2. 3. Coordinating Council will make the final decision if an HSA and a SHPDA are in disagreement. Amend the proposed subparagraph (D) of states with a single health systems agency where such statewide needs will be jointly Amend the proposed amendment by adding the same language to Section 1524 (c) (2) as suggested developed in a way which is responsive to those statewide needs." We endorse the provisions of Section 219(a) and (b) and applaud the recognition of the need to limit and specify the scope of appropriateness reviews in the light of limitations of both HSA and SHPDA resources. We strongly urge that Congress maintain the authorizations proposed in Section 225(e) and we further urge Congress to appropriate funds consistent with the authorization. All previous elements of the statute provide mechanisms for structuring the health care system and the tools for cost containment. However, Health Systems Agencies must have area health service development funds to deal with the accessibility, quality, continuity, availability and acceptability aspects of the health care system and to maintain operational credibility within the community. In addition, the availability of these funds will be the visible "reward" to the communities for cooperating with and supporting what many conceive to be a new expansion of governmental intervention. funds many communities will tend to perceive plan implementation for balanced health services as a negative, if not downright punitive, use of governmental authority. Without such The Association would also like to address an item that was not covered in the proposed amendments but which experience has proved desirable to include. We recommend that a paragraph be added to Section 1532 to read, "1532(d) No determination of a State Agency under Section 1523 may be inconsistent with the State Health Plan and no recommendation of a Health Systems Agency shall be inconsistent with the applicable Health Systems Plan". D.H.E.W. Proposed Amendments The National Association of Single State Agencies did not receive the DHEW Proposed Amendments in time for an in-depth analysis. However, several of the proposals were discussed that coincided with or overlapped those of H.R. 10460. The following comments address only the DHEW Sections that we feel should be modified. Section 208 (b). The members of the group prefer HR 10460 Section 209 (b) (1), as the DHEW proposed requirement that at least one-quarter of the HSA governing bodies be composed of public elected officials imposes yet another quota that governing bodies must meet. We do strongly agree that the inclusion of public elected officials on these bodies should be emphasized. Section 212. We recommend that the broader amendment proposed in HR 10460 Section 206 (a) and (b) be retained as the DHEW proposal gives too much discretion to the Secretary in the awarding of planning grant amounts. Also, it is exceedingly difficult to plan without some foreknowledge of potential minimum allocations. Section 214. While this section is adequate as far as it goes, it is felt that the addition of a new section, 1527, to part C of Title XV, as proposed in HR 10460 Section 218, provides needed clarification and specificity to Certificate of Need legislation. Section 216. This section is the same as HR 10460 Section 223 with the exception of the minimum HSA representation on the SHCC. The Association strongly recommends that the minimum representation from each HSA be set at two as proposed in the House bill. Section 218. We vigorously oppose this section because requiring the Governor to approve the State Health Plan developed by the SHCC would give him veto power over the Plan, which was never intended in the law. We recommend that the language be changed to require consultation with the Governor rather than approval, to ensure that the citizenvolunteer process of health planning be maintained rather than allow it to become another governmental planning process. Lest our comments, suggestions. recommendations and in places, oppositions imply an air of negativism, I would like to reiterate our concurrence with the majority of both the HR 10460 and DHEW proposals. We who are committed to carrying out the legislation, both as citizen-volunteers and staff, recognize the thought and effort that have been expended in the proposed amendments to PL 93-641. We are particularly anxious to preserve the idea of participatory democracy in health planning by the utilization of the governing bodies and the Statewide Health Coordinating Councils as the decision makers and the avoidance of health planning becoming solely a function of the bureaucracies of state or federal government. I have reviewed the proposed amendments to Public Law #93641 as submitted by the UnderSecretary of HEW, Mr. Hale Champion. I will review these title by title and section by section. Title I Section 101. I believe the UnderSecretary has exercised ex- Title II Section 201. No comment. Section 202. No comment. Section 203. I think it would be an error to expand the authority of a public regional planning body or unit of local government that serves as an HSA in relation to the authority of the separate governing body for health planning. At times it will become necessary for the health planning body to make objective decisions with which the parent body would not agree. Giving the parent body more power and authority to remove members for cause could result in coercion of the agency. The |