilill- ])Iiil(lil)gS illiti@ll eicltiij)iiieiit tliei-col) -.iii(I i-el)licemeiit of OI)So]eLe I)tiilt-iii e(litil-)iiieiit Of L11C@ C@,lbtOlll;ll-il)' in- clit(iccl iii t coii.,,Li-tictioii conti-,i(,t be 1),ii(i for 1)), oj)erition:tl grant fLiii(Is. The tl)l)licant is i-@- quireci to fuii-iisli a iiar'ratii,e description to indicate the ii@e(l, IliLtLire 1)tii-I)ose of the @tltel-- -itions - in- tji(I renovations, iii stances, (retail ilie I)Iitiis and specifications. -I'lic amount of the alteration and reiio\,atioii costs OF reqtiestcd is part of a Di\,isioii of l@egioiial Nlcdi- c.-il Proi,,i-,ii-ns @-i-,-int deteriiiincs the t@.pes of sul)- I)or@ing (lociiiiieiits to be stil)niitte(I by the ;11)1)li- ,cant. Aj)j)licants -ire referred to tile i)roccdui-es ind regulations set foi,Lli iii the "Regional I\le(li(-al Pi'@-raiiis-Altei-,itions tti(I Reno\-.itioiis Gtz'cle," -t@-,tilableonreqticst. CIIAPTER 111, @-viseri GLIIDE;"INv. ADD. See Chapter III, Section VII. Finai-icial Management, Part F (page 15): REGIONAL @EDICAI; PROGRAMS ALTERATIOIN AND RENOVATION GUIDE* (SUPPL 2) ti&R Guide, dated 7-7-79. of v. a I)- .;i -no !)v n-c- c-,@l E3 C.-C! -III,' t,-IL@' 1". c-. CIA' C)":7. I.', J. 1. 0 3. bc- L"l E, 1:0 o Io L@ c-. F,'t -ki L) c@, z@, r C., v- 'a@ cc,- c- Fit. REVI.7 @AND APPROVAL PROCESS from letter to Members of the National Advisory Cotincil on-Regional @tedical, Programs, dated November 4, 1970, signed by Wilson, M.D., Administrator, HSMHA) Vernon E. T -e. c. "c-. I' 3 7 C, I.' p 0 rf' c t. r o,., i 17- I: O!- C, . ' L t C, c V -c, Lzk F!C)-L, t-.r@ t: ('o c c c 1.) c-- c 0 J. j- 'C, C V' ay,, tC,' . ... .. Ct o c@ ,t c t s c C.Cl jF ti ('Yi', -Y j@ C)'C-uES OF- G'@ZAJ@i AJP LI CA 71 1 O,,,T S o!l Fiscal Years 1971 and 197-1 Nokrc-i,.,d)er 2, 3.9-/O Vo-11 SOS 'I'Iiis issue Liplates the schc.-,i'.,Lile of IZeoional t-led-i-cai@Proaram application rexrici@ Cycles for the reri-,,aj-rder of Fiscal @'ear 1971. and the first h-alf.of Fiscal Year 1972. It should be noted. that . . . -iinc, Jul@ r@ -i, l@)70"' Regi.oiial @ledical Programs Begim Service inaugurated an anniversary review system, which prc,-k,-lde@ for Ifo-Lir re@i-c-v., cycles a year. Under this system, each Program will submit a single ai-LTiual: composite application into one of the rei,ieiv c),cles shoivn on Page, 2. Because this is a transition year, Programs whose anniversary dates are S--pteml)e'r 1, October 1, November 1, Dece.@Der 1, 1970, and janLi-ar)r 1 1971, may submit their continuation applications 45 days prior to their anniversary date. 'Fhese Programs will be permitted to submit separately, one addi- tional application package containing requests for developmental con-,oonent and/or supplemental and renewal projects in time for the earliest of the-deadlines that they can meet. I . @ .I .11 ."----, ii,' -f' I E O': A. Sclie(itile Al-)I-)Iic@.-tioiis to the DiN,isic,,ii of Reoionil c,ll at an)- time.. A (late ,set al.)I)roxiinatelv six iveelt-,S prior to C,@cli me@till(r of' the Rc,)Ioiiii MitLee is Set I!, [list 11.1)iit l'ol- (if ti-,I)Iicat; fOl- tlle ta'i-it nicctin,, There @ti-c tisti@iliN, l'oiir suc@li e';icli @@cai-. A c,ilencl,ii- of tl-,cL,,(, (lites aiicl the d,,ites of' ill ReN-ic@v ('01",Ilitt(-e "'(I Ile 'i\atioiicil AcIN,isoi-), Coiliicil iiieet-iiigs is ke,,)i (:tii-i-eiit for -,it least one I'Lill iii(I CliStril.)LItC(I to all coordinators. B. Ntiml)er of (.'oj)ies Al)l)liciiits ti-e re(itiesteci to stibillit tiveilt), COI)ies Of II) Zil)])Iicltloll. Stvle Al)l)liciiits should i(.Iopt a typographic style NA'IliC]l IVill I)el-llliL stal)linc, or bindiric, in a three- rin,g E-.icii 1).-ige should be suitti-)Ie for I)ho- -togi-@il@Iiic.i-cl)i,o(itiction. The iiii-rative slioti](I be t@l@Pti sill Icyl),tce@L.@- n6ci@ e Pg, 21 SUPPLET,@ Chapter IV, Section IV. Application Procedure (page 21) with: "As non-competing continuation applications (previously recommended support-type V) become more complex, an increasing amount of time is required for the staff of the Division of Regional lvledical Programs to adequately revieiv them. This fact, coupled iiith the need that Award Statements for such continuing support arrive prior to the scheduled starting date of the new grant period, now makes-.,the following policy necessary and effective immediately: Programs scheduled to start their next budget period on August 1, 1969 or thereafter, must submit their continuation applications to the Division at least 45 days in advance of that ew st rting date, athe-r than the 30 days presently required. Similarly, the Division will advance its schedule for contacting Regions regarding the submission of their I)Te V applications. .;.Addendum to Revised Guideli@es, 2/70, Pg 93 v Cl,,A!,,'J- A@PI)LIC;,,TlOi@S APPLICATIO,N' MR PROC@NI P,7-@@TSION OF Under the au'cliority.of the Pegio-@ial Programs legislation, a single grant, based officially upon a single budget, is Page to each P@gioi-ial @L-dical Program. Altliou&q tliis trc;,P-sa.ctio,-l is@based upon the financial requirements of- a great ipan-,- program coTTo,-.ents each justified and -ipp-roved separately, its pui-.)ose is -t-lie su-,) o-i-t I - p of a total P--gional effort. In attaining operational status eacli. Region accepts -the obligation to evaluate the pro'(7ress of each of the components and assess the total program +,Iaev ccmptise. It also has the option of periodically reassigning its available resources in accordance with emerging plans and priorities. At -this crucial -time when the apounts of fLtding are uncertain and at least temporarily limited, it is important for the Program to understand fully the process of rebudgeting--both the opportunities it pro-,rides and its limitations. Based upon dts'o@,n assessment a'Regional. Medical Program may propose reallocation-of its grant"'rcsources among (1) the direction, planning, and professional service activities of its central staff; (2) funded operational projects; and (3) projects or staff activities which have been approved by the National Advisory Council. Such reallocation requires T)rior approval of the Division of Regional @ledical Programs and is usually applied for as part of the Type V (non-conl)etifig continuation application. Transfer of funds betiveen budget categories within component budgets may continue to be made without prior approval but only to the extent that it makes no substantial change in the approved activity. A Region may propose -rebudZ-tinc, of funds committed for the continuation year and carryover of funds unexpended in the year ending. In applying ror-prograin revision a Fegion must fully under- d the provisions mder which approval of it's plans may be granted. stan The program components involved in the reallocation--those from which, as well as those into which, the funds are to be Tra-nsferred--may not be substantially altered in their purposes, c,,oals, or methodologies. A decision to discontinue a project, short of the time for 'which it was initially approved and for i@,hich funds were committed, must be explained. Rebudgeting of funds am6ng projects may not seive to increase the general level of funding of the entire program in the (Contd) ...Addendum to Revised Guidelines, 2/70, Pg I i @@c 1 in t@ s current or future years (e.g., the size of a project staf.41-- @/ not be increased so iJiat the annualized pz:,yroll is in excess of the approved 'Utido@.@t). Funds carried forward from a previous budE-t period ma@, be used for initiation or e-\-p,,-nsio-.q of projects or staff -activities which can be completed ivith;-n one The temporary increase in the level @- fundina createq @)Y the approval of ca-i-ryover fi-u-icls does not coi,,st-,.-Liite a coyro..l-Lin@en@@ to increa-@c- t'fi-@, 'level of funds for subsequent years. iN,,C.T-E: 'rmcls 1111- expended at tJie end of a p@?riod of sim, port (i'. c. the one, two, or three year -program -period) generally cannot L be carried forward. @, to the coi7r,)iexities of individual situations, hoivever, Regioi-is planning to request carryovey as part of Type II - competing @ne@@@,,il applications are advised to contact the Grants Nlanagement Brancli. APPLICATIOIN Applicatipn for program revision should, as often as possible, be made as part of -the regular Type V (non-coinpet4@ng continuation) application, whether the proposed revision is to be accomplished by rebudgeting or-by use of ca-r-ryo-k7er funds. Application for revision submitted at any other time will be considered under special circumstances and after direc@ discussion with the Division staff@ Each such application must be made utilizing the regular face page and budget pages (NIIi-925-i Rev. 5/66); with a budget for each of t'ne projects affected by the revision and a consolidated budget for the entire program. Under no cir tance-s will such requests be considered following the effective date of the final Report of Expenditures (NIH-925-3) which is due 120 days after the end of each budget period. If a project selected for initiation with rebudgeted funds was originally applied for and approved for more than one ),ear, the application must include not only a budget for that project but a statement explaining how it has been revised to be accomplished within that budget and within the one year, for which the request can be considered. Such applications should include a statement concerning proposed sources of support for proposed continuation of the activities. REVIEW lVhen adequately presented as part of a Type V application, the Division staff can review and act on such requests for revision in the usual time required for the Type V alone. However, if the staff concludes t]-iat the proposed reallocation will result in alterations either in individual grant components or in the nature of the applicant's total program, staff may defer action on the revision request and submit it to the National Advisory Council at its next regular meeting. This can be done without delaying processing of-the other elements of the Type V application. ,NOTE: See Financial Management Rebu@p,@ting of Funds Page o fill @icidicz-il Pro,,@,r,-iiiis to the D,'-vi-sion oA' I%'.eEioiizil Yod for Aduiiiiistrativc Chances in Amounts of Oti-Going Grants On Auotist 28, 1967, the Council approved th(-, following delegations of 0 authority to the Division staff to approve increases in amounts for active grants for the following purposes: (1) Institut-t'on-wide salary increases, social security and other mandatory employer contribution adjustments.., (2) Extension of grant period with additional funds, at a rate not to exceed the current rate of support, for a period not to exceed 6 months--in order to prevent hardship to personnel or loss of investment already made under 'the gra&L-, to provide additional time for preparation, review, and approvil-of a renewal Application, or to provide for orderly termination of the gr@t. Such extension would be reported to the Council. (3) Incr@ases of an administrat'ive nature which,do not represent an expansion of the program or chan-e in any significant manner the nature of the program, such as increased costs for equipment, personnel, travel, rental, and alterations and renovations. Such increases would be limited to 15 percent for any budget category and all increases would be reported to the Council. (4) Rebudgeting of allowable indirect costs to direct cost expenditures -in the indirect cost allowance (an increase- with an equivalent reduction in,direct costs only, not in total grant amount). In requesting such increases, grantees would have to include in their justification reasons why the increased costs could not be covered through rebudgeting within the current grant. Division of Regional Medical Programs August 28, 1967 -August 1968 Council extended the above authority for one year. In addition, authority is granted Division staff a program grant period for not longer than six months at the regions' current rate of support. NOTE: See exerpt from Minutes of Council 8/68 expanding authority. COUN'(,'j-L-DELI:CA@ AT.ITIIORITY TO ST,@F7,' OF -%,PS Dclca,,ition of Auttiorit bY National Advisory Council on Re$,,forinl y Medical Programs to tile Division of Yiedical Progrims Staff for Administrative Changes in Amounts of on-Going Grants On August 28, 1967, the Council approved the following delegations of' authority to the Division staff to approve increases in amounts for active grants for the following purposes: (1) Institution-wide salary increases, social security and other man4atory employer contribution adjustments,., (2) Extension of grant period with additional funds, at a rate not to exceed the current rate of support, for 'a period not to exceed 6 months--in order to prevent hardship to personnel or loss of investment already made under the gr@@, to provide additional time for preparation,, review, and approv.11-of a renewal Application, or to provide for orderly termination of the gran'@. Such extension would be reported to the Council. (3) Incr@ses of an administrative nature which,do not represent an expansion of the program or change in any significant manner the nature of the program, such as increased costs for equipment, personnel, travel, rental, and alterations and renovations. Such increases would be limited to 15 percent for any budget category and all increases would be reported to the Cour@cil. (4) Rebudgeting of allowable indirect costs to direct cost expenditures with an equivalent reduction -in the indirect cost allowance (an increase in direct costs only, not in total grant amount). In requesting such increases, grantees would have to include in their justification reasons why the increased costs could not be covered through rebudgeting within the current grant.. Division of Regional Medical Programs August 28, 1967 August 1968 Council extended the above authority for one year. In addition, authority is granted Division staff a program grant period for not longer than six months at the regions' current rate of support. NOTL@.: See exLrpL from t-"'Lnutes oL- 8 expar)(7iinE, aut,iorir-,. I T 'Et ST@-'j@l@ 01, X7". T, PR@@"-,S TO T@'r' D TTTfSlo@T o@ @A L i., D T- cl- L T@, -L 0 --- O'@ o i On At-,cust 28, 1967, the Council approved -,he d'ele,7ation of aLtho"ity' L to the Division staf'L to approve increases in amounts for -active gr -,'s for-four C-leneral purposes. The second o!'L.these-was.- 11(2) E7,te,-.sion of grant period with additional funds, at a rate not to exceed the current rate of @upport, for a period not to excec3 si:c mo.,-"- in order to prevent hardship to personnel or loss of investr-"-2n'L alrear1@7 i made under -the c-rant, to provide additional tire for preparat o:Z, rev--'----.- and approval of a renc-,7al appliccL'ion, or to pnovide for orderly at-,-o-i of-the gr@tnt. Such a.@tcnsion would be reported to the Council.",.. On August 27, 1968, Council approved the@furt-her use of this the follm,7inv, circL,-tistances: "In the case, of gr,@ts'wliich included 'c @" i-Lr.-@nts for a final bud,-a-. period of 12 full months btit @7hich were arbitrarily shortened (ard concomitantly reduced) by the Divisionts decision to extend cot-r@7.4tz-.en@s longer than 12 months beyond the life o@ P.L. 89-239 (Ju-,ie.30, 196@-) ... August 26-27, 1968 Council Meeting ST-,"@FF OF S' ,itl.()n I)y the 1,TitinTi,-il A(lv-t!-c)ry Critll)ctl to Lile Di@lftsioTi of nistrati.v(! Al)l)rovi3l of f.n Activities Under Approved Operational The following war, al-)pr(,ved by the t@litioiiql A(Ivi,3orv Council on Aitpt'it-,t 28, 1961, nq tl)c for 0(iTnLntstritive ,ict'l,oll by tite staff within specified II.TnitS without refer('Tlce to Council: Staff niiy approve requests for expansion of npproved activities, or initiation of activities ancillary to the Region,)l Ile(lical Ilrogranis -- up to 5 percent of the total direct cost owqr@@led for the current Budget period, but not greater thin $50,000 (plus 'indirL-.ct costs). Tli,-s irRitial Iiiiiit would apply whether it is reached in one or- more individual requests. Approval fo@ thii delegation of authority would be included in each Council:action recommending approval of an operational grant application. Requests must be approved by the Regional Advisory Oroup and should justify Iwhy the increased costs cannot be covered through rebudgeting within the current grant. Division of Regional Medical Programs August 28, 1967 August 1968 Council extended the above authority for one year.