PROPOSAL: INCREASE NUMBER & CAPACITY This discussion of rehabilitation facilities completes our presentation of the five major proposals of S. 2758. 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. Under 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 incomes of the States. With respect to the four categories of facilities covered by S. 2758, the bill provides that the Federal share may vary from one-half to two-thirds. In other words, the minimum Federal share would be one-half instead of one-third. In brief, Mr. Chairman, the proposals contained in the bill represent both a new 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 homes. They would also broaden the provisions of the present law with regard to rehabilitation facilities and diagnostic or treatment centers-which are now eligible 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 additional emphasis and inducement: (1) by specifically earmarking funds which can be used for no other purpose, and (2) by establishing a minimum Federal matching ratio of 50 percent in all States. With the one exception relating to Federal matching ratios, the administrative and fiscal provisions of this bill correspond with those in the present Hospital Survey and Construction Act-including the provisions relating to the allotment 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 under the Davis-Bacon Act for construction workers. Before concluding this statement it may be helpful to note, in summary form, the differences 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 identical, but there are a few points of difference: 1. The House bill includes a declaration of purpose patterned after the declaration in the present Hospital Survey and Construction Act. We believe the addition of such a declaration is desirable. 2. The Senate bill would establish a statutory minimum Federal share of 50 percent 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 would not make it mandatory. Thus, under the House bill, the States could elect 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. 3. With respect to eligible sponsors for the construction of diagnostic or treatment centers, the Senate bill would include any nonprofit sponsor, as well as public 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 the broader 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, "persons 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 hospital. The House bill also adds the words "or surgery" to the phrase "persons licensed to practice medicine.* * *" The objective of these changes, we understand, was to avoid possible conflicts with State licensure-law provisions, with particular respect to osteopathic physicians. We are in agreement with this objective, and some such modification of the Senate bill would appear desirable. 5. 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 cases-particularly with respect to rehabilitation facilities. It would therefore seem to be an appropriate amendment. 6. 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 operating on a nonprofit basis. The House bill contains no such limitation and would 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 number of administrative and legal difficulties. We would therefore strongly recommend 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 authorization or from the appropriate allotment under the new amendments. 46293-54-pt. 1-7 |