ASSOCIATION 151 CAPITOL STREET AUGUSTA, MAINE 04330 • 207-622-479

The following is in response to the Commo-Net call of February 28 involving states with only one HSA. Let me say, initially, that I found the call to be helpful although I have to admit to some concern about the general lack of concern I perceived about single HSA's among the participants.

Perhaps our present situation here in Maine is unique in terms of the
none-too-subtle conflict between the SHPDA, which rests in our State
Department of Human Services, and the HSA, which is an independent entity.
However, on the surface (and even below it) there are serious questions
about the need and appropriateness of two agencies serving the same area
and population gearing to perform essentially identical services. And
at a projected total cost to the tax payer for next year of about one
million dollars!

I recognize, as you do in your recommendation appearing on page 4 of the "Policy Issues Pertaining to Single HSA States" document, that there is a perceived need for so-called "checks and balances" within the planning framework. Apparently this is a major rationale for both an HSA and SHPDA to retain a "two-tier planning framework."

It must be noted, however, that checks and balances in the classical
(Constitutional) sense relates to activities within the same levels of
government. In Maine, at least, we are dealing with planning at two
levels of government: state, in the form of the SHPDA and federal with
the HSA. One responds to the governor and the other to the Secretary of
HEW. And I say this fully cognizant of such poetic phrases as "local
community input," "the needs of the consumer, " and "community based
planning."

In terms of AHA's possible recommendations for modifications to P.L. 93-641 (or the Regulations), we feel at the very least a strong push should be made for spelling out unequivocally the relationship between SHPDA's and HSA's. In this context it should be made clear who, in fact, is "boss," and what exactly is meant by "in consultation with" - and numerous other such phrases with which the law and regs are replete. No organization, system or framework can function with two chiefs. And I state that unequivocally!

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Another approach which we would suggest the AHA explore is the liberalization of the examptions allowed under Section 1536. This would, of course, allow the chief executives of each state which qualifies to address the issue, if one exists in his/her state, in another manner. Call it "local initiative?"

The foregoing then, Mike, are some of my thoughts. We'll continue to address the HSA/SHPDA situation in Maine in what we feel to be an appropriate manner. If you have any suggestions or if we might be of assistance to you, please don't hesitate to contact me.

My regards to Steve and Carol.

Sincerely,

Grant Heggie, Jr.

Vice President

CC/ Fletcher H. Bingham, Ph.D.

S. Portnoy

C. Lively

T. Brook

(MAINE)

STATE HEALTH COORDINATING

COUNCIL

The (Maine) State Health Coordinating Council has taken
a position recently on renewal of the national health planning
law, P.L. 93-641. Thirteen states and territories with single
statewide HSA's face the difficult task of implementing a law
which does not seem to provide for single statewide area
designations. As one of the most active Statewide Health
Coordinating Councils in states with single statewide Health
Systems Agencies, the (M)SHCC has already confronted many issues
which Congress could deal with effectively through amendments
in the existing law.

At a meeting on February 1, 1978, the (Maine) State Health
Coordinating Council passed resolutions which address the problem
of SHCC's in single agency states. These four resolutions are
attached with suggested changes in the specific language of
P.L. 93-641 in regard to resolutions two and three.

We would ask that this letter and its attachments be entered
in the record of testimony before the Subcommittee on Health and
Scientific Research of the Senate Committee on Human Resources.
Representatives of the Council would be happy to meet with you,
members of your staff, or your colleagues in the Senate and the
House, to share our proposals for strengthening national health
planning legislation.

Sincerely,

Melrose

John Melrose, Chairman
(Maine) State Health
Coordinating Council

JM/AK:bvm
Enclosures

Resolutions of the (Maine) State Health Coordinating Council
February 1, 1978

"That the (Maine) State Health Coordinating Council strongly supports renewal of the National Health Planning and Resources Development Act of 1974 in a form which will ensure that it remains an effective vehicle for health planning and for the provision of quality health care at the lowest possible cost.

However, the (Maine) State Health Coordinating Council wants to strongly emphasize the need for structural changes in the law to address problems facing states with single statewide HSA's."

2. Composition of the State Health Coordinating Council.

3.

"That, in states with single statewide HSA's, the number of persons which the Governor may appoint directly to the Statewide Health Coordinating Council may not exceed 60 per centum of the total membership. The representative of the Veterans Administration shall serve as a full voting member on the Council. He shall not be involved, however, in calculation of the Council's composition."

The Status of the HSA Annual Implementation Plan.

"That, in states with single statewide HSA's, the AIP

shall be submitted to the Statewide Health Coordinating Council
for its approval or disapproval prior to its becoming an operative
document. We recommend that this amendment also be made applicable
to states with multiple HSA's."

4. Disputes between the State Agency and Health Systems Agency.

"The (Maine) State Health Coordinating Council expresses its opposition to becoming an arbitrating body between the HSA and SHPDA beyond its already existing statutory responsibility."

25-122 O 78 pt. 2 26

Amendments to P.L. 93-641 recommended by the
(Maine) State Health Coordinating Council

Composition of the State Health Coordinating Council

Section 1524 (b)(1)(B)(i) is amended to read:

"(i) The number of persons appointed to the SHCC under this subparagraph may not exceed 40 per centum of the total membership of the SHCC, unless there is only a single health systems agency designated under section 1515 within the state in which case such number may not exceed 60 per centum of the total membership of the SHCC, and..."

Section 1524 (c)(i) is amended by inserting "and approve or disapprove the AIP" after "coordinate the HSP and AIP."