li i ;II f I;, 26 [?@,f5AR-,-t,.,'iEt4T OF Fl@l..'ALI'li, AND WELFAF@E liFAI"T.1-1 SE:V@VICEf, At4,) RF'GTONAL NIEDICAL June 17, 1.971 FROGRANI$ SER,'ICP- Dear The following 4s a stTimary of the Of tt,e niajor issues 1.1-12, 19@l-, I-11.2etq-nf" of the National and discussions of t,ie May Advisory Council. AltlioL, 1. *,-he -,,ilnute& of this meeting fill not be formally approved until the Council in August, this I surpmary has been prepared to infc@,@ you ol the essential actions of tile Council v.,Iiich affect policy. Cotficil actions concerning projects and programs have been or will be reported in the usual manner. of immediate interest is the Adbi--,iistratioti Is 1,972 Ani-3ropriatio L)-onr- R e5t, which vmuld hol-d 1),'@t? gra,,it funds (exclisive of construction) at $70 million (tire fiscal year 1971 apportionment) through fiscal 972. in t decision to maintain this ,year 1 lie @llous-- hearin@,s the level was questioned closely. No House i-@@tark-up has been announced and the Sp-nate Coi--mittee may not hear testimony on the bill until s ep t drtib e r. Interest in National Ilcalth Insurance reT-,qii-Ls high on all. sides. The nLuiber of bills before the Con-res,. on this subject continues 1:1 to grow, but as year there qce-iiis to be no clear trend toward tile support of any one proposal. TliL- conc<---I)L of Area Health Cc@itiers greatly stimulated by the Carnegie Foundat4on repor@-, is iow in two bills before the Congress. Oii@- P'tans administrative responsibility for Area Health EeAucal@4.o,.-i Centers in the li@lodical Program, the other would resu'Lt in assigiiyrient of responsibility to the National In@titutes of Health. Page 2 The- Area Health L(ilicitic@ii Centir J.@i as yet not full def itic-td, y probably will be i cot-,i,-Iiiiiity-b,,isc@cf, priiit-el-ipit)le agency, built around Health care InstLttitiolis an] I)r,-ictitioners, affiliated ,.,itli health educational ind training iiit;tittitli.ons, including I university health science center. The AIIEC i..,o@ild be a natural a-,Id iriportant concern of the Regional. 1'edical In turn the Regional t4edi.cal Pro?,rzir Bull under any circumftiiiices be associated with the center, because of t-lieir common interest in enhancement of health care services. E-.UIS is cooperating closely ijitli other efforts'to develop Health Maintenance OrgAni-zations. There has been established a national clearinghouse in liSiTr[A to keep records avid oversee all @R-10 activities, but the basic respo@isibil.ity for their development is in the IIEW R&Sional Offices. FdfPs will be especially useful in the early phases by assisting in the con,.7etiinp, of tiiosc- who must meet together and by obtaining for tlie-ii necessary consultation and other required supporting material. They will be of value later in the establishment of an effective health care system particularly by assisting in lUiD efforts monitor the quality ol: care beini,, provided. @NFPS has the specific responsibility for developing guideli-,ies and criteriA for the monitoriii- of quality and for developing a concept and Guidelines for heal.th rY,2intenance. The Civil Service Co,-rLriiission has established grades for Pliysician's Assistants, most of whom will be c@,aployed by the Veterans Administration. The Director of Pd@',PS serves as a retuber of an executive committee advising the Co-xinissioii of the qualifications to be established for the grades GS 7, 9, and 11. l?jN2S continues to have it NCHS &D a keen interest in I'Iiysici.--n's Assistants development and will partici- pate in the further definition oil PAs, their functions, their legal status and their limitations. 0 There have been a number of recent developments in the Regional medical Profra-ma@s Service: A. An expanded focal pbiiit for services to Council and Review Comyaittae is being developed. Tlic, charter of this Office of Council and Committee Affairs will be 'circulated when the reorganization plan is completed. B. The Operations Division is developing four geographically organized "desks. . tach of these will provide i spectrum of services for a designed group of Regional Medical Prograras. Each will be served by designated liaison personnel of the Ilrofessioiial Division. Page 3 C. Since the last Ccitincil. the Equal ETip)oN,,,iient Opportunity I)rt-)graii in I,,!PS his been clevelopiii;5, rapidly. Not only be(-atise it is an agency of but al.so becitise it.,- riiss'lon is to the citizenry, Ri,il'S cannot serve I'@eFioiial. @';',edical Procr,@.-i effectively if it in an 11 y way discritniiiatcs against i!iiiic;,ri.t:ies or women. Not only in R'IPS, but fri ill t.,ic P,'@lls, L)oLli I-'Iqual Lmployi-,lent. Opportunity ;.,n@i minority i@,roup' access Lo health cire are major concerns. Evidence of adherence to these concepts will be soti-i,t in all proF,,rz:,n reviews. Dr. @licliael Breenan, Cliairi-iazi of the Couricil's Subco,-@Ln@ittee on Automation, reported the following as the Co=,,iittee's considerations and recortr..endations concerning aul,or,,,ated iiul.tiphasi.c hea3.tti test@ as an investment A. "At this time eleven Regl-onal i@iedical Prograrng have funded projects that featurIe atto,@nated i@,.ultil)hasic health testipg. The purposes of these projects -r,,!sc.-rit a fair representation of the purposes for which patient health status data are acquired. B. "Autan@ated Health Testiri,, is very costly. The influence of the projects in which it nppears oii regional dc!l)loy,.ient and utilization of health care services is highly unpredictable. For these reasons Council reco-@.xeiids that no new broiects featuriii- reato,- -ed ie@pLtli ii@iF!, be funded. C. "The Co,.arLcil further recc),,-rmeL-ids that the Director, RIOIS, and inating with the appropriate Regional ',-edical ProLrams, coord the lease -per 11 zi' Ln cc-rvice-s Research and D el onal Center . E.' i- eV op- me)it, Co,,wtun4-ty health Services, the national Center for Health Statistics, the National Institute of Gc,-,ieril I.IeG'ical Sciences and other interested agencies institute consultation and investigation 1. Provide riiarket and financial analyses and @-dv ce to avoid loss in post-grant operations of projects currently funded by Regional Medical Prograris; 2. Build into rLT-,T and other projects base line data, defined goals and measures of progrcs@3 for.cotiorts of persons whose initial -,,tiltir.',-iasic tests were positive, ncFati%,e and refused, among such-populations As urban And rural poot,@ employees groups, hcspital and c'Li-,ii6 patietts, to tic-lp resolve debate about the effects of multiphasic testin,, on quality of and access to Health care services and the regional deplo ent an"' utilization of health care resoLl CL,@; r P.ip,,e 4 3 . I!ti I i;, .,e ,,iialysis all i.tiforiration to stimi-ii.-tte ii;it@-irii iiisLor'es of diseases and i.cle!-t@,ijr-y those for wi-iici-i secondary prevention i-.iiglit d acceptable In cost; and be feasible an 4. Condtict ri,.ulti-variant ariz,,I,,ses of the results of tiulti- phasic testing to the possibility that it icati-on of the tests." cou -%, i) 1) 1 ld improve diagnostic.,. COTINCII, A(;TION: Tile Cou nci,l unaniiiioucl,, adopted the above recor.,.r,.ien- .Clatioiis of the Stil)committee on Atito@nipted Vultipliasic Health Testing. Iii this regard, please note that the rcco@@-,nendatiori in Section B e tabli-shes a new policy for Regional 1-i,-Llictl Pr6prams Service. !S I reported briefly on a limited test by x,.,Iiicti out site visitors or Review Committee ]@ave ranked P..egional '-i,@dical Prograa!; in ter-ns of their overall pffectivpness. This typc! of activity will become in- creasingly necessary if chanL?es in levels of available grant funds are to be accommodated in a selective fashion rather than across- the-bo@rd additions or reductions for all programs. A. The Professional Judgment C@,piarJ.s6n To date very broadly conceived criteria of effectiveness' have been employed in the review of our E,,rints. At the last meeting of the Pevi@, Co-cikrtittee the progra.-,is of fifteen Regional Iliedical. Progri;,is wer e corisidered. After the formal actions were corcipleted, the rieTpberf, of the Review Co-a-,rittee agreed to try i?114orm,-Illy to rank those, programs for overall effectiveness. The procedure con-- sisted sir@,ply of distributing tile fifteen Rec,ioiial Yiedi.tal Progr,i,-as iiito "quartile" groups; the results were highly consistent. There i-7ere several instances of identical quartile- assignments, end in almost all cases the differ- ences in assignments were not rare than one quartile apart. This i-,ifo-@,al, no-record e@,ercise was conducted as an extension of the entire review process and appeared to be workable. B. The Grading Comparison Another approach to ccliaparisoii of Re ional 1,4cdical program 9 effectiveness can be u!-jdc- by v,radino or scoring the per-' formance of each on an absolute scale. This approach has not been giv&n a full trial. this year numerical 'grading was used in a li,-,iited w@,.y on several site visits to Rei"ioiial '.Iedical Progr.-,-,iti. 'I'lie results of these trials have shown con!;i-,,,Lcncy Li-te, graders Lliiti did the Review Co,.-,@-IiLkl(-@c--ls cckaipari.,--oii c,17 the fifteen rcgioils. illage 5 C. Lffects of aCt4 In the. run, i.d!r,.-LniSLrative on@, and @tdvi-sory C, ce.)in7@ienda.Li.oris which rcsil@it frorj such deterlii- group re of relative alfect the nations tlerit prii-.i.,-.irily wi- 1. least or@,l most effective Regio:-,F"I- @,,,edi.cal Pro,",rais. cussed with the Dr Vernon Wil,-on, Ad,,itinistrator, council events ind trends tL,,at have iT@ll@liCaLions for t.1le fULLI.-e. A. Consumer interest in quality dctei7@,ination It is not t).nlikely that the I)asi.s of aevisory cr-,uncil actions as well as the ac@iop.!F@ will. becoiTic public records. Increasing ccn,,3u:aer group interest in pro.grqxa processes reduces the I.,ttitude for unsupported judgment. This Cc-,tric'i-l seriru@.'J.y should corsider d,@velop- ment of a rativi'a systerti as a basis for its decisions on grants. T,io iti'L.@,rest of career consumer advocates in this field is rooted in a widely held o,)Inion that pro- fessioii.-!il judgriie-rt@- should be opeiily determined and in- telligible to the 1.4ty mind. There is need for a syste-,a.thaL the ci)nsum-er advocates can u-,iderst-and and apply to reach tile same results as does the Council. There is also a widespread niisundersta'ridi.-ig O'L T,4P by people. who set- it-as an iniplel'-@an'L. of Fe@eral. control of health care. It is also r-aid t",,Ft R!V perfc@riLL,.nce is spotty, does not yield true na@@icnal coVera.c,,e, and that @iP is not as closely related ,to t,ie universities as it should be. We see the flatjq i.ri -@liL-c-c- arguments,, but their proponents ate not easy Lo convince. In PI-T the Federal govern@-,ieiit has a good channel for worki-xig with the pr oV4@ders, but the relationship is not' al@Tayo easy to clarify. We r,,ust continue to emphasize the process and not only tile content of T.L@'@P in our judg- ments. The need is for a foundat4@on of utdersta6 dable judgments on which credibility can grow. B. Two bills to establish Area lik@altl, Education Centers have been placed before the Coti.@,ress.. One i:ould p ace the authorization. Title IX of the Public Health Service Act; the other, which is the Adtqinistration's 40 Page 6 Bill., i..,,otild the autl-"",-)rity in the National Institutes of licaltli. @le rest be pi-ctparcid for either eventuality, and in either case I;otii Lli@ and the @lanpo,.,,,er bureau of the NITH Ii),l f @L'i,(! their activities affected by the @o@,ram. pro-,@or,@il. J,s b-@ing presented as p,%rt of the propor,,Al for extension of. the II,-?olth 1-ianpoN,;er Act. C. The I-lillarci Cc,,-;@-,i-,ittee r<-,-,,,.-)rt has been circulated tuiiaii a litilitc;.,J nuiaber o,'@ adiiirj.@'L-I.',-t-tors and advisors, but has not -been pu bli,-hed. The Llo(--.,,,,ri.@nt was k(@,pt brief by desii,,n, and some of its Coll-CL-DtS are r-Ittier bro@,dl.y -stated. Soiie of its ideas alrea,-4y have been incorporated in testimony pre- sented before Co@igressicii-,,.-I coir.-@-nittees, and more will be 'presented, for example, in testimony oil Section 314 of the Public I-,'.ealth Service Act. Miss Cecilia 0-ozilrath, Chief, ContilyLli.ii.g, Educ,@ti,on and Training, RMPS, spoke on Council and ILNI? volicies and cb,'Ic-!ctiv,,s COTIcerri rip health manpower. At the turn cj--F the ce-@ttui.,y, 80 [, rcent of health Workers were l@i.D. 's, 84 percei-,,t of hc-altl-i i-.@orkers are not t@I.D. 's. About 70 percent of health worke-"s are x,:oinen; r@ny Of their jobs are characterized by, low 1)@ly, littlc for independent judg- Tac-nt, special turnover and dropout problems, entry at the high school level, and re-6titry throuoh established training or re-training. One of 11 every two.liealtli vTorkers entered with less than three years of college education. Ore of every five had less thin full hi@gh school education. Many jobs are routine, iiarrow in s--ope, and t-,everc@,ly limited in opportunities for adva-,icerieiit. R6fresher training for re-entry of dropouts, once entnusiastically advanced as a means of rclievin,,,, shortages of help has not succeeded as hoped . ... too many of the trainees limit their availability to part-time or intermittent fork. is going to be involved in manpovyer problems because it is the logical channel for provider contex!ns. With regard to our relationship to CIIP and NCIISR'u'D, I stated that it is important that !L','@P retain its identify and avoid assumption of CHP responsibilities. it is also irpportatit that P@kiPS and NCHSR&J) work mote fully together. I'he basic guide to RT%IP development now and in the csx;iing years iqill be foLizid in the Federal health strategy. If it is to be ot iiaxitiu-,P. service to this country F-.Mp will work with Pare 7 increasing effectiveness through all of the mechanisms v@hich arr 3-ocal etc.--to n@;,:-,inta-In or improve the quality of h@-altb care T,-hilc- cii,if@l,,,isi.zing increased accessibility, I)etter di.,,'Lribution of ranpu@,Tc-,r, greater-pro- .L -id incr@as.Ifig a ductility ol the health ,;yst@a-a-L fficiency in the delivery-of services. I trust you will find this sur,@iiiary ireful. Starting with the Au,"ust Co7uiicil we shall riail,these 'Highlights to you wJ.tiiin 2-3 days afte@- the Tiseting. Sincerely yours, I-larold ilargulj'es, M.D. Director NATIU,@AJ, ADVISOPY COU',\TCIL Yteeting @lay 11--l.2, 1971' RECOI-.A%Z,',NDliTIONS FOR ACTION APIZONA PJ,',GIO'L\IAT. '@,iEDICAL PPOGVAM PM 00055 5/71 (9uppl.erental) @o additional. funds are recommended for this Regional @ledical Pro-raiii at this t3-rqe. The request for additional core support is specifically, disapproved. 'fli e1,etioii ii,iry rebret-et c-,-\7.-tilabic @kt:ti--ds into any of tlie@projects in lin@ i-7i.Lh its o-,Ti-i priorities. This action coincides with Pevieig Co-,iiriiittee recor,,,i-@enclationl--. BI-STli:.rE Pi@GIO,@4,@ lj7l]DlCAL PROG@@l@l -- P,L@l 00056 5/71 (Suppl.einc-,Yital.). Additional direct cost funding in a reduced amount is reco;ren6nded as f olla@is: Ist year - $16,750 2nd year $15$850 3rd year $15,850 lihile the Pegioii may rebudget available funds into either of the two '@lication, Council coils iders projects included in this ap Project #16 - To Develol) a IfoeLel"for Test:Lr n Continuin Education - innovative and Project #15 A Publ3't EJucati.oii Proclyl-lin on Harinful Ej'fects of tLc@,I.@.tte Sinol Nyes considered I.ox.7 priority., This ac'Li.on coincides with the recoi@i,-,-.,,,,nda'tioii,-, 'of the Review Committee. '4/ -2- CAI,Ii@,01@\,-.LA PJ"CIOII.Al, @ll,@DICtg, Pi@O'JPI'ct-l iiil OOOJ.9 5/71.1 & 5/71.2 Sul)l)l crientil) Region may rebud-et available funds into Proi l@" 1 cct 4 Piticiit 'rlonitoriii-O (Area 1), in line with its own priorities. Council defers consideration of Project c Planilin.11 Effort of llc-gional Medical Progra-.is and Ilocle). Cities for Traiiiina in -the Allied Health Professions Area I pendi.nc, program site visit of Jui-ie-1971. This action differs frore, rov@le.-w Cc)i,,ir,@ttce recoiii:-Li@-ndatioi-is only in relation to Project L PPOGRl@.1 - PIl 0002.7 5/71@ @Si.-Tp IOWA R).,',GIONAL I"DICA Additional direct cost funding is recor,,incnded for the Iowa PIT as follov7s: Ist year - $43,500 2nd year $35,272 3rd year $36,719 Region niay rebudget funds into any of the projects included in the application except for Project #19, Rcinal Failure lfaiia-ementtrainiiig, in line with its own priorities.-- This action differs from the recoi,@iiiicndatio-zis of tb e Pevi ex,7 Couini-i ttee but incorporates the reconiinendations of the Ad Hoc P anel on Renal Disease. 'KMISAS PJTGIONAT, liF.DICAL Pr\OGRIIl - IUI 00002 5/7'1 -(Trieniiial) Tnis Region is approved for triennial review with direct costs fundinc, recoidpciidcld as foll-o@.7s: Ist year -.$1,800,000 2nd year $1.,800,000 3rd year $1,@00,000 3 KANSAS P@@T TONT. 0 The request for devclop,:,,c-litii funding is (lisi proved. p 0 Project #40, D6veloDinent of a Comprehensive Nephrol.o,(,,y@llo r@am, is a proved in line with the recon-.iiei-iclations with the special p !!review by a renal specialist and the site visit teci'ril., This action coincides with the recommendations of the Review Co,,qitiittee. Additional direct ftinris are recoi@if,., i-ieteei for this application as requested: $27,8-q6 0 This action coincides with the Review Committee recommendations. IFISSISSIPPI REGIONAL IIEDICTT, PPOGRAI-I - Pl@l, 00057 5/11 (Anniversary) No additional fuiidinv is recommend C> ed for the Mississippi @IP at this time. The request for developmental fundin-:i.s not approved. The Region may rebudget qvailable funds into the projects in the application, incl-tidip-- Project 7',117 Renal. Disc-cise Pro i@.iri in line with its priorities.. 'D A program site visit is recorc@n,@ndee,'to help this Regioiils core staff, RAG, and Planning Croupfoctis ri@rities on health needs p of Ilissis@ippians; staff assistance is also recommended. C) This action coiiici.dc-.s with the rccc),illllcil(la tion,-, of tlie- PCViC,7 COIIlll-ittc@c J. ,qlli-l ii-iroync)rates the -t(lv'@ of the Ad Iloc -icl on Di@ccascs. MISSOURI REGIONAL 1,11@ DI.CAT, PI'loc@@%M @l 00009 5/71 (Trientil.al) This Recion is approved for triennial review at the followin- direct cost levels: Ist year - $2,500,'OOO 2nd year $2,012,000 3rd ye ar $1,825)000 The request for developmental funding is disapproved. 0 The recommendations of the Pevie@-7 Coiiii:ni.ttee regarding funding -allocations a'won,- the major program elements should be-conve ed y to the Pegi.oii. This ac'L-ioii differs fro7,il the revive., Co-cii.-IiitLee only in the level of fui-idi-n-. reccr.-!iiieiidc-d for the first year. Council felt that $300,000, rather than $250,000, would provide for more orderly phasing out of the computer ind bioengincering activities. MOUNTAIN STATES PECIO'2,t@L MEDICAL PPOGRUL PIl 00032@ @/71 (Trieiini@-il) This Re-ion is approved for triennial review -vTit@ direct cost funding levels as follows: Ist year $1,741,000 2nd year $.@,511,000 3rd year $1,366,000 !he request for developmental fundin- is approved. 0 Funding for Project #3P, I-lountain States Tumor Institute is approved for two additional years only. 0 The interest in foriiiinc, a separate Nevida P,@iT is recognized; at such time as.,,i-,i application is received aTie, icted upon, the funding recoi7-b-.nended for the I,,'otinta-i-ii States P,@T will have to be reviewed also. qp 5 IIOU',\7TATN STATES R@IP. CONT. his action coincides with Povic;-i Corzn@i ttec rccomniendations. NASSAU/SUFI,'OI,K PJ,',GIONAT, @U,,DICAI,,PPOGItA@l li'M 0001.6 (Triennial) 'Operational status is approved for the ,M-IP 0 Three years direct cost funding is recommended as foll@,is: -2nd year - $868,408 3rd yea $908,043 ;Ist year - $829,755 r A site visit should be made to revie@-7 progress during first' year. 0 l@irst continuation application should be rc.-vi.r-,N7ecl by Coi--@,iittee and Council i-7ith idea of increasing funding level if proaress permits. C) This action coincides. xyitli reco,,,iriendati.bbs of Revie@-7 Committee except That Council did not develop a policy on computerized El-,,G as requested by Committee. Council requested a staff paper on this subject for consideration at a later time. Theref6rei the Pegion is hot prohibited from utilizing its funds-for this C> activity if pro-ram priorities so dictate. NEP,RASY,& REGIO,@IAL I-ff-,DICAI, PROGRAT-I - IU,-l 00068 5/71 (Triennial) Status as a separate PI-T is approved for Nebraska. Three years direct cost fundina is recommended as folloi@7s: Ist y@ar - $790,070 2nd year -- $790,070 3rd year - $440,653 C-) R6&ion should be advised of serious concerns about direction of program. A site visit should be made to assess' regress duri.i-i,, next year. NEI'lu.S[,,k KiP CO@T.T. @irst year coiiti.iiuiti-oii aplilicatj-c)li should be revi@.!cd by Cornittee and Council. 0 This action coincides with ReA7ic-,7 Coiii.-iiittee recop)w.Lnditi.ons except -for level of funding recommended for third year. Council feel.s that Pegioli must rovide- -more substantive information about plans p to utilize ftinds cturin- third year. NOTI,Tll CAROLTT!A r,@Ll 00056 5/71- This I'C'gion is approved for revick@,, i-I'tn 'the direct tost levels lst year -- $2,01,"I,000. 2n,-i year $2,0-1,19,000 3rcl year $2,049,000 C) The r6quest for developmental funding is approved. 0 A specific.exception is made to Council policy regarding support of basic education for Project #32 - Career Ladder tication. C,, The funding level does not take into 'consideration funding for Project #28 - r c-,-of Patients with Chronic P-r @ s -11- f 0 r tli Cl- C -1 r Urei-ii,-t-x.ihicli is deferred for further technical review. This action coincides with recorlip,,encl@itions of both the Revic',-7 'Committee and the Ad I'LOC Panel on Peiial. Diseases4 NOP,ffli-@A@STIIPJ@i 01110 F.EGIO,'itJ-. I;FiFDTC-,kT, Pl.",OC,P,-*i -- P@i 00064 5/73. Funding is reco7i-@i-tieii(lecl at the committed level, $78(j,1.87, f or one additional year.. 7 NOP,Tl',t2ASTEI""%, 0111.0 Ri@113 COiiT. 0 The I'@cioii may r oc the ebudget available funds into any proposed nexq projects, exce;t Health (:,Ireel,s in Ohio, in @line with its ox-in priorities. 0 laIPS staf f should explore x@iith this Region, as well as other 'Regions serving Ohio residents, ways to provide a more effective, efficient organization for regional medical prograiiinting in Ohio. Council bel.ieves it may be necessary to ba-,7-c at I.eest two l@,',..iTs serve the. Sc.E',tc-t, but a unified should also be expl-.o----c--d. 0 Site -visits should be made is necessary. 0 This action differs from Re-vic7ti Cdniriittee recommendations in that an alternative other than one Ohio rIIP is suggested and that the 'number of site visits may be negotiated. NOXflll,.T@,STEP,'L\' 01110 REGIONAL @IEDICA@T, PPOGRA','!l P,,,,l 000 63 5Li-iniversar 0 Funding is recommended at the J'ollo@.7i.pg direct cost level for one year only $687,304i 0 This.retoin,,nandation provides for continuation of core and on-goinc, activities at present rate of expenditures, licrvievc.,-r, Recion may rebudget available funds into new projects in line with its own priorities. 0 RI.1ps staff sbbtil.d'explore x@7itli this ret,ion as well. as other Regions serving Oliio residents, ways to provide! a more effective, efficient oroanizati.011 forr,--cioiial iiiceticil in Ohio. Council L) 8 NOP,'Fll'vT],"STI'lUq 01@'10 CO@.,!T. believes it iii@.y be necessary to liive at least two R@[Ps serve the State but a unified r@ll) should also be explored. Site visits should be made as necessary. The request for developmental fLindinc, is disapproved. 4D This action differs from Review Committee recommendations in that an alternative other than one Ohio ILT-EL-' is sLicrgestecl andtth@it the i-iur.,.I)ei: oj' si La viEj.ts in-ciy be :r Orlio r)Ti'@CF R-@,l 000?2 5/71 The reqLl,---St for tri-ai7Ln-i?-al stati-iE-, i.E. e@erii.ecl: f-Linctinc, at the committed direct cost level is recoii-LY.,eiided for one year only as f ollox-7s: $714,075. The request for developmental funding is disapproved. 0 The region may rebudget available funds into projects included in this application, with the exception of Ilcal.th Careers in Ohio (core), Project #29 - P@oire Dial.vs4-s Program and Project #30 Program for Hypc@rtension Detection, in line with its own priorities. MIPS Staff should explore with this Rc-.gton., as well as other Regions serving Ohio residents, ways to provide a more effective, efficient organization for egional medical prograiriuiinc.,- in Ohio. Council believes it Pl@ty be necessary to have at Ic,-tst two IUlPs serve the State, but a unified P@Pi. should :ilso be m,,I)I.orc@d. 0 Site visits should be ir,,idc, aq-necessiry. OIIT.O STATI' CO:@T. 'Tlic- COLITICI-I. c i.nci-cle-s with '.'OcOTt; of Ad lioc Panel on 0 Ronal Disease regarding approval of Project #?7 Cadaveric Transplant Pro"i.-,iffi ind i't28 Pediatric Nel)lir ter, but no additional- funds are recolqBl--nded. OHIO VALLEY PRGIONAL liT-,DICAL PPOGRAil - Pit 00048 5/71 _(c;i@i ll-eL@i -ntcil@ Additional direct cost funding is r(-@coiiiinended as follo,@7s: lst year - $'@8,610 2nd year $96,410 3rd year - 198,360 'Re c, i on DAay reL@ud-et funds into'erLyep@-oiccts i.iicluded'i.n tnis application, e.--,cept that. Coulic:Ll the a.ev-@@abi!:Lty o initia',-.j.iig Project #21,, Intensive-! '@NtirEcs. Tr iniiilc;, at this point in Re(., -a ioii's devel.6pnieiit. '0@ This action coincides with Review Conmittee reconiniendations. OKTAIIOILK PEGIO!@AL I-j'-r])ICP.T- PP\OGPl@ci -- RYi 00023 @/7 ('Trien l@o.. The request for triennial fundino is'clisappilov 0 ed; direct cost fundin- for one year is recoiirLiciided as follo-@..,,s: $913,500 0 The request f or developmental f t!L@di-n- is disapproved. 0 A site visit is recoriii-tend6d to assist this Regioiial Medical Prog-cEini in d(ivelopi.licy specific @oals and objectives, before it submits a Triennial ippli-cation next Febrbary. This action coincides with rc-vic.@,.7 Co,,r.Iiiiittee recor,-!Die-.-idations. I PUF,,P,'FO PJCO RI@GlOlj4AT, Rlvt OC)065 5/71 (Aiini ersii-v) 0 Fuiidii-ic, is reco-l!@i(-,iiclc-.cl for Rei,,-i-on's c"e,cond operational year at the direct cost level,: $989,@62 -10- I"UEI','TO RICO PIiq" CO@IT. -nt@-1 fui-icliiic, is disapproved. The request for dovcl.opml. Region may rebudaet available funds into any project included in C> this.application in line with its priorities. C) !This action coincides with Review Committee recommendation. SOUTH CAPOLU@4 REGIONAL @1EI)ICt.T, PPOR,PAM - P-M 00035 5/71. (T)-iennial) Region is -ri)proved for triennia fundin.-@ at the follo@.,,inc, direct cost levels, ending favc)a:@ible si.tc-,, visit report on Project #55 p Chroi-iic I)isc.@ase LOLiC,,it.-i.o;i a-.i,-, SE@a.-vice lst year -- $1,550,000 2riet ycer --- $1,550,000 3rd year $15550,000 Request for developmental funding is approved.@ Region may rebudaet funds into projects included in this application in- line with its o-v7n priori-tics, except for those activities precluded by Council policy; i.e., Project #52 Ileilth Manpower and Fel.lo@t7shi-ps and #46 Ilelpatol.opic @i'al@ iian i@c-,.,,; .0 This action incorporates advice of Review Committee and the Ad Hoc Panel on Ronal Diseases. -GIONAL IFEDICAI, Pl',OGPAM Pd-I 00059 2 SUSQUEHAINNA ITALLEY I'J, /71 & 4/7.1 (Deferred suppl@e-aiaiit C,- Approval of $1.00,000 supplemental funding is recoril-.endcd for one year with following conditions: tliat,the'Regi.on engaoc effective leadership on its core staff; C, 0 that the Pe(-io.,-i study and m@ilce ii@essary cli@ii-i-c!s in the PI.IP organization to assurc@la viable Pc@ioiial Advisory Group, viable L> medical- center iiivolvc,,iii.@i-it iii(I a viable [,,@aii t C2. c, SUSQUI.'I!A.N'NA VI,@l,I,YY P@it) CONT. iliit P,@@TS iril@e available Sufficient, e xperi.enced staff resources to assist Region in its study and subsequent chan-es. program C> The request for developmental funcli-n- is disapproved. This action essentially Coincides with recommendations of the Review Coiiini:ttee. TRI--S'Z"TE IIJ-'GIO' I Oc)olo2 C-, Action oil the application for fiiiiciiiif, a lqew Enalaiid Facilities f or @.rr@d p---. Oj-T).C, Co"!-,-IC, 3- SttlCl'%7 on technical. site visit report. This action coincides with the recommendations of the Pdviev7 Committee and the Ad Hoc Panel on Renal Diseases. I-IE-STEP,i PJ,,tT4SYI,VANTA REG10iiAT, li.PDICAL P]'O,-"Ptill -- Pi@',0001@ 1 5/71 (Trieiinicil) Approval for triennial funding is recommended at the following direct cost level: 18t year $1,450,000 2nd year-- $1,450,000 3rd year $1,450,boo The request for deNelopmeiital fundin- is appXoved. Funds fox Project #14 Renal Disease - are disapproved as reconwiendecl by the Ad Foc Panel. on Renal Diseases. cl Re ion may rebudget available 'funds into ally proj,ect included in tli e application provided they ire consistent with Council. policy.. 12 I-Tf,;STEPT4 Pl@,N.,'iSYLVAlilA l@,IP CONT. -ans C@ Council notes that the Recioii has not presented specific p] by pr-oject for some of the funds requested in the second and third years of the triennial period. If MTS staff 'sliould .find a disproloi-tionate.share of the funds proposed in the second and third years are for activities not previously st.udies by Council, the application should be reviewed by Council at that time. This action essentially co-'Lnciclcs v7ith recoryne-adotions o L' P,C-'Vi.e%-7 CO-l-@l' ttCC,. KIPS GRB 6/3.1/7J@