1 (e) The amount of any grant under this section shall be 2 determined by the Secretary. A grant under this section may

3 include amounts—

4

5

6

7

8

9

10

11

12

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(1) in the case of the closure of the entire hospital,

to liquidate the net outstanding debt of the hospital,
(2) in the case of the conversion of part of the
hospital from use for inpatient care to another health
care use, to pay for the costs of that conversion, includ-
ing costs of construction, and

(3) that the Secretary determines are otherwise needed to assist in discontinuing inappropriate inpatient hospital services.

(f) The Secretary may make payments under this sec14 tion in advance or by way of reimbursement, and at such 15 intervals and on such conditions as he finds necessary.

16

(g) Each hospital which receives a grant under this 17 section shall (1) establish and maintain such records, and 18 arrange to have performed such audits, as the Secretary may 19 require, and (2) make available those records to the Secre20 tary and the Comptroller General of the United States for 21 examination, copying, and mechanical reproduction.

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23

TECHNICAL ASSISTANCE

SEC. 302. The Secretary may provide technical assist24 ance to hospitals eligible for grants under section 301 to

1 assist them in discontinuing inappropriate inpatient hospital

2. services.

3

4

APPROPRIATION AUTHORIZATIONS

SEC. 303. For the purposes of making grants and pro

5 viding technical assistance under this title, there are author

6 ized to be appropriated such sums as may be necessary for 7 fiscal years 1980 and 1981.

I appreciate the opportunity to comment on the proposed amendments to
P.L. 93-641, submitted by the Department of HEW.

In line with my testimony, I would suggest the following change to
P.L. 93-641. Section 1513-b-2-C, Health Systems Agencies Functions
reads, "shall take into account and is consistent with the national
guidelines for health planning." The words "and is consistent with"
should be stricken. This would assure that local H. S. A.'s would be
able to provide input from the bottom upward rather than responding to
national guidelines.

I would recommend that a Section be added, as C-5, which should read:
"The Agency shall submit to the state Agency a detailed statement of
the reasons for any inconsistencies between its HSP or AIP plan, and the
national guidelines and priorities establish under this Act."

In addition, I would like to bring to your attention a concern of one
of the hospital administrators in my District. He has stated to me that
some type of agreement has been made between the HEW and the H. S. A.'s
regarding a financial mechanism by which HEW would pay a hospital the
costs incurred in closing it down, and that local H. S. A.'s would receive
a percentage of that money. He indicated to me that this seemed to provide
an unusual incentive to close hospitals, especially those financially weak
hospitals, in many rural areas.

One point that has been brought to my attention is the fact that health
planning has given little attention to medically under serviced areas.

As you may know, the emphasis has been on eliminating excess hospital capability, and I would like to assure that adequate emphasis is on assuring that rural areas which suffer from lack of medical personnel are given equal attention.

With best regards, I am

Sincerely,

Arlan Stangstand

Arlan Stangeland
Member of Congress

Thank you for allowing me to comment on the proposed amendments to Public Law 93-641, the Health Planning and Resources Development Act of 1974.

The amendments offered by the Department of Health, Education, and Welfare provide for some general improvement in the Act. One minor point of duplication in the review processes would be eliminated. Also, state elected officials would have a greater opportunity to influence state health policy under these revisions.

However, they fail to address the situation of the single statewide health systems agency structure. As I indicated in my testimony, I believe that this type of system is inappropriate and inherently contains problems which are not conducive to effective and efficient health planning. I hope that you will give consideration to this matter in your deliberations.

Yours sincerely,

Eh/soc