re ' gional medica'l SPECIAL ISSUE programs service FOR LIMITED DISTRIBUTION iie-vvs 0 -1 ][I fo r r-n- at 0 11 *data A 4-oititviijtii(@iiijoll 41(.,iici. (I(.Si.,Ileql to silo-ell of, liquids, Iiill (liti@i (oil 'IFAc)T" RI:I'OIZ'I' fZo Regi.onal \Iedical Programs October 22, ]!)70 - Vol 4, No. 4 F).@ Reproduced in this issue is that section of- the @fA,(;,I"l IZCI)Ort of .July 8, 1970 which is concerned with Regional Medical Programs Service. FAST, an acronym for Federal Assistance Streamlining Task Force was a special Department of Health, I-I'ducation, andIWelfare group working under Frederic V. Malek, former Deputy LJnder Secretary. This group was assigned to study grant review procedures of various Depart-@ mental agencies and to make recommendations to streamline them by eliminating "red tape.lt The recommendations of this.report are currently being studied to see how they can best be implemented in accordance with the orders of the Department, the plans of I-lealtJi Ser-vi.ces and @lental. Ilealth @ Administration and Regional Medical Programs Service, and in the best int erests of the Regional Medical Ilrograns themselves. Distribution: Coordinators of Regional Medical Programs Members of National Advisory Council and Review Committee on Regional Medical I-IrogranLs Staff of Regional Medical Programs Service Regional Health Directors of Department of health, Education, and Welfare l@egional. Offices I-I.S. I)EPAII'1'31EN'I' ()F IIEAI,'I'lf, f,'I)(J(:A'I'ION, AN[) WEI.@'AIIP, ll,til)lii. ficiiflfi S(-rvi(-(, 0. Health St@rvittes an(i Mentitt flealth Afiministratiori 0 lto(!kvillf-, 2011.-v2 July 8, 1970 Reqional Medical Proqram The Regional Medical Program, administered by the Regional Medical Proaram Service (HSMHA-RMPS), provides grant support for organizations or groups of organizations or agencies es- tablished on a regional basis for combatting heart disease, cancer, stroke and related diseases in a defined geographical area, (RMP). There are presently 55 RMP's covering the entire .nation. (See map). An RMP generally includes a medical school, clinical research center and teaching hospital. Some RMP's are incorporated as sepa rate legal entities. others consist of confederations of cooperating groups wIith a medical society or a medical school serving as a fiscal agent. Each RMP is required to have a Regional Advisory Group (RAG) which usually functions like a board of directors and sometimes as a technical review group. The 55 RMP's were set up between 1966 and 1969 under the au- thority of PL 89-239, enacted in 1965. The law provides grant support for (a) organizing and establishing regional medical programs (planning grants), and (b) supporting research, demonstrations and training projects relating to the various disease,cateqbries (operational grants). All but one region are 'npw.."operational". Past@ge of PL 89-239 was stimulated by the report of the Commission on,Heart, Cancer and Stroke established earlier bv Congress "to recommend steps to reduce the,incidence of t@ese diseases" which account for over 70% of all deaths in the U.S. The.Commission was made up of a panel of medical .experts and distinguished citizens. The basic purpose of the legislation is to diffuse and di8- seminate rapidly expanding medical knowledge from the labq- tatories and educational institutions to practitioners for the benefits of their patients. ose Section 900,'Title IX of the Public Health.Service Act defines thO- goal of the Regional Medical Program (RMP) in detail-. "TITLE IX--EDUCATION, RESEARCH, TRAINING, AND DEMON- STRATIONS IN THE FIELDS OF HEART DISEASE, CANCER# STROKE, AND RELATED DISEASES" ,@- '. I "Purposes (a) Through grants, to encourage and assist in the establishment of regional cooperative arrangements among medical schools, research institutions, and hospitals for research and training (including con- .tinuing education) and for related demonstrations of patient care in the fields of heart disease, canc4p:rl, stroke, and related diseases; (b) To afford to the medical profession and the meoi- cal institutions of the Nation, through such cooperr ative arrangements, the opportunity of making available to their patients the latest advances in the diagnOS3'..5 and treatment of these diseases; and (c) By these means, to improve generally the heal@h manpower and facilities available to the Nation, anq to accomplish these ends without interferring with the patterns, or the methods of financing, or patient @are or professional practice, or with the admihis- tration of hospitals, and in cooperation with practice inq physicians, medical center officials, hospital 6@- ministrators, and representatives from appro ate voluntary health agencies._" The Surgeon General has appointed a National Advisory @pu on Regional Medical Programs to assist in the preparatio .p of regulations and to advise on policy matters concerning the administration of this Title. The Council consists of Administrator of the Health Services and Mental Health Aqm@iii s- tration and 15 members who are leaders in the fields of t@6 fundamental sciences, the medical sciences and public affa@rs, It should be noted that review and approval of the 55 RE!q'lOpa edical Programs is not a matter of periodic compptitior@"amgzlg . ligible applicants which results in the full funding Regional Medical Programs and no fundin@ of others. it is rather a continuing assessment of the progress with which each individual Regional Medical Program is carrying out-thp purposes of the legislation. The law authorized Regional Medical Programs for three years. In 1968, Congress ektended the authorization for two more years. 3 Fiscal year ending: Appropriatio n: 6/30/66 $24,000,000 6/30/67 43,000,000 6/30/68 53,900,000 6/30/69 56,200,QOO 6/30/70 93,600,000 There is no apparent national strategy for carrying out the program. The RMP's initiate projects and submit applications to the Government for review. Reviews are carried out on a project-by-project basis. Statistics for approved projects by disease category-and type of activity are as follows: Total Number Current Percent Disease- Activities Funding of total (t ousan s) Heart 168 $14,872.8 28.0,. Cancer 86 6,978.2 13.0 Stroke 56 6,320.8 12.0 Other 56 5,647.0 11.0 Number Total Percent Activity Emphasis Activities Fundinq of.total (thousands) Education & Training 330 28,106.8 53.0 Demonstration of Care 161 18,990.6 .36.0 Research & Development 59 6,091.2 11.0 (Core staff activities support $40 million). Examples of the types of projects funded under PL 89-239 in- clude: cancer registries, mobile,coronary care, training in coronary care, and bioinstrumentation.. The number of projects per RMP varies from 3 to 27 averaging about 10. For obvious reasons the regions which were es- tablished first generally have more operational projects thap latero There is.also considerable variation in project emphasis from region-to-region. one region for example is predominantly.involved in projects relating to instrumentation and electronic hardware. Some are involved primarily in projects relating.to heart disease. 4 by the Regional Medical Program PL 89-239 is administered .ces and Mental Health Ad- Service, a unit of the Health Servi . this onfusion,. referred to in ministration. (To avoid c the abbreviation RMP used report as HSMHA-RmpS as opposed to to designate grantees). EliqiblE t sities, medical schools, public Or nonprofit private univer . ate research institutions and other public or onprofit priv are eligible to apply for a grant agencies and institutions Medical Program, Each appli- to plan and/or operate a Regional ent the agencies and insti- cant must be authorized to repres and de- cooperate in planning for tutions which propose to ical Program. Additionally, each velopina the Regional 14ed coordination and v must be able to exercise program a?plicant onsibility. fiscal resp Th ional Advisory Group must have designated a specifies that each applican@ im in planning and The Act advise h i Advisory Group (RAG) to cifies that the Regiona The Act also spe operational operating the Program. ove an application for any Advisory Group must appr s practicing phys grant. The Advisory Group include dministrators, representa- ;ed-ical center officials hospital a s, and agencies, ..and @ tions, institution f other organiza he services tives 0 iar with the need for t members of the public famil provided under the Program., all advice and gui- cup provides over the planning and The Regional Advisory Gr to the Regional Medical Program in itial stens onward- dance s of the program from the in E,- operating phase lopment of the regional I- is actively involved in the deve nce, and coordinated t as well as the review, guida objectives, . .ng planning and operating functions. evaluation of the ongol Prese t Program e Act, broadly r resentative groups. Since the signinq of th onduct Re dical Proqrams have organized themselves to c which they themselves hav in 55 regions encompass the Nation's -population. these regions first received lanning rants (Section 903). The 55 regions on of the proposed Each award was based on a narr mographic and descriptive data ,on including appropriate de 5 supporting the preliminary delineation of the region, back- ground and history of the proposed organizational structure and how it will function, the nature of the Reqional Advisory Group and how it was selected and a description of how the Flanning activities will contribute to the goal of that Medical Proqram. of the 55 Regional Medical Programs, all but one have since achieved operational status (Section 904). @e A Regional Medical Program is made up of a number of components. The eferred to as the Program core. It provi the Program staff activities. including program direction and coordination of planning, and professional services to the institutions, agencies, and individuals that cooperate to make up a Regional Medical Program. The core component is identified by a separate budget line item. The other grant components are generally referred to as Qroiects. The activities they support are individually des- 'cribed in Regional Medical Program applications and each has a separate budget. These activities are conducted and ad- ministered in much the same way as any project grant. Their.. individual objectives are time limited (usually from one to three and occasionally five years) and they are undertaken as an adjunct activity of an institution or agency whose person- nel and facilities they usually share. It is important to note, however, that the projects which make up a Reqional Medical Proqram Grant have goals and objectives w ich are re- a ed to the goals and objectives of the total Program Grant. The planning activities initially funded under the provisions of section 903 may be continued and expanded as integral part of the operational activities. Applications for initial operational grants (Type I--New) undergo a rather thorough review at the Regional Medical Program Grant level. Most of the 55 regions have in addition to their statutory Regional Advisory Group, a series of cate- gorical and other planning and review committees to assist with the review of operational project proposals. These co,,,- mittees review and evaluate proposed projects and activities 6 for their technical or substantive merit prior to final action by the Regional Advisory Group. Only those favorably recom- mended or approved by the RAG may be included in the Regional Medical Program grant application to the Public Health Service (RMPS). -Federal Review Upon receipt of the application by the HSMHA Regional Medical Programs Service all project components contained in the grant application are subjected to a series of HSMHA Regional Medi- cal Programs Service staff comments and then evaluated by a technical review panel and the Public Health Service Reqional Medical Proqrarn Review Committe (an Advisory Committee com- osed of non-Fede Review Committee meetings ate scheduled regularly to review and evaluate the professional aspects of all 55 Regional Medical Program applications. They consider reports of Public Health Service staff, outside re- viewers and site visit teams and recommend time and amount of support to the National Advisory Council for its consideration at a subsequent meeting. The Review Committee and Advisory Council members participate in site visits to RMP. The final review of applications is by the National Advisory Coun dical Proqrams. The Counci h@e d f: the Review Committee in- cluding the full array of material assembled during the entire review process. The Council s final recommendation, required by statute before a grant can be awarded, concerns the ap- plication as a whole and includes a recommendation of an overall grant amount. Awards After the Council's recommendations are made, the HSMHA Regional Medical Programs Service staff informs the applicant and re- lates the Council's concerns and recommendations in detail. If the recommended amount has been reduced below the amount requested for those projects or activities not specifically disapproved,.the applicant must return to its own decision- making group (Regional Advisory Group), which reassesses pri- orities, and submits a revised budget to HSMHA Regional Medi- cal Programs Service showing a redistribution of the recommended amount among the.approv6d projects or component activities. it is on the basis of this resubmitted budget with the projects it covers that an award is made for the program. 7 of three@years, grant is made for a "program period it of 12-months .each. A single "budget periods no' may ap- which is made up Of iioperational 'On lemental) Having received such a grant, an -supp pi at any time for additional fun Ing ones. These toyinitiate new components or to expand s as described applications go through the same review proce! roup and . ning with the Regional Advisory G previously, begin he National Advisory counc il- with final action recommended by t dll Continuat,ioonn ications: At the end of each "budget perio A Regional Medical Programs Service f each progr ontinuation award (Type V)- staff eview precedes funding of a c am period" of bns: At the end of the "progr al grant, the entire ram Of the app ponents added by SUPPlemental. dine all com es the com- of their budget periods) undergo d staff, as for a new application. 'des for a re it of this review provi ort of the RMP (Type II) and as such renews, extends the program period--with the in, tially the same but purposes remain a essen omponents changing from time to time. with the c I'catiohs and renewal operational project app I In summary, new are generally reviewed as follows: G Review 1) Appj'cation submitted to RMP- technical panel. view by RMp staff and RMP 2) Re for information. 3) Copy,of application to 314(b) agency w committee. view by RMP tevie 4) Re 5) Review and approved by RAG. Federal Review to IISMHA-RMPS. 6) Submitted hni- 7) Grants review branch (GRB) soliIcits management and tec view from RMPS staff. cal re 8) GRB submits package to Technical Review Branch. 8 Committee (site 9) Recommendations submitted to RMP Review visit, if necessary). 10) Review Committee recommendations submitted to National Advisory Council on RMP. 11) NACRMP recommendations submitted to Director, RMPS. 12) Director, RMPS, office negotiates approvals to RMP. 13) Director, RMPS, office issues awards. The findings and recommendations address themselves to the following issues: A) Program review at the Federal level. B) Project review at the RMP level. C) Policy and procedures documents. D) Application forms. E) taff of Core s the RMP. F) Periodic reporting procedures. G) Role of HEW Regional Office. endings The review process has been a source of concern to HSMHA-RMPS. A consultant was hired and served for a year as a member of the staff. During 1968-69, he conducted a study for HSMHA@RMPS titled."The Review Process for Regional Medical Programs". This report states that: "In the spring of 1968, only 13 of the 54 regional programs had progressed from the planning to the oper- ational stage. In the spring of 1969, when the total number o programs had risen to 55, 44 of them were operational. Starting with the April-May 1968 review cycle, the volume of applications for grants began to escalate sharply. Primarily, ap lications for initial oper- ational qrar r Vol 1 n. 9 Regions have been allowed to request operational supplements in every review cycle or as often as four -I'--imes a year. Consequently" in the last two quarter- ly cycles of calendar 1968 and the first two cycles of 1969, the number of applications being presented to staff, Review Committee and National Advisory Council ranged between 45 to 75 applications from 35 to 45 regions in each cycle. In addition there were the usual number o@TFpe extensions for staff review. This process of coming of age strained the review process at both the Federal and the regional levels, in such a way as to make it a crucial subject for study. At the same time the rushing pace of events made it difficult -to get the proper perspective. Fundamental conditions which were the basis of recommended change were themselves being altered with frequency. The overwhelming volume of applications for review is -@robably most obvious when they are presented to the Review Committee. At the j4nvary T969 committee there were 55 applications from 36 re ion§ and at the April 9 1969 committee there were 47 ap Tic6Ltions from 33 region$. p Tn each meeting the applications contained over 200 projects or proposals. In each session the Committee had to be divided into two panels, each of which re- viewed roughly one-half of the applications, represented by a stack of 'phone books' at each member's seat. Even augmented by some ad hoc members, each panel numbered only eight persons and a chairman, with the number dropping as low as five on the afternoon of the second da With a few exceptions, even the most complicated y applications were not considered by the entire Committee, Inevitably there were.diffpring interpretations of policy and other inconsistencies *n the two panels. At neither meeting did either panel learn precisely what action the other panel had taken prior to adjournment.'I The anniversary or annual review @ystem proposed by the Regional Medical Programs Service and announced to the RMP coordinators May 8, 1970, is a major step twQArd the reduction of freg c of ect review of each Regional Medical Program. Howeverf it does not reduce the annual wor%loa4 of the Regional Medical Program or the HSMHA Regional Me@ical P;ogram Service. There would still be more than 40Q project proposals per year plus a 6-month Federal review period for e4gh project. In a@ditiori, the RMP could apvlv for up tQ.lq% of the 4ward as 4 de- ypl6pmental component" to be used to fl4nql,projects during the period between annual Federal reviews. If the RMP does this, 10 however, it automatically would lose any discretionary use of carryover funds. Moreover,' the Regional Medical Program would submit a relatively large package of roject proposals only once each year and-thereby lose the op ty to fund projects when they are most timely. Project review by the Regional Medical Program is conducted ini;ost instances very;much like the Federal review. Peer experts and others participate in reviews-in-depth. Recommendations It is recommended that at anniversary or triennial review system be adopted in the following way: 1. Program Review at the Federal level be conducted trienni- r6gram Review Committee and National ally by Regional Medical P Advisory Council fbr'Reqional Medical Program to include in depth site visit. 2. Annual Continuation:Awards be made on the basis of the previously approved level.of funding for the total program. 3. Applications that involve-significant change in proqram direction or supplementary funds receive full Federal r-ev-iew by the HSMHA Regional Medical Programs Service for the pro- posed ram changes. i lid i licl Ili ,i(--nL fir i c p r f@, -)MI,IA-limils rc-,vj.(-@w sy.,it(,-iii for E)rC)Ipct application.,; ipbinitted key the 55 Regional Medical PrograiTis involves the- fLill-t:i.me. efforts of 20 headquarter staff plus the art-time p efforts of at least 20 HSMIIA-RMPS and other Federal staff. 'These may include the personnel of the Grants Review Branch, -Irants Management Branch and, as needed, Program Assistance Branch Continuing Education, Chronic Diseases, Systems Ahaly- sis, etc. Recommendations are then forwarded to the Review Committee an Council. The process for an application re- (juires about six months. (At least 400 projects are reviewed each year.) Recommendations Tt is recommended tliat: 1. RMPS-IISMIIA phase out project-by-project technical review. 2. RMPS-HSMHA develop criteria I)y Nov(@ml@)er 1, 1970 to permit each RMP to seek qualification as its own project review agency. 3. Application forms be revised to contain only elements necessary for review process. 1 2 Findings Regional Advisory Groups must review and act upon all opera- tional proposals. Only those favorably recommended or ap- proved may be included in the 55 Regions' grant requests to the HSMHA Regional Medical Programs Service. The fact that as of January 1970, slightly less than two- thirds of the proposed operational projects or activities presented to Regional Advisory Groups have been.approved by them--1021 out of a total of 1553--provides evidence that the technical and peer review procedure is being exercised in a critical, rather than mere rubber-stamp fashion. Most Regional Medical Programs have, in addition to their Regional Advisory Groups, a series of categorical and other planning and review committees to assist with the review of operational proposals. These committees generally review and evaluate proposed operational projects and activities for their technical or substantive merit prior to final action by the Regional Advisory Groups. Recommendations It is recommended that: 1. Project review and funding responsibility be decentralized directly to each Regional Medical Program as soon as it meets established criteria. 3 Findinqs The current guidelines for HSMHA Regional Medical Programs. Service policies and procedures used by the 55 Regional Medi- dequate. They are cumbersome, cal Program coordinators are ina complex and repetitive. For example, on page 5 of the Guide- lines dated May 1968, there is a functional statement for the RAG. This statement is repeated on page 8 of the same docu- ment, with only minor modifications The Addendum dated February 1970 is not presented in the same order as the origi- ets no clear statement of Departmental, nal., The coordinator g s and Mental Health Admin and,Regiopal Health Service . istration, Medical Programs Service policies and procedures from which t frequent communication to he can manage his program withou ice to seek elements of HSMHA Regional Medical Programs Sorv advice in these areas. In addition several of the RMPS have established their own guidelines which appear to vary as to the felt needs of the region as stated in the RMP progress summaries dated April 27, 1970. It is not known what consti- tuted the source material of these local guidelines. At the recently held Airlie House'Conference for the 55 Regional Medical Programs' Coordinators and Directors, several coordi- nators related experiences where the same question was answered differently by different elements of the HSMHA Regional Medical Programs Servide. While it is necessary for the Regional Medical Program coordi- nators to have fully detailed statements of instructions con- cerning the types of support permitted under the authority of Title IX, too much detail in the application form instructiozis-- tends to solidify the nature of the program and reduce the opportunities for innovation. Recommendations It is recommended that: 1. HSMHA-RMPS prepare d clearly stated looseleaf policy and procedures manual for use by RMP staff and RO-14EW staff. 2. The manual contain detailed instructions for appliq4tion procedures. 14 Findinqs form requires that infor- The currently Proposed application conf.igur- mation be supplied repetitively but in different .ewed at ations for d-e-tailed project review. The sample rev 1 es of the Airlie House meeting May 8, 1970 contained 112 pag instructions and forms. Form No. 7, for example is used at least five times. on Reviews: Continuation applications like new. c ntinua exceed the size of major city telephone 'a ication examined by the Task Force was directors 5-1/2 incl ghing 14 pounds. These continuation applications ar reviewed by an internal, staff Committee which has neither fixed membership, rules 0 or criteria for review. Membership varies depending procedure usually on the staff available for,attendance. Decisions are made on the basis of informal concensus. If'detai-led Proiect review at the Federal level is eliminated, there is no -need for a lengthy and complex application form with accompanying complex instructions. dations It is recommended that: n form for new and renewals (Types I, 1. An applicatio t with proposed HSMHA master forms. III) be developed consisten An application form for ontinuation (Type V) be developed.. c 2. 15 F Core staff of the 55 Regional Medical Programs performs two primary functions: (1) Administrative management of the basic grant and its components, and.(2) operational activities related to the development, review, and maintenance of projects and programs. For example, the maintenance of a headquarters ,library facility falls under (1) above, while the development of an areawide library system falls under (2). Of the $93.6 million available funds, $40.4 million is used for core support. Generally RMP's estimate that 25-35% of total core staff time ly spent preparing applications for project-by- is current project review and prior approval correspondence. Recommendations it is recommended that: 1. Applications for Regional Medical Program support indicate, clearly the differentiation between core staff support for nd cote staff support for other administrative management a program functions. This will permit the National Advisory Committee to evaluate more critically the needs of different tions. core func 1 6 Findings The proposed triennial review of program will no longer en- able the 55 Regional Medical Programs to provide in a timely fashion the management information which is requested on the application form. Thus, there is a need for,periodic report- ing procedures which will obtain from the 55 Regional Medical Programs, on a regular basis, information which the HSMHA Regional Medical Program Service can use for its own u get development program evaluation, etc. All updated expenditures and budget data for each region should be provided to the HSMHA Re ional Medical Program Service on a continuing basis 9 .rather than "45 days prior to the Region's Anniversary Date or 120 days after the end of each grant period." The HSMHA Regional Medical Program Service procedure for the accountability, control, disbursement and reporting of RMP grant funds should be included in the periodic reporting pro- cedure. Recommendations It is recommended that: 1. Periodic reporting procedures be developed independent of applications for support. 17 Findings It is essential that staff of the Health, Education and Welfare Regional Offices be knowledgeable about all Federal programs which in one way or another interloc@ and be able to coordinate these efforts. The staff from the Health, Education and Welfare Regional Offices should work with Regional Medical Programs so that they may understand problems, be thoroughly familiar with the projects being considered and be able to provide opinions to the Regional Medical Programs and/or the HSMHA Regional Medical Programs Service on the merits or demerits of any particular project or program. Recommendations It is recommended that: 1. Copies of Program applications be sent to the HEW Regional Office from Regional Medical Programs for information and comment to be forwarded to HSMHA Regional Medical Program Service. This activity may Facilitate more meaningful coo@di- nation of RMP with other health programs. 2. Copies of award statements be sent to the HEW Regional Office by the HSMHA Regional Medical Programs Service. 3. Program Assistance activities be conducted from the HEW- Regional Office by appropriate staff. These include attendance at RAG meetings', review meetings, etc., and the alerting of, headquarters to any significant changes in programs. 4.. HEW Regional Office staff participate in all program re@ view site visits. 5. Agreements be executed to assign responsibility to a single Regional Office for those Regional Medical Programs which cross HEW Regional boundaries. Regional Medical Program Map Key' Maipe' @0. Plorida Tri State 30. Mississippi 1. Northern New England 31. Michiqan 4.,eonnecticut 32. InOiana S. Metropolitat-New York 33. Wisconsin 6. Nassau - Suffork 34. Illinois 7' Albany 35. Bi-rState 0. Central New York 36. Northl4nd (Minnesota) 9.@ Rochester 37. Iowa 10. Western New York 38. Missouri 11. New Jersey 39. Arkansas 12. Greater Delaware Valley 40. Louisiana 13. S@quehanna Valley 41. North Dakota 14. Western Pennsylvania 42. Nebraska - South Dakota, 15. Maryland 43. Kansas 16. D.C. 44. Oklahoma 17. Virg@nia 45.'Texas 18. West Virginia 46. MountaiA States 19. North Carolina 47. Colorado - Wyoming 20. South Carolina 48. Inter"-Mountain 21..Northeast Ohio 49-. New Mexico 22. Northwest Ohio 50. Arizona 23. Ohio State '51. Wasbi ngton Alaska 24. Ohio Valley 52. Oregon 25. Tennessee Mid-South 53. California 26. Memphis .54. ]4awaii 27. Georgia ;55. Puerto-Rico 28. Alabama GLOSSARY HSMHA-RMPS - Regional Medical Programs '@ervice-HEW. NACRMP National Advisory Council for Regional Medical Programs. RMPRC - Regional Medical Program Review Committee. GRB Grants Review Branch-HSMHA-RMPS. PAB - Program Assistance Branch-HSMHA-RMPS. GMB - Grants Management Branch-HSMHA-RMPS. RO-HIEW - HEW-Regional Office. RHD - Regional Health Director-HSMHA CLO - Congressional Liaison Office-HEW. RMP - Regional Medical Program-Grantee. RAG Regional Advisory Group-Grantee. @e C/ V",e led IFe v; e v4. @11.6 Col. 8o'@o lo -00 fo I- 0 0 0 o@o on o 0 0 04, ok.L I o@ 'F>O @,I,.e vv' v,, e e 7,e-.A 8 8 -4- bo /.20 Ifo .kip .?70 o -0 Co o@ c IT 41- S70