As a member of the Seventh District's Health Care Advisory Committee, I
have been requested by Mr. Mark Wedel to comment on the upcoming
hearings of the House Subcommittee on Health and the Environment, which
will consider proposed amendments to and the extension of P.L. 93-641.
Due to the relatively short time we have in which to respond to your
request for information, my comments will be somewhat brief and general.
The Bemidji Community Hospital, which is a member of the Minnesota
Hospital Association (MHA), concurs with MHA in its strong support of
the population-based comprehensive health planning process established
in P.L. 93-641. Since the Health Systems Agencies (HSAs) are in the
best position to evaluate the needs and demands of their constituents,
we endorse MHA's position to have the planning process begin at the
local HSA level. We request that the proposed amendments give the
authority for planning to the local HSAs and permit the continued repre-
sentation of our hospitals and nursing homes on the HSA board.

Section 1513b (2) currently directs the local HSAs to develop plans that
are "responsive to the needs and resources of the area" within a frame-
work of state and national priorities. We hope that Congress will continue
with this language, which allows the local HSA to develop its own plan.
We further hope that Congress will give directives to the Department of
Health Education and Welfare which will permit the HSAs to develop their
plans in the best manner they deem necessary. With the tremendous
number of negative responses to the National Guidelines proposed in
September 1977, it is clear that the health care industry has gone on re-
cord to support health planning at the local level and not at the federal
agency level.

If the Certificate of Need law requirements under P. L. 93-641 are to achieve
the expected goal of reducing expensive duplication, the law must be
expanded to include all health care providers and the now-exempt federal
An equal opportunity employer

facilities, i.e., Veterans Hospitals and P.H.S. Hospitals. Currently federal facilities must be represented on HSA boards, but are not included under the law.

The task before our HSAs is formidable indeed. If they are to be at all successful in their endeavors, Congress must give them the authority or means by which to obtain adequate funds. The HSAS should be permitted, therefore, to seek funds from non-governmental sources.

We again welcome this opportunity to express our opinions to you for your consideration.

Red Lake Falls, MN 56750
February 1, 1978

FEB 6 1378

The Honorable Arlan Stangeland

House of Representatives
Washington, D. C. 20515

Dear Mr. Stangeland:

I am writing in regard to Public Law 99-641 which is currently in public hearing. I serve on the board of directors of an area health systems agency. In this capacity I have seen the need for rural HSAs to function as a means of controlling facilities and placement of health care. This letter is a request for increased minimum funding. It is interesting to note that a law has been enacted for HSAs, yet it is very difficult to receive the proper level of funding. With the large rural area that our HSA serves, the costs are significantly higher than in some of the metro areas because of distance in accessibility of areas, etc. Therefore, I would very much appreciate an increase in minimum funding if we are to have this kind of health systems agency concept.

I write to you both as a Board member of the Agassiz Health Systems
Agency and as a hospital administrator in the area concerned.

I ask you to consider imput into the hearings now being held on
PL 93-641 for increased minimum funding for HSA's. In addition

I ask that consideration be given to funding the Area Health Services
Development Fund - congressionally authorized but never funded.

My reasons are:

1. While all HSA's must perform the same functions, rural HSA's usually do not have the same funding capabilities as metro HSA's.

a. Last year Agassiz found it necessary to use $10,000 of
local funds; this year about $20,000 over minimum funding
and next year there will be little or none which means
a reduction in staff, already at minimum.

b.

Although I believe the law intended matching funds based
on population but we have not been able to apply for this
because of our population base (314,000 in 27,000 suare
miles).

Additionally it would seem appropriate to consider additional funding for bi or multiple state agencies because additional costs are incurred.

1.

2.

We have a large area to cover both for staff, Board and
Committees.

We must meet with SHPDA's in two states in order to arrive
at common development and implementation plans - no small
task with different viewpoints with which to contend.

In order for Agassiz and other rural HSA's to remain viable it is
imperative that:

1. Minimum HSA funding be increased to at least $225,000.

2.

3.

Some change be made to allowing matching funds based on a
different population formula.

Additional funding be made available for those HSA's which
cross state or regional lines.

Your serious consideration of these matters will be most appreciated.