"Plans, policies, criteria and guidelines developed by The purpose of the section 1122 program is to ensure that Federal health dollars are not spent in support of unnecessary capital expenditures, and further, to discourage health care facilities and health maintenance organizations from making capital investments for unneeded services and facilities. These purposes were endorsed by the executive branch of the Ohio State government (in the section 1122 agreement with this Department) as well as the Ohio legislature (in enacting House Bill Number 908 which authorized the performance of the regulatory functions of the National Health Planning and Resources Development Act of 1974 and the section 1122 review function). The actions taken by the Ohio Department of Health during the course of the review in question indicate that it is not contributing to the goals of the section 1122 program. The Ohio Department of Health has been designated on a conditional basis, under Title XV of the Public Health Service Act, to be the State Health Planning and Development Agency. This Act, at section 1521(b)(2) (A), authorizes the Secretary to enter into such a conditional agreement with a Governor of a State "with a view to determining the capacity of the designated State Agency to administer the...health planning and development functions prescribed by section 1523." If the Secretary determines that the agency has this capability, then he may enter into a full designation agreement. One of the functions required of a State Health Planning and Development Agency before it may reach full designation is the administration of a certificate of need program which prevents the offering or development of unneeded facilities and services. The experience of the State in administering the section 1122 program will certainly be a major factor in the Secretary's determination as to the capability of the Ohio Department of Health to administer a certificate of need program which meets the requirements of the law. If the Secretary were to find that a State Health Planning and Development Agency did not have the capacity to administer a satisfactory certificate of need program, he would have to turn down its application for full designation (or revoke full designation after it has been granted). If a conditionally designated State Health Planning and Development Agency were to fail to qualify for full designation, then that agency could not receive Federal funds authorized by Titles XV and XVI of the Public Health Service Act. If, moreover, there is no designation agreement in effect for a State on September 30, 1980, the Public Health Service Act, at section. 1521(d), specifies that the Secretary "may not make any allotment, grant, loan, or loan guarantee, or enter into any contract" under the Public Health Service Act and two related Acts for the development, expansion, or support of health resources in the State until such an agreement is in effect. It is important to realize that a substantial amount of Federal funds, in addition to Federal support for health planning activities, are placed in jeopardy in this latter situation. In this situation, the Secretary has no discretion: he would have to deny Federal funds for the development, expansion, or support of health resources to any prospective grantee, contractor, or institution located in the State this restriction does not apply solely to funds intended for the State government itself. On the other hand, in the event that an agency which has been conditionally designated is found not to be capable of assuming the functions required for full designation, the Secretary could then consider an application for designation, on a conditional basis, of a different State agency to be the State Health Planning and Development Agency. Alternatively, the Act, at section 1523(b)(1), provides that the agency administering the certificate of need and section 1122 review functions may be an agency of the State other than the State Health Planning and Development Agency. I would appreciate your prompt response concerning these issues. Sincerely yours, Henry A. Foley, Ph.D. Administrator The Ohio State Medical Association must protest strongly the overt activities of the Health Resources Administration, U. S. Public Health Service. I refer specifically to a threatening letter written by Henry A. Foley, administrator of the HRA, January 17, 1978, addressed to the Ohio Director of Health, John A. Ackerman, M.D., M.P.H. The letter is a patent and transparent effort by Mr. Foley to insert himself and his office into differences of opinion over the needed expansion of medical facilities in an Ohio community. It is an almost incredible fact that Mr. Foley saw fit to "leak" to the opponents of the expansion of two medical facilities his letter several days before Dr. Ackerman received the letter. To do so is gravely insulting to a dedicated public health physician, to those of us in Ohio who are striving to make health planning succeed, and to Congressman Paul Rogers, the author of the planning legislation. Mr. Foley's insult to Dr. Ackerman is further compounded by the fact that he did not extend this respected state official the courtesy of even discussing the matter with Dr. Ackerman before writing him the threatening letter. Mr. Secretary, the "leak" technique may be and is used in Washington with considerable frequency, but there is no place for it here in Ohio. Also, I would ask you to remind Mr. Foley that Mr. Rogers, in explaining the purpose and intent of his legislation before a national meeting of medical leaders stated: "And we've written the planning bill. Contrary to what some may think, it doesn't put all the power in the Secretary because we wrote it where it wouldn't." If your Mr. Foley had taken the time to discuss the issue with Dr. Ackerman, he would have easily learned that (1) present and future projections clearly demonstrate that the approved projects are necessary and in the best interests of the DISTRICT COUNCILORS: FIRST-STEWART B. DUNSKER, MD, CINCINNATI SECOND-W. J. LEWIS, M.D., DAYTON FIFTH-THEODORE J CASTELE M.D., CLEVELAND THIRD-ALFORD C DILLER M.D. CONST consumers they are to serve, (2) the projects were thoroughly reviewed over a considerable period by experienced local health care delivery experts, (3) the projects were approved for Medicare and Medicaid purposes by the U. S. Department of Health, Education and Welfare, (4) Dr. Ackerman gave very serious and very conscientious attention to these matters, working in constant communication and in a spirit of cooperation with the local interests (a quality your Mr. Foley appears to lack). If health planning is to succeed, it must be carried on in a spirit of cooperation, openly and above board. It must be approached with an reasonable attitude, and it must involve all interests equally. We here in Ohio abide by those principles. We expect the Department of Health, Education and Welfare to do the same. Sincerely, William M. Wells, M.D., President WMW: ii RENAL PHYSICIANS ASSOCIATION ONE IBM PLAZA-SUITE 3100 CHICAGO, ILLINOIS 60611 February 20, 1978 Paul G. Rogers, Chairman Subcommittee on Health and the Environment Dear Mr. Rogers: The Renal Physicians Association seeks the opportunity to present the following statement as a matter of record concerning the hearings and deliberations on The National Health Planning and Resources Development Act (PL-93-641). It is our desire to comment first on the program in a general way, relative to certain basic concepts concerning the law, its goals and their impact, and then in a specific way as it relates to the Medicare ESRD Program enacted under PL-92-603. General Considerations The basic concept of this law was to establish local Health Systems Agencies, To this end, the HSA would whose function was to contain the spiraling costs of health care through a system of coordinated planning for health care. plan for needed services, permit orderly and progressive development of services, set standards which would either upgrade services or lead to their deletion, and prevent duplication of unnecessary services and facilities. The very essence of the law, i.e., to halt costly duplication and unneeded services is, in itself, an example of what the Medicare ESRD Program set about to prevent - duplication of already existent planning services. Much in the way of health planning was either developed, or in the process of being developed at the State level when the law was enacted. Thus, the Federal Government not only duplicated a program already in place in many areas, but did it at great cost to the taxpayer. Should all the HSAs ultimately receive designation, the cost to the health Secondly, the HSAs are faced with tasks that simply are not achievable Further, in many areas of the country, it has become evident that the HSAs |