@l I I i ii i !II I !I 11 i DEPAR'NENT OF HEALTII, EDUCATION AND WELF@ARE PUBLIC @TH SERVICE National Advisory Council on Regional Medical Programs I&nutes of the Twenty-sixth Meetingi/ i/ February 8-9, 1972 The National Advisory Council on Regional Medical Programs convened for its twenty-sixth meeting at 8:30 a.m. on Tuesday, February 8 1972, in Conference Room G/H of the Parklawn Building, Rockville, Maryland. Dr. Harold Yiargulies, Director, Regional Medical Programs Service presided over the meeting. The Council Members present were: Bland W. Cannon Dr. John P. Merrill Dr. Michael F- DeBakey Dr. Alton Ochsner Dr. Anthony L. Komaroff Dr. Russell B. Roth Dr. Alexander M. McPhedran Dr. George t. Schreiner Mrs. Audrey M. @lars Dr. Benjamin W. Watkins Dr. Clark H. Millikan Mrs. Florence R. Wyckoff Yw. Sewall 0. Nlilliken Dr. John D. Chase 3/ A listing of @-staff members and others attending is appended. 1. CALL TO ORDER AND OPENING RB@S The meeting was called to order at 8:30 a.m. bt February 8, 1972, by Dr. Harold Margulies. Dr. Margulies called attention to the "Conflict of Interest" and "Confidentiality of Meetings" statement in the Council books. He then introduced Dr. Vernon E. Wilson, Administrator, Health Services and Mental Health A&inistration. I/ Proceedings of meetings are restricted unless cleared by the office of the Administrator, H.3-4R. The restriction relates to all materials sub- mitted for discussion at the meetings, the supplemental material, and all other official documents, including the agenda. 2/ For the record, it is noted that members absent the@elves from the meeting when the Council is discussing applications: (a) from their respective institutions, or (b) in which a conflict of interest@might occur. This procedure does not of course, apply to en bloc actions-. only when the application is under individual discussi-on.- I/ Representing Dr. @rc J. Mzser for the Veterans Administration. 2 11. REMARKS BY DR. VERNON E. WILSON Ihe Council is beginning to pick up responsibilities for advice and coment on things that go beyond the original charge for RMP in its. initial form. Cu-rrently'expanded areas of interest include Emergency Medical Services, Health Maintenance Organizations and Area Health Education Centers. The options for allocation of funds for tiese programs have been discussed with the Secretary, the Office of Manage- ment and Budget, and others. In these discussions it became clear that the mission that @M has been trying to describe for RMP would be well served if the program were to take on Additional responsibil- ities that would make it advisable to release moneys that have been held in -reserve. HW-JA's assumption of responsibility for HMOs and EMS has been particularly helpful in obtaining release of the full amount appropriated. RMP funds will be used for the BIS program. Emergency needs are pri- marily provide'@ oriented and the @IP program is H@'s principal arm for communication with the provider commity. A portion of the $8 million currently available for IMS'will be allocated to support model programs in a limited number of areas. The remainder will be available for allocation through R4P. It is expected that next year $15 million will be available to support EMS instead of the current .$8 million. Because many H@M programs a-re concerned in various ways with emer- al office will be set up under Mr. Riso to gency services, a speci coordinate EMS activities within HSi\,M. Use of RNP funds for HMO demonstrations is expected to be a 1-year activity. There is adequate authority in the RMP legislation for short-term demonstrations of this nature. It is expected that future funding of @10s will be accomplished either through new legislation or through service-type money such as 314(e). Determination of how funds for Area Health Education Centers will be administered is still awaiting a final decision by Dr. DuVal ' In the meantime, there have been many discussions about AfIECs involving HSMHA, NIH, the Department, and others. It is clear from these that RNP will be concerned with those AIIEC programs where there is less emphasis on a degree, certificate or formal program recognition of some kind. The Bureau of Health Manpower on the other hand, would deal more specifically with programs involving or leading to long-tem training, residency training or formal degrees. No matter how -responsibility for an AIIE-C program is divided between NIH and HSNM, there will be a single application and a single award which might be composed of amounts of money from both agencies. In the discussion following his presentation, Dr. Wilson indicated that he would be happy to receive the Council's views on these and any other matters of concern. 3 III. REPORT BY DR. @IARGULIES Dr. @gulies reiterated and amplified some of Dr. Wilson's remarks about BE and MECS. In addition, lie covered the following topics: A. @IP Budget and Spendink Plan 'Ihe total amount of funds appropriated for grants for Fiscal Year 1972 has been released with the understanding that specific amounts will be spent for BIS, AIIECS, @s and construction. The actual figures are sli(xm in the table below. Total Appropriations $135.0 Earmarks MEC $ 7.5 EMS 8.0 BW 16.2 Construction 5.0 Total Earmarks 36.7 Available for RMP $ 98.3 The amount currently available for @1P ($98.3) contrasts sharply with the $70 million available for the previous fiscal year. The additional funds have provided an opportunity to (1) restore previous reductions, (2) provide additional funds to the more advanced R'vlPs in accordance with their relative ratings, and (3) increase the investment in kidney activitie8-by about 50% to ap- proximately $8 million. B. Reduction from 4 to 3 RevieA, Cycles Annually It has been decided to reduto the number of amual review cycles from 4 to 3. This shift will provide more time for technical assistance by staff between review cycles. It will provide more lead time between the notification of Council action and the Region's anni-versa date, and it will enable the Regions at this ry point in time to adjust their programs to the higher appropriation .levels in a more orderly manner. C. FM Review'Process A choice has to be made with respect to whether fMO funding is to be accomplished entirely by contract, or by grants through the RNP mechanism with a clear understanding that review would not follow normal RV pattern. For a number of reasons, the PM Coordinators would prefer@grants to contracts as a mechanism for funding @Ds. First, many of the PMs a-re already involved with ID,10 development and would like to remain close to the activity as it continues to develop and, secondly, it is quite clear that RNPs 4 will have a major role in the professional development of @IDS with respect to such matters as quality of care monitoring, emergency services, health manpower training etc. D. National Coordinators Meeting @The National Coordinators Meeting which took place in St. Louis in January engendered some highly beneficial discussions. There was vigorous discussion of the @IPS-Dosition paper on AECS. The material on Emergency Medical Services was well receive . Some research and development needs were surfaced, and RV-CHP -relation- ships turned out to be a surprisingly live issue. Dr. DuValls -remarks touched on this subject, and, in addition,'he stressed the responsibility of IMs in monitoring the quality of health care particularly in the context of the great liklihood of national .health insurance. All of the Conference material including Dr. DuValls speech will be available for distribution. IV. KIDNEY REVIEIV PROCEDURES Dr. Margulies called upon Dr. Himan to describe proposed procedures for the review of kidney proposals. The kidney review process will involve the following steps- (1) screening of preliminary proposals in -relation to national priorities by @1PS, (2) technical review at '-le local @,IP level by a review panel including at least 3 renal experts from outside the area, (3) RAG review of applications receiving favorable technical review in order to insure that the @ip can adminis- ter the kidney project without hi-ndering.total local @IP program, (4) RMPS staff review relating to national priorities, RAG and CHP comments and preferred method of funding, (5) opportunity for coment by the Review Comittee on program and regionalization, and (6) a final recom- mendation by the National Advisory Council. At a later point in the meeting, a motion to endorse a statement embodying these principles was moved., seconded and carried. The state- ment in reproduced as Attachment A. V. NORRHIEST CANCER CENTER As the next item of business, the Council considered the application for construction of the Fred Hutchinson Cancer Research Center in Seattle. Dr. Henry Lemon, who served as Chairman of the site visit team was invited to participate in the discussion. Both he and Ws. @rs reported in considerable detail on the findings and recom- mendations of the site visitors. Proposed action of the Council with respect to the award of funds for construction of the Cancer Center was moved, seconded and carried with the following amendment: "That there be an additional point incorporated into the draft, point C, which stipulates that the isolated beds not be included as part of the application until such time as justification,is brought before this Council and acted upon favorably." (Tran- script, pa e 127, Vol. i). 9 The complete text of the resolution as amended is appended as Attach- ment B. VI. ADVANCED TECHNOLOGY ACRIVITIES A. Computer Assisted EKG Analysis Dr. Himan summarized a report on computer assisted EKG analysis which was made available to the Council in the agenda book. The Report results from a day long conference in November, 1971 chaired by Dr. Leonard Scherlis of the @IPS Review Committee. The con- fe-rence was the outgrowth of interest in an earlier draft developed by Dr. Kenneth Gimbel of the @IPS staff. The present report indicates that the W role with respect to computer assisted EKG analysis should be one of consultation and advice, of providing linkages and helping to develop systems. Investment in hardware is not considered to be an appropriate RNP function. It was moved seconded and carried that the Council,given general endorsement to the position paper, recommends its distribution and development and implementation of an'appropriate policy statement. (Transcript,, page 132, Vol. I). B. Study of Advanced Technology in-Relation to P,\lP Dr. Margulies called attention to the Councills request at the previous meeting for an RMPS study of the whole question of advanced technology in relation to Regional @ledical Program and improved delivery of health services. There is now a major Government-wide effort to come to grips with issues involving the impact of technology on social systems. This effort involves the Office of Science and Technology and other agencies In addition, the President has indicated that there will be a mes;age to Congress regarding the implications of advanced technology in the coming years. Under the circumstances, it would be unwise for RNPS to mount a separate effort. In the meantime, @IPS will attempt to keep well informed as possible on matters relating to technology. 6 VII. POLICIES AIO DELEGATIONS A. Review Responsibilities Statement The Council was requested to modify the statement, "Review Respon- sibilities Under the Triennial Review System" which it approved at its August, 1971 meeting. The document delegates to the Director authority to fund awards during the second and third year of tri- ennial applications. Dr Pahl explained that the revised language would require Council action only where a change, up or down, in the Council approved level is required. Under the previous wording, Cou ncil action was -required whenever the amount requested exceeded the recommended level of support. Another change eliminates the need for Council .action in the case of small increases in the Developmental Component. It was moved, seconded and carried that t-i 'revise statement e approved. (Transcript, page 139, Vol. 1). The Review Responsibilities statement as passed is reproduced as Attachment C. B. New Policy and Delegation Regarding Triennial Grants Dr. Pahl presented the proposed two-patt policy statement. He explained that the first part constitutes an understan ing.,t-iat w-ien Council acts upon the first year of a multi-year budget, it is understood that the second and third years, if support is approved for those periods, will be identical-with the first year's budget unless the Council recommends otherwise. The second part of the statement.delegates to the Director, RPS authority to approve an W's programmatic changes during the period of transition from four to three-cycle review. It was moved, seconded and carried that the above policies be approved. (Transcript, page 143, Vol. 1). The full statement as passed is appended as Attachment D. C. ABEC Resol@tion Dr. Pahl explained that the purpose of the proposed AHEC Resolution was to implement the AHEC program more expeditiously by delegating to the Director authority to fund small feasibility studies. It was moved, seconded and carried that the Resolution be approved with the addition of the following language: "It is further understood that Regions will first utilize 'free' Developmental Component funds, where available, and that 7 the general policies and procedures of the individual MIPS witIh respect to@revieiv, approval and funding, including RAG concurrence, will apply." (Transcript, 218, Vol. 1). The'full text of the motion as passed is appended as Attachment E. D. IM Delegation Dr. Pahl presented a -resolution for consideration by the Council which would delegate to the Director, RWS, authority to fund MO projects in accordance with the recommendations of the M Service. After considerable discussion and several votes, a substitute proposal-ivas placed before the Council, and moved, seconded and carried. (Transcri t, page 5, Vol. 2). p The motion as passed is appended as Attachment F. E. Equal Employment Opportunity Dr. Pahl introduced Mr. Richard Clanton, Deputy EEO Officer for RMPS, who reviewed RNP activities relating to EEO and directe the ouncills attention to a request from the Review Committee to clarify @IP policy in this regard. Specifically, @l-r. Clanton called attention to-RPS's "Affirmative Action Plan" and described plans to assist Regional Medical Programs with respect to employ- ment,and utilization of minorities and women at all levels,of responsibility. It wa s moved, seconded and carried that the Review Committee'8 proposed policy statement be approved with certain additions which are reflected in the text shown in Attachment G. (Tran- script page 176, Vol. 1). VIII. SPECIAL ACTIONS A. Connecticut @1P Rating It was moved, seconded and carried that the "Connecticut Regional Medical Program be placed in the A category of programs." (Transcript, page 11, Vol. 2). , B. Increased Levels of Support for Certain Regions It was moved, seconded and carried that the approved levels of support for the following RWs should be increased: (Transcript, pages 14, 16 and 17, Vol. 2). Wisconsin, Iowa, Mountain States, Washington-Alaska, Intermountain, Tennessee @lid-South, Indiana, and New Mexico. A table of the specific amounts approved is provided in Attachment H. IX. CONSIDERATION OF THE MINUTES OF THE NO@ER 9-10, 1971 NIE-ETING The Council considered and approved the Minutes of the November 9-10, 1971 meeting. (Transcript, page 3, Vol 2). X. CONFIRMATION OF FURURE MMING DATES The Council set the following dates for future meetings: June 5-6, 1972 October 16-17, 1972 February 7-8, 1973 June 5-6, 1973 XI. REVIBV OF APPLICATIONS* A. Greater Delaware Valley Regional Medical Program Motion made by Dr. Watkins - Seconded by Dr. DeBakey. Approve the Review Committee's recommendation for two year funding: 04 year - $1 900,000 i 05 year - $1,700,000 (Transcript, page 199, line ll.,) The motion was unanimously approved. B. Maryland Regional Medical Program Motion made by Dr. McPhedran - Seconded by Mrs. Mars. Approve the Review Co@ttee's recommendation for two year funding: 04 year - $1,294,960 05 year - $1,294,960 Subject to the following negotiations: (1) Deletion of funds for Project #43. (2) Funding of Johns Hopkins fS,10 proposal to be limited to @1P related activities. (3) Resolution by PdNiPS staff of need for additional funds for Projects 40 and 41 in relation to support of overall RW Evaluation Unit at the University of Maryland The motion was unanimously approved. *All actions include@onsideration of kidney projects, where appropriate, unless otherwise specified. 9 C. Western New York Regional Medical Program, to be changed to Lake Areas Regional Medical rogram Motion made by Mrs. Mars - Seconded by Mr. Milliken. Approval of triennial status at a reduced funding level of: 01 year - $1,219)000 02 year - $1,340,900 03 year - $1,462,800 (Transcript, page 233, line 11.) The motion was unanimously approved. It was further moved by Mrs.-fVyckoff, and seconded by Mr. Milliken, to hold the rating for the lVestern New York application in abeyance until the Review Committee has a chance at its next meeting to assess the new developments and assign a rating based on this information. The motion was unanimously approved. (Transcript, page 245, line 14.) Dr. Roth absented himself during this discussion. D. o olitan D.C. Regional Medical Program Motion made by Dr. Ochsner - Seconded by Dr. Roth. Accept the Review Commi.ttee's recommendations. (Transcript, page 29, line 14.) The motion was unanimously approved. Dr. Schreiner absented himself during this discussion. 05 year - $807,000 General Program 05 year - $202,000 Kidney Program $I.,009,000 Total Direct E. Louisiana Regional Medical Program Motion made by Dr. Komaroff - Seconded by Dr. Millikan. 10 Approve the Review Conunittee's recommendation with the exception that no specific ceiling be placed on the funding for the coro- nary, pediatric, pulmonary units, only a statement that renova- tion and equipment costs are no longer part of RMPS policy and that a very modest expenditure is recommended. (Transcript, page 55, line 14.) The motion was unanimously approved. With regard to the kidney aspect of the application, Dr. Merrill moved, and Dr. Millikan seconded, that it be funded for one year at the level of $94,595 and that the progress be reviewed with regard to funding for the second and third years. (Transcript, page 57, line 1.) The motion was unanimously approved. Dr. Ochsner absented himself during this discussion. F. Illinois Regional Medical Program Motion made by Dr. Schreiner-- Seconded by Dr. Roth. Approve the recommendations of the Review Committee. (Transcript, page 70, line 6.) Approval of the Program for the triennium; Approval of the de velopmental component; and Approval in a reduced amount at the following levels: 03 year - $2,650,000 04 year - $2,8001000 05 year - $3,000,000 The motion was unanimously approved. G. Ohio Regional Medical-Program Motion made by Dr. Millikan - Seconded by Mrs. Mars. Approve the staff recommendations concerning the amalgamation or merger of the Ohio State and Northwestern Ohio Regional Medical Program into the Ohio Regional Medical Program. (Tran- script, page 83, line 1.) Another motion was made by Dr. Millikan, and seconded by Dr. Cannon, that the Northeast Ohio Regional Medical Program be funded at its current level on a year-to-year basis with a project site visit for staff review of progress to be made in late 1972, and that, depending upon the result of that review., further effort be made to produce amalgamation or a combination o: @ortheast Ohio with the Ohio R.egiona-1 Medical Program. (Tran- s ript, page 86, line 17.) The motion was unanimously approved. Mr. Milliken absented himself during this discussion. H. Florida Regional Medical Program Motion made by Dr. Cannon - Seconded by Dr. Millikan. Approval of the site visit and Review Committee recommendations for funding: 04 year - $1,552 706 05 year - $1,673,750 06 year - $1,713,150 This is exclusive of funding for the kidney project. The motion was unanimously approved. (Transcript, page 89, line 4.) Motion made by Dr. Cannon and seconded by Mrs. Wyckoff for approval of the kidney Project #43 'on the basis of the staff information in the amount of: 04 year - $375,000 05 year - $313,500 06 year - $251,625 (Transcript, page 99, line 1.) The motion was unanimously approved. I. Intermou@tain Regional Medical Program Motion was made by Dr. Schreiner - Seconded by Dr. @lillikan. Approval of the Review Committee's recommendations, with the exception that the developmental component funds be increased to maximum allowable level. Total of $2,700,000. (Transcript, page 102, line 6, and page 108, line 23.) The motion was unanimously approved. 12 J. Susquehanna Valley Regional Medical Program Motion made by Dr.'Cannon - Seconded by Dr. Schreiner. Approval in the amount of $750,000. (Transcript, page 116, line 23.). The motion was unanimously approved. K. Alabama Regional Medical Program Motion made by Dr. McPhedran.- Seconded by Dr. Millikan. Approve the recommendations of the Staff Anniversary Review Panel including the funding of the developmental component. Total fifnding level: $1,115,000. (Transcript, page 123, line 18.) The motion was unanimously approved. L. New Jersey Regional Medical Program Motion'made by Dr. Millikan Seconded by Dr. Chase. Approval of the recommendations concurred in by the Staff Anniversary Review Panel and the Review Committee. (Tran- script, page 131, line 15.) 04 year - $2,900,000 05 year - $2,900,000 The motion was unanimously approved. M. Delaware Regional Medical Program Motion made by Dr. Cannon - Seconded by Dr. Millikan. Approval of the application of Delaware for a separate Regional Medical Program provided the grantee.agency is not part of the State Government. Level approved was- $389,050. (Transcript, page 136, line 5.) The motion was unanimously.approved. 13 N. Northlands Regional Medical Program Motion. made by Dr. Komaroff - Seconded by Dr. Roth. Approval at the same level as the previous year $1,511,000. (Transcript, page 142, line 14.) The motion was unanimously approved. Disapproval of the kidney project. Dr. Millikan absented himself during this discussion. I hereby certify that, to the best of my knowledge, the foregoing minutes and C> attachments are accurate and complete. rgulies,@D. Director Regional @4edical Programs Service Ellandal 3/31/72 ATTENDANCE AT THE NATIONAL ADVISORY COUNCIL MEETING February 8-9,. 1972 (this is an attachment to the Minutes) RMPS STAFF OTHERS ATTENDING Mr. Vernie Ashby Dr. J.H.D. Brown, OA-HSMHA Mr. Kenneth Baum Dr. Margaret H. Edwards, NCI-NIH Mrs. Paula Bell Dr. Bruce W. Everist, Consultant Mr. H. Earle Belue Dr. Henry M. Lemon, Review Mr. Cleveland R. Chambliss Committee Member Mr. Richard Clanton Dr. Robert A. Leyton, NHLI-NIH Mr. Tom Croft Mr. E. E. Olexa, OS-ASC-AA Dr. John Farrell Mr. 'Maurice C. Ryan, Region V Miss Myrtle Flythe Dr. Frederick L. Stone, OA-ESMHA Mr. G. T. Gardell Dr ' William Vaun, Consultant Mr. Sam 0. Gilmer, jr. Mr ' Robert A. Walkington, NLM-NIH Dr. K. S. Gimbel- Dr. Vernon E. Wilson, OA-HSMHA Mrs. Eva Handal Mrs. Gloria Hicks Mr. Charles Hilsenroth Mr. George Hinkle Dr. Edward J. Hinman Mr. Burt A. Kline Mrs. Lorraine Kyttle Mr. Walter Levi Dr. Harold Margulies Mr. Ted C. Moore Hiss Marjorie L. Morrill Miss Mary t. Murphy Mr. Frank S. Nash Miss Elsa J. Nelson Mr. Joseph Ott Dr. Herbert B. Pahl Mr. Roland L. Peterson Mr. Michael J. Posta Miss Leah Resnick Mr. Richard Russell Mrs. Jessie Salazar Hr. Luther J. Says Miss Teresa Schoen Mrs. Patricia Schoeni Mr. Matthew Spear Mrs. Sarah J. Silsbee Dr. Margaret H. Sloan Mr. Jerome J. Stolov Mr. William A-4 Torbert Mr. Lee Van Winkle Mr. Frank Zizlavsky AT'FACKI,IENT A S PI,OiDS17D P,\OC]7,D',-TRE -roll, KID',\7!i.Y P',.O',L'OSALS Kidney proposals shal-I be reviewed in the fol.1c)x,7!.ng Tranner: 1. Tmmed crest in the submission of a ibtely upqn an indication of int Kidney proposal by a source within an @-M, the PIIP shoul.d contact the is within the appropriate :,PS Desk to determine the proposal scope of national priorities. At this point, RL,,TS will advise the P@IP whether it is desirable to proceed further. The @,T ni@iy accept or reject this advice. 2. Each RI.IP slub,.-iitfting a renal disease propos .al is expected to provide a technical r-c-v4-c.@.., of the p---oposal by a group which had no'@- participated in its clevelop,@@,ent.an-I Inch incl.ticle-'s at least 3 renal authorities from outside the Re-ion, prior to gub.-,,iission to ic@"?S. The review group may be either an ad hoc or standing cc)@.4,-iiittee. @\IIIS will-iiiaintairt a list of consultants who may be called upon to scrve'ili this capacity. 3. Kidney proposals which receive a favorable local technical. review shall bc- forwarded by the Pc@-ic,,nal Advisory Group (RAG) to Pl@ll'S @,,,itn the IZP.G's comments and to CliP for review and co@-i-nent. The RAG shall consider and corrirr.c,nt- on !the ability oi@ the P,:-,T to Tiiai-ia cc, the Kidney project without C> hindering the development of the overill I'@iT program, and the reasoi,able- 17 ness and adequacy of the Kidney bu,-I,,et. Since idney proposals are separatc-lylfL-,ndcd, there is no reason for the RAG to give priority raiil%irL2-s t to Kidney.l)i-oposals in mediation to other non-Kidney I'@T operational activi-L--@-.@ Kidney proposals shall be considered by P@FPS in relation to national 4. The PILPS st-@ff review shall include consideration of- a. the contribution of the project toward national Kidney priorities; b. the com-.,,crits of the RtiC (point 3, above) and the CIIP acency(ics); C. the preferred method of funding. 5. Applications to@etlier i..,itn R:,IPS staff review and local technical review shall be provided to the' @,TS Review Corirnittee at its option for coTr,,m, cnt on program and regionalization. The Co,,i,,mit'L-ee shall not consider budget and technical aspects of the roposal. p 6. All Kidney proposals shall be submitted to the National Advisory Council for a final reco-ri-,Triendation. - In Irec!ping @..@ith the. categorical nature of the Kidney disease progra-n within l@iPS, the Council will review and ree6w.inend funding.levels for Kidney proposals' separately fro-,n the funding level of the specific @l,!P. PPROVED. February 3, 1972 ATTACW4ENT B ACTION BY NATIONAL ADVISORY COUNCIL ON THE FRED HUTCHINSON CANCER RESEARCH CENTER Council Recommends: A. Award of $5.0 million to the Fred Hutchinson Cancer Research Center in Seattle for the construction of a cancer facility to serve HEW Region X. The award is contingent upon meeting the following conditions: 1. All relevant Federal, State and local requirements concerning the expenditure of Federal funds for the construction of the proposed type of facility including.all needed licenses, clearances, permits and approvals; 2. The University of Washington and Swedish Hospital formalize their relationships with the Center through written agreements; and 3. All'conditions contained in the Council's Statement of November I 197@, entitled "Statement by National Advisory Council on Regional Med'cal Programs on Cancer Center To Serve HEW Region X," are sat sfied. B. The provision of space to accommodate 20 beds, which would be isolated from the Swedish Hospital Medical Center, be reconsidered with further justification for review and approval by the National Advisory Council, RMPS. C. Award of@$50,000 to the Washington/Alaska RMP to assist in developing the regi6nalization of cancer activities. APPROVED: February 8, 1972 ATTACF2!ENT C REVIEW RESPONSIBILITIES UNDER THE TRIENNIAL REVIEW SYSTEM Under the triennial review system, each Regional lledical Program norm- ally will be reviehed by the National Advisory Council only once each three years. The triennial review serves to recognize the Region as 11'aacred4t zation and to set a general level of annual sup- an i @d" organi po@ for-th'e thres-@-ear period. Thus, the Councills favorable recommend- ation constitutes 2 time-limited approval for an RIIP as an organization having recognized capabilities, -rather than being approval for a specific set of activities. In addition to recoiyimending the general level of support, Council actions on individual applications may include advice to the applicant Regional Medical Program, or specific conditions for the grant. Prior to review by the Council, each triennial application will be reviewed by assigned @, S staff, a site visit team and the FIIPS Review Coramittee. Except as specified below, the Director, RMPS,-will make continuation awards, including support for new activities, for second and third (02 and 03) year support without further Council action insofar as the proposed activities are consistent with relevant policies. Specifically, the Councilis advice will be sought when: 1. The Director, RYIP8, has determined, or the Review Committee has recommended to the Director, that' a change in the Council approved level is indicated. 2-.,,-A new Developmental Component is requested. 3. The Director, the Review Comittee, the Region, or a Members of the Council itself requests Council review. 4. The applicant has failed in a material respect to meet the requiremnts of the Program or applicable laws, regulations or formally promulgated policies of the b'epartment, HS@, or RMPS.- A s will be provided to the Council on each Region reviewed by staff for continuation support. This summary will include: 1. The findings as determined by the review of the Director, together. with a statement of the amunt previously recommended by the Council for funding and the @utn awarded. 2. A list of activities supported during the most recent grant year, identifying those which have been completed and those which have been supported through a Developmental Component. 3. A statement of the Region's response to any advice'specifi@'@'- the Council or limitations upon or-conditions of the award C (contin@d) - 2 4. Identif leation of any outstanding accomplishments. 5. Identification of any outstanding problems. 6. Annual reports from the Regional Advisory Group and from RYIPS staff. (These will be made available on request by the- Council.) APPROVED: February 8, 1972 ATTAC@IF,@iT D P@.'r.,-r'Y A',M C.", AU,@T,-.'Lot-.LrTY D7L mLlIE NATIONAL ADVISORY COUNCIL ON REGIOI'@ MICAL PROGR.UIS REGARDING GRAI\ITS IIITH TRIEI@TIIIAL STATUS Effective this date, the following constitutes new Council policy and delegation of authority which supersedes existing relevant policies/auth- orities. Policy In considering the three-year budget submitted by a Regional Medical Program applicant in a triennial application, where the Council recommends support-for more than one year,.it is understood.that the recommended level of support for future years of the approved period shall not be less than the amount recommended for the first year unless otherwise specified. Delegation of AiJthoritZ to the Director, @S The Council delegates to the Director, @UIS, authority to approve an RMP's progrwmtiic changes during the period of transition from four to three-cycle review, including new initiatives in keeping with the natural progress of the Region, provided that the Region submits to the Director a plan cover' the interim period, and receives approval therefor. Ing APPROVED: Februax-y 8, 1972 ATTACIDE14-T E AHEC USOLUTION The Council, recognizing the need for expedicious action and flexibility in funding feasibility studies that would permit local areas to assess the potential and feasibility of developing Area Health Education Centers, delegates to @@-D@ctor of RYYS authority to award supplemental grants to individual Regional Medical Programs for such purposes. It is Ur er- stood that (1) no local area shall receive funds for an AHEC feasibility study in excess of $50,000 (Lotal costs) and the duration shall not exceed 12 months; no single RMP shall receive in excess of $250,000 for such feasibility studies in any 12 month period; and (3) approval and funding of these AHEC feasibility studies by Regions will be within such general guidelines as FL-;IPS may establish. It is further understood that Regions will first utilize "free" Developmental Component funds, where available, and that the general policies and procedures of the individual Regional I'-,edical Programs with respect to review, approval funding, including RAG concurrence, will apply. APPROVED, February 8, 1972 ATTACFU,,'@v,,,T F 1*10 DEL'-PGATION The Council shall discharge its responsibilities in regard to reco- mmending RNP grant support for 1240 feasibility studies and organiz- ation and development efforts by delegating to a subcommittee of the Council full authority to work with the Director, RMPS, and to approve applications for HYO grants. APPROVED4. February 8, 1972 ATTACI*ETYT G REVIEW OF APPLICATIONS WITH RESPECT TO EQUAL,E@:PLOYITLIT AND CIVIL RIGHTS The Council recommends that those participating in the review process, including site visitors and the Review Committee be instructed to give special interest and attention to the,lissues of compliance with the Civil Rights Act of 1964, and the reasonableness and adequacy of rep- resentation @ employment of minorities and women at all levels in RMP activities. An examination of performance in relation to these issues shall be an essential element in the review of every application, and such review shall be adequately documented in each case, If, in fact, the reviewers feel that there is some question of compliance, or inadequate performance, they not only have the, right, but are expected to request that appropriate re view of that issue occur. APPROVED- February 8, 1972 Attachment H Programs with increased levels approved by the NAC PROGRAM PREVIOUSLY LPPROVED LEVEL NEW LEVEL 1. Wisconsin $1,500,000 $1,779,072 2. Iowa 800,000 841,065 3. Mountain States 1,511,000 1,934,117 4. Washington/Alaska 1,679,906 1,796,503 5. Intermountain 2,417,167 2,690,853 6. Tennessee Mid-South 2,082,643 2,166,139 7. Indiana 1,100,000 1,121,411 8. New Mexico 890,000 1,036,719