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                                 REVIEt4 RESPONSIBILI,riEs



              Under the triennial review system which has been initiated, each Regional
         Meidc/al Program generally will be reviewed by the National Advisory Council

         only once during each three year period.  The triennial review serves to "accre.di.

         the Region as an organization and to set a general level of support for the three
         year period.  Thus, except in s@ecifi@case   .s, the Director, P@IPS xjill mal<e
         awards for second aid third (02 and 03) year support without further Council action,

         but will provide the Council with a summary of such awards.  In general, individual

         Regional Kedical Programs will assume responsibility both for technical review and

         for the selection of projects and activities wi@hin the overall Council-approved

         general level of support, while the Director, RMPS, will be responsible for monitoril

         the Reaions and bringing to the Council's attention any substantive failure oil-' the

         Region to meet requirements, or cases where substantial deviations occur from the

         approved application.  It is the purpose of these guidelines to set forth how these

         various responsibilities will be implemented.

         The First Yearts Award

              Subsequent to Council action, the X,,IP will be notified of the proposed

         general level of support and asked to submit re.vise-d budgets for those projects

         and activities which the ILMP selects for funding4 The ltkiP also will submit a

         single, consolidated expenditure report showing any unexpended balance for the

         current grant year.  The following year's award will be negotiated on the basis of
         the revised budgets submitted by the IL@IP and the award will be reduced by the 6rrount

         of any unexpended balance.

         The Develo  enrol Comoonent
                   P-M

              Operational Regional Medical Programs have the option of requesting a
         Developmental Component of up to 10% of the annual direct cost funding level
         for the preceeding year.  The purpose of the Developmental Component is to

         permit a Regional I-ledical Pro-ram to support relevant activities withou t undue

         delay as Opportunities arise.





              A Regional Medical Program may apply on its anniversary date for a DeveloO-
         ibental Component in any year. No Developmental Component will be  approved  unless
         it is specifically requested by an RNIP and recommended formally by the Council.-
         Developmental Components will be awarded only to the most outstanding IL14Ps.
              Approval of a Developmental Component means that the Council and the
         Director, IOIPS, have delegated authority to the individual ITMP to fund core activ-
         ities and projects without prior notice, review or approval by either IOIPS or  the
         Council up,to the amount approved for the Developmental Component.  Thus, projects
         and activities initiated and funded under the Developmental Component of  an  award

         can and generally will include those which never before have been submitted to
         RMPS for review.  Regional Medical Programs, however, will be responsible for notify.

         in RLMPS of each activity funded within the Developmental Component.
              Approval of a Developmental Component does not necessarily mean that
         additional funds will be awarded.  Prpjects'and core activities, however,  may be

         funded under an approved Developmental Component uo to the 10% limit within the

         amount awarded.


         Continuations

              A Regional Medical Program at any time may select projects for funding from

         among those described in its approved triennial or 02 or 03 year application.
         RMPs not approved for a Developmental Component may@include in their applications fo

         second and third year support new projects not previously submitted.  Such projects

         also may be included in second and third year applications from Regions which have

         fully utilized previously awarded Developmental Component funds.  Continuation

         applications for the 02 and 03 years ordinarily will be approved by the  Director.

         Changes in Proiects and Activities

              Minor chan-es in specific projects or activities will be approved by the

         Director, RMPS.  Examples of such chanaes include;
              a4  Chanaes in geographic scope (The project will serve Model City area A
                  instead of Model City Area B or the boundaries of the area to be served ar




                  enlarged or modified in some way.)
               b. Chanoes in sponsor or affiliate (Hospital llxll is  substituted  for  Hospital
                    y" at the'project sponsor, or one or more affiliates is added to or
                   subtracted from a group of cooperating institutions).
               c.  Personnel changes (Changes in the Project Director or staff).

               d.  Target groups (Nurse8 to nurses and PTs; Spanish speaking to Spanish
                   speaking and Indians;  Blacks to Puerto Ricans, etc.)

               e.  Bud-.et ch6nues (PIinor expansion, $50,000 or less, or reduction  of  project

                   budgets or switching local funds fg7A Project A tO Project B, or activating

                   projects by transfer of -Funds from less Productive projects or activities.

          Summary

               The Council approves a general level of support for a three year period     for

          the Region within which the 'L%lP selects projects and activities.  Where  a  Develop-

          mental Component ha's been approved by the Council, the ILMP, on its oiqn  initiative,

          is permitted to-fund any project consonant with law, regulations  and  T)olicies  up

          to the full amount of the Developmental Component.  If a Developmental Component hds

          not been requested and approved, the RMP i  estricted  to  selecting  projects  from

          among those which have been submitted to and approved by I'TMPS in a  triennial,  02

          or 03 year application.  New projects may be included by Regions in second and

          third year continuation applications provided the Council-recommended level of

          support is not exceeded. Since the Councills  review  and  recommendation  applies  to

          approval for a oiven RI%IP as an organization rather than as a specific set of project

          and activities, the details of changes in individual proje  cts or in the spectrum of

          projects and activities, ordinarily will be handled by the Director.











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                             SUII.MARVL OF LEVELS OF -,REVIEW



           s Ot                                   ADplicatioris Revie@@ed_By
     -Aepiication           cout@il                      Review Committee       --'-Director
      TRIENNIAL               All                             All                         -All

      CONTINUATION       Only if;                        None, except at                  All, parti-c-
                                                         Director's request          ularly for such
                         a. New or increased                                         items as;
                            Develop. Camp. is
                            requested                                                a. Geographic
                                                                                        chan-es
                         b.  Supplementary   funds
                            are requested.                                           b. Changes in
                                                                                        target groups
                         c. Council requests
                            review                                                   c. Personnel
                                                                                        changes
                         d. Director, PJIPS Coun-
                            cil  to  review.  (e.g                                   d. Changes in,
                            where fLME' fails or                                        sponsors or
                            appears to fail to                                          affiliates
                            meet    requirements.)
                                                                                     e. Budget changes

                                                                                     f. New  initiative




                         Major chaft,.;es in or-aniz-
                         6tional  structure   will
                         be  referred  to  Council
                         at any time they occur.
                         (e.go  mergers,   dissol-
                         utions etc.)







                  PROPOSED RESPONSIBILITIES OF THE NATIONAL ADVISORY COUNCIL
                               M ER THE TRIENNIAL REVIEW SYSTEM



              A complete application will be submitted annually by each  Regional
              Medical Program in accordance with a schedule of anniversary  dates
              announced by RNPS.

              Under the Triennial Review System, Regional Medical Programs will
              ordinarily be recommended for funding by the National Advisory
              Council every three years. Awards will be made annually  within  the
              general level of support recommended by the Council for the year  in
              question. In addition to recommending the general level  of  support,
              Council actions on individual applications may include advice to  the
              applicant Regional Medical Program, or specific conditions for  the
              grant.

              Each triennial application will be reviewed by assigned RMPS  staff,
              a site visit team and the MQS Review Committee prior to  review  by
              the National Advisory Council.

              The Director  RMPS, will make awards for second and third (02 and 03)
                          !O
              year support without further Council action except in the  following
              cases:


              a.  Supplementary funds are requested in addition to the general
                  level of support recommended for the year in question

              b.  A new or increased developmental component is requested.

              c.  The applicant has failed in a material respect to meet the re4uire-
                  ments of the Program or applicable laws, regulations or  formally
                  promulgated po licies of the Department, HSMHA or RNPS.

              d.  The Council has asked to see the application.

              e.  The Director wishes to bring the application to the Attention  of
                  the Council.

              The Council will be provided with a summary of staff actions regarding
              the funding of second or third (02 and 03) year support  previously
              recommended by the Council. The summary will include  the  following
              for each Region:

              a.  The amount previously recommended by Council for funding and  the
                  amount awarded.

              b.  A list of projects or activities supported during the most.recent
                  grant year, identifying those which have been completed and those
                  which have been supported through a developmental component.









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              c.  A summary of the Regiont
                                          s response to any advice specified by the
                  Council or limitations or conditions of the award.

              d.  A summary of any outstanding accomplishments.

              e.  A summary of any outstanding problems.

              f.  Annual reports from the Regional Advisory Group and from RNPS
                  Staff.  (These will be made available as requested by the Council.)