(b) delete the provision that standards for comprehensive public health services, including scope and quality of services, shall be set by regulations. General (a) provide for the creation of a National Advisory Council to the Surgeon General of the Public Health Service, with authority to approve grants to the States and changes in State plans, and with representation from the national organizations whose state affiliates are represented on the State planning councils; (b) insert a provision indicating there shall be no interference with the private practice of medicine. STATEMENT OF THE NATIONAL ASSOCIATION FOR RETARDED CHILDREN The National Association for Retarded Children has a continuing interest in the Partnership for Health legislation, since health and health related services for the mentally retarded are still inadequately developed. Between 1963 and 1966 mental retardation was looked on by the Public Health Service as a concern of the Division of Chronic Diseases. Although not specifically mentioned in the old law, a "categorical" program of project grants in mental retardation had been initiated. Within the Division it was administered by the Mental Retardation Branch, now the Mental Retardation Division of the Bureau of Health Services. We can only assume, in the absence of positive responses to recent inquiries, that the vital training and service needs to which these funds had been so successfully directed in that brief three years will continue to receive support. Among the mental retardation activities which deserve attention are the Student Work Experience and Training Program, planning funds for universities which are contemplating development of university, affiliated facilities for the mentally retarded, and information and referral services. Of even greater concern to us at this time is the fate of mental retardation within the programs administered by the state health and mental health authorities. In fiscal 1966 the formula grant appropriation for Chronic Diseases and Health of the Aging was increased by $2.5 million to enable the state health departments to initiate activities affecting the health of the retarded, especially the adult retarded. There was, however, no requirement that they do so, and most states gave higher priority to other on-going activities. Clearly action on behalf of the mentally retarded at the state level cannot be realistically anticipated unless federal appropriations are substantially increased. Therefore, we urge the Committee to authorize amounts which are realistic in view of the enormous task before us. In some states (e.g., Ohio and Virginia) the state mental health authority has a significant responsibility for community programs for the retarded (exclusive of education and vocational rehabilitation). In others (e.g., Oklahoma and Florida) responsibility lies elsewhere. Thus, there is no protection for the interests of the retarded in the earmarking of 15% of formula grant funds for the state mental health authorities. We do not ask for earmarking at this time but would urge the Committee to reaffirm its intent, as explicitly expressed in its report of last year, that formula grant funds be used to improve health services to the mentally retarded. Finally, we wish to express support for the new opportunities which would be opened up under Section 3 of H.R. 6418. There is much interest in the application of experimental approaches and use of new materials and functional designs in facilities for the mentally retarded; therefore, we welcome the inclusion of mental retardation facilities among those with respect to which grants and contracts may be awarded. STATEMENT OF THE NATIONAL ASSOCIATION FOR MENTAL HEALTH, INC. The National Association for Mental Health is a national voluntary citizens organization directing its efforts to improved care and treatment of the mentally ill and the prevention and reduction of the incidence of mental illness or disability.,7, We strongly support H.R. 6418, amending the Public Health Service Act by extending and expanding the authorizations for grants for comprehensive health planning and services, and for other purposes. We subscribe fully to the Congress' findings and declaration of purpose set forth in PL 89-749, the "Comprehensive Health Planning and Public Health Services Amendments of 1966", to be extended and expanded by H.R. 6418. We sincerely believe that "to assure comprehensive health services of high quality for every person, . . . comprehensive planning for health services, health manpower and health facilities is essential at every level of government; that desirable administration requires strengthening the leadership and capacities of state health agencies; and that support of health services provided to people in their communities should be broadened and made more flexible”. It was therefore our privilege to testify last year before this Committee in favor of the bills which were later enacted as PL 89-749, although we did at that time express some reservations about the adequacy of the authorizations and the term thereof. We are indeed grateful that we now have this opportunity to support H.R. 6418, which increases those authorizations and extends the term of the program through fiscal year 1972. We favor the proposed amendment of subsection (7) of Section 314 (d) which would require that at least 70 per centum of the amount reserved for mental health services and at least 70 per centum of the remainder of a State's allotment under this subsection shall be available only for the provision under the State plan of services in communities of the State. Through this amendment, funds will be made available on a realistic basis compared with known needs, for the development of mental health services in communities. We regard it as particularly significant that subsection (7) of Section 314 (d) permits specialized planning by the State mental health authority to meet the mental health needs of the State and, at the same time, relates the specialized planning to the comprehensive planning. As was stated by the Office of Comprehensive Health Planning and Development: "Comprehensive health planning neither negates or diminishes the need for continued or expanded functional or specialized planning. Operating State and local agencies and private and voluntary organizations should continue to plan for specialized programs-the construction of health facilities, the development and expansion of community mental health programs, regional medical programs, programs in environmental control, services for the mentally retarded, etc.—and to plan for increasing the supply and effective utilization of trained manpower. Comprehensive State health planning provides a framework for strengthening such efforts by relating objectives in these specialized areas to each other and to the overall needs and resources of the State." "Information and Policies on Grants to States for Comprehensive State Health Planning under Section 314 (a), Public Health Service Act as Amended" (draft dated April 11, 1967), issued by the Office of Comprehensive Health Planning and Development, H.E.W. In summary, we urge passage of H.R. 6418 because, with respect to comprehensive planning, it provides adequate funds to the States, for a reasonable period of time, to continue the vital planning now just beginning; and with respect to comprehensive public health services, because the bill makes Federal grant funds available to States, and through them, to their local communities, on a flexible basis for the provision of comprehensive public health services focused on individuals and on families in their communities. STATEMENT OF KAISER FOUNDATION HOSPITAL PLAN, INC. We appreciate the opportunity to present our views on the important subject of comprehensive planning for health facilities and services as embodied in the "Partnership for Health Amendments of 1967." In our opinion this legislation has significant constructive aspects including Section 5 dealing with improvement of clinical laboratories engaged in interstate activities, Section 7 authorizing the Public Health Service to enter into cooperative arrangements, and particularly Section 3 which will provide affirmative encouragement for innovation in the health care field. We wish to express our support for these provisions. A persuasive case has been made for the benefits of comprehensive health planning and the proposed legislation is a responsibly supported effort to deal with the very difficult problems posed by uncoordinated development of health care facilities and related services. Nonetheless, on the basis of considerable experience and study of both governmental and voluntary planning efforts in the health care field we have deep reservations as to whether or not the benefits claimed for governmentally supported health facility planning will in fact be realized to a substantial degree. In this connection and in the interest of the brevity of this record we would like to refer to our statement made before the Ways and Means Committee of the House of Representatives during public hearings on H.R. 5710, the "Social Security Amendments of 1967."1 More important than the lack of effectiveness which we anticipate is the serious potential inherent in governmentally supported health facility planning for perpetuating the status quo and stifling useful innovation. We urge this committee to give careful attention to the establishment of federal standards which will assure, insofar as realistically possible, that the health facility planning effort contemplated by H.R. 6418 does not become primarily a tool for preserving traditional methods of organizing health facilities and services and precluding or hampering the development of useful or potentially useful alternatives under which the stimulus of competition and the expression of consumer preference may contribute toward improving the efficiency and economy of our health care system. There is one proven alternative repeatedly endorsed by the Federal Government and other responsible sources which deserves particular attention—namely prepaid group practice health care." Because the group practice prepayment approach to the provision of health care services is both effective and non-traditional, it tends to be viewed as a threat or at least with skepticism and concern by many traditionally minded persons and organizations. These forces play key roles in the health care field and are certain to exert considerable influence on the development of state and local health facility plans such as those contemplated by H.R. 6418. Unless special attention is given to this problem, the frequently declared policy and intention of the Federal Government to encourage the development of prepaid group practice health care programs will be frustrated in the planning process. The essential characteristic of group practice prepayment plans, and a likely characteristic of possible variations and innovations not yet clearly formulated or recognized, lies in the concept of assuming responsibility for comprehensive health services for a defined population consisting of individuals and families wishing to avail themselves of an organized approach to the provision of health care. The traditional and dominant health care system in the United States, built around the individual medical practitioner or small group of physicians, involves a strong assumption of responsibility for treating the illnesses of individual patients. Although its full potential is as yet far from achieved, and barely recognized-even by the most advanced thinkers in the field-the group practice prepayment approach involves assumption of a much broader more pervasive responsibility: Assumption of responsibility not only to treat the illnesses of individual patients but also to promote the health of a population consisting of all enrolled individuals whether or not they are patients. To the end that H.R. 6418 may contribute to the effective planning of health facilities and services by encouraging, not inhibiting, assumption of broad responsibility for health rather than narrow responsibility for treatment of illness, we urge that this concept be expressly embodied in federal standards guiding the planning process. A suggested amendment representing one method of including such concept in the legislation is attached as Exhibit A to this statement. We wish to offer another suggestion of a more technical nature. The planning unit dealt with in H.R. 6418 is the individual health care facility. Thus on page 2 lines 17 through 21, the bill requires state plans to "provide for assisting each health care facility in the state to develop a program for capital expenditure . which is consistent with an overall state plan" (emphasis added). A basic point made in the opening session of the National Conference on Medical Costs on Tuesday, June 27, 1967, in Washington, D.C., was the potential value of recognizing and encouraging systems of health care facilities rather than individual units. We suggest that H.R. 6418 should further this useful concept by deleting the 1 Report of hearings before the Ways and Means Committee of the House of Representatives. 90th Congress, 1st Session, on H.R. 5710: Part 2, pages 780 through 786. 2 See, for example, "Medical Care Prices," a report to the President by Health. Education. and Welfare, published February 1967, pages 4 and 5. See also: "Building America's Health" (A Report to the President by the President's Commission on the Health Needs of the Nation). 1952. Vol. 1, pages 33-34: "Health Care for California" (The Report of the Governor's Committee on Medical Aid and Health). December, 1960, page 16; "Health of the Nation" (Message from President Lyndon B. Johnson to Congress), February 10, 1964. language "each health care facility" on line 2, page 18 and substituting language along the following lines: "each health care facility or group of health care facilities under common control or coordinated direction." A similar amendment should also be made on page 3 at line 4. In conclusion we urge this committee and the Congress that even at best the advantages claimed for health facility planning are apt to be of trifling significance compared to the social, technological, and organizational changes and innovations realizable in the health care field in an atmosphere of freedom and flexibility; thus protection of innovation and development in the planning process is a major public responsibility. Respectfully submitted. SCOTT FLEMING, Vice President and Associate Manager. " EXHIBIT A-SUGGESTED AMENDMENTS TO H.R. 6418, PLANNING TO ENCOURAGE ORGANIZATIONS WHICH ASSUME RESPONSIBILITY FOR HEALTH CARE FOR AN ENROLLED POPULATION Insert at the end of section 2 of subsection (a) (2) (I) following line 5, page 3 of H.R. 6418, dated March 1, 1967, the following: “; and (iii) in developing criteria to guide the development of state plans, the Secretary shall give particular attention to provisions for the encouragement of innovation and proven or promising alternatives to prevailing patterns for the organization and delivery of health care services, including alternatives under which a qualified sponsor or sponsors may assume responsibility to provide or arrange reasonably comprehensive health care services on behalf of a population comprised of individuals and families choosing to obtain health care services primarily as provided or arrange by such sponsor or sponsors." Hon. HARLEY O. STAGGERS, [Telegram] Atlanta, Ga., May 2, 1967. 1. Chairman, House Interstate and Foreign Commerce Committee, I heartily support extension authority for grants for comprehensive health planning and Public Health Service as contained in H.R. 6418. Also strongly support adequate appropriation ceilings to at least $500 million level by fiscal year 1971. Gov. LESTER MADDOX. Hon. HARLEY O. STAGGERS, [Telegram] BERKELEY, CALIF., April 29, 1967. Chairman, Interstate and Foreign Commerce Committee, Urge your support of principles involved in S. 1131 with particular reference to proposed section 353 regulating clinical laboratories in interstate commerce. Certain amendments for improvement of bill have been transmitted to Secretary Gardener. Copy being forwarded to you. If these changes are incorporated in bill we would find it entirely satisfactory. Urge your strong support. LESTER BRESLOW, M.D., California Director of Public Health. Hon. HARLEY STAGGERS, [Telegram] JEFFERSON CITY, Mo., May 4, 1967. Chairman, Interstate and Foreign Commerce Committee, House of Representatives, Washington, D.C.: With increased emphasis on licensing of clinical laboratories by each of the 50 States, it is apparent that licensing at the Federal level of clinical laboratories engaged in interstate commerce is desirable. The Missouri Division of Health is favorable to enactment of the "Clinical Laboratory Improvement Act of 1967" as contained in H.R. 6418. L. M. GARNER, M.D., Acting Director, Missouri Division of Health. By J. P. RUSSELL, M.D. [Telegram] TOPEKA, KANS., April 27, 1967. Hon. HARLEY STAGGERS, Chairman, Committee on Interstate and Foreign Commerce, As director of health for State of Kansas may I urge your vigorous support for H.R. 6418? Regulatory action for control of medical laboratories involved in interstate commerce has been long overdue. Many of these laboratories are performing a volume business with little regard to quality of standard and frequently with little concern for consequences of responsible diagnostic testing results on medical patient. Accuracy of such laboratory diagnostic studies can often mean difference between life and death. Licensure and periodic inspection of such laboratories by a government agency is imperative if we are to insure a high quality of medical care to citizens of our State. HUGH DIERKER, M.D., Kansas State Health Officer. Hon. HARLEY STAGGERS, [Telegram] PIERRE, S. DAK., Apr. 25, 1967. Chairman, Interstate and Foreign Commerce Committee, Urge passage of H.R. 6418 regarding licensure of laboratories working in interstate commerce. G. J. VAN HEUVELEN, M.D., Congressman HARLEY STAGGERS, State Health Officer. [Telegram] BISMARCK, N. DAK., April 27, 1967. Chairman, Interstate and Foreign Commerce Committee, In 1967 Idaho Department of Health unsuccessfully attempted to enact State legislation on clinical laboratory licensure on the national level. We strongly support H.R. 6418. This is a definite public health need. A. W. CLOTZ, D.P.H., Director of Laboratory Division, Idaho Department of Health. |