is essential if we are to successfully meet these needs and improve the efficiency of our health care delivery system. The structure of the health planning system provides that decisions about health care needs and priorities are made at the local level by organizations composed of consumers, local elected officials, and providers of health care working together, in conjunction with State governments. I believe that, while the planning program is not without problems, the concept of health planning at the local level is important and that the program established by law should be encouraged. We now need to move to continue to strengthen the health planning system so that it can begin to achieve the goals that have been established. H.R. 3041, the Health Planning and Resources Development Amendments of 1979, which we are considering today, is based on the premise that the basic planning structure created by the National Health Planning and Resources Development Act of 1974 is sound. The proposed changes are aimed at improving it. In doing so the bill is designed to provide as little disruption to the planning system as possible, recognizing the great time and effort that has been expended by volunteers, both consumers and providers, in developing it. While there are many issues that will surface during the course of our hearings, I believe there are six issues that will be most central to our discussion of the extension and amendment of this law: First, there is a need to examine the adequacy of the health systems agencies governing body requirements of the law. Second, the role of the State in the health planning structure deserves careful review. Third, consideration must be given to strengthening the linkage between the planning required at the State and local levels and the planning that should be occurring at the national level. Fourth, there is a need to examine the adequacy of the certificate of need and other review requirements of the law. Fifth, consideration must be given to how to deal with existing unneeded and duplicative health facilities and services. And finally, we must provide that the funding for the planning system will be adequate to do the job. As we begin our hearings, I look forward to many constructive suggestions on these and other issues to improve the health planning system from the witnesses and from the staff. Without objection, the text of H.R. 3041 and H.R. 3167 and agency reports thereon will be printed at this point in the record. [Testimony resumes on p. 105.] [The text of H.R. 3041 and H.R. 3167 follows:] 96TH CONGRESS 18T SESSION H.R.3014 Introduced by Mr. Waxman (for himself, Mr. Preyer, Mr. Maguire, Mr. Walgren, Mr. Broyhill. A BILL To amend titles XV and XVI of the Public Health Service Act to revise and extend the authorities and requirements under 1 Be it enacted by the Senate and House of Representa 2 tives of the United States of America in Congress assembled, I-EO (3) 2 1 2 3 SHORT TITLE; REFERENCES TO PUBLIC HEALTH SERVICE ACT; AND TABLE OF CONTENTS SECTION 1. (a) This Act may be cited as the "Health 4 Planning and Resources Development Amendments of 5 1979". 6 (b) Whenever in this Act (other than in subsections (i) 7 and (j) of section 115) an amendment or repeal is expressed 8 in terms of an amendment to, or repeal of, a section or other 9 provision, the reference shall be considered to be made to a 10 section or other provision of the Public Health Service Act. TABLE OF CONTENTS Sec. 1. Short title; references to Public Health Service Act; and table of contents. TITLE I-REVISION OF HEALTH PLANNING AUTHORITY Sec. 101. Revision and reporting on national guidelines for health planning. Sec. 102. National health priorities. Sec. 103. Designation of health service areas. Sec. 104. Designation of health systems agencies. Sec. 105. Limits on designated agencies. Sec. 106. Planning grants. Sec. 107. Carryover of grant funds. Sec. 108. Membership requirements. Sec. 109. Governing body selection. Sec. 110. Responsibilities of governing bodies. Sec. 111. Meetings and records. Sec. 112. Support and reimbursement for members of governing bodies. Sec. 113. Conflicts of interest. Sec. 114. Staff expertise. Sec. 115. Health plan requirements. Sec. 116. Criteria and procedures for reviews. Sec. 117. Certificate of need programs. Sec. 118. Appropriateness review. Sec. 119. Review and approval of proposed uses of Federal funds. Sec. 120. Coordination of health planning with rate review. Sec. 121. Coordination within standard metropolitan statistical areas and with other entities. Sec. 122. State health planning and development agencies. Sec. 123. Statewide Health Coordinating Council composition. Sec. 125. Report on effectiveness of planning law. 3 1 2 Sec. 126. Effective date. TITLE II-REVISION OF AUTHORITY FOR HEALTH RESOURCES Sec. 201. Revision and extension of assistance. Sec. 202. Conforming amendments. Sec. 203. Technical amendments. Sec. 204. Effective date. TITLE III-PROGRAM TO ASSIST AND ENCOURAGE THE Sec. 301. Authorization of program. Sec. 302. Study. TITLE I-REVISION OF HEALTH PLANNING AUTHORITY 3 REVISION AND REPORTING ON NATIONAL GUIDELINES FOR 4 5 HEALTH PLANNING SEC. 101. (a)(1) Section 1501 is amended (A) by strik 6 ing out "and shall, as he deems appropriate, by regulation. 7 revise such guidelines" in subsection (a), and (B) by adding 8 after subsection (c) the following: 9 "(d) The Secretary shall, on an annual basis, review the 10 standards and goals included in the guidelines issued under 11 subsection (a). In conducting such a review, the Secretary 12 shall review the health systems plans and annual implemen13 tation plans of health systems agencies and State health 14 plans. If the Secretary proposes to revise a guideline issued 15 under subsection (a), he shall make such revision by regula16 tions promulgated in accordance with section 553 of title 5, 17 United States Code. 1 4 "(e)(1) The Secretary shall collect data to determine 2 whether the health care delivery systems meet or are chang3 ing to meet the standards and goals included in the guidelines 4 issued under subsection (a) and to determine the personnel, 5 facilities, and other resources needed to meet such standards 6 and goals. The Secretary shall prescribe (A) the manner in 7 which such data shall be assembled and reported to the Sec8 retary by health systems agencies, State health planning and 9 development agencies, and other entities, and (B) the defini10 tions which shall be used by such agencies and entities in 11 assembling and reporting such data. 12 "(2) The Secretary shall from the data collected under 13 paragraph (1) periodically make public a (A) statement of the 14 relationship between such standards and goals and the status 15 of the supply, distribution, and organization of health re16 sources with respect to which such standards and goals were 17 established, and (B) summary of changes (either through ad18 ditons or reductions) in resources needed to meet such stand19 ards and goals.". 20 (2) Subsection (c) of section 1501 is amended by striking 21 out "In issuing guidelines under subsection (a) the Secretary 22 shall" and inserting in lieu thereof "At least 45 days before 23 the initial publication of a regulation proposing a guideline 24 under subsection (a) or a revision under subsection (d) of such |