#EO0OL1A* ae JACKI® & KEN EBA. U nO {i769 VIGRS MILL RG SILVER SPRING, MARYLAND 20902 LEGISIATIVE HISTORY ON THE PASSAGE OF THE HOSPITAL SURVEY AND SONSTRUCTION ACT, PUBLIC LAT 725, 79TH CONGRESS ae! : \ PEDERAL SECURITY AGENCY a Do ee rote | , ° Public Health Service ~ JULy39W8 so Division of Hospital Facilities nn a8 aw “Aw AT ORT AS oop afro ast ae Op SfMenst we ahd a ee WS Re O33. PART B - SURVEY AnD PLANNING 8 611 Appropriation authorization OL ws $ 612 (a) Applications for Funds _ . § 612 (a) (1) Single State Agency 21: § 612 (a) (2) Advisory Council 12. 8 612-(a) (3): Inventory 13 - $ 612 (a) (4) Reports and Records - /14b 8 012 (b). Approval by Surgeon General “16. ye oes feet Allotments to States Se LOL Ts 5 fol. ~ Appropriation guthorization ee 18-20" : 8.622". ° Promulgation of regulations =: oe 8 622 (a): Number of General Beds Required : : 23-25. & 622. (d) Number of tuberculosis, mental =... ce and chronic beds required Se 26-28 § 622 (c). Number of public healta centers Lil required . 29~30 8 622 (d) Priority) = 0 31-36 oe: (e) Construction standards =~ 37~38 jy, Diderimination (1)! Racé, Color; or "Creed — 39— HL *. (2) Indigent Care. pe Bea “Administratio | Wethoas. of Authority ‘of ‘State ‘Agency . pderd sory” Council - ag te, BB, “ Gonstruction program — ae Relative need 53-55 Methods of Administration 56-57 Standards of Maintenance and Operation 5E-59 Fair Hearing Reports. and Records } . Review of. Plan. ght O88 "Approval. of plans. wis Changes —. two years.§ 5°. Requirements: for Maintenance and - operation legislation ve Allotments to States, . : Ta.’ Extent of Federal Porticipatioa It. Determination of: State? ge Allotment lit. Availability of Allotment 69.70 “ Iv. State Matching of Federal Funds 7O~7L VY. Allotments for Administrative axvenses 71 3 025 8a sporeval or Projects Te 1. General. 73 IT. Maintenance and Operation ~- -— Th rooy¢ o and Cert a § 625 (cy . ‘Amendments to Construction Application BI: § 625 (4) Limitation on use of funds g2-84 8 625 (e) 20-Year use requirement 85 PART D - MISCELLANEOUS 8 631 Definitions 8 631 (a) Allotment percentage 86-87 § 631 (bd) Promulgation of allotment percentage - 88 8 631 (c) Population 9... 89 § 631 (4) State gO: § 632 Ce) Hospital — $ 631 (£) Public Health Center| ~ £631 (a) - Nonprofit. Hospital § 631° €hy °° ~ Construction” ; § 631 (i) Cost of Gangstruction . § 632 (a) Withholding of Certification 101-102 8 632 (bd) (1) Judicial Appeal / 103-104 § 632 (b}(2)(3) Finding of Fact 105 633 (a) Administrative Regulations 106 § 633 (bd) Federal Hospital Council 107 ; cote 3s Composition of. Council 208-109 | % s Fanatdone 8 the Council noes 09-110, sa tavedss nace tener Bott #6 ESRC aie a tate es whee IRS thn i Ng PAE Ge ate ocak a aaa SS “Aas caddy Hv tami ate oral BBN oe at ae BANE IO Wie Mate 1 canbe Mate nia LAL aR AM SPS EK i ae, EE tA ed OEE ee Be Bibliography Interim Revort From the Subcommittee on Wartime Health and Education to The Committee on Education and Labor jae 7, 73th Jongreas, 2ad Sagsicn, - uc, S. Senate, Subcommittee Revort wt Senate Report No. 674 o on S. 191, ‘October 30, “agus. Senate Bill 191, October 30, 1945. Letter from President Truman to the Chairman of the House Committee on ee and Foreign Sommen¢es January 3 igh enate Committee Print’ No’. _Eabor, U. Se 3, Revort -to: the Committee or’ Education and Senate, 79th Congress, 2nd Session, March, 1946. Hear ngs Before A Subcommittee. of the Committee on Interstate and. _ Foreign Commerce on S. 191, House of 3 Representatives, 79th Congress ’ and Session, March, 1946. . cate Co ° “House Report Yo. 2519 on S. 191, salty 13, 1 “19u6. LS tigate I EERE ee abit a ee a Rm Ter eh eh cee ane Te me nance aD Maetenet anna eee Re et EM a enteme eet k e ae A ee eos al, patter cal Lysouorion. a Newt ; . . 3 : . . The 2resident and verious membe: “s some - thought to the este iees of 4 “Ped Cc a tO _ 3 er oy: + . oO 2 be TA and thinking in the Public Health Servi fA TA ev or 2942. Ae civugion.ci Nontital saci 8 Seetion. oY the Stases. nelations Jivisic nj ‘initiated anit of establi ishing. the policies: and. srocedures. eon to the Postvar brief statement b Vv 8 poet 1944, the “Public Health Service subri Planning Committee of the American Hospital Associ Letio g setting forth the major characterictics of the »srovosei hospital survey snd construction srogran. In }-ay 1944, &@ similar submission was mace to the Subcomnittee on Fedical. Care of the Sormibttee on kaministrative Practice oF ane American Public Health essoGiation=" ae we ere” 3 cr @ fu tenedve! o reaeeal eeaevae veys to. ‘determine Ho: she and: health Pistlity neéds,” “th devaloning ‘Statevide ‘construction SORTA , and in: er tde, prouran. 27 oars, Tound. necegsar nd in, conforril rownh: Senteniver, 1944, 4 number ‘of national orgénize- ‘tions, “including ‘the. American Hoss itel association, the arericen iedical i. -. £ssocietion,. as ell. as farm, iebor, and other groucs, endorsed the urgent -_ need for hospital and health center fee: lities end the need for Yedéral | assistance to sumriy those Pacilitie stee in its interin _ report 2 recommended that Federal er anis-in-aid to States be authorized to assist, an postar constructi ion of hospitals, 1 necacat centers end b niers | vo rat . D a ia st cr cas G 3 BY i : OU: BT? bor @ ‘Session (1945) (Referred "to hérein as. S wei chee weiner hal Sing toes! fae Ske ted ak rebate KEE AE ome acca Sede ate ss pce RSM NE ited le RNIB WT art eit dar Te nem . \ Tn hey version of the agnersi Urey -yingell siil wes introduced, 3ich tor the f tare erbo" ‘ied orovisions fom the construction of hospital enc nealth cent . in vie. of the (vu estion betveen the Hill- urton 5il. 2a as cortion 72 whe L upeor-cingell. oils. Lnerea ofe Tome uueso.con “Ss “9 -hether che saucetion and Lacor Jommitcee 7 OULG LAers i seport. ‘S.. 194 tavorebly. cn. Sejtenber ld, 1945, @ subcommittee .as appointed to study! S.2 “sugges td nse which: had been meade during, the: / cublie hearing nic exséerts’ from: Public’ Health: © ey. “the American Hospital " Resocietion, and ‘the Social Security ‘Board, : “this sub-- e committee revrote the bili 50-25 ta clevizy several crovisions in the bill ang to clarify the civision of ressonsibility cet.een the Surgeon Generel and the Federal Hosot ‘tal Council, on the one henc, and on the other, between the Federal Government inc the States. On Ccteber 30, 1945, the Senate Ecucation and Labor Committee resor tec ew S, 191 favorably. 4/ This resort included a minority report by the Commitcee Chairman, Senator hurray % me had agreed, with reservations, to re porting the bill, faverably. .. Senator :: urray objected. to three feetures of. the bill: a “(1)> The’ ‘assignment: ‘or adminis tre tive HOwerE. ‘to. a oart House, rais ing the flat grant. from 33 1/3 to 40: and changin 7 vi- esresentation on the Feceral Hossital Council. from. back sncean DRE LES : t bo “adjourn, a qnoru in favor of the conterence rerort. page tone geb passed: b " . on fugust “33, 198; Be egite ent Trumen signed ©. 191, objecting to the Meg tvo orovisions cited in his letter of Jemusry 31, nemely siministretive orers “ - of the Federal Hosnitsal Council anil court vrevier. ©. i9] becnme Public Lar 725, 79th Congress. ees Conference Bevort, Zouse of. 2nd: Session, (194 8) (Herein sae beatae Me ie I one hate ve AS ae aa me Sai we ER kd et aidlie S eae We aon otwet roee E fn fet To amend the Public Health Service Act to authorize grants to the States for surveying their hosoihals ee OE ited es the "Hos vitrl Survey » of ‘bhe bb ‘of duly hy 19L4, thereof tne toliowing ne. Eitle: metry ue - ives Lom OTT Toe o if Cr Ts : " adit V pe COHO PE! STiCw Ca TRUE Paula “the States ‘carrying “out: ‘such ” a ctgane ne Coan ttes ‘believes - that's fedeteleia™ Po progran of ‘the. character seb: forth in the renorted Sill, which sil supplement. és cons stru uct State and locai funds for’ lanning and cerrying out cut will at the seme time onourave the Stetes to hesure for carrying out the »orogram to the greatest &@ proper check unon expenditure of fecersi a. effective in a jong-range; hosojtel construction »rogram! worrdations,. are fact thet, vithout exce: tion, 211 these witnesses, ‘revresenting 2 y SHoKke - in. favor of the, objectives.in this bill. wis elion, if ever, have T. seen so large 4 groun’ of” tivergen’ talks. of Life so mich ok one ving on any. this, unanimity or Op UNS On Fas, extraors SAME ye: ve Steel? extraordinary. t ENeSSES : ‘from sd, ridely < mae ‘not Sontroversicl.m' Senator Semmston ’o ‘on ‘the’ Committee Print #3, o. SL. “Poor ae the ain December 10, 1945, S. A oe AMaGtr ak gy om: Le DAMS Las 1e bili are containe? in numerous “laces enate Yeprings veges 1O1l, 119, 125, in the hearings, nerticulearliy i 166, 197, 201, 227, 228, 256. 257, 240, 318, 344° Youse Hesrings 3 = ~ a Statements in sunsort of th inc “ag 7A so - 7 ~ 30, oT 33, 136, Lud aU y aL is LS, nae} wip gy meg be a co y.2 “The: American Hosoital agsootaticn : nd. its members have given, much... consideration to ne need. af: batter, 44 distri butior of. host it : ces whic ac t thet this program’. univeraily recognizedas' tha finest in the vorld: ‘We fee for the careful expangion of facilities for rendering that care merits your careful and earnest consideretion. As a°first steno in the improvement of the distribution of hosnital and medicel cere, ve urge the vrompt and favorable action by this committee on the Hospital Survey and Construction Act as nassec by the Senate." House Hearings, nage "The pmerican Wedical Association oelieves that the program crovide S. 191, as passed by the Senate, wromises to contribute to immroved hospi a and medical care in this country, encorses the bill strongly, and offers _ every: assistance in: carrying: ‘out. the Provisions of the measure y: shoulda. the ~ become a Houge Hearings, p « HOA, : sO oe hie ae & - Statements in. opposition to the pill may be found in Senate Hearings | pages y- 266, . 3135" House Heerings: seges. 167, 224,238. The only serious... epposition was made by Congreseman Cannon, testifying as Chairman of the House Appropriations Committee. ‘The objection raiged was thet the Feceral Government was not in @ position to esgume additional financial obligetions enc that the States and local governments could better finance the crogranm. 4. Hearings, nege 167. 1042; 12 ue8 a Ley . 8 001 ‘ sae sme we oo te stevéy the ne ed for construction of “hos SOL itais, to develon vrogrems for construction of such : \ 5 ody un public % and other non profit hospitals: facilit ities, a TS _ C3) to construct public c.end oth ner non dprorit : “ . = ep gO tte : 7 ae - s : : Le . . : Fy . : hnospita als in scecorjance vith such vrograms."| ditional hospite no programs for the « construction of such public and other non profit Yosvitals as will, in conjunetion sith existing facilities, afford , td Say 3 ~ s the necessary physical facil ities For furnishing adequate hospitel, eed clinic, and | similar. serv rice all f, the 76 eonle, and. second. E * leat SE ak aE 2 Sean Apa eeaiie eh eee ia ta ein aa: Si ade ate Sate OE celle SE Tae Ee a 601 Congressmen Harris: In studying chis oill in vebail « the fact. that certain broed. fundanental. 12 Stanned health’ program, related: to ‘epenstie health needs as. “determined by competent local authority, and not as an incident to a -gublic. works orogram or some other purpose not specifics :lly and directly related to health needs as such; second, thet States' rights and local initiative.be preserved ana encouraged as essential to the success of the undertaking; and third, that the voluntary, nonzrofit institution is duly recognized for the nlece it holds in its contribution to the _ Nation's 6 health". Ae He arings, page iz eS oa “there. are numerous. “other statenents pelative to the. general purposes. of the: ¥y : FEE co-sronsor of. the bill: eth : Senate 10; 1945, (3 ofimi Etec. Print: No.3, page. ‘48 et seq. Je and Seo Hearings, 77; 1805 202, 28T, 274; He Hearings ,. nages 22, 375,43, 455° on in ‘addition bo being commented unen i - . : ‘ - : : : Se This feeture of the legislati favorably jn most of the foregoing stetements, received garticular notice and approval./ Or. hott. of the Farm Security suministre tion. fessioriel grox th of their ‘staffs, ‘end their role as veal centers of “health for ell the neople they serve. ‘e may hore that many of these _ centers will come to represent the mobilizetion of all the health "+ resources in the Como ee Gas to apnoly the techniques of pre- Nention,. diagnosis, , and cherepy in. & coorsinateg.. effort. ta. promote: t. 4 \ t { ¥ nite eviden unléss* there eee? ; “goiiig’ to havea hodgencdge of ttosnital fac ilities, so T think that. -7- Be bad De pe EU ae PR EA A Radi om faa eM cette ett asta cate oe Eee Bette Le eet at ae a a Ba Tee te aah Poke oe Bd ee A: “ “Too mach: emchasis cannot be placed upon the imvortance ol a comprehensive and criticak analysis of existing hossital facilities in any long-range clanning orogranm. It is an activity which requires extensive detailed study of all of the factors “hich affect both she use and extent of oresent facilities as well as the possible chenges in oudlic appreciation of hospital cere, methods of finence, and : medicel. care practice of the community. 4 study such as is needed / .. would best be made at. the State >» Level rather than. from 4 central n. national office." _ B a hoe tu Ye GeGULETS Not #8 10.72 The Ctate hospital construction .prograir . ty ~ ~ griority regulations. (>) The Ctate agency sheil cetermine through field investigation, end | other ise, the approxinat 8 cond tata te epee Pia enn eb ene EB brane tt ene arate ae + penetra te ae eo cant ae ate an cr Tata mba ew oMtateme aaron ates * enti eae kaa! Aone PR need for each vroject includ we ty of funds fue availaoil leces hosvitel construe 7 me by the Surgeon General, Co et on a Pep ‘i contein such revisions of the ‘ag the ageacy. consid “construction ¢ MORRT B--SUHVEYS anD PLANS TAG" ray eth Sempre eat a RIDES " nu PHOPLEAT Tou on BPP . in orter to assist she States in umposes of, Section 601 (a). ‘the sum of - 3.0 000, 000, to remain sveiluble until excended. The sums enerovriate: + under this section shali 3¢ used for taking cayments to States which have submitted, and hau avproved oy the Surgeon General, State applications for funds for carryin, , + . ae Fob such purposes eS . No es ~ “ ‘A x, Br ne 1, and the dill renorte! by the Senate Commi The original oil ta o u are authorized an angrooriation of § million dollers. Since the House had cut the Federal share of survey end planning funds from 50} to it also cut the authorization to three million dollars, dH. Henort Ho... 2 519, he: tmited s » # 612 (a) (1) c ° "STATS APPLICATIONS" LAY: "Sec, 612. (a) To be weroved, a State sonlication for funds for carrying out the ourcoses of seczion ‘single Stet ge the sole. , (1) designate 6 agency for carryi ing out such surnoses: Provided, Theat an has seen avoroved under section 623, any m. ne qT oD ie rter a St further survey or crogremming functions shell be carried out, garsuent to section 623 (a). (10), by the agency : ‘section 623. (a), (a). wt ~ destghated. in eecontande with ( A.similar provision tas cont sined in the originel bill »ith the ~ exception of the proviso chich nas added by the Senate Committee. This edditional srovision assures continuity af the State administrative vovers arter in J DALE there was no sefeguerd that _aporovel of the Stete olan. In one origenat Dos the State. vould continue. ats oe ‘pages: | TO6,. “2g: and 272'- Rote the: sug eatiens on Dag State Health. Department be. snecifica ity nesed in the for carrying out..ib¢.2 = Ere ivities.:. fee's. ‘Hearings ,. re s 129 and.272 that. the. «atte i ingieletion as. the single _ reduire, pursuant to fas 7 rye enim ¢ sewees : eee : + - . « - . “s tect saa ff a . ek! : : : yet wwe ee OO TE OY & wnich shall: include. re-_ te agencies, concerned with the us, FRR and of Sta overgtion, construction, or utilization of hes vitals, : 4 nelucing representatives of the consumers or * y,-the-application must tom: ant: use’ of. ho a a ‘Note alsa’ the suggestion 5. Hee of local advisory councils. — ee . pes : cs ~ § 612 (a) (3) - a rn "SkC, 612 (a) (3) vrovide for making an inventory Lave and survey in accordance ‘ith section 601 (a) eontaining all information required cy the section 622; ... - regulations vrescribed under ay “the. Study,” Se Hearings, “nage 233 Ot be seq. 4 me "Tao: much emchasis cannot be slacei uson the Lu 50 ca comprehensive and critical analysis of existing hospital fe long-range Dlanning Drost ei: Th is an activity which requires extensiv ‘detailed study of all: of § ne factors which effect both. the use end extent of Ee ohe. nenges in. public: appreciation. of; o actice: of the commintt «present facilities: hospital care,. Note also the testimony relative to the North Caroline survey, &. er ngs, pages273 ,et seq.. 282 et seq. The comments on cehsit of the American citute of architects at: nage 269° are also.of interest. See also H.Hearings, tyneg- of: survey n ‘eh: ‘See. ‘alas thee sonmentery “on the desirebility’o a “legislation, § 601, sucra. . = ts . . a mot . 7 + . _ . 7 ee tae adie) Citebase iad ean asec Tian ON ne AE MER an “anes Ss 7 3 - “ sa v, . . . wosyee seshcrna acdc egal cadstc ately uate LA ta pS I an ai i et AA ace thes Sanne ee pine coat ee LL A aad cates a g 612 (2) (4) | mee, 612 (a) (4) vrovice thet the State agency oA s “Ll make such renorts, in such form end omtain- ‘access to the records on which such revorts are based. al a PRES i Somevhat, ‘Sintlar provision th ‘the omission o: of the ‘nord "reasonably" - , was! contained: in’ the original bill. “The Language adooted vas suggested by - the Senate Committee. identical janguage is used in 3 623 (a) (9) infra. | 0 bole ee nc RL teresa arene ena ee Ne ane om Rat a ema alinwiod a inthe I tle A eee be wns a eure ak 1 ae De Bae ln ee EL et at ae mt tn a mea ro oes ent na ene een Mo weer ue cn eS na wae Nee art poo : a a oa . ‘ . "SC. 612 (b) The Surgeon Genera any io : LAs . set , aoplication for funds which romnntlies “ith the nrovisions. of subsection (a). LO ERE a Under the original bill St to comply with such stenda t Council, might prescribe. The Sen ~ --yenge of Federal administrative ad be carried’ out in accorden ate ee for furis would heve had & ‘eon ueneral, vith the acorovel oF the b thee felt ib desirable to limit the ere etion| and provider that these functions egulations. S. Renort No. 674,. page 3; ar tn ya carab ea “powers, by. ‘Conerese! Note- the, discussion ‘on’ the. relative Peiornsttete pers © , commentary S 835, intra, es to the : Hearings, ge s of Skate seendles, Se pertakthe cin ct I ce sa er oS REI tee ob. cee lia ew ERE had ceed ees tad Cina died abn situ a tn BAL eee iM i diZa Lreth ab B Ge atin Pete a eed ick ede ww tS NALLOTMENTS TO STATES" LAW: . "5.C. 613 (a) Each State for which e State w--linetion under section Slé nas Deen approves shall Bee atte 4 bear’: Lo’ the “populat on of ell’ the States, ‘and within such ellotment it shall be ent sitled to. i/2 nec ceatur of its expenditures in of section 601 te) in fo, x shat ne é the sum to under this section, curing euch ensuing 1l therewson certify to the mey determine, and shall t ee Secretery of the Treasury ‘ the Srount SO. estinated's receaiag to the Tressury of the United Cintes." A aw le a a a a - nee a ER eee ean te teat mel en ae a La: leah ela ee (a) The criginal bil: survey emg cvLamminc cunce 1 factors as he lled. outya wag chengea él survey and flat 50% grant an -olanning funds to the States. cut the flat grent to 33 1/3%, deleted the crovision for loens and cut the sum suthorize: to be 0. 2519, sages ilion. a. Revort 8 rit ) appropriated from five miitlion to three mi "3, 7. 2The original bill containe No. Dro ‘the State. The Senate Commits oe t vision for‘thé repayment. of ee 8. Ses as Ted CB ye “.gurvey. and planming funds unexpended by ose ces! eet a. Se ee bce km ate a tt ete eta ee en a ate es ene a g 621 BET C--COacTEUCTION OF HUSPITELS bey Se UATLE FACEIIPIIEE" 7 VAG tT yA ap - : VAUMY OS TE AT EGS Op a cv! cuplie end other non jrorit hospitals; end there are further au thorized to be appropriated for such cong truct? “1 ee / Suns. appropriated | Surgeon General, State plans for carrying out the purgoses of section 601 (5); and for making »ayments to political subsivisions of, sublic or other non profit Tome x Lat ‘ agencies in, such States." The bill, ss originally introduced, vrovided for a ‘program of | indefinite guration, 160,000,000, for the Sirst year end, after the first year, set no ceiling on the funds thut could ansronriated. The bili va reported out of the Senate committee vith 4 iimitation of 5 years on the duration of the program and a limit of 75 mi iiiion. dollars per year on funes ‘>that might: be. sppropriaee Report No. O74». yak : lk Se page G.- * * ‘ Bhe. Thysicien' S| ‘In the: amended Senate. bizL;: the aosropriations for’ the hospital © coristruction. progren have been. souk te 75,000,060 per year for. A years dm ‘amount..that. ‘would barely meet one-quarter: ‘of, the...” Sy inown Heeds +" The: provisions. or ‘the original-bill. for; 2 $00,000,000 the firss year, plus necessary zmounts in succeed~ ing years, would ce oreferable This is carticulariy true 13 wet eta Mngt a So Ate hg ne Te Eat Dhan Fanart dna NRE TP Doe TIN Do BO te \ muction in subsequent years ime ced at the rresent time since the cost o necessary const cannot 3OS3t tbhy 6 #o7ursh go anaes? EMorestLe CMa Ue “Wr, Parran: "I woul. orefer to e discretion of Congress atter the first year initial anoro riation of -.75, O00, 000 & year, 6lso to § . = ... bill. operete over a 10-year verioc. If, on the other hend, - the..Co wishes to impose a- ceiling which--~I hove- that the’ ; first year fr 375 y000; 000. si mecessary +: re Perrans , end “especially as IE think you ealth - pointed out, Mr. Sro¥n , “in connection: with the mental heelth fo a ce ce pill, nobocy fnovs. how meen & Aollar will buy ? years from now. Aes oe Mire Brown: That is right - soe ee a we Dre. Parrent tant: that ts the: reason ry first rac commendat ion , oe it to Congress from year to yeer to determine to be aon propriated unger the ill efter ific abt DL the c coun noi) on recice ance tion end “hoeni 9 os Or 08 doliere, sums jlennec 3 -anding 2ni ireroving it#hs z.COnS imetéd at at Sie aed nani ce hae iN la ine DN A SAN a iat a The Senate Committee recomnizec 2 donut thet r + ~ + plas ya 7 =e : ion authorizec in this bill revresent 2 roksneve- 20 oercent of the bota LL costs or the hospitel sna suolic healta. timated bY. the, Surgeon general to be facilities es, . She state burveys., ‘are comleted and. State éonstruction.. : Mprograns $approved y LE omey De: ‘necessary for* Congress to ins." J. 5"? “erease the amount of Fedetel ase sistance for constructzon, either by increesing the anthorizetion ceilings or by ex tending the time serioc curing waich Fecerel funds ney 5e aporo wr ete. for thig curcose, or through both methods." (3. Pecort 2 vO e 674, sti E $) Senator Taft in the nebete on the. bill stated: oe Re heve ‘provided a 5. -year olen calling for sw exrenditure G 215,000; 000:e year. That. wild: ‘be sufficient to enable the: 28. 0 roject to be started. “It's afford: the ‘tremendous advantage 8 inducing every Sta te to fale a -comrehensive hospital slen”™ os for itself, fs. they .ill be given an incentive to tie. together ty ‘alk ther loose’: enc. of: the’ hosndte L “systems ta include cublic va") and “svivate hosoit sls, end then to decide shether additionel hospitals are needed, anv, if so, vhere. *e uccorolish that, no matter. how large Print Ho. 3, 2age Si. TE 3 the aovrorietion may be." S. Committee provide: Me eecen vitotnenta, £6 hospitals: ‘pursuant to” the first. ‘sentence of Section’ Gor “of the Public: Health Service Act, ‘as amendéd by the first Section of this act." WU ne Soe eS a a ARO Se Pte eae anda LAv: NGISERAL HEGULeTIONS" ‘months shall by serieral regulation cwresoribe os tere nade more. 2 gynlicit in af Yeteral regulations © the seul as & more Ue ablogatdon ‘of Federal. ‘ands § ility with more pot fer and, discretion left, to the States. Note. nat -bill provided. for. Federal grants. to. the: States. for Caan "y tans), in Line with” Ee wolicy. adopted, the ‘orovision we: s - omitted then renorted out by the Senate Committee. "The Committee took the position that the ftates should and A would bé able. to ha andle this. feature’ witho out Federal aid." S. Report } No.674, Page 8. Hearings, rage 47, 121. Compere the 8 Forum (H. Hearings,..p See also S. _ peerings page us a A Bab ety Sida fonbatiede raat hectealion tc et inl he ELST tO Hn he tie AB IP SD nat a ey ito eas eS saline ental aie AO Ea a TAO On rR nN GULATIONS : PART 1O--uktas io FOR oe OL mursuent to the vrovisions of Myiic Heclith Service Ach ss amenued by the Hosyi on #et (Public Lew Wel, TWth a ongress)_ as roved fugu st 13, 1946, which scded to the Sarr’ 4 . YT. 4 : . . . - i ~ |: . . wgeon General shail . - “nromulgate regulations o.resecribing ceners? nolicies. ee ... to: be followed in setting um and i gu clans for construction of re a ee a Pinata ts mere at ct Seen Decune tle b e adae ae bm Re at nee hth SRE hn I aa de Sd0¢¢ (Aa) "smc. 622 (a) The number of general hospital beds reauirec to nroviee adequate hospital services to the neonle resicing in 4 interme¢iate areas, act - “total: of such bees # for any “State shall not exceed four an@ one half per thousant porulation, excert that in States having less than twelve anc more than gix nersons per square mile the ve beds ver thousand nopulation, and in States ht 8 eH st (a & iS te hr oy oo fHty re samt salt be “are nore beds than required by the gtandares crescrives oy the { >= oye Supegan General, the excess over such gtancards may be eliminated in calculating this maximum ellowance. “Gsrinss testified: ear et Paes | beds. ser. ‘L 900: peonle ag. A reasonable estimate, : 16 000 's : tees “Ef In. accition,! i; ts estimated nitak fation, E think the sondervetive five. ‘heds ger. “enousand. ot think Dr. Parren has used the fizure 4.5 beds ner thousand, ane other authorities in other places also heve: a varieticn of that nunder, but I think it is the consensus of ominion now that it woult require five. beds ner ‘thousand. (S. Hearings, »- 2h) In sus gestiz nz the foo 7 dimitations: the. Comittee reportec: ritnes 3e8,, “your committee. concluéed. y hospital bets per: oh 0003 persons | a 5 pos under this’ 6 ; . wee 2 1m j of the American Medical Association, vol: ‘123, No. 13. “Merch 27, 1 193. - Ege oo timates of: replacement.. needs were: ‘based. om-the- arbitrary assumtion that, at. /: S ‘existing facilities” are obgolate d.shoul* Be- replaced: ‘in areas Tae : vp. beds: ver’ 1. 000. Honulation.: The: estimtes.” “given to the ee subcommittee ‘were based on a ration of LIA ‘beds per ‘t,000 for persons in © cities of 10,000 and over, anc 5.0 ner 1 1,000 for gmalier towns and rural areas. ecause of the ranidly growine use of noenitals, rresent estimates ore Saset on 4.5 beds for all the nopulation as tne arooadle witimate need." . ~23~ se bee an ae nen TA ca a nD ml Pe me Ls em inaeeatebeln “ats . sad a perce ak ak mT omental ana wists wma lee Sea eed aime ns and be Hn Had he nein A Mae Boa te 5 venerai oe: her “rovized four committe e therefore set 4 limit for: rederel aid | fart distrivutea among oase areas, inter rmediate are to orevent inequities in. the application or this ‘provided. that. in States: havin 1 “ene state health authoritys 90 0 01.) Ba ede ne eb Lins ot cette ati! ain dl ik athe hE bes he ey | 822 (a) 822 (4) The general manner in which the State “Agency. "Sac fo. LAW: “am 3 determine the ‘priority ‘of projects based on the relative need of different sections of the copulation and the oe, _ ee pens. : , , ~ , Jo hes = 4° bd. .détarmine _ sor da s 3 pr bed. by. the.Surgeon. General, with. the ‘approve ofthe Council. Thii ie" movisiod was’ changed by” the: ‘Senate Committée to the" ', language “finally® adopted. This was in accordance with that :Committeets . : . decision that. the. Surgeon General's functions be cérried out: in aecordance with regulations. dote the following in the. Rone hat Hearings at page” 87s. t My I draw Senator raters ‘attention to" céFtain dansuees on: pee 7 7 f the, bill, language which does seem very broad in giving authoritys a: determined thes “suggest to you y in“ “the: ‘bil. that the Loo petathe sinks 6% nS ene eet) oat be asta Tat as abe ee UN al it et ae EI ae aN SG ai at Lt te Sha al § 622 (d) ‘Dr. Smelzer of the .merican Health Association in the House Hearings commented: “However, it ssems wise that this act dces not attempt to establish rigid standards of. relative need. I+ is impossible now to make any final decision as. to exactly what hospital facilities may be necessary to offer adequate \ service to all: or the people and the act permits a changing definition of need - to fit. circumstances: as they, my be.founde It may. well happen shat. in . eg eo ae. ay ‘struction Of" “Large: ‘teaching’ ‘hospitals ‘te. ‘serve ‘these same aread, Such hos-— 2 “pitals might establish the key to adequate quality of care in an entire State, and, in addition, function as training centers for physicians, nurses, and other technical workers required to staff outlying hospitals. The definition of need should, therefore, be developed by the State agency in accordance with existing circumstances under the guidance of Federal regulations and standards,’ He Hearings, page 50, need only make certain that absolute: priority be given ‘to. a consideration of “needs, In other words, ‘the language should be so framed, that. no institution ‘would be constructed’ in a less needy area before all pore needy areas were provided for, merely ‘because. the legs needy area could assure financial main- tenance +" ei Hearings y. Page. 198). See, also “PRESS. 105, 6) 128, » ABS 261, 2926 "Senator LaFollette. “In view of your answer, I twill ask you another question, if IT maye To what extent do you think it will be possible | for the hospitals to meet the neéds of rehabilitation?" 0 ae aaa he cla Mad acca date Lana ee titel Aad a Jah irae oh x Pl de etn a mga ma Rt chee ee name a wis WE TR Cath le une pani Rew Tae a Ba eee a ts Fee at pate ee Fan * a rs . ” ; vi ““Senator LaFollette. In other words, thé larger proportion of whatever funds are appropriated, should: this bill become law, would be devoted to the construction of new facilities?" Te may not: be appropriate to outline construction priorities | in the bill itself. Perplexing questions, moreover, as to the relative need for such facilities as general or tuberculosis hospital beds are bound to confront -. administrators and advisory councils. ‘With regard to general hospitals, i however, I believe that the first priority in constructing projects in . approved « State ‘Plans. should, oho and, explicitly be given to medical. service x Such construction. Should preceds : fae eed Ready Lede § 622. (d) as In determing proportionate needs, facilities “aha ‘those under construction consideration shall be given to existing without assistance under the Federal Acts: ‘and additions: ‘to existing hospitals and heel th centers “shall be. given priority over “replacements, except: (a) there eee ena is of minor " character: and x oh A which constitutes a public. hazard; ote) here, in the case of a public health center, S x ¥ “qntermediate, or mural) in which. the project will be : . - . . Pook 7 . . 7 + : = ~ noe oo ‘ * oo. ’ . a fein TA S20 tin aw a iets 2 Fi ae avi aaa ned aE agente el tan Mie tate inn Ean 24 sate eee se ne en iad hen otal a be ee te Ble 2 tne eS a ARTEL IE AEE SE De tal omer ‘Lede adits at aba Rica od a ak Ne el Cat! .. .* 7) SMAT]L financial resources; (bd) The extent to which. beds will be made 2 "groups of ‘the population. ~ @ mg 10645 Chronie diseasa category. Priority shall be | a . . given to those Progen in which the chronic disease “ a eet Oey St ath lhe bad detente ena a as a al Colina en a A i ai Sel et al td Flora ce Gat rw Nacertdarem ben! LF pre res b i eae salt 8. 622 (a) ok 8 10.77: (») order of processing applications. The State Agency snail process spi tonssons received in the order of re- - . > gue of the order of priority if: —Q) the State Agency has afforded reasonable opportunity for f development and presentation of projects in the order 9, the Surgeon General © yee al that: financial resdurées for the construction,, maintenanes + priority are. not then! 2 cavadlables — an aan 62 ORDUSL AE Se The p prior rity | ‘of a project under the State plan shall \. . . z not be affected by the xeou that other projects of lower Cae teabae A Pat Cipla ate ten Ne Sees SoU Dos sect att ly iia nil pl SIT lat pact a Pe mee ORR ate am ne Ae Ra aetna Tamme cee as ee ae eens amet YEE Ne oe LAs - “"Fagea,- 622 (e) General standards of. construction and The: sriginal pill “aid not contain any requirement for such re- gulations. + required the State to set forth a construction program in accordance wi wa standards Prescribed YY. the Surgeen Generale we 8. 4 612 > &b). “622, suprae © aa : ; . by the. Senate provided thet the “Surgeon General: hould: have, among others jthe: responsibility and. authority for. prescribing. Pgeteral standards: 3f construction ‘and equipment for hospitals of different _ glasses and in different types of Iocations, In our opinion this provision ig greatly improved in H. R. 5628 by providing | that the Surgeon General shall © . “also have responsibility for prescribing standards: for maintenance and for a ‘operation as well as’ for the construction | and equi pment of these facilities." (He Hearings, page 158. d. ‘: va gt ere a “Government's ‘ragulatory: “requirenents.." “(Se Report wo. 674, page &) The House Conn ite “did not change, the provisiod adopted Y the. Senate « ; : of. fund: S v A ae! Buch tes and ° ‘Ghe finaneds1 inability ‘of the’ ‘States to: provide Ne neéded facilities.” “"gée" g q 623 (a) ) 835,, infra. oT Sy gel. 8 622 (a) REGULATIONS : o£ 10.51 General. Plans and specifications for each project submitted to the Surgeon General for approval under the Haden) act shall be prepared in accordance Witn the locations as prescribed by the Surgeon General set forth oS 7 in Appendix'-A. The Surgeon General may approve plans and ‘specifications which contain deviations from the re- - quirements présoribed, ifhe is satisfied that the oe — and. Local Las, ‘codes, and “ordinances arid with the approved.” Le rola Bo AL. wns . SPR E n e “state plane The plans and specifications mist be “complete and adequate for contract purposes and, ‘have the approval we te Ben ain ae arte TR ae Pay tl ler ANE dail oo ea a ann int eden Ja et ae AO ei Sak RCSB akan be la, ae Bie ie te aI ae Fed a nett bn bo —— | 3 o22 (1) C0 BAW sE0. 622 Cf). ‘That the State plan shall provide for 2 ae DE Be adsquate hdspital: 1 factaitted. for the ‘people ‘residing dna Stase, ° wi toot “diserigination on. account, of race, see hp 19. for adequate | “hospital” “wlation| may. require that ‘before, approval of any, applica- oe a ae " €lon ‘Yor a “hospital or. addition. ‘to. a hospital, is recom “mended by. a State agency, assurance shall be received by eopot “ote: state 4 from the gnplicent, ‘thet. (1). such hospital or a ati entation at EAE a D vec \aj) ‘ . oN income status prohibits the purchase of these services... » Our ~N organization asked for certain antidiscriminatory amendments to the ‘Senate bill which were essentially included. In the Senate version of S$. 191, cage 24, lines 17 through 24, ending with the vord teroup!, thers is a provision on discrimination because of race, creed, or color. The designate _ purpose for this- provision was that this stature would pro— : : 3 facilities because of race, ver, we, belleve.that the.orlginel intent. of this. snot quit ‘elearwhere the wo tprovided® is used in line 21. like to change the word ‘provided! to ‘required by State law.! We should like also to change the word ‘shall’! in line 20 of that section to 'may'.. Even though in a grant-in-aid program which is to be admin-— istered and financed partly by a State, State law would obtain, hence, separate hospital facilities would be mandatory and the word 'shall! would probably be correct. However, we prefer the word ‘may', which is dis- cretionary rather than mandatory." H. Hearings, pages 185, 186. - -° . See also, S. Rearings,. page. 319. . | st atenents in ‘the’ Committee reports, Se. Report | 2519, page 8, were quite explicit as to ©.) a ee eae ee ev entraen te A ad bet BS ene La ee ate oe dea cool nce AL ha tad a mee Tec ete Ee REGULATION a ech ee Aihara thE im OI tA ta ed at un as ve ve be ag ibe Top fee... 4 ee ties for ‘persons unable to pay therefor. | \ § 622 (fF) * ‘3 10.61 General. The State plan shall provide for adequate hospital facilities for the people residing in a State without discrimination on account of race, creed, oF, solor and shalt Provide , for adequate. RoEpitat facilic, + Peay aed, ceo, oe "§ 10,62 Non-discrimination, Before a construction application is recommended by a State Agency for approval, the State Agency shall obtain assurance from the applicant that the facilities to be built with aid under the Act will be made available without dise?inination on. account of of race, creeds, ‘or color to all persons residing int the area to be served by hat hospital. However, in any area where separate hospital facilities are provided for separate population groups, the State Agency may waive the requirement of Gasurence from the construction applicant if (a) it ‘finds that the plan otherwise makes .__ equitable provision, on. the basis of need for. facilities WE pa ne nd service es ‘of, ‘Like, quality for each, ‘such P puletion group in the area, and (b) such finding is subsequently approved by the Surgeon General, Facilities provided under the Federal Act will be considered as _ making equitable provision for separate population groups when the facilities to be built for the Mo group less. well provided for heretofore are equal to the cana ee Fake AT ge le proportion of such group in the total population of the area, except that the State plan shall not program facili- ties for a separate population group for construction be-~ yond the level of adequacy for such group." - 4] « ple ei at eal eabe eet ae ete 3 S 622 (£) _ LAW: - . typo, 622 (f) (2) There will be made available in each such nospital or addition vo 4 nospital a reasonable woe Str volume: of hospital services to persons unable to pay “therefor, but an exception shall be made if such 4 requirement is not feasible from a inancial standpoint." woe _»This provision; added by the Senate Committee was not in the original . bill. Senate Report No. 674, page Ie on Note that this is permissive and that the Surgeon General is not re- quired to issue such a regulation, See S. Report No. 674, page 9, He Report Noe 2519, page 8. Some thought was given however to a definite requirement that recipients of Federal funds handle a certain number of indigent patients, S. Hearings, page 190. Note also the testimony of Dr. Boas of the Physicians - Forum; 9.) °°! Tee , , Ko: “The provision exempting hospitals from providing services to persons unable to pay, if it is financially imoracticable to accept them is unfortunate indeed, since it is these very patients who are most in need of such care throughout the countrys It would be highly desirable to remove this condition if at all possible. But should such a@ condition appear to be financially inevitable, there should at least be an anti-discrimination clause attached: ~._ vol -to this’ provise, for other wise there is the distinct danger that the in- Nd. _°" stitutions supplying separate facilities for different population groups might “par thé Indigent of @ minority group only.” He Hearings, page 147. = rss Loe - . - eco ate $ 622 (f) mS! REGULATIONS: "g- 10,61 General. The State plan shall provide for adequate hospital facilities for the seonle. residing in @ State without discrimination on account of race, creeg, ilities for’ persons” mable to pay therefor. "g “10. 63 Hospital services for persons unable to pay therefor. Before a construction application is recommended bY a . State Agency for approval, the State Agency shell Pa ee noe cen - obtaa assurance, ‘thet. the applicant will furnish, a reason- Pferad below cost or free. to persons unable to pay _ (~ - therefor, including under ‘persons unable to pay therefor,! both the legally indigent and persons who are otherwise | oe Sen fesuppor sang | a are: unable: to Bey the. full cost of pital jusel?. In detern nining what constitutes. a reasonable volume of free patient care, there shall be considered conditions in ‘the area. to ke served a the. subject osubsedisat epprovel Bae: General, that furnishing such free patient care is not feasible financially." . Doe . ee EF oe : ent Re Cea ee ae a gm A ee fe RS are ema ba ete te abt ST a Re me a on So - 7 7 : § 622 Cg) sats a. "SEC. 622 (g) General methods of administration . a . of the plan by the designated State agency, <> This provision was added by the Senate Committee. Note the statement that the authorization to the Surgeon General for issuing regulations on general methods of administration, "relates soley to administration of the construction program by the State agency, and - does not in any way rélate. to the administration of hosvitals_con-.. Struc rea under the -program.'"..5. Report No. 674;. Page 93 8.62 | a) ay: ; ‘se 29 g 623 (a) LAW: "State Plans "SEC. 623. (a) After such regulations have been _ Assued, any arate desiring | to take advantage cr . See the coitmentary on § 601 (b) supra. Note. the following discussion between Senator Murray, and Dr. Smelzer of the American Hospital Association: " - a You provide’-in-. the bill, als gto. restrict ‘the ‘proposed: Federal: grant::exclusively . ‘to’ States: ‘which- have: ‘submit- “ted and.. have” “approved. state-wide’ plans.” Do-you think. that is a wise : ‘provision? “It: may be hat. neral description ar it ahs Oe Lts Prowassess sagt ok eae oe sf ad he ie a ‘the cae ee shee list for Te on, ‘upon ee scomaintinits tavetbant lid Lace Coe Ne Fey : ~3 ot 7 ~ : ve ena Oe w Taka nae bs Te taeda ae 9 Micah art bi Aa haa a tee te a ooh aed Pa ae “O60 \&s Vy) "SEC. 62 (a) (5) set forth the relative need determined in ~ a of 7 “accordance ‘with the regulations’ “prescribed under section 622 (d) for the several projogte, inoiused te suck orograms, and ~ Sool” gible, in the order of such relative. need.” - . See 8622 (d), supra. The original bill contained a similar provision i. providing that-relative need would be determined in accordance with ' "standards" / prescribed by the Surgeon General. . See al so S.. Hearings, page 71, H. Hearings 2 0; 63; “Ss Report. No 674 l menner in which REGULATIONS + we 41. Manner of determ nations | The ; genera “ata to existing hospitals and health centers shall be given priority over replacements, sxcept: 2} Vihere replacement is of minor character. and. necessary > “0. "essential to eliminate an. existing needed hospital which t- : : a S me : _ constitutes a public hazard; 7 (ce) Where » in the ‘case of 4 public health center, wr > all be determined after con- . priority. projects sh sideration. of the following factors in the order of impor t= é ith relatively small financial 4 ng TA tc ¢tt 2 aot oo gt soups y - @ 10.25 Chronic dusease oS “sory. 3 wa ot ee a “ 16. 46 Public health conterss” ' Big O a - this category shall. be given “to the provision of facilibies oAS ate a § 623 (2) (6) LAW: "suc. 623 (a) (6) provide such methods of administration o- the State vian,. including methods relating to tne establish , ment and maintenance of personnd! s oo ~~" authority with respect to the selection, tenure of office, or compensation of any individual employed in accordance with such rethods), as the Surgeon General prescribes by regulation under section 622 (g)." aaa hindstration, Tt vas ‘silent’ on: “the: equirensiits “for a merit Syston The “Senate Committee inserted this requirement which conforms with other Federal grants-in-aid programs, “Note that the merit system requirement does not apply to personnel. operating hospitalse aoe > * “ be See § 622 (g), supra. include provision for: oe Lo (2) tmpartiel 8 administration of she me rit Systems _ ~ 56 - : & a ‘ na ele Ea ne Re Meine i Nae abba abr nat a ilies fae tae enw bel lin bth tec ete eT Pte an et ie atthe EE aban can ds AoE A tn mao ve ik SR agin FE LM We Ae i AS in ch rte oo oo a | BF g >623 (a) (6) oy . Co ag Ce, . ee . . . : : _ . ke Ss ~ . ' and responsibilities; oe (a) Establishment of compensation schedules adjusted to ; the responsibility and difficulty. cf the work; ar as on. the. bas: Penh ese gk wc * ae eR MRE vide & genuine te me of qualifications and so conducted as to afford all qualifie: . : re ‘ ' applicants opportunity to compete; Hs 8) avancement on the basis of capacity and meritorious «service; and. on , ¢ ‘deemed to meet the requirements of the reg 3 623 (a) (7) , _. Nothing was contained in the original bill on minimum State standarac’ of maintenance and operation. The Senate Committee added this provision » Congressman ‘Priest's. He Re-5628;- (revised: version of Se. 191). ‘provided, _in addition, for the stablishment of ‘Federal maintenance and operation Standards. - Note- that “one of Senate Iiurray's objectives was the failure of the bill to “provide. ‘for such. Federal standards. 5S. ‘Report Noe 674, page 19; Be: Commi ttes Print Now 3; ‘page 1005: Seq the® ‘Commentary on: g 622, (e) supra, ~ ~ a the: Senate Hearings the following is noted at page 282: , D, res \ : "Senator Donnell. You pref Local hands? er to have these matters of control and ‘aintenance left in ‘General for “backed | : tor Donnell e. ae ¥ ¢ talking about: the meintenance after the hospital is constructe ° a Would. you: rather: have: the actual control of ‘the » me interiance and. {opera tion. of 7 the ospitat: left. to “tha: State? “Dre Reynolds. Absolutely.” In the H. Hearings Dr. Smelzer of the American Hospital association noted: "The danger of excessive Federal dictation. is avoided by careful i definition of, the areas. within which, the: Surgeon General and the Federal RE hospital. eauneil may prescribe. standards, these Breas have been sa.es= ° ) tablished as to assure that the survey and construction programs will, bew. ‘Feasonably uniform throughout: all af: the. ‘States that participate-in-the “program and. yet they: Likewise assure that, Federal: control shall not extend ta. the: operation’ or, direction, aft those hospitals. once they have. ‘been con=:, ‘here: is: a Tequirement thatthe participating States shalt. legislate: as e ‘such standards of maintenance and operation; but the act ch “wisely recognizes that this is a State responsibility with which the Federal Government should not interfere. H. Hearings, page 46-6 - = 5B ow: Be Toca wan aaah wh elyfdbea leashes aah ciate nite bina nia ese absanat abe Baie ts nce eee a NL i et cat ene AE ee ve event edie EMCEE et aie ta doa 633 fa) (7) C207 rds: Osteovatny and liinimum Standa entirely for determination by. the respec State such. as the place of osteopathy in general hospital. service would be - . determined: by State law." S. Report Noe 674,. page Ll. See the statements by Dr. Johnson of the American Hospital Associa‘ion HE. Hearings, page 103; Le I. Gourley, and Dr. Swope, of the American Osteopathic Association, H. Hearings, pages 179, 1835 ~ eo, 7 eek Construction. standards. , The State Agency, shal wes “are , -df construction and e€ general: standards oo ___ the. various-‘types’ of nospitais and health centers he INOS assisted under this progren. The standards adopted shall toe fe rye Lo ei ean Oe eld are oe hat a g 623 (a) (8) ~ "src 623 (a) (8) nrovide for affording to every apo licen ~ sonstimiction nroject 2m ancortu aw 2 7 Se ee oy . ao j QO fore the State agency." “There was no “gimiler vrovisi ion in. the original bill: it was added by the Senate Committee. Note that the bill, as rvevorted by the committee also vernitted an annlicent to anneal to the J, S. Cirevit Court of Anseals. The House Committee deleted such provision. See 8632 (») (1), infra, H. Hearings, pp. 68. 80. “ “nad rae SOLOS: oJ Le ring Stete Agency shall establish ~". "sig dissatisfied with any action of the State agency Te- ~*~ ‘garding its application." 21 “ete Nt Tae abd Nn ais Teer wi Si Ne a SRL lane ak A ae nie Poe eS oe tebeues Re “ts Sui Sauce ne ek Da tla ne ae td A hPa tee teres ta ee g623 (a) (9) S77 sales LAY: "See. 623 (a) (9) provide that the State agency Wilk Base "such renorts in such form anc cont may, £ oA...) to the’ records upon which such information is based; and" A somewhat similar provision, with the word "reasonably": omittec, was conteined in the originel bill. The language adopted was suegested by a the Senate Committee... Identical, language.is. contained in 8612 (a) (4). infra. fy i 4 . wo 80235 Ya) \LO) oo LAW "Sec. 623, (a) (10) provide that. the “State agency wild | eto oo. * from tine to fimo review its nospital construction program modifications thereof oT riginal Sur “required: the ‘State plant. include provisions for the State “agony? 8 ‘submission of "any necessary mocifications" of its con- struction program. The question as to who would determine that necessity -was. left to interpretation. As passed by the Senate the requirement refers: ~. tomodification "which it ‘Lthe State A -gency/’ considers necessary". It-+ wag supsested in the hearings that the Bild. provide for at ‘ew: by. the States of. their construction programs. a Note. that the Reculations. have incorporated this, $ Teast an. annual. rev. y — a . a a Co $623 (») LAW: - "See. 623 (b) The Surgeon General shell apmrove any Stete nlan and any nedification thereof which somlies with she General for failure to comply with subsection (a), the Feder- val E Hospital Council shall, uron ‘request of the State / agency, afford it an opportunity for hearing. If such Council deuerntaes thet the plan or modication commiies c “with: the proyisio: as of, such subsection, the Surgeon General The original bill contained < only the ‘first ‘sentence. The Senate Committed added the renaining two gentences stating: . oy se Se : "In any case in which the Surgeon General disapproves 6 plan, the Federal Hospital Council must afford the State Agency an opportunity for hearing, and if the Council determines that the pian complies with. such requirements the Surgeon General must _: porove the plan." Si Report Yo. 674. p. It. This was ‘in-aecord.. with the ‘Committés! & aims: to Limit administrative discretion. (see® . 8612 by supra). § ‘and. increase the “powers, ‘of the Federal Hospital woe f et: un Satabliched. for construction applications... "Bose () (2), inf a r Snelzer of: the American Hospital Association. stated: “ The Federal Kospital council @ also has a semijudicial function in the approval of State plans for hospital construction; >. but again, it is. exercised from the standvoint of technical wisdom 2 ,and experience. In the development of this act it was realized ee ‘there: should ‘be some: provision for apveal- from possible, . r i.thé part’ of a singlé administrative office. 2 appre al a disappro al of State plans... né Yat, “because of he: ee and: ‘complex ‘gonsiderations. involved, “EG seems. in- to. prévide an. appeal: to the court because of the 9 * familiarizing any court with “problems a a et Fo EY * . “ moot - - 7 : .. * es a ce Ena we we ME ce a Ne rile ee TE URL ee EL See lc Tt a tae aa PP Ng eee hv ae toe es . However, court appeal has. been provided. in the case of an individual project whose | application has been. refused by the Surgeon General and in the case of a State whose further fun a have been cut off by the Surgeon Gener rel gor allegec nishanéglin i'n these cases, 2 clear-cut legal issue san na developed for 4 court decision upon the basis of “she law. 3ut in the approval of the-.questian: is. less: a, matter. of legal right. that it. experienced Ke ‘people of the State should’ — “not etteay ae ‘to orie sdtwidaal “ some richt of apneal from any “possible arbitrary one man decision is needed. The Federal Eosvital council, with a membershin of persons who are authorities in fields pertaining to hosnital anc health care, and who will be in everyday 1 day contact with the working conditions governing a wise decision, seems to be the anpropriate ‘body to neat such an appeal with re- “be. ‘gard. to the approval of the State plan." . Heerings, D. 48. LAW: "Sec. 623. (c ) No changes in motets nian shall. be required | C es within’ two years, after initial approval thereof, or within ey se bee tn . CO , two years ‘after any ‘change’ “thereafter required therein, by in the regulations en DUTSU2 1b reason of any change re . e clearly 1's : _ Vo gimilay ur provision was” contained in “the original pill. Senate Committee added the provision in line with its policy of mor , delineating Stete and Federal functions and limiting the Surgeon Gen nera powers. See a fe) supra, 8635. infra, . ; plea hag been enoroved. by the Surgeon General, “sno. ‘ates tt pied may. required | bye reason of changes. in the re-. é of ars, ! ; the “consent. of the. Stat ‘the 1 Congress prevent modification of thi plan by the State Seency of its. own initiative, ‘but no such: modification. w e. effective unless. approved by the Surgeon. Gerieral inthe: sane manner, as the original plane 8: Report Mo. 67. Be 10- Zo Ri Won Sama a arm nt Net in GonSae nabe hes acento baste & LAW: a D "Seo » 023 (a) tf any § State, prior to July 1, 1948, has not bee "Teascted Tesi tate ‘on provideing that compliance: with min- imum standards: of maintenance and overation shall be rior to that date. vor, at she. option oF tne -cdeived Federal inal hospitals which shell have re oo oe a, aid under this bitte, sich State shall not be entitled to any - gurther. sllotments under Section, “624 until such time : as ‘such. State has enacted such 2 Legislation. “Upon 8 pert be “entitled to allotments requtzenents of ‘thi he: committed makes ¢ ear’ h Of mini mom ‘standards for the maintenance an operation ‘of hospitals’ shalt be a matter entirely for determination by the respective States. A provision. - wag included, however, to the effect that each State must, prior to July 1, a 1947, enact. legislation establishing minimum standards for the maintenance “and eenetiet of hospitals which shall have received Federal aid under this Questions. such. as the place,.of. osteopathy. in. general. hospital services ine Wace ANE fat owl ich failed: -to: enact, such-legis— r eilotments un le bilh. "(Senate Report Li ne y oaplt be req utred™ tithe: ‘case of A shall have: pacers Pedeval. ‘aid-under: this: t shall -not: be- entitled to. any further allotment under zee ntenaic : pattale, whtels gis QUCH. Stage “Section att Pp. L. P35. goth Congress, He OR. 6339 amended this section. 66 : Sa iandat Mas ae ea Kae ha Eoin eh ap cinta a sued tas oO | MALLOT MENTS: 20 STATES" s LAW: «MSEC. Gal, Bach State for which @ State. olan has been , approved rior to or during e fiscal year snall be en- Sitled for suck year to an allotment of a sum Deering vag same. ratio: to the. sums authorized. to be appropriated our-~ the copulation of such State and (0) the square of its “allotment percentage fag defined in section 631 (a) ) bears to the. sum of the corresponding products for ail of the States: | provided, that no such allotment = any State “Tor paynest of e533. 51/3 5 per, centum of the cost of approved a : projects within such State. “The Surgeon General shall calculate one allotments to be ‘nade: under this section and nn sums s allotted for such State for such next | fiscal 3 year. ” BO any ‘mount of ‘the. sums: “guthorized ‘to. be spproneiatea for a.” : t om Le PETG Bm wie f f PEt oe : : gated at the end-or the period for, waich it is available to such State, is hereby autnorized ta be appropriated. 67 ~ - . ” ° ‘ -r 2 Pa z i p twee Ake sa aa tne ye tices genteel ty he Cia Ra i A ane nd ts aA acim nib lated ah the ad bne P AEE ak A ac eat AM om a Ratatat Fig a iene Neil Sat ed Pema g Re ae en cae etigs Math rete Ake ae MI RED abs oe are 8 “ for. the next fiscal veer. ‘in eddition to the sum other- « I. Bxtent of Federal “partiotoation: — . , + 1 . Tee original sill -rovised for ,wWhich the Federal contribution ranged from 25% is oO ‘De in the pocrest ‘State. ha’. Surgeon: Generaia calc oF 2rants, in rye weelthiest State, ! ce Hearings, pe Ts. oo \ foot che Federal Beets between tone dt which are: “boo wide” “thas is 2h to: 5 the Surgeon General fixes the aeseret percentage on the Hearings, “percent age per cent. ... basis of the States! relative financial needs. ! See also ©. peges 20, 29 1TH 75, 935 159. Consistent with the Senate Committee! Ss efforts to narrow she renge ‘of Federal’ ‘Administrative: discretion, ‘the Comuittee uncertaol "to. Incorporate a in its. amendment an “allgtment, procedure which leaves 00. . 4 ; = Report: No. 67 ome also. Tat mut The. variable Federal percentage. however: we ant of 3-1/38. ee port. 0. i “was never adop OS BTOpo ed: eteing the erent. to rere Conference Report, “hn, LiFe. See 8621, sura, for | a discussion : ee the several? Limit of Foieral 1 partieiprtion: oo = “set ‘forth. ‘ig Sectors ‘for: determining the Dr,./Smelzer of .th American. e} roent by ithe poorest’, 75: x althiest State. “the. variation within the range “Of: ‘these 7 orcentaees is “determined for the several ‘States on the. basis: of their : relative ‘financial need_which. we understand ig a mathematically measurable | 5 13) e:° “See also S.-Hearings. - : ve "For each Stete there vould be determined by statutory formula rn Caee. 631 (a) Ya Federal percentage, ‘which would’ be utilized as a ‘factor ™. in determining the allotments as among the States (sec. 6c4) . and als . to fix the proportion of the‘cost of individual vrojects in the eeaeectix 8 States which would be naid from Federal funds. (Sec. 625 (o)). This Pedarsl cercentege which vould oe redet armined every 2 years (sec. 632 (9)), ig such that the non-Federal share of project éosts would vary in pro- “portion. to the per eapite: income: of th State. bate with upper and. lower. ecified ta! qual. to: the national e arnish ‘from: ocal resources, truction project within the State. -In a State with a per capita” ‘income “only half of that of the Netion as a whole, the ‘Federal: Government’ would - bear 15. percent - of the cost of projects, the meximum Federal vercentege -provided; while in a State with a per canita income one and one-third times the national averege the Federal percentage would ve 33- -1/3,° the minimum authorized. For projects in Alaska and Hawaii, the. Federal percentage _ _ would be. 503 for those in Puerto Rico, (Teo . 7 . from Fodéral- ‘fund and | ve ee ‘from State ‘and local. sources “combined, woule: var yin proportion to -popula- poo ved -fhon and (within the ‘specified. Limits) | ‘yer capita income; a result which, Ae RS. stated above: would mean an apportionment. roughly adjusted, to hospital “8 construction needs. WeoS: Report No. OTS BD. “ll, 12." ‘all tted ona straight” Population: asi; = : ‘struction funds takes. into consideration. ‘the Tieforenee in wealth ameng “: the: States eee ee poputation since the,feficit in: hospital side iano tog td er a ete Lt . x vad fal git aed eS alan ik Ni me i A an a Pin oa ate edna ahe weeded B62 ; "ATotments gre to ‘be nade only to. ‘those States. “with apsroved of. hospital construction plans. A State may receive an allotment ror a fiscal year if its plan has been anproved | either prior to or during thet year." (S. Report No. 674, p. 12. ) See $623 (a) supra. _§) Two-year provision ” ovides tha if ‘funds. allotted toa lapse, ‘or if in any year the appropriations or the ‘allotments: ‘should be less.than the authorized amount, any such residue of funds appropriated or of funds authorized. but not appropriated is to be added to the following year's authorization and to be subject to reanpropriation or apyropriation for the purposes of the program. a ($, Report No. 674, p. 12-) fom ,_ See, 8611, supra. woo Survey a Planning Allotments Sep Pees Nos ovision. was out tnea i ‘the’ origina oe ° * Federal fond ee ar © of the: ‘States. problem congidere “of She bildrens! Be mks ‘the it is” now ; written, “the Stat e is ‘not required to parti- ~gtpate financially. Unless State funds are available to pay part.of the 7 -eonstruction costs when necessary, hospitals and health centers will be constructed only where the locality is able to provide the full amount that mL must be put up to match the Federel grant." (S. Hearings, p. 130) . F _ Union’ stated. “Ye, believe, ‘doreover,. that such ‘appropi viations, susht to. follow the natehing principle” ‘Instead. of following the grant-in-eid principle of mth ut: ve. believe. that. the very A ; ngadorees "the Srinciple of State supple-— mentation of Federal funds in order to assure facilities for tne neediest -70- . “ ok eter nat he bic BA ek 2 Set a cote avehien Te whl ety a Vibe wittnle eld ened Sle Lt tee ee iter auch erate a mens cA ea oy a eck becca Ts ecret lech tae Dh BSB ek ea. areas, no Solution ‘could te found which would te both workable and at. the same time compatible with the objectives: and intent of this legis- . -“Iation. For this reason, the Committee decided against any express TS~ quirement: at this time that ‘the Stete Government contribute ta any local project." v. Allotments for: dministrative Bimenses See EL rogram 86... “in | his testimony: raised Be que: ; . the’ “amount ‘of. funts? rn “During the first year , 45, 000,000 is providec to assist State agencies in meeting administrative expenses in carrying out State plans ‘under this act; and thereafter. such annual apnropriations as may be necessary are authorized. We question the advisability of appropriating ‘this amount or Federal Sunes: to the Stat 28 | for administrative expenses." §, Hearings, 3 saittes taolg i S Soeteton s festure without, ‘Foderel aid oo an Section: 1 of Pe Le "830, goth Congress, H. R. 4816 added the “proviso. “to the. first, sentence of. 8624, providing for a minimum State Po £5 $E0 Oe tava - States athersthan the, Virgin Islanas.., wee _"aAPPTOVaL OF 2 ens 5 AND TAYMEDTS “702 ONSTEUC crroi" a LAW: "suc 625.-(r) For each project for construct jon pur-, ~ there suant to a State olan anproved under this part, shall be suomittec to the Surgecn General - through id - we Mn we Te \ roe o, gener. Such application shell set forth (1) a descrip- * tion of the site for such project, (2) nlens anc speci- -fientions therefor in accerdance with the Tegal +Ons pre- mS Pe scribed by. the, Surgeon, General. under section 628 (e), (3) 27. so 0. the construction of the project and for its maintenance and. : Ppt 8 : "operation when completed, and (5) reasonable assurance that zed "in con-" the rates of ‘pay for laborers and mechanics, enge. to,nay 35- U5 per centum of tne cost of construction of @ allotment ta: the State s bee teeta atintin es Cans Cee nnn ar ede Bh ed fat EN SF akiba ats sr Anita cadence “yt . - . Wl ea dk RRO tree Noted ie lcci a Rene ak Shion dm nck SAT ao ts NE cee ae Bad Be md a Pe (a) fc a el in accor’ with ten preserived pursuant to section S22, (C) the nemilations in conformity with sne Sta tions prescribed pur- the regule cuant® 5O “section 622 (2), regarding the provision of facili- i ties without discrim: sation on account of race, creed, or oitel facilities for igning néeded hos mended ‘by the State agency” and. is entitled to priority over : “other ‘projects, within the. State. in accordance with tae - i wet “regalations precerived x pursuant to section 622 (a).- No. While the. pplications through the State agenc “ling througa the State Agency was not speci ifically reauired. The . Senate revision: mae such procedurs, mandatory. The original pill con- : ilar. provialo. for: site description, plans and and. Supp ct .<.-The.: seavatl: Committee... é : ¥ to. “she Surgeon ‘General, eae ee Pohl Coane ead Pr a mr tal Mactan Ban. isa. we battee can 1 Santendnet! Kate S Sena aes SLE Bitte we So Moy Ning II. Maintenence and. Cperation. See 8623 (a) () supra. , During the course of the Senate Hearings Senator Taft stated at vd. 26: 'We had that auestion in. the last hospital bill and decided it “was ‘perfectly foolish to. ‘build - ‘the hospital ‘unless you were prenared to thet, Af you cannot. p either a grant ought. not osaibly Federal aid t or S W. R Oze of the American Farm Bureau Federation noted: es is also vitally important to make certain that these newly constructed “acilities can be maintained and supported after they are | constructed. The language of the bill, therefore, should be clarifies and strengthened so as to assure that before any grant is made for ‘ oe constructing | or improving | local, hospital facilities, adequate assur- ‘> -) 2é: 18, given | ‘that. financial ‘resaurces will, he available. for mainten-:..“. acilities.from Local resources." ‘S.-Hear- = See ‘alse: He Hearings, pages oly Pll. ngs considereblé attention + was ‘given to the: ‘pro-. L lem of “Fointenance “and, operation. It wes generally recognized ‘Shat ~ “ewhile this bill failed to provide for assistance in maintenance and ..operation, the problem wes. nevertheless 4 serious one and would merit* “the attention of Congress. One of Senator Murray's objections to. the bit. -:was its failure to provide Federal funds for maintenace and operation thus leaving onresolved the problem of eiding the most needy com- munities." $..Report No.- 674, p. 20.. Discussions are to be found in earings; Dp: 85; 130,149, 152-129 BO, 28th. 520, BTL. use. Hearings. PP “BO. -12T,. 47, 150 '., Senate Committee: rings, s “American Farm ‘Bureau Federa- gee ere , ‘strongly eooea’ to. ‘the. ‘inclusion of the requireneat in projects: mist. be given as urances: aD Senet oe ages Wit peat tee eb dette daothals TL Bate ee! aie Lode Ean we x ‘ Mile UL bank en ee ee EIN ee wat chee | Mabeaie ds tein be Reader Pa iene ai ee 8 line Lr oe eee tte bate E vind a alee piece net ce at el ace te ig Tas cae abe ator BGS oe ou BYGY Ne n of some Legal: authori- a Walsh-Eealey Acts wou- 1d ruction Act: even it C _ -. It sh hould be noted that it is the opinio . ties “that the provisions of the Bacon—lavis an extend to the Hospital Survey and Const probably this svecific provision were not included in the Act. It was with a ble misunderstanding on this point, however, she nearings =n view to avoiding any possi i $s wag incorporatec in vA act during e..ge enate Committ ee that the wages etropelitan fs not expecte ae: “community. © It: areas shall be ‘those ‘prevailing in m paid in remote, rural areas. Discrimination ané Cheritas See 8622 (4) supra, 2 se cared ion to the: Surgeon General. ho: Tay corti? Ficat fter the erate Agency has approved, a construct ion : : . , ee "application, it shall recommend | it to the Surgeon . ve General, for ‘approval and shell certify: “cost. of maintenance ond: onerr - 2 Ava dlapili ty” of fun a0 for the non-Federal share Site alt ea ae ne mE Ce beeen nnciee ER ie! ated tee ae pie cts Daten ei ee nnd nde ee has nD re 4 tlt Sanaa, AM kee oe can ee anette a Te te ete Mk t,o woe . 7 . | a . — - eo. 8625 (a) : a assurances acceptable to the Surgeon General. [0 ¢ Sete OF ee ee i AS ae - (44) To assure the availability of funds for main~- me : s kanauens and overstion. the annlicetion for the con- _gtruction.of a new project oe fately fallowing » the ear D addition to an ex- TO - its como letion. In the case of an isting facility, the applicetion mst include a state- difference betwe ‘completion. 60 ae : - oy Cope 7 oF rn the plans. and.-specifications ere in accora with 4 . " in oye i Li Lo . roe ra Lote ‘iniconformity with th ae ‘aoplicant will. conform requirements 10:62, and 10.63 regarding the provsion of 7. ny Nee Fe co oO applicant will conform to St rate standarés for opere whe snd maintenance and to ell applicable State Laws anc Stete and Local co¢es, regulations, end ordinances; ; ies urge para- section; and cee Te ala Te oe $625 (3) oar hy n application under this _ m 3 a 3 “a te He) WG 0 Coaneral shell certify to the Secre- 1/3 ner centum of she project and de- at Be -... State, except that if th lew to make peyments to t to the applicant. Upon -.sghall pravide sae t he applicant, the Surgeon Gen eral shell ty Secretary . to et et ; na geory General. ae _after ged on’ such ! ow la add en's YR eta aes ee, A 8625 (d) fc See 8624, supra. Certific or made "after sucn inspection ané on such conti General shall determine. ote that under 025 the Surgeon General is mancatorvy” and | that nnds ation wicer tne : ~4 meant oft a ication 23 70 S3m0uny iS Tilzawige ~angavor oe Bhe- original bill provided for certification "after such in- spections and on such conditions designed to assure satisfactory com- pletion of the project. ag the Surgeon Generel shall determine." In this Connect ion the Surgeon General vas to utilize the services of the Federal orks Agency. The Senate Committee omitted this provision. See BE. Hearings. p. 209 “Wnder the original bill el insnactions would. have been mde by Federal agencies but under the bill es reported this fun otion would “pecome primarily a: ‘State respongibili ity, with the, Federal Government... making only. ach checks as might. ‘be necessary. to assure itself that: the “States were discharging ‘their: responsibility or to investigete alleged .. defaults... S.. Report. No. .674, pe Lk. ; L 1 Ae a This was consistent ' 5 Sonate Committee? S ‘policy of oo delegating additional functions “to the § States. See 8612 (»), 622 supra, co (635 infra. Til. Direct Paymen to Anvlicnnts This orovision was contains in the original bill and was yin the: Senate ! Hearings, p- 107: “Note the t payments. to 2 hand: exsept in: ‘the ‘situation. spelled. out in, the Act, & niteant for the cost of vork nerformed end materials and pleted. 70. 14 ea cle waltatelT bodman etc edu cles ea cn be crane en eae elt ne CE a he RS aan Fame et fo marge cat amen be ane IRN RR Te dl oe alate LCS Bae ade! Mo -- $625 (oy (2): The second installment when the mechanical work has been substantially roughed in, and” - (3) The third installment when work under the con- So." oY “sable costs such as architect's fee, inspection cost, and cost of equinment shal? be incluéed in requests for pay- or more of the stages in¢dicated in this | woe .... Ments- made at one che bests fof & e. entire pro- ‘cation by - cee eg es Ma ane lat Sind dee ante caret antl tin Nah Se sadinitines adie! stion Spa a - “dle ¢.. 625 (c) Amendment of any approved apolic is So _° , shall be subject to aporovai in the same manner as *. néer suosection (») Gartifieation wz upon approval te Pe any additional paym nt be made from the aoplicable allot- : ment. for the fiscal year in which such amended certiri- on's conformity with suffice for the amendment. Ber Fate Uo it lant ide $625 (4) . LAW: sw tee, 625 (4) The funds naid under this section for 1 the construction veall be used solely of en approved sha tant Serna tt sect as so snnrovec. REGULATIONS: "$19.79 Us) Gonsteuction > a peveive Fetereal 7uncs for apoiionnis for constiuction Oe project grants, or the State itself is en , ede- : es 2g of account an fiserl controls s Se we State. local or other funcs uge N é- disbursement of af : gf . at apolicants receiving . all funds rece syed for egardless of whether Federe x -. . records shall be. maintained © Agency or directly. ag. through the State bec let pachb sehen os he gperilus ebb” ne ~ 3 ee tat aie dena ve in anand ee 8625 (a) Cc certified for payment by the Surgeon General for aorroved. construction projects." ° ‘ o 5 - “anplicant for the cost of work nerforned ‘and 1 naberials and equipment furnished. Requests for vayment uncer the construction contract shall be submitteé in each oF three stages, as fo liows: ee test jastetiaent went ie than 25 percent oy The second installment when the mechanical work has Ko . been substantially roughed in, and ' (3) The thiré installment when work under the construc- this veracranh. ~ ° ye All casts that have not been Geternined at the time the ee caliyccanleni Pao el int Me aia AoC Bd a ab ater ai oe Ee AER ad Cha meiedecte atc AT ee L e a te Ba alee i . w . : 4 ‘ : c oo, a w Of a my @ of D nedu2 sone ta accp less £ ‘6. AS wheat tee tree Eid CRE, nib bmi isa € tet est a A a Aa oe TE aA Bir oP Sen aca tn? : - 3 “2 - ' LAW: “" ‘ttgee. 625 (e). If any hospital for which ‘funds have Deon this section shell, at any time within twent; $ 2 3 sr (2) whieh is not he as 2 transferee by . the State Acency designe ted vursuant to se ation 623 (a) & v é x @, or its successor, or e) caase to be a nonprofit ‘nospital, as ‘defined in _ seotion 632 (a). he United. States : einen ad ade RS an acetate Rated 5 ee abaes Satine mice nm 631 (a) : . Sah Bt Ee "Part D--Miscellaneous - ‘ arcentag per centun as the ner. ‘capita income of sist. rratio. “t050 State bears to the ner capita income of the continental United States (excluding Alaska), axcent that (1) allotment, percentage shell in no case be more than 75 per s . oo! oa ’ ' “for determination of Stetes' allotment. a oOo oO cain oa ine = a 7 3 rg we x ; percentage . ranging from: io ionle Bee ncn Stare there would be determined by. “stetutory | . 631 (2)) 2 Fecerel nercenteze, which would de rminine the sllotments as among . r “formule (se utilized as a factor in deter the | States (sce, 62), and elso ta fix the proportion of the : _pragects, in the respective States which serene funds, eae 625 (o)).., This Federal... ee opet, bosts.: c ine of the * ‘State bu ne ae a dette eae eet ae A aoe aoe vk en” See Sa BEAN ee a Sanwa nem BE RUE Smee ae dose rete oe . ; s 8631 (a) fo - capita income equal to the nabiona. ever ee would have a Bo Federsl percentage of SC, end would therefore have to fur- nish from State or local sources one-half “ne cost of each o State with a ter construction project within the State. In sapita income enly ¢ a of that cr tne tabio 1 as @ Whole, ne FeGeral Government would bear 75 percent of the cost of oro- -jects, the maximum Poderal. pe eccentage orovided; while. in a ¢ ; r one and one-third. times, the: 3 lie: Federa? percentage, ‘would Be 33-1 /3cethe “Ainimum authorized. « For’projects in Alaska and Hawaii, the - _' Federal percentage woule. be 50; for those in Puerto Rico, 2. ° - " §. Report No. 674, p. 11. . It may be spelled out in the following canner: 100% ~ 50% K Stete averaze per capita income _ Average per. capita Continental U. S, income ne phe ‘and apnroved:. Senate pills the age wag’) ‘6 ‘used in determining the” extent. of Pederak particine Stion ‘in. individual projects. This variable’ percents ge was: “chenged by the. House Committee to the . flat. 33- 1/36: of, constructio eosts: Report J To. 2519, Be es re “S60 suvra mee os ‘The provision. with respect to the Virgin Islands was { a -edded by P. Le 13, Sota Congress, | H.R. 5889. _ fae me Peach eign ace a SMaeme Li Glade Ay cnt A Tat ety Bea te ah, TONE sada! ere ON Ce ot | Oo B31 Cb) fl ~ igec, 631. (5) the allotuent nercentages shall. be pro- | aCe a Me LS en oh ne . oe : eo / mulgated oy the Surgeon General between July 1 and 1 2£ each even-numbered year, on the basis of Nod ar capi ree rag v4 Fa taged wel, : saa poe! pits “ “consecutive years for which ‘satisfactory data’are. se ". -. availedle from the Denartment of Commerce. Such vrorml- « be conclusive for each of the two fiscal “years in the period beginning July 1 next succeeding .-.; Proviéed, That. the Surgeon General Le e original vill provided simply that the allotment arcentagas would be determined by reguletion on the basis of ‘relative — nancial neeé, the Senate Committee's revision snecifically set forth @ basis of measuring such relative need, viz., ver capita income i h figures for the three most recent consecutive my f t “the result is ani ynenéifure in the poorer States, neec.' E. Hearings, n- 16. 631 (c) she severe 21 States of the latest figures LATIONS: (0) Povulation. In computing the population of the a ree cece Stabe. thereot for “purposes of + the eee “ “Shc e2 fasten ts. stat 1: not result in any. increase, in the ue ao. lt : : - mn Bo Peat cole ' _ total ponulat ion of the 2 State over | the figures cert . , . Die pb Vey LAW: : gee, 631 (ad) the term iState! includes Alaska, + . . : . + NS ~ . Hawaii, Puerto Rico, tne ¥ Tirgin-Islands, and ta: iu . District of Columbia." nthe fon: . contained, 4 a The virgin Hass wets ads e Tea ate Laan aan Liha ae kc ae f bae 2 eethewe Eae t T i . ae 7 8631 te) Nec. 6 (s), the. “torn” hospi ital! (except. as used in a a 7 ‘section a2 (a) 2 4 2) includes Siblt c health cente rs. Tae . . . feeb. a , : sported in Sonnection with hospitals, “but aces. not "7... dnelinde any hosnital furnishing primarily domiciliary “1 hospital, as “you: genf lenien well know, already | far beyond as strucyure of bricxs anc. mortar, con- is. something taining a given | number” of beds for- occupancy by sick neople. It. represents: a ¢ combination of “facilities” ané staff ‘that serves. the. dual. 2 smose of caring for netients and training personrel. nucleus or oreenization for medical sefvice- a whe ee aca a ail “ / DUJL Gs primarily don iciliary care. The term "hosnital” ex- | - cent as applied genere to include nublic healta centers, shall be trestricted to institutions vro- “widing community” service. for in- spatient 2 anit or sur: . found. to sentawute public hazare. (z) Allied special hospital. Cardiac, eve-ear-nose- throat isolation, matern ity. children's orthopedic, anc ‘skin and cancer “ag wetl a s other hospitals providing re . Bg a ge . Ad nosoital , the prisary treatment of chronic illness, ¢ includi ine + generative Giseases, anc which furnishes. 2 he Ge “cilosis and mental hospitals, nursing homes, ne 2), . . stitutions, the primary purrose of which is domiciliary decane Sloveh, RA Lo EO Seat ares nat Nn eh RV allen Alte BE a Laden het a BRT te ine ined abn et tas Bia Rate oe bein Dai tanbenbiore altar ee Qe fetes em Fat O° . ¢ . 3631 (e) c ; mo St te - se a. oe, / / . a I days Curing the year are customarily assignable. to the a) following oategor : Chronic, convalescent, and rest, crug and alcos -olic, 7 ‘ x eroatgert of nervous anc nental {liness but exclucing in- tics. tS stitutions for the feerle-minded and epiler hic h sel, A tyne of mental hospital ge oe LE where patients may: rere ive intensive tre atment, oes “af * saa A hospital for. the diagnosis ” \ Va “and treats nt of tuberculosis, exclucing preventoria. ~ - (n) Eogpital bed. A bed for an adult or child patient. he newsorn in a nursery, pecs in lasor ee ta ed ee Na baa de Fr Sete Coons a De, LR ete ti ice tea Ra ee Lom hea at ng OO naa ae eet cre A A eMac ae ae Ble 3 Me 8631, (2) Fe aa oo wo . : j he LAM: a NS), 631 (e) the ‘term ' public ‘health center’ meens a a nublicly owned fscility for the ‘provision of suolie na ata oo. raleted facilities uci 28 “glinies! ant aininfetrative offices: ateh -asepaduulpngay 234 .In the original dill the term wes Cefine? to mean “a pubicly owned facility for the provision of wublic pee services anc. pecical | Carena—. The last three wor cs were omitted in oo te, the Sureéon Gen neral's stot proper Ww orkshop. ‘for: fhe tm -- culerly in more rem mote areas, “the of. providing neet.ed. emergency “bets a! “$. Hearings 2 pe ATS 5. “Hear INES Tb. health. zenter ‘may be. j > Wo Hearings, ov. 22..- Soe also 9 yo SRE Lk wi - gurisciction.’ =~ cer pete (r) Public health services. a $ : tort ia high deg ee already vroviees 28 @ 0. ervices wnich the community +. matter of practice, the term shall incluée such acti- _—_ _ : .. tional services as the commun Sige mk vedbe Hat ag tte coe nba it Res Decalsindnn cotinine, Laken eck cam wi fare td saben Ln a be Se. 3631 (Cg) LAW: Sec. 631 (zg) the tern ‘nonprofit nospital' means sny hospital cwne? and onerate? by 4 enroors.tion or essocie- 7 - of the net earnings of which inures, oF & DE ESS shoresolte er : 6 The original bill containec a simil-r fefin wores “or may lawfully inure” were omitted... T ‘these works thus confsrming the definition te o 22101 66) of the Internal Rew enue Code “Beep possibly. fo war’ ‘ energoncy grants s undor. was “apparently ne recedent for: Federa gi eer teofib tastitibuicns De. Bre role: ‘end -importance of the voluntary nonprofit. organization in “the hospital “system. Was well Aeveloped: in the hearings. . Dr. Snelzer of - the Anerican Hospital Association testified before both ao with tho ba wckeround of ‘the nonprofit commmity hospita £ oy the citizens of the the community, these hospitals now ranéer a major portion of th general hospita al care to the citizens of this country. Meny of these ~ voluntary hospitels are operated ty tho various = churches Their et organization ‘ant. Suppor, Private charity’. ‘throug a “hese « eed ay ne ticularly f forthe: ‘der “and the ‘tuberculous. “However, fe ts fortunate “that in “legislation ~ with the croad. aims indicated. his bill, provision is mace for. maintaining. the best in our present svsten of hospital. service. naxing nossibdle ¢ ke to bota nonnrofit. ank aqvernnentsl nospsts PWR stevie ee dg _ frase say ike be cemtavnele Te ie a poy . Wo - te . pain ha sian ia aA lt a Ta ne a tan Be ol Cd emg LS nah nal elas So bd danni Sy Se a ena hc aaa nt EL aol 7 y ae tele (a at at Caen Baas Cogtees ies ae oy may’ ne” gede. ‘bo affer its agsistence to Ghat ‘class of: instruc—’ oo i Mee " ¢40ns which are alreaty: carrying: the major. burden of nospitel care." H. Hearings, n. 4a; see also p. 66. — #eAsonable than an: gubrich £ public. gift. ‘to any “ieind of private rather vedical denarture fron “hospital. At least, it: seems to me a rat stablished practice. " §, Eeerines 0. 22. Elsewhere in’ the Senate Hoarines (pn. 300, 36u} there was testimony that rublic grants be confined to pudlic institution Tre Senate Committee however re- nonprofit institutions -tainec the original provision for grants to o and added $625 (e) - supra. thus protecting She public investment’ for’ hs Te heard, off ‘erg Federal “through - the States, under: Stat e ‘plans, to private charitable hospitals fit, Thetis a éerarture: from some ‘principles. not! onerated ‘for, protit.. Sone of. +hose- hosnitats. are denominational. in: character; others are not be in favor of such 4 be Se opurely > charitagle. Orfinerily T voult t . grant; dut. the hospite al situation. is: pecul tar... If we. undertake tO confine? hospital a eid. to public ho nitais, in. effect we ‘freeze the aééition ‘to ‘a particular “agspital in’ a “certain section. ol. me that in that event it is. rerfectly oroner thay Federal aid be eX- tented’ vo suck, private “hospitals. as welk 28 za: public nospitals - t : : “SE. 3 j . coke . 1 t at ao thee, Sta Sahat es bin ic hatred dd, - : ” oe a es i - : mo er . Sos , - ™ a cop ee ee 7 Pa Lo LAW: ‘tlgec, 631 (h) the term ‘construction’ incluces con- . “ a +. \ : struction of ney buil’ings, expansion, renoceling, anc excépt with respect to nubdlic health centers, the cost of: The original ill: and “the pall as renor in Iudet’ in. the definition lentscani het “by. the Senate Committee oes ing, legal. fees. anc. Nall other, expenses "T1iustrative oF gorollary fa cilities: which would be eligible for -y | | Federal aid would de nurses! home or treining facilities, out-patient A “ane laboratery facili ties in connection: with ‘hospitals, laboratories, a _ ant. clinics in conne ection with Stats or local health cepartments. to which, night. be aided. fin ineiatly: from Federal, pogren iowld include’ the ing of new y stress wi cnt eet has hte a 2 Ad carte Te ral ese ATP a a tert ante eae me a rt “eli aii damien A hate oa desta nds wy sch a Bd . call euch items a vart of the con- “Mr. Langer: The Senator would struction cost? « . pena st a s at oy Shey ‘ivalr. constitute | part oF saaalyly St ACD hte ene nt one oe me tmnt hae” fee TE Neamt tne a iJ, 4631 ( Tee, f construction! means the a 4 w ¢ 2 OF necessary a a fo bet bat . ‘. F pete 9 aidan tee a ie nb a ke aa LAW: "Sac, 622 (a) Whenever the Surgeon General, efter reason- vy i ta :3 QO ch t4+ Loy oO v 3 a o os 3 oO rH et 5 i + <2 5 4 om rs s aD p Kh + mr vt et oO co mw ao tn ct e ct eo 2 foo: . - . agency, Cesignatec in accor¢ance with section 612 fa) (2), finds that the State agency is not complying substantially oO | oo with the nrovisions ‘required ty section 612 (a) to ve contained in its aprlication for funes uncer part 3, oF fter reasonazle notice anc orportunity for hearing to the State agency cesianatec in accoréance with section 623 (a) (1) finds (1) that the State agency is not com- +o ying substentiel’y with ‘the provisions required by section 62% (2), or by remulstions nreseribed pursuant 7 . to section 622, to ve conteinec in its plan eubmibted } that e any fonds have been NO under section 623 fa), or ( 2 ition, diverteé from the surieses for which they have deen allotted 9 r nai, or (3) that any assurance given in an an a “applicn ion. filed ) under section 625 is not being or can re . “ hot. be carrict, out, or © that there” is @ Substanti ial . "peliore to carry ‘out. plans “ane. specif fications 4 ipproved. ‘bY the Surgeon General under section 625, the Surgeon General may forthwith notify the Secretary of the Treasury and the Strte agency thet no further certificat- will be nade under par rt Bor part 0, as the case may be, Ea ey nig or ‘that no further certification will be nate for any x : ot project or projects desianated oy the Suraéon General as "being at rfectad oy the default, as the Surgeon General mney ‘geteraine to de aprrovriate anéer the circumstances$ -101- cman tag sti nen Me nS ens mac te erm | nt Mee a TT I EAD ie ane om teeter ee ae cn me tim tw meme es ee ee et nn ee in oe ceca 8632 (a) ane, excent with reeard to any nroject for which the aprlicetion has alreaty been approve’. anc which is aot 4 x 0 4 rt a b ‘ qi t as 1. ee af ann Aatantt feist Sirectly affected by such Cereult, ne may viveso-- Q certifications until there is no longer any failure to pores #8 uF. Loe COMDLy,. or, If compliance is impossible, until the State revays or arranges for the repayment of Federal monies which have teen Civerted or improperly expencec. A somevhat similar provision was conteine’. in the criginal dill which required the Surceon General to ‘withhold nayments to the States’. / if, after hearing, he found failure to comply with any requirements of a State anvlication for survey and planning funés or of a State plan. Withholding would continue until there was no longer failure to comply. The Senate Committee revised the provision to nermit with- holding unéer such circumstances as well as in the event of func ¢ci- version or failure to comly with construction nians and snecifications; also that payments to the State or construction annlicant might ce ‘withheld, as approvriate, end withholding may continue until there is no longer failure to comly or until revayment of Federal funcs is arrancec. Note that the bill as reported dy Senate Committee gave sinilar “opportunity to a construction anplicant for a hearing before the Surzeon General. $. Report No. 674, my. 13, 14. The House Comnittee See $632 (d), infra. “restricted the opportunity to the State. ‘ vo 6 oO rn 8652 (>) (1) — C baw, "Sec, 632 (v) (1). If the Surgeon General refuses to acprove any acplicstion uncer section 625, the State ‘may arneal to the Unite States circuit court of anveals for the circuit in which such State is locates. The i place : in ‘the. United States. The Susebon eoneres shall | Se “ a bas been sugcester. th at there. ought to be some “un. - Have you given consideration to that in. . may: “may not: be, consi idered ‘unless es connentiig 8 nore: directly on your question, Senator, it 2 | think,. ‘i put. in an appeal, ec eae ete vee mere Ea are Semaine Fate dear ot anna rasta teed wee eer te hdd Bt haat alt oar aA ATS en aT Rae dae De a eet SP ert oot a ee Feed Bet 7 ‘8652, ) @, ag omitted. ‘tn “the” mo “objected to the: court “review Dr rovision. oducet by Congressman ' House version of the e bill, A C&R. 562 6, in Priest). Be ware ed extentet, periods. In resnect of the objections to the power of the council, LT want. to be perfectly fair and repeat that I said to the Senete Committee that this is a matter oor the Coneress tc determine. uenerst ol feel, could: administer the bili either his score and. r support his -./ 276 The Surzeon n , of it. ‘organization epplying for ‘funes “unéer the: ne of tHe. aor ant. ‘which is not satisfied with the: ‘determination of. the Sunzeon ‘General denying @ construc- “tion ‘project may appeal “torthe United States: Circuit Court of a ‘Apneals.. Ye fee hat this would establish’ bad precedent in — ee that: at. would: forthe first time under. a Federal proaran of : ‘the pverruling - ‘é x the. Senate J the jurt:. if, his appli~. “ie lets id Fein Baar aa ta ha Sa ade ce es 8652 Co), (2) - | LAW: Dae SS eg, 632 (b) (2) The findings of fact by the Sure eo * X General, unless substantielly contrery to the weight of the evidence, shall te conclusive; cut the cours, we ‘findings of fact and mey nocify his previous action, and shall certis “7 to the court the transcrint and re- “cord of, the. eur ether proceedings. Such new or modified “is’ atisfied- with the Surgeon. General's. a¢ ion iéing provision, or if he refuses te anvrove an appli Nation, ther re “may D be an appeal to the United States Circuit of ety ~Arpeals, which would have. jurisdiction to affira: his action or ta set a oe Lb aside, | in whole or. in. part. = Tha hearing in court would be upon | Fs om General of : Spates taser hag alts cbse a Bie lS ate tet ab wont oe Thee ant IE greta ete FEE RA eae ad le Bi ce ee LE Ei Aye "Federal Eosnital ations shall be subject to. the apnroval of tke Administrator." , for more eeteiled @iscussions ; Acminis trative. regulation ns ; ee 8 02, Supra, ant. 8635, : nower ss." : 4 ~ointed mems ers shall be persons who are _outstants ing : ia flelds nerte ining to nosrital and health activities, “three of whon shall be puter twas. in tatters releting rey TE + he consumers hospital eezrices and shall be e@ "persons. feniliar L te with the ‘need for, hosn vital services in. urban or f- ms wo Bat aeereea ia ‘ z o wh . 4 5 : _ surat areas. Bach an sointed member shall hold office for 2 term of four years, exce ot that any memoer ap~ painted | to “eau a “vacancy occuring | prion voy the ex | Adninistrator at » ‘end. of the: first 3 elizible for reannoint men nt if he has no ot served -107- patna nite lata: ii Rae hn oe torte re enemas creat tment. “The council. of the cousct, shot? receive , compensation fixed by ‘the ‘Adninistrator, but not exceeding | i ‘a Federal “Advisory. Counédl in’ which the eight -péreons were. 4 toiba-outstert ing in fields. perteinine to hospital and health activities, 2B Rajon ty. OF. vhor. were, fo. be. Authorities, on. hospital ep 7 : psi me ne SEB eh telat ate! erent ls A at eae Bae an EG, late entkialtte be al athe ait RS eA EE “The Senate rej rar's amendment for aqvat public and ‘professions? re" ‘Print So. 3. vp. 66, 70. ected Senator ur 8 tetion. 8. inous- best imony as 49 oe abe 235 2TeF LE, 29, 15, 9 0, itt changed the repre- tatives 5 3 The House Son Council's compositis étainin, authori Tre conference ‘Re- he Senate! s 5 to 3 Oye hospit : Hh. Rovort “port, which was not adopted “pronosed. a return to + represgatation. 'C, Report No. 2697, -P- 13. who Dee Jiation of Council menbers, ving apnointments conrirmed osteopatnic | representation, 12 or.16 members, H ‘Mote the discussion on 54 8. ‘Hearings p. iki; the advisability of by: ‘the Senate, 5- ‘Hearings, DY. tho; 15 se “E,- “Hearings p. 180; and, a darger, Council ‘of ings: pe 16d: nolitical ¢ aifh ray 8 seeteiun the! nay ge ‘program including. the-power of ‘prior ¢ ( aos out the program. Consistent. ‘with changing’ the: designation of the A as teavisory” council to a Whogpitel”™ council, the Senate Committee cue “tained the genéral njowers* “Sf advising the- “Surgeon General, “granted: -. nower for prior annroval of reeulations on the formation ard adminis- tration of State plans and arantec powervfor the conduct of hearings on a ith final -abthority, 10. approve such. plans... ha egulation ma, ons: et “and ‘in its aes. ‘functions 3 otéd ‘ina. quasi-judicial capacity-— 8h ‘Committee Print No. 3, D- co. ‘The President's: letter of January £ the House, Committee ‘objected to the pro- ._ ary “A946, to the Chairman of. ased: functions of. the. Council, particuler ty, the power te nears the aT ai Kiet m nape dakaabbenc ta id Beee as Nee rit elegy Ma Soa Tt Li, a pF et Ia we Rene ie aban a i Seadsetetiileins a ciel Manan Legh lt rena aed voty with power %o overrice the actions of the resmonsibl: ad- ~ ninistrator, the Surgeon General. This part-time council, .con- posed of members wno continue with their usual occupations ead whose ~rinary allegience is to essociatians ang sxrouns outsice the Federal Government, are given finel suthority. As Senator - Murray, has statec, “WThe: oroposec, council is. probably unpre=. t-coulé. make: for muddled: inefficient» and po as ristrA ; noint ed they % members,” are’ nt trely indenendont both of the. Surgeon Gen al i < -and the Administrator. There is no- procedure for anneal. from the action or inactions of this council * * * which is accountable to nobody, reponsible to nobody. Yet this new kin nd of independent agency has important a€ministrative duties, quasi- -jucictial functions, and a veto power over the Surgeon General in * * * carrying out a progran that enyoives granting large sums of money from the Federal Treasury." Such a council thus becomes @ semi-autonomous . administrative bod dy, W which is insultated from the. general adminis— ow ji tration of the: statute and inaccessible to control through public ‘opinion... - We strongly urge” “thatthe ouncil -be-made nly: 3 Advisory Council in’ the aanner “suggested by Senat fi » by. it would’ bev assured thet. ‘the: ‘council .would- be consuited, that’ “ite would: make its.views known -i Plt, thinks. it has. been. ignored” re n Géneral ane’ that. the Presiden and Congress’ coul “be inforn mec- of what: is hannening. ss cw pee ee E See however - the steten ent. at on. 9 dy Dr. Sensenich of the S A, wa, ‘ . _ ee ‘ ‘ : “the House, Committee “aid not chang 2 she Council! Ss. fonctions. . & . objection EEG beg nee $655 (0) TAY: "Sec, 633 (c) In a¢ninistering the provisions of this General, with the approval of tse . of : ‘ wo 4 . . - * = uy Be a ic goes. nhy executive éeparthent i - vy : 2 x _ance with an agreement with the hea@ thereof. Fay- ° - ' - ment for such services and facilities shall be mace , in afvance or by way of reimbursement, as may de and the: a “ agreed “Administrator. nt furnishin of in the origirel Dill. Sea Maye 3 Ss. SHEE Cpt ae eiete Pil it tt cote ware Ae necator PR EE EN es ot te he Ci aa ae a ee a mt tla naa ark a a Ba - a . poe ce "Conference of State Azencies zu... ,Whenever in his opinion the purposes af bit RS RM AB i aph Ae - + ” Shig. title would ae ~remeted Ly a conterencs, hy 4 . . vee . a ection 623 (a) (1), ‘confer a os ss deems necessary or proper. Unon the aimlieation of De _ five or sore of such State agencies, it shell. be tne f. the Surgeon General to call a. conference. wine Fe cin whewten alee bie eh a he 8 8635 ‘nothing a this. ‘title shal 1 te construed as conferring ee oe on any Fegeral 0 fficer or employee the right to ex- ercise eny suncrvision or control over the adminis~ - tration, personnel, raintenance, ¢ or operation of any oo The ovigizal BELL 4d not , céntain this parsgranh.. The: Senate’ Was urged ta incornarate’ such a peovision into. the legislation. See. Ss. “Eearings pr 146, 282, 366; Ss. Report’ 3 No. 674, p. 15. ry “4 ~ Senator Tart , on the Senate floor statee: Wy | Presicent, in generel we have trie, therefore, to throw . @8 much vere ve on the Ste tes os possible, so ag to. remove. as: , Buch Cisereti s possible from. ‘the Federal. administrative official's This. job te not-p3 rimerily an administrative’ ones. prescribe 2n..the » with, whit States. tab comply, bepause in, “the hos ichnit ca So what we have tried to co is, first much delegation of eoneressional newer to the aCministrative. - dosarés,. as.some cf the social- Security laws: have. Gone x7 and alsa. ta leave a as uch Giseretion and. power the £ Stat - 20 ; to get | away fron too. een: given. to. the, ‘Surescn ‘General. -Parn Burean Federatio z@ 2 hee #8 ‘of ‘Tocal “inttistige ‘and “resnonsibilisy ane to" avoid centrelizes — control. One of a weaknosses in she Sill as originally intro- -113- ‘ ny ka td Pads cibisdtien. 7 x, , an Aad ase ae Bom Te a cal teen yr Ae lati oP Sata eo wo, eg Pata) ene ewe oe ka ee ae ie wet oe Pi a wik Tecate benian feist ae eae Tay ae ae a dae BE ed * weer est OO Ea ae Naar et deck rat DENSE ee ee ae ad % Si” ape aie re TB eae oe Be lta et teers ani Bt “a. nats be ie brs cama) olay a ia Re -tration felt that anplicants for Fed 4655 Auced was that it vested tao mich Giscration and control of the nrogrem in the Surzéorn General. In order to correct Qa Ss . * suka urs ead : eh nie wero agresd to oY 4-4 this weakness, Senate. While amendments, ae Baas much improved oy these h determinations: on. General, and ws 1 “On. the other hand General Plening of the Federal Works Adminis—— Saral funds should not be re- , quire? to. 40 throuch State agencies. H. Hearings, mr- 213, 219. See also 8612 (»), supre. Py "Sec. Fublic assist’; Ay Why, ane ease our lieu thereof comma and the following - ing oe the _ pees of title | St (2). to ASS 7% in (cerry -inelusive,. of this Act he. Pus Lic Health Service Act. ag Matin essed, GOH Talat IE era FF