c. 3/ Review Functions of Health Systems Agencies (cont.) Section 1513(e)(1) and (2) ̧ for regulation, but through strengthening planning capabilities and activities that so far, have been inadequately implemented or totally lacking. Finally, the regulatory decision, once a judgment of consistency or inconsistency with established plans is made by the planning unit, should rest with a governmental unit, either at the state or federal level. This is the only way in which necessary checks and balances can be maintained, and the only way to bring about orderly change consistent with the available resources. Therefore, we recommend that this section be amended so that the function is more accurately identified as review and recommendation by the Health Systems Agency. Legislative Language. The following is proposed legislative language to amend the National Health Planning and Resources Development Act in accord with the above policy. REVIEW FUNCTIONS OF HEALTH SYSTEMS AGENCIES SECTIONS 1513(e)(1) and (2) "(e)(1)(A) Except as provided in subparagraph (B), each health systems agency shall review and approve-or-disapprove make recommendations to the Secretary or, in the case of grants or contracts described in subparagraph (ii) of this paragraph, the appropriate State health planning and development agency on each proposed use within its health service area of Federal funds- "(i) appropriated under this Act, the Community Mental Health Centers Act, or the Comprehensive Alcohol Abuse and Alcoholism Prevention, Treatment, and Rehabilitation Act of 1970 for grants, contracts, loans, or loan guarantees for the development, expansion, or support of health resources; or (ii) made available by the State in which the health service area is located (from-an-allotment-to-the-State-under-an-Aet-referred-te-in elause-44 for grants or contracts for the development, expansion, or support of health resources. "(B) A health systems agency shall not review and approve-or-disapprove make recommendations on the proposed use within its health service area of Federal funds appropriated for grants or contracts under title IV, VII, or VIII of this Act unless the grants or contracts are to be made, entered into, or used to support the development of health resources intended for use in the health service area or the delivery of health services. In the case of a proposed use within the health service area of a health systems agency of Federal funds described in subparagraph (A) by an Indian tribe or intertribal Indian Organization for any program or project which will be located within or will specifically serve - "(i) a federally-recognized Indian reservation, "(ii) any land area in Oklahoma which is held in trust by the United States for Indians or which is restricted Indian-owned land area, or "(iii) a Native village in Alaska (as defined in section 3(c) of the Alaska Native Claims Settlement Act), a health systems agency shall only review and comment on such proposed use. 3/ Review Functions of Health Systems Agencies (cont.) Section 1513(e)(1) and (2). "(2) Notwithstanding any other provision of this Act or any other Act referred to in paragraph (1), the Secretary shall allow a health systems agency sixty days to make the review and recommendations required by such paragraph. If an agency disapproves recommends against a proposed use in its health service area of Federal funds described in paragraph (1)(A)(i), the Secretary may not make such Federal funds available for such use until he has made, upon request of the entity making such proposal, a review of the agency's decision recommendations. In making any such review of any agency's decision recommendations, the Secretary shall give the appropriate State health planning and development agency an opportunity to consider the decision recommendations of the health systems agency and to submit to the Secretary its comments on the decision recommendations. The Secretary, after taking into consideration such State agency's comments (if any), may make such Federal funds available for such use, notwithstanding the disapproval recommendations of the health systems agency. Each such decision by the Secretary to make funds available shall be submitted to the appropriate health systems agency and State health planning and development agency and shall contain a detailed statement of the reasons for the decision, including the comments, if any, of the State agency. 676 a. 4. Review Functions of Statewide Health Coordinating Councils Section 1524 (c) (6) Policy Position. The American Hospital Association supports an amendment that Statewide Health Coordinating Councils are advisory Councils and would make recommendations to the Secretary. b. Rationale. This amendment corresponds with the prior amendment regarding the review functions of Health Systems Agencies (see section 1513(e) (1) (2)). This would make the review functions of the Statewide Health Coordinating Council advisory only. The Councils could neither commit federal funds nor deny them. Like the Health Systems Agency, the Statewide Health Coordinating Council, or SHCC, is a planning agency, and its function in the review and approval process should be advisory only. Further, when the HEW Secretary or State Agency makes a decision regarding a grant or contract contrary to the recommendation of the Statewide Health Coordinating Council, we recommend that HEW provide a written explanation to the applicant as well as to the Health Systems Agency. c. Legislative Language. The following is proposed legislative language to amend the National Health Planning and Resources Development Act in accord with the above policy: REVIEW FUNCTIONS OF STATEWIDE HEALTH COORDINATING COUNCILS SECTION 1524 (c)(6) "(c) A SHCC shall perform the following functions: "(6) Review annually and approve-or-disapprove make recommendations to the Secretary on any State plan and any application (and any revision of a State plan or application) submitted to the Secretary as a condition to the receipt of any funds under allotments made to States under this Act, the Community Mental Health Centers Act, or the Comprehensive Alcohol Abuse and Alcoholism Prevention, Treatment, and Rehabilitation Act of 1970. Notwithstanding any other provision of this Act or any other Act referred to in the preceding sentence, the Secretary shall allow a SHCC sixty days to make the review and recommendations required by such sentence. If a SHCC disapproves recommends against such a State plan or application, the Secretary may not make Federal funds available under such State plan or application until he has made, upon request of the Governor of the State, which submitted such plan or application or another agency of such State, a review of the SHCC's decision recommendations. If after such review the Secretary decides to make such funds available, the decision by the Secretary to make such funds available shall be submitted to the SHCC and shall contain a detailed statement of the reasons for the decision. 5. Elimination of Grant Making Function of Health Systems Agencies Section 1513(c) (3) a. Policy Position. The American Hospital Association supports an amendment that would convert the Area Health Services Development Fund to the State Health Services Development Fund, to be administered by the designated State Agency. b. Rationale. The purpose of this amendment is to eliminate the grant-making function from the functions mandated for a Health Systems Agency (HSA). Instead, Health Systems Agencies would solicit proposals from individuals, public and non-profit private entities. These proposals would assist the Health Systems Agencies in planning and developing projects and programs which they deem necessary for the achievement of the goals described in their health systems plans and annual implementation plans. The proposals would then be submitted to the State Health Planning and Development Agencies, which would be responsible for selecting and funding the proposals. We disagree with the assignment to Health System Agencies of direct developmental assistance functions. However, we are in agreement that a developmental assistance function is necessary and should be supported by federal funds. We believe that this activity snould be the responsibility of the State Agency. Health Systems Agencies' planning functions should be limited to reviewing and making recommendations on developmental proposals in light of the established plans. To provide Health Systems Agency planners with resources to implement their own plans, would detract from the principal function of the planning agency. Health Systems Agencies are more appropriately advisory to another agency. When development funds are at the local level, a conflict of interest may well be unavoidable. For instance, a problem may arise when Area Health Services Development Fund support is sought for activities which may result in projects or programs which will require an eventual formal review by the Health Systems Agency that underwrote its planning. The Health Systems Agency would then be presented with the inherent conflict of having to review objectively a proposal which was planned with Area Health Services Development Funds made available by the Health Systems Agency, but the Health Systems Agency would also have to face the possibility that, when presented with the details of the proposal listed in the annual implementation plan, it would refuse its endorsement and thereby repudiate its own plan. It might also be noted that the danger of litigation would be real if entities in the community make a major investment of their time and material resources in the development of a project which is listed in the annual implementation plan and/or stimulated by the award of Area Health Services Development Fund monies to underwrite its planning but then failed to receive Health Systems Agency endorsement and a certificate of need. These dangers, it would seem, would be eliminated if health services development funds were specifically limited to planing for projects already endorsed by the Health Systems Agency review procedures and to planning activities of the kind that would not result in proposals requiring Health Systems Agency review. 5/Elimination of Grant Making. Function of HSAS (cont.) c. Legislative Language. The following is proposed legislative language to amend the National Health Planning and Resources Development Act in accord with the above policy. ELIMINATION OF THE GRANT MAKING FUNCTION OF HEALTH SYSTEMS AGENCIES "(c) A health systems agency shall implement its HSP and AIP, and in implementing the plans it shall perform at least the following functions: "(3) The agency shall, in accordance with the priorities established in the AIP, make-grante-to-public-and-nonprofit-private-entities-and-enter inte-contracts-with solicit proposals from individuals and public and nonprofit private entities to assist them in planning and developing projects and programs which the agency determines are necessary for the achievement of the health systems described in the HSP. The proposals shall be submitted with the agency's review and recommendations to the State health planning and developing agency. Suek-grents-and-contre-to-shażl-be-made-from the Area-Health-Services-Development-Fund-of-the-ageney-established-with-funds provided-under-grants-made-under-section-1640---No-grants-or-contract-under this-subsection-may-be-used-(A)-to-pay-the-costs-incurred-by-an-entity-er Individual-in-the-delivery-of-health-services-tas-defined-in-regulations of-the-Seeretary),-or-(B)-for-the-cost-of-construction-or-modernisation-of medical-facilities---No-single-grant-or-contract-made-or-entered-into-under thie-paragraph-shall-be-available-for-obligation-beyond-the-one-year-period beginning-on-the-date-the-grant-or-contraet-vas-made-er-entered-inter--If an-individual-or-entity-receives-a-grant-or-contract-under-this-paragraph fer-a-project-or-programy-suck-individual-or-entity-may-receive-only-one more-suck-grant-or-contract-for-suck-project-or-program," |