1 2 3 4 5 6 7 8 "(J) reasonable assurance that at all times after such application is approved (i) the facility or portion thereof to be constructed, or modernized, or converted will be made available to all persons residing or em ployed in the area served by the facility, and (ii) there will be made available in the facility or portion thereof to be constructed, modernized, or converted a reasonable volume of services to persons unable to pay therefor and the Secretary, in determining the reasonableness of the volume of services provided, shall take into consideration the extent to which compliance is feasible 12 from a financial viewpoint. 9 10 11 221 13 14 15 16 17 18 19 "(2) (A) The Secretary may waive— "(i) the requirements of subparagraph (D) of paragraph (1) for compliance with modernization and equipment standards prescribed pursuant to section 1620 (2), and "(ii) the requirement of subparagraph (E) of paragraph (1) respecting title to a project site, 20 in the case of an application for a project described in 21 subparagraph (B) of this paragraph. "(B) A project referred to in subparagraph (A) is a 23 project "(i) for the modernization of an outpatient medical facility which will provide general purpose health serv 6 ices, which is not part of a hospital, and which will serve a medically underserved population as defined in section 1633 or as designated by a health systems agency, and "(ii) for which the applicant seeks a loan under part A the principal amount of which does not exceed $20,000.". TECHNICAL AMENDMENTS 8 SEC. 303. (a) Part A (as so redesignated) is amended(1) by striking out section 1621 and by redesignating sections 1620 and 1622 as sections 1601 and 1602, respectively, 10 11 1272 13 14 15 16 17 18 19 (2) by striking out "section 1622 (d)" in subsection (a) (1) of section 1601 (as so redesignated) and inserting in lieu thereof "section 1602 (d)", and (3) by striking out "section 1620 (b) (2)" each place it occurs in subsection (d) of section 1602 (as so redesignated) and inserting in lieu thereof "section 1601 (a) (2) (B)". (b) Section 1625 of part B (as so redesignated) is re20 designated as section 1610. 21 (c) Subsection (a) (1) of section 1622 (as so redesig22 nated) is amended by striking out "section 1604" and in 23 serting in lien thereof "section 1621". 24 (d) Section 1623 (as so redesignated) is amended by 25 striking out "STATE" in the heading for such section. 1 (e) Section 1624 (as so redesignated) is amended by 2 striking out paragraphs (1) and (2) and by redesignating 3 paragraphs (3) through (16) as paragraphs (1) through 4 (14), respectively. 5 (f) Section 1626 (as so redesignated) is amended by 6 striking out "section 1604" and inserting in lieu thereof 7 "section 1621". 8 9 EFFECTIVE DATE SEC. 304. The amendments made by this title shall take 10 effect October 1, 1979. Mr. ROGERS. We are pleased to have as our first witness today for the Department of Health, Education, and Welfare the Honorable Hale Champion, who is the Under Secretary of HEW. Mr. Secretary, we welcome you to the committee and your colleagues, Mr. Foley, Ms. Davis and Ms. Hanft. We will be pleased to receive your statement and it will be made a part of the record in full. We will be pleased to have your statement at this time. STATEMENT OF HON. HALE CHAMPION, UNDER SECRETARY, DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE, ACCOMPANIED BY HENRY A. FOLEY, M.D., ADMINISTRATOR OF HEALTH RESOURCES ADMINISTRATION; KAREN DAVIS, DEPUTY ASSISTANT SECRETARY FOR PLANNING AND EVALUATION (HEALTH); AND RUTH S. HANFT, DEPUTY ASSISTANT SECRETARY FOR HEALTH, RESEARCH AND STATISTICS Mr. CHAMPION. Thank you, Mr. Chairman. I am pleased to be here today to discuss proposals to revise and extend the health planning authority first enacted in the National Health Planning and Resources Development Act of 1974. I am also pleased to be the first HEW witness to testify this session as your subcommittee begins work on its formidable agenda. The work you will do this year holds promise for major improvements in the quality and efficiency of our Nation's health care delivery system. I think it is appropriate that you are commencing your legislative hearings this session with the Health Planning and Resources Development Act. Comprehensive planning at local, regional and national levels is no longer a luxury in America. It is a necessity. It is a necessity if we are ever to implement a comprehensive, universal system for the national health. Ît is a necessity if we are ever to provide sufficient health care resources in areas which are underserved, while curbing unnecessary and expensive duplication in areas which are not. It is a necessity if we are ever to fashion a flexible system responsive to all the health care needs of individuals-one which recognizes the importance of research and education to teach people how to stay healthy, in addition to providing appropriate, high quality services for them when they cannot. In short, good planning is essential if we are ever to overcome defects and inefficiencies wrought by decades of haphazard growth, fragmentation, maldistribution, and perverse economic incentives in our national health care system. In 1946, Congress made its first major effort to correct some of those defects and deficiencies, when it passed the Hospital Survey and Construction Act-better known as Hill-Burton. While the primary purpose of Hill-Burton was to fund construction of new hospitals in medically underserved areas, the act also required States to survey their own health needs and develop State plans for the construction of facilities. Hill-Burton was extremely successful as a construction program. However, its planning requirements were largely targeted on the needs of underserved areas. Moreover, some of its basic planning assumptions have since proved to be mistaken or outdated. During the 1960's, Congress attempted to remedy that deficiency by enacting a number of planning amendments to the basic HillBurton Act and other health authorities. In particular, programs like the comprehensive health planning program (CHP) sought to create a structure to develop area-wide health plans and to afford local review and comment on Federal grantmaking activities. However, the outcome of these efforts was too often vague, untargeted, and ineffective. Moreover, the CHP program was hamstrung by the statutory requirement that it plan, "Without interfering with exist✓ing patterns of private professional practice of medicine, dentistry, and related healing arts." In 1974, Congress finally scrapped the earlier, tentative planning efforts, in favor of a completely new system for health planning: The National Health Planning and Resources Development Act, which enacted the provisions before us today for review. And while that system has proved to be complex and difficult to start up, it gives every indication of some day becoming the program its visionary drafters-including you, Mr. Chairman-expected it to be: A comprehensive, nationwide planning effort for "the achievement of equal access to quality health care at reasonable cost." For that reason, while we are submitting a number of amendments for improving the operation of the 1974 law, we agree with you, and with your colleagues in the Senate, that the basic structure of the planning act is sound, and that we should concentrate our efforts on assisting that structure to become fully operational in the months and years ahead. The balance of my testimony this morning, Mr. Chairman, will be devoted to a brief progress report on current implementation of the act; a description of the few problems and issues we believe you should address in extending this authority; and a discussion of several of the more important amendments being proposed by the Department, and in your bill, to address those problems and issues. CURRENT HEALTH PLANNING PROGRAM OPERATIONS At this time, all 205 health systems agencies, with staff totaling 3,200, have been designated and funded. Although only nine HSA's have been fully designated, we anticipate that by next September 30, 175 HSA's will be fully designated. Over 8,000 people serve on the 205 HSA governing bodies. Consumer and provider representation on these governing bodies is balanced-53 percent consumer and 47 percent providers. However, I should note that such a balance can sometimes be more theoretical than real, and we are concerned about the effects on the health planning process in such cases. Additionally, nearly 500 advisory subarea councils with 13,000 members have been organized by many HSA's. At the State level, all 56 State health planning and development agencies have been designated. Forty-eight States have established their statewide |