- Union C Calendar No. 409 “erSear H. R. 3140. ; " | [Report No. 963] Ww THE HOUSE OF REPRESEN TATIVES J ANUARY 19, 1965 My. Harris introduced the: following pill; which was referred tothe Com- ae on Emershane and For eign Commerce ‘ SupreMBeR 8, 1965 om. Reported with amendments, committed to the Committee of the: Wholé House bs} on the State of the Union, and ordered to be printed : [Strike out all after the ‘enacting clause and insert the part printed in italic] | ne A BILL To amend the Public Health Service Act to assist in combating heart disease, cancer, stroke, and other major diseases. ‘Be it enacted by the Senate and House of Representa tives of the United States of America in Congress assembled, “That this Act may be cited as the “Heaxt Disease; Cancer; and Stroke Amendments of 4965" / - Sne. 2: The Public Health Service At (42 T:S.C5 eh. GA}. is amended by adding ab the ond thereof the following tT sn a oo. hook J bd Ce © © @ © om w 10 11 12 13 14 15 16 17 18 19 20 21 22 23 25 2 FOR RESEARCH AND TREATMENT TY HEART DISEASE, CANCER, SEROKE, AND OTHER ~ MAJOR DISEASES “PURPOSES “Se, 900: The purposes of this title are— ‘“e\ Through grants; to encourage and assist in the establishment of regionally: coordinated arrangements among in the fields of heart disease; cancer; stroke, and ether major arrangements; the epportunity of making available to their “(e}. De accomplish these ends without interfering with the pattems, or the methods of Snancing, of pationt eare or SAUPHORIZAPION OF APPROPREATIONS “Gre, 904; ta} There are authorized to be appropriated sueh sums as may be neeessary fer each of the next four - seal years; for grants to assist publie or nonprofit private O NM en © Oo 3a @®@ Oo FE 10 11 12 13 14 15 16 17 18 19 20 21 22 23 25 3 printed under this section for any fiseal year shall remain available for making such grants until the end of the fiscal is made: (5). A grant under this title shall be for part er all to which the application is made; exeopt that any such evant with zespeet to consizuetion of, or provision of builtin for, any facility may net exeeed 90 per eentum of the cost ef such construction or equipment: | ‘net be available to pay the eost of hospital, medical; or other eare of patients exeeps te the extent it is; as determined “pRERTEPIONS 4 is ede: of whieh 48 engeged ih research, wainiig,. diagnosis, H2 no a Re > hed rs AP r ‘ uv fe Ey tOM Te 4 5 7 8 9 ii... oly ois 12, i 1B 14.00 15... 16 17 18 ce 7 19: and ene er more hespitals affiliated therewith for teachings 20: ... 21 22 23 eb, tHe. eptien ‘ef the applicant, any ether diseasé found by iho, Surgeon General to bo of inajor signifeanee to the health of the Nation; bus only if such eroup—. i on) Sh} is situated sthin geographic ares, eo | posed of any: part er parts of any one. dr more Statés, with regulations, to be appropriate for carrying. out the + i, aRpéses of this de: am 48} has in effect axrangements for the coordination of the activities of iis component anits which the Sux geon General Gnds will be adequate for effectively: earsy: “{e} The term ‘eategérieal research conter’ means an institution tor part of an institution} the primary function of which is research including clinical research}; training co fo DT & 10 1¥ 12: 13 14. 15° 16. 17 18. 19 21, 22 23 for diagnosis aiid treatment by’ ‘providing: quelity: diagnostic and treatment services to outpatients and 5 «therelithy plovides spectaliadd, high quility Alagnostio-and ‘teatinent services for inpatients and outpationts: ¢ ‘ei unit of a hospital or éther health facility, thé primany fanetion of which is to suppost and augment Meal enpability “te} The term ‘nonprofit: as applied te any. institution oF ageney means an institution er ageney which is ewned and operated by ene er more nonprofit corporations or asse- dividual 7 Poh . initial . ef nex build 7 : nodeli Ps and alteration ‘of existing buildings; including’ architects! -sertiees, but sxe} 43 2 ff . o + - Spud the to sities of lend: Dg a 6 | referzed to as the ‘Council’}, is authorized to make grants. to publie or nonprofit private universities, medical schools, opment of regional medical complexes: | “{b} Grants under this section may bo made only upon sueh appheation may be approved only if i contains or is “{4} Hederel funds paid pursuant to any such grant will be used only for the purposes for avhiel! paid and in secordance with the applicable provisions of this title and the regulations thereunder: | : (9). the applicant will provide for such Sseal eon- : trol and fand accounting procedures as axe required by the Surgeon General te assure proper disbursement of - and adeounting for such Federal fandss form and containing such information as the Surgeon General may from time to time reasonably cequire, and Will keep such reeords and afford such access thereto of an advisory group, to advise the applicant Yand the -B9 ‘© oO a oO On ca Ge 10 Sul 12° 13 14 15 16 17 18 19 20 21 20 23 24 OR 7 | untis\. ip formulating end eamying out the plan for the establishment and operation of such regional medical the lind te be eartied on by the complex and members of the public familier with the need for the services " provided by the complex: — “GRANTS FOR ESPABLISHMENT AND OPERATION OF svith the Council, is autherized to make grants to publie or + 4e t . and ether puble er nonprofit private agencies and institutions te easish in esteblishment and operation of equipment of facilities in connection therewith: £5) Grants under this section may be made only upon such application may be approved only if i contains or is “(4). Federal funds paid pursuant to any such grant +A.) sill be used only for the purpeses for which paid - and in aeeerdance with the applieable previsiens of this | det NW eS on 0 Of DW & 10 dd: 12. 13° 14. 15. 16... 17 18... - 19... 20: 21 22. 23 | 24 25. | 8: supplant funds thet are otherwise available for esteblish- ment oF operation of the regional medion! complex with respect te whieh the grantismade;. ATH) fhe opplicens svil-provide for etal Steel com the Surgeon General te assure. proper disbursement of and: accounting fer such Federal fads: - (8 spon il he ch opto | General may from time to time reasonably require, and will keep such records and afferd such aeeess therete as. ti Bb 6 in cing othe an the regional medical complex; and 2{6} any laborer. er meehanie employed by ans less: than t} ailk on eat mo, y in the | E-S.G; 276a—-2760-5}; and the Seeretary ef Labor shall 10 ii 12 13 14 15 16 17 18 19 20 21 22 23 24 9 “oe AMEONAT ADVISORY COENCH, ON MEDICAL COMPEESES “ee, 905; {a} The Surgeon Generel, with the ep- proval of the Seeretary, may appoint; witheut regard te the civil service laws; a National Advisery Couneil on Medical Complexes: The Council shell consist of the Surgeon Gen- otherwise in the empley of the United States; whe are lead- ers in the fields of the fandamental seienees, the medieal sei- bers shell be outstending in the study; diagnosis, or treatment of heart disease; one shall be outstanding in the stady; diagnosis, ex treatment of cancer; and one shall be outstand- “(b\. Each appointed member of the Council shall held effiee for a term of four years; except that any member ap- pointed to fll a vacanes prior to the expivetion of the term for the remainder of such term; and exeept that the terms of office of the members first taking offiee shall expire; as desig- H.R. 3140-2 ho” 1 oOo eo A 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 10 ‘nated by the Surgeon General at the tine of appointment, four af the end of the first year; four at the exid of the seeond year, and four at the end of the third year alter the date of appointment: An appointed member shall not be eligible “e). Appointed members of the Counell, while attend basiness of the Council, shall be entitled fo receive eomper- cation at rates Gxed by the Seexetazy, but net exceeding $100 from their homes or regular places ef business they may be allowed travel expenses; including per diem in Hea of sub- istence, as authorized by section 5 of the Administrative General in the preparation of regulations fer; and as to peliey matters arising with respect to; the administration of this title. ‘The Council shall consider all applications for grants under this Htle and shall make recommendations to the Surgeon General with respect to approval ef applientions fox and the amounts of grants under this title: “REGULATIONS | “ge, 906: The Surzeon General, after consultation with the Couneil, shall preseribe general regulations covering the © co ~ QO on He Os no = or 5S A & & FB B&B ES 20 21 22 23, 24 25 11 thorized under other titles of this Act or other Acts of “Gre, 90% On er befere June 30; 1969; the Surgeon to the Secretary for transmission to the President and then to the Congress, a report of the aetivities under this title tegether with (4) a statement ef the relationship between Federal finsneing and financing from ether seurces of the activities undertaken pursuant te this title; {2} an appraisal of the activities assisted under this title in the light of their effectiveness im eamrying owt the puxposes of this ttle, and tion of this title in the ight thereof” Sue, 8: (a) Section + of the Publio Health Serviee Act is amended to read as fellows: “Gnomon 4, Titles E te EX, inclusive; of this Act may be cited as the ‘Publie Health Service Act” 4b} The Act of duly 4 4044 {58 Stat, 682); 08 nents o fvdbor emended by sonembering te IX 40 sm effect prior to the enactment of this Act)- as title X and 14 15 16 VW 18 19 20 21 22 23 24 . é ihe saeaytaeg eat : troieh 1014, tively 12 4 ofthis set ond serene tha¥ete, as That ihis Act my be cited as the “Heart Disease, Cancer, and. Stroke Ainendments of 1965”. Suc. 2. The Public Health Service Act (42 U.8.C., ch. 6A) is amended by adding at the end thereof the following new title: “TITLE IX—-EDUCATION, RESEARCH, TRAIN- ING, AND DEMONSTRATIONS IN THE FIELDS OF HEART DISEASE, CANCER, STROKE, AND RELATED DISEASES | “PURPOSES “Suc. 900. The purposes of this title are— Re “(a) Through grants, to encourage and assist in the establishment of regional cooperative arrangements among medical schools, research institutions, and hospitals for re- search and training (including continuing education) and for related demonstrations of patient care in the fields of heart disease, cancer, stroke, and related diseases; “(b) To afford to the medical profession and the medi- cal institutions of the Nation, through such cooperative ar- rangements, the opportunity of making available to their pa- tients the latest advances in the diagnosis and treatment of these diseases; and ne we be an co 06S 10 — 11 12 13 14 “15 13 “(c) By these means, to improve gener: manpower and facilities available to the Nat: complish these ends without interfering witi or the methods of financing, of patient care practice, or with the administration of ho: cooperation with practicing physicians, med cials, hospital administrators, and representati “priate voluntary health agencies. “AUTHORIZATION OF APPROPRIA “SEC. 901. (a) There are authorized to $50,000.000 for the fiscal year ending J $90,000,000 for the fiscal year ending Jun $200,000,000 for the fiscal year ending . for grants to assist public or nonprofit pri medical schools, research institutions, and oth profit private institutions and agencies in j ducting feasibility studies, and in operating the establishment, of regional medical prog. training, and demonstration activities for purposes of this title. Sums appropriated for any fiscal year shall remain available “grants until the énd of the fiscal year follow for which the appropriation is made. “(b) A grant under this title shall 1 of the cost of the planning or other acti: he health nd to ac- patterns, fessional , and in nter offi- Mm ¢ ppro- propriated 30, 1966, 1967, and 30, 1968, iniversities, -blic or non- ing, in con- projects for of research, ying out the r this section making such ‘he fiscal year r part or all : with respect Co am om BR oc ty “Oo 10 1 12 13 14 15 16 17 18 19 20 21 29 23 24 25 14 to which the application is made, except that any such grant with respect to construction of, or provision of built-in (as determined in accordance with regulations) equipment for, any facility may not exceed 90 per centum of the cost of such construction or equipment. “(c) Funds appropriated pursuant to this. title shall not be available to pay the cost of hospital, medical, or other care of patients except to the extent it is, as determined im accordance with regulations, incident. to those research, training, or demonstration activities which are encompassed by the purposes of this title. No patient shall be furnished hospital, medical, or other care at any facility incident to re- search, training, or demonstration activities carried out with funds appropriated pursuant to this title, unless he has been referred to such facility by a practicing physician. | “DEFINITIONS . “SEC. 902. For the purposes of this title— “(a) The term ‘regional medical program’ means a cooperative arrangement. among a group of public or non- profit private institutions or agencies engaged in research, training, diagnosis, and treatment relating to heart disease, cancer, or stroke, and, at the option of the applicant, related disease or diseases; but only if such group— “(1) is situated within a geographic area, com- posed of any part or parts of any one or more States, w on 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24. 25 15. - which the Surgeon General determines, in accordance with regulations, to be appropriate for carrying out the purposes of this title; “(2) consists of one or more medical centers, one or more clinical research centers, and one or more hos- pitals; and | “(3) has in effect cooperative arrangements among its component units which the Surgeon General finds will be adequate for effectively carrying out the purposes of this title. “(b) The term ‘medical center’ means a medical school and one or more hospitals affiliated therewith for teaching, research, and demonstration purposes. “(e) The term ‘clinical research center’ means an insti- tution (or part of an institution) the promary function of which is research, training of specialists, and demonstrations and which, in connection therewith, provides specialized, high- quality diagnostic and treatment services for inpatients and outpatients. “(d) The term ‘hospital’ means a hospital as defined in section 625(c) or other health facility in which local capability for diagnosis and treatment is supported and augmented by the program established under this title. “(e) The term ‘nonprofit’ as applied to any institution or agency means an institution or agency which is owned a oe 10 il 12 13 14 16 17 18 19 20 21 22 23 Od - 16 . and operated by one. or more nonprofit. corporations or asso- ciations no part of the net earnings of which inures, or may lawfully inure, to the benefit of any private shareholder.-or individual. “(f) The term ‘construction’ includes alteration, major repair (to the extent permitted by regulations), remodeling . and renovation of existing buildings (including initial equip- ment thereof), and: replacement. of obsolete, built-in (as - determined: in accordance with. regulations) equipment of existing buildings. - “GRANTS FOR PLANNING “Sno. 903. (a} The. Surgeon General, upon the rec- ommendation of the National Advisory Council on Regionat Medical Programs established by section 905. (hereafter in this title referred to as the ‘Council’), is authorized to make grants to public or nonprofit’ prwate universities, medical schools, research institutions, and other public ‘or ‘nonprofit private agencies and institutions to assist them .in planning the development of regional medical programs. “(b) Grants under this section.may be made only upon application therefor approved by the Surgeon General. Any such application may be approved only if it contains or as supported by— | “(1) ‘reasonable assurances that Federal funds paid pursuant to any such’ grant will. be used only for \ a 1.0.5 the purposes for. which paid-and in accordance with 2. \..the applicable: provisions of this title. and the regula- 3... ‘tions thereunder; 4. . “(2) reasonable assurances: that the: applicant will 5 provide for such fiscal contro]. and fund accounting pro- 6... -- cedures.as are required: by the Surgeon General to 7 | assure proper disbursement of and accounting for such 8. . Federal funds; - 9 (8) sreasonable assurances that the applicant..will 10. .:.. make. such reports, in: such: form and. contaming such 11...:-.; information..as: the Surgeon. General.may from ‘time 12.4 to. time. reasonably) réquire, and will keep -such records 13: . and afford stich: access thereto. as the Surgeon General 14 may -find necessary to assure the correctness and. veri- 15... fication, of ‘such reports; and 16, 3... “(4). @ satisfactory showing that the applicant. has 17: .. designated an‘ advisory group, to advise: the applicant 18... «°*(and: the. institutions Gnd. agencies participating wm the 19 _:.esulting regional medical. program).in formulating and 20... yw carrying out-the plan for. the establishment and opera- 21... tion of such regional medical program, which advisory 22. 3. group: includes:..practicing ° physicians, medical center 23... «\ officials, ‘hospital administrators, représentatives from: 2h appropriate medical societies, voluntary health agencies, 17% 10° ji 12 13 14 15 16 17 18 19 20 21 | 22 23 24 ono Od aAanrk &©& NS me 18 and representatives of other organizations, institutions, and agencies concerned with activities of the kind to be carried on under the program and members of the pub- lic familiar with the need for the services provided under the program. “GRANTS FOR ESTABLISHMENT AND OPERATION OF REGIONAL MEDICAL PROGRAMS “Suc. 904. (a) The Surgeon General, upon the recom- mendation of the Council, is authorized to make grants to public or nonprofit private universities, medical schools, re-— search institutions, and other public’ or. nonprofit private agencies and institutions to assist in establishment and opera- tion of regional medical programs, including construction and equipment of facilities in connection therewith. “(b) Grants under this section may be made only upon application therefor approved by the Surgeon General. Any such application may be approved only if it is recommended by the advisory group described in section 903(b) (4) and contains or is supported by reasonable asswrances that— “(1) Federal funds paid pursuant to any such’ grant (A) will be used only for the purposes for which paid and in accordance with the applicable provisions of this title and the regulations thereunder, and (B) will- not supplant funds that are otherwise available for: 6 Mn, a) i) ono oe AOD OF 10 11 13 14 16 17 18 19 21 22 19 _ establishment or operation of the regional ‘medical pro- gram with respect to which the grant is made; (2) the applicant will provide for such fiscal con- trol and fund accounting procedures as are required by the Surgeon General to assure proper disbursement of and accounting for such Federal funds; — | “/ 3) the applicant will make such reports, in such form and. containing such information as the ‘Surgeon General may from time to time reasonably require, and will keep such records and afford such access thereto as the Surgeon General may find necessary to assure the correctness and verification of such reports; and — “(4) any: laborer or mechanic employed by any contractor or subcontractor in the performance of work ‘on any construction aided by payments pursuant to any ~- grant under this section will be paid wages at rates not less than those prevailing on similar construction in the locality as determined by the Secretary of Labor in ac- cordance ‘with the Davis-Bacon Act, as amended (40 US8.C.276a—276a-5); and the Secretary of Labor shall have, with respect to the labor standards specified in this paragraph, the authority and functions set forth in Re- organization Plan Numbered 14 of 1950 (15 F.R. nse 3. 4 5 a) q 8 9 10. 11, 12 13... 14. 15 16 17. 18... 19 20 21 22, 23 24 25 20° oo 8176; 5. 08.0. 1832-15). and section 2: of the Act of Trine 13; 1984, as amended (40 U.S.C: 276c). .. “NAPIONAL ADVISORY ‘GOUNCIL ON: REGIONAL MEDICAL (os sproGRAMge (0 See ' “60.905: (a) The Surgeon General,: with: the ap- proval of the Secretary, may appoint, without regard to the .-eivil service laws, a: National Advisory Cowicil on Regional Medical Programs.. The Council shall consist of the Surgeon General, who shall be the chairman, and twelve members, not otherwise “in ‘the. regular full-time employ. of the United. : States, who. are: leaders in ‘the fields ofthe fundamental: sciences; the.medical sciences, or public affairs. At least two. of the. appointed ‘members shall: be'practicing: pliysicians, one shall be outstanding in the study, diagnosis,or treatment of: heart disease, one shall be outstanding im the study, diagnosis, or treatment of cancer, and. one shall be outstanding in the study, diagnosis, or treatment of stroke. _.. &(b) Each appointed member of the Council shall hold \ office: for a term of four years, ‘except that any member ap- ‘pointed to fill. a. vacancy prior to’ the. expiration’ of ‘the term- for which: his. predecessor was: appointed shall be appointed : for the remainder of sich term, and eéeept that the terms of: office of the member's first taking office shall expire, as desig- nated. by the Surgeon General at the time of appointment, four at the end of the first year, four at the end of the second okt ote oOo FF © bf} wb 6S £ Ae ae @& ® oe ee oO p we ww WY DS BW 1 BRBRBBR SE SA GS abo year, and four at'the end: of the third year’ after the date ‘of appointment. An appointed ‘member shall’ not: be eligible 46 servé continuously for more'than te terns “oS “(c) Appointed members of the Council, while: attend- Ling meetings: or conferences thereof oP otherwise ‘sérving ‘on business of the Council,.shall be entitled to receive compén- | gation at rates fined by’ the Secretary, but tiét exceeding $100 -per day, including -traveltime;: and while so serving away - from their homes or. regular places of business they may be allowed travel’ expenses, including per diem im lieu: of sub- «> sistence, as. duthorized: by: section 5 of the Administrative . Exnpenses Act of 1946 (5 U.8.0. 73b-2) ‘for persons in . the Governinent service employed intermittently. ba “(d)-The Council shall advise: and assist the Surgeon 5. General. in the preparation of regulations for, and as to policy . matters arising with respect to, the administration of this title. The Council.shall consider all applications for grants under. this. title and. shall- make recommendations to the Surgeon General with respect to approval. of applications for and the amounts of. grants under this title. | . “REGULATIONS ... “Sze. 906. The Surgeon General, after consultation with _ the Council; shall prescribe general regulations covering the -. terms and conditions for approving applications for grants -under this title and the coordination of programs assisted ~~ Ce 10 11 12 13 14 15° 16 17 18 19 20 21 22 23 20 oD Oo DO oO | 22 under this title with programs. for training,‘ research, and demonstrations relating to the’ same diseases assisted or au- thorized under other titles of this Act or. other Acts of Congress. “INFORMATION ON SPECIAL TREATMENT AND TRAINING | CENTERS “Suc, 907. The Surgeon Genéral shall establish, and maintain on a current basis; a list or lists’ of facilities in the United States equipped and staffed to provide the most ad- vanced methods and techniques in the diagnosis and treat- ment of heart disease, cancer, or stroke, together with such related information, including the availability of advanced specialty training in such facilities, as he deems useful, and shall make such list or lists and related information readily available to licensed practitioners and other persons requir- ing such information. To the end of making such list or lists and other information most useful, the Surgeon General shall from time to time consult with interested national pro- fessional organizations. “REPORT “Sng. 908. On or before June 30, 1967, the Surgeon General, after consultation with the Council, ‘shall. submit to the Secretary for transmission to the President and then to the Congress, a report of the activities under this title together with (1) a statement of the relationship between Federal bt ee eo KN Oo oO EY W 10 “U1 12 13 14 15 16 23) financing and financing from other sources of the activities undertaken pursuant io this title, (2) an appraisal of the activities assisted under this title in the light of their effective- ness in carrying out the purposes of this title, and (3) recom- mendations with respect to extension or modification of this title in the light thereof.” Sc. 3. (a) Section 1 of the Public Health Service Act is amended to read as follows: ““SRorIoN 1. Titles I | to IX, inclusive, of this Act may be cited as the ‘Public Health Service Act’.” (b) The Act of July 1, 1944 (58 Stat. 682), as amended, is further amended by renumbering title IX (as in effect prior to the enactment of this Act) as title X, and by renumbering sections 901 through 914 (as in effect prior to the enactment of this Act), and references thereto, as sections 1001 through 1014, respectively. Amend the title so as to read: “A bill to amend the Public Health Service Act to assist in combating heart disease, cancer, stroke, and related diseases.” - tzgoutv0 Sgsuastp JvEY “‘Buyyequxoo UL 4SIssB “+, OF PY eolareg YTV onan ou uous, OL ¢ payuyid aq OF perepi0 pus ‘com, : -- ©} JO OFBIG aq} UO aSNOZT STOMA OT} FO 90} TUT - “UL OT} 0} peq3TUTULOD ‘syuauIpuewe [ITAA peroded - 2967 ‘g AMENITIES goraTIM0D - wapaOg pus eTBIayUL MO sa} aq} 04 ponsopou | - GO6T ‘6T ZUVONVE | save =A -eSCOSTD. 10 Cota suo poy foxons THaVv § oa Lee "en 10doy] OVIE MH sic. 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