B&B INFORmikirlom IMAME MkNA=L-mENy 300 @iftcc Mmances aoulxv Ulmonew Kl%"LA=sto, Ma P40 Z077Z 11 U SA 0 920 I 3 24WO I I 0 DEPP.RT14EN-T OF HEALTH, ED@T,-,ATION AND WELFARE PUBLIC HEP@T-T',-l SERVICE National Advisory Council on Regional Medical Programs Minutes of the Twenty-seventh Meeting I/ 2/ June 5-6, 1972' The'National Advisory'Council on Regional Medical Programs convened for its twenty-seventh meeting at 8:30 a.m. on lt,6nday, June 5, 1972 in Conference Room 14.of the Parklawn Building, Rocl,,ville, Maryland. -Dr. Harold Margulies, Director,',Regional Medical Programs Service presided over the meeting. The Council Members present were: Dr. Michael J. Brennan -Dr. Clark H. Millikan Dr. Bland W. Cannon Mr. Sewall 0. Milliken Mrs. Susan L. Curry- Mrs. Mariel S. Morgan Dr'. Michael E. DeBakey Dr. Alton Ochsner Mr. Edwin C. Hiroto Dr.'Ruasell B. Rot@ Dr. Anthony L. Komaroff Dr. George E. Schreiner Mrs. Audrey M. Mars Dr. Benjamin W. Watkins Dr. Alexander M. McPhedran Mrs. Florence R. Wyckoff Dr. John P. Mqrrili Dr. John D. Chase 3/ Dr. Gerhard A. Meyer A listing of RMPS staff members and others attending is appended. Doctors Chase, DeBakey, Millikan, Ochsner and Roth-were present on June 5 only. Dr. Brennan was present beginning on the afternoon of June 5.' I. CALL TO ORDER AND OPENING RElans The meeting was dalled to order at 8:30 a.m. on June 5, 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 called upon Mr. Baum to make some routine announcements concerning the conduct of the meeting, dinner arrangements and Council materials. Proceedings of meetings are restricted unless cleared by the Office of the Administrator, HSMHA. 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 themselves 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 discussto 3/ R@'prese'nting Dr. Marc J. Musser for the Veterane.Administration. -2- II. CO;-SIT)ER-@@TT@)" 0!7 @LIL@ OF Tlli: 17@-BPUA-PY 8-9, 1972 IfrF.Iflilll@, The Council considered and avproved the Minutes of the February 8-9, 1972 meeting (Transcript, Vol. 1, page 8) III. It,,TROI)UCTIO,@'t Or GUESTS AID NEW R,"S PROFESSIONAT- STAFF Dr. Margulies introduced a number of guests attending the meeting and two nei7 members of the RMPS professional staff, Dr. Larry Rose, Senior Health Consultant, who is in charge of Em2rgency Medical Systems activities in the Division of Professional and Technical Development, and Mr. Robert Walkin-ton, Chief, Evaluation Branch, Office of Program Planning and Evaluation. IV. CO',%TIRMATION OF FUTURE liv-rTING DATES The-Council confirmed the following future meeting dates which had been set previously.- (Transcript, Vol. 1, page 10) October 16-17, 1972 February 7-8, 1973. June 5-6, 1973 V. REPORT BY DR. MARGULIES A. Budget Outlook After considering all the variables, the maximum amount that may be available to RNPS for obligation in Fiscal Year 1972 will be about $112 million. RMPS is prepared to utilize that full amount with no difficulty because oi the variety of activities which it has developed. It is too early to predict what the final outcome will be with respect to the Fiscal 1973 appropriation. The Department's request was for $131 million, which contrasts sharply'with the previous re- quest for.$52.5 million obligational authority for FY 1972, and apparently recognizes a rising interest in what Regional Medical Program are doing. Various other proposals range up to a maximum of $229 million. B. Pulmonary Pediatric Centers The Congress has required through express language in the FY 72 Appropriation Act that pulmonary pediatric centers be funded at the level of the preceeditig Fiscal Year. RMPS will, therefore,be receiving a number of pulmonary pediatric activities in order to maintain a $1.7 million total for such centers. C. Automated Multi2hasic Health Testing The Council's attention was called to the'report of the conference on automated multiphasic health testing which vas held in Rockville, -3- I,,Iaryland an I:arch 8-9, 1972. The conference was called in response to the Council's request for additional information on the status of 12 automated multiphasic health te3ting projects funded by RMPS. There was considerable discussion of one project summarized in the report which showed that only 507. of those persons referred, as a result of screening,actually see a'physician. Dr. li',argulies indicated that questions raised in'the discussion exemplified the need for further study of the u@ility of Ah-,iT before further in- vestments in these kinds of activities are m--d6 by RMP. The Council raised no objection to the Report or its major con- elusion that the RITS moratorium on funding of @ET projects be continued. (Transcript, Vol. l,'page 50) D. Three-Cycle Review of Grant Applicaftions The shift from 4 to 3-cycle review'is taking place smoZhly. Anniversary dates have been changed as necessary, and RtiP'a is negotiating new levels for affected regions on the basis of their new fiscal years. In-the process of shifting to the new 3-cycle system, RMPS was able toachieve two other things. One is to.schedule staff visits to the regions three to four times per year,on a regular basis, giving greater attention to those regions which have shown up poorly in the review process. The other is to cut down on staff paperwork.which accounts for the changes in some of the materials being provided to the Council. E. Regulations. I)r. Pahl and Mr. Baum discussed proposed draft Regulations. The draft provided for consideration of the Council was developed in legal form and language by the Office of the General Counsel (OGC) to reflect both the current RIIP legislation and current program policies and-procedures. RMPS staff has drafted several additional sections to be added to the mater ials drafted-by OGC. These relate to Grantee-RAG-Coordinator relationships, Section 91-0, and con- struction projects. Dr. DeBakey and others expressed the opinion that certain language appeared to rigidly set ranked priorities for certain types of activities which Dr. Margulies and Dr. Pahl indicated was not the intent. Other objections were raised to-the use of the term "care" without an adequate definition. The Council was advised that M2S would revise the material along the lines suggested, and resubmit the revised draft at a later date for further Council consideration. I -4- F. Coordination with National Cente-r for H--alth Serxrices-Research and DevelopT-.2nt Dr. Margulies called u-on Dr. Rob'prt Van Hoek, the new Director of r the National.Center for Health Services Research and Development. Dr. Van Hoek stated that through its programs, the Center would participate in and carry out studies on how health services are delivered, the components of the related service activities, and their effectiveness. He indicated-that appropos of the previous discussion of multiphasic healtir testing, one of the Center's main concerns is the level of patient acceptance, patient followup and other response to whatever professional guidance may be viven. Another area of emphasis for the'Centdr concerns resource utili- zation and productivity. Efforts in this area will focus on testing techniques which can measure proficiency and productivity and feed necessary information into the educational system, as well as .licensing and certification programs. G. Delegation Concerning Educational Projects Councills attention was called to the-need for a new delegation of authority to.enable the Director, RMPS, to fund small projects (under $50,000) stemming from the.January St. Louis conference. The projects in question are community based extensions of RMP activities which deal with educational goals appropriate to Me. It was moved, seconded and carried that the delegation be approved. (Transcript, Vol. 1, page 64) The.resolution,as passed,is reproduced as Appendix A of these Itinutes. H. Remarks by Mr. Chambliss Mr. Cleveland Chambliss, Director, Division of Operations and Development, reported that four members of the RMPS Review Com- mittee: Drs. Spp-llman, Besson, White and Mayer would be completing their terms at the end of June. Dr. FAayer', the present Chairman of the Committee,will be succeeded by Dr. Alexander M. Schmidt. Mrs. Maria Flood of El Paso, Texas',has accepted an appointment'to fill one vacancy on the Committee.. Specific individuals have been invited to fill two other vacancies, but have not yet responded. Mr. Chambliss also discussed a General Counsel's opinion relating to rights to and income from materials developed with grant funds (video-tapes being the case in point). The grantee can sell or otherwise dispose of the rights to such materials without prio'r HEW approval. The Department retains the right to reproduce such material,irrespective of copyrights by the grantee or others, and any income up to the cost of production is treated as grant related income. Such income may be recovered by BMS or waived to.the grantee for grant related purposes. I.,..Governin,q Principles for Discretionary 'Funding Council's attention was called for information purposes to a proposed policy statement entitled, "Governing Principles and Requirements, Discretionary RMPFundings"' dated May 26, 1972. The stater-3nt, reproduced as appendix B of these ixint,-t--es, tries to set forth general principles for rebudgeting funds by regions within their level of support and also states the conditions under which prior RMPS approval must be obtained. No.objections to the pro- posed policy were expressed. J. Grantee and Regional Advisory Group Responsibilities and Relationships A second proposed policy was brought before the Council for ex- planation and action. This relates to "Grantee and Regional Advisory Grour responsibilities and Relationships." Dr. Pahl called the Councils attention to the salient points of the proposed new policy. Among other things, the Council's attention was specif ically called to the following key statement in the draft: "The grantee organization shall manage the grant of the Regional Medkcal Program in a @nner which will implement the program established by the Regional Advisory Group and in accordance with Federal Regulations and policies." This language is intended to makd it clear that as a matter of policy the Regional Advisory Group and not the Grantee is responsible for establishing an RMP's program.. It was also pointed out that the statement clearly indicates that the Coordinator is an employees of the grantee, and that he is nominated by the RAG,but selected by the grantee. Similarly, the RAG Chairman is selected by the RAG and confirmed by the grantee. These procedures are designed to insure that both the Coordinator and the RAG Chairman are acceptable to the RAG and Grantee alike. It was 'moved, seconded and carried that the statement be approved. (Transcript, Vol. 1, page 112). The statement is reproduced as Appendix C of these Minutes. K. Kidney Guidelines Dr. Hinman reviewed the new kidney disease "Guidelines and Review Procedures Statement." The guidelines require that each kidney proposal be reviewed at the local level by at least three kidney experts who do not reside or work within the Region submitting the application. The written comments of these reviewers would be.pre- sented to the Regional Advisory Group. The RAG would approve or disapprove the project and send it in to RMPS where it would be presented to the Review Committee for priorities concerning funding, but not for further technical evaluation, There was-extensive discussion of two points concerning the policy as a result of which it was decided that WeS would issue a clarification.of the term "full-time transplantation surgeons," as I -6- used in item 6B on page 2 of the,guidelines document. A proposal advanced by the Review Co=ittee that technical reviews be conducted only by experts selected from a roster maintained by RI-I?S ( i.e., a closed national panel) was not accepted. Subsequent to the dis- cussion,it was moved, seconded and carried that the guidelines be approved as presented with a letter to be distributed later clari- fying the meaning of full-time surgeon. (Transcript, Vol. 1, page 124). A copy of the guidelines as discussed, is attached as Appendix D of these Minutes. VI. INPATIEI,'T BI-IDS FOR SETTTLE C-AN"-'ER CENTER Mr. Richard Russell, Acting Chief, Western Operations Branch, reported' to the Council on the applicant's justification for 20 inpatient beds' in the Center. This material was submitted in resRonse to the Council's previous recommendation that "the provision of space to accommodate 20 beds which were isolated from the Swedish Hospital Medical Center be reconsidered withfurther justification for review and approval by the Council."@ Mr. Russell also reported that three other conditions to the grant., which were previously set by the Council,had been met by the Cancer Center. These were: (1) that all rel4vant State, Federal and local requirements for the construction of the,proposed type of facility be met,--(2) that the'University of I..Tashington and the Swedish Hospital formalize their relationships with the Cancer Center, and (3) that all conditions contained in the Council's November 10, 1971 statement on a Cancer Center to serve HEW Region 10 be satisfied. Subsequent to the report, it was moved, seconded and carried that the grant award be approved, including approval for inpatient beds in the Center, on the basis that the other conditions established by the Council had been met.. VII. EMS PROJECTS -Dr. Margulies introduced Dr. Leonard Scherliswho served as Chairman of a special committee which reviewed proposals for grants for Emergency Medical Systems. Dr. Scherlis described the review of EMS proposals. The Committee reviewed 35 proposals requesting a grand total of $33 million for three years. Of these, 5 were disapproved, and the remainder recom- mended for funding in the total of $11,663,059 for the three year period. Dr. Margulies raised the question of whether funds recommended for EMS should be treated as raising the level of commitment for the RMPs involved. After a-ilrief discussion, he stated the sense of the Council to the effect that the "emergency medical activity'is of high priority. and should be given full consideration in any executive funding." Subsequently, it was moved, seconded and carried that the recommddations of the special EMS Review Committee be approved. (Transcript, Vol. 1, pages 143 and 147.) Specific amounts.approved are shown in Appendix E of these Minutes. I VIII. PROPOSALS FOR, RMP HEAI;i-ll SEP,',FICES' E-DUCATIO.4 ACTIVITIES Dr. Fargulies called on Dr. Warren Perry, a member of the RMPS Review Committ,r.e who served as Chairman of a special review group established to review request supplementary requests frpm RI-lPs for educational programs. He indicated that these proposals are largely an enhancement of what R-MPs have been doing for a long time to iL-prove the education of health professionals and the relationship of that education to the delivery of services. Because of uncertainties about funding, the projects in question ha%,e been clearly separated out from anything that.appeared to be an area health education center as originally or currently defined. Dr. Perry indicated that requests were received for $10,229.,881 and that, of these, a grand total of $6,874,996 was recommended for approval. He described-the review process and cited a number of the specific proposals. He indicated that several factors had led to disapproval of - some proposals. These factors included excessive emphasis on contin- uing education, need for more adequate community involvew@ , availability of alternative funding, and lack of key components of the consortium. Dr. Maraulies then called upon Dr.' Chase with respect to the VA point of view concerning educational activities of the type under consider- ation. Dr. Chase stated that the VA is enthusiastic about the approach and is again con=itting another $3 million as its contribution for the 1974 Fiscal Year. Next, it was moved, seconded and carr3.ed that the special.Review Committee a recommendations be adopted including a list of priorities for funding included in the group's report.. (Transcript, Vol. 1, page 215) A list of individual actions and priorities included in the action is attached as Appendix F of these Minutes. IX. SPECIAL ACTION FOR INCREASES IN NAC-APPROVED LEVELS FOR CERTAIN REGIONS The Council was requested to increase the approved level for six Regional Medical Programs. These increases would permit the funding of pediatric pulmonary centers in accordance with Congressional action, and would provide RMPS with flexibility in dealing with'requests from certain Regions where actual funding'either was at, or approaching -the Council-approved level, and where.progress indicated a possible need for additional funds during the extended period established to phase all regions into the new review cycle. It was emphasized that funds would actually be awarded only after consideration of specific requests from the affected Regions. It was moved, seconded and carried that the levels be adjusted as proposed. (Transcript, Vol. 1, page 222) A list of the individual Regions and the specific amounts included in the Councills action is attached as Appendix G. X. HEALTH@MAINITEI;ANCE ORGANIZKTIONS The use of RMPS funds to support feasibility and planning studies was debated-vigorously and at length by the Council. Extended discussions on this subject took, pldce'at several different points in the meting and involved at times the Administrator, Dr. Frederick L. Stone, Special Assistant to the Adni-nistrator, and Yx. Gerald R. Rir:,o, Deputy Administrator for Developnient. None of them were present during all of the discussion. Dr. Gordon MacLeod, Director, Health Maintenance Organizations Se-vice, HSM9-, was'l.ntroduced to the Council.' He described the PILOS review process and asked the Council to consi-der block action on 29 projects for $4.3 million as reco,-manded by the lil,'IOS review. He indic' --c-d that there is existing authority in the lUfP and other legislation to do certain things with respect to the health care delivery system in the country, and stated specifically that the Office of the General Counsel has issued an opinion authorizing the utilization of RIT money for HYO activities if the activity is limited to fhe planning and developmental phases. Dr. Roth raised the following'points: 1. It,is premature to foster new HY-,Os in the absence of specific legislation, appropriations and a legislative definition of an HMO. Presently such legislation 'does not exist. Pending HMO bills differ and have little chance of passage in the current Congressional session. 2. HMOs are no longer experimental. Thirty existing groups which serve 7.5 million people have been formed without Federal funds. 3. There is a question as to the'legality and appropriateness of using RMP funds to support HMOs. HMO projects relate to develop- ment of a reimbursement system rather than the dissemination of knowledge or development and use of manpower. 4. All of the RMP funds reserved for sup@ort of HMOs should be released to RMPS., The program is not limited to the-support of Regional Medical programs and has great flexibility under Section 910. Dr. DeBakey advanced the following opinions: 1. There are no Congressional earmarks for HMOs. 2. The Council should be consulted on the use of appropriated funds. 3. There is a question of whether HMOs, given the limited resources available to RMP, should have sufficiently high priority for RMPS, funding. 4. There has been inadequate advance discussion with the Council of the substance of HKO proposals, and there is insufficient evidence that the support of HMOs advances the Regional Medical Programs, particularly within the intent of Congress. -9- Dr. Cannon, Dr. Komaroff and Dr. Wat@ins, who participated in the final ILYO reviews in Washington as representatives of the Council, reported that: 1. Thc'HMO review process-is adequate.' 2. Thirty eight percent of the HMO applications did not include an educational component which is essential to initiating some quality control. 3.. The subcommittee did not consider the desirability of usinc, RMIS c; funds for the general support of PNiOs. Other points brought out in the discussion by various Council members were: 1. RMPS funds should not be tapped more than once for HMOs. 2. There should be no objection to RMPs initiating or participating in 11.1,10 related activities. 3. The Council has repeatedly taken the position that a quality .control element should be an integral part of every HMO. Dr. Margulies served as the princi pal spokesman for the HSMHA position in favor of'funding the HMO proposals. He indicated that the Department had every reason to believe that HMO legislation would have passed months ago. He pointed out that every government administrator has to find the resources to anticipate new programs and, indeed, Me would have benefited from preparatory work prior to the passage of Public Law 89-239. In line with this, the Secretary has indicated in testimony to Congress that RMP appropriations would be used-only once for HMOs, and would -not be used for-such purposes again. No RMPS grant or contract funds have been used to date for HMOs except for intra-RMP, IMO-related activities. Because of the slowdown in HMO funding, all of the RMP funds reserved for this purpose will not be utilized leaving additional funds for the regular RMP program. Dr. Margulies further stated that it.is not possible to have good -control programs in a poor delivery system. Allocation of UIPS funds on a one-time basis will be a useful investment in improving delivery. In addition, the funding of HMOs involves considerations that extend beyon d the RMP program alone. A narrow definition of program pur- poses by UIP and other programs would impede innovation and encourage fragmentation of Federal efforts. By a narrow margin, the Council voted to approve the action recommended by HMOS with a stipulation that a quality control element be included as an integral part of every project. Further.discussion showed that the Council was uncomfortable with its-action, and it was moved, seconded and carrie.d, with one, dissenting vote, that the previous action on.HMOs be set aside, and that a subsequent ballot be taken either by mail or -lo- another meeting of the Council aftei- provision of further information demonstrating how grant funds for 13,MOs would contribute to the purposes of RM.P. (Transcript, Vol. 1, pages 197 and 200.) Additional information was mailed to the Council members and the following resolution passed by a substantial majority: "It was moved and seconded that the National Advisory Council approve the award of grants under 910(c) authority of $4.3 million to the 29 In.Ds selected by the IU-IOS review process for continued planning and development with the understanding .that RMPS grant support would be limited to one year and that adequate. attention be given to the quality to be provided. Council mem- bers have been assured by 1.1,SMHA staff that such grants can be made within authority of 910(c) and it is understood that an affirm- ative vote on this issue is conditioned by that assurance." X. CONSIDERATION OF RMP APPLI-CATIONS A. Northeast Ohio Moved: Dr. Schreiner. Seconded: Mrs. @rgan Approval at the recommended level of $600,000 (Transcript Vol. II, pg. 229, lines I and Z) B. Ohio Moved: Dr.'Schreiner Secot,ded: Mrs. Vars Approval of the Review Committee's recommendations for disapproval of the 3 kidney proposals and approval of the general funding level in the amount of $1,200,000 for the 01 year and $1,305,000 for the 02 year. (Transcript, Vol. II, pg. 234, lines 3-8 and 23-25.) C. Nassau Suffolk Moved: Dr. Komaroff Seconded: Dr. YxPhedran Approve "the Review-Co=nitteets recommendation on Nassau-Suffol@ for $1,099,000, and approve the plan of' joint funding of the RMP and CHP provided that both advisory groups vote in favor of that and defer a recom- mendation on the regional project." The vote included funds for a kidney project for a regional owner-donor program in the amount of $27,060 for the first year. A second kidney request for a home dialysis training pro- -gram was.disapproved. (Transcript Vol. II, pg. 38 and 39; vote pg. 41, line 15,) tMr. Milliken absented himself during the consideration of this application. D. South 6a'tota Moved: Dr. Cannon Seconded: Dr. l.@cphedran "To'fulfill the request of $424,662 and to expedite the fundinrv of the E!4.s and health services education program." (Transcript, Vol. II, pg. 41; Vote pg. 46, line 8.) E. Missouri Application is for second year of triennium.. It was brought before the Council (1) because increased fundd were requested; (2) the I-,eview Commitpee recommended a reduction in the committed level; and (3) a technical site visit for the computer project resulted in an unfavorable report. Moved: Dr.-McPhedran Seconded: Dr. Komaroff Disapprove funds for the automated El@'G, automated physician's assistant.and bio medical information service. Disapprove the Developmental Component. Approve a level of $1,625,417 each for the 02 and 03 years of the trennium and recommend that a site visit be conducted during the summer of 1972 to ex press the Council's concern with the Region's poor performance and io clarify areas of misunderstanding. Dr. Margulies agree4 to bring the Region's next anniversary application before the Council even through still in triennial status. F. Nebraska Moved: Mr. Milliken Seconded: Mrs. Wykoff Approve a funding level of $725,,OOO for the 02 year and a tentative recommended level of $@00,000 for the 03 year. Advisb the Region to utilize the $25,000 above the requested program staff budget for initiating small planning and feasibility studies which result in short-term pay-offs. Disapprove' the two kidney disease activities and advise the Region to develop a statewide kidney plan. (Transcript, Vol. IT, pg. 80, lines 1-20.) G. Oklahoma Moved: Dr. Komaroff Seconded: Mrsi Mars Accept the recommendation of the Review Committee that the Region's current level of $739,000 be -12- increased to $839,000' Advise-the Region to recruit a strong coordinator, strengthen the advisory group, encourage'subregionalization and relationships with CHP. Also advise the Region to continue the initial experimentation with health care delivery issues shown for the first time in the present application. (Tran- script, Vol. II, pg. 82, lines 12-35.) H. Oregon Moved: Dr. YicPhedran Seconded: Dr. Ilatkins Accept the Review Conmittiae's recommendation for an award of $921,530 for the 05 year with no developmental component. Award a developmental component of $75,000 for each of the next two years and provide $250,000 of growt-5 funds for those years to cover the costs of the patient transportation system development, computer review system, development and patient orientation study. (Transcript Vol. II, pg. 89, lines 2-13.) I. Puerto Rico Moved: Dr. Brennan Seconded: Mrs. Mars Accept the Review Committee's recommendation for $1.1 @million authorization for the third year-for the Puerto Rico Regional Me dical Program (Transcript, Vol. II, pg. 92, lines 8-10.) J. Mississippi Kidney proposal Moved: Dr. Merrill Seconded: Mrs. Curry Recommend for all three parts in the total amount of $183,634 direct costs for the first year, $161,915 for the second and $120,403 for the third. K. SARP Reco @ ndations Continuing Applications from the following Regions which were reviewed by SARP and proposed actions by the Director were called to the Councills attention: Kansas South Carolina Mountain States Western Pennsylvania North Carolina There were no Council comments with respect'to these applications. (Transcript, Vol. II, pg.,94 and 95.) -13- I hereby certify that, to the best of MY knowledge, the foregoing minutes and attachments are accurate and complete- 14. D. Director Programs Service Regional Medical -NATIO',\'AL ADVISORY COln@'CIL ON REGION.AL IEDICtiL PROGRAMS Appendices to Minutes of,June 5-6, 1972 treating Appendix A - Delegation Concerning Educational Projects Appendix B - Governing Principles and Requirements, Discretionary RMP Funding Appendix C - Grantee and Regional Advisory Croup Responsiliilities and Relationships Appendix D - Kidney Disease Activities ---Guidelines and Review Procedures Statement Appendix E - Action on DIS Proposals Appendix F - Action on Proposals for MV Health Services' Education Activities Appendix G Action for Increases in Na'tional Advisory Council Approved Levels for Certain'Regions Appendix H Action on HMO Proposals Appendix I Attendance List APPENDIX A DELEGATION OF AUTIIORITY FOR APPROVAL AND r@ UI\TDING OF CO@DMi'ITY BASED EDIJCATIOINAL ACTIVITIES FEASIBILITY STUDIES -The Council, recognizing the need for expeditious action and flexibility in funding feasibility studies that wouid permit @lP@ and local areas to assess the potential'and feasibility of developing community based educational activities, delegates to the Director of PIIPS authority to award supplemental grants to individual Regional Medical Programs for such puffposes.' It is understood that (1)' no local area shall receive funds for such feasibility study in excess of $50,000 (total costs), and the duration shall not exceed 12 months; (2) no single RMP shall receive funds in excess of $250,000 for such feasibility studies in any 12 month period; and (3) approval and funding of such feasibility studies by the Regions will be within such general guidelines as PIIPS 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 Medical Programs with respect to review, approval, and funding, -including RAG concurrence, will apply. Approved: National Advisorv Council on Regional Medical Proyra.-ns, June 5, 1972 A PPENDIX B 'TS GOVEr,,NILN'C PRT,'CIPLES REQUIPI'-@fE@\ DISCP@TIO.,N'ARY R.1,P FUI-@'DING AND REBUDGETI,@ AU-.CIIORITY A. Princl.Rles The follo@7ing principles shall be -encrally applicable in all situations,. 1. No activity shall be undertaken that is'contrary Lu the @NIP (P.L. 91-515) and other applicable legislation, regulations, and @;ritten DeparLiiiental, 11SIfflA, and RNIPS policies. 2. Any activity undertaken with the Requirements enunciated below shall be subject to the regular review, funding, and rebudgetiii- requirements and approvals of the particular @IP and its grantet- organization and Regional Advisory Group. 3. Any operational activity or project initiated by an @IP within its discre 'tionary authority must have current RAG approval. That is to say, it must have been approved by the RAG in the budget period during which it is begun or, the immediately preceedinv, one. If not, such an operational activity must be reapproved by the RAG-before it can be undertaken. 4. When there are any substantive questions or doubts as to the scope and applicability of the discretionary funding and rebudgeting authority, the grantee or the coordinator on its behalf shall communicate uitl- @TS-for advice and guidance. B. Requirertients - Prior PIFPS approval is req uired in the'following instances. 1. @iPs approved for a triennial Deriod must obtain prior approval for any proposed program or operational activity involving: a. Alterations and renovations in excess of 825,000 or any new construction. (Present policy generally precludes the latter.) b. Human subjects. (This represents proaraumatic approval as 0 differentiated from approval of the grantee's system for safe:- guarding the rights and welfare of human subjects.) c. HMO related feasibility--s-tudies. d. End-sta-e treatment of kidney disease (e.g., dialysis, transplantation) and supportive facilities and services. e. Other specialized activities which may, from time to time, be-' identified by @HS',,DiA/Ri%fPS. 2. @iPs not yet apnroved for a triennial period must o'btain prior approval,' for: a. Any activit,, eziutnerated above e..zcept c."-tat any al,lerati.ois nj renovations regardless of cost must be submitted. 2 A P P%'D L,. 3 b. Any new operational ac-ivity'not gei'orally covered by its procram as approved by the Council. C Notification - New activities inav be initiated by an @.IP without prior P-',LPS approval in accordance with the discretionary funding authority stated above and the criteria for rebudacting qontainc-d'on page 4 of Instructions for the Financial Data Record. Ri,.TS-should be notified in accordance with those instructions at the time the activity is initi@ted, whether or not there has been a redistribution of funds. APPROVED: National Advisory %'council on ReLional @,'Ied'ical Pro,,re,.Ps June 5, 1972 APPE@\IDIX '4 7 APPElaIX C ILtlPS POLICY CON'CE@Zl@';G GT@W-ITEF, 1-1,'D )IEGIO"qi',L ADVISOR',' Gil0it- RLSPOZ3SIBILITII,;S IJID RELII.TIO'iSI'IIP I-',ay 26,- 1972 In'f--roduction Tliore are three.major components of the Regional Medical Program at tire regioaa-L level: the grantee org-@,iiz--tio-,i; the regional Ad@,-isory Group; and the Chief Executive Officer (often referred to as the RHP.tlloord-inator) with his (or her) pro-r,--m staff. The responsibilities tli--t each has and 1)'ow they relate aid interact with one mother are important factors in a successful Pkegional liedical Program. The follo-@Ti ng outli.iia sets forth a framework for these responsibilities aid relationships. Crrii t e The p,,rantee organization rhall L@n-@ge the grant of the Pegiotial I-ledical Program in a maruier which will implement the progran actfblis@ted by the Regional Iidvisory Group and in accordance- ivitli Federal regulations and policies. Tnis aliall include: 1. Initially designating a Regional Advisory Group in accordance and conference with Section 903(b) (4) of the Act. Such designation includes.selection of the Chai-L-man tmtil such time as the bylaws of the RAG have been a?proved by P@,TS. (TI.,is is a responsibility of the applicant organization whicl-i requests planning support for the establishment of an IULP).- 2. Cmfirming subsequent selection of R&G Chairmea. 3. Selecting the Chief Executive Officer on the basis- of Pegional Advisory Group nomination. 4. Peceiviiig, -Iministering, and accounting for funds on behalf oA-. the Regional Medical Program. 5, Reviewin,, operational and other activities proposed for P,@T funding with respect to: for and. cc-.ifo-i-mance with a. WS --,id otlicr Federal fLA-idin,(,, requirements APPENDV C 2 b. capal)"iities b-r f iliaCes to manage pr.-nt funds properly. Prescribi,-,,P .fiscal and a8.miiiistrativa procedures designed to insure i.,'tli all Federal requirements and t6 t,@a-@cZ;uard tLiL- gr@-itee igainst audit liaDilitiC3. 7.' IZegoti@iting pi:ovisio-,-i,-ti and/or final indirect cost rates for affiliates. ',fP all thosd administrative and B. Providing to the @ supliortiv@ senicc .s that are included in the gratitee's .indirect 'cost rate. dhief Exvcuti ve Officer a-a employee oK- the grantee, the Ciiie'L Executive Officer the full-time person..- with diy-to-day re-sponsiL)ilit,- for the nanagepient of the 111'2 --- is respoiisiz)le to it; lie is also responsible to the Rc-.ional @d@ory Group which cstalilislies program policy. llis rcsl)oiisibiliLies include; 1. Providing day-to-day adminif-,trative direction for the- program in accordance with tlict procedures established by the grantee @-id the pro-ra,-,i policies ertiblis'-Iicd'by the Ilegio-Lial Advisory Group. Providing acequate staff and other support to the @f,,ional Advisory Group and its committees for effective functioning. Developing the r-'-IP c;tiff ori-,anization, selecting prograLl staff, and supervising their activities. 4. Insurinp, both tl-ic effectiveness of operational ictivities and integration of all operational @d ,;taff activities into a total program. 5. ).ionitoring prant-supported activities to insure that all Federal rcqui@meilts are being complied with. 6. Establishina and maintain@.n@,.@n effective review process in accordance uitli R@IPS require-@nts. APPE!4DIX ..7. l@4tita'Lning -,pprcpriate relationships and li@oi-i with r,-I@T S l.nelLid;.ng Officc-. -taff. 'Etii!j -@hall i,.icl.ude the dioc-c-,,-,--fnation of Fc-der@,l program incl-icics and rc,.qtlircmeat:a to staff, Rfgic-iid'Ac-Tvisory Group, and regional provider groupc- and institutions; rite visit prep.-@rat'@o-as; and cor,@,.,@utaicatio-,t o@@ important deirelcinmei-,to within t'tc P,-Sion and program to YIJ.@S. C. Pe p 0 Lip ,ionr,l ticiv-is_ory _G,,, The Regional Advisory Group (or RAG) has the responsibility for setting the gen@ral dimctioi,oe the P@D? wi d f oru,.ul-ating pro-ram policies, objectives, and priorities. Moro specifically, RAG Lhall include: 1. Establishin- goals and objectives for the region's -total 13, program.; settin,, priorities for both operational and staff activities; 7,nd evaluating overall program progress and accomplishments. 2. t@pprov.Lug any applications submitted to alps. .3. -Approi-ing Vla organizational structure and significant program staff activities. 4. lip@-ro-ting overall budget policy a-,id major budget allocations. li@nating the Chief Executive officer for.selection by the grantee (see B.3 above). Selecting the Cliai@-n for confirmtion by the grantee. 7. Subsequent -to its es tz6lishmeat (see B. 1 above) , procedures- for selecting its cFjn ric,@eri3,, insuring appropriate repre- seatation on the P-act,,ional l@,dvisory Group in accordance with the Act, P@f?S regulations, and guidelines; insuring its ccrsitinuity; other than the CnairL@, selecting its ova officers; and establishing an executive committee fro-a its m-m membership to act on its behalf between Pt@G meetings. 8. Developing, formally adopting, a-,id periodically updating PAG bylaws %,ihic,',x set forth duties, authorities, operating procedures, terms of of f.ice,, categories of representation, mothod'of selections and frequency of Meetings for the -tUtG anA its coumiittees. APPENDIX C 9. Approving any d&legatiolis of relative to SI)CCific alloc-,Cioi@7, to tilo Cliicf Lxecutive Officer, its executive coim,.iittec--, illid otli(--ra. APPROVED: National.Advisory Council on Rcpional Medical Progra,,ns June-5, 1972 TV GUIDELINES AL-@TD RT--IIEW PROCEDIRES STATE@IENT Kidney Disease B@%CKGROU-tNTD Nowhere in medicine does the same gap exist.between technology and delivery as in the area of treatment of patients with end-stage renal disease. Tech- nological developments in recent years have made pos--ible the rapid expansion of programs to provide patients with hemodialysis in institutional setting@.. Innovations which allow self7dialysis by the patient in his home, or in a low overhead facility, vastly extend the utilization of delivery res.ourcIes, and reduce the cost to the patient. Techniques of or @ harvesting, pre- servation, and transplantation have made renal homotransplantation a service entity, no longer a research tool. It is estimated that of the approximately 50,000 per6ons.who die each year from'kidney disease, 7,000 to'10,,OOO are suitable candiates for chronic hemodialysis and/or renal transplantation, and that an additional 10,000 to 20,000 might benefit from each treatment. At present, the annual increment of-new patients being offered treatment for terminal kidney disease is pro- bably no+,- more than 3,000. CURRENT @IPS PROGRA.M E@iPI-LkSIS FOR KIDNEY DISEASE PROPOSALS Although national priorities for kidney disease programs will be established and modified over time as appropriate by a panel of renal authorities, for the present it is necessary to focus on improvement and expansion of the delivery of care to end-stage kidney disease patients. RNPS is primarily concerned with the development and implementation of kidney disease pro-rams which will provide the therapeutic tertiary care services of dialysis and transplantation to patients who do not now have access to such life-saving care. The substance of such programs includes: 1. Procedures to assure early identification of patients in or approaching a terminal stage of renal failure. 2. Rapid referral'of such patients from the level of primary care (private physician) to tertiary care facilities for dialysis and transplantation. 3. Early patient classification with regard to tissue type, and other per" tinent factors. 4. Dialysis and transplantation facilities which assure treatment alter- natives to both the patient and physician. I 5. Effective cadaver kidney procurement operations, coupled with rapid kidney donor-recipient matching. 6. Selective training to meet the specific needs of the above pro-ram. The characteristics of such programs include: 1. The patient has access to conservative management before kidney function has ceased. 2. The patient is registered in shared recipient rosters to assure optin-..Uri tibsue matching, and maximum utilization of harvested cadave!r kidneys. 3. The patient can be trained to carry out dialysis at home, or if not eligible for this mode-of care delivery, has access to satellite dialysis, or in-center care. 4. Dialysis facilities encompassing all three of the above modes of dialyt'ic treatment will serve, or be an integrated part of a system which serves a population o'L no less than 500,000. 5. The patien-t- can gain access to transplantation if such therapy is his choice, with his L3hysician's concurrence. 6. Transplantation facilities are centralized to: a. limit duplication of high cost facilities and services.. b. assure maximum utilization of full-time transplantation surgeons. c. assure availability of complementary backup services required for special patient evaluations and treatment. d. -provide the coordinating point for patient referral, donor- recipient matching, patient data exchange, and organ sharing. 7. Transplantation centers will serve populations of 3-4-milli-on persons. 8. Maximum utilization is made of services and facilities for kidney disease pa.tients. 9. Continued development of third- arty payment mechanisms is pursued p to support expanding kidney patient care services. 10. Integration of,renal disease patient services with other patient services and facilities.is organized at all levels. 11. Pediatric dialysis and transplantation services are coordinated with adult facilities to provide optimal use of services. 3 REVIEW PROCEDIJRES The openly categorical nature of cnd-s'a-e kidnev disease activities, and C, I- 0 - the need to effectively coorj4Lnate integrated dialysis and transplantation systems indicate the need for continued central direction for development of a national program. Thus, applications for I-.-'-dney activities will be handled in a manner different from other Regional 'L-ledical Program applica- tions, but modified from the procedures followed ti-,-=retofore. 1. Policy Preclearance - iL--.iediately uucn an indication of interest in tile submission of a ir-idney proposal b-,r a source within an Pd,,,T, the RIIP should contact the appropriate MLPS Branch in the Division of Operations and Development (DOD). It is suacested that a brief abstract or letter c' of intent be submitted which outlines the nature of the prospective activity, the probable role the proposal would pla5, in the Regional program,'and the-need which will be satisfied within the overall renal disease program of the Region. The Branch which serves the Region will utilize.the Region* written inquiry to confer with staff of the Divi- sion of Professional and Technical Development (DPiM). P%IIPS will advise the Region whether it is desirable to proceed further. The PM, of course, may accept or reject this advice. 2. Technical Program Review,- prior to submitting application for a renal disease program, the RI.!P is expected to obtain a technical review of' the proposal by a group which has not participated in the program's development. The technical review group mustbe comprised of at least 3 renal authorities from outside the Geographic area served by the -vices will be made Region. Payment of the costs of such consultant ser by the requesting RNP. The Region may obtain the names of consulting renal experts by calling the appropriate operations Branch for assistance. The Division of Professional and Technical Development maintains a list of renal consul- tants, and is responsible for coordinating their assignment. Should the PbiP desire to choose its own review panel, the names and curriculum vitae of prospective consultants must be cleared with the DPTD. Technical reviews of renal programs need not always be made by consultant site visits, but may be accomplished by mail when appropriate. The RMP will negotiate any compromise needed should conflicting technical advice be given by the technical reviewers. 3. Forwarding Proposals - only -those proposals which are recommended favor- ably by the local Technical Review Group (paragraph 2., above) shall be eligible for consideration by RT-@iPS. In addition, an opportunity must be provided prior to consideration of the proposal by the RAG for review and comment by the appropriate CIIP agency(ies) as required by Section 904(b) of the Act. 4 L Tlit.@ I'\.AC shall consider any CIILP comments and comment on Eric ability of thc@ IZ@T to m-ali.,tcye the kidney project without hindering the dLvclopiic-nt of the overall R,'Q program, and the reasonableness and adL@quacy of the kidney budget Droposed. The RAG is responsible also for indicating how major issues raised by the local technical review group will be resolved. Since kidney proposals are reviewed separately at tti(@ national I.cvel, the PXAG need not give.priority ranking to kidney proposals in.r.elation to other non-kidney PIIP operational activities. Kidney proposals shall be considered by PL@IPS in relation to national priorities. The complete comments of the members of 'the Technical Review Conunittcc, and any CFIP age,-icy comments, must be included in the forw@ardcd proposal. 4. PITS Staff Review - the initial review at RNPS shall include: a. the contribution of the.project toward kidney program objectives. b. the completeness and nature of the comments of the RAG (point 3., above). c. comments of CHP agencies. d. the preferred method of funding. 5. @IPS Review Committee - PITS staff will summarize for the BMS Review Committee available information as to how each kidney proposal proposes to support the National Kidney Program objective s, and the substantive points developed through local review processes by the Technical Review Committee, the RAG.' and the CHP Agency. For those applications for which the RAG; CIIP Agency; Director, FL@IPS, or RNPS Review Committee has indicated a concern apart,from the technical merits of the project, the RIQS Review Committee will be asked to make a recommendation to the National Advisory Council. The RMPS Review Committee specifically will not review on a technical basis the merit of-the proposal, or establish formal numerical ratings for individual proposals. 6. Council Review - all kidney proposals shall be submitted to the National Advisory Council for final recommendation. In keeping with the catugori- cal nature of the kidney disease program within IUIPS, the Council will review and recommend funding levels for kidney proposals separately from the funding level of the specific RMP. Kidney program funding will be in addition to other program funding. 5 PREPti-R.kTIO',i OF APPLIC-,kTIO@@ITS Effective July 1, 1973, all kidney proposals must be submitted as I)art of the PI-!P's regular annual =.pplication in accordance with the Region's assigned anniversary date. Prior to July 1, 1973, kidney proposals may be submitted in accordance with the document "Procedures for Requesting Supplements to IWS O.rants, April 7, 1972". Sponsors of applications for support of kidney disease projects should submit them to the appropriate P-'.IP in the format which the @T prescribes. An application involving 2 or more FM 's may be submitted where appropriate. In such cases, one @ip should be designated to act as "applicai-it" and submit a single application. Such applications must be approved by 6ach RAG and sliall include a description of mutually agreed upon arrangements for administration of tLie project. In view of the preliminary clearances which are called for in these guidelines, it may be helpful to develop and submit a letter of@ntent to the appropriate RIT's before an applica- tion is prepared. In addition to the suw@iiary information to be provided on @ttie forms sl)(.!ci- fied for applications, narrative should address in detail the program elements specified below. Descriptions.@.7hich are comprised only of genera- lized narrative will not be acceptable; disease con@rol needs and the applicability of the proposed program must be presented on the basis of solid data relating to patient populations and distribution, ' specification of existing services and resources, and clearly documented commitments of cooperation and participation from key persons and institutions. Assistance can be obtained from the program staff of the MQ. Program elements to be addressed are: 1. the magnitude of the rena@ disease problem. 2. facilities and prograns-currentfy in operation and the needs they are meeting. 3. the needs which the new proposal will meet and how the program will integrate with existing programs to improve patient care services without duplication of existing services or facilities. 4. existing and potential sources of third-party payment for care and how these resources will-be developed. 5. the commitment of cooperating institutions, groups and health prac- titioners whose collaboration is essential to insure the success of the program. 6. training, when pertinent to the plan, which is directly related to the projects comprising the plan, or judicious expansion of existing programs. L) 7. the system or method of program evaluation which will be employed. S. a decromeiatal rate or proportion of Federal (i@TS)contribLition to the proorarl over tiipe. C3 9. the program's phase-out as an Unsupported activity. Program costs rel.ated to tlie Federal share of support should normallybL2 identified ulith personnel n-nd equip-ta-nt requirements in Lertiary care facilities. RMPS will not fund ALG-related activities. Such funding may be included in the future if standardized production arid testing is achieved arid its efficacy is demonstrated. The NIff is sponsoring research in- ALG tlirou-Ii a contract. A@IARDS A,olards for kidney projects will be issued as a part of the total award to the Regional. liedical Program. Th(- amount allocated for the kidney activity will be specified in ILem Izi., under "Remarks", of the Notice of Grant Award, Form HSM-457., Funds awarded for kidney ictivities must be spent for such activiti4es.- except that unexpended balances may be rebud- geted in certain cases provided that,prior approval for such reprogramming is first obtained from @S. A 'NIPS but uiifuiid d. @ii a 1-id-Liey proposal may be approved by R- .n some cases, PIIP may fund such a kidney project through rebudgeting other RNP funds to the kidney activity. Rebudgeting of this nature should be undertaken only after the RAG has carefully considered the effect of such action on the remainder of the PM program. Likewise, a kidney project may be expanded as determined by ti-ie RAG by rebudgeting of funds to the kidney activity in addition to those specifically earmarked for kidney in the Notice of Grant Award. OTHER A glossary of kidney disease terms is enclosed for. your information. GLOS-ct@aY OF KID@,@-Y TERI@IS 1. AL.G ALS Abbreviations for A'ntilynipliocytc. Globulin; AiitiLymptiocvte Serum. Both are products of animal serum used to prevent rejection of transplanted organs, especially kidneys. 2. Artificial Kidnev - Total system used @or hemodialysis consisting of dial3,zer and dialysate delivery system. 3. Belzer lizcliine - Special type of perfusion equipment developed by Dr. F. Belzer. There ,re others, some devised by local hospitals. Perfusioii n@zichin-es preserve harvested cadaver kidneys in a viable condition, sometimes for periods of up to 48 hourd. 4. Back ialnsis - Dialvsis given patients trained for self care u2 D who, under special circumstances, are unable to perform dialysis without additional assistance. Also, pre- and postoperative dialysis provided transplantation patients, particularly when the newly grafted organ is unable to assume its full function immediately. 5.' Cannula - SurgicaLly prepared, exposed connection made between an artery and a vein. The exposed connection between artery and vein is,made with plastic tubing. 6. Care Facilities PrimpLry - The initial facility to which a patient seeks medical advice and care; may be the physician's office. Secondary A general hospital or equivalent capable of rendering definitive diagnosis and treatment. Also, a satellite dialysis facility. Tertiaa - Sophisticated medical center. In the case of kidney end-stage disease, it is a facility capable of performing trans- plantation, supportive dialysis therapy, and consultation to primary and secondary facilities. 7. Decremental FundinE - System of phased reduction of the Federal share of the costs of an activity, usually by increased assumption of costs through earned income and local tl-iird-party payments. 8. Dialysate - The solution used in an artificial kidney to rid the body of accumulated waste products in the blood. 9. Dialysate Deliverv That part of the artificial kidney wliicli supplies t e dialysate and regulates such critical items as raLc, of' flow, temperature, and concentration of dialysate... -2- 10. Di.alN,sis - Process by which waste products arc removed from the blood by diffusion from one fluid coiiniartnient to another across a sc-inipcr- meabl,e membrane. In the case of kidney dialysis, blood is one of the fluids and the bath solution or dialysate is the other. 11. Dialyzer - That part of the artificial kidney 'through which waste products pass from the blood to the bath solution or dialysatci. 12. Fn.d-staUe (Renal) Disease - That stage of renal impairment which cannot 7o favorably influenced by conservative management and wlii.cli requi-es dialysis and/or kidney transplantation to maintain life and health. 13. End-Stagc, (Rc-nal)_Tr_eatn,--nt - Refers to either dialysis or kidney transplantation or both forms of therapy. 14. Fistula - Surgically prepared unexposed connection made directly between an artery and 9'vein to allow repeated and ready access to the blood stream. Dialysis access to the blood stream is obtained with large holloi,7 needles, creation of a fistula is an alternative to suraical insertion of a cannula. 15. Functions of the Kidnpa - The normal kidiiey's work includes 1) control of.electrolyte concentration in the body, 2) maintenance of proper water balance, 3) maintenance of the body buffer system, 4) excretion of the by-products of cellular metabolism (urea, creatinine, and uric acid). 16. Kidney Disease - Spectrum of ailments wLiic h directly or indirectly affect the kidneys and compromise their function. (Frequently involves the entire urinary tract.) 17. Low Overhead Facility - Any kind of a building where the expensive operating costs of a general hospital can be avoided. Such facilities are used for dialysis services, making minimal use of physician time in staff required. 18. organ Preservation Maintenance of the kidney after it has been removed from the'donor and until it has been transplanted into a recipient. Organ preservation is an integral part of a kidney transplantation program. 19. organ Procurement - The identification of a prospective donor; the surgical removal and transportation of a donor kidney. 20. Peritoneal Dialysis - An alternative to hemodialysis - the-process by ;Thich the dialysate is introduced into the abdominal cavity using the peritoneum as the semipermeable membrane. - -N I v I -3- 21. Satellite Facility_ A resource providing limited, specific services under the general direction of a secondary or tertiary care facility. 22. Self-Di4lysis - Dialysis performed by a trained patient at home or in a special facility with or without the assistance of a family mem- ber or friend. 23. Shunt (noun) The means by which blood is passed through other than the usual channels. There are two types of shunts used in dialysis 1) the cannula, 2) the fistula. 24. Tissue ing- - Laboratory procedure used to determine the degree of comparability between the donor organ and the recipient of a kidney transplant. 25. Urinar Tract -'Gollective term referring to the kidneys', ureters, bladder, and urethra. APPEl,t)',rv, E Action on EMS Proros.:!-t.'Ls* Name of Pcgion Priority Funds (Direct Costs) of Projects) Rating Requested RecoTnTnended Reco=,,ended for Disapproval Albany 0 $1,198,726 0 Florida 0 1,54 445 0 N.E.Ohio 0 815,150 0 Oklalioma 0 140,690 0 Oregon 0 532,950 0 R@ommended for Ap@roval Alabama (2) -4 5,268,559 450,000 Ari@oria 3 116,386 65,000 Arkansas (6) 3 1,103,228 102,456 Bi-State 3 1,31 549 O@00.000 California (2) z..9 517,773 100,000 Central '.7ew York 3 261,705 261,705 Connecticut 3 328,095 19,000 'Georgia 3 934,313 50,000 2 1 4 3- --3 7 6 Hai@Ta i i. 1.7 5 Illinois 1,525,327 1;039,327 3.9 Intermountain 667,825 @l, 5 667,825 Lakes Area 3 8241819 250,000 Louisiana (4) 4 363,089 325,940 Maine 4 209,280 209,2S@ Memphis 3 1,117,781 67,038 Metro D.C. 2 79,475 79,475 Missouri (2) 2 4,269,023 77,000 lit. States (3) 3 657,576 150,000 New Jersey (2) 2.5 223,250 40,000 -Nei.., Mexico 4 712,110 712,110 N.Y. Metro 3 156,798 50,000 No.N.England 4 72,060 722060 Northlands 4 310,050 63,800 Ohio Vallev 2 62,970 20,000 Rocliester 3 572,946 186,256 South Dakota 2 470,468 50,000 .Tri-State 4 2,542,357 2,542,357 Virginia 3 30,250 30,250 W.Virginia (3) 2 197,742 63,375 Wisconsin 5 1,959,256 1,959,256 Total 01 Yr. $14,071,987 $ 5,788,122 02 Yr. 10 875 664: 3 302,464 03 Yr.. 8,302,746 21572,473 Grand Total $33,250,397 $11,663,059 Approved: National.Advisory Council on Regional Medical Programs, June 5,'1972 00 cr) co r-4 r, C', pt cq t co C,4 ;4 >4 LI) C,4 co 00 cn Lr) r- (n Cl) Cl) Lr) C,4 f) C:) C) C) 4.4 tn C:) ri 00 4-) 00 :i r-4 %D 0 la 00 r-i C,3 C:) C:) C,4 C:) It (D C:) 0 C) cn C,4 $4 C:> tn C) oo r, -T Lr) co C\l H -W 0 E-4 $4 C) CD CD %D 4= CD LO H 00 C) cn H co 0 a4 to 0 rq -H f-i $4 $4 (d 0 4i ci > 0 (44 co E-i 0 4J 0 r-A $4 0 r-q ri H u 4.J :j r4 -H -H r, V Cd $4 r-) 4-) > > pq F 0 0 CD U) 0 F-4 F--i 4-J H W H > > > C,4 0 0 C) v 0 @ Cs 0 r_ 0 @. r-4 0 w @ I @ C) C) (2) Cf) a) (Ij (L) -H a) C' Cl) 0) C) ol C.) m 0 P $4 r, C) $4 0 4-J 4J $4 r-4 E p 10 0 tn r') =1 !U) < (a (13 0 r. 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C, 0 c: 0 0 co cd x CJ Ca Cd VI w 0 0 SI Ai 0 Si :i r 0 14 4) 0 0 ci L) U. z 41 Action on l@10 Pro,-csal,,; HE'.4 Ret, ion and Prev i o@i s Amount 0 A,-o iit Applicatit Award Reauested Reco,@-;ended Re@ion I Health, Inc. 121,858 73,400 -0- Harvard 98,785 248,224 10,13-224 Matthew Thornton 21,000 21,375 21,375 Ab,iaki 167,679 161,136 161,136 Re@ion II Niontefiore 57,689 63,408 63,408 Mt. Sinai 53,029 145,975 145,975 N.Y.C. Health & Hospita@ 100,000 289,752 -0- Nassau-M,S.F. 64,000 1869871 110,000 Group Health Foundation 212,540 504,110 334,110 Reqion III Geor-etown 130,892 243,377 29,312 Region IV Florida Hcalth Plan 75,000 260,635 208,000 Health Facilities Research 55,000 103,823 103,828 Tenn. Group Health 250,105 733,508 106,000 @10, South Carolina 25,000 120,000 112,440 So. Carolina Bd. of Health 25,000 124,764 121,764 Re@ion V., Detroit Health Facilities 79,650 61,150 -0- Lincoln Memorial Hospital 56,000 309500 20,000 Shawnee (Carbondale) 70,785 260,947 -50,000 Cuyahoga Hospital 80,075 230,085 90,000 Marion Health 25,000 95,000 115,000 Colu-nbus Health 25,000 129,320 -0- Detroit Medical Foundation 25,000 137,255 70,000 Region VI Lovelace 114,601 188,255 1889255 Bexar 63,820 122,340 122,340 New Mexico Health 25,000 224,600 224,600 Tulane 81,7'07 86,096 -0- Pc- iaii and Pr c-,? iou s A-,rioi-, n t At)-)! icn:it Awi-zd Recuostpd ed T\@ioi VTII Rocky ',Nlotlntain 33,000 222,162 210,036 Alamosa 180,578 180,578 Missoula 55,9,-j5 165,5-04 -C)- , R@udre Vpllev 25,000 163,4'-)7 161);,4)7 Bl.ue Cross/,%orth Dakota 25,000 .120,3(jO 12rJ,300 Region IX M.C.F./ Sacranento 122t266 295,232ir 190,3t-)7 Health Services/'Saii Jose 108,500 274,900 219,850 S.@4. Conn. Hlth. Plan/Lutheran 100,000 330,455 290,855 Sonomo' 102,750 218,206 128,206 St. Joseph 25,000 130,284 -0- John l@qle 25,000 300,294 208,104 A PPRO.',l r.D National Advisory Council on Reg'ional @ledical Progr@-ris -s of June 5. 1972 per mail ballot pursuant to Council Resolution of that dpt"e. ATTENDA14CE t-T THE NATIOIIAL ADVISORY COUi',""IL MEETRIG -June 5-6, 1972 RMPS STAFF OTHERS-ATTE@IDING Mr. Kenneth Baum lir-; Arthur Broerin-,, I,.TL!l-NIH Mr. Cleveland R. Chambliss Dr. liargarct-. H. Edvards, NC!-NIII, Mr. Richard Clanton Dr. @lanning Feinlieb, N-TUI-NIH Mr. Tom Croft Dr. Alan Kaplan, EIIS Dr. John Farrell lflr. John I'lorn, Smoking and Health Mr. C. T. Gardell Dr.-Gordon FacLeod, FriOS 1.@. Sam 0. Gilmer, Jr. Yir. E. E. Olexa, OS-ASC-AA Mrs. Eva Handal Mr.-Dave Perry, OMB Mr. Charles Hilsenroth Dr. Warren Perry, Review Committee Mr. George Hinkle Mr. Gerald Riso, OA-HSMHA Dr. Edward J. Pinman Dr. Leonard Scherlis, Re@@w Committee Mr. Walter Levi Dr. Frederick L. Stone, O.A,-HSMHA Dr. Harold Ilargulieb Dr. Robert Van Hoek, NCHSR&D Dr. Herbert B, Pahl Dr. Vernon E. Wilson, OA-U-SMHA Mr. Roland L. Peterson Mr. 14ichael J. Posta Dr. Lawrence Ros7e Mr. Richard Russell Mrs. Patricia Schoeni Mr. Matthew Spear Yxs. Sarah J. Silsbee Dr. Margaret H. Sloan Mr. Jerome J. Stolov Mr. Lee Van Winkle Mr. Frank Zizlavsky