The Honorable Edward M. Kennedy

The Honorable Richard S. Schweiker
Page -2-

February 8, 1978

Our conclusions are also clear, and we hope that the Senate Subcommittee on Health and Scientific Research will be mindful of our situation in formulating its recommended revisions to Public Law 93-641. May I ask that:

1)

the functions of the SHCC be strengthened by granting the SHCC authority to oversee a sufficient portion of the SHPDA budget to be used for SHCC coordination; and,

2) the authority of the SHCC to approve the State Health Plan and State Medical Facilities Plan be maintained, and not be turned over to the Governors as proposed. In such event, the Governors would generally delegate that authority to the SHPDA.

These requests are urgent. If health planning is to be a function of citizen participation in decision-making, these requests must be met. Otherwise, the decision-making will remain in the hands of one special interest group in our state, the State Medical Association.

The spirit and intent of PL 93-641, to permit the consumers of health care to have a significant voice in the health decision-making process, was appropriate to address problems such as ours in Alabama. I cannot think of any greater example of the need for such a law as Alabama. For more than 100 years our health deícisions have been made by one small special interest group---the physicians. In 1971 the Legislature considered changes to the State Board of Health but only wound up adding four other health providers to the 12 physician-member State Board. This means that there are no females nor blacks nor lower income individuals represented on the agency which makes all of the important decisions in our state. Our SHCC is so ineffective and frustrated that we have failed to obtain quorums in two of the last three meetings. Members have difficulty identifying their purposes served in the process.

Thank you very much for the opportunity to present this information to you. The citizens involved in health planning in Alabama will appreciate your sensitivity to this matter as the Senate Subcommittee on Health and Scientific Research makes final considerations on the proposed amendments.

2.

Subcommittee on Health and Environment,
House Interstate and Foreign Commerce
Committee

Senate Subcommittee on Health and Scientific
Research, Committee of Human Resources

1.

2.

3.

4.

5.

REPRESENTING

The Governor of the State of Texas;

The Statewide Health Coordinating Council;
Texas Area 5 Health Systems Agency;

The Texas Bureau of State Health Planning and
Resource Development; and

The Texas Medical Association Council on Health
Planning.

I.

II.

Consideration of interaction of all health legislation as it affects Public Law 93-641 and 93-641 as it affects other health legislation.

(1) Since local and state health planning agencies are the only agencies authorized by the Act to deal with matters concerning health, it is evident they will be involved in the administration, planning, or implementation of most health legislation.

(2)

(3)

Although 93-641 provides no authorization for a
closure of any institution or decrease in its
services or deferment of payment for services
by cost reimbursers, for failure to conform to
National Guidelines, health systems plans and
state plans must conform to these guidelines.
If future legislation such as cost containment,
national health insurance, or regulation issued
affecting federal cost reimbursers, choose to
adopt quantitative guidelines issued by DHEW
under 93-641 as their standard, punitive authority
not intended under this Act could be invested in
other acts.

National Guidelines

(1)

(2)

(3)

National Guidelines issued January 18, 1978 are
a marked improvement over those previously issued.
These guidelines still require conformity to
quantitative standards although methods of
exceptions are outlined.

In many areas in Texas the number of exceptions
required would be greater than the number of
non-exceptions.

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(4)

(5)

State and health planning agency staffs would
be required to expend excessive amounts of
time documenting and defending exceptions.

It is easy to enforce conformity to guidelines,
but far more difficult to insure exceptions.

OBSTETRICAL SERVICES

(1) Most nonurban medium sized communities act as
Level II obstetrical units and do not deliver
1,500 birth per year. They maintain a high
standard and a cost effective operation. This
standard is not acceptable at level II.

NEONATAL SPECIAL CARE UNITS

Most nonurban level II units in Texas do not have 15 beds. They deliver a high standard cost effective service. This standard is not acceptable at level II.

RECOMMENDED AMENDMENT TO SECTION 1501. (b) (2). This
section should be amended to read:

a statement of national health planning goals
developed after consideration of the priorities,
set forth in Section 1502.

And delete:

...

which goals, to the maximum extent practicable, shall be expressed in quantitative terms.

The removal of the term quantitative would then allow local and state health planning agencies to develop their own quantitative standards without the necessity of defending exceptions from national standards.

ACCOUNTABILITY OF THE DEPARTMENT OF HEALTH, EDUCATION,
AND WELFARE

Accountability of DHEW and promulgating rules, and regulations and guidelines could be insured by several modalities.

(1)

(2)

(3)

Ratification of guidelines by the appropriate
committees of the House and Senate

Approval of the guidelines by the House and/or
Senate.

Ratification of guidelines with the state
legislators.

25-122 O 78 pt. 2 41

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(4) Approval of the guidelines by the governors
of the individual state.

III. COMPOSITION OF THE GOVERNING BOARD

(1) Broadly representative.

Congress should
for once and for all define the term
"broadly representative".

(a) This subcommittee has in the past
expressed that broadly representative"
does not mean proportional, and that
Congress has no intent to set quotas.

(b)

The Fifth Circuit Court of Appeals
on September 23, 1976 in the suit
Texas Acorn versus Texas Area 5
HSA, Joseph Califano, the Secretary
of DHEW, Floyd Norman, Regional Health
Administrator, made the following
specific points:

(1) "broadly representative" does not mean
proportional representation.

(2) Congress had no intent to set quotas.
(3) The setting of quotas might hinder the
implementation of the Act.

(4) One class may actually represent another
class although it is not a member of the
class which it represents.

CONGRESS AND HEW, should tract the decision of the Fifth
Circuit Court of Appeals.

IV. CAPITAL COST CONTAINMENT

(1) All factors causing the escalating cost of medical care should be considered.

(2)

(3)

This committee should specifically consider those factors relating to congressional acts and departmental regulation over which the local area has no control.

The method of cost reimbursers, of reimbursing institutions at less than cost, should be addressed. (4) Methods of encouraging ambulatory fee for service medical care should be addressed.

(a) All third party reimbursers should reimburse
for ambulatory care services.

(b) Consideration of issuing tax credits for
development of fee for service ambulatory