HEALTH MAINTENANCE ORGANIZATION SERVICE 1. Review Comittee; 2. Grant Review Procedures; 3. General Counsel's Opinion of May 3, 1972. VT'e,'ANCE AND PROJECT REVIEW WORK GROUP IDIO COORDINATING CO@i",IITTEE May 31, 1972 DR. FRANK SEUBOLD) IDIOS - CHAIRMAN MR. KEN MASON, MIIOS RM. 13A-31, PARKLA@4N BUILDING RM. 13A-31, PARY,@kliN BUILDING 443-2256 443-2256 MR. GLEN J. MARTIN, SSA/BHI Three Members of the National Advisorv 1-0-4 LOW EAST BUILDING Council on Regional Medical Programs 6401 SECURITY BLVD. BALTIMORE, MD. 21235 Bland W. Cannon M.D. (301) 594-8387 Anthony L. Koma;off, M.D. Benjamin W. Watkins, D.P.M. MR. ARTHUR SPINDLER, SRS-OPPE 101. 55-18, HEWS 13-28301 DR. H.R. JOLLEY, SRS-MSA Pit. 4 5 2 4IIEIIS 13-33381 DR. RICHARD GREEN, OEO RII. 615 1200 19th ST., N.W. WASHINGTON, D.C. 20506 254-5920 DR. THO'@@LkS DUBLIN, BIL%IE, NIH RM. 5C-23, BUILDING 31 14-62573 MRS. MARIE HENDERSON, CSC IL't. 4 3 5 1 1900 E ST., N.W. WASHINGTON, D. C. 20415 632-6127 MR. ROBERT ;HORNER, H@IOS RM. 13A-22, PARKLAI,'N BUILDING 443-4617 MRS. BESSIE DRAPER, HMOS RM. 13-06, PARKLAI-,N BUILDING 443-4106 MR. LOUIS FIREISON, iimos RM. 13A-23, PAI'KLAI,'N BUILDING 443-2253 MR. ODIE WILLIAIIS, HIIOS FJ4. 13A-03, PARI,.LAI,,N BUILDING 443@4778 HEALTH MAINTENANCE ORGAIQIZATION SERVICE Grant Review Procedures The Health Maintenance Organization Service (HMOS) was established by the Secretary as an element of HS,@IHA in October after nearly a year of functioning both as a Task Force in the Office of the Secretary and as an Olfice in the Office of the Administrator, HSMHA. The @MOS serves as lead agency within DHEW to promote the development of HY@Os through technical and financial assistance, as required, in order to support achievement of the 1980 National Health Strategy goal of making the 1-YO option available to enroll 90 percent of the population, if they so desire. Specific objectives of the program are: to convert Federal, State, local and private purchasers of health care to provide the HMO option to provide a comprehensive range of professional and technical assistance services and financial support to HMOs in the planning, development and eventually in the initial operating stages to increase provider and consumer understanding of the HMO concept and operations and of their potential roles in IDIO development. To realize the goals of delivery of high quality comprehensive health care services with cost containment, the MIO must emphasize * coordination of resources and services * improved manpower utilization and productivity * effective medical records and information sys ems * approaches to increased accessibility of medical care. The IMOS is a decentralized program providing for the needs of the grantees through our Regional Office staff. Central Office staff provides a resource to the field offices in the areas of technical assistance, consumer education and information, medical care and professional practices and project management and planning. Page 2 - Grant Review Procedures the HMOS has funded 110 planning and As an experimental programt s and the District of Columbia. development projects in 42 state Until legislation is passed, grant funding will be limited to con- tinuation of planning and development functions, with no new projects tc be initiated and no funding to be allowed for payment for services ir@. an operational F'.io. 1-i the grant cycle presently under consideration, eligibility is limited by administrative decision to transition from planning to development or for continuation of development by: 1. Any organization funded for planning and development in June 1971, as long as that organization is not operational as an @MO and is not asking for speci.fic support to pay for health and medical services. 2. Any organization funded for planning in January 1972, with the sar.,e proviso. l,e MOS utilizes a -ulti-level procedure for review, evaluation and @.@.";ard of planning and development grants_ Regional, central office, a@id interagency reviews are required before a selection is made. The -.@,@.@viex,7 process is sur-.rarized in the attached chart. @z should be emphasized that the @MOS review process involves repre- @entatives fro,.--,. different agencies and from different programs within Agencies. In all of the regional offices the following organizations i@epresentativcs are involved in our review: A. RI.TS B. SSA C. SRS D. IL",OS ,,,ome of the regional offices also involve representatives from other -@S1,MA progra,-s and from rIH and OEO. '@,.eview and comment is obtained on all projects from the Comprehensive 'fealth Planning "B" agency, or where there is no "B" agency, from the A agency. Tiie 1-140S has not made any award to date which is contrary to the area-x@,ide or state-wide planning agency. On May 24 and 25, the IDIOS review committee will consider the applications submitted for re%,iew. Review and comments by the ad hoc HMO Committee of the @IP.'@AC and by the Finance and Project Reveiw Work Group of the HMOS Coordinating Cormittee will take place May 31 , 1972. One copy of Page 3 - Grant Review Process each application and 20 copies of the summary sheets will be made available to the RMPS. Members of the ad hoc INO Committee will present the recommendations of the May 31 action to the RMPS National Advisory Council on June 5, 1972. Final action on recommendations will be made by the Administrator, HS@@ and award notices issued. rt r) @(D rt Mt- r-t go 0 (D CL 0 H -mp,. pi rt :J aq tl (D Pt En aq )3 H. 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CL (D O :J F- (D e,0 M Pi r-t 0:5 D) 03 10 LI) a, F- n C) 003 P3 F- 0 00 H. 0 Pi H- rL t-h P- (D 0F, 0CO 0 :i CL P. rt r) rt C: rD Fl- rt C') 0 (D cn 10 :J En 0 cn 0('D (D rim(D Ln cn :r rt 0 0(D0 txl 0r) 0r- .4 En Pd H txi 0m rt 0 m H pi :i0 D) rn"> Lt) 1-h (D t-h rL 0) r) (D rD CD FJ- rt rt :D 0 rt @n ri r-r (D ti 0 el :3 0(D 03 10 m " 0 rt (D CL CO ?I 0 0 00 Pd Fj. P) " (D C) L.J.0 ct tri :i rlr rt (D rn 11 (D )I. Fl.0 OQ0Fl- rt 23 r) (D0 C) 0 Fl 0H- o p; aq0 :i r_ rt .. ;j rt t3i C-) :i m rt 10 93 ct ElMEn (D00 A3 0 F, (D rt :J Pi0(D rt0 0 (D (D0 r)0 0 ?I CD rt rL H. rL (D m C-) 03 En txi C/) fti (n D) rL cn C-) (D M 0WM 0 0 0 rt"0 r_ rt H- H. rt :3 cn F4 r) rD OOr- 0 0 C') 0 CL :3 :J En H. oq :4 LO D) Ei w 4CO in 0 rt H- 4 "rl 1-d rt rt F,0CL el FA- rt rlt rlt pi0 0 rt :r m :r ti CrQ Fl- :3 M (D M Cr' C) (D" CO 03 CD (D0(1) D) 0H L4 0 D) r_0 C') C: t-h r-L 10 :J 0 0 ri r) r- (D M(D 0 0 1Fl0 0 Ln M 0 1 rL 0Po rt CL En H- fD ftJ En OI,. rt (D 03 :3 En :3 D) CL Fl rt 0 cn 03 CL En4(D r_ pi0 (D Pi H. CL U) O DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE PUBLIC HEALTH SERVICE HEALTH SERVICES AND MENTAL HEALTH ADMINISTRATION ROCKVILLE. MARYLAND 20852 OFFICE OF THE ADMINISTRATOR SAMPLE AWARD TRANSMITTAL LETTER This'award has been made under the authority of Section 910(c) of the Public Health Service Act as amended and constitutes a.continu- ation of your present grant, No. . made under the authority of Section 314(e) of the same Act. The change was necessitated by program priority considerations within the Health Services and Mental Health Administration in the absence of specific Health Maintenance Organization legislation. These funds, made available through the Regional Medical Programs Service, will support the project for this one funding period and will not be available in subsequent years. The funds are intended to support planning and development activities only; under no cir- cumstances can they be used to support payment for services delivered. As in your prior award, the Health Maintenance Organization Service will be responsible for the programmatic activities of the grant. Financial reports required for Grants Management are to be submitted to the Regional Medical Prograr,,s Service in Rockville, Maryland. i lir. Coreld R. Piso oFrICL, OF IIM C12Z)--P@,L COWSR-L Dc,,Yuty tidministrak-or for Dcvelopm@--nt MAY 3 .1972 rp.ON Sidney EdelL-@an Assistant Ger,-c@ral@ @/@l for public Health SU&TECT: Use of section 910(c), Public Ilealth Service Act, to fund planning and development you have requested our advice iiith respect to the legal authority 910(c), I-lublic llc-alth Service Act,, of under section (1) awarding grants for continued develovment support of 'to i.-h". grantee rjid contracts leave previously been i-aade (tiuder statutory authority i.,iliich is not identified), and (2) ti-iarding contracts to or"anizatiois (both profit and nonprofit) for th,- purijose of provi%'Aing tcciltilical assistance in certain rz;,.nageraeat areas to (soma of i,:hich and sc;.is of wtivi.ch have not) whicli care in the planning and davelopi@--iit stage. This Office has previously advised, in the context of proposals for I-..'O plannina and develo@,)T,2ent, tl,.zt, to the extent that I/ proposed activitici3 t@all within tire nurvoses of -,ection 910(c),- funds appropriated for Title IX %could he available for ttic!ir supported/ tile have aluo adv'Ased that, in 15..-Iit of the language of the provision itself as well as tile liy-.Jtations imposed oa tle use of I:itle IX Section 910(c) reads as follows: "The Secretary is authorized to support research, studies, investigations, training, and dcLaozlsLrations desiored to @@iwize the utilization of manpoiic-x C, in the delivery of health services." ifemo, Gil (Ed.ebi,-an) to IIS CIil,-;on), "tl:D--Availability of Title IX funds", Deceinber 21, 1970 (I)Te 'V'47); lior-lo, Gli (Edel,@,2n) to Divi@eion of Eud-et (@,.fleyer), Authority to rrtablish under Title I:,, as co7@Dared u-ith the Admiiiistrator's Proposals" DeceL.-ber 103, 19@i (I,,F -rt56). rare 2 lir. @rald R. Piso 4/ funds in general by sections 900(d)3-/ and section 901(C),- xqe considered section 910(c) of doLbtl@ul u:-ility as rA vehicle for the supi,)ort of opernti.oi--l IU,li) zctivities.-- tin you have described the proposed activities under Dresent consideration, they appear clearly tct @ill within ttic ciri@it of- plannin,A and development of and do not involve actual operation of such or@P-nizatioj:ts. Accordingly, to the extent tiiat the propo!lal raay reasonably b3 ter,@d "demonstrations" and are 114,c.,,i,-,ned to in,'iyiiaize tlia utilization of maanowor in the delivery of hcalth services" (a i:t@itter -tihicli is I)rifi,.Lirily :for administrative they cppear authorized by s(@ctioti 91.0(c). Since t!iat provision speaks of t;u@)T)ort" I)y th2 Secretary of the Bnecified activities, and since section 900(a) includes both grants and contracts in describing the purposes of Title L@, it is our opinion that citi-icr grants or contracts may be utilized fo.r financial support of such activities. cc: Dr. Harold Ifargulies @Mr. Hastings 3/ Section 900(d) in pertinent part directs that the Durposes of Title IX be accomDlishf--d "v.,itY&out i.rite-rforring xiith the patterns,, or tiLe aeuhods of 'LinaLicia,,, of patient care or professional practice Section 901(c) prohibits the provision of hospital, medical or othcr care to a patient "at any facility in--ident to research, training, or demonstration activities carried out x,;itti funds appropriated pursuant to this title, unless he has been referred to such facility by a practicing physician or, where appropriate, a practicing d,--atist". Memo ,GC (ilastin-s) to 113 (Riso), llt%vailability of IMI funds for support of operational D--@,!aber 21, 1971 (DF Yio-mo, CII (Edelman)- to l@',.)S (,,-iacLeod) "rundinp, sources for lii,:D projects",, December 16, 1971 (DF j'r56).