It. Eastern Operations Branch Staff Aoalysis Puerto Rico Regional Medical Pro Status of the Region: . Phe Puerto Rico RMP is in an anniversary status prior to triennial application. It was in the process of preparing its first triennial application when the February 1972 phase out telegram was received. . The Program was last reviewed by the June 1972 NAC. . Council's review was based on the Review Committee's recommenda- tion, a SARP recommendation and a December 1971 RMPS staff assistance visit. Council accepted the Review Committee recommendation for increased support. Although conditions were not imposed, the absence of allied health and nursing personnel on the Program Staff and the RAG, and both the compositicn and geographical distribution of RAG members were expressed concerns. Inadequate contribution from the private physician and private hospital sector remained a continuing problem. . The Program was initially scheduled for complete phase cut on June 30, 1973, as requested. The Region received $41,666 in August 1973 (FY 74 funds) and the use of unobligated funds awarded prior te the phase out to continue operations. The remaining $173,794 allocation provided from the Departmental $17.1M release was awarded per the attached back-up sheet. Current Status of the Region's Funding . FY 73 annualized level prior to phase out $1,000, 000 . FY 73 NAC recommended funding level $1,100,000 . Percent of total FY 73 funds - 1.26% . Maximum allocation from FY 74 funds $ 519,573 , FY 74 funds awarded October 1, 1973 . $ 215,460 . Maximum FY 74 funds remaining for allocation Jan. 74 §$ 304,113 Page 2 - Puerto Rico RIP iit. Sienificant Events Since the Last Council Review A BMPS staff visit was made in June 1972 to discuss the NAC review and provide orientation ebout RMPS crganizational structure, policies and review procedures to the new Fuerto Rico RMP administrator. . A Management Survey was initiated in October 1972, The survey did not disclose any gross management deficiencies although several constructive recommendations were made. The team found major improvements relative to Program Staff and the RAG. . A Review Process verification visit was conducted in late October. The review process was not certified pending final structuring and formalization of process. Documentation was received in late January 1973 that responded to questions raised during the verifi- cation visit. RMPS follow-up action was not completed, . Dr. Jorge Fernandez, Program Coordinator, appointed Rafael Rivera-Castano, M.D., M.P.H., as Acting Coordinator in September 1972 while he was working on a Committee for National Health Insurance for Puerto Rico. Effective September 1, 1973, Dr. Rivera was appointed Coordinator. Dr. Fernandez has remained on the Program Staff (50% effort) and is Project Director of a grant to the Puerto Rico Department of Health that is designed for training of auxiliary persormel in dental health. . Dr. Merlin Lugo-Faria, Chairman of the RAG resigned subsequent to joining the staff of the VA hospital in Houston, Texas. Mr. Joel R. Garcia is the new RAG Chairman. . Program Staff Professional Tech & Secy Total Dec. 72 18 13 31 July 73 3 5 8 Now 4 8 12 s A ” © 4 i LE ‘4 ‘ eee RLCION Puerto Rico . ALLOCATION FY 74 BY OPTION RM 00065 BeYWUUaLLLy Ao puLanec C-EMS D-Kidney Disease E-Hypertension / + co00 Program Staff f C001 Health Manpower C002 Project Evaluation remy PERIOD 10/1/73-12/31/73 $ 173, 794%% 41,666* PROJECT & PROGRAM ID. A C D OTHER 73,1 Development 54,579 23,656 C003 Health Planning Assistancd 22,453 TOTAL 100,688 73,10 r *Avarded 8/27/73. **In addition, $35,000 has been awarded for Pediatric Pulmonary Disease at os ed VI. Puerta Rico. 4 Program approved if e the Prosrei: ‘are delive are ge with op aff. Bec St ca rity to RMPS to the maximum subsequent to a staff site ~ sancLes with qualified (b} intactness of RAG 1d degrees involvement ; tement of two sat ag yn sys ed jects; and {c) need for reinst categorical orevious ly. ¢ nt & (d} evaluation of Puerto Rico staff activiti 7 rly 1, 1973, - GOOG ~ 03 ‘ i i i ny : : : ; : i ° : [gene cette sees Peas vattuavenen pane af i es GOGO : i 82,039 5 i i COOL 55,461 f De i i 21,157 oe O3 Heal th Planni 28,874 | Vem p19 Program for Andio= 7, O24 suel Aids dn General ok 4s tology if “70 Cancer 33,084 Blood Care in 13, 000° rare of | ‘Sub-Total All. Project Activity (SLLG,%82) Total 168,966 Percent: 55.6% Il. Tid. Rep was February 14, 1974. below were sroved to € #008 ~ Voluntary OFFS #010 ~ Malci-Unit eae request i 2 projects prog to coal « to February 14, 1974. The Univ ted support to continue program & of West Vir beginning Fel a cc vuary 16, 1974. Current Status of the Region's Funding . FY annualised level prior to phase out (enmualized level as of Jan. 1, 1973) - $1,909,900 . Region's percent of total FY 73 funds - 1.262 . Allocetions for FY 74 funds ~ $519,573 . Amount of FY 74 funds awarded to Region October 1, 1973 - $215,460 . Amount of FY 74 funds remaining to Region for allocation January 1, 1974 - $304,113 ‘ Significant Events Since Last Council Review: . Staff Visit was made on three EMS projects in July 1973 . Revision of by-laws to cont form to BMPS policy concerning grantee and RAG res sponsibilities and relationships The West Virginia RMP has been able to retain all program staff members except two that have found employment in other health related agencies. D , 600 5 mM Ss a = oo © " “ wu u mm ™~ fra : sal ro | ri “Yr as ws ! e uy i wy ed { m4 3 “au i a © oO my cH rl va) ad a Pa a oO oO dea ms a ; es ae) ww i a, 3 mu fr a > oO 2 & Qo Program Start hec. Lo7Z 14 & 2 July 1973 12 4 16 12 4 _ le RW OE The demor program de ment. The a oe et ety wed ros EASE We Lanning op Emerg i Kid ana aL Staff's Analysis of FY 1974 as tounen CAP (a) Wiedticen comments ‘by the CHP veview with this submitted to RMPS with the applica- on and has met three times th on on October 25, The next The West Vixrg the cur of the $24,073, CHP (a) iad a MaDe, YerodLa GUO. recount Renal of rvices of a glestor © serv The Univers a transplant cae BOR ~ 11/21/73 COO5 COOG ‘sunk “County Comrar C007 EM. Oc System C008 Total SM ca tcLon 49,959 16.5% rm 16,560 A fre by CU 31,600 | 31,000 ‘10.2% S152, 804 152,804 50.2% Il. Til. FLORIDA RMP Status of the Region: The Florida RMP now in its 05 operational year (2nd Year Triennium) received triemial status beginning March 1, 1972, during the February 1972 National Advisory Council. Council's actions were in agreement with the findings and reconmendations of the January 1972 Review Committee and Site Visit Team (conducted December 1971) with recommended funding levels (including a Developmental Component) of the following: Fourth Year: $1,927,706 Fifth Year: $1,987,250 Sixth Year: $1,964,775 These funding levels included funds for arenal project of $375,000 for the fourth year; $313,500 for the fifth year and $251,625 for the sixth year. By special action during the June 1972 NAC, the previous NAC approved level of $1,927,706 was increased by $321,000 to a total annualized level of $2,248,706, The action of the February 1973 NAC was in agreement with SARP and Review Committee's recommendation that the region's second year triennial application (05 operational year) be funded at the Council approved level of $2,248,706 including a developmental component and kidney activities. No key issues were identified. Florida's termination date under the phase-out concept was November 30, 1973. The region submitted a plan which requested funds for the continuation of 14 operational activities, initiation of nine new studies and the gradual reduction to a staff of 12 between June 1973 and February 15, 1974. The approved phase-out plan was for the reduction of program staff to 12, the continuation of three of the 14 operational activities, and the initiation of one study through November 30, 1973. Current Status of the Region's Funding: FY '73 annualized level prior to phase-OUt..ccecesscceseeceeen es eh 2,248, 706 Region's percent of total FY '73 fundS..cccccesssesesceseacveeees 2.83% Region's maximum allocation from FY '74 fundS..cccevceevececeessedly 166,978 Amount FY '74 funds awarded the Region 10/1/73...ssceeseseeee +e + $483,930 Maximum FY '74 funds remaining to Region for allocation 1/1/74...$683,040 Significant Events Since Last Council Review: None co0o CooL ca02 eer NL i) oS © ta al 2 Oo ai 2 102 | )} 118 ‘v} 1 1 9 122 123 7 % 225 rok fa RICCION Florida ALLOCATION BY OPTION os FY 74 B-Quality Assurance C-EMS ; D-Kidney Disease E-Hypertension RM 00024 peRtop 20L/73-12/31/73 $ 483,930 PROJECT & PROGRAM ID. B C D- E OTHER Program Staff Comm. Based Midwidery - Study Quality Standards for Rehabilitation Quality Standards for Care of Burn Patients PSRO - Quality Assurance Program ; Neonatal EMS Network | Development of Policy & Procedures: for Ed. EMS Hospital Required Infact- jon Surveilance (Miami) Hospital Required Infec~ tion Surveillance (Tampa) Community Hospital Output Drug Incompatibility Study Blood Bank Management ~ Control System Study Data Bank for Health “Planning State and Area Wht Wide Hlth. Planning Process Study Kidney Reporting and Assessment Information Sys} Community Based Hyperten-~. sion Control Program Community Based Manpower Development & Utili. Prog. 9,500. 14,500 40,000 75 ,000 175, 0 8,750 7,500. 10,000 50,403 "3,500 30,000 19,261 4,500 4,150, 5,000 263866 | * Ca a e Il. IIT. FLORIDA RMP Status of the Region: The Florida RMP now in its 05 operational year (2nd Year Triennium) received triennial status beginning March 1, 1972, during the February 1972 National Advisory Council, Council's actions were in agreement with the findings and recommendations of the January 1972 Review Committee and Site Visit Team (conducted December 1971) with recommended funding levels (including a Developmental Component) of the following: Fourth Year: $1,927,706 Fifth Year: $1,987,250 Sixth Year: $1,964,775 These funding levels included funds for arenal project of $375,000 for the fourth year; $313,500 for the fifth year and $251,625 for the sixth year. By special action during the June 1972 NAC, the previous NAC approved level of $1,927,706 was increased by $321,000 to a total annualized level of $2,248,706. The action of the February 1973 NAC was in agreement with SARP and Review Committee's recommendation that the region's second year triennial application (05 operational year) be funded at the Council approved level of $2,248,706 including a developmental component and kidney activities. No key issues were identified. Florida's termination date under the phase-out concept was November 30, 1973. The region submitted a plan which requested funds for the continuation. of 14 operational activities, initiation of nine new studies and the gradual reduction to a staff of 12 between June 1973 and February 15, 1974. The approved phase-out plan was for the reduction of program staff to 12, the continuation of three of the 14 operational activities, and the initiation of one study through November 30, 1973. Current Status of the Region's Funding: FY '73 annualized level prior to phase-OUt...ccsesescescceeees ee s$2, 248, 706 Region's percent of total FY '73 funds..cccecescesneecsscecaecees 2.83% Region's maximum allocation from FY '74 funds.....ccceeeeeeveesees $l, 166,978 Amount FY '74 funds awarded the Region 10/1/73.....seeeeseeeeee $483,930 Maximum FY '74 funds remaining to Region for allocation 1/1/74...$683,040 . * oo « . Significant Events Since Last Council Review: None ae oor fy ¢ f co000 C001 c002 c003 004 C005 ~46A 465B 102 118 119 122 123 125 Nl Florida ALLOCATION BY OPTION FY 74 B-Quality Assurance C-EMS D-Kidney Disease E-Hypertension RM 00024 REGION pertop 101/73-12/31/73. g 483,930 PROJECT & PROGRAM ID. B c Dd E OTHER Program Staff Comm. Based Midwidery - Study Quality Standards for Rehabilitation Quality Standards for Care of Burn Patients PSRP - Quality Aasurance Program , Neonatal EMS Network Development of Policy & Procedures for Ed. EMS Hospital Required Infact- ion Surveilance (Miami) Hospital Required Infec~ tion Surveillance (Tampa) -Community Hospital Output Drug Incompatibility Study Blood Bank Management ~ Control System Study Data Bank for Health -Planning State and Area Wht Wide Hith. Planning Process Study Kidney Reporting dnd Assessment Information Sys}. Community Based Hyperten-. sion Control Program ( Community. Based Manpower Development & Utili. Prog. 9,500 14,500 40,000 75,000 175, 0 8,750 7,500. 16,000 50,403 "3,500 30,000 19,261 4,150, 5,000 26;866 | ' IV. FLORIDA REGIONAL MEDICAL PROGRAM Analysis of the Resien's Capability to "ffectively Utilize Remaining VY _'74 Funds its Allocation of Although a few support personnel were terminated, the key program staff has remained intact and functional throughout the phase-out period, As of June 30, 1973, program staff consisted of sixteen professionals and ten support staff. The present staff consists of one part-time professional, 14 full-time professionals and five full-time support staff. The region is requesting a total of 12 new program staff positions; three full-time Program Manager positions; one Program-Evaluator and eight new support staff positions. The present staff represents a broad range of expertise including competence in fiscal management, program design and development, evaluation, journalism, communications and publications and nursing education. The Florida RMP as in the past continues to demonstrate flexibility, t ingenuity and foresight in adapting and responding to RMPS initatives to solve the health problems of the State. For example, the region, prior to the time that special funds for Q 3 2 o£ t EMS programs were available through RMPS, the FRMP developed and i) 2 $ = implemented a state-wide plan for EMS. A system of district EMS Advisory Councils were completed covering all areas of the state providing opportunity for refinement of the broader system recommendations developed by the State EM3 Council and its special technical committees. This activity recently received an appropri-~ ation from the State Legislature in an amount of over $600,000 and is now operating without further FRMP support under the auspices of the Florida Department of Health and Rehabilitative Services/Division of Health. Establishment of a state-wide Kidney Transplant program also demonstrates another area in which the FRMP preceded the establishment of special federal funds for this purpose. Florida now has a system of transplant centers, an organ procurement program and dialysis support facilities. State funds in the amount of nearly $500,000 have been appropriated to support this program during fiscal year 1974, While the issue of quality care evaluation has not been seen as an urgent problem in the State of Florida, the FRMP, as a result of the RMPS new priorities and options, has been asked and is assisting in promoting and establishing quality assurance programs for health care providers in selected areas of the state. Based on its close imvolvement in the planning development and implementation Page 2 - Florida RMP VI. of the Southeastern Inter-Regional Symposium on Quality Care Evaluation in 1972, the region proceded to translate this to meet Florida's needs through a series of workshops in Quality of Care Maintenance in six community hospitals in South Florida. The Regional Advisory Group, composed of 27 voting members, has remained intact and active and continues to be a viable health improvement force. Throughout the phase-out period, the Group and its committees has continued to meet to define problem areas, develop new priorities and appraise needs in relation to priorities and suggest areas for future planning. The RAC has meet three times during the current year with an average attendance of 60 percent. Analysis of the Current Application Florida's application requests the full remaining allocation of $683,048 for the period January 1, 1974 - June 30, 1974. The application was reviewed and fully endorsed by the Regional Advisory Group on October 14, 1973. The Program plan includes requests for support of twenty new project activities which will be conducted under contract between the FRMP, Inc., and various institutions and agencies in the State of Florida; project-like activities to be conducted by the Program Staff and support of the Program Staff itself. Of the twenty activities included in the application, seven address the RMPS option area of Strengthening Local Planning Processes; seven are designed to Strengthen Local Quality Assurance Efferts; four are directed to EMS; and two are directed to Kidney Disease. Florida's record in the area of attracting non-RMP funds to support successful activities has been impressive. The region states that for every RMP dollar invested in the State of Florida, more than five dollars in local support were generated. During 1972 - 1973, of a total of thirty-four program elements, thirty-two were continued without further FRMP support. Each activity presented in this application outlines the region's plans for those activities requiring ongoing support beyond June 30, 1974. Of the twenty new activities requested, eight will terminate June 30, 1974. Staff Recommendation: The Florida RMP has requested $627,536 for the support of a program staff component and twenty operational activities, all of which conform to the RMPS priorities and options, Page 3 - Florida RMP South Central Operations Branch staff recommends approval of the application as submitted. The Florida RMP application includes requests for the support of two Kidney Components. The region should be alerted to the provision contained in the Interim Rules and Reguiations issued under Title #20, Chapter 3 of the SSA-DHEW Regulation #5, Part 405 ~ Federal Health Insurance For The Aged. This regulation pertains to payment for services in connection with kidney transplants and renal dialysis to entitled beneficiaries. SCOB/DOD 11/20/73 ee ar bead CREEL, “sy bob ra aed Bae ALEOCATION BY OPTLON C-ENS Pate 1 of 2 PY 74 D-Kidney Disease _ beHypertension S REGION Florida Riu 00024 PERLOD — 1/1/74-6/30/74 $683,048 PROJECT & PROGRAM LD. A B C D Bo fOTRER- C000-Program Staff oy . 322,203 C-123-Kidney Disease Reporting and Info. system ‘| 10.,000 C-127-Advanced: EMT 21,645 C-142-EMS-Palm Beach 30,000 C-143-Quality Standards for Care of Burn Patients 15,000 C-144-PSRO-Quality Assuranc¢ Program 20 ,000 . 6-Development of Policy and Procedures for Emergency Departments (EMS) 7,000 C-147-Comminity Based Midwifery Study 20,500 C-i48 Quality Standards | 17,500 C-149-Model for Quality Caré Assessment in a Disease Category 5,000 C-151-Genetically Determined » Disease Resource Study 35,000 C-152-Quality Medical Care Standards for Short. . Term Penal Institutions 35,000 C-153-Quality Standards for Care of Renal Disease Patients ; 7,500 Page 2 of 2 RUGTOS AS Florida LOG! TRON LY PY 74 VyAe SAG PERTOD UTA 6/50/74 / OPYTON 00024 g | 685, 048 Ane ent PROIECH bs PROGRAM LD, C-155-Statewide Blood Bank Management Control System Sub-total Program Staff \ctivities (546,348) 0119-Data Bank for Health Planning 0126- EMS Frostproof area 0-135-Areawide Health Plannin: support Region VII @ ~Areawide Health Planning Support Region VI 0-139-Areawide Health Planning Support ’ Region IX 0140-Areawide Health Planning Region TIT 0-141-Study of Ambulatory Care Services Attached . to Health Facilities and Major Free Standing Ambulatory Centers Sub- a Project Activities (136,700) 29 ,000 oe 15,000 15,000 15,000 15,000 19,000 C beQuality Assurance C-EMS D-Kidney Disease I-Hypertension YT ~ fOTHER 7,700 30 ,000 TOTALS percents 119,500 17 135,200 20% 17,500 Ww ao 47 322,203 8 6 TE. Til. GEGRGIA REGIONAL MEDICAL PROGRAM Status of the Region The region will enter its (06) operational year, 3rd year of triemnium, on January 1, 1974. The 05 year continuation application was reviewed in September 1972 by the Staff Anniversary Review Panel and the National Review Committee. During its October 1972 meeting, the National Advisory Council considered the recomnendations of these review groups and recommended their approval to the Director, RMPS. The termination date for this region under the phase-out concept was Febcuary 14, 1974. The region's plan proposed the retention of eight staff members to February 14. All operational activities in the original plan were to have terminated by June 30, 1973. However, the plan was later amended following the region's request for a two month extension for selected operational activities. The request was approved. At the time of the phase-out application, the region was supporting, out of fiscal year 72 funds, 14 contracts with termination dates ranging from August 1973 thru December 1973. These were approved for continuation. Current Status of Region's Funding .- FY 73 annualized level prior to phase~out .....$2,563,000 . Region's percent of total FY 73 funds .....3.23 . Region's maximum allocation from FY 74 funds .....$1,331,922 . Total amount of FY 74 funds awarded to region October 1, 1973......$552,330 Maximum FY 74 funds remaining to region for allocation January 1, 1974 .....$779,592 Sienificant Events Since Last Review On June 5-6, 1973 an RMPS staff team visited the region to assess progress to date and plans for future support of the EMS system in DeKalb County. The Georgia RMP was one of the many RMPs which ‘competed successfully for special EMS projects to be supported out of FY 72 supplemental funds. C000 ) 32 “36 42 Nas 53 55 \ 58 “Statewide Cancer Program On cular Area Facili- Ries 38. Georgia and No. Florida REGION Georgia PERLOD_10/1/73-12/31/73 ALLOCATION BY OPTION FY 74 RM O0046 552,330 A-Strengthening Local Pl B-Quality Assurance C~EMS D-Kidney Disease E-Hypertension re PROJECT & PROGRAM ID. OTHER Program Staff . Visiting Consultants Program. for Community Hospitals 18,108 Area Facilities for Continuy ~ ing Education Facility Planning and Development Stroke Area Facilities Kidney Disease Program for Georgia Emergency Care for South Statewide System of Care — High Risk Maternal/infant Patient and Family Ed. Nurse~Midwife Service in a Multicounty Area Regional Emergency Medical - Service System Hypertension Detection and Treatment. Program TOTAL 1,969 9,857 13,000 6,000 47,519 6,700 60,900 1-186, 383 15,000 39,980 9,689 3,700 133,52. 42,934 8% 60,219 LLY 247,283 44% 15,000 3% 53,369 10% I. Tit. GEORGIA REGIONAL MUDTCAL PROGRAM Status of the Resion seion will enter its (06) operational year,.3rd year of triennium, on January 1, 1974. The 05 year continuation application was reviewed in September 1972 by the Staff Anniversary Review Panel and the National Review Committee. During its October 1972 meeting, the National Advisory Council considered the rec tions of these review groups and recommended their approval to the Director, RMPS. The termination date for this region under the phase-out concept was February 14, 1974, The region's plan preposed the retention of eicht staff members to February 14. AJL operational activities in the original plan were to have terminated by June 30, 1973. However, the plan was later amended following the region's request - for a two month extension for acted operational activities. The request was approved. At the time of the phase-out application, the region was supporting, out of fiscal year 72 funds, 14 contracts with termination dates ranging from August 1973 thru December 1973. These were approved for continuation. Cr E Current Status of Region's Funding . FY 73 annualized level prior to phase-out .....$2,563,000 . Region's percent of total FY 73 funds .....3.23 . Region's maximum allocation from FY 74 funds .....$1,331,922 . Total amount of FY 74 funds awarded to region October 1, 1973 .....$552,330 . Maximum FY 74 funds remaining to region for allocation January 1, 1974 .....$779,592 Sienificant Events Since Last Review On June 5-6, 1973 an RMPS staff team visited the region to assess progress to date and plans for future support of the EMS system in DeKalb County. The Georgia RMP was one of the many RMPs which ‘competed successfully for special EMS projects to be supported out of FY 72 supplemental funds. ee Cardiovascular Area Facili- “ies 7 J 52 ) 43 gee” REGION Georgia PERITOD_10/1/73-12/31/73 ALLOCATION BY OPTION teen PY 7h RAM 9 NO046 552,330 A-Strengthening Local Pl B-Quality Assurance C-EMS D-Kidney Disease E-Hypertension PROJECT & PROGRAM ID. OTHER 2 000 Program Staff . 3 Visiting Consultants Program for Community Hospitals 13--Statewide Cancer. Program 20 Area Facilities for Continu- ing Education 30 Facility Planning and Development Stroke Area Facilities “36 Kidney Disease Program for Georgia Emergency Care for South Georgia and No. Florida 38 Statewide System of Care ~ High Risk Maternal/Infant 42 Patient and Family Ed. Nurse-Midwife Service in a Multicounty Area 53 Regional Emergency Medical Service System Hypertension Detection and Treatment Program TOTAL 18,108 1,969 9,857 13,000 6,000 47,519 6,700 60,900 1-186 ,383 39,9380 9,689 15,000 3,700 133,52 60,219 11% 247,283 44% 15,000 | 53,369 3% 10% 133,5: 24% GEUKGLA KMP IV. Analysis of Region's Capability To Effectively Utilize its Allocation of Remaining FY '74 Throughout the phase-down period the GRMP has maintained its key professional staff, providing overall program leadership, program design and development, evaluation, monitoring, fiscal management, comunications and publications; and a history. of solid relationships with health care providers in Georgia. During February, 1973, the GRMP had a total of 46 full and part-time staff positions. In the current application, support is requested for 22 full-time and three part-time personnel. There is one secretarial vacancy. Most of the reductions have been accomplished by the centralization of the Division of Operations and thus the elimination of field personnel and their supportive staff, plus the elimination of part-time RMP representatives in the medical schools along with their supportive staff. The leadership of staff in providing program development assistance to provider institutions and local community groups continued actively during the threatened phase-out period. As examples, staff directed and participated in the development and preparation of hypertension screening program for a southeast multistate area; made community contacts and supervised the development and preparation of a large scale emergency medical service plan for the metropolitan Atlanta seven-county area; assisted a number of small Georgia communities to develop and submit applications for personnel under the National Health Service Corps Act; and continued to manage and monitor two quality assurance related contract activities funded earlier by the region. The Regional Advisory Group continues to be active in RMP affairs, and, as such, provides overall guidance including the approval of an effective contingency plan responsive to the FY'74 national priorities. Georgia has had a tradition of an excellent task force/committee structure, which provides the RAG with professional and technical review of applications. - They have now combined all Ad Hoc and standing groups into three standing task forces. Currently the region has the following standing task forces: 1) specialized services; 2} primary health services and; 3) manpower utilization and development. Because of the increased activity caused by the events of the past year, some of the groups have met on a monthly basis. The RAC meets three to four times a year. The region has been successful in attracting other funding to insure continuation support for RMP initiated activities. For example, the EMS program in DeKalb County, which received one-year GRMP support, is now self-sustaining. Also, when the original phase-out of RMP (February 1973) was announced, the region had a total of 86 program activities which it was supporting. As of November 1973, 80% of these activities are being supported by other than RMP funds. Further, The Georgia RMP has been a leader in establishing primary health care centers in under-served areas. As of August 1, 1973, support for two of the centers, Wilcox County and Danielsville, are being provided by the Department of Human Resources. Georgia RMP Page 2 . Analysis of the Current Application The application for continuing support for the remainder of FY '74 funds was reviewed and approved by the Regional Advisory Group on November 5, 1973. The total request ($779,592) is the exact amount that constitutes the region's proportionate share of available funds. The region has not requested indirect costs for any of its project activities. They have requested approximately $50,000 indirect costs in the program staff component which are to be paid to the grantee, the Medical Association of Georgia. This is considered a necessary expense for office space, heat etc. Projects #36B and #36C are requests for the continued support of renal activities. SCOB staff analysis of the application along with telephone conversations with the region reveal that RMP funds are being utilized for the training of personnel; the development of an organ procurement program; and the development of a statewide follow-up and data system. The application requests continued support for three EMS activities which were initiated and extended through 12/73, two by contract and one as a project. The Georgia RMP has had a good track record in developing an EMS prototype program in DeKalb County (one of the counties in the metropolitan Atlanta area). These three activities are a part of the region's overall plan to now regionalize and extend comprehensive EMS systems to other areas of the state, Two of the three remaining project activities are new priority thrusts, which are to be coordinated by the State Medical Society, The quality assurance effort emphasis will be placed on activities to begin to assist commmity hospitals meet PSRO Quality Assurance standards. The GRMP, through the Department of Human Resources, has supported a successful Atlanta-based Hypertension Control Program, The region now plans in cooperation with the Heart Association, the department of Human Resources, local commmities and hospitals and the State Medical Society to extend the effort on a statewide basis. Each operational activity summary in this application outlines the region's plans for continuation of the activity. While the region has requested continuation only for the prescribed period 1/74-6/74, support is requested for some of the activities through 12/74, subject to the availability of funds. Further, the region states that they have "many appropriate projects" for which support would have been requested had there been sufficient funds in the current allotment. In the event additional funds become available to RMPS, they have plans approved that fit the national priorities.Comprehensive Health Planning Agency Review of this application have now been received. . Georgia RMP . . Bege © VI. Staff Recommendation: The Georgia RMP has requested $779,592 to support a program staff component and five operational activities involving eight institutions or organizations. Program Staff Component......+e- 62 $255,971 | Operational Project Activities...... $523,621 SCOB Staff recommends approval of this application as submitted. The Georgia RMP application includes requests for the support of two Kidney components. The region should be alerted to the provision contained in the interim rules and regulations issued under title #20, chapter 3 of the SSA-DHEW Regulation #5, Part 405 - Federal Health Insurance for the Aged. This regulation pertains .to payment for services in connection with kidney transplants and renal dialysis to entitled beneficiaries. RMPS : SCOB : DOD JTJ:omg:11-19-73 Me REE LRT LES FIO A ES ’ DeQuality Assurance ~ ALLOCATION BY OPTION C-LMS D-Kidney Disease | ‘ . FY 74 . , . ’ sete ee : ; k-ilypertension REGION___GEORGIA RN_00046 PERIOD 1/1/74-6/30/74 $779 592 PROJECT & PROGRAM ID, A B C D iB . OTHER C000 Program Staff Component ° 285, 866 36--Kidney Disease Programs : Emory University 7,500 Medical College 7,500 95-Regional Emergency Medical Services Systems: South Georgia Medical Center 54,068 (ageham County 129,65] of Columbus | ~ 85,550 63-Statewide System of care High Risk Maternal/Infa. Enory University 12,500 Department of Human , Resources 30,150 64-Strengthening Quality Assurance Efforts- Medical Assn. of Georgia 86,500 65-Statewide Hypertension ‘Control Program-Medical ‘Assn. of Georgia . | ; 80 ,307 TOTALS | 42,650 86,500 |269,269 | 15,000 | 80,307 | 285,866 Percents 53 113 353 2% 10% 37% It. Iii. INDIANA REGIONAL MEDICAL PROGRAM Status of Region The region is currently in anniversary status prior to triennium. The region was reviewed by the National Review Committee and the National Advisory Council during the September/October 1972 review cycle. The reviewers agreed that Indiana had shown considerable progress in turning the program around but was not ready for triennial status. A two year funding was recommended for the region at $1,200,000 for each of the two years to give them sufficient time to hire a full-time director and to respond to the new directions the program had delineated. Current Status of Region's Funding . The FY 73 annualized funding level for IRMP prior to phase-out was $1,000,000. This is 1.26 percent of the total FY 73 level. . The FY 74 allocation for the region is $519,573. . The region has been awarded $215,460 of the FY 74 allocation. The funds remaining for the region to apply for is $304,113 for the period of January 1, 1974 - June 30, 1974. . The phase-out plan as approved allowed the region to continue thru February 14, 1974. They had requested funding for an orderly phase-out of program staff, 5 operational activities and 6 contracts. The region was approved for the phase-out of program staff and the funding of the 6 contracts and 2 operational activities. Significant Events Since Last Review . Mr. Louis Gordon was hired as a full-time Executive Director to administer the program. . The region's review process and by-laws were re-written to conform to RMPS guidlines and policies. ALLOCATION BY OPTION A A-Strengthening Local B-Quality Assurance C-EMS D-Kidney Disease FY 74_ — E-Hypertension REGION__ Indiana RM__00043 PERIOD_10/1/73=12/31/73 $ 215,460 PROJECT & PROGRAM ID. A B C D E OTHE C000 Program Staff 39,092 | 58,638 | 39,092 58,638 C002 Regionalization 20,000 ' TOTAL 20,000 39,092 58,638 | 39,092 58,638 10% 18% 27% 18% 27% Vv, yan TN! a ene ue the Research OOpe The Indiana di 1SC] p phi Uy and Pyalue 5 i t Ht a de is however, e total the The Cooi actively program, re ime employee. The pre the pr Decenmbe . Son who is now serving as Director of JRMP's Communi ty “Relation Divis ion. maintained and b5% of all RAG ad support im writing 15% elected to ' the RAG has been en continued par ticipatic Sever i to oth : RAY reduc " In recent montas, Executive Com on are ition to the chairnc _Sroup so this + s formed and te) consisted clearing- the Coor reves ce L pr Cpos: " The full RAG re : : at ‘the RAG meeting above 70% and there was roported to be good 1 . the program. a “very 4 In ad 4 tha of Der, Ronald By ttee under entbusias7 Analysis of Current ld seven project proposals, of cn by the RAG. They , Specialized Medical Tel-Med, and Perinata: The proposal review committee which six are new activities, include proposals for Kidney, S; “ization or EMS, 2 arid Infants mortality. Four of these : s were funded with the October 1, 1975, award and support for tl remaining three are requested in the current application. ‘These activities are a J result of program development by staff that has been on-going during recent months. 4 Services, cat 1 Prosram staff continue to fund and monitor a number of projects and contracts which have either phased out of IRMP support and into other means of financing or soon will. Specific outcomes of these activities are being recorded in periodic and final reports, but : fow of them should be noted as follows; Neighborhood Health centers, Renal Allograft. Family Nurse Practitioner, Home Care Agency H ealth Maintenance Teaa, and various continuing educational projects. Page 2 The region has continued their sub-regionalization thrusts and. have functioned as a facilitator, convener, and broker in developing a munber of much needed programs at both regional and subregional levels. some of the programs are as follows: 1. Production of an EMS bill for introduction by the Covernor into the upcoming session of the legislature. Through efforts of TRHP, which served as coordinating agency, some twenty groups helped develop the legislation and now are participating in the effort to gain its passage. 2. Strengthened relationship between the health planning and health program implementation functions in the region, A series of con- ferences ané studies this year resulted, in most. instances, in inclusion of IRMP's Area Action Groups into the planning process. 3. Funding and monitoring of projects and contracts which have either phased out of IRMP support and into other means of financing or soon will. 4. Strengthened relationships through the RAG with health care organizations throughout the state, 5. Development and approval of new by-laws for the RAG to reflect national guidelines. 6. Completion of a review process that conforms with RMPS guidelines. Indiana has a State Renal Comnittee and has developed a plan for a statewide program. As a result of the efforts of the IRMP staff, the State Legislature has appropriated $500,000 annually for the support of their chronic dialysis and transplant program. The transplant efforts at the present time is a cooperative effort between Indiana University Medical School, VA Hospital, and Methodist Hospital of Indianapolis. They presently are training 55 patients for home dialysis, 2 per week in Center, and are transplanting an average of three patients monthly. Project 0036 requests funds for the expansion of this program aimed at the development of testing procedures for the prevention of immunological loss of transplanted kidneys. The IRMP has been extremely cooperative in recent months to advice and recommendations of RMPS staff. The current application suggests that the region is being more responsive to the health care needs of the people of the state. CHP review and comments are included in the current application. Indiana RMP Page 3 eae eit me : VIwe Staff Recommendation: indiana RMP has requested $304,115 for Progra Staff and three activities for the period 1/1/74-6/30/74, SCOR Staff recommends approval of this application as submitted. The IRMP application includes one kidney component. The region should be alerted to the provision contained in the Interim Rules and Regulations issued under Title 20 -. Chapter 3 of SSA-DHEW - Regulation #5 - Part 405-Federal Health Insurance for the As This regulation pertains to payment tor services in connection with kidney transplants and renai dialysis to entitled beneficiaries. RMPS :SCOB : DOD 11-20-73 Wr omg A~Strenpthening Local Plng, -Qualily Assurance “ " rs re Cp ik ye TP AE , . ALLOCATION BY OPPTON C EMS ‘ FY 74 DeKidney Disease ae ’ HeHypertension REGION: T ndiana PERLOD 4/1 /74-6/30/74 een mere Nera 4 mornin ee det ss ee sia soonest eine ! PROJECT & PROGRAM 3). A BO C I) Bo. forms. (000-Program Staff 195,984 i? 0034-Categorization of ENS 23,500 0036-Kidney Project 39,429 nN 0037-Specialized Medical Services 45 ,200 TOTALS 45,200 23,500 39,429 195,984 : Percent of Allocation 15 ae co go "13% . 64% I II III MEMPHIS Status of the Region: August 71 Coumcil approved triennial status, but withheld developmental component authority because of complexity of organization. November 72 Council accepted Review Committee's reconmendation on the region's first anniversary application within the triennium, which approved developmental component authority. The region was continued at its triennial funding level; a $100,000 ceiling was placed on the developmental component; the region was complimented on its new and more meaningful organizational structure and its new Regional Advisory Council; and in view of the size and depth of core staff, the region was advised no further increases in core staffing were warranted. The termination date of this region under the phase-out concept was February 14, 1974. The region's plan proposed the gradual reduction from approximately 45 employees to 10 employees (but 15 employees were included in an expanded operational activity and were still included in the budget). The plen also proposed the continuation of 8 operational activities. ‘The fimding level approved for phase-out was computed so as to require more rapid reduction of staff; and 5 operational activities were approved. ‘The expanded activity to receive 13 staff members was not approved. Current Status of Funding: . FY 73 annualized level prior to phase-out...... eeeeee ee $1,627,000 Percent of total FY 73 fumdsS....c.eceeee ence eees sevens 2.05% Maximum allocation of FY 74 funds......seeeeeees seceeee $845,338 FY 74 funds awarded October 1, 1973 ©. ceeeeeeeeces .. = $350,550 Remaining FY 74 funds for January 1, 1974 allocation ... $494,788 Significant Events Since Last Review . The EMS activities supported by earmarked funds were site visited in June 1973. Dr. Joseph Johnson, Chancellor and Vice President of the U.T. Medical Unit (an interested and informed supporter of RMP) has been replaced by Dr. Edmund Pellegrino (an interested and informed supporter of RMP). Po REGION Memphis PERIOD _10/1/73-12/31/73 ALLOCATION BY OPTION “FY 74 RM C-EMS D-Kidney Disease E-lHypertension QOO51 350,550 PROJECT & PROCRAM ID. A OTHER -C000 Regional Staff Serv. COOL Ident. of Inactive Nurses r in Region -CQ002 Ident. of Hyper. Preva-~ lence & Resources C003 Assist. in developing Subreg. CHP Plan. / C004 Ident. of Incidence/Pre- valence of Kid. Dis.& Res ' C005 Invent. of Hlth., Ed, & Welfare Resources © High Risk Infant Prog. 33 Improved Assurance in Death Certificates ae 34 Nurse Audit & Improved Utilization of Nursing Manpower 40 Hypertension Control 47 Audit Centered Post Grad. Ed. 48 Home Hlth Care & Ed. in the ‘Missouri Bootheel 49 Crittenden Clinic Home Health Care Proposal / 50. Expansion of Mid-South Eye Bank 52 Multiphasic Screening \ - Evaluation at. ae ’ bee Bo | 4,646 3,896 31, 662 30,000 © 5,300 20, 000 34,301 18,878 . 15,099 10,948 17,941 ot 4,796 4,746 10,000 106,3: B-Quality Assurance se ALLOCATION BY OPTION C-EMS “BY 74 D-Kidney Disease . —— E-Hypertension dq. RECION Memphis (Cont'd.) ' RM 00051 PERIOD 10/1/73-12/31/73 ; S PROJECT & PROGRAM ID. A Bo C D E OTHER 53 Gibson County Hlth Serv. ] and Manpower Utilization Project . 8,000 . 54 Arlington Hlth. Serv. and Manpower Utilization Projecy 9,000 / 59 Hith. Care Facilities Utilization and Review Pro-]. posal 15,900 TOTAL 92,504 132,167 : 4,796 14,746 106,33 . 24% 38% 2% 5% 1% oo I Il III MEMPHIS i) Status of the Region: . August 71 Council approved triennial status, but withheld developmental component authority because of complexity of organization. November 72 Council accepted Review Committee's recommendation on the region's first anniversary application within the triennium, which approved developmental component authority. The region was continued at its triennial funding level; a $100,000 ceiling was placed on the developmental component; the region was complimented on its new and more meaningful organizational structure and its new Regional Advisory Council; and in view of the size and depth of core staff, the region was advised no further increases in core staffing were warranted. The termination date of this region under the phase-out concept was February 14, 1974. The region's plan proposed the gradual reduction from approximately 45 employees to 10 employees (but 13 employees were included in an expanded operational activity and were still included in the budget}. The plan also proposed the continuation of 8 operational activities. ‘The funding level approved for phase-out was computed so as to require more rapid reduction of staff; and 5 operational activities were approved. ‘The expanded activity to receive 13 staff members was not approved. Current Status of Funding: FY 73 annualized level prior to phase-out. .......ee2+++ $1,627,000 Percent of total FY 73 fumds.....cceececeene eee reeerecs 2.05% Maximum allocation of FY 74 funds.....eseeeeeeeceeeeeee $845,338 FY 74 funds awarded October 1, 1973 9 ...seeeeeeeeseees $350,550 Remaining FY 74 funds for January 1, 1974 allocation ... $494,788 Significant Events Since Last Review The EMS activities supported by earmarked funds were site visited in June 1973. Dr. Joseph Johnson, Chancellor and Vice President of the U.T. Medical Unit (an interested and informed supporter of RMP) has been replaced by Dr. Edmund Pellegrino (an interested and informed supporter of RMP). {4 I j - C000 C001 co02 ' €003 C004 : C005 @ 33 34 40 47 /\ 5 52 a i. tT 49 RLGION Memphis PERLOD 10/1/73-12/31/73 ALLOCATION BY OPTION “FY 74 RM C-EMS D-Kidney Disease E-Hypertension Q0Q51 350,550 PROJECT & PROCRAM ID. OTHER Regional Staff Serv. Ident. of Inactive Nurses in Region Ident. of Hyper. Preva- lence & Resources Assist. in developing Subreg. CHP Plan. Ident. of Incidence/Pre- valence of Wid. Dis.& Res Invent. of Hlth., Ed. & Welfare Resources High Risk Infant Prog. Improved Assurance in Death Certificates Nurse Audit & Improved Utilization of Nursing Manpower Hypertension Control Audit Centered Post Grad. Ed. 48 Home Hlth Care & Ed. in the ‘Missouri Bootheel Crittenden Clinic Home Health Care Proposal Expansion of Mid-South Eye Bank Multiphasic Screening Evaluation . . 4,646 3,896 31,662 30,000 © 5,300 20,000 18,3878 15,099 10,948 117,941 34,301 4,796 4,746 10,000 106, 3: ALLOCATION BY OPTION B-Quality Assurance C-EMS D-Kidney Disease “FY 74 — E-Hypertension REGION Memphis (Cont'd.) RM PERIOD 10/1/73-12/ 51/73 PROJECT & PROGRAM ID. A B D E OTHER 53. Gibson County Hlth Serv. and Manpower Utilization ; Project: 8,000 54 Arlington Hith. Serv. and Manpower Utilization Project 9,000 / 59 Hith. Care Facilities Utilization and Review Pro-}. posal 15,900 TOTAL 92,504 132,167 4,796 14,746 106,3: 244, 38% 2% 5% 31% yy ae veqion curr a well siots are m development. agencies ef $494,788. These antly ongoing over’) and to ntract ropriate Lons and those ney returned an gotiation, Time co submission of Wor to Fin Memphi are under ne unfavora did. not p this alloca IV. wy a o ebivities se he wee RMPS : DOD :SCOB Bi woe PUT SS 1i-21-73 rye, oe bo Q nas th kidney di the re con, 5 Serves niles Tennessee Sease aren. DEB thi olen, The attac t. the percent of funds ail coated to the various options. The 12 activit: fori The vegion has been successful in nding other sources of funding for a of 12 or 60 percent of terminating activit ‘tes, The stati g has 1 instrumental in eccomplishing this in epite of the Lack of economic resources in Missi ppd. The current application was submitted to the Comprehensive Health Planning agency for their review. A letter of endorsement appears in the application. rent in the region's health ing influence on develop The Mississippi RMP has been a change care delivery syster ig and exerts incre ments now taking place in the improverent of the health care of its people. An example of this is the appointment of Dr. Lampton to serve as Chairman pro tem in the developmental stages of a select health committee composed of lenders of both legislative health committees and other significant health policy makers in the State to efvace health problens that can be affected by short-term action. f he Vi. ge 2 - Mississippi RMer Monitoring and evaluation includes on-site ¥v to each of the operational activities Beppe: as quarterly fiscal review and evuluatic . . 4 ties ineluded in this application enhance the re ization efforts currently on-going in the resion, ap! this include the EMS, Kidney, fund ] encies, Shared Hos pital Services, aad other ope The activi FL rr iy cational Staff Recommendation Mississippi RMP has requested $325,836 to support 18 activities for the petiod 1/1/74 ~ 6/30/74. South Central Operations plication as submitted. Branch staff recommends approval of Project 17A and 17%, are continuing progr: thet care of Kidney patients in the and Renal exist: should be alerted to the provision contained in the 1 a The reg Interim Rules and Reeu. 2 ~ £ lations issued under Tit Part 4065 — Pederal of SSA-D Regulation #5, P rance For The d. This verulation pertains to pe it for services in conne idaney trans: and ection wit ed benefic entith SCOB/DOD 11/20/73 REGTON PERTOD Jan rye ALEOCAT LGM ty aL OPTION a Nes arn a: oe Ome PROJECT & PROGRAM AeStrenethening Local Ping. B-Quality Assurance CHES D-Kiduey Disease E-tlypertension Sa sak OTTER COO0- Propram Staff, Sa ries/ Wages etc, Clill-Regional Intermediate Care Center Cll2-Local Hospital Shared Service system Cli3-Hosp. Nurse Coordinator Curriculiss Cll4-Miss.. EMS Services Project i-Quality Assurance Medical Peview System Cll?7-Physician Interaction Quality Assurance Program C]23- Rural Family Health Center Clz6-Video Tape Loan Library C127-Areawide. Deve lopment Prog. B-Agencies C128-Statewide High Blood Pressure Datection C132-State Board of Health District Plan 3,000 2,000 6,000 9,200 5,000 1,000 1,000 17,000 5,000 2 » “ page 2 of 2 ALLOCATION BY FY 74 BeQuality Assurance C-EMS D-Kidney Disease E-Hypertension RE@IO MISSISSIPPI Re 00057 PERIOD dan T-Jume 30, 1974 9 _. PROJECT. & PROGRA A 3 D hE FOLHER Cl33-Training Medical Record Transcriptionists C135-Expand MO] Services 017A-Renal Dialysis T taining. U17B-Renal Transplantation U54-Patient & Staff re tion-Selected uronic Diseases tinuing Education alt h Providers TOTALS Percent of Request 2,000 7,500 Bo oe 1,000 110,174 se 33% 41,069 5,000 |143,0 13% % 4 A tA ws ae a ce Ii IT] NORTH CAROLINA Status of Region The region was awarded triennial status by the June 1971 National Advisory Council for the triennium 7/1/71 - 6/30/74. The region is currently in the 05 operational year. The region's anniversary application within the triennium was last reviewed by SARP in April 1972. SARP's recommendation to the NAC during the May/June review cycle was a funding level of $2,080,008 for the 05 operational year which was subsequently approved. There were no key issues or conditions cited by the reviewing bodies. Current Status of Region's Funding The FY 73 annualized funding level for NRMP prior to phase-out was $1,930,000. This represents 2.43 percent of the total FY 73 level. The FY 74 allocation to the region is $1,002,034 of which $415,530 has been awarded. ‘The funds remaining for the region to apply for are $586,504 for the period Jan. 1-June 30, 1974 The region took the phase-out orders from RMPS quite literally and proposed a phase-out plan to terminate all program staff and operational activities by June 30, 1973. However when the current legislation was extended and phase-out orders cancelled, the region re-applied and was awarded the necessary funds to continue program staff and operational activities. . Significant Events Since Last Review None. co00 . |COO1 26 28 31 36B 41E 52 41A, ALLOCATION BY OPTION A-Strengthening Local Pp B-Quality Assurance C~EMS b-Kidney Discase FY 74 es E-Hypertension REGION North Carolina RM 00006 * PEKLOD__10/1/73-12/31/73 : S 269,732 L45, 798% PROJECT & PROGRAM ID. .[> A B C Dd OTHER Program Staff 6,943 | 6,943 Medical Air Operation 4,200 4,150 4,150 Emphysema & Lung 2,750 Care of Patients with Chronic Uremia 54,940 29 Health Manpower & Develop. | 27,318 Cardiac Pacemaker Ed. Info, 37,506 Family Nurse Prac. 10,116 Radiation Therapy Treatment Planning Service 17,686 Community Hospital Tumor Boards 112,446 : 40-Ed. Testing Service 8,630 Area Health Ed. Sys. 15,000 Area Health Ed. Sys. 15,000 42 Migrant Hlth. Serv. . 23,790 49 Emer. Room Trng. 12,236 i Measurement of Quality - in Physical Therapy 5,928. TOTAL 80,264 111,199 423,329 ' 54,940 30% 413° 9% 20% Vi. North Carolina oF Current SETS D ANAG ESE the period 1/1/% application es cation in Nor’ ~tWo revi have resy imarud.s OF 9 effectively. to. serve, with the committees ation was reviewed and ainder of ° theta ALI activ: the activities the Per jonalivat: Lon md ively > den onstrated their rctivities in a limited surport 27 activities for mmends approval of this Care of Pa the Interin North Carolina - Page 2 Na alysis to entitled services in comection regulation pertains to payment for with kidney transplants and renal cd beneficiaries. RMPS : DOD: SCOB WPromg:11-2i-73 AnStyvenethenine Local Plu BeGaras bly Ascuranvce a ae pats Na FOALS ALLOCATION bY OPTION oe ; ; 2) eat y Pisecaue E-liypertension Page 1 of 2 REGION North Caroling RE 06000 — PERTOD dans. i-June 30, 1974 eee ti PROG Ca & PROGRAM Sete nomena aint EMEA Hf A Mane Ne RE SSN Ne de means moe 7 A 4s C D E “TOTHER ent i 2M a ci name orem mcmtntes fcmmarmans mcmeamaccene oct ae wish tame: eae @ ms ao vaca aN Gent Miles teenie ites Date ane Mita eeattoen cin net tu ae nie enim akan > © 260-Emphysema and Lung Dis. Program 2,750 ' & 28-Care of Patients with a Chronic. Uremia 40,250 © 29-Health Manpower aa Deve lopment 27,338 ew 51-Comp. Cardiac Pacemaker Educ. Prog. 3,852 '-Family Nurse Practioney) 20,232 Mc Service 17,686 ©. 568- Community Hosp. Tumor Boards 12,446 © 41A- Region R. AHES 15,000 s.41E~Foothills AES 15,000 © 42-Migrant Healta 235,790 & 43-Share-Your-Skills Prog. in Diabetes 25 ,870 jf 46-Comp. Speech and Hearink Services 29,796 oe NM 48-Walston Burg Commnity Clinic 15,000 N 49-Emerg. Room Training Community Hospitals 24 472 Measurement of Quality in Physical Therapy Svs. 24,556 A Seon n t hen i nye Loca je t bre n Pose 2 of 2 BeGQuality Assurance Begs d y | ALLOCATION BY OPTLON CmENS wy 74 D-Kidney Disease oes bediypertens ion rye North C it . REGION North Caroline RM OOBN6 PERLOD Jan, BU LO 74 _ aetna enemies seotnemeielan a A Db C i D E POTHER > Health Svs. 40 000 for Regions . NOS5-EN Regions > Planning For C,D,4E A! 96-EMS Plan for Region H. 57-Physicians Assistant Svs. Prog. 3° Stroke Control Prog. recs “ES Al 59- Plan for Region G. 60-EMS Region R Ww 61-Childhood Cancer i! 62-Comprehensive Human Svs. System 63-PSRO Educ. Prog. #2 64-High Educ. TOTALS Percent of Allocation Blood Pressure Research Prog, 19,180 30,000 10,918 25,000 20,847 10,717 10,119 18,403 62,6 a <3 nO oe 20,630 264,487 | 155,101 1106,036 | 40,250 20 ,630 fa wn oe 26% 18% ~J ae t= ao SOUTH CAROLINA | a I Status of the Region Triennial status was approved by May 71 Council to begin July, 1971. June 72 Council accepted SARP's review of the region's first anniversary application within the triennium. ‘The region was continued at its existing triennial funding level. The key issues were: ' When this region entered triennial status it was advised that the scope of its interests needed to be expanded; that RAG needed re- organization; and that goals and objectives needed updating to align with assessed needs. The anniversary application did not satisfactorily respond to those issues. However, free-standing of the application document (which was prepared 3 months prior to SARP's review) the region had planned an agenda for the annual retreat of the RAG specifically addressing the areas of goals; RAG composition; RAG membership; and a neorganizatton of core staff. SARP recommended acceptance of the region's promissory note; the annual retreat was successful; the region updated its goals; broadened its interests; completed phase I of restructuring RAG; and reorganized staff. The termination date for this region under the phase-out concept was February 14, 1974. The region's plan proposed the retention of . 8 staff to 2/14 and the continuation of 8 operational activities (1 of which was a 3 part kidney project). The region's plan was approved. II Current Status of Funding: FY73 annualized level prior to phase-out..........eeeeee $1,700,368 Percent of total FY73 fumds....ccscc ccc s ccc cecereeccenes 2.14% Maximum allocation of FY74 fumds......c.c eee e eee ee eeees $882,450 FY74 funds awarded October 1, 1973.......cceeceeeeeeeees $365,940 Remaining FY74 funds for January 1, 1974 allocation..... $516,510 III Significant Events Since Last Review Governor West has created a State Health Policy and Planning Council which is viewed ultimately as being the clearinghouse for health dollars in the state. Dr. Moseley serves on the Steering Committee of the Task Forces (developed to address such areas as emergency ted cak care, quality assurance, etc.). In July 1972, the region's review process was assessed and the procedures found to be in compliance. Phase II of the restructured RAG membership question temporarily suspended because of phase-out orders. prrtop L0/1/73-12/31/73 REGTON South Carolina ALLOCATIO“ Ui “WY 4 Ba i OPTION 00035 365,490 PrUQULL dd Ly earrersen cer ese Cabri , D-Kidney Disease E-Hypertension PROJECT & PROGRAM 1D. OTHER a ~ jco00 Program Staff y COO1l Development of HLlth. Management info. Sus. mu C002 State Areawide Health Planning Support Ni c003 State Areawide Health Planning Support y| coos State Areawide Health Planning Support (/| C005 Area Manpower Develop- @ ment and Utilization vi: 6 Area Manpower Develop- ment and Utilization | } 'c007 Coastal Heart and Hyper- tension Survey’. Af D025 EIS Provider Conference ff D026 PSRO Planning Study W \p027 Pilot Project: Stroke Club AM |po28 Family Practice Confer- ence 42 Heart Implementation {> 45 Nuclear Medicine Training 51 Continuing Education for Health Professionals EP OO. OO Hemodialysis Continuing Education Sc 20,285 . 3,000. 3,000 3,000 5,000" 5,000. 2,500 . 2,000 11,980 29,572 4,000 110,44! 8,079 1,250 17,320 13,522 \e Y? > == = 2B = BEGION PERTOD ALLOCATION GY OPTION South Carolina (CON'T) “EY 74 KM. BeOtear bi ty Ar anee Cebus De Kidney Disease Be-lypertcrs bon. ¥I mente PROJECT & PROGRAM ID. 8 OTHER Unit 55D Expansion of Home Train- ing in Dialysis 59 Greenwood CCU Linkage 60A Children's Cardio- Respiratory 60B Expansion of Children's Cardio-Respiratory dis- ease Project Bioengineering Support Service Education Program for Diabetics - 67. Perinatal Center 68 Mobile Health Unit for - Williamsburg County 69 Shared Health Manpower Development Program 70 Eastern Pee Dee Hospital Training Program 71. Advanced Training for 72. Areawide Social Services TOTAL 55B Development of Transplant Emergency Medical Techs. 4,291 21,400 6,020 3,425 8,537 7,968 2,000 18,308 5,975 32,096 4,100 6,000 6,264 76,921 212 85,940 23% 36,096 10% 23,622 7% 32,913 9% 110,44: 30% @ SOUTH CAROLINA I Status of the Region Triennial status was approved by May 71 Council to begin July, 1971. June 72 Council accepted SARP's review of the region's first anniversary application within the triennium. The region was continued at its existing triennial funding level. The key issues were: - When this region entered triennial status it was advised that the scope of its interests needed to be expanded; that RAG needed re- organization; and that goals and objectives needed updating to align with assessed needs. The anniversary application did not satisfactorily respond to those issues. However, free-standing of the application document (which was prepared 3 months prior to SARP's review) the region had planned an agenda for the annual retreat of the RAG specifically addressing the areas of goals; RAG composition; RAG membership; and a reorganization of core staff. SARP recommended acceptance of the region's promissory note; the annual retreat was successful; the region updated its goals; broadened its interests; completed phase I of restructuring RAG; and reorganized staff. The termination date for this region under the phase-out concept was February 14, 1974. The region's plan proposed the retention of 8 staff to 2/14 and the continuation of 8 operational activities (1 of which was a 3 part kidney project}. The region's plan was approved. II Current Status of Funding: FY73 annualized level prior to phase-out..........eeeee. $1,700,368 . Percent of total FY73 fimds.... ccs cceccec ec ces ec eceveves 2.14% . Maximum allocation of FY74 funds......ccc eee cere ene e eee $882,450 » FY74 fumds awarded October 1, 1973......sccccccvevcscece $365 ,940 Remaining FY74 funds for January 1, 1974 allocation..... $516 ,510 III Significant Events Since Last Review | Governor West has created a State Health Policy and Planning Council which is viewed ultimately as being the clearinghouse for health dollars in the state. Dr. Moseley serves on the Steering Committee of the Task Forces (developed to address such areas as emergency meacat care, quality assurance, etc.). . In July 1972, the region's review process was assessed and the procedures found to be in compliance. Phase II of the restructured RAG membership question temporarily suspended because of phase-out orders. ‘ PERLOD rEG]oN South Carolina 10/1/73-12/31/73 ALLOCATI GU lv “EY U4 My a0 OPTION 00035 365,490 we DUEL a Gy a aeterern rr Cbs , D-Kidney Discase E-Hypuertension al PROJECT & PROGRAM TD. * {coo0 Program Staff / COOL Development of Hlth. Management Info. Sus. v C002 State Areawide Health Planning Support 5 V/ c003 State Areawide Health i Planning Support | coo State Areawide Health Planning Support /|C005 Area Manpower Develop- @ ment and Utilization ye Area Manpower Develop- | ment and Utilization /:C097 Coastal Heart and Hyper- tension Survey. DO25 EMS Provider Conference ff DO26 PSRO Planning Study Vip027 Pilot Project: Stroke Club / \po28 Family Practice Confer- ence ~ -~| 42 Heart Implementation (2. 45 Nuclear Medicine Training 51 Continuing Education for Health Professionals {2 Cc Hemodialysis Continuing Education So 20,285 - 3,000. 3,000 3,000 ~ 5,000: 5,000. 2,500 . 2,000 11,980 29,572 4,000 D E OTHER 110,448 8,079 1,250 17,320 13,522 oe \4 C we " = “PY 74 De Riduey Disease om _Belypertcnsioenu REGION South Carolina (con! T) Ry. PERLOD , $ __ PROJECT. & PROGRAM LD. A 8 Co - }) kK OTHER 55B Development of Transplant Unit 4,100 55D Expansion of Home Train- ing in Dialysis 6,000 59 Greenwood CCU Linkage 4,291 60A Children's Cardio- Respiratory 8,537 60B Expansion of Children's : Cardio-Respiratory dis- ease Project 7,968 65 . Bioengineering Support Service 2,000 Education Program for Diabetics 6,264 67 Perinatal Center 18,308 68 Mobile Health Unit for | Williamsburg County 21,400 69 Shared Health Manpower Development Program 6,020 70 Eastern Pee Dee Hospital ‘ . _ Training Program 3,425 71. Advanced Training for ; Emergency Medical Techs. 32,096 72 Areawide Social Services 5,575 TOTAL 76,921 85,940 36,096 | 23,622 32,913 110,44 © - 21% 23% 10% 7% 9% 302% = = = 22 F ALLOCATION UY GPTEON PeOtabity Ac reagee CABS IV SOUTH CAROLINA rion's Capability to Effectively Utilize its Allocation Py seeice Tunds This region currently is operating with a 13 member staff, 7 of whom would be categorized as professionals. One cf the 7 is a recently appointed Program Representative. All are full-time employees. No new professional slots are reques However, when this application was discussed at the recent full RAG mecting, the staff also presented a Plan B staffing pattern which provides for limited expansion of the professional ranks. The coordinator and the chairman of the RAG advised the full RAG that at this time, with the dedication and expertise found in the remaining program st the nucleus SCRMP staff could effectively manage the region's activities at the current level. The Plan B expansion was approved in the event additional finds should permit an expansion of ‘omponent activity thereby requiring additions to staff. SCRMP staff additionally produces exceptional staff work. Its Regional Advisory Group represents a very conservative constituency. SCRAP staff does an outstanding job of keeping it well informed. RAG members in the South Carolina RMP come to meetings with a level of knowledge concerning the agenda items far above many counterpart groups. However, its traditional conservatism stil tends to produce programmatic confinements. For example, only after considerable debate, ental component did the full RAG body approve a $2,000 develop: planning study in the PSRO area. As a group, though, through the extraordinary efforts of SCRMP staff to bring new issues to debate, the RAG is moving in new directions. lis current Chainman also fortifies progran efforts in expanded interests. When phase-out directions were being implemented, project directors were required to attest to their capability for continued support from other sources as a prerequisite for inclusion in the region's funding plan beyond June 30, 1973. Many components submitted plans for continuation for support (other than thru RMP) beyond February 14, 1974 and the RAG adopted a motion not to fund any such activity beyond that date. SCRMP staff usually introduces new concepts to RAG via proposed developmental component activities. ‘The region's involvement in PSRO considerations began in this fashion. A provider conference on EMS is another example of staff's efforts to engage the program in conyenor- type activities. This region possesses excellent financial/managerial capabilities The grantee is the Medical University of South Carolina and therefore all staff appointments are subject either to faculty considerations or the state personnel system. ‘There have been many instances where the classification confinements of the state system have posed seriqus wae annnl dnnadimante and vet SCRMP staff reflects a dedicated competent V Pege 2-South Carolina coved by the full RAG at its November meeting, tics permitted propo oP finding for 10. Pour of these quality care, 2 are in the arca of renal disease, 1 of. 4 4 het A. proposes to strengthen a local planning | ifies appy " pa < cnsion, and a CONLETNS ition, this application proposes continucd support for 8& activities t 3 with limited VY 74 fund allotment. Four of these : j {forts (basic h the de ‘ration of 1 3 in the area of quality care, 1 addresses concerns hypertension screening. of these activities is very good and tory sprea vc when one considers i Of the 18 activities "Sponsored and these are predominently quality care and hane regional coverage. This region has close ties to area CHP agencies. It also sponsors an annual CUP - RED conference. Because tame did not afford the 30 day review :. at by C C 1 to reconvene RAG in approvel of f on after CHP comment involved in kidney disease. ovision contained in the Rules. and Regulations ‘issued under Title 20 Chapter 3 of ¥ Regulat rion #5 part 405-Federal Health Insurance for The vlation pertains to payment for services in comection splants and renal di alysis to entitled beneficiaries. Bion cludes a component ‘This The re Inter SSA-~T Aged. ‘This re The South Carolina RMP has requested its full remaining allocation of $516,510. The South Central Operations Branch reco ommends its approval as suomitted. SCOB/DOD 11/20/73 d A-Strengtl ening Local Pine, B-Quality Assurance 1. rrp MS ALLOCATION BY OPTION C~EMS ‘ D-Kidney Disease E-liypertension EGION PERTOD PROSEC wy Lad Hyper~ 27,416 idren 66°. Quality Assurance 12,6506 fox Diabetics 67 ~ Perinatal 29,000 — Guaiity Assurance 68 - Rural Mobile Hith 41,142 69 ~ Shared. Health 5,350 Manpower x, Dee Manpower 10,784 Development 71 ~ EMS Advanced Tre. 35,015 72 ~ Inprove Nosh. and 6,058 Ambulatory. Care 73 - Communications 18,016 for Quality Assurance 74 - Upper Savannah 6,325 Quality Assurance 75 ~ Computerized Care 22,625 in Kidney Disease 76 - Hyper. Control 14,320 77 ~ Ed. for EMS 1 4,500 78 - Uropathies and 24,150 Hypertension Screening in Children . 9 ~ Hospital Care 20,000 Evaluation - LEAR Se a& Wa fo A~Strengthening Local Ping. ‘ B-Quality Assurance ALLOCATION BY OPTION CHE D-Kidney Disease E-Hypertension mt 2 PERIOD 1/4/74 ~ 6/30/74 s PROJECT. & PROGRAM ID. A 5 c D E OTHER &0 -- Neonatal Mursing LS, 2604 81 ~ Catawba Planning 20,158 Data Ease 82 - Hypertension Study 10,850 (Charlester Go TOTALS 27,434 91247 39,515 46,775 52,586 188,953 Percentages 19% 18% 8% 9% 10% 36% S - WISCONSIN I Status of the Region The August 1971 NAC approved Triennial Status including a Developmental Component, beginning September 1, 1971. The October 1972 Council accepted SARP and Review Committee's recommendation on the Region's second year triennial application (06 operational year) to fund the region at a level of $2,153,624. This amount represented an increase of $374,552 over the NAC approved level of $1,779,072. No key issues were identified. The Termination date for the WRMP under the phase-out concept was December 31, 1972. The region submitted a phase-out plan requesting funds for the reductions of program staff to two, the continuation of one operational activity (EMS) and three contracts through February 15, 1974. The approved phase-out plan was for the reduction of program staff to two and the continuation of the EMS activity through December 31, 1973. II Current Status of the Region's Funding: FY 73 annualized level prior to phase-out .....-+seeee- $1,779,072 Region's percent of total FY 73 funds.......ee...e see 2.24% Region's maximum allocation from FY 74 funds .......... $923,686 Amount of FY 74 funds awarded to Region October 1, 1973..$383,040 Maximum FY 74 funds remaining to Region for allocation an January 1, 1974.......0. 06. $540 ,646 Ill Significant Events Since Last Council Review .. May 1973 - Staff visit to the Wisconsin RMP to assess EMS Program Progress, current status and plans for future support. Dr. John S. Hirschboeck, Program Coordinator resigned, effective October 31, 1973. Dr. Paul C. Tracy, Assistant Coordinator for Program Development was appointed as Dr. Hirschboeck's successor. 8 no wen ALLOCATION BY OPTION B-Quality Assurance C-EMS D-Kidney Disease .FY 74 ee E-Hypertension RIGION Wisconsin RM ; : PERIOD 10/1/73-12/31/73 ° 383,040 PROJECT & PROGRAM ID. A B C D E OTHER C000 Program Staff 121,16 30 North Central Wis. Out- . reach 6,340 32 Research & Planning of Hlth. Care Delive-ed 28,276 38 Wis. Hlth Care Review 23,042 40 EMS Program 194,846 43 Health Manpower Program for La Crosse Area 9,375 » TOTAL . ° 43,991 23,042 1194,846 121,16 11% 6% 51% 32% OER a TV. WISCONSIN REGTONAL MEDICAL PROGRAM Analysis of the Region's Capability to Effectively Utilize its Allocation of Remaining I’'¥ '74 Funds Throughout the phase-out pericd, the Wisconsin RMP has been able to maintain most of its key professional staff. The one exception was the resignation on October 31, 1973, of the former Program Coordinator, Dr. John S. Hirschboeck, who assumed a position in the health care delivery system. Dr. Hirschboeck will continue to serve as Secretary and Treasurer of the Corporate Board of Directors. Dr. Paul Tracy, former Associate Corrdinator and a member of the WRMP program staff since September, 1971, was appointed to succeed Dr. Hirschboeck., Currentiy the staff consists of six full-time professionals; five part~time professionals; four full-time support staff, and two part-time support staff. The region has requested support for two new positions: an accountant to be hired on a consultant basis; and a part~time evaluation analyst. The present staff appears to represent an adequate range of professional disciplines, including competence in evaluation, program design and development and manpower development. In the original phase-out plan, the region had planned to combine its two offices, Milwaukee and Madison, into one central office in Madison. This was effected on July 1, 1973. The closing of the Milwaukee office occasioned the resignation of only two of the professional staff. Two other program staff members from the Milwaukee office were retained as consultants for the Milwaukee area, Historically, the WRMP has demonstrated a unique ability to respond to new national priorities. For example, in early eptember, 1973, following directives on fiscal 1974 priorities and options, the WRMP canvassed 54 organizations throughout the state for requests to compete for the second quarter funds. As a result of this region wide distribution, 31 proposals were developed and submitted to the Review and Evaluation Committee. The Review and Evaluation Committee reviewed and graded 26 proposals that fell within the priority areas. Only five proposals were deemed inappropriate. The 26 proposals were considered and ranked by the Regional Advisory Group during its November 5, 1973 meeting. Page 2 - Wisconsin RMP The RAG bas remained intact and active during the phase-out period. While the RAG is scheduled to meet quarterly, they have only met three times during 1973, due to the threatened phase-out. The region states that the normal rate of resignations from the volunteer conmittees has not been experienced this calendar year. In fact, according to the region, many members of the RAG, R& E and Steering Committees have asked to stay on during this period of uncertainty. The R & E Committee, which is scheduled to meet as workload requires, has met four times during calendar 1973. This group provides professional and technical review end make recommendations to the RAG regarding approval or disapproval of applications and continuation or discontinuation of projects. VY. Analysts of the Current Application The Wisconsin RMP application requests $540,646 for the period January 1, 1974 - June 30, 1974. This amount represents the regions full remaining allotment for FY '74. The application requests support for ten activities. Seven represent new activities, one is for continued support of an ongoing activity and two are EMS conponents. At the time of the RMPS - EMS staff visit to the region, the EMS activity was believed to be the leading program among those funded from special RMPS supplemental funds. One of both the national and the region's priorities was to begin an evaluation of EMS activities. One of the components in the current application is to hegin to accomplish this. The second EMS component requests funds te purchase equipment which will complete the statewide microwave EMS network. The region plans to work with the Wisconsin Health Planning Council, appropriate CHP agencies, the University of Wisconsin, and others to produce a series of standards, such as: patient care for emergency medical services; licensing of health professionals; quality assurance and review. These are to be supported as a part of the program staff component. The region states that copies of the current application were sent to each of the areawide CHP "b" agencies and the CHP "a" agency for review and comment. The region has received only three responses, all favorable. These reviews were available to the Regional Advisory Group during their review of the application, The Wisconsin RMP has been quite successful in attracting other sources of funds to insure the continuance of successful activities initiated by the RMP. For example, the Nurse Associate and Physician Team in Delivery of Primary Health Care Program, which received one year WRMP support, is now being continued through funds from the University of Wisconsin and revenue sharing funds. Page 3 - Wisconsin RMP The activities presented in this application outlines the region's plans for those activities requird support bevond June 30, 1974. Of the ten components, will terminate on June 30, 1974, the remainir three activities wi re continued Tune 30, 1974, the remaining three activii 11 be t ed through funds from various local sources, VI. Staff Recommendation: Uhe Wisconsin RMP requests $540,646 to support a program staff component and ten operational activities, all consistent with the new RMPS priorities and options. South Central Operations Branch recommends approval of the application as submitted. SCOB/DOD 11/21/73 A-Strengthening Local Ping. B-Quality Assurance ALLOCATION BY OPTION C~EMS FY 74 ‘D-Kidney Disease — E-Hyper tension REGION. Wisconsin RM 00037 PERIOD — January 1 ~- June 50, 1974 S 540,646 PROJECT & PROGRAM ID. A B C D E OTHER C000-Program Staff . . $242,845 C001L-Development of Health Standards $5,100 i C00Z-Devel. of Health Standards #2 $5,100 C003-Health Policy Council Feasibility _ Study #1 $30,041 C004-Feasibility Study #2 $50,041 COG5-Feasibility Study #3 $30,043 0004-Hypertension Screehing . Treatment gFollow-bp $50,842 0008-EMS Component. #2 - Microwave Network $71,000 00012-EMS Component #2 Evaluation $47,850 0036-B(14) Shared Servilces Inc. - LaCrosse $12,602 00030-Community Based Manpower Program $15,212 Totals $100,325 | $27,814 | $118,850 50,842 | $242,815 % 22% 95 45% 19% 5 we TENNESSEE MID-SOUTH I ‘Status of the Region: * November 1970 Council approved triemial status beginning February 1971 but did not accord developmental component authority because of RAG's demonstrated inability to deal with decision-making problems. November 1971 Council accepted SARP's and Committee's recommendation on the first anniversary application within the triennium. The anniversary continued the region at its triennial funding level; developmental component authority was again withheld for the same reasons (but the Core budget was set at a level which would permit staff to generate develop- mental activities); and the region was given strong written advice to develop an active, informed RAG; new by-laws were recommended. February 1973 Council accepted SARP's recommendation on the second anniversary application within the triennium. The anniversary continued - the region at its triennial funding level; developmental component authority was granted with contingency (see key issues below); strong advice was given concerning RAG-Grantee relationships; a deadline of» April 1973 was set for resolution of organizational difficulties. ‘The key issues were: In August 1972 RMPS issued a policy statement |: concerning Grantee and RAG responsibilities and relationships. It also » articulated the relationship of the Coordinator to the RAG and the - Grantee. The by-laws as well as the functioning apparatus of this region ‘were not in compliance. A 2 month extension beyond the March 1,.1973 : ~~ compliance date was granted for the region to place itself in substantial be Ea compliance. .. The, termination date for this region under the phase-out concept was — February 14, 1974. The region's plan proposed the gradual reduction, (between January 1973 and February 1974) to a staff of 11 and the ~. continuation of 9 activities. The phase-out plan approved for this — region called for the reduction of staff to 7 and authorized the "continuation of 5 activities. 41 Current Status of Funding: FY 73 annualized level prior to , phase- Out.......... seeecees $2,166, 139 Percent of total FY 73 fundS.........seeee esse eee es beeeeees 278% Maximum allocation of FY 74 funds....... ccc cece cseceeseenes $1,125,742... FY 74 funds awarded October 1, 1973....ccecccceeuececeveces $466, 830 Remaining FY 74 funds for 1/1/74 allocation.......... rr feng, 12 7 Prd Page 2-Tennessee Mid-South Til Significant Events Since Last hkeview: . Grantee sought and was given an extension to September 30, 1973 for compliance with RAG/Grantee relationships and responsibilities policy. . Dr. Paul Teschan was removed as Coordinator. . Dr. Richard Cannon was naned Coordinator. . By-laws revised and approved as being in compliance with RMPS policy. . Nes RAG met under new by-Jaws on October 31, 1973 and considered this application. v C052 48 61 62 66 67 68 69 ‘72 73 ALLOCATION BY GrPiLon A-Strengthonidng. Loos W-Ouality Assurance C- EAS D-Kiduey Discase PY 7A . een E-Hypertension REGLON_Tennessee Mid-South RL __ O0OTBR pertop 10/4/73-12/31/73 AO BBO PROJECT & PROGRAM ID. A ' i C D E OT: Quality Care Assurance Program (Prog. Staff) 311,238 Improved Control of Hypertension 22,499 S.E. Health Services Ed. Program 36,700 Mid-East Health Services | 11,516 High Risk Newborn Care 7,237 Koxville Neighborhood Health Services 15,000 Cayce Homes Community . Clinic 7,200 Nurse Clinician in Public Health Dept. Setting 5,060 High Risk Obstetrics 5,440 Upper East. EMS 25,000 Pennyrile EMS 20,000 TOTAL 75,416 323,915 | 45,000 22,499 . 16% 69% 10% 5% Il TENNESSEE MID-SOUTH Status of the Region: November 1970 Council approved triennial status beginning February 1971 but did not accord developmental component authority because of RAG's demonstrated inability to deal with decision-making problems. November 1971 Council accepted SARP's and Conmittee's recommendation on the first anniversary application within the triennium. The anniversary continued the region at its triennial funding level; developmental component authority was again withheld for the same reasons (but the Core budget was set at a level which would permit staff to generate develop- mental activities); and the region was given strong written advice to develop an active, informed RAG; new by-laws were recommended. February 1973 Council accepted SARP's reconmendation on the second anniversary application within the triennium. The anniversary continued the region at its triennial funding level; developmental component authority was granted with contingency (see key issues below); strong advice was given concerning RAG-Grantee relationships; a deadline of April 1973 was set for resolution of organizational difficulties. The key issues were: In August 1972 RMPS issued a policy statement concerning Grantee and RAG responsibilities and relationships. It also articulated the relationship of the Coordinator to the RAG and the Grantee. The by-laws as well as the functioning apparatus of this region were not in compliance. A 2 month extension beyond the March 1, 1973 compliance. The termination date for this region under the phase-out concept was February 14, 1974. The region's plan proposed the gradual reduction (between January 1973 and February 1974) to a staff of 11 and the continuation of 9 activities. The phase-out plan approved for this region called for the reduction of staff to 7 and authorized the continuation of 5 activities. Current Status of Funding: FY 73 annualized level prior to phase-out.......... eeeceess $2,166,159 Percent of total FY 73 funds......... beeen e enero eee eeeace 2.73% Maximum allocation of FY 74 funds...... ccc er scesveeecaces $1,125,742 FY 74 fimds awarded October 1, 1973......ceeeeereescecsevee $466,830 Remaining FY 74 funds for 1/1/74 allocation................ $658,912 Page 2-Tennessee Mid-South III Significant Events Since Last Review: . Grantee sought and was given an extension to September 30, 1973 for compliance with RAG/Grantee relationships and responsibilities policy. . Dr. Paul Teschan was removed as Coordinator. . Dr. Richard Cannon was named Coordinator. . By-laws revised and approved as being in compliance with RMPS policy. New RAG met under new by-laws on October 31, 1973 and considered this application. £EEER 48 61 65 66. 67 68 ALLGCATION BY OPTTOS A-Strenethoning. Loca B-Qualilty Assurance CES DeRidnuey Discuse “PY 74 } ee ke-liyper tension REGLON Tennessee Mid-South RE OOO018 pen1o9_10/4/73-12/31/73 § 466,830. ee PROJECT & PROGRAM ID. A ' 1 C - ) E POT! Quality Care Assurance 4 Program (Prog. Staff) 311,238 Improved Control of Hypertension 22,499 S.E. Health Services Ed. Program 36, 700 Mid-East Health Services | 11,516 High Risk Newborn Care 7,237 Koxville Neighborhood Health Services 15,000 Cayce Homes Community . Clinic 7,200 Nurse Clinician in Public Health Dept. Setting 5,000 High Risk Obstetrics 5,440 Upper East EMS 25,000 Pennyrile EMS 20,000 TOTAL 75,416 323,915. 45,000 22,499 . 16% 69% 10% 5% IV. TENNESSEE MID-SOUTH Analysis of Region's Capability to Effectively Utilize Remaining Funds This region has experienced a tremendous reduction in program staff (pre phase-out 40 » staff) as well as a recent change of Coordinator. There are currently. four professionals on the staff, including the Coordinator, covering the areas of program planning, program development, communications, and financial management. However, a large portion of the former "staff were less than full-time employees and were engaged in what the region terined central activities which have been terminated. Additionally, a number of people who were institutionally located throughout the region as area coordinators and field representatives are no longer on the roster. TMS certainly represents a bare bones central staff and must be categorized as being very thin when viewed in light of the percent of the total FY 74 funds allocated to it. Staff's visits to the region have reported a less than satisfactory interface with the region's fiscal counterparts in the grantee. This situation will require the building of greater financial expertise within central staff. This condition, however, is not confined to TMS; it is mentioned here because it is yet another area for which the new Coordinator will have to build in-house coverage. Dr. Cannon is. aware of it. and is taking steps to correct it. Presently though, it consumes a disproportionate amount of time from an already overburdened staff. The application contains a program staff item labelled 'hmassigned salaries,'' and the fiscal management problem is one of the areas to be staffed. In the final analysis, though, this region with a restructured RAG, a new Coordinator and a drastically reduced staff, produced from its constituency proposals almost double the amount of funds allocated to it. The'new'’ RAG approached its review task with gratifying sophistication when one weighs its current involvement against its vraditional behavior. The fonner posture of RAG was a reliance on program staff to the point of almost abGicating its decision-making responsibilities, At its first meeting, the restructured RAG had a very good discussion of its role (at the instigation of its new chairman who remained scrupulously impartial insofar as institutional and grantee prerogatives are concerned). It is a new-look RAG; has met only once under its amended by-laws; and it shows promise, : At this point in time, the rebuilding of a central capability, (either through cmployment of staff or contracted services) that can function with reasonable scparateness from the grantee is a high priority. It will require continucd technical assistance and is a priority of the South Convzal Operations Branch, Dr. Cason quite successfully nepotiated the thorny matter of bringing the region into compliance with arended by-laws; he is now turning to the challenge described above. @ Page 2 - Tennessee Mid-South V. Analysis of Current Application: - ‘the application requests the full remaining allocation of $658,912. The activities are spread among 18 components; 13 new activities funded for the first time, two proposals fortifying and continuing activities generated October i, one fortifying a contract let from the October 1 award, one continuing an activity approved to December 31, in the phase-out plan, and one instituting support for an activity pre- viously funded but with a short break in funding due to phase-out. Three of the 18 are Vanderbilt sponsored. The sponsors of the remaining 15 display a good range across a neighborhood health center, the Tennessee Department of Public Health, the Unviersity of Tennessee, the Kidney Foundation, a foundation for medical care, a regional Council of Governments, health planning councils, local volunteer societies, etc.. The geographic distribution of the activity generated by these components is very good, Projects seated in Knoxville, Nashville, Chatanooga, and several rural settings are included. For the most part, the primary option emphasis would be categorized under strengthening local planning processes through the demonstration of more effective utilization of manpower in the community. Several of. these activities have a secondary option emphasis, however. One of © the proposals (Project #82) covers activities in the renal disease area that should be flagzed to assure the services ultimately provided are compatible with the interim guidelines issued by SSA under Titles 18, 19 and 5. This entire application was reviewed by the full RAG. Many of the members were newly appointed and were attending their first meeting. The discussion was full; it was not rubber stamped. The proposals here were selected from a larger number of applications and prioritizing was required in order to pare the request to the maximum remaining a~location. Several approved proposals remain in the region's coffer awaiting funding. They are not, however, as immediately identifiable as being within the option areas as one would like. Frankly, the RAG thought some of them were excellent and they are holding them ready for funding (through rebudgeting or, hopefully, additional awards) should expansion of the option areas materialize. The GIP A agency is represented on the RAG and its representative attended the mecting at which this application was considered. The full application has been submitted to the A and B's for comment. When comments are received, they will be forwarded, © Page 3 - Tennessee Mid-South V1. Staf£ Recommendations: The Tennessee Mid-South RMP has requested its full remaining allocation of $658,912. The South Central Operations Branch recommends its approval as ‘requested. SCOB : DOD: RMPS ~ IMK:11-20-73 REGION Tennessee. Mid- PERTOD 1/1/74-6/30/74 ccm eet per Rn tn tee epee PROJECT & PROGRAM Eb, Tn aaa NR aE rte atin Ae ALLOCATION BY OPTION PY 74 South ooo RN O0018 A-Strengthening Local Pins, beQuality Assurance CHEATS D-Kidney Disease Lellypertension A B C § 658,912 Program Staff 57-Hypertension Follow Up 64-Pediatric Ed. Service System 65-High Risk Newborn 68-Primary Care Nurse Clinician 74-Wynn-Habersham Clinic Jevelopment of Norms and Standards 76-Renal Dialysis 77 Paramedical Training 78-Midwi fexy & Child Dev. 79-Organ Donor Ed. 80-Public Education 81-Ga.-Tenn. EMS 82-Chronic Kidney Disease 83-Pharmacits in Hyper 84-Hyper Screening 85-Cost Reduction 86-Standard Proced for Lymphedema following g@pkastectomy Best Tenn. EMS TOTALS Daw sw Aa ee 32,820 19,200 14,898 32,000 88,291 15,000 8,530 24,350 50,000 10,232 3,050 30 ,000 80 ,000 ann 157,030 7A ot 91,341 aren 199,668. 41,035 13,200 19,138 50,000 2,500 5,000 82,338 48,535 199,668 Louisiana RMP: Current Grant Period 3/1/72 - 1/31/74 If. Ill. Mid-Continent Operations Branch Staff Analysis - F. Zizlavsky I. Status of the Region « The Louisiana RMP has been operational under anniversary status. SARP reviewed the last application in December 1971. Last Council review: February 1972. The March 15, 1973 phaseout plan was approved for program extension through 1/31/74. Nine projects and a reduced Program Staff were approved. . In contrast,* 16 activities were ongoing prior to the planned phase-out. On October 1, 1973, 11 program activities were approved. Five activities were previously approved in the phase-out. See attached chart, Allocation By Option. , Current Status of the Region's Funding FY 73 annualized level prior to phase-out ...$886,580 FY 73 NAC recommended funding level......+++- 1,000,000 Percent of total FY 73 funds........-- 1.412% Maximum allocation from FY 74 funds (DC & IC) .....-.eee- $461 ,843. FY 74 funds awarded Oct. 1, 1973.....-ceeeeeescseseees -191,520. Maximum FY 74 funds remaining for allocation 1/1/74... $270,323. Significant Events Since Last Council Review Four HS/EA activities ($715,969) and 3 EMS activities ($325,940) funded as supplemental applications in June, 1972. An HS/EA visit was conducted on May 21, 1973. An EMS visit was conducted’ on May 30, 1973. Pediatric Pulmonary Project (#17) was funded $230,000 for the 02 year from RMPS earmarked funds. . Director, Joseph A. Sabatier, Jr., M.D. on 25% time 7/1/73. Deputy Director, Paul Cook, D.D.S. 100% time. . g000 ¢002 ¢003 / boos , 15 26 10) fo 41 33 42 43 44 A-Strengthening Local Pine§ B-Quality Assurance ALLOCATION BY OPTION C~ENS FY 74 - D-Kidney Disease oo E-Hypertension REGION Louisiana rm —s«0.0033 PERIOD _-10/1/73-12/31/73 ° 191,520 PROJECT & PROGRAM ID, A B Cc D E OTHER / Program Staff . 76,249 Medical Ed. and Physician Utilization 2,000 H1th-Manpower Inventory 3,000 Quality Assurance Sens. | 6,000 Leuisiana Hlth. Data Info 12,832 Updating EMS - 5,500 HS/EA 13,550 HS/EA 13,550 . HS/EA 17,650 " EMS for Infants 17,024 Containment Costs in ° Medicaid Pediatric Case 12,100 Hypertension 12,065 TOTAL 62,582 18,100 {22,524 12,065 76,24¢" et Il. Ill. SALA etic 1 TAC EAE MN NE Mid-Continent Operations Branch Staff Analysis - F. Zizlavsky Louisiana RMP: Current Grant Period 3/1/72 - 1/31/74 Status of the Region The Louisiana RMP has been operational under anniversary status. - SARP reviewed the last application in December 1971. Last Council review: February 1972. The March 15, 1973 phaseout plan was approved for program extension through 1/31/74. Nine projects and a reduced Program Staff were approved. . In contrast,'16 activities were ongoing prior to the planned phase-out. Gn October 1, 1973, 11 program activities were approved. Five activities were previously approved in the phase-out. See attached chart, Allocation By Option. Current Status of the Region's Funding FY 73 annualized level prior to phase-out ...§886,580 FY 73 NAC recommended funding level........-- 1,000,000 Percent of total FY 73 funds.........- 1.12% Maximum allocation from FY 74 funds (DC RIC) cece cee eees $461,843. FY 74 funds awarded Oct. 1, 1973. ...csseeeeeereseccess -191,520. Maximum FY 74 funds remaining for allocation 1/1/74... $270,323. Significant Events Since Last Council Review Four HS/EA activities ($715,969) and 3 EMS activities ($325,940) funded as supplemental applications in June, 1972. An HS/EA visit was conducted on May 21, 1973. An EMS visit was conducted on May 30, 1973. Pediatric Pulmonary Project (#17) was funded $230,000 for the 02 year from RMPS earmarked funds. Director, Joseph A. Sabatier, Jr., M.D. on 25% time 7/1/73. Deputy pirector, Paul Cook, D.D.S. 100% time. \s ¢o00 ¢002 {003 r004 15 26 0 33 42 43 44 ALLOCATION BY OPTION A-Strengthening Local PL B-Quality Assurance C~EMS - D-Kidney Disease _FY 74 — E-Hypertension REGION Louisiana RM ~ 00033 PERIOD 10/1/73-12/31/73 * g 191,520 PROJECT. & PROGRAM ID. A B Cc D E OTHER Program Staff 76, 24! Medical Ed. and Physician Utilization | 2,000 Hith-Manpower Inventory 3,000 Quality Assurance Sems. 6,000 Leuisiana Hlth. Data Info} 12,832 Updating EMS ° 5,500 HS/EA 13,550 -HS/EA 13,550 HS/EA 17,650 EMS for Infants 17,024 Containment Costs .in ° Medicaid Pediatric Case 12,100 Hypertension 12,065 TOTAL. 62,582 18,100 [22,524 12,065 76,2 IV. Mid-Continent Operations Branch Staff Analysis - F. Zizlavsxy fan oS re tet Cent “ > iT oem Ty ‘ffectively Utilize its Allocation s of 12-31-72 8 Of 6-30-72 as of Nov. 73. (4 1/4 professiona al, 1 clerical) ' * Full Time Equivalents (F. F F ( TE T .t haril 15- June. 30) the Program staff was During the RMPS phase-out period drastically reduced to @ part-time Director and a business manager, seven oe had been approved for extension, were of the nine project aCUTVHETES sk in atbempting to respond to for “the nodule J and stre ng thening of regional Joseph A. ry MAL rector has re- ane an ram Plannd ing and hired on 20% part- ram and evaluation 7} and grants . Program will be mec hr Chi ot yt I 4 aya Roberts iS om @ relainer providing 4 ‘a mo me In my opinion, the Program Staff appears capable to handle the requested project activities. The Prog PMPS options (new initiatives) during the 10/1/73 thru 12-3 Strengthen Local Planning.....33% Guadity ASSHPATICE occa econ eaee 9% Emergency Medical Service.... 12% Kidney kcal aia RnRaaeS 1% HypertenSiOn... ccc sec ceeecaee G2 Other EE 4og The LRMP Regional Advisory Group met 7 November 8, 1973 and reviewed and approved this application. David M. Smith, Chairman of the RAG, indicated that "the RAG is intact and some of it members ave contributing generously of their time in an ongoing effort to support the Program Staff in program development and implementation. Since September , 1973 there have been two meetings. of the RAG, one meeting of its Evaluation Committee, one meeting of its Executive Committee and two meetings of the Board of Trustees. The LRMP requests $51,899 (19%) for Program Staff and $218,424 (81%) for operational activities. The program request includes 7 new and 6 continuation Vi. Louisiana cont. activities. See attached green chert, Allccatiun by Gption. In should be noted that $45,025 of the {51,899 requast in Py pagram Staff, represents EMS and quality assurance seminars. Atso included is an activity to develop a quality assurance program with respect to services pre ovided to Medicaid. patients under TITLE XIX of the Social Security Amendments of 1972. The Program ¢ continues to strengthen its ¢@ ancy medic through reque sts foy continuation of project #'s 27+ £ 28 ~ EMS-Two-Way Communication, and #42 - EMS for High Infants LEMP has sought to constructively end effectively use seed movies without long term comm tine nt. It has sought to support activities which will have some degree of viabs Vity and will continue after LRMP fiscal support terminates. Evidence of continued support for most of the operational activities is included. Staff Recommendation The request for $270,323 is recommenced fer approval. However, the Program should be encouraged ‘0. recruit additional staff. Particular reference should be given to the Program Director who is employed on a 25% io bas is Se Because of the marked changes brought about through planned phase-out, a site visit to the Region is recommended prior to the next schecul ed NAC meeting n 1974. B-Quality Assurance ° C-EMS ‘ , D-Kidney Disease ALLOCATION BY OPTION . E-~Hypertension a " © REGION Louisiana RMP RM 43 PERIOD L/L/24 to 6/30/74 _ 4 270,323 A. E PROGRAM STAFF : 6,874 4,775 PROJECT & PROGRAM T-0- : x : Ce. +B. _E. OTHER a ‘ue? 6 N C004 - EMS & Quality Assurang Seminars N C005 - Quality Assurance Seminars-L.S.U. 6,000 N COO6 - Q.A. in La. Medical Program B4 250 oO Total Program Staff-($51,899) C #27-EMS. Training 14,551 ¢ #28-EMS- Two-way Communication 36,028 #32- Cenla HS/EA 6,775 #38- Outreach Nutritional Counseling Program for Diabetics 7,229 C #42~ EMS for High Risk Neonates and 111 Infants 43,756 C #43- Quality Assurance in ¢ - Medicaid Pediatric Care 25,934 C #44~ Patient Follow-up in Hypertension Screening Program 21,775 No €45- Ambulatory Health Car Inventory “£242 N . #46- Service Availability 485435 and Utilization 7,041 No. #47- Cost containment cri- teria for Hosp.Health Facility — 6,900 oe TOTAL PROJECTS ~ (218,424) 25.64 | 24x 364 34 64g TOTAL 4 69,151 66,184 | 99,110 21,775 414,103 et cd ek aati a a HOU hk em Ht in eet tw 6