DEPARTMENT OF HEALTH, EDUCATION AND WELFARE PUBLIC HEALTH SERVICE National Advisory Council on Regional Medical Programs Minutes of the Thirty-first Meeting I/ 2/ November 26 - 27, 1973 The National Advisory Council on Regional Medical Programs convened for its thirty-first meeting at 9:00 a.m. on November 26, 1973 in Conference Room M of the Parklawn Building, Rockville, Maryland. Dr. Herbert B. Pahl, Acting Director, Regional Medical Programs Service presided over the meeting. The Council members present were: Dr. Bland W. Cannon Mr. Sewall 0. Milliken Dr. Laurence Foye, Jr. 3/ Mrs. Mariel S. Morgan llr. Edwin C. Hiroto Mr. C. Robert Ogden Mrs. Audrey M. liars Dr. Russell B. Roth Dr. John P. Merrill Dr. George E. Schreiner Dr. Benjamin 14. Watkins A list of RNPS staff members and others attending the Council meeting is appended. I. CALL TO ORDER AIM OPENING REMARKS The meeting was called to Order at 9:00 a.m.. on November 26, 1973 by Dr. Herbert B. Pahl. Dr. Pahl called attention to the Conflict of Interest and Confidentiality of Meetings statements in the Council's folders. 1/ Meetings are conducted in accordance with the Federal Advisory Committee Act. Proceedings of the closed portions of meetings, and materials sub- mitted for discussion during such closed portions are restricted unless cleared by the Office of the Administrator, HrA 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 discussion. 3/ Dr. Foye represented Dr. Marc J. Musser for the Veterans Administration. 2 Dr. Pahl noted that Dr. Alexander M. McPhedran had to resign from the Council on assuming a position with the Veterans Administration. He then. noted that the terms of four Council members expire at the end of November 1973. Dr. Bland W. Cannon and Dr. Russell B. Roth have served two terms on the Council. Dr. Benjamin W. Watkins and Mr. Sewall 0. Milliken have completed one term. Dr. Pahl thanked the retiring members personally and officially for their service on the Council and expressed the hope that those eligible for reappoint- ment would be reappointed. II. PRESENTATION BY DR. KENNETH M. ENDICOTT Dr. Pahl introduced Dr. Kenneth M. Endicott, Administrator HRA, who discussed reorganization, legislative developments and @IP issues. On July 1, 1973 the health functions of IIEW were reorganized into six agencies. NIH and FDA are essentially unchanged, while the former Health Services and Mental Health Administration has been split into four separate units: the Communicable Disease Center, Alcoholism, Drug Abuse and Mental Health Administration, Health Services Administra- tion and Health Resources Administration. The latter includes the National Center for Health Statistics, National Center for Health Services Research and Development, the former NIH manpower programs, Hill-Burton, CHP and PMP. Nearly all the ena'oling legislation for H-RA programs expires on June 30, 1974 and Congress has yet to act on any significant piece of legislation except for Emergency Medical Services which provides for an ambitious implementation program which is no longer a demonstra- tion. Legislation for extension of NCHS and NCHSR & D which is considered to be relatively noncontroversial. With respect to manpower, it is now the policy of the Federal Govern- ment to limit higher education support to student@ and phase out support of institutions. For the current fiscal year the Administra- tion proposes to make some exceptions to the general policy and continue several forms of institutional aid for medical, dental and osteopathic schools only. Capitation grants and special project grants for nursing, optometry, podiatry and other sc'hools presumably would be eliminated, but this is all tentative since manpower policy and strategy are still under consideration. Consolidation of a number of manpower programs can apparently be expected. It also seems likely that student loan guarantees will be emphasized over scholarships. 3 There has been considerable discussion within the Department with respect to consolidation of CHP, @IP and Hill-Burton. Two separate proposals are currently being debated. One would provide for regional health authorities made up primarily of providers and the other would place heavy emphasis on State functions. It appears that.a-,iy proposal must take into account the functions of CHP,RMP and Ilill-Burton if it is to receive serious Congressional consideration. While some consolidation,will probably take place eventually, what form this will take is not presently clear. In the meantime KM has set up a task-force.to monitor the situation and assist in developing Agency plans for administering whatever legislation finally emerges, The funding situation with respect to Regional Medical Programs is still uncertain. The total amount available for Fiscal 74 us still unknown, and release of fiscal 1973 money is being sought through the Courts. In considering grant applications, the Council will have to ignore the uncertainties and assume that funds will be available and, in addition, that project periods will be 1 year. III. PRESENTATION BY DR. HAROLD MARGULIES Dr. Pahl introduced Dr. Harold Margulies, Acting Deputy Administrator, HRA who discussed -@@e Department's position concerning RMP priority areas and the lifetime of local RMPS. New understandings apparently have been reached within HEW to extend the termination date for IUIP activities beyond June 30, 1974. The understandings, however, even though based on high level oral discussions, are still subject to change. Another understanding within HEW concerns the use of grant funds. While the purposes for which funds can be expended may be altered by new legis- lation, 11,RA and HEW still consider the five PIIP options as high priority areas. While they should receive continuing emphasis, the options should not be regarded as exclusive areas of grant awards. While all activities within the scope of the Mission Statement and the Act are permissable, the options are related to existing and potential initiatives such as PSRO, Kidney Disease, Health Planning and Health Insurance, and as such should receive continuing attention... III. COUNCIL ACTIONS RELATING TO PRIORITIES AND OPTIONS The Council took 2 actions in relation to the above discussions. It was moved seconded and carried that, 1. The Council accepts the Options as priorities and not restrictions, and 4 2. The Council endorses the Department's present position that RMPs be permitted to expend funds through December 31, 1974. IV. COUNCIL ACTION CONCERNING ALLOCATION OF ADDITIONAL FUNDS Because of the lawsuit by the National Association of Regional Medical Programs, Inc., there as a possibility that substantial additional funds will become available for award in Fiscal 1974. In view of that possibil- ity, the Council adopted a resolution concerning allocation of such funds. The Council's resolution, as passed, is shown as Attachment 1. V. COUNCIL ACTION ON CW-@NGES IN DISCRETIO@TARY FT@TDI NG AUTHORITY The Council voted to modify the RMPS policy entitled "Governing Prin- ciples and Requirements: Discretionary @iP Funding and Rebud.geting Authority," originally issued on September 20, 1972. The revision removes the distinction formerly made between "triennial" and "Anniver- sary Regions with respect to rebudgeting authority. The Council, while recognizing that the difference between these categories presently is no longer relevant, requested that the Regions be informed that the "Tri- ennial" and "Anniversary" classifications might.be reinstituted if the RMP program is continued. The revised "Governing Principles" as approved by the Council are shown as Attachment 2. VI. COUNCIL ACTION ON MANAGEMENT ASSESSMENT AND REVIEW PROCESS CERTIFICATION VI.SITS RMPS plans to reinstitute Management Assessment visits and Review Process Certification visits, since the award of Fiscal 1974 funds requires that the,Regions have.adequate capacity to allocate, award and manage funds. The Council's action endorsing the resumption of these activities is shown as Attachment 3. VII. REPORT OF THE DIRECTOR Dr. Pahl discussed budget matters which are summarized in the table shown in Attachment 4. VIII. SPECIAL REPORTS a. Overview of current status of RMPs - Mr. Peterson Mr. Roland Peterson, Director, Office of Program Planning and Evaluation, PMPS, presented statistical data on Coordini.tor changes, program staff, committee activity, and categories of proposed aT activities. These showed, among other things, that @lPs have re- tained about half the staff they had prior to phaseout and that about 75% of proposed activities are within the option areas. In general-, data presented indicated that the Regions have attained a surprising 5 degree of stability and renewed viability considering the events of the last year. b. Reports generated under Section 907 - Dr. Sloan Dr. Margaret Sloan, Assistant to Dr. van Hoek, reported in the outcome of RMPS' long-standing effort,to carry out the provisions of Section 907 of the RMP statute. This has resulted in the publication of a seven volume inventory of services entitled Hospital Services for Selected Chronic Disease Patients. Copies have been rnailed to all RMPs and will be sent to Counc i I members. The inventory was developed through a questionna ire under a contract with the joint Commission of the Accreditation of Hospitals. It.covers 92% of the Nation's hospitals. Special runs can be made from the data contained in the inventory. The JCA@L Steering Committee felt that a list of outstanding.facilities should be published only after actual site visitations to facilities. It was dec-@ided, therefore, that the public interest would be served best by publishing the basic data and criteria -which could be applied by users to develop lists suitable to their particular needs. Four criteria documents have now been completed. The kidney and stroke criteria appeared in the October 1973 JP@1A. The heart disease and cancer criteria will be published in Movembet- and December respectively. These are tentative documents and comments and suggestions are invited. Comments should be addresse to Dr. Sloan at the Parklawn Building. The American Cancer Society, American Hos' iation and pital Assoc JCAH are interested in keeping the data up to date and have dis- cdssed this with HRA. It is therefore possible that the inventory will be repeated in another year. c. End-Stage Kidney Disease Regulations Mr. Matthew Spear, who has been on detail with others developing ,standards for the new Social Security kidney reimbursement program, reviewed the Interim Kidney Regulations. Mr. Spear stated that medical care has now been extended to persons with end-stage kidney disease who arefullycovered by Social Security. Reimbursement for care under ti-ie Act was authorized to begin on July 1, 1973, -.--and- intf@rim Regulations were promulgated on June 29th. The Regulations blanket in coverage of existing end-stage renal services and provide coverage for new services only on an exception basis. The Regulations provide for (1) minimum utilization, (2) medical review, (3) facility affiliation and (li) cost containment. All RMPS kidney activities must comply with the above regulations, and conditions to that effect were placed on all kidney activities reviewed and approved at the present Council meeting. 6 IX. Presentation by Dr. van Hoek Dr. Robert van Hoek, Director Bureau of Health Services Research and Evaluation, discussed a number of matters of'mutual interest to the Bureau and RMPS. The Emergency Medical Services program which was initially lodged in the Bureau has now been transferred to the Health Services Administration. There is a bill in the House (H.R. 11385) which would combine the National Center for Health Services R&D with the National Center for Health Statistics, but passage is not expected. The Bureau has developed a lengthy program statement on health service research needs which have been mailed to all RMP Coordinators. In summary these Program needs are: 1. studies of planning licensure and legislation, especially certificate of need and planning mechanisms 2. quality of health care including (a) assuring quality, (b) disseminating findings and (c) implementing the PSRO legislation, the quality aspects of kidney and HMOs (if legislation passes). 3. financing of medical care 4. productivity of -the health care system especially in regard to manpower 5. data systems emphasizing improved medical record systems in ambulatory and institutional settings 6. long term care Dr. van Hoek suggested that RMPs could assist the health service research and development effort in disseminating BHSR&E research findings and a so in developing indices of standards of medical care and the effectiveness of medical,care processes. X. Consideration of Minutes of February 7, 1973 Meeting It was moved, seconded and carried that the @linutes of the February 7, 1973 meeting be approved. XI. Future Meeting Dates Future meeting.dates were set for January 11-12, February 12-13 and March 12-13, 1974. XII. Other Business Dr. Roth stated that the survival value of r@lPs would depend on building on categorical activities. He noted that l@,iT has spawned a generation of activities that are self supporting and continuing and have some survival value. He expressed strong disagreement, however, with the involvement of FliT in such activities as PSROS, @10s and strengthening of local planning. 7 Dr. Cannon expressed the opinion that the development of directives for spending @T money before the Council has had an opportunity to make recommendations has been detrimental to the effectiveness of the program. Mr. Ogden noted that a quorum of serving Council members was present and expressed the need to reestablish a review committee. Dr. Donal R. Sparkman, Director Washington/Alaska RMP and Chairman of the National Steering Committee of PMP Coordinators, noted with pleasure that the restrictive language concerning the options had been removed and that the June 30, 1974 termination date had been relaxed. He called attention to the fact, however, that the current applications were prepared under time pressure using new "options" which were viewed as restrictions. Dr. Sparkman also noted that Council members had expressed various views on RMP priorities and suggested that the Council review its approved "Mission Statement" and the "Directions Statement" developed by the Coordinators. Dr. J.S. Reinschmidt, Director Oregon RMP, addressed the Council in behalf of the National Association of RMPS. He explained that the Association is a nonprofit organization to promote the interests of and provide information about RlfPs. Two member @,Ts have filed a class action suit to secure release of funds and relief from restrictions. XIII Review of Applications Approved Council actions on individual applications are shown in Attachment 5. 11 rbert B. Pahl. Ph.D. A ting Director, RMP ATTACHMENT 1 RESOLUTION BY THE NATIONAL ADVISORY COUNCIL ON REGIONAL MEDICAL PROGRAMS RECO@IMENDING ALLOCATION OF ADDITIONAL R@IPS FUNDS IN FISCAL YEAR 1974 WHEREAS: RMPS has established a method acceptable to this Council for allocating the funds already made available for Fiscal Year 1974, and WHEREAS: Substantial additional funds may become available for obligation by RMPS in Fiscal Year 1.974, - BE IT RESOLVED THAT: The National Advisory Council recommend that; 1. the Regional Medical Programs Service allocate by established mode the full amount of Fiscal Year 1974 funds made available, up to the maximum amount anticipated under the IFEW Continuing Resolution or Appropriationi $81.9 million. 2. up to $10.0 million of any amount over $81.9 million which the Regional Medical Programs Service may be directed to obligate in Fiscal Year 1974, may be distributed in a manner that the Director, Regional Medical Programs SerVice, finds will make the best possible use of funds in accordance with existing legislation, Council, Department and RMPS Dolicies. All such distributions will- be reported to the Council. any other funds in excess of $81.9 million, not awarded pursuant to item 2, above, shall be awarded subject to the Council's recommendation thereon at its next regular or special meeting after such funds shal-1 have become available for obligation. APPROVED: National Advisory Council on Regional Medical Programs - 11/26/73 11/26/73 ATTACID' ENT 2 GOVERNING PRINCIPLES ANI) RE(@UIRE\@l,'@o@TTS: DISCRETIONARY R@it" FUNDING AND REBUDGETING AUTHOR1@ APPROVAL AND FU'@NDING AUTIIORITY An R@IP, at its discretion, may fund any eligible operational 3r program staff activity (including new activitie or rebudget I s funds within the total direct costs awarded subject to the prir,- ciples and requirements set forth below. PRIINCIPLES The following principles shall be generally applicable in all situations: @A. Consonance With Federal Requirements 'Fitle No activity shall be undertaken that is contrary to IX of the PHS Act and other applicable legislation, regulations, written Departmental, HRA, and R@TS policies, and/or specific conditions of the grant. B. ApDlicabilitv of Local R@IP Procedures Any activity undertaken pursuant to the authority conferred by this poll.cv shal-A- be subject to the regular review, approval and funding requirements of the particular PL%FP, the c,,rciiitee (where different), and the Regional Advisory Group, as described in NID of August 30, 1972. C. Current Regional Advi-.or Grou A-_L ovll Any operational, activity initiated by an @NIP within its discretion- ary authority must have current RAG approval. That is, it must be approved by the RAG in the budget period during which i-t is initiated or the immediately preceding one. If not, the activity must be re- approved by the RAG before it can be undertaken. Likewise, any pro- gram staff activity must have current RAG approval in accordance @,.@i.tn the policies or normal- administrative procedures of the IU,[P. D. Activities Jointly Funded by Two or, ,lore R@ll's Any activity which involves, anticipates, or requires funding bv more than ol.-ic lUfP durin@ the total ant-.ici-p@ited R@,?S su requires prior IC-ff'S approval for Such funding (but not for -the f t2c-il--- nical design or details of the activity). E. Obli,,,ations of Finds De-rived From Grant Related Income No grant related income may be cxpended without prior R@aS approval Pg. 2 Dl,',AFT: ]I./2r)/73 F. Resolution of Questions Regardtn? s as to the When there are any substantive questions or doubt scope and aT)!)]-icability of the discretionary funding and re- budgeting authority, the grantee ox the Coordinator on its behalf shall communicate with Ri\tPS for advice and guidance. LE 1-@R fEiNTS Because of the changing conditions that have prevailed, the following authorities to act are identical for all R@iPs regardless of previous st,atus. R@,Ts must obtain prior approval. from the Director, RMPS for any pro- posed program staff or operational activi-t37 involving, 1. Alterations and renovations in excess of $25,000 total Federal direct costs per activity, or any new construction regardless of amounts 2. Research or other activities involving the. use of human subjects. (Progra-,nmat-,.- approval by @-S is -required in addition to approval by -@Ill of an institutional. plan for safeguarding the, ri-glits and welfare of huiaii subjects.) 3. H.@10 related feasibility studies. 4. End-staQe treatment of kidneN, dise@is6. (e.g. dialysis, transplant- atioit and supportive I'acilities and services). 5. Other specialized activities as identified by RYi]'S. TV. NOTIFICATIO',\S l@@'PS should be notified immediately whenever an activity is initiated has not bi-en funded previously. Tli(-.,- following documents should be submitted: 1. The.budc,et@ for the new activity on P@IPS 34-1, Page 16. 0 '2 .- E@, vic;ed bL-i@,,getg for @inv activity from Which funds have I)e-ei-i-- withdrawn, L@@7aiii on R@ll'S 34-i, P@t@,e 16. 3. A brief description of t@lic@ activity on the applic@it)].c form, ]@ll'S 34-1, Pages 6, 9, 11, 1'-', or -1.5, as appropriate. @i -- I'cir iiot@i-f-yiii@- R-,'fPS of i-eblidets I!i z7!'Ll other (,-i@:cl",,, ii(,rlT'@l f o 1. ")4-1, j6. ATTACHMENT 3 REO@01,U'flON BY THE FA'i'IONAI, ADVISORY COIINCIL ON REGIONAL MEDICAL PROG[kA,'I'@ 'i@,"POR'.r ON STATUS OF RMPs' COMPLIANCE WITIT Ri@,virw REQUIRE@IENTS WHEREAS: Some RIlPs still have not complied fully with the the "',',MPS %eview Process Requirepients and Standards" and administrative management requirement, then BE IT THEREFORE RESOLVED:. The National Advisory Council. reiterates the necessity for all RMPs to be in compliance with the "R@IPS Review Process Requirements and Standard.-," and administrative management requirements as soon as possible, and therefore, reqtiests'the Director, RMPS, to report the status of RMPs' compliance at the next 'Council. meeting. APPROVED: National Advisory Council on Regional Medical- Programs, November 26, 1.973 SOURCES AND STATUS OF RMPS FUNDS ANTICIPATED TO BE AVAILABLE FOR EXPENDITURE BY RMPs IN FISCAL YEAR 1974, AS OF NOVEMBER 1, IL973 So'ti'.,ZCE AND CATEGORY OF FUNDS STATUS AS OF 11/l/73 Fiscal 73 Funds FY 73 Balance ...................... 6.900 m Awarded 6/30/73 but may not be spent by RMPS. Direct Operations(73 Supplemental).. 1.700 m Available to RIIIPS Congressional Construction Earmark (73 Supplemental Appropriation)... 5.000 m $.5mawarded to North Country Hosp., Newport, Vt. Remaining ,@4.5 m earmarked by Congress for Seattle Cliildren's Medical Center. Total 73 Funds ...................... $13.600 m$13.600 m Fiscal 74 Funds F,.MP Support .......................... $41.236 m $17.1 awarded 10/l/73. Remaining $24.136 n apportioned and release@- for RMP Grants. HEW Earb-,.ark for Pediatric Pulmonary Centers ................. 2.000 m Eight centers funded in the amount of $1,340,420. Two centers Calif. and N.M. still to be awarded. Georgia Pediatric Pulmonarv application withdrawn. Direct 0 @-ons ................. 2.314 m Available to RMPS C, Pe at Other ............................. 1.464 m $.338 m set aside for HMO contract extensions through 12/31/73. Total 74 Funds .................... $47.014 m $47.014 m TOTAL A,@TICT@PATED AMOUNT FOR FY 74 .............. $60. 614 m ATTACIDIENT 5 INDEX OF APPLICATIONS Eastern Branch Page Mid-Continent Branch @e Albany 5 Arkansas . . . . . . . . . .7 Central N.Y. 6 Bi-State . . . . . . . . . . Connecticut . . . . . . 6 Colorado/@lyoming . . . . . Gr. Delaware Valley . . 6 Intermountain . . . . . . .7 Lakes Area . . . . . . . 7 Iowa . . . . . . . . . . .7 Maine . . . . . . . . . 7 Kansas . . . . . . . . . . .8 Maryland . . . . . . . 6 Louisiana . . . . . . . . .5 Metro D.C. . . . . . . 7 Missouri . . . . . . . . . .7 Nassau/Suffolk . . . . . 7 Nebraska . ... . . . . . . .7 New Jersey . . . . . . . 7 New Mexico . . . . . . . . .7 New York Metro@ . . . . 6 North Dakota . . . . . . . .7 Northern New England . . 7 Oklahoma . . . . . . . . . .7 Puerto Rico . . . . . . 7 South Dakota . . . . . . . .1 Rochester . . . . . . . 7 Texas . . . . . . . . . . .7 Susquehanna Valley . . . 7 Tri-State . . . . . . . 5 South Central Branch Virginia . . . . . . . 7 West Virginia 7 Alabama . . . . . . . . . .1 Pennsylvania . . . . . . 7 Florida . . . . . . . . . .1 Georgia . . . . . . . . . .2 Western Branch Illinois . . . . . . . . . .2 Arizona . . . . . . . . 4 Indiana . . . . . . . . . .2 California 4 Memphis . . . ... . . . . .2 Hawaii . . . . . . . . 4 Michigan . . . . . . . . . .1 Mountain States . . . . 5 Mississippi . . . . . . . .2 Oregon . . . . . . . . . 5 North Carolina . . . . . . .8 Washington/Alasl(a . . . 5 Northlands . . . . . . .. . .7 Ohio Valley . . . . . . . .3 South Carolina . . . . . . .3 Tennessee/Mid-South . . . .3 Wisconsin . . . . . . . . .3 Novei-aber 26 27, 1973 Council Meeting CONSIDERATION OF APPLICATIONS South Dakota Moved: Dr. Roth Seconded: Dr. Cannon Approval as recommended by staff in the amount of $120,680 Operational status approved (discussion pp. 48 & 49). (Transcript p. 51, line 14.) Colorado--14y2m:Lnp Moved: Dr. Roth Seconded: Dr. Cannon Approval in the amount of $335,604. Agreed that rebudgeting could be requested for the implementation of the genetic counseling project. (Transcript p. 54, line 17.) MichiRan Moved: Mrs. Morgan Seconded: Dr. Watkins Approval in the amount of $627,5369 with the deletion of the $2,000 requested for stipends. (Transcript p. 8@, line 4.) Alabama Moved: Mr. Milliken Seconded: Mr. Ogden Approval as requested at the level of $410,312. (Transcript p. 88, line 24.) Florida Moved: Mrs. Mars Seconded: Dr. Foye Approval as requested in the amount of $683,048. (Transcript p. 91, line 16.) Georgia Moved: Mrs. Morgan Seconded: Dr. Watkins Approval as requested in the amount of $779,592. (Transcript'p. 93, line 22.) Illinois Moved: Mr. Ogden- Seconded: Dr. Foye Approval in the amount of $806,142 with the kidney condition, and the recommendation that staff follow up with the RMP regarding strengthening of their staff. (Transcript p. 97, line 20.) Indiana Moved: Dr. Watkins Seconded: Mrs. Morgan Approval in the amount of $304,113 with the kidney proviso, In light of long term aspects of activities generated, Council advised staff to follow up in terms of future support should I@IP terminate. (Transcript p. 103, line 21.) Memphis Moved: Mr. Hiroto Seconded: Mr. Milliken Approval as requested for $494,788 with small kidney portion being flagged with regard to the Social Security regulations. (Transcript p. 108, line 19.) Mississippi Moved: Mrs. Mars Seconded: Mrs. Morgan Approval-as requested in the amoint of $325,836 with staff recommendation to alert the region to the provision in the interim rules and regulations under Title, 20, Chapter 3 of the SSA-DHEI-I Regulation 5, Part 405, Federal Health Insurance for the Aged. (Transcript p. 1-13, line 8.) 2 Ohip Vallp-_y Moved: Mr. Hiroto Seconded: Mrs. Morgan Approved at the level of $497,201 with the kidney condition, and advice that the management program be followed rather carefully. (Transcript p. 121, line 3.) South Carolina Moved: Mrs. Mars Seconded: Mr. Milliken Approved at the requested amount of $516,510 with the kidney condition. (Transcript p. 125, line 17.) Tennessee-Mid South Moved: Mr. Ogden Seconded: Mrs. Mars Approved as requested in the amount of $658,912 with the following four conditions: 1. That the general kidney condition be put on with regard to Social Security Administration; 2. That the amounts proposed for the purchase of the E'i4S communications equipment and kidney dialysis equipment be restricted pending technical review; 3. That the staff carefully monitor the RAG review process; 4. That the coordinator be urged to seek the advice and assistance from his experienced peers in other Regional Medical Programs in matters of developing a central capability and reasonable programmatic separateness from the grantee. Wisconsin Moved: Mr. Milliken Seconded: Dr. Foye Approved as requested in the amount of $540,646. (Transcript p. 137, line 13.) - - ------- ------ Hawaii Moved: Dr. Cannon Seconded: Mrs. Morgan Approval of staff recommendations to approve the Pacific Basin for the full amount, and an amount, to be determined by staff, of the remaining portion be restricted and not available for expenditure until.the full review at.the next Council meeting; site visit by Council and report back to next Council meeting. Hawaii is to be advised that no funds will go for the Waianae Coast project until. RMPS received assurance from the RAG that it clearly understands the problem involved, and would ensure the M,[P funds and program staff activities will be used in a coordinated manner to strengthen the capability of the Waiaflae Area to effectively manage programs locally. Also, the kidney project will undergo its exception approval. Six council members voted for the motion; two against. (Transcript p. 33, line 17.) Arizona Moved: Dr. Cannon Seconded: Mrs..Mars Approval in the amount of $359,623 with the condition that the region be visited to determine whether they really have changed direction and responded to previous concerns. (Transcript p. 41, line 5.) California Moved: Mr. Ogden Seconded: Mrs. Mars Approved as requested at the amount of $2,645,305, with the proviso that the kidney applications be reviewed and funded in accordance with the Social Security regulations; that the Quality Assurance, DIS and Hypertension components not be funded by CC@IP until they have been subjected to CCPMP's total review process including review by technical panels; that the central staff needs augmentation; and- that good management is a must. (Transcript p. 144, line 10.) Mr. iliroto absented himself during this discussion 4 Mountain States Moved: Mrs. Morgan Seconded: Mrs. liars Approved as requested in the amount of $470,652. (Transcript p. 147, line 15.) Oregon Moved: Mrs. Morgan Seconded: Dr. Watkins sted for $289,560. Approved in the amount reque (Transcript p. 149, line 24.) w laska Moved: Mrs. Mars Seconded: Dr. Watkins Approved as requested in the amount of $545,473. (Transcript p. 153, 'l-in-e 8.) Mr. Ogden absented himself during this discussion. Louisiana Moved: Dr. Roth Seconded: Dr. Cannon I Approval in the amount of $270,323, but the program should be encouraged to recruit additional staff, particular reference to the P rog rarn Di rector .BeCaLJse of the marked change brought aIbout through planned phaseout,§taff visit to the region is recommended prior to the March Council meeting. (Transcript p. 47, line 6.) Tri-State Moved: Dr. Roth Seconded: Dr. Cannon Approval for the remainder of FY 1974 in the amount of $569,609. (Transcript P. 70, line 12 and p. 80, line 7.) Albany Moved: Mr. Ogden Seconded: Mrs. Morgan Appro,'c@d as reOLie-,ted for $325,836 Keith the I