Having read with great encouragement and reassurance your remarks made when you introduced H.R. 10460 January 19, 1978, I respectfully request that this letter and its attachments be made a part of the record of the current hearings pertaining to that legislation.. The Ohio State Medical Association is a willing supporter of the position stated Those of us who have followed your development of local planning and resources development concepts through your original legislation, (the National Health Planning and Resources Development Act of 1974) know full well that your statements once again are a strong reiteration of the purpose and intent of the original Act, Public Law 93-641. I remember being so heartened, when I heard you subsequently address the American Medical Association Leadership Conference, by your forthright explanation of the purpose and intent of your legislation. I was particularly pleased when you then explained, quoting from your address: "Contrary to what some may think, it (the Rogers Act) doesn't place all the power in the Secretary because we wrote it where it wouldn't. We've put it in that local planning area, and we said we want direct providers on it, and we've protected the direct providers of health. "And we give the basic decision to the local planning groups-people at home--people who are there with the problem, who know what's to be done. We don't sift it up to the Secretary. It's to be done there." DISTRICT COUNCILORS: FIRST-STEWART B. DUNSKER, M.D., CINCINNATI SECOND-W. J. LEWIS, M.D., DAYTON FIFTH-THEODORE J. CASTELE, M.D., CLEVELAND THIRD ALFORD C. DILLER, M.D., CONVOY You again reiterated the necessity for local decision-making authority by your statement January 30 in convening hearings on H.R. 10460, particularly in your reference to the revised guidelines announced January 18. We share your clearly expressed dedication to preserving the independence of the local planning groups and the state agencies in carrying out the intent of Congress. I urge you to read the enclosed correspondence. It clearly illustrates the power-hungry attitude of HEW toward health planning. We have reviewed your proposal (H.R. 10460) to strengthen your legislation. The need for it is clearly demonstrated by the fiasco of the regulations published in the Federal Register September 23, 1977, and the attitude and tactics of HEW as demonstrated in the enclosed correspondence. Also, we have reviewed the amendments proposed by the American Medical Association before your subcommittee January 31, and we urge the adoption of those recommended amendments. Thank you for your courteous attention. Please let me know if you have any questions or would like additional information. enclosures: Letter of January 17, 1978, from Health Resources Administration Letter of January 30, 1978, from Ohio Director of Health Letter of February 2, 1978, from President, Ohio State Medical January 30, 1978 The Honorable Joseph A. Califano, Jr. Dear Mr. Secretary: On January 23, 1976, I received a letter from a Henry A. Foley of your department criticizing actions of the Ohio Department of Health. On January 20, 1978, copies of this letter were made available to the Dayton Daily News and to the legal staff of Blue Cross of Southwest Ohio. A hearing was scheduled before the Insurance Commission of the State of Ohio on an appeal by St. Elizabeth's Medical Center against Blue Cross of Southwest Ohio. Attempts were made to enter copies of Mr. Foley's letter into the record at that hearing. At the time of the hearing, I had not yet received the original letter. I am greatly disturbed, Mr. Secretary, that a responsible member of your staff would resort to such unethical behaviour in a flagrant attempt to influence and prejudice a legal hearing. I request some assurance that this type of action will not occur again, that proper disciplinary action be taken against Mr. Foley, and that I receive a written apology for the actions of your Department. It is difficult enough to carry out our capital expenditures reviews without harassment and dirty tricks from HEV. I will anticipate a speedy reply. Sincerely, Joha . Ackerman, A.D. Director of Health JUA/jv The Health Resources Administration recently completed its review pursuant to three requests for reconsideration under Section 1122(f) of the Social Security Act, of the capital expenditure proposed by the Kettering Medical Center for the purpose of constructing an affiliate hospital. Upon reconsideration, the Acting Administrator determined that Titles V, XVIII, and XIX reimbursement related to the capital expenditure will not be withheld under the authority of section 1122. A copy of the response to each reconsideration request was forwarded to you. Serious and legitimate complaints have been made concerning the conduct of this section 1122 review performed by the Ohio Department of Health (the designated planning agency (DPA) for Ohio). Although there is no statutory basis for applying a sanction against the proponent of a capital expenditure because of an error by the DPA, I feel it essential to the integrity of the section 1122 program that the defects of this review not be repeated in the future. I find the following aspects of the review particularly troublesome: Congress clearly required, in section 1122(b), that the Hill-Burton plan be included among the standards, criteria, and lans for reviewing proposed capital expenditures. The submission to the Department of Health, Education, and Welfare of findings of conformity for the two projects, when at least one proposal was not in conformity with the Hill-Burton plan, is strictly inconsistent with the terms of the section 1122 agreement between this Department and your agency, as well as the goals of the health planning program generally. Although I am prevented by the statutory language of section 1122 from requiring you to reconsider your action on the Kettering proposal, responsible health planning would have precluded the action of approving the two expansion projects contrary to the need specified in the health plans. 2. In your letter of May 17, 1975, to Mr. Davie, you 3. The application for review of the Kettering Medical Center proposal was deemed by the DPA to be incomplete and further information was requested (in the April 2, 1976, letter from Stephen F. Sears to Marlowe H. Schaffner, M.D.). Pursuant to the section 1122 regulations at 42 CFR 100.106(a)(3), when timely notification of incompleteness is provided, the review period begins on the date the additional information completing the application is received. Thus, your determination of the date on which the review period began was in error. This had the effect of shortening the period within which the areawide health planning agency could study the proposal as well as the period for your consideration of that agency's negative finding and recommendation. DPA's hasty decision, which was contrary to the recommendation of the areawide health planning agency, is especially troublesome in light of your own Rule HE-8-18(A): The |