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 Sangstand

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 si

EH/soc

HPC
REES

HEALTH PLANNING COUNCIL OF THE EASTERN SHORE
P.O. BOX 776, CAMBRIDGE, MD. 21613

301/228-8911

DORCHESTER

ATTN: Bob Crane
Re: P. L. 93-641

Dear Congressman Rogers:

We have recently received a letter from Congressman Satterfield
indicating that the record of your Committee Hearings on

P. L. 93-641 would remain open for 10 days following the
presentation of the Administration Bill. We thank you for this
additional opportunity for input and comment on revisions to
P.L. 93-641 as proposed by the Administration.

For the most part we are of the opinion that the Administration's
Proposal is sound, and in particular we are pleased with the
changes embodied in sections 204 and 207.

There are a number of other areas where we feel that changes to
the Administration's Proposal are needed. I have summarized
those by section below.

Section 208: Since representatives of governmental
authorities have a great many other time consuming
responsibilities we have found that they frequently
have difficulty attending meetings. For this reason
we do not favor the change. If the change increasing
that representation remains in the Bill we recommend
that the quorum requirements for meetings be lowered
from one half of the members to one third of the
members in section 1512 of the current law.

Section 212: As our testimony on allocation of grants
indicated, we favor the use of minimum funding levels
for small population HSAs, with a substantial increase
in the minimum funding level. In addition, we favor
the recognition of local funds raised by all HSA's on
an equal basis in allocating federal matching funds.

We feel that House Bill 10460, Section 206, amending
section 1516 accomplishes the desired end concerning
local match, and congratulate the committee for its
work in this area.

Section 216: SHCC representation based on HSA population will bias State level planning decisions to metropolitan areas and high cost tertiary care, to the detriment of rural area needs for less expensive primary care. This change is highly undesirable in our view.

Section 218: State Health Plan approval by the Governor would make the SHCC an organization without meaningful function in our view, and that change is undesirable.

Again we thank you for this additional opportunity to comment on these important legislative matters.

FAD: jf

Yours truly,

Fred A. Dierks
Executive Director

for

Col. Bertram Parr
Vice President

Health Planning Council of

The Eastern Shore