SECTION 1650 continued

1650(c): No grant may be made under subsection (a) unless an application has been submitted to and approved by the Secretary. Such an application shall be submitted in such form and in such manner and contain such information as the Secretary may require. In the event that a grant under subsection (a) is renewed, funds may be carried forward to the next grant period without being deducted from the subsequent grant award.

1650(d): Each SHPDA shall make payment to any corporation or organization sponsoring any existing institutional health services found to be unneeded prior to the imposition of any sanction providing for loss of licensure or otherwise resulting in termination of services. The amount of payment which shall be made to an organization or corporation sponsoring such an institutional health service shall be the sum of the fair market value (as determined in regulations promulgated by the Secretary) of any facility or equipment related to such institutional health services and any outstanding debt relating to such facility or equipment to the extent that such debt exceeds the fair market value minus the fair market value of such facility after the completion of the activity described in section 1523(a)(4), and shall include funds for appropriate re-employment and severance pay for laid-off employees.

1650(e): For purposes of making payments pursuant to grants under subsection (a), there are authorized to be appropriated $400 million in FY 1979, $500 million in FY 1980, $600 million in FY 1981.

EXECUTIVE SUMMARY

I. PURPOSE OF CONTRACT

The purpose of this study was to describe for BHPRD the operations in 13 single HSA and three Section 1536 states in terms of structures, roles, relationships, and performance of functions, to learn what problems and successes these states have experienced, to identify those situations felt to be primarily a function of single HSA or Section 1536 status and resulting work programs, to learn how the various "publics" affected by health planning perceive the effectiveness of the chosen organizational structure, and to analyze the results in a way that permits the development of recommendations to BHPRD for additional or modified policy guidance, program administration, legislative and regulatory changes, and guidelines for Section 1536 and single HSA states.

II. RESEARCH DESIGN

The Research Design for the study resulted in a sequential process: development of interview checklists for single HSA states, Section 1536 states, and the "Public" (individuals outside of PL 93-641 structures), formulation of an analytic plan, a pre-test, and modification of the checklists, visits to the Regional Offices and study states, revision of the analytic plan and data analysis.

We also visited the eight Regional Offices with jurisdiction for these states: Regions I, II, III, IV, VI, VIII, IX and X.

One Arthur D. Little, Inc., staff member visited the applicable Regional Office for one day prior to the visits to each state to speak with the Project Officer (s) for the state and to review documents (area designation plans, grant applications, correspondence, etc.) as background to the site visit. Two Arthur D. Little, Inc., staff members visited each state for

two days. Interviewees were selected with the help of the Regional Office and Agency Directors to include as many of the following as possible: SHPDA staff, SHCC representatives, other directly involved state level officials, HSA staff, HSA governing body and governing board representatives, subarea advisory council representatives, and representatives of outside interest groups such as PSRO, A-95 agencies, consumer and provider groups (e.g., Hospital and Medical Associations), local elected officials, and voluntary associations. The study team typically spoke with a total of 15 to 20 individuals in each state.

In addition to the visits to the eight Regional Offices and 16 single HSA and Section 1536 states, two Arthur D. Little, Inc., staff members attended the meeting of the National Association of Single State Agencies in Omaha, Nebraska, on September 10, 1977.

The data were analyzed (1) for each state visited; (2) for single HSA states as a whole; (3) for Section 1536 states as a whole; (4) to compare these statewide structures to multiple HSAs visited under two other studies performed by the study team for BHP RD. We analyzed the data, using a method that involved preparation of descriptive memoranda for individual interviews with respondents and for each state as a whole. Memoranda were read by all study team members followed by intense study team meetings to share, describe, and analyze all information collected and formulate conclusions and recommendations.

Many of the single HSA and Section 1536 states have developed structures and processes under PL 93-641 that, whether fully anticipated under the law or not, are constructive consequences and represent adaptations and proactive solutions to often difficult problems. These developments have, in our view, considerable potential for the future of health planning and regulation in the United States. Principal examples include:

The

A statewide HSA which sees its role as one of issue surfacing
and political mobilization on a statewide basis. To this end,
they have organized a statewide Labor Council for input into
their planning processes, and they expect shortly to establish
a Businessmen's Council and possibly a Women's Council.
idea is to convene a series of interested groups whose members
care about health affairs from a more or less coherent per-
spective such that the HSA can integrate some aspects of the
consumer view on health matters that each such group will represent.
Their liaison with the state legislature and with a network of
statewide communications media adds further to their capabilities.

A statewide HSA which is organized and staffed to bring a high
level of technical expertise to health planning and regulation
in the state. Faced with considerable expertise on the part of
providers in this state, the HSA has made a conscious effort
to approach health planning and regulation with a highly