i i iin@i@i 11, i@ iilllii@# ii cl I DEPARTMENT OF HEALTH3 EDUCATION AND WELFA E Health Services and Mental Health Administration Division of Regional Medical Prograrns National Advisory Council on Regional Medical Programs Minutes of Meeting March 31-April 1, 1970 National Institutes of Health Conference Room 4 Building 31 DEPAFOW OF @TH, EDUCATION, AND WELFARE Public Health Service National Advisory Council on Regional Medical Programs Mihutes of,,the Nineteenth Meeting I/ 21 March 31-APril 1, 197.0 The National. Advisory Council on Regional Medical Program convened for its nineteenth meeting at 8:30 a.m., Tuesday March 31, 1970 in Conference Room 4. Building 31, National Institutes of Health,,Betliesda., I"land. Dr. Joseph T. English, Administrator, Health'Services and @ntal Health A@stration presided over the meeting. The Council mrrbers present were: Dr. Michael J. Brennaid Dr. Alfred M. Popma Dr. Bland W. Cannon (I'/31 only) Dr. Russell B. Roth Dr. Bruce W. Ever-ist Dr. Mack I. Shanholtz (3/31 only) Dr. Clark H. Millikan (3/31 only) Mrs. Florence R. Wyckoff (3/31 only) Dr. Ednund D. Pellegrino A listing of W staff m@'ers, and others attending is appended. I. CAJ-L TO ORDER AND OP@G FEMARKS The meting was called to order by Dr. Harold Margulies who introduced himself as Acting Director of Regional Medical Program Service. Dr. Margulies replaces Dr. Stanley W. Olson whose resignation was accepted by Dr. English on March 16, 1970. II. ANNOUNCEMENTS Dr. English acknowledged Dr. Olson's very important contributions to the developmnt of Regional Medical Program, both as a formr Coordinator of Tennessee/Mid-South He and as Director of the Service and stated that he has asked Dr. Olson to remain as a consultant until he assums his new position in San Antonio. 1/ Proceedings of meetings are restricted unless cleared by the Office of the Administrator,, HSMHA. The restriction relates to all material submitted for discussion at the metings, the supplemntal material, and all other official documnts, including the agenda. 21 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 ply to en bloc actions occur. This procedure does not, of course, ap only when the application is under individual discussion. Page 2 In addition to his principle position as Administrator of the Health Services and Mental Heqlth Administration, and also as of the National Advisory Council on Regional @ical Programs, Dr. English explained that he has now increased his direct involvemnt in Regional Medical Prograrm by assuming into his office the direct operational responsibility for the Regional @dical Progr@ Service. He has asked Dr. Margulies to accept, on an acting basis, the direct responsibility of administering RPS. Dr. English asked the Council for their help in finding a pe ent Director and suggested that they write directly to him with the names of candidates whom he might consider and also any special characteristics that they feel he n-dght wish to identify in making his final selection. Dr. English reported briefly to the Council on his recent appearance, along with Dr. Egeberg, before the House Ways and -ans Co@ttee, as YL a part of their closed hearings in regard to the MEDICAID Task Force report. He said that both he and Dr. Fgeberg considered this a significant first opportunity for representatives of the nation's health professions to be included in discussions of Federal financing of health care services. III. CONSIDERATION OF FUTURE I G DATES 'Ihe dates of July 28-29 and Decerrber 8-9,'1970 were reconfi@d. No dates were made for meetings to be held in 1971. IV. CONSIDERATION OF S OF THE DECIIT3ER 1969 AND Me Council unanimusly recomwnded approval of the Decerrber 16-17, 1969 and the special 14arch 2, 1970 r,-eet@. V. UPDATE IN THE LEGISLATIVE PROCESS tion A. Extension Le In discussing the Health Services Irrprovenent Act of 1971 the Council reactions were essentially the same as those elicited at the tirw of their earlier discussion of the proposal with Mr. Irving Lewis, at the special @eting on March 2, 1970. Dr.@ English assured the Council that many of their concerns were based on what he believes is a misunderstanding of the intent of the Administration inthis legislative proposal. He made it very clear that there are no intentions to place one Page 3 of the programs "under" any other of the progr@ involved, and that the very essential role to be played by Regional Medical Programs in the Federal effort to @rove health care services is, in effect, a vote of confidence by the Department in the success of Regional Medical Programs. As further evidence of this confidence in the viability of the Program, Dr. English cited the decision made by the Department and the Bureau of the Budget to release for use by the Program, $?O million in grant funds which have been part of the expenditure limitation in 1969 and 1970. As was the case in the March meeting, the Councills most serious concerns relate to what they fear are premature and drastic changes in the basic concepts of the Program, which will result in loss of the interest and cooperation of the private ,,;sector. As stated by Dr. Everist, it is the involvemnt of .these groups which has "made Regional Medical Programs a federal, rather than a Federal, program.11 The Council was assured by Dr. English that the effect of the A stration's legislative proposal is to be the first step in a gradual and incremntal approach to consolidation of the efforts of the Health Services and Mental Health Administration; rather than any attempt to change, subordinate, or-destroy one Program while endorsing or developing another. The Council is not, however, sufficiently confident that the Program can withstand vihat will be the apparent, if indeed not the real, effects of the irfplementation of the provisions of this proposal. The members a]-so expressed frustration in their ability to @e a genuinely supportive interpretation of the proposal to their colleagues who have served and cooperated so enthusiastically ,,at the national and local levels and in their institutions. Dr. Pellegrino effectively s ized the Councills belief that none of them can honestly and conscientiously serve as a salesman for the proposed Health Services Act of 1971 and therefore, their only effective role at the present tire can be that of "negotiator." This they can do by attempting to identify the aspects of Regional Medicpl Program that have made it sufficiently useful to the A stration, and then to make every effort to see that these aspects of the Program are preserved. In discussing the future role of the Council, several of the mmbers, particularly those who had,been unable to attend the March meetino- were surprised and disturbed to learn that Section 901 CD .1 of S 3443 is in error, and that in fact the role of the expanded Page 4 comprehensive advisory council would be limited to advice and assistance to the Secretary on policy matters and an annual retrospective review of the grant supported activities. Such a role. they believe, would severely limit the effectiveness of the Council in influencing either t'h(5 dir@ction or the quality of the program. Questions were raised concerning the administrative arrangements to be established under this legislative proposal and the general concept of peer review of grant application. The Council voted unanimously to go on record as recommending that the present mode and authorities of the National Advisory Council on Regional Medical Programs be preserved; by administrative regulations if not by law; either as an independent Council or as a subgroup of the larger comprehensive Council proposed in the Health Services Improvernent Act of 1971. The Council likewise voted uranimusly to record their recommendation that the disease-categorical emphasis of the program be preserved, not as a limiting factor on the development of the Program, but as a focus for program emphasis and 0 define the "principle concerns" of Regional Medical Programs. B. Appropriations - FY 1971 Dr. Margulies informed the Council that hearings before the House Subco @ ttee on Appropriations were tentatively scheduled for the week following the Council meeting. He said that he expected them to be uncomplicated and probably brief, in this Congressional election year. VI. APPORTIONMENT OF THE FY 1970 BUDGET AND BUDGET PLANS FOR FY 1971 Dr. Margulies reviewed the circ = tances which led to the DHEW and Bureau of the Budget decision to release the $20 million in grant funds which had been held by the Department as part of the expenditure limitation. Based on a specific plan presented by Regional @ical Program Service at the request of the Dep@me.nt and the Bureau, $5 million is available for obligation between now and June 30, 1970 and the remaining $15 million is to be added to the amount requested in the 1971 budget; bringing the total amount proposed for grants in FY-71 to $94.5 million. VII. IMP ATION OF MULTIPROGR*L SERVICE G@S (SECTION 910) @s grant authority was added to the RT legislation in June 1968. Page 5 However, due to the expenditure limitation imposed at the sam -tire, and subsequent'constraints on available grant funds, it has not been jiTplerwnted. The Council was rem-Lnded of the general guidelines reco@nded by a special subcomdttee chaired by Dr. john Hogness, the report of which was adopted by the Council at its meting in August 1969. Staff advised the Council that they intend to develop a set of specific Terms and Conditions, based on the general guidelines contained in the, Council re---omend9,t,!-Ons. These will be made available nationally and applications will be invited to co@ete for grant awards early in fiscal year 1971. In this connection, mrs. Phillips described the Senior Clinical Traineeship program, which provides direct support for individual pnysicians to undertake pc>st-residency training in the clinical managemnt of neoplastic diseases. This program was begun as a Clinical Fellowship program of the National Cancer :Institute very early in that organization's history. In 1963 it was transferred to the Cancer Control Branch of the Division of Chronic Disease. Initially it was funded by them as a direct award program, and later as a program of institutional awards under the 314(e) authority. Scheduled for phase-out a-long with the other activities of the Division of Chronic Diseases, this program was singled out both by the Office of-the Assistant Secretary for Health and Scientific A-ffairs, and by oncologists in the mdical/acaderdc co ty, as being of sufficient @ortance to the Nation's potential for caring for cancer patients as to warrant its continuation as part of the ongoing activities of the Regional @dical Progr@ Service. It was agreed by the Health Services and Dlental Health Administration that this Program would continue to be funded at an annual level of approximately $1 million, and be administered under the Section 910 authority of the Regional M@-dical Program legislation. Although at this late date in the @dical/acade@ year probably only a small number of qualified.candidates remain unplaced and only a very few first rate training opportunities remin unfilled, it was agreed that it is important to maintain the continuity of this program. Therefore, an aTmunt of $300,000 (of the newly released $5 million - see above) will be set aside for awards to be made Ourin the remainder of this fiscal year. 9 Because the Council will not met again in this fiscal year, the Council unanimusly agreed to delegate to Dr. Brennan the authority to select appropriate candidates for these awards. He WI-11 be assisted in this effort bv an ad hoc panel of experts in clinical meant, of cancer, representing the six basic disciplines Page 6 of internal Medicine, pediatrics, surgery, radiology, pathology, and gynecology. VIII. GUIDELINES - IMPROVING CONTIMINIG EDUCATION ACT=IES USING DISTRUCTIONAL TECHNOLC)GY Pol..I.-@,-7ino reported on the -viork of the subconnittee which developed the draft guidelines which were before the Council. He explained the workings of the task force which undertook the study and the nature of their report to him and to Dr. Mack Schmidt and Dr. George Miller who represented the Review Co=dttee. He said that after a great deql of discussion it had been agreed to present this very preliminary draft to the Council only as an indication of the directions being taken by the subco @ ttee. The Council agreed to approve Part I of the report, in principle, with the recomendation that it undergo substantial substantive and editorial revision and resubmission to the Council. Part II of the report was considered separately and found to be entirely satisfactory in its resent p format. The Council unanimusly reco@nded its approval without further substantive revision. T-X. GUT-DELTI\TES FOR CANCER CARE Dr. Sloan recalled to the Council that these Guidelines were prepared by a Special Advisory Comdttee on Cancer Care Facilities of the Cancer Co@ssion of the Anerican College of Surgeons, under contract with the Division of Regional Dbdical Programs, in response to Section 907 of the Regional @ical Programs legislation Vnich provides that "The Surgeon General shall establish, and maintain on a current basis, a list or lists of facilities in the United States, equipped and staffed to provide the most advanced mthods and techniques in the diagnosis and treat@tit of heart disease, cancer, or stroke. . . She introduced Dr. Warren Cole, who served as chairman of the Special Advisory Comittee. Dr. Cole outlined the procedures, the representation, and the data gathering activities of the Comdttee and formlly presented the report to the Council. He also reported that the Guidelines had been reviewed extensively by the National Advisory Cancer Council who reco @ nded that a concise s be prepared. In response to questions the apparent stringency of the guidelines, Dr. Sloan rer@ed the group that the document is indeed intended only as a guide, and only for hospitals which wish Page 7 to be designated as providers of definitive cancer care. @-accepting the report, the Council offered their congratulations and sincere thanks to Dr. Cole and the Comdttee. In further discussion, however, they stated very clearly that in accepting the report they have not approved it for publication. Instead, they agreed unanimously to reco@nd @her work on the report and further assistance from the National Advisory Cancer Council, with reference of the final draft to a subcomdttee of the National Advisory Council on Regional Medical Programs before presentation to the Council as a whole. X. FFPORT FROM THE AD HOC CO@= ON KIDNEY DISEASE Dr. Margulies reported briefly on a one dav ad hoc meeting held February 13, 1970,of a group of experts in kidney field. Although the principle purpose of the @eting was to offer professional guidance in the development of an effective kidney disease program as an integral part of Regional Medical Programs under pending -'Legislative proposals, the discussion concentrated on recent trends in the treatment of end-stage kidney disease, focusing particularly on regional requirements. Although it was not presented as a definitive doc @ nt, the general recommndations of the ad hoc committee net with general agreemnt on the part of the Council. Dr. Everist suggested that when such a documnt is finally prepared it should,include more e@hasis on prevention of kidney disease, particularly in children. XI. REVIEW OF APPLIR,ATIO@IS A. Relevant Issues 1. RMP grant contribution to the establishment of and continued demonstrations in intensive care units At the request of the Review Co@ttee, the Council was asked to consider the role of Regional Medical Programs in continuing to establish and equip facilities-resources in institutions which a]-though initiated for purposes of training and demonstrations, will continue to provide patient services for which fees are routinely collectable from virtually all third party payers. Recognizing the very great difficulty faced by the Review Comdttee in @ng judge@nts on such projects, particularly vfnen they are of recognized value in the establishment of a Regional iMedical Program in a comunity; the Council continues to believe it @,,r,@ise to atteTpt to develop a finn policy, arbitrarily including or excluding such projects from Repiona.1 Medical Program grant support. Page 8 Relating this general issue to a specific request contained in the application from the Greater Delaware Valley Regional Medical Program, Dr. Millikan suggested, and the Council unanimusly agreed,t@L, @ds from@ Regional Medical Program should not be used for support of the establishment or maintenance of stroke centers designed to evaluate specific modalities of stroke treatment. S@teen such centers are currently funded by the National Institute of Neurological Diseases and Stroke for carefully designed and thoroughly controlled studies of these therapeutic mdalities, and will provide sufficient information and data to make the definitive judge@nts in this regard. 2. Need for a study of Rezional Medical Program Part! Projec s involvi-n omated TL- c o In response to a repeated request from the Review Committee for guidance concerning projects which are clearly identifiable as 1'research and developments and require large expenditures for expensive equip@nt, the Council has agreed to undertake a study in this regard. They also agreed with Dr. Margulies on the necessity for some background information on the current status of Federal funding of such activities, particularly funding by the various component programs of HSMHA. This study Dr. Margulies promised to have available at the next meting as a basis r further investigation of specific roles of Regional Medical Programs in this arena. 3. Review of Council Policy on Health Manpower and Recruitment At the suggestion of the staff the Council voted unanimously to amend the Guidelines on health careers recruitment (Guidelines Addendum, February 1970, page 15) to include the following additional staterwnt: '''This does not include the use of PjqP funds for remdial education, enrichment programs, or student loans or scholarships.It Kidney Disease Policy - Retain for Remainder of FY 70 or Revise! In the light of the present unccrta-Ln@.ties regardin@ both tD legislation and appropriations for Regional Medical Programs in 1971, the Council agreed that'it would, at this time, be premature for them to undertake the development of a more specific policy regarding Regional Medical Program support of kidney disease activities. Page 9 -At the same tire they recognize the difficulties inherent in continued deferral of action on specific kidney disease projects which reach them for final recomwndations. In addition to several which are before them'in this round of review the Council agreed to reconsider the three which were reco@nded for deferral at the previous meeting:. WISCO14SI]@l REGIONAL MEDICAL PROGRA14 Project #15 - A Conprehensive Program in Renal Disease Approval in the time and amount requested with the suggestions and recoumndations cited by the Review Comdttee in July 1969 (see also,Section XI C). NEW YORK I=OPOL-TTAN REGIONAL MEDICAL PROGRAM Project #13 - A Regional Program for Training of Physicians and Other Allied Health Professionals for the Managemnt of Chronic Renal Disease Patients Approval at the reduced level and with the specific conditions recomended by the Review Coudttee (see also Section XI C). MEIROPOLITAI@ WASHINGTON, D. C. REGIONAL it4EDICAL PROGRAM Project #31 - Hemdialysis Training Program Although conditional approval was originally recoffmnded by the Review Co@ttee, the major reservation expressed was the absence of a transplantation center to which this project can directly relate, either imediately or in the forseeable future. In the absence of any satisfactory resolution of this particular aspect of the recommendation the Council again deferred final action. Page 10 B. Special Actions NEBRASKA/SOUM DAKOTA The Council was apprised of recent correspondence between the Region-a-od the Division regarding its possible separation into two state Regional Medical Prograro, and the proposal of the South Dakota Governor to combine RMP and CHP in his state. The Council expressed interest in this as an experimnt but declined to make any forml recomendation. It was agreed -that their involvemnt would be appropriate only at such tire as an application for a planning grant from South Dakota is submitted. WESTERN PENNSYLVANIA - Ct 8 Laurel Mountain Home Health Aide Training and Demonstration This revised application was submitted to Council at the specific request of the Region in order to provide additional info@'ition intended to clarify the relationship of the project to the Region's total effort. Council. reaffirmed its original assessment of the inherent quality of the project, particularly the educational aspects. On the basis of the additional information and the revised budget, they agreed on its appropriateness as a part of the Western Pennsylvania RMP and believe that the cost is realistic. Approval is recommended for the +U-@ and in the revised amount requested with the understanding that the income produced by the project Hill be used for the purposes of the project., as stated by the applicant. 01 $76 600 02 $77,850 03 $81,500 Page 11 1/ Recommendations for Action The Council recorded their recommendations in the format which was adopted in the previous review cycle (Appendix I). ALABAMA REGIONAL MEDICAL PROGRAM Approval with specific conditions reco @ nded by the Review Cormiittee. 01 - $257,357 02 - $231,956 03 - $0 ALBANY REGIONAL MEDICAL PROGRAM Return for revision with the suggestions of the Review Condttee. ARIZONA REGIONAL DEDICAL PROGRAM Return for revision with the suggestions of the Review Com-nittee. BI-STATE REGIONAL ME)ICAL PROGRAM Non-approval Project 10 - Non-approval I = Inappropriate for FJe funding - Council finds this project outside the policy guidelines relative to basic training of allied health personnel. Project 11 - Non-approval II = To be revised according to suggestions of the Review Committee. Dr. Pellegrino abstained from voting. 1/ All amunts are direct costs only and unless otherwise specified refer to 12-month periods. The designation 01, 02, etc. relates to the first, second, etc., budget periods of the subject application, not necessarily the budget periods that will actually be supplemented. Page 12 CALIFORNIA REGIONAL MEDICAL PROGRAM' Approval with specific conditions, as detailed below, in amounts not to exceed: ol - $806,942 02 - $828.%158 03 $885,254 #7R -P,.pproval I for one year only. #54 - Approval II with conditions set,by the Review Co@ttee. #55 - Approval I #56 - Deferral with the new info@tion to be reviewed by experts in the field. #57 - Non-aiDproval II with the suggestions of the Review Comdttee. #58 - Approval I. #59 - Non-approval II with the suggestions of the Review Co @ ttee. C NEW YORK REGIONAL MEDICAL PROGRAM Approval, without additional funds and with the advice of the Review Committee. COLORADO/WYOMING REGIONAL M)ICAL PROGRAM Approval with specific'conditions as recorrinended by the Review Co@ttee. ol - $481037 02 - $67,003 03 - $73,471 FLORIDA REGIONAL MEDICAL PROGRAr4 Approval with specific conditions as recommended by the Review Co@ttee. ol - $146,380 02 - $162,918 03 - $179,857 GREATER DEAW@ VALLEY REGIONAL MEDICAL PROGRAM M4 00026 3/70.1 - Approval with specific conditions as recommended by the Review Committee. -- $190,628 493 ol 02 - $195,655 03 - $1503 EM 00026 @/70.2 - Return for ?evision. The Council agrees that this project is proposed by highly competent individuals, to be conducted in an institution well Page 13 situated for, and capable of becoming, a regional center for training and demnstrations in the diagnosis and mmgemnt of stroke patients. They therefore recommend that it be revised to focus on those objectives and offer the following suggestions: 1. RMP funds should not be used to establish or otherwise support centers for the evaluation of methods of treatment of stroke patients, since sixteen such centers are funded under careful study by the National Institute of Neurological Disease and Stroke. 2. The-proposed number of beds is unnecessarily large and umanageable for teaching and demnstration purposes. 3. Although the proposed course material ,7i-o-oears to be well planned and inclusive there is no evidence that the potential trainees from throughout the Region have been included in the planning nor has any study of their training needs or home-resources been undertaken. 4.@ There is only very brief mention of cooperative planning with other metropolitan centjers toward the establislnent of Philadelphia Gene@al as the stroke training and demnstration center for the Greater Delaware Valley RMP or for any area of it. HAWAII REGIONAL MEDICAL PROGRAM Approval- with specific conditions as recomended by the Review Comdttee. Fd4 00001 - 3/70.1 ol - $165,200 02 - $127,328 03 $120,521 RM 00001.- 3/70.2 01 --$116,381 02 - $110,000 03 $1103000 ELINOIS FEGIOnkL @ICAL PROGFAM Deferral including a site visit and with the suggestions of the Review Co@ttee. Note: The Council agreed generally with the Review Comdttee concerning project 12 but recalled the difficulties in inter-institutional cooperation within the Region. They Page 14 recomended that the e@ire application be included in the site visit. INDIANA REGIONAL @EDICAL PROGRAM Approval with specific conditions as recomended by the Review Co@ttee. 01 - $211,516 02 - $30,050 03 - $32,390 DMRMUWAIN REGIONAL @ICAL PROGRAM Approval in the revised amount and under the specific conditions set forth by the Review Comittee and technical site visitors; with further clarification of the issue of future-support of this-project as part of the RMP. 01 - $3825478 02 - $223,483 03 - $193,409 IOWA REGIONAL MEDICAL PROGRAM Approval with specific conditions reco@nded by the Review Co@ttee. ol - $82.v437 02 $945089 03 - $12@689 KANSAS REGIONAL MEDICAL PROGRAM Approval 01 - $58)051 02 $6 415 MAINE REGIONAL MEDICAL PROGRAM Approval with specific conditions recomended by the Review Co@ttee. 01 - $50 000 02 $70$000 Note The Council expressed special interest in project 15 d urged staff assistance to the Region in further development of the activity. Page 15 MARYLAND REGIONAL MEDICAL PROGRAM Deferral for a site visit. #24 - Non-approvql II. #25 - Deferral #26 - Deferral #27 - Deferral. T-Tie Council asked '.-hat the site visitors further assess the merit of this project vrithout the film corrpo.,ier-t. They question the value of teaching fi @ for these patients or for physicians and allied health personnel who work with them, principally because of the great variation in the physical and emotional characteristics of the individual patients and the great variety of surgical procedures resultin@ in the stoma. ;METROPOLITAN VIASHTIT(j'TON, D. C. REGIONAL AT. P@30rrPV@ RM 00031 5/69.1 - Approval with specific reco@@,;ions of the Review Co@ttee on projects 1R, 3R, and 35; but with 34 recomended for non-app,-oval I. @01 - $2641058 02 - $213,337 03 $29,850 NOTE: Project 34 is considered inappropriate for RMP funding on several counts. First, the Council is generally very doubtful of the value of films for use with-oatients or health professionals in the management of stomas because of the great variation among patients (both physically and emotionally) and the location and function of the stoma. Secondly, the Council was not impressed with the value of this particular project as a regional effort. Thirdly, the,relations@lps among the proposing group., the national organization of the American Cancer Society, and the Regional 14edical Program, in the joint sponsorship of such a film is uncertain. F,M 00031 5/69.1 and 8/69.1 - Project 25 - Cancer Radiation Therapy Unit for Howard University. Tiie Council agreed to lift its previously imposed restriction on the funds approved for this project; thus allowing the grantee-affiliate (Howard University) to expend funds pr or o the actual errplo@nt of a project director. They restated - their condition, however, that the director appointed must be a qualified radiotherapist. The revised budget seemed to fulfill the other conditions of the award relative to expenditure ceilings for equipment,. T'iae revised direct costs are: 01 - $273,000 02 - $143,850 03 - $149,572 Page 16 MICHIGAN REGIONAL MEDICAL PROGRAM Approval. 01 - $85,730 02 - $9@926, 03 - $107,900 MISSOURI FEGIONAL MEDICAL PROGRAM 3/70.1 - Approval with specific conditions and contingencies, r three years, beginning July 1, 1970. 01 - $2il29,133 02'- $1,129,333 03 - $1,129,133 The approved level for the 01 year includes $1,129,133 for Core support and $1,000,000 for those projects (mainly the advanced technology activities) for which the Region has requested only one year support -- projects #2R, 13R3 14R, and 49. In the 02 and 03 years, Core support is continued at the 01 year level. The Council stated that the $1,000,000 support for the one year renewal projects be contingent upon assurances from the Region that the recoumndations of the site visit report on each advanced technology project would be generally followed. 3/70.2 - Approval with specific conditions. i The National Advisory Council concurredkith the recomendations of the Review Co@ttee, except that project #54, ODARS, was returned for revision because it was not considered to be technically ready for expansion. The Council reco@nded that the approved projects receive Approval TT (approval without additional new funds) in the 01 year, and Approval I (new funds) with specific conditions as described by Review Co @ ttee in the 02 and 03 years. Project #50 - Approval with specific conditions Project #51 - Approval with specific conditions Project #52 - Approval with specific conditions Project #53 - Non-approval I Project #54 - Non-approval- II (return for revision) Project #55 - Approval with specific conditions Project #56 - Non-approval I Project #57 - Non-approval II (return for revision) Project #58 - Approval with specific conditions Project #59 - Non-approval I 01 - $532.,154* 02 - $562,24o 03 - $4o4,8ll8 *To be funded from unexpended balances in the grant period ending 6/30/7c and by rebudgeting from computer-oriented projects as they are phased out (including the heretofore restricted $240,483). Page 17 MISSOURI REGIONAL MEDICAL PROGRAM (Cont) Over-all pro p:ram Recommendations 1. The National Advisory Council considered the recommendations of the site visitors on not only the operational renewal and operational supplements described-above, but also the overall levels of support foi- Missouri @ -- including projects previo@ly approved bycouncil which carry a continuation co@tment. They were in general agreement with these recommendations: In the grant year beginning July 1, 1970, the site visitors -ecomended that approximately $3,o6o,ooo in new funds be made available to the Missouri RMP in the grant period beginning July 1, 1970. This total reco@nded level includes four coiTponQnts,: (1) Core, $1,129,733; (2) Renewal projects, $1,000,000; (3) Projects #46, "Hi-Blood," approxirpately $160,000; and (4) Continuation, projects #25, 26, 27, 29, and 33, approximately $800,000. * The site visitors suggested that the Region use up to approximately $940,000 in carryover funds for the support. of additional subregionalization activities approved by Council -- project.s #36, 37, 38, 39, 43, 50, 51, 523 55, and 58. * In the grant years beginning in July 1971 and 1972., the visitors reco@nded that approximately $2.2 million and $1.8 million, respectively, in new,funding be available for the approved Core, new supplemental, and continuation projects. Counc il stated that these recomended levels in no way represented ceilings., and that the Region could compete for additional funding with subsequent applications. * None of the advanced technology activities are recoiTmended for support beyond the 01 year. Council pointed out, however, that if any of these activities develop sufficiently to the point that Council feels they could contribute significantly to LTproving the health care delivery system., and to developing regional cooperative arran gements., they could compete for future funding. 2. Council concurred with the site visitors and the Review Comftttee that'the.region be strongly urged to expand the Missouri Regional Advisory Group. 5 G03 RM 00009-02Al In a special action, the Council reconsidered a request made in April 1968 for $246,483 for use in project #17 Bioengireerirz Originally recommended for approval the funds have been restricted (Continued Page 18 MISSO= REGIONAL YED@CAL PRC)GRAM (Cont) pending the outcome of a study of the Passouri RMP such as the one just completed. The Council now recommends release of the funds, to be rebudgeted., with DRMP approval, into any previously approved.activities except Core, #2R. 13R, 14R, and 49. NEW MEXICO REGIONAL MEDICAL PROGRAM Return for revision, reflecting the recommendations of the Review Co@ttee. NEW YORK POLITAN FEGIONAL MEDICAL PROGRAM RM 00058 3/70.1 - Return for revision, reflecting the recommendations of the Review Co@ttee. RM 00058 3/70.2 - Approval with specific conditions recomended by the Review Comittee. 01 - $181 02 - $181,300 .1300 03 - $181.,300 NORTH CAROLT-NA FEGIONAL MEDICAL PROGRAM Approval with specific conditions as recommended by the Review Conm-Lttee. 01 - $54.,813 02 - $23,763 03 $0 NORFHEASTERN OHIO REGIONAL DIEDICAL PROGRAM Approval with specific conditions. The Council concurred with the Review Co @ ttee and the site visitors in their recommendation that this Region be awarded operational status. In review@o- the differences between the- site visit and Review Comdttee recomendations on the individual projects, the Council has accepted those of the Review Co@ttee. In regard to @oject 9 (Sumer Vioi,kshop in Career Developmnt) the Council considers it outside the policy guidelines and thus inappropriate for HvT funds (see Section XI of these Minutes). 01 - $786. 03 .il87 02 - $803,696 - $805,221 Page 19 'NO S REGIONAL YEDICAL PROGRAM Approval with specific conditions recommended by the Review Cormiittee. 01 - $121,904 02 - $1403898 03 - $45,941 NORrnREST OHIO REGIONAL MEDICA-T, PROGRAM Approval with specific conditions recommended by the Review Condttee. ol - $335,200 02 - $0 03 - $0 .oBj,6 STATE REGioNAL mEDicAL PRoGRP24 Approval with specific conditions. 01 - $78,559 02 - $75,000 03 - $76 000 OHIO VALLEY REGIONAL MEDICAL PROGRAM Return for revision reflecting the suggestions of the Review Co@ttee. OREGON REGIONP.L 1,FDICAL PROGRAM Approval. 01 - $28,920 02 - $28.1180 03 $293622 PUERTO RICO REGION@T I)EDICAL PROGRAM Deferral for a site visit. The Council concurs in the recommendation of the site visit with one exception. Based on information gained on a previous site visit, the Council agrees to delegate to the site visit team the authority to investigate further and, if appropriate, reco@,nd approval and determine the award level for project 10 - Co ty Fandly Prevention Program on Stroke (not to exceed the amunt requested). 01 - $10)4,,4c)@ 02 - $193,356 O@ - $202,503 page 20 RocEEsTER FEGIONAL IIEDICAL PROGRAM Approval pending endorsement of the site visitors whose visit to the Region as a whole is to take place on April 20-21, 1970. TT-ie Council is in general agreement with the Review Cormdttee I s Recommendations but would not insist on any of specified budget cuts except that of the office space costs. They believe that special nursing services and regular professional handling and transportation of these critical patients is essential and that back-up sets of the highly delicate equipment are required. SOUTH CAROLINA REGIONAL MEDICAL PROGRAM Return for revision reflecting the recommendations of the Review Committee. SUSO@ZIA VALLEY FEGIONAL lvEDICAL PROGRAM Approval with specific conditions as recommended by the Review Co@ttee. 01 - $595,503 02 - $603,199 03 - $571,16o (Figures include project 16, a budget for which has been subndtted and reviewed by staff since the Review Co @ ttee meeting). VIRGINIA REGIONAL MEDICAL PROGRAM APProvql with specific conditions recommended by the Review Co@ttee and with special emphasis on the questions regar.ding the computer aspects of project 8. 01 - $225,444 02 - $211,225 03 $226,025 WESTERN NEW YORK RFGIONAL MEDICAL PROGRAM EM 00013 3/70.1 - Deferral for technical site visit to each of the three projects @q 00013 3/70 - Srecial AcL@,@-on -@C'ferral, to be studied as par- of the site visit recommended I-or the other projects. Staff is authorized to arrange for funding to maintain the program until final action is taken. Page 21 @NSIN RFIGIONAL MEDICAL PR)GRAM RM 00037 @forrwrly 8/69.1 and 12/69.1) -.Approval in the time and anx)unt requested, with the suggestioh-s and reconmridations cited by the Review C@ttee in July 1969. (See also section XI, A, 4 of these minutes). 01 - $5421155 02 - $465$305 03 - $442.%805 XII. Adjournrrient @eting was adjourned at 10:45 a.m. on April 1, 1970. I hereby certify that, to the best of rrjy knowledge, the foregoing minutes are accurate and complete. Harold Mar@ies, Acting Director Regional Medical Service Text of the statements and additional materials which were distributed at the rweting are available in the Office of the Council Secretary. Page 22 ING OF RECOMMENDARMONS Pmm the Panels to the Review Co,=ttee (On Projects Only) Technically sound and capably directed Feasible under specified conditions Unapprovable on technical grounds the Review Co ttee to the National Advisory Council (On Projects) Approval I '@'Additional funds reco@,nded Approval II - No additional funds reco@nded Non-approval I - Inappropriate for D@ funding Non-approval II - Revision required ,to action taken - Need additional information Need site visit Need Council decision (On Entire Applications) Approval Ppproval with specific conditions Deferral Return for Revision Disapproval - Inappropriate for DRMP funding the National AdvisoEy Council to the Pdm-inistrator (On Entire Applications) Approval Approval- with specific conditions (As reco@nded by the Review Committee or others) Defer Return for Revision val Imppropriate for DIM funding Page 2 3 ATIMANCE AT THE NATIONAL ADVISORY COUNCIL March 31-APril 1, 1970 RWS STARF ATDMING Bloz, Kidney Disease Program Dr Edward T. quist, Acting Chief) s Review Mrs. Marilyn Buell, office of Grant Mr. J. Edgar Caswell, Heart Disease Pm@ Dr. Donald R. Chadwick, Deputy Director, DFW Mr. Clyde Couc@, program Assistance Branch program Assistance Branch Mr. Spencer Colburn, urological and SensOrv Diseases Program Dr. Clifford H. Colej, Chief, Ne ,7 Education and Training Branch Dr. Veronica Conley, Continuing Dr. Sam Fox, Chief, Heart Disease Pro@ oT,,@cations and Mr. Edward Friedlander, Assistant Director fG public Infonmtion nt Mr. Charles Hilsem-oth, Assistant Director for Managem Miss Dona Houseal, Office of Grants Reviewh Mr. Robert Jones, Chief, programs Assistance Branc ng and Evaluation Mr. Ted Koontz, office of P g House for Smoking and Health Mr. John M. Korn, Jr., National Clearin W. Gregory Lewis, Chief, Grants Management Branch Mr. Ray Maddox, PrO@ Assistance Branch Dr. Richard Manegold3l Associate Director for @ Operations & Develop@nt h & Systems Analysis Branch Dr. Mark, Chief, Operations Researc miss i4ajorie rrillj office for RMP Operations and Developffent m Operations and Development miss Elsa Nelson, office for RNP Dr. Stanley W. Olson, Consultant ctor for Grant & Contract Policy mrs. Martha L. Phillips, Associate Dire Mrs. Jessde Salazar., office of Grants Review Mrs. Sarah Silsbee, Assistant Director for Grants Review Dr. Margaret Sloan, Associate Director for Organizational Liaison W. Robert Thorner, Assistant Director for Health Data OTHERS ATIEDING Dr. C. A. Rosenberg, Veterans Adndnistration Dr. Philip Donham, A. D. Little, Inc. Mr. Charles Rosenberger, NCI/NIH Mr. John Pendleton, NCHSR&D/HSMHA Dr. Bernard Daitz, CHS/HSMHA Dr. William Zukel, NH&LI/NIH miss Joan @lton, OL/HSMHA Dr. Lee Langley, @NIH Page 24 -NATIC:@-AL ADVISORY COLJNCIL ON REGIO.',@lpj, r@,,DIC@T PROG@'vbS BRENI,LA,N, Michael J., M.D. (72) P@EG@0, EdiTnnd D., M.D. (70) President., Michig:an Cancer Foundation Vice President for the.Healtli 4811 John R'Street Sciences and. Director of the Ctr. Detroit, Vdchigan li8201 State University of New York Stony Brook, Nevi York' 11790 Professor of Medicine Wayne State University POPMA, Alfred M., M.D. (70) Regional Director CANNON, Bland W., M.D. (73) Mountain States H.IP 910 Madison Avenue 525 West Jefferson Street @his, Temessee 38103 Boise., Idaho 83702 Division of Neamsurgery RCYTH, Russell B., M.D. (73) University of Temessee College 240 West 41st Street .of Medicine Erie, Pennsylvania 165b8 CROSBY, Edwin L., M.D. (71,) Vice Speaker of the House of Executive Vice President and Director Delegates, A-MA American Hosp4-tal- Association Chicago, Illinois 60611 SHANHOTJTZ., D4ack I., M.D. (70) State Health Comdssioner DEBAKEY, Michael E., M.D. (72) State Depar'u@-it of health President and Chief Executive Officer Richmond, Virginia 23219 Baylor College of Medicine Houston, Texas 77025 TREEN, l@. Curtis (71) Director Professor and Chaii,@ Pension and Insurance Dept. Departrrient of @g---ry United Rubber, Cork, LiroleLLm, College of Medicine and Plastic Workers of @rica 87 South High Street EVERIST-, Bruce W., M.D. (71) Akron, Ohio, 44308 Chief of Pediatrics Green Clinic WYCKOFF, Mrs. Florence R. (72) Ruston, Louisiana 71270 243 Corralitos Road Watsonville California 95076 MILLIYMI, Clark H., M.D. (72) Consultant in Neurology Mayo Clinic Rochester, Minnesota 55902 CHAIRMM Dr. Joseph T. Fn-lish A@nistrator Health Services and Mental Health Administration 5600 Fishers Lane nri