are 10 Il 12 13 i4 16 17 18 19 20 25 HOOVER REPORTING CO., INC. 320 Massachusetts Avenu3, N.E. Washington, D.C. 20002 DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE PUBLIC HEALTH SERVICE HEALTH RESOURCES ADMINISTRATION THIRTY-FIRST MEETING OF THE NATIONAL ADVISORY COUNCIL ON REGIONAL MEDICAL PROGRAMS Conference Room M Parklawn Building 3600 Fishers Lane Rockville, Maryland Tuesday, November 27, 1973 The meeting reconvened at 9:00 o'clock, a.m, Dr. Herbert Pahl, Acting Director, Regional Medical Program Service, presiding. | COUNCIL MEMBERS PRESENT: MRS, AUDREY M, MARS GEORGE E, SCHREINER, M.D, MR. EDWIN C, HIROTO DR, LAWRENCE FOYE MRS, MARIEL S, MORGAN BENJAMIN W, WATKINS, D.P.M. MR, SEWALL O, MILLIKEN MR. C, ROBERT OGDEN 6 wT? 10 11 12 e = 14 16 17 18 19 20 no — 2D HOOVER REPORTING CO, INC. | 320 Massachusetts Avenu3, NE. Washinetan. B.C. 20002 157 CONTENTS Page Approval of minutes 158 Motion 158 Vote 158 Resolution re allocation of additional RMPS funds 159 _“ Motion fer thos 161 ' Vote 162 Gn my 10 WW 12 © 13 i4 16 17 18 19 20 n aw 24 25 HOOVER REPORTING CO, INC. 320: Massachusetts Avenu2, NE. Washington, D.C. 20002 158 PROCEEDINGS DR. PAHL: Will the meeting come to order. We are starting the open session again this morning and will have that goon as long as 1t seems desirable, and the we will again go into executive session to complete the Council review of applications, Now, I had two items of business for this session carried over from yesterday. One has to do with the Council's approval of the minutes, which I called to your attention yes- terday as being in the agenda folder, I would entertain a mo- tion for approval or amendment if you have had a chance to reas them, MR. OGDEN: Move @Pprovel oF “he minutes as Meiieds. MRS, MARS: Second. DR. PAHL: Tt has been moved and seconded to accept the minutes, Any discussion? If not, all in favor say "aye." (Chorus of ‘ayes.") DR, PAHL: Opposed? (No response) DR, PAHL: So moved, The second item of business from yesterday has to do with a reconsideration of the draft resolution that we consid- ered and what we have already distributed to you is a reworked version which I believe has those kinds of directions in it which came out of yesterday's discussion. L's 10 11 12 e » i4 16 17 18 19 20 21 HOOVER REPORTING CO, INC. 320 Massachusetts Avenu2, NE. Wachinatan NC INNhe 159 We have eliminated some of the whereases, We have introduced the fact that Council and Departmental policies, in addition to existing legislation, of course, should be pur- sued. We have also indicated that there is a Limitation on the discretionary authority given to the Director. We have Sug gested in this resolution that it be no more than $10 million. That, of course, is an arbitrary figure that is even yet dif- ficult to justify and it is not something which I would care td state isn't alterable in one fashion or another from my point of view. If anything, it could perhaps be lower, I certainly don't see any need for additional funds, So let me read for the record the redrafted resolution and ther see what kind of discussion we may have, This is a resolution by the National Advisory Council on Regional. Medical Programs, recommending allocation of additional RMPS funds in fiscal year 19743; "WHEREAS : RMPS has established a mode for allo- eating the funds already made available for Fiscal Year 1974, and "WHEREAS: Substantial additional funds may become available for obligation by RMPS in Fiscal Year 1974, "BE IT RESOLVED THAT: The National Advisory Council recommends that: "1, the Regional Medical Programs Service D p 10 ll 12 e i4 16 17 18 19 20 21 25 HOOVER REPORTING CO, INC. 320 Massachusetts Avenu>, NE. Washington, D.C. 20062 160 allocate by the established mode the full amount of Fiscal Year 1974 funds made available, tp to the maximum amount anticipated under the HEW Continuing Resolution or Appropriation, $81.9 million. "Oo, up to $10.0 million of any amount over $81.9 million which the Regional Medical Programs "2, up to $10.0 million of any amount over $81.9 million which the Regional Medical Programs” Service may be directed to obligate in Fiscal Year 1974, may be distributed in @ manner that the Director, Regional Medical Programs Service, finds will make the best possible use of funds in accord- ance with existing legislation, Council, Department and RMPS policies, "2. any other funds in excess of $81.9 million not awarded pursuant to item 2, above, shall be awarded subject to the Council's recommendation thereon at its next regular or special meeting after such funds shall have become available for obliga- tion.” That is the end of the proposed resolution, I would like to have whatever discussion or comments you may have relative to this, I hope that we have incorporated the points that wer made yesterday. i on 10 ll 12 e «= i4 16 17 18 19 20 21 22 23 24 25 HOOVER REPORTING CO, INC. 320 Massachusetts Avenu>, NLE. Washington, D.C. 20062 161 Dr. Foye. DR, FOYE: Does somebody have a thing about "mode"? (Laughter ) I am wondering about"method" or something. The first one might read: "RMPS has established a method, acceptable to this Council, for allocating the funds already made available for Fiscal Year 1974." More than established, RMPS has picked a method, it is a method acceptable to Council; and then the other would be at the énd of 2 be added: "all such distributions will be reported to the Council at its next regular meeting." DR, PAHL: Sorry, that point was made yesterday. We did include, certainly those are two appropriate points. DR. FOYE: "Acceptable to Council,’ in the first para- graph, is protective, DR. PAHL: Yes. Is there other discussion? MRS, MARS: I think with those points incorporated, it is an excellent resolution, does cover everything, and I move it be accepted, MRS, MORGAN: I second it. DR. PAHL: It has been moved and seconded to accept the draft resolution as prepared and amended by Dr. Foye. Any further discussion? 162 1 MR, MILLIKEN: Question, 2 DR, PAHL: If not, all in favor say "aye." 3 (Chorus of "ayes,") 4 DR. PAHL: Opposed? (No response. ) on 6 DR, PAHL: So moved, 7 Now, that completes the items of business I believe 8 I carried over fron yesterday, 9 It is open for any other matters that the Council 10 or the public may have. 11 MR, OGDEN: Herb, I might suggest at this point, 12 since we have adopted this resolution, anticipating the possi - © 13 bility of additional funds, that this raises the question of i4|| how the regions res pond in the event there are additional funds 1b and how quickly they can do so, 16 _ It occurred to me, thinking about this last night, 7 perhaps ‘what we should do is if not by resolution, then by ig|| Some other action of Council, reiterate the fact that our y9|| mission statement in 1971 remains valid and Council will respond 20 to applications or to those already on file based on the @ 91|| priorities encompassed in that mission. statement as well as in 99| Subsequent mission statements, which have been promulgated 93 || by RMPS or by this Council. oA I don't know exactly how to go about doing that, but 25 I think you see what I have in mind, because there may be little HOOVER REPORTING CO, INC. 320 Massachusetts Avenu>, N.E. Washington. D.C. 20002 163 1 time in which to get these funds committed. bo I am sure that all of our programs would like to 7 go back to doing what they were doing before they were told td phase out. Yet I suppose at this point they would need to make formal application to be able to do that. on 6 I don't know whether we can go back and simply say let's go back to where we were before, but this is what I have 8|/ in mind. 9 DR, PAHL: I think it is most appropriate that you 10 again today refer to the mission statement and this point il came up yesterday. As a matter of fact, I think that some of 12 the coordinators have indicated to me that this: is something 6 138 which should be in the public record, that the Council did en- 14 dorse this mission statement, It still represents a funda- 15 mental document of RMPS. And the comments that were made yes- 16 terday by Dr. Endicott and Dr, Margulies in relationship to 17 the options and priorities as being areas of high interest, 18 but no longer used ina restrictive sense, implied, and I 19 think it is good to make it explicit, that the mission state- 20 ment unless changed by the Council is still endorsed by the Council. And we will bring that fact in written form to the 22 attention of the regions after this meeting, Nw re 23 So that the framework of what regions may do will be broadened, 24 or, if you will, referred back to the dimensions that it was 25 prior to the phaseout. HOOVER REPORTING CO, INC. 320 Massachusetts Avenu, NE. Washington, D.C. 20002 164 1 MR, OGDEN: In other words, you don't feel it will 2 be necessary for the Council to make a further statement on 3 this at this time? 4 DR. PAHL: I don't feel it would be necessary for Council to do so, I think if you believe, in view of yester- on 6 day's discussion, it would be appropriate for you, I see no 7 reason why you should not do so, 8 From staff's point of view, I believe the discus- 9 Sion we have had at this Council meeting, with Dr, Endicott am .T 10 Dr. Margulies and then the Council itself, gives me sufficien 11 authority to transmit such information to the regions in 12 such form, 6 13 MR, OGDEN: Will you have the record read that i4 it was discussed by Council, it is the sense of the Council 15 this is the case with which you concur? On the basis of the 16 statements by Dr. Endicott and Dr. Margulies. And we would 17 urge the regions begin standby preparation for the submission 18 of proposals, 19 DR. PAHL: Yes. 20 MR, OGDEN: To move back to the programs which they © 2] were engaged in prior to the time of the phaseout, 92 DR. PAHL: Also at the Chicago 18th or 19th meeting 23 of the coordinators and number of the chairmen of the’ Regional Advisory Group and number of our own staff, we did discuss what 25 the position would be with both local RMP's and RMPS should HOOVER REPORTING CO, INC. 320-Massachusetts Avenu, NE. Washington, D.C. 20002 HOOVER REPORTING CO, INC. |. 10 ll 12 13 14 16 17 18 19 20 24 25 320 Massachusetts Avenu>, N.E. Washington, D.C. 20002 165 sizeable funds come to us for distribution, And the challenge that this places on the regions to develop appropriat kinds of activities. Because merely having the funds come to RMPS is not in and of itself sufficient for us to distribute these to regions unless they in fact have programs that can justify their use, so that we again will make this information available to the regions. MR, OGDEN: What I say, I don't mean to ignore the recent statement we have made concerning the five, what were priority areas. DR, PAHL: No. MR, OGDEN: Certainly those represent a subsequent mission statement which has been promulgated and which is of considerable importance. Because what we are doing here today recognizes that. An I should hate to see these things aban- doned in favor of going back to things that had been done before. I thinkthese need to be blended together now by the regions so they are moving ahead with many of the quality assurance items, with all due regard to the fact Dr. Roth is not here and he and I had a little debate about that yes- terday afternoon. MR. HIROTO: Conversation. MR. OGDEN: "Conversation'that is a better tern, (Laughter ) Doesn't put it quite in a strained light, I don't e 2 wn 10 ll 12 e » i4 16 17 18 19 20 25 HOOVER REPORTING CO, INC. | 320 Massachusetts Avenu, NE. Washington. D.C. 20002 think there was that indeed, Okay. DR, PAHL: Is there further discussion om this point? Dr. Sparkman, DR. SPARKMAN: Dr, Pahl, I would like to support this, not because I come from the State of Washington -- (Laughter ) -- aS does my esteemed colleague, MR. OGDEN: I appreciate the support. (Laughter ) DR, SPARKMAN: I think the action, I am pleased to hear the action of the Council yesterday saying that the five priorities are options from which -- that there is action possible beyond that point, in light of the fact you just disemssed; namely, additional funds may be available, may be made available, It would be helpful to have some kind of fur- ther guidelines or parameters I believe Mr. Ogden and you are discussing. I belie ve the mission statement of May 1971 adopted by this Council is an appropriate one. I find nothing else in your minutes since tha time to indicate there was any change in that, I wonder whether there should also be any suggestion that the regions return to the priorities that they themselves “1 10 ll 12 13 14 16 17 18 19 20 25 HOOVER REPORTING CO, INC. 320 Massachusetts Avenu>, NE. Washington, D.C. 20002 167 set within the mission statement. Or is that necessary or is it inappropriate now? It would be helpful to us in considering the kinds of proposals that will be coming in as we think about con- tingency planning in case funds are available, DR. PAHL: I think what we wish to return to, again as local decision making, and what we have as I understand as a Department understanding now, from statements made yesterday, is that there are areas of priority interest to the Department which should be made known to regions and it has been the experience I think of RMPS when such priority areas-by the Department are announced, regions and regional advisory groups take these into account. But it is not a restriction placed upon the local regional advisory group in arriving at its set of priorities. Very honestly, I think that we continue to thread our way through a series of understandings and I would ilke tq indicate since we are in public session, that what I intend to do is to take the sense of this discussion, yesterday's dis- cussion, together with the comments that were made by those who have spoken for the Department, and try to formulate these in a brief statement which will have the concurrence of those who spoke to you, Dr, Margulies and Dr. Endicott. So that there is no further need for understandings. And then submit this to the coordinators and regional advisory groups. 6 m=} 10 ll 12 13 14 16 17 18 19 20 21 23 24 20 HOOVER REPORTING CO., INC. 320 Massachusetts Avenu>, NE. Washineton. D.C. 20002 168 I believe that that is probably our best insurance for having understanding. Because when something is com- mitted to paper, we can then have something we can all focus upon and we can refer back to. I don't believe there will be any difficulty in this since we have the understandings and the transcripts, and I believe we can move ahead much more expeditiously than we have in the past, So in that regard, we will try to clarify the situation and take into account all of the points that have been made throughout this Council meeting relative to the mission, local decision making, termination dates, and those important issues, MR, OGDEN: I might just comment, DB think you are covering what Dr Sparkman was saying. DR, PAHL: Yes, All right, thank you. There are other comments from Council? Other members of the public who may be here? Dr. van Hoek is on the side here and will be ver happy to respond to any questions that may come to mind as a result of yesterday's discussion, and Mr, Landman, from General Counsel Office, is here, if there is anything else that has occurred to you as a result of discussions and those we have expressed yesterday. Well, if not, I thirkI will then close the open md 10 ll 12 13 i4 16 1? 18 19 20 24 20 HOOVER REPORTING CO, INC. 320 Massachusetts Avenu, NE. Washington, D.C. 20002 169 session of the meeting and ask those who are not again involve with the direct review of grant applications if they will please leave at this time. And we will then turn to Mrs, Silsbee for a continuation of our review of grant applications MR, OGDEN: Herb, did we announce in public session what we are doing about Council meetings? DR. PAHL: Yes, that was public session when we set. the dates. MR, OGDEN: All right. I just want to make sure tha has been announced to the public session, MRS. MORGAN: To go in the Federal Register, too. DR, PAHL: Yes. As a matter of fact, we have a very efficient staff; we already have rooms reserved in anticipatia I hope of some cancellations. We also, of course, will be publishing this immedi- ately in the Federal Register. So all the Loose ends will be taken care of, (Whereupon, at 9:20 o'clock, a.m., the Council adjourned the open session and reconvened in executive session. ) jor n