January 4, 1975 - 3 LANE MEDICAL LIBRARY Pub STANFORD-AF. 94305. 2227 that the provider be encouraged to play an active role in developing health policy at all levels. (6) Large segments of the public are lacking in basic knowledge regarding proper personal health care and methods for effective use of available health services. (b) In recognition of the magnitude of the problems described in subsection (a) and the urgency placed on their solution, it is the purpose of this Act to facilitate the development of recommendations for a national health planning policy, to augment areawide and State planning for health services, manpower, and facilities, and to authorize financial assistance for the development of resources to further that policy. REVISION OF HEALTH PLANNING PROGRAMS UNDER THE PUBLIC HEALTH SERVICE ACT SEC. 3. The Public Health Service Act is amended by adding at 42 USC 201 the end the following new title: "TITLE XV-NATIONAL HEALTH PLANNING AND DEVELOPMENT "PART A-NATIONAL GUIDELINES FOR HEALTH PLANNING "NATIONAL GUIDELINES FOR HEALTH PLANNING .note. "SEC. 1501. (a) The Secretary shall, within eighteen months after 42 USC 300k-1. the date of the enactment of this title, by regulation issue guidelines concerning national health planning policy and shall, as he deems appropriate, by regulation revise such guidelines. Regulations under this subsection shall be promulgated in accordance with section 553 of title 5, United States Code. "(b) The Secretary shall include in the guidelines issued under subsection (a) the following: "(1) Standards respecting the appropriate supply, distribution, and organization of health resources. "(2) A statement of national health planning goals developed after consideration of the priorities, set forth in section 1502, which goals, to the maximum extent practicable, shall be expressed in quantitative terms. "(c) In issuing guidelines under subsection (a) the Secretary shall consult with and solicit recommendations and comments from the health systems agencies designated under part B, the State health Post, p. 2229. planning and development agencies designated under part C, the Post, p. 2242. Statewide Health Coordinating Councils established under part C, associations and specialty societies representing medical and other health care providers, and the National Council on Health Planning and Development established by section 1503. "NATIONAL HEALTH PRIORITIES "SEC. 1502. The Congress finds that the following deserve priority 42 USC 300k-2. consideration in the formulation of national health planning goals and in the development and operation of Federal, State, and area health planning and resources development programs: (1) The provision of primary care services for medically underserved populations, especially those which are located in rural or economically depressed areas. 88 STAT. 2228 42 USC 1320c. Establishment. "(2) The development of multi-institutional systems for coordination or consolidation of institutional health services (including obstetric, pediatric, emergency medical, intensive and coronary care, and radiation therapy services). "(3) The development of medical group practices (especially those whose services are appropriately coordinated or integrated with institutional health services), health maintenance organizations, and other organized systems for the provision of health care. "(4) The training and increased utilization of physician assistants, especially nurse clinicians. "(5) The development of multi-institutional arrangements for the sharing of support services necessary to all health service institutions. "(6) The promotion of activities to achieve needed improvements in the quality of health services, including needs identified by the review activities of Professional Standards Review Organizations under part B of title XI of the Social Security Act. "(7) The development by health service institutions of the capacity to provide various levels of care (including intensive care, acute general care, and extended care) on a geographically integrated basis. "(8) The promotion of activities for the prevention of disease, including studies of nutritional and environmental factors affecting health and the provision of preventive health care services. "(9) The adoption of uniform cost accounting. simplified reimbursement, and utilization reporting systems and improved management procedures for health service institutions. "(10) The development of effective methods of educating the general public concerning proper personal (including preventive) health care and methods for effective use of available health services. "NATIONAL COUNCIL ON HEALTH PLANNING AND DEVELOPMENT "SEC. 1503. (a) There is established in the Department of Health, 42 USC 300k-3. Education, and Welfare an advisory council to be known as the National Council on Health Planning and Development (hereinafter in this section referred to as the 'Council'). The Council shall advise, consult with, and make recommendations to, the Secretary with respect to (1) the development of national guidelines under section 1501, (2) the implementation and administration of this title and Post, p. 2258. title XVI, and (3) an evaluation of the implications of new medical technology for the organization, delivery, and equitable distribution of health care services. Membership. "(b)(1) The Council shall be composed of fifteen members. The Chief Medical Director of the Veterans' Administration, the Assistant Secretary for Health and Environment of the Department of Defense, and the Assistant Secretary for Health of the Department of Health, Education, and Welfare shall be nonvoting ex officio members of the Council. The remaining members shall be appointed by the Secretary and shall be persons who, as a result of their training, experience, or attainments, are exceptionally well qualified to assist in carrying out the functions of the Council. Of the voting members, not less than five shall be persons who are not providers of health services, not more than three shall be officers or employees of the Federal Government, not less than three shall be members of governing bodies of health systems agencies designated under part B, and not less than three shall be members of Statewide Health Coordinating Councils under section 1524. The two major political parties shall have equal representation among the voting members on the Council. "(2) The term of office of voting members of the Council shall be six years, except that— "(A) of the members first appointed to the Council, four shall be appointed for terms of two years and four shall be appointed for terms of four years, as designated by the Secretary at the time of appointment; and "(B) any member appointed to fill a vacancy occurring prior to the expiration of the term for which his predecessor was appointed shall be appointed only for the remainder of such term. A member may serve after the expiration of his term until his successor has taken office. "(3) The chairman of the Council shall be selected by the voting members from among their number. The term of office of the chairman of the Council shall be the lesser of three years or the period remaining in his term of office as a member of the Council. 88 STAT. 2229 Post, p. 2247. Terms of office. "(c) (1) Except as provided in paragraph (2), the members of Compensation. the Council shall each be entitled to receive the daily equivalent of the annual rate of basic pay in effect for grade GS-18 of the General Schedule for each day (including traveltime) during which they are engaged in the actual performance of duties vested in the Council. (2) Members of the Council who are full-time officers or employees of the United States shall receive no additional pay on account of their service on the Council. 5 USC 5332 and note. Travel "(3) While away from their homes or regular places of business in the performance of services for the Council, members of the Council expenses. shall be allowed travel expenses, including per diem in lieu of subsistence, in the same manner as persons employed intermittently in the Government service are allowed expenses under section 5703(b) of title 5, United States Code. "(d) The Council may appoint, fix the pay of, and prescribe the functions of such personnel as are necessary to carry out its functions. In addition, the Council may procure the services of experts and consultants as authorized by section 3109 of title 5, United States Code, but without regard to the last sentence of such section. "(e) The provisions of section 14 (a) of the Federal Advisory Committee Act shall not apply with respect to the Council. "PART B-HEALTH SYSTEMS AGENCIES "HEALTH SERVICE AREAS Experts and consultants. 5 USC app. I. "SEO. 1511. (a) There shall be established, in accordance with this Establishment. section, health service areas throughout the United States with respect 42 USC 3001. to which health systems agencies shall be designated under section 1515. Each health service area shall meet the following requirements: Requirements. "(1) The area shall be a geographic region appropriate for the effective planning and development of health services, determined on the basis of factors including population and the availability of resources to provide all necessary health services for residents of the area. "(2) To the extent practicable, the area shall include at least one center for the provision of highly specialized health services. 88 STAT. 2230 42 USC 1320c-1. Notice to "(3) The area, upon its establishment, shall have a population of not less than five hundred thousand or more than three million; except that "(A) the population of an area may be more than three million if the area includes a standard metropolitan statistical area (as determined by the Office of Management and Bulget) with a population of more than three million, and (B) the population of an area may— "(i) be less than five hundred thousand if the area comprises an entire State which has a population of less than five hundred thousand, or "(ii) be less than "(I) five hundred thousand (but not less than two hundred thousand) in unusual circumstances (as determined by the Secretary), or 66 "(II) two hundred thousand in highly unusual circumstances (as determined by the Secretary). if the Governor of each State in which the area is located determines, with the approval of the Secretary, that the area meets the other requirements of this subsection. "(4) To the maximum extent feasible, the boundaries of the area shall be appropriately coordinated with the boundaries of areas designated under section 1152 of the Social Security Act for Professional Standards Review Organizations, existing regional planning areas, and State planning and administrative areas. The boundaries of a health service area shall be established so that, in the planning and development of health services to be offered within the health service area, any economic or geographic barrier to the receipt of such services in nonmetropolitan areas is taken into account. The boundaries of health service areas shall be established so as to recognize the differences in health planning and health services development needs between nonmetropolitan and metropolitan areas. Each standard metropolitan statistical area shall be entirely within the boundaries of one health service area, except that if the Governor of each State in which a standard metropolitan statistical area is located determines, with the approval of the Secretary, that in order to meet the other requirements of this subsection a health service area should contain only part of the standard metropolitan statistical area, then such statistical area shall not be required to be entirely within the boundaries of such health service area. "(b) (1) Within thirty days following the date of the enactment of this title, the Secretary shall simultaneously give to the Governor of each State written notice of the initiation of proceedings to establish health service areas throughout the United States. Each notice shall contain the following: "(A) A statement of the requirement (in subsection (a)) of the establishment of health service areas throughout the United States. "(B) A statement of the criteria prescribed by subsection (a) for health service areas and the procedures prescribed by this subsection for the designation of health service area boundaries. "(C) A request that the Governor receiving the notice (i) designate the boundaries of health service areas within his State, and, where appropriate and in cooperation with the Governors of adjoining States, designate the boundaries within his State of health service areas located both in his State and in adjoining States, and (ii) submit (in such form and manner as the Secretary shall specify) to the Secretary, within one hundred and twenty 88 STAT. 2231 days of the date of enactment of this title, such boundary designations together with comments, submitted by the entities referred to in paragraph (2), with respect to such designations. At the time such notice is given under this paragraph to each Publication Governor, the Secretary shall publish as a notice in the Federal in Federal Register a statement of the giving of his notice to the Governor and Register. the criteria and procedures contained in such notice. "(2) Each State's Governor shall in the development of boundaries for health service areas consult with and solicit the views of the chief executive officer or agency of the political subdivisions within the State, the State agency which administers or supervises the administration of the State's health planning functions under a State plan approved under section 314(a), cach entity within the 42 USC 246. State which has developed a comprehensive regional, metropolitan, or other local area plan or plans referred to in section 314(b), and each regional medical program established in the State under the title IX. 42 USC 299. “(3)(A) Within two hundred and ten days after the date of Publication enactment of this title, the Secretary shall publish as a notice in the in Federal Federal Register the health service area boundary designations. The Register. boundaries for health service areas submitted by the Governors shall, except as otherwise provided in subparagraph (B), constitute upon their publication in the Federal Register the boundaries for such health service areas. "(B) (i) If the Secretary determines that a boundary submitted to him for a health service area does not meet the requirements of subsection (a), he shall, after consultation with the Governor who submitted such boundary, make such revision in the boundary for such area (and as necessary, in the boundaries for adjoining health service areas) as may be necessary to meet such requirements and publish such revised boundary (or boundaries); and the revised boundary (or boundaries) shall upon publication in the Federal Register constitute the boundary (or boundaries) for such health service area (or areas). The Secretary shall notify the Governor of each State in which is located a health service area whose boundary_is revised under this clause of the boundary revision and the reasons for such revision. "(ii) In the case of areas of the United States not included within the boundaries for health service areas submitted to the Secretary rs requested under the notice under paragraph (1), the Secretary shall establish and publish in the Federal Register health service area boundaries which include such areas. The Secretary shall notify the Governor of each State in which is located a health service are the boundary for which is established under this clause of the boundaries established. In carrying out the requirement of this clause, the Secretary may make such revisions in boundaries submitted under subparagraph (A) as he determines are necessary to meet the requirement of subsection (a) for the establishment of health service areas throughout the United States. Boundary revision; publication in Federal Register. other health "(4) The Secretary shall review on a continuing basis and at the Review. request of any Governor or designated health systems agency the appropriateness of the boundaries of the health service areas established under paragraph (3) and, if he determines that a boundary for a health service area no longer meets the requirements of subsection (a), he may revise the boundaries in accordance with the procedures prescribed by paragraph (3)(B) (ii) for the establishment of boundaries of health service areas which include areas not included in boundaries submitted by the Governors. If the Secretary acts on his |