11 ,iiiiti )I@ll Allen * p U I,,,) r oi. be i 'L)urczlji@i level Wi.ti,iii tiiv csi-, to i@lilli)l.'OVC both t' in the tlireLigi) the administration of exi..@-It@i,nci, stt@'ttitory as well. as If.R. l@6/'-04 o@- substantially sirii-lar pet@di.-Li47 Legislation curr,-ntl-,%,,- beiDO' considered clearly Q'i.ctates the need -lo perf'orm the following 1. Dev6lj.op, format, promulgate, coordi-ria@te. a.-,id revise as necessary a sufficient body of polic),, regulations, oiii.ciel-I.iies, ind bpeia- tional procedures to facilitate the. practice o--F +,.he I.ecj.slative intent, 2. Provide for the Establishment, de@rt-,Iclpiiie-ot, assistance anJ. support of health planning agc-.iicic,-, in and designated areas, and to promote through them *,,he development of health systems and resources which meet identified needs and eliminate, known deficiencies ivithi,3i their zones of influence. 3. Monitor assess, evaluate, and reau.I.ate within the, context of Z> ex@-.S+ili law the progress -.,,d practice of the established 9 4. ProNic'@-- for analysis, I)romulgltion of iifol'-, matif)n a-;-,d ste-)@- to assi.@-,t a.,,@(I oticoLi@-,ige hea.lth -planniii@'; agencies ,coward a;l effective @)f -i)lanni.i@ig expertise lqll(l inet@iccl.olooy. 2- ORG,,V;ilz-,AI'10!'@AL ']'o tccc)iiiplish its mission, the Central Office (CO) structure will be flat to provide for rapid -communication and active response to regional iic@c-,d.s. SLICI-I ]. structure will be devoid of management layering with clear lines of communication and well articulated delegations. Ilic- structure cliould also promote horizontal cooperation, communication, and interdependence, and discourage the formation of "turf" problems. Lastly, the organization should provide the capacity for its leadership to delegate authority and responsibility as completely as possible, and to as low a level in the structure as is feasible, while retaining an ability to become involved in critical issues. Two facts dictate this philosophy: 1. I'he staffing of the Central Office, in terms of numbers, will be small. 2. 'Fhe program scope is wide and diverse. Both facts speak for an exceptionally tight knit orgai-ii- zation with maximum use of every position. Much must be accomplished @through the small group intrapersonal relationship of activity and interest that in larger organizations is relegated to structural entitles e.g.@ program coordination embodied in a "coordination staff". The bureau will be strongly centralized from the standpoint of policy and program coordination but its operations will be decentralized. The Central Office will provide basic policy And programmatic goals, regulations, and guidelines. The regional staffs will translate these basics into active-assistance to the agencies. The regional staffs will observe and assess the activities of the agencies and, through synthesis An structured reporting to the CO. provide the necessary information to test, and as necessary, bring About the reversion and improvement of policies and regulations. The Central Office/Rec,,',-onal Office (RO) relationship, like that of the 0)@e, t)-"- is not on of ol!(, or the CN-Lilei-. The success ol' t-li-,at relationship is on l@lic! Ind accurl@tc-, transi,,t-',s.,,ioi-, of tied nce(:Ls of both in order to .,.t-tai.i -tl-ie cyo@-.ls of Structure: See attached c]iLirt' Basic Compone-,qt Functions: 1. Office of Ilie 13ttr(,a.u Directo@r,: Provides executive leadership and direction for the programs and activities of the Bureau. Specifically: (1) Coordiiiates the functioning of the bureau both internally and in the context of other national health programs; (2) Develops program objectives, alternatives, and policy positions consistent with broad administration guidelines; (3) Evaluates program accomplishments; (4) Develops and administers operating policies and procedures and provides assistance to bureau constituents to achieve effectiveness and economy in the management of bureau programs; (5) Provides selected management services for bureau constituents and carries out necessary coordination with respect to management services provided for the bureau by higher headquarters; (6) Serves as principal contact and advisor to the Department, the Health Resources Administration arid other PffS agencies, The National Council for Health Policy, and other interested parties on matters relating to planning and development of health systems (7) Directs and coordinates bureau activities carried out in support of equal. employment opportunity programs; (8) Provides guidance and assistance to DliEW regional offices in executing.the Bureauls responsibilities for the efficient and effective conduct of the Bureauls programs- (9) Provides,:tll:r-ough appropriate channels, information about bureau programs to the general public, health pi,ofes- F,i.c.ils associations, a!-I(.[ ot-11--y (10) and coordj-,,i-iLc,5; in(i ('II) PlaD-,, dc@vclol)s aiici tr,-tiliin@,, atict rpanaaci-,,ic@it of clci-'I-@-,il servi.ces Policy Serves as t]-ie 'Locus for burcau-i;;ido pojj.(:.), coordination and the, maiiAgement of controlled correspondence having potential policy involve- Pici-it or impac,:.. Functioning as one of Bureau Director's primary staff ai,es: 'I) Coordinates, performs aDalyses of, and assesses the impact of diverse proaram policy on the mission of the bureau; (2) Brinus to the attention of the Bureau Director and Executive Staff poli.cy issues which halie not found resolution at lower levels; (3) Evaluates trends and indicators of potential policy problems and issues needful of revision or lateratior,; (4) Negotiates and maintains a program of planned change i-ii programmatic policy; (5) Assures that bureau personnel are informed and kept aware of policy evolution on a periodic basis; (6) Serves as a focal point for communicating with other HEIV components with regard to policy clearance. In support of its policy coordination functions: (1) Receives and reviews controlled correspondence and makes action assignments and follows up to assure timely and appropriate action; (2) Establishes standards for and ensures the quality of written communications and is- suances throughout the bureau; (3) Maintains for the Di-rector a docket of pending requests and a structured device for insuring timeliness of response; (4) Establishes and maintains central files for the Bureau Director; (5) Establishes and assures implc-,.,iteiitat ion of bureau and administration corres- porLdence procedures and policies. F-,v@illiat i o,-t ai-icl I.,c,( a@, Stil I-f' as st,-;f-f' i-iiiit I-)il-il)cip",Ll soi-i@-rco or advi.cc oil aiiti (2) Ovc-i.-sees ).tid/c)r conducts co-ii.-iiiiri@ic-atioii.@ bol-wc@on illic.! litii., an levels of on all matters that involve c@vo,].Li@itioiis of performance; (3) taiiis liaison v,,i.tli otli@r and on matters within its area of responsibility; (41) Prepares and directs the implc@@iir-,Pta- ti-oli of comprehensive program evaluation strategies to ob-tiiii needed E,'va.,--- uati-ve data; (5) Monitors oii-going information systems which produce evallia- tive data about the Bureauls programs; (6) Ide-,iti.fi.es problem areas in achieving bureau and program objectives and recommends a-ctions to be tal@@fl in response to those problems; (7) Monitors, and makes recommendations for needed change in, legislation affecting the bua.-eauls programs; and (8) Provides leadership for task oriented problem resolution at the discretion, of the Director. Office of Management Plans, directs, and evaluates the administrative management support activities of the bureau. Serves the bureau by providing or acquiring services and resources in the requisite management areas: (1) Plans, directs, and coordinates those personnel management and trai.ning programs iihich meet the particular needs of the bureau; (2) Plans, directs and coordinates property management and procurement programs required for the bureauls operation; (3) Conducts organization and management surveys and prepares necessary systems and controls to maintain and further the or- ganiza-Lion and management practices of the Bureau: (4) Provides, through the Office of the Administrator, HW@, a program of financials management for the bureau, inclusive of budo7et, planning, formulation and execution, 6@- and )clmj-riistri-tic)!i c):F a-;-, the po@@lit ill tli(,' for the systci@is )iil police,,, p.taillii.])- and (6) Dcvci@ops fc).-i, and the btireatt's reports syst(-,itis; '7) Cooi,Lll-tiati.-.,s t,!-ic bui-(@,i.i.) !Icti.@ri.ties in t SLICfl t.@OCLITPcnts i,,iana,,Yer,iciit pla, and prcl')a.res, J-tl-l l@'C(-LI 'LC, illl)LI S, 1 as the foi-tk,-,ird plan, OPS, and I)iii-cau @Lc) level plan- nin activities; (8) Conducts bureau niai,,a,,c@ifici-it iiiiproveiiiol,lt proar@ims; 9 r, 0 (9) Participates in program and loojslt@t-Iii),o ])J.,,inning to asstii-(,, recogri- tion of management and resource problems; and (10) Ma:Liii-lai.ils necessary extra-bureau liaison to acquire clearances and support of its activities. Office of Operations @lonitorino Provides a bureau focal point for coordination of operations activities: (1) Plans, directs, and coordinates the bureau monitoring and assessment programs; (2) Participates in bureau Executive policy formulation by advising on the operational implications of the bureauls plans and programs; (3) Devises, controls, and operates the necessary systems of management control and information; (4,) Through the operation of MIS and monitoring activities, provides the bureau with an effective source for the transmission of routine information; (5) Collaborates with the program divisions to establish criteria, parameters, and content of information required for the effective MOTlitO'ring Of program operations; (6) Maintains close liaison with the Office of Regional Operations (ORO) HRA; and (7) Provides analytical and advisory capacities where operational matters involve interprogram conflicts. Division of Planning Methods and Toclino.l,ogy Provides a bureau and National. focal point for the development and dissemination of technical materials, planning, approaches, methodologies, 7- .Kate. policies, am. for til"@ I i: health resources and services. The stil-)jcct of such activities include but are not limited to: (1) ']'he I)-eov:Lsl-ojl Of pri-i-,ii.ry care services for medically uiiderserved populations; (2) 'I'lie dc,@vel.opmeiit.of- i-nulti- institutional systems for coordination coii@,olid@itiioi-, of ilistiLiitioi,,al health services; (3) 'F@lic development of i-iod i.c a. I group ractice whose p services are appropriately coordinated or with institutional health services; (4) The training and increased utilization of physician assistants-, (5) The development of niulti-iiistitutional arrangements for thezshatln,u of support services; 6) Improvements in the quality of health services; (7) The;-.dovelopment of@liealtli service institutional capacity to provide various levels of care on a geographically integrated basis; (8) The adoption of uniform cost accounting, reimbursement, and utilization reporting systems; and (9) Effective methods for d cating the general public on basic personal health care and use of available health care resources. The division will produce guidelines for the conduct of planning processes and also will specify the minimum data needs for determining the health status of residents of health service areas, for determining thb status of.health resources and services, and for describing the use of such resources and services. The Division is responsible for the establishment, coordination) and consultative direction of the NAti.onal Center for Health Planning Information and the Centers for Health Planning and provides technical assistance and technical materials to the Health Systems Agencies and state Agencies for use in health planning. -8- Division of Agency Development Provides a Bureau focus for the management and operational develop- ment of health systems agencies and state agencies: (1) Provides a central referent and problem resolving source of comparitive information on agency management and operational development; (2) Prepares prototype plans of organization and operation of agencies; (3) Provides determinants, alterations, and interpretations of guides to meet the needs of a broad variety of agency situations and levels of development; (4) Participates in the development and maintenance of agency performance standards and assessment criteria; (5) Provides assistance, information, guides and interpretation including, but not limited to; guides to incorporation, revision of by-laws, staffing patterns, personnel policies, organization models, administration manuals, salary determination., position descriptions and agency policy and procedures; (6) Serves as a consultative resource on agency development matters as they relate to other programmatic divisional activities; (7) Coordinates activities closely with other program divi- sions to assure that agency development activities are properly inclusive of emphases which benefit and further all programmatic Activity; and (8) Participates in establishing MIS reporting that is conducive to agency development and problem determination and resolution. DIVISION OF FACILITIES DEVELOPMENT Serves as the bureau focal point for guidance, assistance, and standard setting for the construction, modernization and expansion of health care facilities. (1) Participates, with the Division of Planning Methods and Technology, in the development and maintenance of criteria, standards and guidelines to be used by state health planning and development agencies and health systems agencies in preparing and administering facilities plans; (2) Coordinates the financial feasibility reviews and project approval requirements for Section 242 of the National Housing Act and carries comparable responsibilities for direct loans and loan guarantees administered by DHEW; (3) Maintains liaison with Treasury, the Federal Financing Bank, HUD, FNMA, GNMA, and other agencies regarding development of policies and other guide- lines; (4) Serves as the Bureau focal point in providing technological assistance in the operation of health care facilities by providing leader- ship in the architectural, engineering, and equipment aspects of the health facility construction program; providing consultative assistance to repre- sentatives of fore ign governments to federal, state, and local officials and to the public; conducting studies on the design and construction re- quirements of health care facilities; and maintaining liaison with State hospital associations, and professional and technical organizations con- cerned with the design, construction, and equipping of health care facilities in order to be aware of technological developments and needs in order that they may be provided for in minimum construction requirements; (5) Participates in the analysis of data on the Nation's health care facility needs and resources, the evaluation of programs in relation to health care facility needs, the development of measures of adequacy for -10- the health care facility system, the developmental analyses in support of legislative program proposals and appropriation requests for the Office of Management and Budget and congressional presentations, the pre- paration and testing of allocation formulae for use in the administration of the grant, loan, and loan guarantee programs, evalua tive studies developed in the annual evaluation plan; and the conduct of miscellaneous studies attendant to program development; (6) Collaborates with the Office of Operations Monitoring in providing guidance for the effective monitoring of facilities grants and loan programs; and (7) Coordinates its activities with programs within the Bureau, the Department and other agencies and groups concerned with health care facilities. Division of Regulatory Activities Functions as the focal point for all regulatory activities of supported (1) Creates and maintains standards for certificate of need agencies. and 1122 agreements; (2) Prepares, and modifies as needed, criteria and guidelines for review and approval activities; (5) Serves as a consultative resource regarding rate review practices, standards and utilization; (4) Through analysis of review and approval activities, identifies trends and developments which., through cooperation with Planning Methods'and Technolog Division, will assist in priority setting or development of y needed Planning reserach; (5) Participates in the development of and/or reviews programmatic guides, performance standards, and criteria to provide comment on, or reaction to, regulatory impact; (6) Establishes minimum standards for adherence to Federal regulations; and creates models for optimum performance of regulatory intent; f7) Prepares and revises monitoring criteria for inclusion in the MIS which will provide requisite information for regulatory assessment and evaluation; (8) Participates in Executive Staff consideration of policy c anges or programmatic alterations which impact on regulatory activities iterations which will further attainment and (9) Suggests legislative consi of regulatory goals. PROPOSED BUREAU OF HEALT@I RESOURCES PLP@NTNTNG Office of Bureai'i Pol icy Director 1 T0 Coordination Staff Office of Office o Operations Manp.,,)--me Monitoring Division of Division of Division of D Facilities Agencv Planning Development Methods Development Az land Teclinol gy