96th Congress > House > Vote 453
Description: TO AGREE TO THE CONFERENCE REPORT ON S. 544, HEALTH PLANNING. (MOTION PASSED)
Bill summary: (Conference report filed in House, H. Rept. 96-420)
Health Planning and Resources Development Amendments of 1979 - =Title I: Revision of Health Planning Authority= - Amends title XV of the Public Health Service Act (National Planning and Development) to direct the Secretary of Health, Education, and Welfare to review annually the national guidelines for health planning promulgated under such Act. Requires the Secretary to determine whether health care delivery systems are meeting the standards
(...show more)
and goals set forth in such guidelines and to publish periodically a summary of changes in resources needed to meet such goals. Stipulates that the authority to make such reviews and determinations does not authorize new budget authority before the beginning of fiscal year 1980. Directs health systems agencies (HSAs) and State health planning and development agencies (State Agencies) to provide such data as will enable the Secretary to carry out such duties.
Requires the Secretary to consult with certain entities at least 45 days before establishing or revising the guidelines. Requires that the guidelines include standards which reflect the unique circumstances and needs of medically underserved populations including isolated rural communities.
Adds to the list of subjects deserving priority consideration in the formulation of national health planning goals: (1) the discontinuance of duplicative or unneeded services and facilities; (2) the adoption of policies to contain the rising costs of health care delivery; (3) the improvement of mental health care, including eliminating of inappropriate placement of persons with mental health problems in institutions and emphasizing outpatient mental health services by assuring access to community mental health centers; and (4) the promotion of health services which recognize the psychological components of health maintenance; and (5) the development and use of cost saving technology.
Increases from 15 to 20 the membership of the National Council on Health Planning and Development. Increases from five to eight the minimum number of Council members who must be consumers, including members of urban and rural medically underserved populations. Requires that at least one voting member of the Council be an administrator of a private hospital.
Sets forth a finding that the prevailing methods of paying for health services, particularly inpatient services, have diminished the effect of competition on the decisions of providers respecting the supply of such services. States that the HSAs and State Agencies should perform their functions with regard to the extent to which competition appropriately allocates the supply of services.
Revises the procedures for the redesignation of health service area boundaries. Directs the Secretary to review such boundaries on his own initiative, or at the request of any Governor or health systems agency (HSA), and provides that they may be redesignated if the boundaries of the proposed health services area meet the current requirements in a significantly more appropriate manner. Provides that no proposed revision of a health service area shall comprise an entire State without the prior consent of the Governor.
Requires the Secretary to prescribe criteria for the revision of health services areas within one year of enactment. Eliminates the provision which gives priority for designation of health service areas which formerly had an areawide Comprehensive Health Planning Agency under previous health planning authority.
Revises the status of Puerto Rico for the purposes of the health planning program by bringing it under the special provision which allows the State Agency to perform the functions of the HSA.
Revises the procedures for the designation and termination of health systems agencies, including requiring the Secretary to: (1) give priority to an application for HSA designation which has been recommended by the Governor or the Statewide Health Coordinating Council (SHCC); (2) permit the appropriate State Agency to comment on the performance of an HSA before its designation is renewed; and (3) consult with the Governor and the SHCC before terminating an HSA's designation. Authorizes the Secretary, after consultation with the National Council on Health Planning and Development, to terminate a designation agreement with an HSA under certain circumstances. Allows the Secretary to return an HSA which has not performed satisfactorily to a conditionally designated status for up to one year.
Directs, rather than allows, the Secretary to provide technical assistance to entities which have the potential to become HSAs.
Increases the minimum planning grants to HSAs. Sets forth a per capita funding formula. Allows the Secretary to increase funding levels for certain extraordinary expenses. Permits grants which are unobligated in the fiscal year for which they were made to be used in the succeeding fiscal year.
Requires that HSA governing body members who are residents of the health service area: (1) include individuals representing the principal social, economic, linguistic, handicapped, and racial and geographic areas; and (2) be broadly representative of such area.
Permits providers whose principal place of business is in an HSA area to be members of such HSA's governing body. Adds "podiatrists", "physician assistants", "rehabilitation facilities", and "other providers of health care" as additional provider categories with respect to HSA governing body composition. Increases from one-third to one-half the proportion of the providers of health care who are members of the governing body or executive committee of an HSA who must be direct providers of health care.
Makes additional revisions in the composition of an HSA governing body, including that the membership consist of individuals knowledgeable about mental health services and representative of: (1) any qualified health maintenance organizations which may be in the health service area; and (2) the Veterans Administration if the area has at least one VA health care facility.
Eliminates the current provision that consumers on HSA governing bodies cannot have been health care providers within 12 months preceding appointment. Requires that subcommittees or advisory groups of HSA boards have a consumer majority. Revises the requirements for the membership of HSA governing bodies with respect to government representatives.
Redefines "provider of health care" to: (1) eliminate the category of an "indirect" provider; (2) stipulate that an individual shall not be considered a provider solely by being a member of a governing body of an entity engaged in health care research or instruction or drug production; and (3) raise the income test from one-tenth to one-fifth.
Directs each HSA to establish and make public a process for the selection of the members of its governing body and any subarea advisory councils, which assures: (1) selection in accordance with current composition requirements; and (2) the opportunity for broad participation of the residents of the health service area.
Requires such process to prohibit the selection of more than one-half of the members by other members of such body or councils.
Revises the responsibilities of an HSA which is a public regional planning body or local government unit with respect to its delegation of duties.
Extends the immunity from damages currently given HSA employees to the HSA itself, but excepts from such immunity bodily injuries and physical damages to property. Provides that no member, employee, consultant, or agent of a HSA or SHCC shall be personally liable for damages under any Federal or State law if such individual could have reasonably believed that he was acting in an official capacity and acted without gross negligence or malice.
Stipulates that an HSA which is a public regional planning body or unit of general local government shall be given a reasonable opportunity to comment on the health systems plan (HSP) of an HSA. Exempts from such stipulation an HSA which was designated and functioning on January 1, 1979, and which is a unit of general local government.
Prohibits the use of Federal funds by an HSA to pay an individual to lobby with respect to regulations or legislation at the Federal, State, or local levels, where the primary responsibility of such individual is to influence such governmental action.
Excepts from the current requirement that HSA governing body meetings be public, meetings dealing with HSA employees which, if public, would be an unwarranted invasion of such employee's privacy. Extends similar scope of protection to HSA personnel records and data and to employees of State health planning and development agencies.
Requires each HSA to have an identifiable program of providing assistance to the members of a governing body or other decision-making entity. Provides that at least one member of the HSA staff shall be responsible for assisting the members of the HSA governing body, particularly the consumer members. Authorizes HSA governing bodies to make advances to HSA members for reasonable expenses incurred in the performance of HSA duties.
Prohibits any member of a governing body of an HSA or any member of a SHCC from voting on any matter with which such member has any substantial ownership, employment, medical staff, fiduciary, contractual, creditor, or consultative relationship within the 12 months preceding such vote.
Requires HSA staff to have expertise in financial and economic analysis, disease prevention, and mental health resources.
Directs the SHCCs to establish in consultation with the HSAs and the State Agencies a uniform format for HSPs and AIPs.
Stipulates that the "healthful environment" which an HSA is directed in current law to describe in a detailed statement of goals shall be concerned primarily with health care equipment, health services provided by health care institutions, health care facilities, and other providers of health care and health resources.
Adds to the material to be included in the HSP goals for the delivery of mental health services.
Requires that each State Agency determine statewide health needs after consultation with appropriate State authorities and to refer the HSPs to such authorities (including the State mental health authority) for review and recommendations. Requires the State Agency to make public its reasons for not acting upon such recommendations.
Requires the HSP and the State health plan to describe specified institutional and non-institutional health services and the extent to which facilities and equipment need to be modernized, converted to new uses, constructed, or acquired. Requires the AIP to include a statement of changes in personnel, facilities, and other resources which are necessary to meet the HSA's objectives.
Changes the frequency of the HSA, State Agency, and SHCC reviews from annually to triennially.
Applies procedures for public comment on proposed HSPs of an HSA to the triennial review and amendment of HSPs. Requires that the same such procedures be used with respect to the AIPs.
Eliminates the requirement that the HSP of an HSA be consistent with the national guidelines issued by the Secretary, but requires the HSA to submit to the State Agency, the SHCC, and the Secretary a detailed statement of reasons for any inconsistencies between its HSP and AIP and such guidelines.
Authorizes the Governor of a State to disapprove the State health plan approved by the SHCC upon a determination that the plan does not effectively meet the statewide health needs determined by the State Agency.
Prohibits the Secretary from making any grant to a State Agency which does not have in effect a State health plan.
Directs, rather than allows, HSAs to provide technical assistance in obtaining and filling out necessary forms to applicants applying for projects to achieve the HSP.
Requires plans established under the Comprehensive Alcohol Abuse and Alcoholism Prevention, Treatment, and Rehabilitation Act of 1970 and the Drug Abuse Office and Treatment Act of 1972 to be consistent with the State health plan.
Revises the review functions of the SHCCs. Enumerates additional criteria for HSA, State Agency, and SHCC review.
Requires a State Agency to establish a period within which approval or disapproval of applications for certificates of need must be made. Allows an applicant to bring an action in a State court to enforce such requirement. Requires a certificate of need program to provide an administrative appeals mechanism for review of decisions of a State Agency not to issue a certificate. Provides for judicial review of a final decision rendered by a State Agency with respect to a certificate of need, and requires affirmance of the Agency's decision unless it is arbitrary, capricious, or was not made in conformity with applicable law. Prohibits ex parte contracts between an applicant for a certificate and any person in the State Agency with responsibility respecting such application after the hearing on the application commences.
Specifies the requirements of the certificate of need program administered by a State Agency. Applies such program to major medical equipment, institutional health services, and capital expenditures. Stipulates that the issuance of a certificate of need may not be made subject to any condition not directly related to specified criteria, including criteria prescribed by the State Agency in accordance with State law. Authorizes a State Agency to withdraw a certificate under certain circumstances. Requires each decision to issue a certificate of need to be consistent with the State health plan except in emergency circumstances posing a threat to public health.
Exempts from the certificate of need program the offering of an inpatient institutional health service, the acquisition of major medical equipment, or the obligation of a capital expenditure for the provision of an inpatient institutional health service by: (1) a health maintenance organization or a combination of HMOs; (2) a health care facility which primarily provides inpatient services and is controlled by an HMO; or (3) a health care facility which an HMO has leased for a period of at least 15 years.
Exempts from such program the acquisition of major medical equipment which will not be owned by or located in a health care facility unless: (1) a notice requirement is not met; or (2) the State Agency finds that the equipment will be used to provide inpatient services. Allows a State program to require certificates for such acquisitions until September 30, 1982.
Requires the issuance of a certificate of need for a capital expenditure to the extent that it is required to prevent safety hazards or to comply with State licensure or accreditation standards.
Requires a certificate of need program to provide for enforcement procedures and penalties.
Defines "capital expenditure" and "major medical equipment" for purposes of the certificate of need program.
Directs the Comptroller General to evaluate the exemption provisions of the certificate of need program and to report the results to the appropriate congressional committees by February 1, 1982.
Directs the Secretary to promulgate regulations to enable State to establish certificate of need programs meeting the requirements of this Act within 180 days of enactment.
Requires an HSA and State Agency to conduct an appropriateness review of institutional and home health services which are offered in the area or State and with respect to which goals have been established in the State health plan (instead of "all" institutional services as currently provided). Requires an HSA in making the appropriateness review to consider the need for the service, its accessibility, availability, quality, financial viability, and cost effectiveness.
Establishes procedures which allow the Governor of a State to review an HSA decision disapproving a proposed use of Federal funds, and to authorize such use after considering any comments by the State Agency.
Requires each HSA to coordinate its activities with any State entity which reviews rates and budgets of health care facilities. Requires HSAs located within the same standard metropolitan statistical area to coordinate their activities.
Provides for Indian self-determination with respect to health planning.
Requires each HSA to collect annually and make public the rates charged for the 25 most frequently used hospital services in the State. Requires that the State administrative program assure compliance with requests for information made by an HSA in carrying out such function.
Extends from one to three years the period of the designation and redesignation of a State Agency.
Permits the HSA and SHCC to comment on the performance of a State Agency before its designation is renewed. Authorizes the Secretary, after consultation with the National Council on Health Planning and Development, to terminate a designation agreement with a State Agency under certain circumstances. Allows the Secretary to return an HSA which has not performed satisfactorily to a conditionally designated status for up to one year.
Adds to the functions of a State Agency the preparation of an inventory of medical facilities located in the State and an evaluation of their physical condition. Eliminates the requirement that an HSA make separate recommendations to the State on medical facility projects for modernization and construction.
Reduces by 25 percent per year for each year in which a State has not designated a State Agency, the amount of any allotment, grant, loan, or loan guarantee which has been committed to the State under this Act, the Community Mental Health Centers Act, or the Comprehensive Alcohol Abuse and Alcoholism Prevention, Treatment, and Rehabilitation Act of 1970 for the development of health resources, such reduction to become effective upon the expiration of a specified period.
Requires a State Agency to provide technical assistance in obtaining and filling out the necessary forms to individuals and public and private entities for the development of projects and programs.
Authorizes the Secretary to extend the conditional designation of a State Agency for an additional period (beyond the current 36 month limit) upon a finding that the Agency is making a good faith effort to comply with its statutory requirements.
Revises the composition of the SHCCs. Authorizes the Governor to select the chairman of the SHCC with approval of the appropriate State legislative body. Increases from one-third to one-half the proportion of members of the SHCC who must be direct providers of health. Provides for ex officio representation of the Veterans' Administration on the SHCC when the State has at least one VA facility, instead of two facilities as currently provided. Requires members of the SHCC who are consumers to include individuals from rural and urban medically underserved populations which exist in the State. Provides for proportional representation of interstate HSAs on the SHCC.
Adds to the functions of the Centers for Health Planning the dissemination of education methodologies to HSAs and State Agencies.
Redefines "institutional health service" for the purpose of the Act. Defines "rehabilitation facility" and "medically underserved population" and stipulates that any reference to "health" includes physical and mental health.
Extends through fiscal year 1982 authorizations for: (1) planning grants; (2) State health planning and development; (3) rate regulation; (4) centers for health planning; and (5) area health services development funds.
Amends title XIX of the Social Security Act (Medicaid) to allow an HMO three years from the time it is qualified to meet the requirement that at least 50 percent of its enrolled population be made up of other than Medicare and Medicaid recipients.
=Title II: Revision of Authority for Health Resources Development= - Amends title XVI of the Public Health Service Act (Health Resources Development) to repeal the part which provides allotment grants to States for facility construction and sets forth requirements for the State medical facilities plan.
Authorizes the Secretary of Health, Education, and Welfare to make loans through fiscal year 1982 for: (1) the discontinuance of unneeded hospital services or facilities; (2) the conversion of existing facilities to needed health services and facilities, including outpatient and long term facilities; (3) the modernization of medical facilities; (4) the construction of new outpatient facilities; and (5) the construction of new inpatient facilities in areas experiencing rapid population growth.
Provides that the Secretary may pay the holder of a loan an amount sufficient to reduce by not more than one-half the net effective interest rate if the loan is located in an urban or rural poverty area.
Authorizes the Secretary to guarantee through fiscal year 1982 the payment of principal and interest to: (1) non-Federal lenders for their loans to public and nonprofit private entities for medical facilities projects; and (2) the Federal Financing Bank for loans to public and nonprofit private entities for such projects.
Authorizes the Secretary to make grants for construction or modernization projects designed to: (1) eliminate or prevent imminent safety hazards; or (2) avoid noncompliance with State or voluntary licensure or accreditation standards, with respect to medical facilities owned or operated by public entities or private nonprofit entities which can demonstrate that they serve their community in a capacity similar to that of a public hospital.
Authorizes the Secretary to make grants in fiscal years 1981 and 1982 for projects for: (1) construction of outpatient medical facilities providing services for medically underserved populations; and (2) conversion of existing medical facilities to provide such services.
=Title III: Program to Assist and Encourage the Discontinuance of Unneeded Hospital Services= - Amends title XVI of the Public Health Service Act (Health Resources Development) to direct the Secretary of Health, Education, and Welfare to establish a new program for providing grants and technical assistance to assist and encourage hospitals to discontinue the provision of unneeded hospital services, including the provision of debt, incentive, and conversion payments for the discontinuance of all inpatient health services or an identifiable part of a hospital which provides inpatient services.
Requires a hospital's application to include reasonable assurance that all laborers and laborers and mechanics employed by contractors or subcontractors will be paid wages at rates in accordance with the Davis-Bacon Act.
Requires an HSA or State Agency, in determining the need for any service proposed to be discontinued or converted by an applicant, to give special consideration to the unmet needs and existing access patterns of urban or rural poverty populations.
Directs the Secretary of Labor to prescribe guidelines for the protection of employees affected by the discontinuance of such services.
Authorizes the Secretary to make grants to State Agencies (not to exceed 10 percent of the authorizations for this program) for specified activities for the purpose of demonstrating the effectiveness of various means for reducing excess hospital capacity.
Directs the Secretary to study the effect of such program on the elimination of unneeded hospital services and to report the results to Congress by January 1, 1982.
Click to hide full description.
Bill titles: An act to amend titles XV and XVI of the Public Health Service Act to revise and extend the authorities and requirements under those titles for health planning and health resources development, and for other purposes.; A bill to amend titles XV and XVI of the Public Health Service Act to revise and extend the authorities and requirements under those titles for health planning and health resources development.
Original source documents: Digest of the Congressional Record vol. 122, p. 8236;
Links for more info on the vote: congress.gov
