1415* DEPARD@ OF @Tli, EDUCATION AND WELFARE PUBLIC @fH SERVICE National Advisory Council on Regional @ledical Programs @linutes of the Twenty-sixth Meeting February 8-9, 1972 The National Advisory Council on Reuional Medical Programs convened for its twenty-sixth meeting at 8:30 a.m. on Tuesday, February 8, 1972, in Conference Room G/H of the Parklawn Building, Rocl-ville, @laryland. Dr. Harold Margulies, Director, Regional @ledical Programs Service presided over the meeting. 11 ...-ie Council @,lem:)ers present were: Dr'. Bland W. Cannon Dr. John P. Merrill Dr. @tichael E. DeBakey Dr. Alton Oclisner-- Dr. Anthony L. Komaroff Dr. Russell B. Roth Dr. Alexander M. McPhedran Dr. George E. Schreiner @Irs. Audrey M. @lars Dr. Benjamin W. Watkins Dr. Clark H. NLillikan Mrs. Florence R. Wyckoff Mr. Sewall 0. Milliken Dr. John D. Chase 3/ A listing of R%ffl staff members, and others attending is appended. I. CALL TO ORDER AND OPENING RENMS The meeting was called to order at 8:30 a.m. on February 8, 1972, by Dr. Harold D,Iargulies. Dr. Margulies called attention to the "Conflict of Interest" and "Confidentiality of Meetings statement in the Council books. Ile then introduced Dr. Vernon E. Wilson, Administrator, Health Services and Mental Health Administration. 1/ Proceedings of meetings are -restricted unless cleared by the office of the Administrator, H.3,ffiA. 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 mi-(Tht occur. This.procedure does not, of course, apply to en bloc actions-- only when the application is under individual-ai'scussion. f, Representing Dr. Marc J. Trusser for the Veterans Administration. 2 II. REN@S BY DR. VERNON E WILSON The Council is beginning to pick up responsibilities for advice and connent on things that go beyond-the original charge for RNIP in its initial form. Currently expanded areas of interest include Emer(Tency @ledical'Services, Health Maintenance Organizations and Area Health Education Centers. The options for allocation of funds for these programs have been discussed with the Secretary, the Office of @'lanage- ment and Budget, and others. In these discussions, it became clear that the mission that @IHA has been trying to describe for R@1P would be well served if the program were to take on additional Tesponsibil- ities that would make it advisable to release moneys that have been held in@yeserve. H@-IA's assumption of-responsibi.lity for HI-10s and EMS has been particularly helpful in obtaining release of the full amount appropriated. RMP'fu-nds will be used for the aiS program. Emergency needs are pri- marily provider oriented and the @,IP program is HaM's principal arm for communication with the provider community. A portion of the $8 million currently available for DAS will be allocated to support model programs in a limited number of areas. The remainder will be available for allocation through PNIP. It is expected that next year $15 million will be available to support EMS instead of the cur-rent $8 million. Because many B@ilHA programs are concerned in various ways with emer- gency services, a special office will be set up under Ilr. Riso to coordinate aLS activities within HSNM. Use of R'V funds for FY40 demonstrations is expected to be a 1-year activity. There is adequate authority in the @IP legislation for short-term demonstrations of this nature. It is expected that future funding of @10s will be accomplished either through new legislation or through service-type money such as 314(e). Determination of how funds for Area Health Education Centers will be administered is still awaiting a final decision by Dr. DuVal. In the meantime, there have been many discussions about AHECs involving HSNM, NIH, the Department, and others. It is clear from these that RMP will he concerned with those AHEC programs where there is less emphasis on a degree, certificate or formal program .recognition of some kind ' The-Bureau of Health @lanpm,;er on the other hand, would deal more specifically with proarams involving or leading to long-tem training, residency training or formal degrees. No matter how -responsibility for an AEEC program is divided between NIH and H@ffA, there will be a single application and a single award which might be composed of amounts of money from both agencies. In the discussion following his presentation, Dr. Wilson indicated that he would be happy to receive the Councills views on these and any other matters of concern. 3 III. RE-PORT BY DR. @,IARGULIES Dr. @@gulies reiterated and @ified some of Dr. Wilson's remarks about ENIS and AHE-CS. In addition,, he covered the following topics: A. RV Budget and Spending Plan The total amount of funds appropriated for grants for Fiscal Year 1972 has been released with the understanding that specific amounts will be spent for DIS, AHECS, @-.10s and construction. The actual figures are shown in the table below. Total Appropriations $135.0 Earma,r AIIEC $ 7.S ENIS 8.0 MO 16.2 Construction S.0 Total Earmrks 36.7 Available for $ 98.3 The amount currently available for @IP ($98.3) contrasts sharply with the @70 million available for the previous fiscal year. The additional funds have provided an opportunity to (1) restore previous reductions, (2) provide additional funds to the more advanced R@g's in accordance with their relative ratings, and (3) increase the investment in kidney activities@by about SO% to ap- proximately $8 million. B. Reduction from 4 to 3 Review Cycles Annually It has been decided to reduce the number of annual*review cycles from 4 to 3. This shift will provide more time for technical assistance by staff between review cycles. It will provide more lead time between the notification of Council action and the Region's anniversary date, and it will enable the Reaions at this point,in time to adjust their program to the higher appropriation .levels in a more orderly manner. C. FM Revieiv' Process A choice has to be made with respect to whether fMO funding is to be accomplished entirely by contract, or by grants through the RW mechanism with a clear understanding that review would not folloi@ normal @T pattern. For a number of reasons, the @IP Coordinators would prefer grants to contracts as a mechanism for funding @10s. First, many of the lWs are already involve with HMO development and would like to remain close to the activity as it continues to develop and, secondly, it is quite clear that @lPs 4 will have a major role.in the professional development of HYiOs with respect to such matters as quality of care monitoring, emergency services, health manpower training, etc. D. National Cbbrdinato s Meeting The National@Coordinators Meeting which took place in St. Louis in January engendered some highly beneficial discussions. There was vigorous discussion of the @,IPS -oosition paper on AECS. The material on Emergency Medical Services was well received. Some -research and development needs were surfaced, and RNP-CHP relation- ships turned out to be a surprisingly live issue.. Dr. DuValls remarks touched on this subject, and, in addition, he stressed the responsibility of PJvlPs in monitoring the quality of health care particularly in the context of the great liklihood of national .health insurance. All of thC Conference material, including Dr. DuValls speech will be available for distribution. IV. KIDNEY REVIBI PROCEDURES Dr. Margulies called upon Dr. Hinman to describe proposed procedures .for the review of kidney proposals ' The kidney review process will involve the following steps: (1) screening of preliminary proposals in -r'elation to national priorities by R\IPS, (2) technical review at the local P,,',,IP level by a review panel including at least 3 renal experts from outside the area, (3) RAG review of applications receiving favorable technical review in order to insure that the @IP can adminis- ter the kidney project without hindering total local RNT program, (4) RMPS staff review relating to national priorities, RAG a d CliP comments and preferred method of funding, (5) opportunity for comment by the Review Committee on program and regionalization, and (6) a final recom- mendation by the National Advisory Council. At a later point in the meeting, a motion to endorse a statement embodying these principles was moved, seconded and carried. The state- ment in reproduced as Attachment A. V. NORFHVEST"CANTCER CENTER As the next item of business, the Council considered the application for construction of the Fred Hutchinson Cancer Research Center in Seattle. Dr. Henry Lemon, who served as Chairman of the site visit team, was invited to participate in the discussion. Both he and Mrs. iNIays reported in considerable detail on the findings and -recom- mendationt of the site visitors. Proposed action of the Council with respect to the award of funds for construction of the Cancer Center was moved, seconded and carried with the following amendment: 5 "That there be an additional point incorporated into the draft, point C, which stipulates that the isolated beds not be included as part of the application until such time as justification is brought before this Council and acted upon favorably.'' (Tran- script, page 127, Vol. 1). The complete text of the resolution as amended is appended as Attach- ment B. VI. ADVANCED TECHI\ULOGY ACFIVITIES A. Computer Assisted EKG Ana Dr. Hinman summarized a report on computer assisted EKCI analysis which was made available to the Council in the agenda book. The Report res'ults from a day long conference in November, 1971 chaired by Dr. Leonard Scherlis of the RNIPS Review Coimnittee. The con- fetence was the outgrowth of interest in an earlier draft developed by Dr. Kenneth Gimbel of the @IPS staff. The present report indicates that the @IP role with respect to computer assisted EKG analysis'should be one of consultation and advice, 'of providing linkages and helping to develop systems. Investment in hardware is not considered to be an appropriate Mffl function. It was moved,, seconded and carried that the Council.given general endorsement to the position paper, recommends its distribution and development and implementation of an appropriate policy statement. (Transcript, page 132, Vol. 1). B. Study of Advanced Technology in Relation to,,@1P Dr. Nlargulies called attention to the Councills request at the previous meeting for an @IPS study of the whole question of advanced technology in relation to Regional @ledical Programs and improved delivery of health services. There is now a major Government-wide effort to come to grips with issues involving the impact of technology on social systems. This effort involves the Office of Science and Technology and other agencies. In addition,, the President has indicated that there will be a message to Conaress regarding the implications of advanced technology in the coming years. Under the circumstances, it would be urntise for @IPS to mount a separate effort. In the meantime, P,NTS will attempt to keep well inforiked as possible on matters relating to technology. 6 VII. POLICIES AND DELEGATIONS A. Review Responsibilities Statement The Council was requested to modify the statement, "Review Respon- sibilities Under the Triennial Review @istem" which it approved at its August, 1971 meetina. The document delegates to the Director authority to fund awards during the second and third year of tri- ennial applications. Dr. Pahl explained that the revised language would -require Council action only where a change, up or down, in the Council approved level is required. Under the previous wording, Council action was required whenever the amount requested exceeded the recommended level of support. Another change eliminates the need for Council action in the case of small increases in the Developmental Component. It was moved, seconded and carried that the -revised statement be approved. (Transcript, page 139, Vol. 1). The Review Responsibilities statement as passed is reproduced as Attachment C. B. New Policy and Delegation Regarding Triennial Grants Dr. Pahl presented the proposed tvo-part policy statement. He explained that the first part constitutes an understanding that when Council acts upon the.first year of a multi-year budaet, it is understood that the second and third years, if support is approved for those periods, will be identical.with the first year's budaet unless the Council recommends otherwise. The second part of the statement delegates to the Director, RNIPS authority to approve an R@IP's programmatic chanceslduring the C, period of transition from four to three-cycle review. It was moved, seconded and carried that the above policies be approved. (Transcript, page 143, Vol. 1). The full statement as passed is appended as Attachment D. C. AIIEC Resolution Dr. Pahl explained that the purpose of the proposed AIE-C Resolution was to implement the AIFC program more expeditiously by delegatin- to the Director authority to fund small feasibility studies. It was moved, seconded and carried thqt the Resolution be approved 'th the addition of the following language: wi "It is further understood that Regions will first utilize 'free' Developmental Component funds, where available, and that 7 the general policies and procedures of the individual @s 0 with respect to review, approval and funding, including RAG concurrence, will apply." (Transcript, 218, Vol. 1). The full text of the-motion as passed is appended as Attachment E. D. FM Delegation Dr. Pahl presented a resolution for consideration by the Council which would delegate to the Director, RPS, authority to fund HMO projects in accordance with the recommendations of the @10 Service. After considerable discussion and several votes, a substitute proposal was placed before the Council, and moved, seconded and carried. (Transcript, page 5, Vol. 2). The motion as passed is appended as Attachment F. E. Equal Employment Opportunity Dr. Pahl introduced Mr. Richard Clanton, Deputy EEO Officer for RMPS., who reviewed RNP activities relating to EEO and directed the Councills attention to a request from the Review Committee to clarify RW policy in this regard. Specifically, Mr. Clanton called attention to RMPS's "Affirmative Action Plan" and described lans to assist Regional Medical Programs with respect to employ- p ment and utilization of minorities and women at all levels-of responsibility. It was moved seconded and carried that the Review Connittee's .1 proposed policy statement be approved with certain additions which are reflected in the text shown in Attachment G. (Tran- script, page 176, Vol. 1). VIII. SPECIAL ACFIONIS A. Connecticut RNIP Rating It wat moved, seconded and carried that the "Connecticut Regional Medical Program be placed in-the A category of programs." (Transcript, page 11, Vol. 2). B. Increased Levels of Support for Certain Regions It was moved, seconded and carried that the approved levels of suppo-Ft-for the following @lPs should be increased: (Transcript, pages 14 16 and 17, Vol. 2). Wisconsin, Iowa, Mountain States, Washington-A-laska, Intermountain, Tennessee Mid-South., Indiana, and New Mexico. A table of the specific amounts approved is provided in Attachment H. IX. CONSIDERATION OF THE @II,\TUTES OF THE NO@[BAER 9-10, 1971 MEETING The Council considered and approved the Minutes of the November 9-10, 1971 meeting. (Transcript, page 3, Vol 2). X. CONFIPIIATION OF FUFURE MEETING DATES The Council set the following dates for future meetings: June 5-6, 1972 October 16-17, 1972 February 7-8, 1973 .,June 5-6. 1973 Xi. REVIBV OF APPLICATIONS* A. Greater Delaware Valley Regional Medical Program Motion made by Dr. Watkins - Seconded by Dr. DeBakey. Approve the Review Committee's recommendation for tiio year funding: 04 year - $1,900,000 05 year - $1,700,000 (Transcript, page 199, line 11.) The motion was unanimously approved. B. Maryland Regional Medical Program Motion made by Dr. McPhedran - Seconded by Mrs. Mars. Approve the Review Committee's recommendation for two year funding: 04 year $1,294,960 05 year $1,294,960 Subject to the following negotiations: (1) Deletion of funds for Project #43. (2) Funding of Johns Hopkins @,K) proposal to be limited to t RMP related activities.. (3) Resolution by PNIPS staff of need for additional funds for Projects 40 and 41'in relation to support of overall R%IP Evaluation Unit at the University of Maryland The motion was unanimously approved. *All actions inclu e consideration of kidney projects, where appropriate, unless otherwise specified. 9 C. Western Now York Regional Medical Program, to be changed to Lake Areas Regional Medical Program Motion made by Mrs. Mars - Seconded by Mr. Milliken. Approval of triennial status at a reduced funding level of: 01 year - $1,219,000 02 year - $1,340,900 03 year - $1 462,800 (Transcript, page 233, line 11.) The motion was unanimously approved. It was further moved by Mrs. Wyckoff, and seconded by Mr. Milliken, to hold the rating for the Western New York application in abeyance until the Review Committee has a chance at its next meeting to assess the new developments and assign a rating based on this information. The motion was unanimously approved. (Transcript, page 245, line 14.) Dr':. Roth absented himself during this discussion. D. Metropolitan D.C. Regional Medical Program .i - Motion made by Dr. Ochsner - Seconded by Dr. Roth. Accept the Review Committee's recommendations. (Transcript, pag'e 29, line 14.) The motion was unanimously approved. Dr. Schreiner absented himself during this discussion. 05 year - $807,000 General Program 05 year - 202,000 Kidney Program $1,009,000 Total Direct Ei Louisiana Regional Medical Program Motion made by Dr. Komaroff Seconded by Dr. Millik..@. 10 Approve the Review Coirmiittee's recommendation with the exception that no specific ceilina be placed on the funding for the coro- nary, pediatric, pulmonary units, only a statement that renova- tion and equipment costs are no longer'part of P.NIPS policy and that a very modest expenditure is recommended. (Transcript, page 55, line 14.) The motion was unanimously approved. With regard to the kidney aspect of the application, Dr. Merrill moved, and Dr. Millikan seconded, that it be funded for one year at the level of $94,595 and that the progress be reviewed with regard to funding for the second and third years. (Transcripti page 57, line 1.) The motion was unanimously approved. Dr. Ochsner absented himself during this discussion. F. Illinois Regional-Medical Program Motion made by Dr. Schreiner - Seconded by Dr. Roth. Approve the recommendations of the Review Conmiittee. (Transcript, page 70, line 6.) Approval of the program for the triennium; Approval of the de velopmental'compopent; and Approval in a reduced amount at the following levels: 03 year - $2,650,000 0 04 year - $2,800,000 05 year - $3,000,000 The motion was unanimously approved. G. Ohio Regional Medical,Program Motion made by Dr. Millikan - Seconded by Mrs. Mars. Approve the staff recommendations concerning the amalgamation or merger of the Ohio State and Northwestern Ohio Regional Medical Program into the Ohio Regional Medical Program. (Tran- script, page 83, line 1.) Another motion was made by Dr. Mill@lkan, and seconded by Dr. Cannon, that the Northeast Ohio ReRional Medical ProRram be funded at its current level on a year-to-year basis with a project site visit for staff review of progress to be made in late 1972, and that, depending upon the result of that review, further effort be made to produce amalgamation or a combination of Northeast Ohio with the Ohio Regional Medical Program. (Tran- script, page 86, line 17.) The motion was unanimously approved. Mr. Milliken absented himself during this discussion. H. Florida ReRional Medical Program Motion made by Dr. Cannon - Seconded by Dr. Millikan. Approval of the site visit and Review Committee recommendations for funding: 04 year,,- $1,552 706 05 year - $1,673,750 06 year - $1,713,150 This is exclusive of funding-for the kidney project. The motion was unanimously approved. (Transcript, page 89, line 4.) Motion made by Dr. Cannon and seconded by Mrs. Wyckoff for approval of the kidney Project #43 on the basis of the staff information in the amount of: 04 year $375,000 05 year $313,500 06 year $251,625 (Transcript, page 99, line 1.). Thelmotion was unanimously approved. I. Intermountain Regional Medical Program Motion was made by Dr. Schreiner - Seconded by Dr. @lillikan. Approval of the Review Committee's recommendations, with the exception that the developmental component funds be increased to maximum allowable level. Total of $2,700,000. (Transcript, page 102, line 6, and page 108, line 23.) The motion was unanimously approved. 12 J. Susquehanna Valley Regional Medical Program Motion made by Dr. Cannon - Seconded by Dr. Schreiner. I Approval in the amount of $750,000. (Transcript, page 116, line 23.) The motion was unanimously approved. K. Alabama Regional Medical Program Motion made by Dr. McPhedran - Seconded by Dr. Millikan. Approve the recommendations of the Staff Anniversary Review Panel including the funding of the developmental component. Total funding level: $1,115,000. (Transcript, paae 123, line 18.) The motion was unanimously approved. L. New Jersey Regional Medical Program Motion made by Dr. Millikan - Seconded by Dr. Chase. Approval of the recommendations concurred in by the Staff Anniversary Review Panel and the.Review Committee. (Tran- script, page 131, line 15.) 04 year - $2,900,000 05 year - $2,900,000 The motion was unanimously approved. M. Delaware Regional Medical Program Motion made by Dr. Cannon - Seconded by Dr. Millikan. Apporoval of the application of Delaware for a separate Regional Medical Program provided the grantee agency is not part of the State Government. Level approved was: $389,050. (Transcript, page 136, line 5.) The motion was unanimously:lapproved. 13 N. Nortlilaiids Regional Medical Program Motion made by Dr. Komaroff - Seconded by Dr. Roth. Approval at the same level as the previous year - $1,511,000. (Transcript, page 142, line 14.) The motion was unanimously approved. Disapproval of the kidney project. Di. Millikan absented himself during this discussion. I hereby certify that, to the best of MY knowledge, the foregoing minutes and attachments are accurate an comp ete. Harold Margulies, @I.D. Director Regional Medical Programs Service Ellandal 3/31/72 v ATTENDANCE AT THE NATIONAL ADVISORY COUICIL MEETING February 8-9, 1972 (this is an attachment to the Minutes) RMP-S STAFF OTHERS ATTENDING Mr. Vernic Ashby Dr. J.H.U. Brown, OA-HSMHA Mr' Kenneth Baum Dr. Margaret H. Edwards, NCI-NIH Mrs. Paula Bell Dr. Bruce W. Everist, Consultant Mr. 11. Earle Belue Dr. Henry If. Lemon, Review Mr. Cleveland R. Chambliss Committee Member Mr. Richard Clanton Dr. Robert A. Leyton, NHLI-NIH Mr. Tom Croft Mr. E. E. Olexa, OS-ASC-AA Dr. John Farrell Mr.,Maurice C. Ryan, Region V Miss Myrtle Flythe Dr. Frederick L. Stone, OA-HSM Mr. G. T. Gardell Dr. William Vaun, Consultant Mr. Sam 0. Gilmer, Jr. Mr. Robert A. Walkington, NLM-NIH Dr. K. S. GimbeL- Dr. Vernon E. Wilson, OA-HSMHA Mrs. Eva Handal Mrs. Gloria Hicks Mr. Charles llilsenroth Mr. George Hinkle Dr. Edward J. Hinman Mr. Burt A. Kline Mrs. Lorraine Kyttle Mr. Walter Levi Dr. Harold Margulies 14r. Ted C. Moore Miss @larjorie L. Morrill Miss Mary E. Murphy Mr. Frank S. Nash Miss Elsa J. Nelson Mr. Joseph Ott Dr. Herbert B. Pahl Mr. Roland L. Peterson Mr. Michael J. Posta Miss Leah Resnick Mr. Richard Russell Mrs. Jessie Salazar Mr. Luther *J. Says Miss Teresa Schoen Mrs. Patricia Schoeni Mr. Matthew Spear Mrs. Sarah J. Silsbee Dr. Margaret H. Sloan Mr. Jerome J. Stolov Mr. Willia@ A.. Torbert Mr. Lee Van Winkle Mr. Frank Zizlavsky ATTACTL@,IENT A ),l,OPOS17D rEVIElq l@ KIDi@!,@Y I"POPOSALS Kidney proposals slial.1 be reviewed in the manncr: erest in (lie submission of a 1. Ti-nmediately upon an indication of int Kidney proposal by a SOLIRCC- N,7itllill an @lp, the P@T should contact t-@lic appropriate L'@l,?S Desi,, to determi-iie N,,Iic-tlier tlic, proposal is within the scope of ii,-it-iot-ial priorities. At this point, P-',@-S will advise tlic, P@l? whether it is desirable to proceocl further. The r,!fP niiy accept or ):eject this advice. 2. Each -R@@fP sul,),,@i-t'ting i renal disease proposal is expected -to provide a technical r-,-vl".ci.., of the p,.oposqi by i group N@I)icli had no!-- participated in its (level-op,,-.-,ent.and' in--Iticles at least 3 renal 2u,L-liL)rities fro-.i outsid-e the Re-ion, prior to sub,-nissioii to W.,;PS. The review group may be eitlici7 an ad hoc or standing P,,@@PS will. maintain a list of consultants N.@lio may be called upon to serve-iii this capacity. 3. Kidney proposals which receive a favorable local technical review shall be forwarded by the Recic,.,ial Advisory Group (RAG) to PI.IPS i.@itli the Pj',G's C. co@,ntiicnts and to CII@P for review ziid co-.-rneiit. The RAG shall consider and con,,iren J- t on the ability o@ the P,:,@T to i,-,ana(,e the Kidney project without hindering the development of the overall P\,%Tx pro-ra-,ii, and the reasonable- .ness and adequacy o@- the ',,@4@clney burJ-et. Since Kidney proposals are separately f-tiii-Jed, there is no reason for the RAG to give priority r,-tnl-lir.Rs to Kidney P170POSals in relation to other non-Kidney P\I.IT opcrat2j-onal Kidney proposals shall be considered by 'ICITS in relation to national pricr-@-t--:-z 4. The P,12!PS staff' review shall include consideration of: a. the contribution of the pro'ect toward national Kidney priorities b. the co-in.-.,,cnts of the RAG (point 3, above) ind the CIIP a-ency(ics); c. the preferred iiethod of funding. 5. Applications to-ethei-- with M,,TS staff review and local technical r e,,7 i e.@,7 shall- be provided to the @,TS Review Co-,firnittce it its option for c o c n t on pro-grar..i and rcgionali;,,a - The Committee shall no 'ider bud-et tion t coils and technical aspects of the roposal. p 6. All Kidney proposals sl)all- be submitted to the National Advisory Council for a final recori,-.-,c-n(laticp. . In Iceeping Nqitli the categorical. nature of the Kidney disease pro-ya-,n within PJ!PS, the Council uill review and recoir.inend funding level-s for Kidney proposal@' separately from tl-ie ftindin- level of the specific APPitOVED: February 3, 1972 AT'RACILMENT B ACTION BY NATIONAL ADVISORY COUNCIL ON THE FRED HUTCHINSON CANCER RESEARCH CENTER Council Recommends: A. Award of $5.0 million to the Fred Hutchinson Cancer Research Center in Seattle for the construction of a cancer facility to serve HEW Region X. The award is contingent upon meeting the following conditions: 1. All relevant Federal, State and local requirements concerning the expenditure of Federal funds for the construction of the proposed type of facility including all needed licenses, clearances, permits and approvals; 2. The University of Washington and Swedish Hospital formalize their relationships with the Center through written agreements; and 3. All conditions contained in the Council's Statement of November 10, 1971, entitled "Statement by National Advisory Council on Regional Medical Programs on Cancer Center To Serve HEW Region X," are satisfied. B. Th@ provision of space to accommodate 20 beds, which would be isolated from the Swedish Hospital Medical Center, be reconsidered with further justification for review and approval by the National Advisory Council, RMPS. C. Award of $50,000 to the Washington/Alaska RMP to assist in developing the regionalization of cancer activities. APPROVED: February 8, 1972 ATTACM,,ENT C REVIEW RFSPONSIBILITTES UNDER TI-T@ -TRIE-?.INIAL REVIEW SYSTEM Under the triennial revie'07 System, each Regional Medical Program norm- ally will be reviewed by the National Advisory Council only once each three years. The triennial review serves to recognize the Region as an accredited" organization and to set a general level of annual sup- poi-t-for the thres-@-ear period. Thu-,, the Councills favorable recommend- ation constitutes a time-limited approval for an PD@IP as an organization having recognized capabilities,'rather than' being approval for a specific set of activities. In addition to recommending the general level of support, Council actions on individual applications may include advice to the applicant Regional 14edic'al Program, or specific conditions for the grant. Prior to review by the Council,.each triennial application will be reviewed by assigned REPS staff, a site visit team and the RIIPS Review Committee. Except as specified below, the Director, RMPS, Hill make continuation awards, including support for new activities, for second and third (02 @ 03) year support without further Council action insofar as the proposed activities are consistent with relevant policies. Specifically, the Councilis advice will be sought when: 1. The Director, MIIPS, has determined, or the Review Committee has reco@- nded to the Director, that a change in the Council approved level :*Ls indicated. 2-.-,-A new Developmental Component is requested. 3. The Director, the Review Committee, the Region, or a member(d) of the Council itself requests Council review. 4. The applicant has failed in a material respect to meet the requiremnts of the Program or applicable laws, regulations or formally promulgated policies of the Department, HS@IA, or MPS.-- A s will be provided to the Council on each Region reviewed by staff for continuation support. This su y will include: 1. The findings as determined by the review of the Director, together with a *tatement of the amount previously recommended by the Council for funding and the armutn awarded. 2. A list of activities supported during the most recent grant year, identifying thosewhich have been completed and those which have been supported through a Developmental Component. 3. A statement of the Region's response to any advice specifiecl'by' the Council or limitations upon or conditions of the award ATTAC@T,T,,'T@ tcontinue@l 2 4. Identification of any outstanding accomplishments. 5. Identification of any outstanding problems. 6. Annual reports from the Regional Advisory group and from RL,,PS staff. (These will be made available on request by the Council.) APPROVED: February 8, 1972 ATTA.C@TI,I,',T D P^V'U-LCY Oii AiiD U-V AU:T!I-URITY FC TIE NATIONAL ADIIISOQY COUNCIL ON REGIONAL IEDICAL PROGRAYS REGARDING GRA NTS V@ITH TRIENNIAL STATUS Effective this date, the following constitutes new Council policy and delegation of authority which supersedes existing relevant policies/auth- orities. Polip.y In considering the three-year budget submitted by a Regional Yiedical Program applicant in a triennial application, where the Council recommends support-for more than one year,,it is understood.that the recommended level of support for future years of the approved period shall not be less than the amount recommended for the first year unless otherwise specified. of Aqthorit Del@ation a to the Director, RMPS The Council delegates to the Director, FAIPS, authority to approve an RIT's progr tic changes during the period of transition from four to three-dycle review, including new initiatives in keeping with the natural progress of the Region, provided that the Region submits to the Director a plan covering the interim period, and receives approval the:Cefor. APPROVED: February 8, 1972 ATTACM,,T@Y,T E AIJEC RESOLUTION The Council, recognizing the need for expedicious action and flexibility in funding feasibility studies that would permit local areas to assess the potential and feasibility of developing Area Health Education Centers, delegates to the-Director of RMPS authority to award supplemental grants to individual Regional Yedi@ Programs for such purposes. It is under- stood that (1) no local area shall receive funds for an AHEC feasibility study in excess of $50,000(total costs) and the duration shall not exceed 12 months; (2) no single RI.!P shall receive in excess of $250,000 for such feasibility studies in any 12 month period; and (3) approval and funding of these AHEC feasibility studies by Regions will be within such general guidelines as Rlv!PS may establish. It is further understood that Regions will first utilize 114,reell Developmental Component funds, where available, and that the general policies and procedures of the individual Regional Yedical Programs with respect to review, approval and funding, including RAG concurrence, will apply. APPRCAFED, February 8, 1972 ATTACP=@,@,T F lEi'O DTLEGATION The Council shall discharge its responsibilities in regard to reco- mmending R14P grant support for HMO feasibility studies and orgaiiiz- atio,n and development efforts by delegating to a subcomittee of the Council full authority to work with the Director, RMPS, and to approve applications for 121,0 grants. ,-.APPROVED: February 8, 1972 ATTACIR,7L?NT G REVID,@L OF APPLICATIONS WITH RESP-BCT TO EQUAL Fj,!PLMEI@'T AND CIVIL RIGI@S The Council reco@,ends that those participating in the review processt including site visitors and the Review Coramittee be instructed to give special interest and attention to the issues of compliance with the Civil Rights Act of 1964, and the reasonableness and adequacy of rep- resentation and employment of Minorities and women at all levels in RMP activities An examination of performance in relation to these issues shall be an essential element in the review of every application, and such review shall be adequately documented in each case, If, in fact, the reviewers feel that there is sorae question of compliance, or inadequate perfor@nce, they not only have the night, but are expected to request thatlappropriate review of that issue occur. APPROVED: February 8, 1972 Ire Attachment H Program with increased levels approved by the NAC PROGRAM PREVIOUSLY APPROVED LEVEL NEW LEVEL 1. Wisconsin $1,500,000 $1,779,072 2. Iowa 800,000 841,065 3. Mountain States 1,511,000 1,934,117 4. Washington/Alaska 1,679,906 1,796,503 5. Intermountain 2,417,167 2,690,853 6. Tennessee Mid-South 2,0821643 2,166,139 7. Indiana 1,100,000 1,121,411 New Mexito 890,000 1,036,719