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PROPOSAL: INCREASE NUMBER & CAPACITY
OF COMPREHENSIVE REHABILITATION FACILITIES

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$ i OM, LUOV FECIL "LEJA

8 MILLI STATE S. LA FUNDS

$18 MILLION I

This diskussion of rehabilitation facilities completes our presentation of the five major proposals of S. 27ăn. In addition to these major proposals, the bill includes another provision designed to stimulate State and local action in constructing chronic hospitals, nursing homes, diagnostic or treatment facilities, and rehabilitation facilities. I'nder the present act the Federal share of individual projects may vary from one third to two-thirds of the total construction cost, in accordance wtih a matching formula keyed to the relative per capita

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homes of the States. With respect to the four categories of facilities covered

358, the bill provides that the Federal share may vary from one-half to to-thirds. In other words, the minimum Federal share would be one-half Estad of one-third.

la brief, Mr. Chairman, the proposals contained in the bill represent both a in emphasis and a broadening of the scope of the present act. They would add to the present act one entirely new category-nursing and convalescent boes. They would also broaden the provisions of the present law with regard W reabilitation facilities and diagnostic or treatment centers--which are now endie for Federal funds only if they are parts of hospitals. For each of these ypes of facilities, as well as for chronic hospitals, the bill would provide additrial emphasis and inducement: (1) by specifically earmarking funds which an be used for no other purpose, and (2) by establishing a minimum Federal Gatching ratio of 50 percent in all States.

With the one exception relating to Federal matching ratios, the administra-
it and fiscal provisions of this bill correspond with those in the present
Bspital Survey and Construction Act—including the provisions relating to the
ument formula ; the role of the State agency; the procedures for submission
301 upproval of construction grant applications; appeals to the Surgeon General
and the Federal Hospital Council; and the applicability of minimum-wage rates
uter the Lavis-Bacon Act for construction workers.

Before concluding this statement it may be helpful to note, in summary form,
e diferences between S. 2758 and the bill passed by the House, H. R. 8149.
As far as approach, scope, and major content are concerned, the two bills are
Hentical, but there are a few points of difference:

1. Tb- House bill includes a declaration of purpose patterned after the declara-
tios in the present Hospital Survey and Construction Act. We believe the addi-
txo of such a declaration is desirable.

2 The Senate bill would establish a statutory minimum Federal share of 50 xment of construction costs for all projects in the categories covered by the bill. The House bill would authorize such a minimum, at the option of the States, but sool1 tot make it mandatory. Thus, under the House bill, the States could het 1 of 3 matching alternatives—either of the 2 options provided in the Present law, or the new 50 percent provision. We would have no objection to this amendment.

With respect to eligible sponsors for the construction of diagnostic or treatDent centers, the Senate bill would include any nonprofit sponsor, as well as utile sponsor. The House bill would limit eligibility to a public body or, in tbe up of a nonprofit sponsor, to one owning a nonprofit hospital. We believe the brader eligibility provision of the Senate bill is preferable. 4. The Senate bill requires that medical and related health services in the facilities covered by the bill must be prescribed by, or under the supervision of, Tersons licensed to practice medicine in the State.” The House bill modifies this requirement by applying it only to facilities which are not connected with a bospital. The House bill also adds the words "or surgery" to the phrase porains licensed to practice medicine.* • *" The objective of these changes, we understand, was to avoid possible coniets with state licensure-law provisions, with particular respect to osteopathic physicians. We are in agreement with this objective, and some such modificatop of the Senate bill would appear desirable.

3. The House bill contains a provision permitting two or more States to pool funds from their several allotments for the construction of facilities which will operate on an interstate basis. This provision could well be useful in some 2003 particularly with respect to rehabilitation facilities. It would therefore seem to be an appropriate amendment.

The Senate bill adopts the same 20-year limit provided in the present act with respect to recovery of Federal funds in the case of facilities no longer qarating on a nonprofit basis. The House bill contains no such limitation and soain delete the 20-year limit from the present act. We believe that this indefinite extension of the recovery authority is not needed and might give rise to a dumber of administrative and legal difficulties. We would therefore strongly recommend retention of the 20-year limit in the Senate bill. 1. The Senate bill contains a provision, not included in the House bill, relating to projects which are eligible under both the existing law and one of the new categories. This provision would permit payments for such projects to be made, at the discretion of the States, either from allotments under the existing authorsation or from the appropriate allotment under the new amendments.

46293-54-pt. 1

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T

FACILITIES REQUIRED
FOR PRESIDENT'S VOC. REHAB. RECOMMENDATIONS

1959 GOAL

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* 5 TIMES PRESENT TOTAL

US CAPACITY

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PROPOSAL: INCREASE NUMBER & CAPACITY
OF COMPREHENSIVE REHABILITATION FACILITIES

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1

This discussion of rehabilitation facilities completes our presentation of the five major proposals of s. 275. In addition to these major proposals, the bill includes another provision designed to stimulate State and local action in constructing chronic hospitals, nurning homes, diagnostic or treatment facilities, and rehabilitation facilities, Inder the present act the Federal share of individual projects may vary from one-third to two-thirds of the total construction cost, in accordance wtih a matehing formula keyed to the relative per capita

2

becomes of the States. With respect to the four categories of facilities covered 18. 275$ the bill provides that the Federal share may vary from one-half to, wo-thirds. In other words, the minimum Federal share would be one-half stead of one-third.

la brief, Mr. Chairman, the proposals contained in the bill represent both a x eliphasis and a broadening of the scope of the present act. They would ed to the present act one entirely new category-nursing and convalescent So They would also broaden the provisions of the present law with regard tordabilitation facilities and diagnostic or treatment centers—which are now dnble for Federal funds only if they are parts of hospitals. For each of these types of facilities, as well as for chronic hospitals, the bill would provide additrual emphasis and inducement: (1) by specifically earmarking funds which to be used for no other purpose, and (2) by establishing a minimum Federal ishing ratio of 50 percent in all States.

With the obe exception relating to Federal matching ratios, the administratif and fiscal provisions of this bill correspond with those in the present Hspital Survey and Construction Act-including the provisions relating to the

a fent formula; the role of the State agency; the procedures for submission and approval of construction grant applications; appeals to the Surgeon General and the Federal Hospital Council; and the applicability of minimum-wage rates Borbe Tavis-Bacon Act for construction workers.

Beure concluding this statement it may be helpful to note, in summary form, the lingerences between S. 2758 and the bill passed by the House, H. R. 8149. As far as approach, scope, and major content are concerned, the two bills are betical, but there are a few points of difference:

1. The House bill includes a declaration of purpose patterned after the declaratop in the present Hospital Survey and Construction Act. We believe the addiLos of such a declaration is desirable.

2 The Senate bill would establish a statutory minimum Federal share of 50 Ferrant of construction costs for all projects in the categories covered by the bill. The House bill would authorize such a minimum, at the option of the States, but Frald not make it mandatory. Thus, under the House bill, the States could skett 1 of 3 matching alternatives-either of the 2 options provided in the stesent law, or the new 50 percent provision. We would have no objection to this amendment

3 With respect to eligible sponsors for the construction of diagnostic or treatDent centers, the Senate bill would include any nonprofit sponsor, as well as publie sponsor. The House bill would limit eligibility to a public body or, in the case of a nonprofit sponsor, to one owning a nonprofit hospital. We believe Do broader eligibility provision of the Senate bill is preferable.

1. The Senate bill requires that medical and related health services in the Syllites covered by the bill must be prescribed by, or under the supervision of,

teons licensed to practice medicine in the State.” The House bill modifies this requirement by applying it only to facilities which are not connected with a bospital. The House bill also adds the words "or surgery" to the phrase bersons licensed to practice medicine.* • *" The objective of these changes, we understand, was to avoid possible con ficts with State licensure-law provisions, with particular respect to osteopathic physicians We are in agreement with this objective, and some such modificaOta of the Senate bill would appear desirable.

& The House bill contains a provision permitting two or more States to pool frads from their several allotments for the construction of facilities which will operate on an interstate basis. This provision could well be useful in some

en particularly with respect to rehabilitation facilities. It would therefore etto to be an appropriate amendment.

& The Senate bill adopts the same 20-year limit provided in the present act Tith respect to recovery of Federal funds in the case of facilities no longer perating on a nonprofit basis. The House bill contains no such limitation and wald delete the 20-year limit from the present act. We believe that this inedinite extension of the recovery authority is not needed and might give rise to a bomber of administrative and legal difficulties. We would therefore strongly Teromoeod retention of the 20-year limit in the Senate bill.

7. The Senate bill contains a provision, not included in the House bill, relating to projects which are eligible under both the existing law and one of the new categories

. This provision would permit payments for such projects to be made, at the discretion of the States, either from allotments under the existing authorluation or from the appropriate allotment under the new amendments.

40292-64--pt.17

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