88 STAT. 2252 Requirements. health systems agencies and States Agencies may vary according to the purpose for which a particular review is being conducted or the type of health services being reviewed. "(b) Each health systems agency and State Agency shall include in the procedures required by subsection (a) at least the following: (1) Written notification to affected persons of the beginning of a review. 66 “(2) Schedules for reviews which provide that no review shall, to the extent practicable, take longer than ninety days from the date the notification described in paragraph (1) is made. "(3) Provision for persons subject to a review to submit to the agency or State Agency (in such form and manner as the agency or State Agency shall prescribe and publish) such information as the agency or State Agency may require concerning the subject of such review. "(4) Submission of applications (subject to review by a health systems agency or a State Agency) made under this Act or other provisions of law for Federal financial assistance for health services to the health systems agency or State Agency at such time and in such manner as it may require. (5) Submission of periodic reports by providers of health services and other persons subject to agency or State Agency review respecting the development of proposals subject to review. "(6) Provision for written findings which state the basis for any final decision or recommendation made by the agency or State Agency. "(7) Notification of providers of health services and other persons subject to agency or State Agency review of the status of the agency or State Agency review of the health services or proposals subject to review, findings made in the course of such review, and other appropriate information respecting such review. "(8) Provision for public hearings in the course of agency or State Agency review if requested by persons directly affected by the review; and provision for public hearings, for good cause shown, respecting agency and State Agency decisions. "(9) Preparation and publication of regular reports by the agency and State Agency of the reviews being conducted (including a statement concerning the status of each such review) and of the reviews completed by the agency and State Agencv (including a general statement of the findings and decisions made in the course of such reviews) since the publication of the last such report. "(10) Access by the general public to all applications reviewed by the agency and State Agency and to all other written materials pertinent to any agency or State Agency review. "(11) In the case of construction projects, submission to the agency and State Agency by the entities proposing the projects of letters of intent in such detail as may be necessary to inform the agency and State Agency of the scope and nature of the projects at the earliest possible opportunity in the course of planning of such construction projects. "(c) Criteria required by subsection (a) for health systems agency and State Agency review shall include consideration of at least the following: "(1) The relationship of the health services being reviewed to the applicable HSP and AIP. "(2) The relationship of services reviewed to the long-range development plan (if any) of the person providing or proposing such services. 88 STAT. 2253 "(3) The need that the population served or to be served by such services has for such services. "(4) The availability of alternatives, less costly, or more effective methods of providing such services. "(5) The relationship of services reviewed to the existing health care system of the area in which such services are provided or proposed to be provided. "(6) In the case of health services proposed to be provided, the availability of resources (including health manpower, management personnel, and funds for capital and operating needs) for the provision of such services and the availability of alternative uses of such resources for the provision of other health services. "(7) The special needs and circumstances of those entities which provide a substantial portion of their services or resources, or both, to individuals not residing in the health service areas in which the entities are located or in adjacent health service areas. Such entities may include medical and other health professions schools, multidisciplinary clinics, specialty centers, and such other entities as the Secretary may by regulation prescribe. "(8) The special needs and circumstances of health maintenance organizations for which assistance may be provided under title XIII. "(9) In the case of a construction project— "(A) the costs and methods of the proposed construction, and "(B) the probable impact of the construction project reviewed on the costs of providing health services by the person proposing such construction project. "TECHNICAL ASSISTANCE FOR HEALTH SYSTEMS AGENCIES AND STATE HEALTH PLANNING AND DEVELOPMENT AGENCIES 42 USC 300e. "SEC. 1533. (a) The Secretary shall provide (directly or through 42 USC 300n-2. grants or contracts, or both) to designated health systems agencies and State Agencies (1) assistance in developing their health plans and approaches to planning various types of health services, (2) technical materials, including methodologies, policies, and standards appropriate for use in health planning, and (3) other technical assistance be necessary in order that such agencies may properly perform as may their functions. "(b) The Secretary shall include in the materials provided under subsection (a) the following: "(1)(A) Specification of the minimum data needed to determine the health status of the residents of a health service area and the determinants of such status. "(B) Specification of the minimum data needed to determine the status of the health resources and services of a health service area. "(C) Specification of the minimum data needed to describe the use of health resources and services within a health service area. "(2) Planning approaches, methodologies, policies, and standards which shall be consistent with the guidelines established by the Secretary under section 1501 for appropriate planning and Ante, p. 2227. development of health resources, and which shall cover the priorities listed in section 1502. “(3) Guidelines for the organization and operation of health Guidelines. systems agencies and State Agencies including guidelines for "(A) the structure of a health systems agency, consistent with section 1512(b), and of a State Agency, consistent with section 1522; 88 STAT. 2254 National health planning information center. Establishment. Operation cost system. Cost accounting system. Rates, caloulation system. "(B) the conduct of the planning and development processes; "(C) the performance of health systems agency functions in accordance with section 1513; and "(D) the performance of State Agency functions in accordance with section 1523. "(c) In order to facilitate the exchange of information concerning health services, health resources, and health planning and resources development practice and methodology, the Secretary shall establish a national health planning information center to support the health planning and resources development programs of health systems agencies, State Agencies, and other entities concerned with health planning and resources development; to provide access to current information on health planning and resources development; and to provide information for use in the analysis of issues and problems related to health planning and resources development. "(d) The Secretary shall establish the following within one year of the date of enactment of this title: "(1) A uniform system for calculating the aggregate cost of operation and the aggregate volume of services provided by health services institutions as defined by the Secretary in regulations. Such system shall provide for the calculation of the aggregate volume to be based on: "(A) The number of patient days; 66 (B) The number of patient admissions; "(C) The number of out-patient visits; and "(D) Other relevant factors as determined by the Secretary. "(2) A uniform system for cost accounting and calculating the volume of services provided by health services institutions. Such system shall: "(A) Include the establishment of specific cost centers and, where appropriate, subcost centers. (B) Include the designation of an appropriate volume factor for each cost center. "(C) Provide for an appropriate application of such system in the different types of institutions (including hospitals, nursing homes, and other types of health services institutions), and different sizes of such types of institutions. "(3) A uniform system for calculating rates to be charged to health insurers and other health institutions payors by health service institutions. Such system shall: "(A) Be based on an all-inclusive rate for various categories of patients (including, but not limited to individuals receiving medical, surgical, pediatric, obstetric, and psychiatric institutional health services). "(B) Provide that such rates reflect the true cost of providing services to each such category of patients. The system shall provide that revenues derived from patients in one category shall not be used to support the provision of services to patients in any other category. "(C) Provide for an appropriate application of such system in the different types of institutions (including hospitals, nursing homes, and other types of health service institutions) and different sizes of such types of institutions. "(D) Provide that differences in rates to various classes of purchasers (including health insurers, direct service pay 88 STAT. 2255 ors, and other health institution payors) be based on justified "(4) A classification system for health services institutions. Classification Such classification system shall quantitatively describe and group system. health services institutions of the various types. Factors included in such classification system shall include "(A) the number of beds operated by an institution; "(B) the geographic location of an institution; "(C) the operation of a postgraduate physician training program by an institution; and "(D) the complexity of services provided by an institution. "(5) A uniform system for the reporting by health services Reporting institutions of "(A) the aggregate cost of operation and the aggregate volume of services, as calculated in accordance with the system established by the Secretary under paragraph (1); "(B) the costs and volume of services at various cost centers, and subcost centers, as calculated in accordance with the system established by the Secretary under paragraph "(C) rates, by category of patient and class of purchaser, as calculated in accordance with the system established by the Secretary under paragraph (3). Such system shall provide for an appropriate application of such system in the different types of institutions (including hospitals, nursing homes, and other types of health services institutions) and different sizes of such institutions. CENTERS FOR HEALTH PLANNING system. "SEC. 1534. (a) For the purposes of assisting the Secretary in carry- 42 USC 300n-3. ing out this title, providing such technical and consulting assistance as health systems agencies and State Agencies may from time to time require, conducting research, studies and analyses of health planning and resources development, and developing health planning approaches, methodologies, policies, and standards, the Secretary shall by grants or contracts, or both, assist public or private nonprofit entities in meeting the costs of planning and developing new centers, and operating existing and new centers, for multidisciplinary health planning development and assistance. To the extent practicable, the Secretary shall provide assistance under this section so that at least five such centers will be in operation by June 30, 1976. "(b) (1) No grant or contract may be made under this section for planning or developing a center unless the Secretary determines that when it is operational it will meet the requirements listed in paragraph (2) and no grant or contract may be made under this section for operation of a center unless the center meets such requirements. "(2) The requirements referred to in paragraph (1) are as follows: Requirements. "(A) There shall be a full-time director of the center who possesses a demonstrated capacity for substantial accomplishment and leadership in the field of health planning and resources development, and there shall be such additional professional staff as may be appropriate. "(B) The staff of the center shall represent a diversity of relevant disciplines. 88 STAT. 2256 Appropriations. Budget, review and approval. 42 USC 300n-4. Performance standards. Ante, p. 2232. "(C) Such additional requirements as the Secretary may by regulation prescribe. "(c) Centers assisted under this section (1) may enter into arrangements with health systems agencies and State Agencies for the provision of such services as may be appropriate and necessary in assisting the agencies and State Agencies in performing their functions under section 1513 or 1523, respectively, and (2) shall use methods (satisfactory to the Secretary) to disseminate to such agencies and State Agencies such planning approaches, methodoligies, policies and standards as they develop. "(d) For the purpose of making payments pursuant to grants and contracts under subsection (a) there are authorized to be appropriated $5,000,000 for the fiscal year ending June 30, 1975, $8,000,000 for the fiscal year ending June 30, 1976, and $10,000,000 for the fiscal year ending June 30, 1977. "REVIEW BY THE SECRETARY "SEC. 1535. (a) The Secretary shall review and approve or disapprove the annual budget of each designated health systems agency and State Agency. In making such review and approval or disapproval the Secretary shall consider the comments of Statewide Health Coordinating Councils submitted under section 1524 (c) (3). Information submitted to the Secretary by a health systems agency or a State Agency in connection with the Secretary's review under this subsection shall be made available by the Secretary, upon request, to the appropriate committees (and their subcommittees) of the Congress. (b) The Secretary shall prescribe performance standards covering the structure, operation, and performance of the functions of each designated health systems agency and State Agency, and he shall establish a reporting system based on the performance standards that allows for continuous review of the structure, operation, and performance of the functions of such agencies. "(c) The Secretary shall review in detail at least every three years the structure, operation, and performance of the functions of each designated health systems agency to determine "(1) the adequacy of the HSP of the agency for meeting the needs of the residents of the area for a healthful environment and for accessible, acceptable and continuous quality health care at reasonable costs, and the effectiveness of the AIP in achieving the system described in the HSP; "(2) if the structure, operation, and performance of the functions of the agency meet the requirements of sections 1512(b) and 1513; "(3) the extent to which the agency's governing body (and executive committee (if any)) represents the residents of the health service area for which the agency is designated; "(4) the professional credentials and competence of the staff of the agency; "(5) the appropriateness of the data assembled pursuant to section 1513(b) (1) and the quality of the analyses of such data; "(6) the extent to which technical and financial assistance from the agency have been utilized in an effective manner to achieve goals and objectives of the HSP and the AIP; and "(7) the extent to which it may be demonstrated that— "(A) the health of the residents in the agency's health service area has been improved; "(B) the accessibility, acceptability, continuity, and quality of health care in such area has been improved; and |