@ul * It * m 0 0 0 KtUlUlIAL IYILUIL,, LEGIc-LATIVE/BUDGET STORY FOR 1972-1973 0 'E. Budget/Ap@ropriations Legislation/Autho rl,zation @uary, 1972 President's Budget for FY 1973 requests $130.3M for RVP. ust 16, 1972 First Labor-HEW Appropriation bill for FY73 vetoed. Contained $164.5M for PIIP. .ober 27, 1972 Second Labor-HEII Appropriation bill vetoed - Again $164.5M for RMP. @.ober 27, 1972 'Because of the veto, a continuing resolution (H.J. Res. 1331 signed Oct., 26, 1972) went into effect. Permitted appropriation at lovier-of House or Senate levels in first appropriation bill - i.e.., $15OM- for DIP which was House figure. PRESIDENT'S BUDGET FOR FY 1974 PROPOSES: iaary 29, 1973 (1) 'A reduced amended level of (2) The termination 'of RMP in FY74.- $55,358,000 for grants and contracts in FY.1973, and rch I,-1973 House Subcommittee on Public Health and Envionment (Rep. Rogers, Chmn.) holds overview hearings on FY74 health budget, with Sec. Weinberger testifying. rch 81 1973- S. 1136, proposing one-year extension of 12 PHS authori ties due to expire 6/30/73, including P.MP, introduced by Senator Kennedy with 15 of the 16 members of the Senate Labor and Public Welfare Committee cosponsoring. Authorization for RMP kept at $250M. 'E Budget/Appropriations Legislation/Authorization H.R. 5608 introduced in the House by Rep. James -ch 14, 1973 -Hastings with the cospons rship of the entire 0 Subcommittee on Public Health-and Environment. Also extends 12 PHS authorities for one-year, with RiliP authorization set at a level of $250M. -ch 22, 1973 Hearings were held on S. 1136 by the Senate Health Subcommittee. Secretary Weinberger testified. Committee ordered bill favorably reported. Report #93-87.@ -ch 27-, 1973 Senate passed S. 1136, the PHS Extension Act, by a vote of 72-19 with RMP authorization-16vel of.$250 million'for FY 1974. rch 27,.1973 House Appropriations Committee held heari.ngs on the FY74 budget relating to RMP - Dr. Sencer, Dr. Margulies testified. rch 27-2@,, 1973 Hearings were held on H.R..5608 by the House Subcommittee on Public Health and Envirohmen-t. Secretary Weinberger testified, as did Rt4P representa- tives. 1 8, 1973 Oversight hearings on Regional Medical Programs hold by the Subcommittee on Public Health and.Envirotiment-,-' Testimony by Dr. John Zapp and Dr. Margulies-for HEW; a panel of physicians involved in RI,!P's;-and four RMP coordinators. y 15, 1973 Representative Hastings (with all members of the Subcommittee on Public Health and Environment Co- ring) introduced H. R. 7806 - a new PHS Extension sponso Act bill - in lieu of H.R. 5608.. Set RMP authorization for FY 1974 at $159 million. Legislation/Authorization TE Budget/Appropriations H@.R. 7806 reported unanimoIsly by.the.H6use Inter- y 24, 1973 state and Foreign CommerceuCorrinit,T.'ee. House Report f93-227. An amendment was added to the second y 29, 1973 Supplemental Appropriations bill for FY 1973 (H.R. 7447) in the Senate by a vote of 59-14 which would add an additional $20 million to the FY 1973 RMP appropriations House passed H.R. 7806, the PHS Extension bill by a @y 31, 1973 vote of 372-1. The bill would authoriz@.$159 million for RMP in FY 1974. Senate agreed to the House version of the PHS Extensioi ine 5, 1973 ith its 1 vel of $1@9 million Act by a vote of 94-0. w e for RMP. 'esident. H.g. 7806 sent to the Pr ine 6, 1973 ine 81% 1973 Senate Labor-HEW Appropriation Sub- committee held hearings which included RMP 'n terms of the FY74 budget. ine 13, 1973 Senate Labor-HEW Appropriation Sub- -comittee again held hearings which included RMP for FY 74. une 18, 1973 President signs S. 1136 in,@.o,law as P.L. 93-45, which inc7udes one-year extension of RMP-with authorization level of $159 M. une.,19,, 1973 Conferees on Second Supplemental Appropriation bill fo@ FY 73 (H.R. 7447) del-ete $20 million added bv Senate for..RMP (H. Rept. #93-29@). Budget/Appropriations Legislation/Auth6rization rE ie 21, 1973 House Appropriations Committee ordered the Labor-HEW Appropriations bill favorably reported (H. Report #93-305). ie 26, 1973 House passed H.R4 8871, the Labor-HEW Appropriation bill for FY74 by a vote of 347-58. Funds were included for RMP at a level of $81,953,000. ly 1, 1973 The President signed.the continuing. resolution (H.J. Res. 636) following compromise on the Cambodian Resolution;. Congressional interpretation of the current rate" under the continuing resolution is the more restrictive of the FY74 House passed rate ($81.935M) and the current rate ($150M). Thus Congressional interpretation of the continuing rate for RMP would be the FY74 House figure of $81.935M. RELEVANT QUO'RATIONS ON REASONS FOR TEPtiINATIO@l AND COt4TINUANCE OF R14P January 29, 1973 - The President's Budget "No extension beyond June 30, 1973, of.the regional medical program authorities is being request6d. Over a period of 8 years, the Federal Government, by means of grant awards and direct staff activities, promoted and developed 56 RMP'S, regional cooperative arrangements among the Mation!.s health care providers and institutions. Originally established to upgrade the health care of persons threatened by heart disease, cancer, stroke, kidney disease and relbted diseases, the RMP's in recent,years sought more to improve access to and generally strengthen the health care delivery system. Despite Federal expenditures in excess of $500 million for,these-'activities however, there is little evidence that on a nationwide basis the RMP's have materially affected the health care delivery system. Further expender of scarce Federal health resources on this program, therefore, cannot be justified on the basis of available evidence." January 30, IOJ73 - Mateeial Prep,-:ired for DHEW Presentation of President@'s BLi "The greatest expenditure of RMP funds has been in the area of continuing education and upgrading,training of health personnel'. It is not an appropriate use of Federal funds to finance continuing education tor professionals generally capable of firianciq_g his own education to improve professional competence." "As a result of various legislative and.administrative decisions in recent years, several activities for improving the quality of care previously assigned to RMP are now being supported by other tir'_W organizations such as the special NIH cancer and heart initiatives and the system of Profes5iona Standards Review Organizations being set up.under the Medicare authorities. March 1, 1973 - President's- MessaSe to Conaress on Human Resources "Regional Medical Programs likewise can now be discontinued. The planning function they have performed can better be conducted by comprehensive State planning efforts., A second function of these programs, the continuing education of physicians Who are already licensed, is an inappropriate burden for Federal taxpayers to bear.11 Martli 22, 1973 Secretary Weinbei-qeris.Testiniony before the Senate SLib- co.,i@nittee oii-i-lealth Coi,-iritte(-, on Lal)or and Public "We are proposin the termination of the Region,-] Medical Program because We believe that it has not achieved itspronis'e v,,hen it Was first enacted seven years ago, and shows no reasonable chance of doing so in the future. Frora the outset, the RMP has had great difficulty in defining a clear role for itself. 'O I .. . ;,I I 4 covet-iri a limited number of major regions in the Originally conceived as . 9 -'United Stailes, a total of 56 regions were funded. In 34 cases, the regions became coterminous with State boundaries. This fact alone brings RMP into direct conflict with State-based and areaiiide health planning, coordinating and service programs, such as comprehensive health planning. There is no 'f getting significant evidence that the.RilPls have achieved their goal 0 research advances rapidly into regular medical practice. The training programs undertaken are typically of limited scope and duration, and there is no substantial evidence that they have had an effect on actual medical practice. Further, we believe that continuing education for physicians should be paid for by Iphysicians and not by the Federal Government. A major RPiPa'ctivity has been the funding of demonstration projects, but many other HEW programs, and many different Federal, State and local agericie similarly fund demonstration projects, thus adding to proliferation of separate projects. In the final analysis, it has become increasingly appare that Rt'iP's have not succeeded in developing the efficient, rationa'l and regional health systems which their original purpose sought." ----------------------------------------------------------------------------- March 23, 1973 - Report of the E;eriate Committee on Labor and Public Welfare on S.1136 Keport 1/93-87 "The Committee believes that it is essential and urgent for it to upgrade, improve and delete when necessary the provisions of the PUblic Health Service Act and the Mental Retardation Facilities and Community Mental Health Centers Act. In that complic'ated process, which is now underway, the Committee will strive to consolidate, recodify, and rationalize those legislative authorities in a nianner consistent with the appropriate Federal role in respect to the health needs of the American people. The Committee is hopeful that this major legislative undertaking will resul in fewer but more productive health authorities. The Committee is convince that this process cannot reasonably be completed by the time the authentic expire June 30, 1973. And the Committee cannot stand by while the Executi@, branch implements decisions which could effectively terminate existing health programs before Congress has an opportunity to work its will." May 25, 1973 Report of the House Committee on Interstate and Foreign CoFime on H.R. T80-6 (Fep-rrt. 9--227) "Th is i sanother program which the'Admi@-stration has proposed to terminate, saying that the program has failed to meet its original intents; regional.i2 health se r v i ce s a n d -d i s s-eni i na t i ng - new b.i or,-,ed i ca I . know I c dge. . Fu r t he r , . they feel that the program has wa@,ted an excessive amount of money on administri costs. The Committee will be reviewing the future of this program in-con'- junction with the Comprehensive Health PI'atining and the Ili]]-Burton p@gra,- but feels that in the meantime the proposed 6brupt'terniination is inappi-opr Further, while some criticism of the regional medical program may be justif it i's clear that it has had many individual successes and that many peor.)Ir- become dependent upon it. [.adequate provision has not been made for fitidinc alternative sources of for the successful parts or the people depcr on the program. The presc,,it legislation would authorize $159 million f@oi t 2 reg-ional medical programs in fiscal year 1974. -itions bill June 19, 1973 Conference Report on Second Supplemental ro)ri, H.R. 7/-T (I c ort "'F,3-20,5 "Amendment No. 29. Delc@tes appropriations of $20,000,000 for-regional medic programs and $1 5,000,000 for -construction of outpatient fac i I i ti es proposed by the Senate. In agreeing to delete these additional appropriations, the conferees take n of the fact that $150,000,000 has already been appropriated for fiscal year for regional medical programs and $70,000,000 has been appropriated for con struction of outpatient facilities. The Congress is clearly opposed to the termination of these programs. Legi@lation to extend the authorizations fo them through June 30, 1974 has been passed by overwhelming majorities in bo the House of Representatives and the Senate. The conferees urge that the funds which have been appropriated for the regional medical,programs and th Hill-Burton program be released for obligation, in accordance with Congress intent." June 21, 1973 Report of the House Appropriations Comnittee on FY 1974 Labo HEW Appropriations - H.R. 8 77 (Pepc)rt @,; 93-30 "Health services planning and development. This appropriation funds a group of programs ENCHSR&D RMP CHP, and Hill-Burton] whose common purpose is to improve the delivery of health care and to make the most effective us of available resources. "The budget proposed no appropriations for regional medical programs for fiscal year 1974. The legislative authorization for the regional medical programs has recently been extended through fiscal year 1974 by a nearly unanimous vote of Congress. While the Committee is aware that some of the regional medical programs may not have been as productive as they should be others have been highly successful. In any case, the Committee believes th the original objectives of the regional medical programs'are still valid, a that the Department should seek to improve the operations of the programs rather than terminating them. The Committee has included in the bill the s of $81,953,000 to conti@ue the funding of the regional medical programs. 'T Committee urges that every effort be made to strengthen and improve the weaker prograi-7113. Second Supplemental Appropriations Act - P.L. 93-50-July ],-1973 "Health Services Planning and Developmc>nt For an additional.amount for "Health'services planning and development", for carrying out, to the exte'nt not other'wise provided, section '1;04 and title IX of the Public.@lealtli Servi Act, $17,.000,000, to remain available until expanded." The Senate Report (No. 93-160) plus floor deb2te indicate that these fund,-;, are for the following items: (1) $12,0-00,000 to permit comp]6tion of the new Cfilldren's Hospital [,-,'at Medical Center in Washington, D.C. 3 (2) $4,500,000 to meet the initial needs for a childrerils medical center I :p serving the northwestern regions ol the U.S. "Plans a e now undcrwa, to transform the Children's Orthopedic Hospital Center into a children's regional health service center, comparable to the Children's Medical Cen@'er in Boston. The committee recognizes that existing facilities are hopelessly outmoded and inadequate and that some corrective action must be tat-,en iri,,@nediately. For this reason the Committee recommend,- that $11,500,000 be provided to meet the critical, immediate needs of this facility." (3) $500,000 to 'complete a hospital in northern Vermont - the North Country Hospital and Health Center at Newporti Vermont by provding additional grants for hospital construction. 4