— ~ ~~ Status Report: Regional Medical Programs Legislation Legislation extending and amending Regional Medical Programs passed in the House on October 13 and the Senate on October 14 and is now awaiting the President's signature. Included for your information on the current status and major changes in the new legislation are the following items: (1) Chronology of Legislative Action for Regional Medical Programs Extension of 1970. (2) Summary of Major Changes in New RMP Legislation. (3) Copy of the Conference Report on H.R. 17570, listing actual changes (Pages 1-4 and 17-18 of the Conference Report pertain directly to RMP.) (4) Copy of the 1968 legislative extension for purposes of com-- parison. Chronology of Legislative Action for Regional Medical Programs Extension of 1970 Of the 14 bills introduced concerning the extension of Regional Medical Programs, action centered on two, namely: S. 3355 - Sen. Ralph W. Yarborough (D.-Texas) H.R. 17570 - Rep. John Jarman (D.-Oklahoma) Action Taken in House - H.R. 17570 1. Legislation introduced 2. Hearings before the Subcommittee on Public Health ----—~“" and Welfare of the House Committee on Interstate Jan. 29, 1970 May 11, 1970 May 11, 1970 and Foreign Commerce. June 1, 2, 3, 4, 1970 3. Subcommittee approved for full committee action H.R. 17570 amended 4, House Committee on Interstate and Foreign Com- merce ordered favorably reported H.R. 17570. 5. Passed in House by vote of 365-0 Action Taken in Senate - S. 3355 1. Legislation introduced 2. Hearings before the Health Subcommittee of the Senate June 16, 1970 July 13, 1970 (Report No. 91-1297) August 12, 1970 January 29, 1970 Committee on Labor and Public Welfare. February 17, 18, 1970 3. Subcommittee approved for full Senate committee consideration, with amendments, S. 3355 4. Senate Committee ordered favorably reported, with ‘amendments, S. 3355 5. Senate Report issued. (Report No. 91-1090) 6. Senate inserted the text of S. 3355 and then passed its version of H.R. 17570 by a vote of 56-1. Conference 1. Conference Report submitted (H. Report 91-1590) 2. House agrees to Conference Report on H.R. 17570 3. Senate agrees to Conference Report on H.R. 17570 Presidential Action June 4, 1970 June 11, 1970 August 11, 1970 September 9, 1970 October 8, 1970 October 13, 1970 October 14, 1970 Major Changes in New RMP Legislation Present Legislation P.L. 89-239; P.L. 90-574 Legislation as passed in House and Senate 1. Categorical Heart disease, cancer, stroke Adds kidney disease, and other Emphasis and related diseases. related diseases. 2. Additional Emphasis on making available Promotes medical data ex- _ Emphases the latest advances in diag- change as well as résearch, nosis and treatment, and on cooperative arrangements for research, training and re- lated demonstrations of patient training, and demonstrations of patient care; medical data exchange relates directly to kidney transplants to include care. data exchange between tissue £ . typing banks and, on a re- gional basis, among medical schools, hospitals and other institutions and providers. - Adds prevention and rehabil- itation explicitly. - Gives additional emphasis to regionalization of health care resources and services in order to strengthen and . improve (1) primary care and (2) the relationship between primary care and specialized care. . Concerned with increasing capacity as well as quality, and with areas with limited health services. 3. Construction Authority Limited to "alteration, major repair, remodeling and reno- vation of existing buildings... and replacement of obsolete built-in equipment of existing buildings," up to 90% of cost. Adds authority to include "new construction of facilities for demonstrations, research and training when necessary to carry out Regional Medical Programs." Present Legislation P.L. 89-239; P.L. 90-574 Legislation as Passed in House and Senate Relationships to Compre- — hensive Health Planning Duration - Authorization Levels (in Millions) Funding Mechanism Regional Advisory Groups None specified in law. Grants, with two-year availability of funds. Composition: - Requirement there must include “practicing physicians, medical center officials, hospital ad- ministrators, representatives from appropriate medical societies, voluntary health..." and other health-related agencies...'' and members of the public...'familiar with health needs. Requires that the appropriate regional, metropolitan, or local areawide comprehensive health planning agéncy 314(b), have an opportunity to consider operational grant proposals before the RAG may recommend approval. Three-year extension “7 FY'7L $125 FY'72 150 FY'73 250 Includes provision that no more than $15 million shall be available for kidney disease activities in FY'71, and also includes a $5 million discretionan earmarking for new construction. Adds contract authority as well as RMP grant authority, and would permit Regions to obtain services in-kind from Federal ' agencies. One-year availability | of funds. Requires official health and health planning agency repre- sentation on such advisory groups; requires that public members include persons familiar with the financing of, as well as the need for services, and that such public members be sufficient in number to insure adequate com- munity orientation. Also includes a representative of the Veteran's administration as an ex officio member, if there is a VA institution in the Region. Present Legislation P.L. 89-239; P.L. 90-574 Legislation as Passed in House and Senate 8. National Advisory Council 9, Listing of Advanced Facilities Advisory Council responsible for RMP matters, Sixteen members - leaders in fields of fundamental sciences, medical sciences,or public affairs. At least 2 practicing physicians, one expert each for heart disease, cancer and stroke. Lists of facilities equipped and staffed to provide the most advanced methods of diagnosis and treatment in heart disease, cancer and stroke are to be established. Provides that the Assistant Secretary for Health and Scientific Affairs of HEW ‘shall be Chairman, replacing the Surgeon General in this position. Makes the Chief Medical Director of the Veterans! Administration an ex officio member of the Council. Increases the size of the Council from 16-20 members. Provides for: ‘ (1) one member who is out- standing in the study or care of kidney disease; (2) leaders in the field of health care administration as well as the fundamental and medical sciences; (3) two members outstanding in the field of prevention of heart disease, cancer, strokc or kidney disease; (4) ‘four of the twenty should be ‘members of the public. Adds a similar requirement for kidney disease. Present Legislation P.L. 89-239; P.L. 90-574 Legislation as passed in House and Senate 10. 11. Multiprogram Services - Section 910 General Authorities Provides for grants for services needed by, or which will be of substantial use to, any two or more regional medical programs. All authorities and de- terminations under Title IX, including the awarding of grants to Regional Medical Programs, are exercised by the Surgeon General of the Public Health Service. None specified in law Provides for both grants and contracts for a broad variety of activities including: activities of use to two or more regional medical programs, devel- opment or demonstration projects, collection of epidemiologic data, development of training, and conduct of cooperative clinical field trials. Also authorizes assistance in meeting the costs of special projects for improving or developing new means for the delivery of health services concerned with the diseases included in this title. Authorizes support for research, studies, investigations, training and demonstrations designed to maximize the utilization of man- power in the delivery of health services. Authorities and determinations exercised by Secretary rather than Surgeon General. When a single project receives grants from two or more sources within certain parts of HSMHA, the Secretary may issue regulatior under which administrative functions with respect to such projects will be performed by a Single administrative unit; ap- plications may be consolidated; and duplicative requirements ~ revised Present Legislation Legislation as passed in House and Senate 12. 13. Joint Funding (continued) Annual Report P.L. 89-239; P.L. 90-574 None specified in law. Limited to projects funded under Sections 304 and 314 and Title IX of the Public Health Service Act. This includes Regional Medical Programs, Comprehensive Health Planning and Services, National Center for Health Services Research and Development. Provides for an Annual Report from the Secretary on the ac- tivities carried on by the prograr: covered in this legislation.* It will cover an evaluation of the effectiveness of the programs, relationship between Federal and non-Federal financing, and recom- mendations for changes in program legislation. * Rather than a compilation of Separate reports, this is designed to be an overall integrated , report covering the coordinated range of activities of Regional Medical Programs, Comprehensive Health Planning and Services, National Center for Health Service Research and Development, and the National Center for Health Statistics. ** In addition, the Conference Report calls for a separate study and report on the appropriate scope of Regional Medical Programs in relation to disease coverage ,1.€ whether or not the scope of the program should be expanded to cover "other major diseases and conditions." Vise Conaress HOUSE OF REPRESENTATIVES Rerovr Od Nession. No. 91- 1590 | REGIONAL MEDICAL PROGRAMS AND COMPREHENSIVE HEALTH PLANNING AND SERVICES ACT OF 1970 OcronerR 8, 1970.—Ordered to be printed — sarge Mr. Sracazrs, from the committee of conference, submitted the following CONFERENCE REPORT [To accompany IT... 17570] “The committee of conference on the disagreeing votes of the iwo Houses on the amendments of the Senate to the bill (H.R. 17570) to amend title TX of the Public Health Service Act so as to extend and improve the existing program relating to education, research, training, and demonstrations in the fields of heart disease, cancer, stroke, and other related diseases, and for other purposes, having met, after full and free conference, have agreed to recommend and do recommend to their respective Houses as follows: That the House recede from its disagreement to the amendment of the Senate to the text of the bill and agree to the same with an amendment as follows: In licu of the matter proposed to be inserted by the Senate amend- ment insert the following: TITLE I—AMENDMENTS TO TITLE IX OF THE PUBLIC HEALTH SERVICE ACT Sec. 101. This title may be cited as the “Heart Disease, Cancer, Stroke, and Kidney Disease Amendments of 1970". Sec. 102. Section 900 of the Public Health Service Act is amended to read as follows: “PURPOSES “Sze. 900. The purposes of this title are—~ (a) through ¢ rants and contracts, to encourage and assist in the establishment of regional cooperative arrangements among medical schools, research institutions, and hospitals for research and training (ineluding continuing education), Jor medical data exchange, and Sor demonstrations of patient care in the Jields of heart disease, can- cer, stroke, and kidney disease, and other related diseases; 45-006—-70——-1 2 *(6) to afford to the medical profession and the medical institutions of the Nation, through such cooperative arrangements, the opportunity of making available to their patients the latest advances in the pre- vention, diagnosis, and treatment and rehabilitation of persons suffering from these diseases; “(e) to promote and foster regional linkages among health care institutions and providers so as to strengthen and improve primary care and the relationship between specialized and primary care; and “(d) by these means, to improve generally the quality and enhance the capacity of the health manpower and facilities available to the Nation and to improve health services for persons residing in areas with limited health services, and to accomplish these ends without interfering with the patterns, or the methods of financing, of patient care or professional practice, or with the administration of hospitals, and in cooperation with practicing physicians, medical center officials, hospital administrators, and representatives from appro- priate voluntary health agencies.” . See. 103. (a)(1) The first sentence of section 9O1(a) of such sAet is amended by striking out “and” immediately after “June 80, 1969,", and by inserting immediately before “, for grants” the following: “, $125,000,- 000 for the fiscal year ending June 30, 1971, $150,000,000 for the fiscal year ending June 30, 1972, and $260,000,000 for the fiscal year ending June 80, 1978”. (2) Such first sentence is further amended by striking out the period after “title” and inserting in lieu thereof “and for contracts to carry out the purposes of this title.” (8) Such section 901 (a) is amended by striking out the second sentence and inserting in. lieu thereof the following: “Of the sums appropriated under this section for the fiscal year ending June 30, 1971, not more than $15,000,000 shall be available for activities in the field of kidney disease. Of the sums appropriated under this section for any fseal year ending after June 80, 1970, not more than $5,000,000 may be made available in any such fiscal year for grants for new construction.” (b) Section 901 of such Act is further amended by adding at the end thereof the following new subsection: “‘(e) At the request of any recipient of a grant under this title, the pay- ments to such recipient may be reduced by the fair makret ralue of any equipment, supplies, or services furnished by the secretary to such recipient and by the amount of the pay, allowance, traveling expenses, and any other costs in connection with the detail of an officer or employee of the Government to the recipient when such furnishing or such detail, as the case may be, is for the convenience of and at the request of such recipient and for the purpose of carrying out the regional medical program to which the grant under this title is made.” See. 104. Section 902(a) of such Act is amended by striking out “training, diagnosis, and treatment relating to heart disease, cancer, or _ Stroke, and, at the option of the applicant, related disease or diseases” and inserting in Liew thereof “training, prevention, diagnosis, treatment, und rehabilitation relating to heart disease, cancer, struke, or Iridney disease, antl, at the option of the applicant, other related. diseases’. (b) Section 902(f) is amended by striking owt “includes” and inserting in lieu thereof “means new construction of facilities for demonstrations, research, and training when necessary io carry out regional medical programs”. - 83 See. 105, Section 903(b) (4) of such Net is amended-— ~ (1) by striking out Sroluntary health agencies, and” and insert ing in lieu therenf “voluntary or official health agencies, health planning agencies, and”; (2) by inserting immediately after “under the program”, where it first appears therein, the following: “Cineluding as an er officio member, if there is located in such region one or more hospitals or other health facilties uf the Veterans’ Administration, the individual whom the Administrator of Veterans’ Affairs shall have designated to serve on such advisory group as the representative of the hospitals or other health care facilities of such Administration which are located in such region)” ; and (3) by striking out “need for the services provided under the pro- gram” and inserting in liew thereof “need for and financing of the services provided under the program, and which advisory group shall be sufficient in number to insure adequate community orientation (as determined by the Secretary)’’. Sere. 106. That part of the second sentence of section 904(b) of such «let preceding paragraph (1) is amended by striking out “section 903(b) (4) and” and inserting in. lieu thereof the following: “section 903 ( 5) (4), uf opportunity has been provided, prior to such recommendation, for con- sideration of the application by each public or nonprofit private agency or organization whieh has developed a comprehensive regional, metropolitan area, or other local area plan referred to in seetion 314(b) covering any area in which the regional medical program for which the application is made will be located, and if the applieation’’. Sere. 107. (a) Seetion 9O5(a) of such Act is amended to read as follows: “See. 905. (a) The Secretary may appoint, without regard to the civil service laws, a National Advisory Council on Regional Medical Programs. The Couneit shall consist of the Assistant Seeretary of Health, [ducation, and Vi elfure for Health and Scientific Affairs, who shall be the Chawman, the Chief Medical Director of the Veterans’ Administration who shall be an ex officio member, and twenty members, not otherwise in- the reqular - full-time employ of the United States, who are leaders in the fields of the Jundamental sciences, the medical sciences, health care administration, or public affairs. At least two of the appointed members shall be practicing physicians, one shall be outstanding iin the study or health care of persons suffering from heart disease, one shall be outstanding in the study or health care of persons suffering from cancer, one shall be outstanding in the study or health care of persons suffering from stroke, one shall be out- standing in the study or health care of persons suffering from kidney disease, two shall be outstanding in the field of prevention of heart disease, cancer, stroke, or kidney disease, and four shall be members of the public.” (6) Of the persons first appointed under section 905 (a) of the Public Health Service Act to serve as the four additional members of the National sidvisory Council on Regional’ Medical Programs authorized by the amendment made by subsection (a) of this section— (1) one shall serve for a term of one year, (2) one shall serve for a term of two years, (3) one shall serve for a term of three years, and (4) one shall serve for a term of four years, as designated by the Secretary of Health, Education, and Welfare at the time of appointment. - 4 (c) Members of the National Advisory Couneil on Regional Medical Programs (other than the Surgeon General) in office on the date of enact- ment of this Act shall continue in office in accordance with the term of office for which they were last appointed to the Council. Sec. 108. Section 907 of such Act 's amended by striking out “or stroke,” and inserting in lieu thereof “stroke, or kidney disease,” Sec. 109. Section 90% a) of such Act is amended by inserting “or - contract” after “grant” each place it appears therein. See. 110. (a) Section 910 of such Act is amended to read as follows: “MULTIPROGRAM SERVICES “See. 910, (a) To facilitate interregional cooperation, and develop ‘umproved national capability for delivery of health services, the Sécretary ws authorized to utilize funds appropriated under this title to make grants to public or nonprofit private agencies or institutions or combinations thereof and to contract for— - (1) programs, services, and activities of substantial use to two or more reyional medical programs; ““(2) development, trial, or demonstration of methods for control of heart disease, cancer, stroke, kidney disease, or other related diseases; ‘*(8) the collection and study of epidemiologic data related to any of the diseases referred to in paragraph (2); ““(4) development of training specifically related to the prevention, diagnosis, or treatment of any of the diseases referred to in paragraph (2); or to the rehabilitation of persons suffering from any of such diseases; and for continuing programs of such training where s horlage of trained personnel would otherwise limit application of knowledge and skills important to the control of any of such diseases; and (6) the conduct of cooperative clinical field trials. ‘“(b) The Secretary is authorized to assist.in meeting the costs of special projects for improving or developing new means for the delivery of health services concerned with the diseases with which this title is concerned. “(c) The Secretary is authorized to support research, studies, investiga- tions, training, and demonstrations designed to maximize the utilization of manpower n the delivery of health services.” Src. 111. (a) The heading to title 1X of such Act is amended by striking out “STROKE, AND RELATED DISEASES” and inserting in lien thereof “STROKE, KIDNEY DISEASE, AND OTHER RELATED DISEASES”. (b) Sections 902 (a), 903 (a), 908(b), 904 (a), 904(b) , 905(b) , 905(d), 906, 907, and 909(a) of such Act (as amended by the preceding provisions of this Act) are each further amended by striking out “Surgeon General’, each place it appears therein and inserting in lieu thereof ‘ ‘Secretary’’. ‘TITLE IE-AMENDMENTS TO TITLE I/I OF THE PUBLIC HEALTH SERVICE ACT Part A—Rasearce anno Demonstrations Retarine to Hearn Facitirizs ano Services Sec. 201. (a)(1) Section 304(a) of the: Public Health Service Act is amenled— i (A) by inserting “(1)” immediately after “Src. 804. (a)”; (B) by redesignating clauses (1) and (2) as clauses (A) and (B), respectively; a 5 ((') by redesignating clauses (AY, ( B), and (C) as clauses (i), (7), and (iti), respectively. (2) Section. 3804 (b) of such Act is amended — (.4) by striking out “(b)” and in serting in liew thereof “(2)” > and (B) by striking out “this section” each place it appears therein . and inserting in lieu thereof “this subsection’. ‘ (3) Section 304(c) of such Act is amended - - (A) by striking out “(ey)” and inserting in Lien thereof “(3)?: and (B) by striking out “this section” etch place it appears therein and inserting in lien thercof “this subsection”. (b) Scetion 304 of such Act is further amended by adding after the pro- vision thereof redesignated as paragraph (8) by subsection (a)(3)(A) of this section the following new subsection: “Systems Analysis of National [Tealth Care Plans “(b))(A) The Secretary shall develop, through utilization of the systems analysis method, plans for health care systems desiqned ade- quately to meet the health needs of the simerican people. For purposes of the preceding sentence, the systems analysis method means the analytical method by which various means of obtainng a desired result or goal is associated with the costs and benefits involved. “(B) The Seeretary shall complete the development of the plans referred tom subparagraph CA), within such period as may be necessary to enable him to submit to the ¢ ongress nol later than September 30,1971, a report thereon which shall deseribe each plan so developed in terms of-- “(i) the number of people who would be covered under the plan; " “Othe kind and type of health care which would be covered under the plan; ““(ttt) the cost involved in carrying out the plan and how such costs would be financed; ‘“(iv) the number of additional physicians and other health care personnel and the number and type of health care facilities needed to enable the plan to become fully effective; ‘‘(v) the new and improved mei ods, if any, of delivery of health care services which would be developed in order to effectuate the plan; “(ot) the accessibility of the benefits of such plan to various socio- economic classes of persons; “(vit) the relative effectiveness and efficiency of such plan as compared to existing means of financing and delivering health care; and “(oti) the legislative, admin istrative, and other actions which would be necessary to implement the plan. “(C') In order to assure that the advice and service of experts in the various fields concerned will be obtained in the plane authorized by this paragraph and that the purposes of this paragraph will fidly be carried out— , , : “(1) the Secretary shall utilize, whenever appropriate, personnel Jrom the various agencies, bureaus, and other departmental sub- divisions of the Department of Health, Kducation, and Welfare; “(ti)_ the Seeretary is authorized, with the consent of the head of the department or ayency thvolved, to utilize (on @ reimbursable : basis) the personnel and other resources of other departments and agencies of the Federal Government; ail 6 “(ii) the Secretary is authorized to consult with appropriate State or local publie agencies, private organizations, and individuals. “Cost and Coverage Report on Existing Legislative Proposals “(2)(A) The Secretary shall, in accordance with this paragraph, con- duet a study of each legislative proposal which is introduced in the Senate or the House of Representatives during the Ninety-first Congress, and which undertakes to establish a national health insurance plan or similar plan designed to meet the needs of health insurance or Sor health services af all or the overwhelming majority of the people of the United States. ‘“(B) In conducting such study with respect to each such legislat ive proposal, the Secretary shall evaluate and analyze such proposal with a view to determining --- “(7) the costs of carrying out the proposal; and “(ir) the adequacy of the proposal in terms of (1) the portion of the population covered by th ey proposal, (I1) the type health care provided, paid for, or insured against under the proposal, (111) whether, and if so, to what extent, the. proposal provides Sor the development of new and improved methods for the delivery of health care and serrieces, “(C) Not later than March 81, 1971, the Secretary shall submit to . the Congress a report on each legislative proposal which he has been directed to study under this paragraph, together uth an analysis and evaluation of such proposal.” (ce) Subsection (d) of section 304 of such Act is hereby redesignated as subsection (c) and is amended to read as follows: ““(c)(1) There are authorized to be appropriated for payment of grants or under contracts under subsection (a), and for purposes of carrying out the provisions of subsection (b), $71,000,000 for the fiscal year ending June 80, 1971 (of which not less than $2,000,000 shall be available only Jor purposes of carrying out the provisions of subsection (6)), $82,000,000 Jor the fiseal year ending June 80, 1972, and $94,000,000 for the fiscal year ending June 80, 1978. ; “(@) In addition to the funds authorized to be appropriated under paragraph (1) to carry out the provisions of subsection (b) there are hereby authorized to be appropriated to carry out such provisions for each fiscal year such sums as may be necessary.” (d) The amendments made by subsection (c) of this section shall be effective only with respect to fiscal years ending after June 80, 1970. Sec. 202. That provision of section 304 of the Public Health Service Act redesignated by section 201(a) of this Act as paragraph (8) of sub- section (a) is further amended— (1) by inserting “(A)” immediately after “(3)”; and (2) by adding after and below such provision the following new subparagraph: “(B) The amounts otherwise payable to any person under a grant or contract made under this subsection shall be reduced by— “(}) amounts equal to the fair market value of any equipment or supplies furnished to such person by the Secretary for the purpose of carrying out the project with respect to which such grant or con- tract is made, and 7 “() amounts equal to the pay, allowances, traveling erpenses, and related personnel erpenses atiributable to the performance of services by an officer or employee of the Government in connection with such project, if such officer ur employee was assigned or detailed by the Secretary to perform such services, . but only if such person requested the Secretary to furnish such equipment or supplies, or sueh services, as the case may be.” _ Sze. 203. That provision of section 304 of the Public Health Service «let redesignated by section 201(a) of this Aet as paragraph (1) of sub- xection (a) is further amended by— (1) striking out the period at the end thereof and inserting in lien thereaf “, and?; and (2) adding after and below the clause thereof redesignated by such section 201 (a) as clause (iii) the following new clauses: ‘‘(w) projects for research, experiments, and demonstrations deal ing with the effective combination or coordination of public, private, or combined public-private methods or systems Sor the delivery of health services at regional, State, or local levels, and “(v) projects for research and demonstrations in the provision of home health services.” Parr B—Natrionat Hratty Surveys anv StupiEs Sre. 210. (a)(1) Clause (1) of subsection (a) of section 3065 of the Public Health Service Act is amended by striking out “and” before “(E)”, and by inserting after the semicolon at the end of such clause the following: “(F) health care resources: (G) environmental and social health, hazards; and (H) jamily formation, growth, and dissolution?”. (2) Such subsection is further amended by adding at the end thereof the following new sentence: “No information obtained in accordance with this paragraph may be used for any purpose other than the statistical purposes for which it was supplied except pursuant to regulations of the Secretary: nor may any such information be published if the particular establishment or person supplying it is identifiable except with the consent of such establishment or person.” : (6) Section 305 is further amended by redesignating subsections (b), (ce), and (d) as subsections (c), (d), and (e), respectively, and by adding after subscetion (a) the following new subsection: “(b) The Secretary is authorized, directly or by contract, to undertake research, development, demonstration, and evaluation, relating to the design and implementation of a cooperative system for producing com- parable and uniform health information and statistics at the Federal, State, and local levels.” (c) The subsection of such section 305 redesignated (by subsection (b) of this section) as subsection (d) is amended to read as Jollows: “(@) There are authorized to be appropriated to carry out this section 415,000,000 for the fiscal year ending June 80, 1971, %20,000,000 for the fiscal year ending June 80, 1972, and $26 000,000 for the fiscal year ending June 80, 1973.” > Part C'—Grants to Srares ror Comprenunsive Srave HraLru PLANNING Sec. 220. (a) (1) The Jirst sentence of section 314(a) (1) of the Public Health Service sAct is amended by siriking out “June 30, 1970" and inserting in Liew thereaf “June 80, 1973”, 8 (2) The second sentence of such section 8 L4(a)(1) is amended by striking ont “and $15,000,000 for the fiseal year ending June 30, 1970" aiid inserting in lieu thereof the following: “$15,000,000 for the Jiseal year entling June 80, 1970, 815 000,000 for the fiscal year ending June 80, 1971, $17,000,000 for the fiscal year ending June 80, 1972, and S20,- 000,000 for the fiscal year ending June 30, 1973", (b) Section 314(a)(2)(B) of such Act is amended by striking out “State and local agencies” and inserting in liew thereof “Federal, State, anid local agencies (ineluding as an ex officio member, if there is located m such State one or more hospitals or other health eare facilities of the Veterans’ Administration, the individual whom the Administrator of Velerans’ Affairs shall have designated to serve on suck council as the representative of the hospitals or other health care facilities of such ‘\dministration which are located in such State)”. (c) Section 314(a)(2)(B) of such clet (as amended by subsection (b) of this section) is further amended by rnserting “(ineluding representation of the regional medical program or programs included in whole or in part within the State)” immediately after “concerned with health?’ © (d) Section 31.4(a)(2)(C) of such Act is amended (1) by inserting “and including hame health care” immediately after “private”, and (2) by inserting immediately before the semicolon at the end thereof the following: “and including environmental considerations as they relate to public health’, Parr D—Prosecr Grants ror ARgawipe Hearra PLaxyxing Sze. 280. Section 814(b) of the Public Health Service Aet is amenled-— (1) by striking out, in the first sentence thereof, “June 30, 1970” and inserting in lieu thereof “June 30, 1978”; _ @) by inserting after the word “services” the second place it appears therein, the phrase “and including the provision of such services through home health care’; (3) by striking out, in the second sentence thereof, ‘and $16 000,000 Jor the fiscal year ending June 30, 1970” and inserting in Liew thereof the following: “$15,000,000 Jor the fiscal year ending June 30, 1970, $20,000,000 jor the fiscal year ending June 30, 1971, $30,000,000 for the fiscal year ening June 80, 1972, and $40,000,- 000 for the fiscal year ending June 80, 1978"; (4) by inserting “(1) A)” immediately after “(b)” > and (5) by adding after and below the existing language contained therein the following; “(B) Project grants may be made by the Secretary under subparagraph (A) to the State agency administering or supervising the administration of the State plan approved under subsection (a) with respect to a particular region. or area, but only tf (1) no application for such a grant uxth respect to such region or area has been filed by any other agency or organization qualified to receive such a grant, and (ti) such State agency certifies, and the Secretary finds, that ample opportunity has been afforded to qualified agencies and organizations to file application for such a grant with respect to such region or area and that 7 is improbable that, in the foreseeable Suture, any agency or organization which is qualified for such a grant will file application therefor. 9 (2) (A) In order to be approved under this subsection, an application for a grant under this subsection must contain or be supported by reasonable ~ assurances that there has been or will be established, in or for the area with respect to which such grant is sought, an areawide health planning counei, The membership of such council shall include representatives of public, voluntary, and nonprofit private agencies, institutions, and organizations concerned with health (including representatives of the interests of local government, of the regional medical program for such area, and of con- sumers of health services). A majority of the members of such council shall consist of representatives of consumers of health services. — “(B) In addition, an application jor a grant under this subsection must contain or be supported by reasonable assurances that the areawide health planning agency has made provision for assisting health care Jacilities in its area to develop a program for capital expenditures for replacement, modernization, and expansion which, is consistent with an overall State plan which will meet the needs of the State and the area for health care facilities, equipment, and services without duplication and otherwise in the most efficient and economical manner.” Parr E--Prozrer Grants ror TrAnine, STUDIES AND Davuonsrrarions Sec. 240. Section 814(c) of the Public Health Service.Act is amended — ' () by striking out, in the first sentence thereof, “June 30, 1970” and inserting in liew thereof “June 80, 1973”; and (2) by striking out, in the second sentence thereof, “and $7,500,000 Jor the fiseal year ending June 80, 1970” and inserting in lieu thereof the following: “$7,500,000 Jor the fiscal year ending June 80, 1970, $8,000,000 for the Jiscal year ending June 30, 1971, $10,000,- — 000 for the fiscal year ending June 30, 1972, and $12,000,000 for the fiscal year ending June 80, 1973”, . Parr F-—Granrs ror Comprenensive Pystic Hrattr SERVICES Sec. 260. (a) Section 314(d) (1 ) of the Publie Health Service Act is amended by striking out “and $1 00,000,000 for the fiscal year ending June 80, 1970” and inserting in liew thereof “$1 00,000,000 for the fiscal year ending June 30, 1970, $130,000,000 for the fiscal year ending June 30, 1971, $146,000,000 for the Jiscal year ending June 80, 1972, and $16,000,000 for the fise year ending June 30, 1973". (6) Section 314(d)(2)(C) of such Act is amended (1) by striking out “and (tii)” and inserting in lieu thereof “(iti)” and (2) by inserting before the semicolon at the end thereof the following: “; and (iv) the plan is compatible with the total health program of the State’. Parr G—Prosect Grants ror Heattn Services Dreve.opMenr Szc. 260. (a) Section 314(e) of the Public Health Service Act is amended by striking out “and” immediately after “June 80, 1969,” and by inserting after “June 30, 1970,” the following: “$109,600 ,000 for the fiscal _year ending June 30, 1971, $186,000,000 for the Jiscal year ending June 80, 1972, and 8167 000,000 for the fiscal year ending June 30, 1978,” H, Rept, 91~-1599-—-2 10 (b) The first sentence of 814(e) is further amended by inserting im- mediately after “cost” the following: “(including equity requirements and amortization of loans on facilities acquired from the Office of Economic Opportunity or construction im connection with any program or project transferred from the Office of Eeonomie Opportunity)”. (c)(1) The second sentence of such section is amended to read as follows; “Any grant made under this subsection may be made only if the application jor such grant has been referred for review and comment to the appropriate areawide health planning agency or agencies (or, if there is no such agency in the area, then to such other public or nonprofit private agency or organization (if any) which performs similar functions) and only if the services assisted under such grant will be provided in Genendance with such plans as have been developed pursuant to subsection a). (2) The amendment made by paragraph (1) shall be effective unth respect lo grants under section 314 (e) of the Public Health Service Act which are made after the date of enactment of this Act. Parr IF--Apministration or Grants in Cnevain Movriaranr Proseers Sze. 270. Part A of title IIT of the Public Health Service Act is amended by adding at the end thereof the following new’ section: “Administration of Grants in Certain Multigrant Projects “Src. 310A. For the purpose of facilitating the administration of, and expediting the carrying out of the purposes of, the programs estab- lished by title IX, and sections 3804, 314(a); 314(b), 314 (c), 814(d), and 3i4(e) of this Act in situations in which grants are sought or made ander two or more of such programs with respect to a single project, the Secretary is authorized to promulgate regulations— “(1) under which the administrative functions under such programs with respect to such project will be performed by a single administra- twe unit which is the administrative unit charged with the adminis- tration of any of such programs or is the administrative unit charged with the supervision of two or more of such programs; “(@) designed to reduce the number of applications, reports, and other materials required under such programs to be submitted with respect to such project, and otherwise to simplify, consolidate, and make uniform (to the extent feasible), the daia and information required to be contained in such applications, reports, and other materials; and ; (8) under which inconsisient or duplicative requirements imposed by such programs will be revised and’ made uniform with respect to such project; except that nothing in this section shall be construed to authorize the Secretary to waive or suspend, with respect to any such project, any requirement with respect to any of such programs if such requirement is imposed by law or by any regulation required by law.” Parr {--AnxuaL Report, Nationayn Apvisory Councin, Erc. Src. 280. Part «A of title ILE of the Public Health Service Act is further amended by adding after section 310.A thereof (as added by section 270 of this Act) the following new section: It “Annual Report “SLOB. On or before January 1 of each year, the Sceretary shall trans- mat to the Congress a report of the activities carried on under the provisions of title IX of this Act and sections 304, 805, 314(a), 814(b), 814(e), . 914(d), and 814(e) of this title together with (1) an evaluation. of the effec- tiveness of such activities in improving the eficiency and effectiveness of the research, planning, and delivery of health services in carrying out the purposes for which such provisions were enacted, (2) @ statement of the relationship between Federal financing and Jinaneing from other sources of the activities undertaken pursuant to such provisions (including the pos- sibilities for more efficient support of such activities through use of alter- nate sources of financing after an initial period of support under such pro- visions), and (8) such recommendations with respect to such provisions as he deems appropriate.” Ske. 281. Title TLL of the Public Health Service Act is amended by adding after section 815 thereof the following new section: “NATIONAL ADVISORY COUNCIL ON OOMVPRULNENSIVE HEALTH PLANNING PROGRAMS “See. 310. (a) The Secretary shall appoint, without regard to the civil servier laws, a National Advisory Couneil on ¢ ‘omprehensine TTealth Planning Programs. The Council shall. consist of the Sceretary or his designee, who shall be the chairman, and sixteen members, not otherwise in the regular full-time employ of the United States, who are (1) leaders in the fields of the fundamental sciences, the medical sciences, or the organi~ cation, delivery, and finaneing of health care, (2) officials in State und areawide health planning agencics, (3) leaders in health care adminis- tration, or State or eommanity or other publie affairs, who are State or local officials, or (4) representatives of consumers of health care. At least six of the appointed members shall be individuals representing the consumers of health care, one shall be an official of a@ State health planning gency, one shall be an official of an areawide health planning agency. and one shall be a member of the National Advisory Council on Regional Medical. Programs. “(b) Each appointed member of the Council shall hold office for « term of four years, except that any member appointed to fill a vacancy prior to the expiration of the term for which his predecessor was appointed shall be appointed. for the remainder of such term, and except that the terms of office of the members first taking office shall expire, as designated by the Secretary at the time of appointment, four at the end of the first year, Jour al the end of the second year, four at the end of the third year, and four at the end of the fourth year after the date of appointment. An appointed member shall not be eligible to serve continuously for more than two terms. “(c) Appointed members of the Council, while attending meetings or conferences thereof or otherwise serving on the business of the Council, shall be entitled to receive compensation at rates Sized. by the Secretary, but at rates not exceeding the daily equivalent of the rate specified at the time of service for 95-18 of the general schedule, including travel- time, and while so serving away Jrom their homes or regular places of business they may be allowed travel espenses, including per diem in lien of subsistence, as authorized by section 5708(b) of title 5 of the United States Code for persons in the Government service employed intermittently, 12 “(d) The Council shall advise and assist the Secretary in the preparation of general regulations for, and as to policy matters arising with respect to, the administration of section 314 of this title, with inereased emphasis on cooperation in the coordination of programs thercander with the National Advisory Council on Regional Medical Programs, with par- ticular attention to the relationship between the improved organization and delivery of health services and the financing of such services: and shall, tm carrying out such functions, review, not less often than annually, the granis made under section 814 to determine their effectiveness in carrying out its purposes.” Sec. 282. Part B of title III of the Public Health Service Act is amended by striking out “Surgeon General” each place it appears and inserting in liew thereof ‘“Secretary’’. Part J—Rxeutation or Vacernrs, Broop, Boon Components, AND ALLERGENIC PRopucTs See. 201. Section 351 of the Public Health Serrice Act is amended by inserting, after “antitoxin”, each time such word appears, the following: “vaccine, blood, blood component or derivative, allergenic praduet,”. Parr K—Exreinsion ov Resvarcn Conrracr Avruorivy Sze. 292. Paragraph. (h) of section 301 of the Public Health Service “Act is amended by striking out “five succeeding fiscal years” and in- . Fe serting in lieu thereof “eight succecling fiscal years”. TITLE [1l--COMMUNITY MENTAL HEALTH CENTERS Sec. 301. Seetion 201 of the Community Mental Health Centers cimendiments of 1970 is amended by adding at the end thereof the following new subsection: “(e) In the case of any community mental health center- - “1) for which a staffing grant was made under part B of the Community Mental Health Centers Act for any period which began on or before June 30, 1970; and “*(2) (A) with respect to which the portion of the costs (as deseribed in section 220(a) of such Act) which may be met from funds under a grant under such part B is increased (by reason of the enactment of the preceding subsections of this section) for any period after June 80, 1970; or “(B) with respect to which the period during which a grant under such part B may be made. is extended by reason of the enactment of subsection. (a) of thix section; the provisions of section 221(a)(4) of sueh Act shall be deemed to have been. complied with for any period after June 80, 1970, if the Secretary determines that there is satisfactory assurance that the amount of total costs, Federal and non-Federal, (as described in section 220(a) of such Act) which will be incurred by such center for staffing purposes for any period after June 80, 1970, will not be less than the amount of such total costs for the period which last commenced on or before June 30, 1970, except that the grantee shall not be required to increase the amount con- tributed ax the non-Federal share in the event the amount of the Federal participation is redueed.” . 13 so ~ LITLE IV—-ACTHORITY FOR GROCP PRACTICE Suc. 401. (a) The Secretary of Health, Education, and Welfare may, im accordance with the provisions of this section, authorize any carrier, which is a party to a contract entered into under chapter 89 of title 6, United States Code (relating to health benefits for Federal employees), or under the Retired Federal Employees Health Benefits Act, or which par- ticipales in the carrying out of any such contract, to issue in any State contracts entitling any person as a beneficiary to receive comprehensive ~ medical services (as defined in subsection (b)) from a group practice unit or organization (as defined in subsection (c)) with which such currier has contracted or otherwise arranged for the provision of such services. (b) .As used in this section, the term “comprehensive medical services’ means comprehensive prenentive, diagnostic, and therapeutic medical services (as defined in regulations of the Secretary), furnished on a prepaid basis: and may include, at the option of a carrier, such other health services including mental health services, and equipment and supplies, furnished on such terms ani comlitions with respect to copayment and other matters, as may be authorized in regulations of the Secretary. (c) As used in this section: (1) The term “group practice unit or organization” means a non- - profil agency, co-operative, or other organization undertaking to provide, through direct employment of, or other arrangements with the members of a medical group, comprehensive medical services (or such services and other health services) to’ members, subscribers, or other persons protected unter contracts of carriers. (2) The term “medical group” neans a partnership or other association or group of persons who are licensed to practice medicine in a State (or of such persons and persons licensed to practice dentistry or optometry) who (A) as their principal professional activity and as a group respon- sibility, engage in the coordinated practice of their profession primarily in one or more group practice facilities, (B) pool their income from practice as members of the group and distribute it among themselves according toa prearranged plan, or enter into an, employment arrangement with a group practice unit or organization for the provision of their services, (C) share common overhead expenses (if and to the extent such expenses are paid by members of the group), medical and other records, and substantial portions of the equipment and professional, technical, and administrative staff, and (D) include within the group at least such professional personnel, and make available at least such health services, as may be specified in regula- tions of the Secretary. (¢) Nothing in this section shall preclude any State or State agency Jrom regulating the amounts charged Jor contracts issued pursuant to sub- section (a) or the manner of soliciting and issuing such contracts, or from : regulating any carrier issuing such contracts in any manner not incon- sistent with the provisions of ihis section. TITLE V—STUDY RELATING TO ENVIRONMENTAL POLLUTION Suc. 501. (a) The Vongress finds that there is general agreement that . air, water, and other common environmental pollution may be hazardous to the health of individuals resident in the United States, but that despite the existence of various research papers and other technical reports on the 14 health hazards of such pollution, there is no authoritative source of aeier- mation about (1) the nature and gravity of these hazards, (2) the araila- bility of medical and other assistance to persons affected by such pollution, especially when, such pollution reaches emergency levels, and 13) the meas- ures, other than those relating solely to abatement of the pollutcon, “hat may be taken to avai‘ or reduce the effects of such pollution on the Acalth of individuals. (b) The President shall immediately commence (1) a study of the nalare and gravity of the hazards to human health and safety created by air, water, and other common environmental pollution, (2) a survey of the medical and other assistance available to persons affected by such pollu- tion, especially when such pollution reaches emergency levels, and (8) a survey of the measures, other than those relating solely to abatement of the pollution, that may be taken to avoid or reduce the effects of such pollution on the health of individuals. ’ (e) The President shall, within nine months of the enactment of this a let, transmit to the Congress a report of the study and surveys required by subsection (b) of this section, including (1) his conclusions regarding the nature and gravity of the hazards to human health and safety created by environmental pollution, (2) his evaluation of the medical and other assistance available to persons affected by such pollution, especially when such pollution reaches emergency levels, (3) his assessment of the MEGSUTes, uther than those relating solely to abatement of the pollution, that may be taken to avoid or reduce the effects of such pollution on the health of wnidi- viduals, anid (4) such legislative or other recommendations as he may deem appropriate. (d) Tre President shall, within one year of his transmittal to the Con- gress of the report required by subsection (c) of this section, and annually thereafter, supplement that report with such new dala, evaluations, or recommendations as he may deem appropriate. (@) There are authorized to be appropriated such sums as may be necessary to carry out the provisions of this section. LITLE VI-MISCELLANEO us ‘NATIONAL ADVISORY COUNOIL Sec. 601. (a)(1) Sections 217(b), 432(a), 448(6), and 703(c) of the Public Health Service Act are amended by inserting “or committees” after “councils” wherever it appears therein. (2) Sections 481, 482(b), 488, 443, and 452 of such Act are amended by inserting “or committee” after “council” wherever it appears therein. (3) Subsections (6) and (c) of section 222 of such Act are amended by inserting “council or’ before “commitice”’ wherever it appears therein. (4) Such section is further amended by inserting in the heading thereof “councizs or” before “‘commirrzns’’. (b)(1) Subsection (c) of section 208 of the Public Health Service Act is amended to read: *(¢) Members of the National .Advisory Health Council and members of other national advisory or review councils or committees established under this Act, including members of the Technical Electronic Product Radiation Safety Standards Commitiee and the Board of Regents of the National Library of Medicine, but exchuting ex officio members, while attending conferences or meetings of their respective councils or com- mittees or whale otherwise serving at the request of the Secretary, shall be 15 entitled to reecive compensation at rates to be fixed by the Secretary, but at rates not exceeding the daily equwalent of the rate specified at the time — of such service for grade GS-18 of the General Schedule, including trarel- time; and while away from their homes or regular places of business they may be allowed travel expenses, including per diem in liey of subsistence, as authorized by section 5703 (b) of title 6 of the United States Code for persons in the Government service employed intermittently.” (2) The second sentence of subsection (d) of section 306, the second sentence of subsection (d) of section 507, the first sentence of paragraph (2) of subsection (f) of section 358, subsection (d) of section 878, sub- section (¢) of seetion 641 , subsection (d) of section 708, subsection (d) of section 726, subsection. (d) of section 774, subsection () of section 841, and subsection (c) of section 905 of such Act ure deleted. ; (8) Paragraph (2) of subsection (1) of section 868 4s further amended by striking out “under this subsection” in the second sentence thereof and by inserting in Leu thereof ‘to members of the Commiitee who are not officers or employees of the United States pursuant to subsection (ce) of section 208 of this Act’. (4) Subsection ‘(d) of section 905 of such Act is redesignated as sub- section (e). (c)(1) Subsection (a) of section 222 of such Act is amended to read: “(a) The Secretary may, without regard to the provisions of title 6, United States Code, governing appointments in. the competitive service, and without regard to the provisions of chapter 51 and su chapter ITT of chapter 53 of such title relating to elassifeation and General Schedule pay rates, from, time to time, appoint such advisory couneils or com- mittees (in addition to those authorized to be established under other pro- visions of law), for such periods of time, as he deems desirable with such period commeneing on a date specified by the Secretary Jor the purpose of alvising him in connection with any of his functions.” (2) Subsection (c) of such section is amended by inserting “‘or programs” after “projects”. (d)(1) Subsection (g) of section 408 of the Food, Drug, and Cosmetic «let is amended by striking out “as compensation for their services a reasonable per diem, for time actually spent in the work of the committee, and shall in addition be reimbursed Jor their necessary traveling and subsistence expenses while so serming away from their places of residence.” after “shall reeeive” and by inserting in Lieu thereof “compensation and travel expenses in accordance with, subsection. (b) (5) (D) of section 706.” (2) Subparagraph (D) of paragraph (6) of subsection (b) of section 206 of such Act is amended by stroking out the third sentence thereof and by inserting in lieu thereof the following new sentence: “Members of any advisory committee established under this Act, while attending conferences or meetings of their committees or otherwise serving at the request of the Secretary, shall be entitled to receive compensation at rates to be fixed by the Secretary but at rates not exceeding the daily equivalent of the rate specified at the time of such service Jor grade GS-18 of the General Schedule, ineluding traveltime; and while away from their homes or regular places of business they may be allowed travel expenses, including per diem in lieu g subsistence, as authorized by séction 5708(b) of title 6 of the United States Code for persons in the Government service employed intermittently.” 16 TRAINING AUTHORITY OF INSTITOTE OF GENURAL MEDIVAL SULES CLS Sec, 602. Section 442 of the Public Health Service Act is amended by striking out “research? before “training’’. And the Senate agree to same. That the House recede from its disagreement to the amendment of the Senate to the title of the bill and agree to the same. Hanger O. Sraacens, JOHN JARMAN, ‘ Paut G. Rogers, - Winuiam L. Springer, ANCHER NELSEN, Managers on the Part of the House. Raury YARBOROUGH, Hariison A. Wituiams, Jr., EKpwarp M. Kennepy, Thomas F. Eaaueron, ALAN ORANSTON, HWaroup EK. Huanes, CLAIBORNE Penn, Perper H. Dominick, Jacon K. Javrers, Grorcu Murpuy, Winsron LL. Proury, Wituam B. Saxss, Managers on the Part.of the Senate. STATEMENT OF THE MANAGERS ON THE PART OF THE HOUSE The managers on the part of the House at the conference on the disagreeing votes of the two Houses on the amendments of the Senate to the bill (H.R. 17570) to ninend title TX of the Publie Health Service Act so as to extend and improve the existing program relating to education, research, training, and demonstrations in the fields of heart disease, cancer, stroke, and other related diseases, and for other purposes, submit the following statement in explanation of the effect of the action agreed upon by the conferees and recommended in the accoulpanying conference report: The Senate amendment to the text of the bill struck out all of the House bill after the enacting clause and inserted a substitute amend- ment. The committee of conference has agreed to a substitute for both the House bill and the Senate amendment to the text of the bill. Except for technical, clarifying, and conforming changes, the following statement explains the differences between the House bill and the substitute agreed to in conference. The House has passed two separate bills dealing with the subjects embraced in the Senate amendment; H.R. 17570, and H.R. 18110, a bill extending and expanding the program of comprehensive health planning and research and demonstrations relating to the delivery of health services. The Senate amendment deals with the programs contained in both House bills. REGIONAL MEDICAL PROGRAMS Scope of program . Both the House bill and the Senate amendment expanded the scope of the program to include kidney disease as well as heart disease, cancer, and stroke. However, the Senate amendment changed coverage of other related diseases to other major diseases and conditions. The conference substitute is the same as the House bill. The Man- agers for both Houses were in doubt as to whether the scope of the srogram should be limited (as in the House bill) to diseases related to heart disease, kidney disease, cancer, and stroke or whether it should be limited (as in the Senate amendment) to major diseases und con- ditions other than heart disease, kidney disease, cancer, and stroke and expect the Secretary of Health, Education, and Welfare to conduct a study of the scope of the regional medical program and to report to the appropriate committecs of Congress his recommendations. Construction The Senate amendment contained a provision not in the House bill which expanded assistance for construction to include assistance for new construction of facilities? for demonstrations, research, and training when necessary to carry out regional medical programs. “(17) 18 The conference substitute is identical with the Senate amendment except that if is provided that not more than $5 million may be made available in any fiscal year for grants for such new construction, Participation of Veterans’ Administration personnel The Senate amendment contained a provision not in the House bill - which would (1) make the Chief Medical Director of the Veterans’ Administration an ex officio member of the National Advisory Council for the regional medical program, and (2) require local advisory groups to include as an ex officio member the person designated from the local Veterans’ Administration health facility. JOINT ADMINISTRATION OF PROJECTS he House bill’ would amend the Publie Health Service Act to provide that in the case of projects funded under more than one Fed- eral law, one agency could be designated to administer financial assis- tance for such projects, single non-Federal share requirements for such projects could be established, and conflicting grant or contract re- qturement could be deleted. The Senate amendment contained a similar provision. The authority in the Senate amendment would be limited to projects funded under title TTL or EN of the Public Health Service Act and no authority for a single non-Federal share requirement or for waiver of conflicting re- quirements required by law or by regulations required by law would be provided. The eonference substitute is identical with the provision of the Senate amendment. RESEARCH AND DEMONSTRATIONS RELATING TO HEALTH FACILITIES ‘ AND SERVICES sluthor ization of appropriations The House bill would extend for three fiscal years (through fiscal year 1973) the authorization of appropriations for the programs of Federal financial assistance under section 304 of the Public Health Service Act (relating to research and demonstrations). The following amounts would be authorized: $58 million for fiscal vear 1971, S79 “million for fiscal year 1972, and $94 million for fiscal year 1973. The Senate amendment would extend such program for five years (through fiseal year 1975) and would authorize the following amounts: $80 million for fiscal year 1971, $85 million for fiseal year 1972, $94 million for fiscal year 1973, $110 million for fiscal year 1974, and $130 million for fiseal year 1975. The conference substitute would extend such programs for three years (through fiscal year 1973) and would xuthorize the following amounts to be appropriated for such program: $69 million for fiscal year 1971, $82 million for fiscal year 1972, and $94 million for fiscal year 1973. Research, cte., on delivery of health services The Senate amendment contained a provision not in the House bill which would authorize grants-and contracts under such section iPThereferenco ty the House bill in the discussion of this and the succeeding provisions is to HI. 18110, a8 passed the House, - 19 304 for research, experiments, and demonstrations, relating to the effective combination or coordination of methods or systems for the delivery of health services. The conference substitute contains the provision of the Senate amendment. Tlome health, services The Senate amendment contained a provision not in the House bill which would authorize grants and contracts under such section 304 for projects for research and demonstrations in the provision of home health services. The conference substitute contains the provision of the Senate nmiondiment. elnalysis of national health care plans The Senate amendment contained a provision not in the House bill which would amend such seetion 304 to direct the Secretary of Health, Kduention, and Welfare to develop, through utilization’ of systems analysis method alternative plans for health care systems designed adequntely to meet. the health needs of the American people and to report to Congress not later than June 30, 1971, on such plans. Under the amendment, the Secretary would also study bills introduced in the 91st Congress which propose a national health insurance ‘plan or similar plan to determine the costs of such plans and their adequacy. The Secretary would report to Congress not later than December 31, 1970, the results of such study. $4 million would be authorized for fiscal year 1971 for the development of such plans and for the conduct of such study. The conference substitute is the same as the Senate amendment except that (1) it is made clear that the Secretary is to develop more than one plan for health care systems, (2) the Secretary’s report with respect to plans for health care systems is to be made not later than September 30, 1971, (3) the Secretary’s report on bills introduced in the 91st Congress is to be made not later than March 31, 1971, and (4) $2 million is authorized’ for fiscal year 1971. THE NATIONAL HEALTH SURVEYS AND STUDIES The House bill would amend section 305 of the Public Health Service Act to extend for three years (through fiscal year 1973) the program of national health surveys and studies and would authorize or such program the following amounts: $10 million for fiscal year 1971, $21 million for fiscal year 1972, and $22 million for fiscal year 1973. The Senate amendment would continue the open-ended authoriza- tion for such program. The conference substitute extends such program for three fiscul years and authorizes the following amounts: $15 million for fiscal year 1971, $20 million for fiscal year 1972, and $25 million for fiscal yeur 1973. - Report on Activities Uxper Tirnrs ITP ann IX or tue Posric Heatre Service Act The Senate amendment contained a provision not in the House bill which would amend the Public Health Service Act to direct that on or before January 1 of each year the Secretary of Health, Educa- 20 tion, and Welfare report to Congress on activities under tithes TT] and EX of the Public Health Service Aet with (1) an evaluation of the effectiveness of such activities in improving the cficieney and effec- tiveness in research in, planning for, and delivery of, health services, (2) an analysis of the relationship between Federal and loeal financing. and (3) such recommondations as the Secretary deems appropriate. The conference substitute is identical with {he Senate amendment. Comprenensive Heattu PLANnineg STATE HEALTH PLAN sluthorication of appropriations Tho Tlouse bill would amend seetion 3144 of the Public Health Service Aet Co oxtend for three yours (through: fiseal year 1973) the program: of grants to States for comprehensive State healdle phinning wid would authorize the following amounts: $10 million for fisent year 1971, $15 imiflion for fiseal year 1972, and $20 million for fisen! year 1973. The Senate amendment would extend such program through fiseal year 1975 and would authorize the following amounts: $15 million for fiscal year 1971, $17 inillion for fiscal year 1972, $20 million for fiscal year 1973, $30 million for fiscal year 1974, und $35 million for fiscal year 1975. The conference substitute extends such program through fiseal year 1973 and authorizes the following amounts: $15 million for fiscal yeur 1971, $17 million for fiscal year 1972, and $20 million for fiscal year 1973. Veterans’ Administration representation on State health planning council Tho Senate amendinent contained a provision not in the House bill which would provide that the State plan under such section 314 (1) would include State planning for home health care. The conference substitute contains the provision of the Senate amendment, PROJECT GRANTS FOR AREAWIDE HEALTH PLANNING Authorization of appropriations ; The House bill would amend section 314/4b) of the Public Health Service Act to extend through fiscal year 1973 the program of proj- ect grants for areawide beth planning and would authorize the following amounts: $15 million for fiscal’ year 1971, $25 million for fiscal yenr 1972, and $40 million for fiscal year 1973. The Senate amendment would extend such program through fiscal your 1975 and would authorize the following amounts: $20 million for seal yoar 1971, $30 million for fiscal year 1972, $40 million for fiscal yoar 1973, $50 million for fiscal year 1974, and $60 million for fiscal year 1975. The conference substitute extends such program through fiscal year 1973 and authorizes the following amounts: $20 million for fiscal year 1971, $80 million for fiscal year 1972, and $40 million for fiseal year 1973. . 2 flame heatth care The Senate amendment contained a provision not in the louse bill which would provide that aren plans under such section 314(b) would include home health care services. The conference substitute is identical with the Senate amendment. Grants to State agency The Senate amendment contained a provision not in the House bill which would provide that under certain circumstances the State planning agency could receive a grant under such section 314(b). The conference substitute is identical with the Senate amendment. Areawide health planning eouncil The House bill would amend such section 314(b) to provide that the areawide health planning council would include representatives of consumers of health services. The Senate amendment would require that a majority of the membership of such council be representatives of consumers of health services, The conference substitute is identical with the Senate amendment. GRANTS FOR COMPREHENSIVE PUBLIC HEALTH SERVICES Authorization of appropriations The House bill would extend through fiscal year 1973 the program under section 314(d) of the Public Health Service Act for grants for comprehensive public health services and would authorize the follow- ing amounts: $125 million for fiscal year 1971, $140 million for fiscal year 1972, and $160 million for fiseal year 1973. The Senate amendment would extend such program throngh fiscal year 1975 and would authorize the following amounts: $130 million for fiscal year 1971, $145 million for fiscal year 1972, $165 million for fiscal year 1973, $180 million for fiscal year 1974, and $200 million for fiscal vear 1975. The conference substitute extends such program through fiscal year 1973 and authorizes the following amounts: $130 million for fiscal year 1971, $145 million for fiscal year 1972, and $165 million for fiscal year 1973. PROJECT GRANTS FOR HEALTH SERVICES DEVELOPMENT Both the Senate and House bills, and the conference substitute, provide a continuation of the existing program of project grants for health services development under section 314(e) of the Public Health Service Act, with authorizations for fiscal year 1971 of $109,500,000, $135 million for fiscal year 1972, and $157 million for fiscal year 1973. The conference substitute does not contain the further authorization of appropriations for fiscal years 1974 and 1975 contained in the Senate version. The conference substitute also authorizes the use of funds appro- priaied for section 314(e) for meeting obligations heretofore incurred with respect to certain facilities of the Office of Economie Oppor- tunity which have been, or are in the process of being, transferred to the jurisdiction of the Department.of Health, Education, and Welfare. 99 sa REGULATION OF CERTAIN BIOLOGICAL PRODUCTS The Senate amendment contained an amendment to section 35 of: the Public Health Service Act: making clear that the authority of that section includes authority to license vaccines, blood, blood com- ponents or derivatives, and allergenic products. This amendment is Wentieal to the provision of H.R. 15961, already passed by the House. With respect to this amendment, the conference substitute is the same as the Senate version. AUTHORITY FOR GROUP PRACTICE The Senate amendment contained a provision notin the House bill which would authorize the Secretary of Health, Edueation, and Wel- fare to authorize insurance carriers, which are parties to, or which participate in the carrying out of, contracts relating to health benefits for active or retired Federal employees, to issuc in any State contracts entitling beneficiaries to receive comprehensive medical services from a group practice unit with which the carrier has arranged for the provision of such services. The conference substitute contains the provision of the Senate amendment. RECEIPT OF INCREASED STAFFING GRANTS FOR CURRENTLY FUNDED COMMUNITY MENTAL HBALTH CENTERS The Senate amendment contained a provision not in the House bill to change the application of the maintenance of effort requirements under the Community Mental Health Centers Act to facilitate receipt by currently funded community mental health centers of the increased Federal share of staffing costs provided under the Community Mental Health Centers Amendments of 1970 (Public Law 91-211). The conference substitute contains the provision of the Senate ainendment. ' COMPENSATION OF ADVISORY COUNCIL MEMBERS, ETC. The Senate amondment contained a provision not in the House bill which would amend the Public Health Service Act and the Federal Food, Drug, and Cosmetic Act to provide uniform rules on compensa- tion of advisory council members and to authorize committees to be established where there is authority to establish advisory councils. The conference substitute contains the provision of the Senate amendment. RESEARCH CONTRACTING AUTHORITY The Sonato amendment contained a provision not in the House bill which would amend section 301(h) of the Public Health Service Act, to climinate the fiscal year limitation (fiscal year 1971) on the research contracting authority of the Secretary of Health, Education, and Welfare. The conference substitute extends such authority through fiscal yoar 1973. : 23 TRAINING AUTHORITY OF NATIONAL INSTITUTE OF GENERAL MEDICAL SCIENCES The Senate amendment contained a provision not in the House bill which would amend section 442 of the Public Health Service Act to provide that the National Institute of General Medical Sciences could conduct and support clinical as well as research training. The con- ference substitute is identical to the Sonate amendment. STUDY RELATING TO ENVIRONMENTAL POLLUTION The Senate amendment contained a provision not in the House bill which directed the Secretary to siudy (1) the health and safety hazards presented by environmental pollution, (2) medical and other assistance available to persons affected by such pollution, and (3) - mesures, other than abatement, that can he taken to avoid effect, of such pollution on human health. The conference substitute is the same as the Senate amendment, except that the study is to be conducted by the President. Haruey O. Stacerrs, JOHN JARMAN, Paut G. Roars, ' W. L. Sprincer, ANcHER NELSEN, Managers on the Part of the House. O pines Pa 1S peeing cee wa Se December 9, 1968 LEGISLATION EXTENDED AND AMENDED By The Congress On October 15, 1968, the President signed Public Law 90-574 which extends and amends the original Regional Medical Programs legislation, To reflect the details of this action, a copy of Title I of the new law (Public Law 90-574) which refers to Regional Medical Programs, is reproduced on the inside front cover of this issue. To indicate how the total Regional Medical Programs law now reads as part of the Public Health Service Act, all changes have been interpolated into the original law (Public Law 89-239) on the pages that follow. U.S. DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE Public Health Service * Health Services and Mental Health Administration ° Bethesda, Maryland 20014 "Ss |’ Public Law 90-574 90th Congress, H. R. 15758 October 15, 1968 . eo ‘Qn Act To amend the Public Health Service Act so as to extend and improve the provi- sions relating to regional medical programs, to extend the authorization of grants for health of migratory agricultural workers, to provide for specialized facilities for alcoholies and narcotie addicts, and for other purposes. 82 STAP. 1005 Be it enacted by the Senate and House of Representatives of the United States of America in Congress assembled, Public Health . Service Acty TITLE I—REGIONAL MEDICAL PROGRAMS amendment. EXTENSION OF REGIONAL MEDICAL PROGRAMS Sxc. 101. Section 901(2) of the Public Health Service Act (42 Appropriations. U.S.C. 299a) is amended by striking out “and” before *$200,000,000” 79 Stat., 926. and by inserting after “June 30, 1968,” the following: “$65,000,000. for the fiscal year ending June 30, 1969, and $120,000,000 for the next fiscal year,”. ; EVALUATION OF REGIONAL MEDICAL PROGRAMS Sec. 102. Section 901(a) of the Public Health Service Act is further amended by inserting at the end thereof the following new sentence: “For any fiscal year ending after June 30, 1969, such portion of the appropriations pursuant to this section as the Secretary may deter- mine, but not exceeding 1 per centum thereof, shall be available to the Secretary for evaluation (directly or by grants or contracts) of the program authorized by this title.” INCLUSION OF TERRITORIES Sec. 103. Section 902(a) (1) of the Public Health Service Act (42 S.C. 299b) is amended by inserting after “States” the following: “(which for purposes of this title includes the District of Columbia, oo the Commonwealth of Puerto Rico, the Virgin Islands, Guam, Amer- ican Samoa, and the Trust Territory of the Pacific Islands)”. COMBINATIONS OF REGIONAL MEDICAL PROGRAM AGENCIES Sec. 104. Section 903(a) and section 904(a) of the Public Health Service Act (42 U.S.C. 299c, 299d) are each amended by inserting after “other public or nonprofit private agencies and institutions” the follow- ing: “, and combinations thereof,”. . ADVISORY COUNCIL. MEMBERS Sec. 105. (a) Section 905(a) of the Public Health Service Act (42 ‘S.C. 299e) is amended by striking out “twelve” and inserting in heu thereof “sixteen”, (b) Section 905(b) of such Act is amended by striking out “and four Tem of at the end of the third year” and inserting in lieu thereof “four at the office, end of the third year, and four at the end of the fourth year”. MULTIPROGRAM SERVICES Sec. 106. Title TX of the Public Health Service Act is further 42 usc 300= amended by adding at the end thereof the following new section: 909, “PROJECT GRANTS FOR MULTIPROGRAM SERVICES “Src. 910. Funds appropriated under this title shall also be available for grants to any public or nonprofit private agency or institution for services needed by, or which will be of substantial use to, any two or more regional medical programs.” CLARIFYING AND TECHNICAL AMENDMBPNTS Sec. 107. (a) Section 901(c) of the Public Health Service Act is 79 Stat, 926 amended by inserting before the period at the end thereof “or, where. 45 js¢ 299a,.. appropriate, a practicing dentist”. ° (b) Section 901 of such Act is further amended by adding at the end thereof the following new subsection : “(d) Grants under this title to any agency or institution, or com- bination thereof, for a regional medical program may be used by it to assist in meeting the cost of participation in such program by any Federal hospital.” Public Law 89-239 89th Congress, S. 596 An Act To aménd the Public Health Service Act to assist in combating heart disease, cancer, stroke, and-related diseases. Be it enacted by the Senate and House of Representatives of the United States of America in Congress assembled, That this Act may As amended by October 6, 1965 Public Law 90-574 79 STAT, 926 Heart Disease, be cited as the “Heart Disease, Cancer, and Stroke Amendments of Cancer, and 1965”. Stroke Amende Sec, 2. The Public Health Service Act (42 US.C., ch. 6A) is ments of 1965. amende:. by adding at the end thereof the following new title: “TITLE [X—EDUCATION, RESEARCH, TRAINING, AND DEMONSTRATIONS IN THE FIELDS OF HEART DIS- EASE, CANCER, STROKE, AND RELATED DISEASES “PURPOSES “Sec. 900. The purposes of this title are— “(a) Through grants, to encourage and assist in the establishment of regional cooperative arrangements among medical schools, research institutions, and hospitals for research and training (including con- tinuing education) and for related demonstrations of patient care in the fields of heart disease, cancer, stroke, and related diseases; “(b) To afford to the medical profession and the medical institu- tions of the Nation, through such cooperative arrangements, the oppor- tunity of making available to their patients the latest advances in the diagnosis and treatment of these diseases ; and ; “(c) By these means, to improve generally the health manpower and facilities available to the Nation, and to accomplish these ends without interfering with the patterns, or the methods of financing, of patient care or professional practice, or with the administration of ospitals, and in cooperation with practicing physicians, medical cen- ter officials, hospital admmistrators, and representatives from appro- priate voluntary health agencies. . “AUTHORIZATION OF APPROPRIATIONS “Src. 901. (a) There are authorized to be appropriated $50,000,000 for the fiscal year ending June 30, 1966, $90,000,000 for the fiscal year ending June 30, 1967, $200,000,000 for the fiscal year ending June 30, 1968, _ $65,000,000 for the-fiscal year ending June 30, 1969, and $120,000,000 for the next fis year, for grants to assist public or nonprofit private universitie. , medical schools, research institutions, and other public or nonpeere private institutions and agencies in planning, in conducting feasibility studies, and in operating pilot projects for the establishment, of re- gional medical programs of research, training, and demonstration activities for carrying out the purposes of this title. Sums appro- priated under this section for any fiscal year shal] remain available for making such grants until the end of the fiscal year following the fiscal year for which the appropriation is made. For any fiscal year ending after June 30, 1969, such portion of the appropriations pursuant to this section as the Secretary may determine, but not exceeding 1 per centum thereof, shall be available to the Secretary for evaluation (directly or by grants or contracts) of the program authorized by this title. “(b) A grant under this title shall be for part or all of the cost of the planning or other activities with respect to which the application is made, except that any such grant with respect to construction of, or provision of built-in (as determined -in accordance with regula- tions) equipment for, any facility may not exceed 90 per centum of the cost of such construction or equipment. “(c) Funds appropriated pursuant to this title shall not be avail- able to pay the cost of hospital, medical, or other care of patients 58 Stat. 682. 42 USC 201 note, cal 79 STAT, 927 to such Pub. Law 89-239 -2- October 6, 1965 except to the extent it is, as determined in accordance with regula- ae tions. incident to those research, training, or demonstration activities which are encompassed by the purposes of this title. Ne patient shall be furnished hospital, medical, or other care at any facility incident to research, training, or demonstration activities carried out with funds appropriated pursuant to this title, unless he has been referred . acility by a practicing physician or » where appropriate, a practicing dentist. "(d) Grants under this title to any agency or institution, or combination thereof, for a regional medical program may be used by it to assist in meeting the cost of participation in such program by any Federal hospital. “DEFINITIONS “Src. 902. For.the purposes of this title— “(a) The term ‘regional medical program’ means a cooperative arrangement among a group of public or nonprofit private institu- tions or agencies engaged in research, training, diagnosis, and treat- ment relating to heart disease, cancer, or stroke, and, at the option of the applicant, related disease or diseases; but only if such group— “(1) is situated within a geographic area, composed of any part or parts of any one or more States,’ (which for purposes of this title includes the District of Columbia, the Commonwealth of Puerto Rico, the Virgin:.Islands, . Guam, American Samoa, and the Trust Territory of the Pacific Islands) .which the Surgeon Gen- eral detertaines, in accordance with regulations, to be appropri- oe, ate for carrying out the purposes of this title; (2) consists of one or more medical centers, one or more clin- ical research centers, and one or more hospitals; and (8) has in effect cooperative arrangements among its com- ponent units which the Surgeon General finds will be adequate for effectively carrying out the purposes of this title. “(b) The term ‘medical center’ means a medical school or other medical institution involved in postgraduate medical training and one or more hospitals affiliated therewith for teaching, research, and demonstration purposes. . “(c) The term ‘clinical research center’ means an institution (or part of an institution) the primary function of which js research, training of specialists, and demonstrations and which, in connection therewith, provides specialized, high-quality diagnostic and treat- ment services for inpatients and outpatients. “(d) The term ‘hospital’ means a hospital as defined in section 625(c) or other health facility in which local capability for diagnosis and treatment is supported and augmented by the program established under this title. “(e) The term ‘nonprofit’ as applied to any institution or agency means an institution or agency which is owned and operated by one or more nonprofit corporations or associations no part of the net earn- ings of which inures, or may lawfully inure, to the benefit of any private shareholder or individual. “(f) The term ‘construction’ includes alteration, major repair (to the extent permitted by regulations), remodeling and renovation of existing buildings (including initial equipment thereof), and replace- ment of obsolete, built-in (as determined in accordance with regula- tions) equipment of existing buildings. . October 6, 1965 -3- Pub. Law 89-239 79 STAT, 928 “GRANTS FOR PLANNING “Sec. 903. (a) The Surgeon General, upon the recommendation of the National Advisory Council on Regional Medical Programs estab- lished by section 905 (hereafter in this title referre to as the ‘Council’), is authorized to make grants to public or nonprofit private universities, medical schools, research institutions, and other public or nonprofit private agencies and institutions and combinations thereof,. to assist them in planning the development of regional medical programs. “(b) Grants under this section may be made only upon application therefor approved by the Surgeon General. Any such application may be approved only if it contains or is supported by— . “(1) reasonable assurances that Federal funds paid pursuant to any such grant will be used only for the purposes for which paid and in accordance with the applicable provisions of this title and the regulations thereunder; “(2) reasonable assurances that the applicant will provide for such fiscal control and fund accounting procedures as are required by the Surgeon General to assure proper disbursement of and accounting for such Federal funds; “(3) reasonable assurances that the applicant will make such reports, in such form and containing such information as the Surgeon General may from time to time reasonably require, and will keep such records and afford such access thereto as the Sur- geon General may find necessary to assure the correctness and verification of such reports; and “(4) a satisfactory showing that the applicant has designated an advisory group, to advise the applicant (and the institutions and agencies participating in the resulting regional medical program) in formulating and carrying out the plan for the estab- lishment and operation of such regional medical program, which advisory group includes practicing physicians, medical center é officials, hospital administrators, representatives from appropri- f ate medical societies, voluntary health agencies, and representa- tives of other organizations, institutions, and agencies concerned with activities of the kind to be carried on under the program and members of the public familiar with the need for the services provided under the program. “GRANTS FOR ESTABLISHMENT AND OPERATION OF REGIONAL MEDICAL PROGRAMS “Sec. 904. (2) The Surgeon’ General, upon the recommendation of the Council, is authorized to make grants to public or nonprofit private universities, medical schools, research institutions, and other public or nonprofit private agencies and institutions and combinations thereof, to assist in establishment and operation of regional medical programs, including construction and equipment of facilities in connection therewith. “(b) Grants under this section may be made only upon application therefor approved by the Surgeon General. Any such application may be approved only if it is recommended by the advisory group described in section 903(b) (4) and contains or is supported by reason- able assurances that— . “(1) Federal funds paid pursuant to any such t (A) will be used only for the purposes for which paid and in accordance with the applicable provisions of this title and the regulations thereunder, and (B) will-not supplant funds that are otherwise available for establishment or operation of the regional medical program with respect to which the grant is made; | i “(2) the applicant will provide for such fiscal control and fund | ‘ accounting procedures as are required by the Surgeon General to — e proper disbursement of and accounting for such Federal UNS ; : “(3) the applicant will make such reports, in such form and Records. containing such information as the Surgeon General may from aa time to time reasonably require, and will keep such records and 79 STAT, 929 Pub. Law 89-239 -4- October 6, 1965 ~ 49 Stat. 1011; 78 Stat. 238. 64 Stat. 1267. 63 Stat. 108, Appointment of members, Term of office. Compensation. 60 Stat. 808; 75 Stat, 339,340, Applieations for grants, recom= mendations. afford such access thereto as the Surgeon General may find neces- sary to assure the correctness and verification of such reports; and (4) any laborer or mechanic employed by any contractor or subcontractor in the performance of work on any construction aided by payments pursuant to any grant under this section will be paid wages at rates not less than those prevailing on similar- construction in the locality as determined by the retary of Labor in accordance with the Davis-Bacon Act, as amended (40 U.S.C. 276a—276a-5) ; and the Secretary of Labor shall have, with respect to the labor standards specified in this paragraph, the authority and functions set forth in Reorganization Plan Numbered 14 of 1950 (15 F.R. 3176; 5 U.S.C. 1832-15) and sec- tion 2 of the Act of June 13, 1934, as amended (40 U.S.C. 276c). “NATIONAL ADVISORY COUNCIL ON REGIONAL MEDICAL PROGRAMS “Sec. 905, (a) The Surgeon General, with the approval of the Secretary, may appoint, without regard to the civil service laws, a National Advisory Council on Regional Medical Programs. The Council shall consist of the Surgeon General, who shall be the chair- man, and» sixteen members, not othérwise in the regular full-time employ of the United States, who are leaders in the fields of the fundamental sciences, the medical sciences, or public affairs. “At least two of the appointed members shall be practicing physicians, one shall be outstanding in the study, diagnosis, or treatment of heart disease, one shall be outstanding in the study, diagnosis, or treatment of cancer, and one shall be oustanding in the study, diagnosis, or treatment of stroke. “(b) Each appointed member of the Council shall hold office for a term of four years, except that any member appointed to fill a vacancy prior to the expiration of the term for which his predecessor was appointed shall be appointed for the remainder of such term, and except that the terms of office of the members first taking office shall expire, as designated by the Surgeon General at the time of appoint- ment, four at the end of the first year, four at the end of the second yeary four at the end of the third year, and four at the end of the fourth year after the date of appoint- ment. An appointed member shall not be eligible to serve continu- ously for more than two terms. “(c) Appointed members of the Council, while attending meet- ings or conferences thereof or otherwise serving on business of the Council, shall be entitled to- receive compensation at rates fixed by the Secretary, but not exceeding $100 per day, including traveltime, and while so serving away from their homes or regular places of business they may be allowed travel expenses, including per diem in lieu of subsistence, as authorized by section 5 of the Administrative Expenses Act of 1946 (5 U.S.C. 73b-2) for persons in the Govern- ment service employed intermittently. “(d) The Council shall advise and assist the Surgeon General in the preparation of regulations for, and as to policy matters arisiig with respect to, the administration of this title. The Council shall consider all applications for grants under this title and shall make recommen- dations to the Surgeon General with respect to approval of applica- tions for and the amounts of grants under this title. Pub. Law 89-239 -6- October 6, 1965 79 STAT, 931 _ 42 USC 201 (L)_ The Act of July 1, 1944 (48 Stat. 682), as amended. is further note. amended by renumbering title IX (as in effect prior to the enactment of this Act) as title X, and by renumbering sections 901 through 914 (as in effect prior to the enactment of this Act), and references t ereto, as sections 1001 through 1014, respectively. Approved October 6, 1965, 10:15 a.m. "PROJECT GRANTS FOR MULTIPROGRAM SERVICES "SEC. 910. Funds appropriated under this title shall also be available for grants to any public or nonprofit private agency or institution for services needed by, or which will be of substantial use to, any two or more regional medical programs. LEGISLATIVE HIstoRY: P.T,, 89-239 HOUSE REPORT No. 963 accompanying H. R. 3140 (Comm, on Interstate & Foreign Commerce) » SENATE REPORT No. 368 (Comm. on Labor & Public Welfare). CONGRESSIONAL RECORD, Vol. 111 (1965): dune 25: Considered in Senate. June 28: Considered and passed Senate, Sept. 23: H. R. 3140 considered in House. Sept. 242 Considered and passed House, amended, in lieu of H. R. 3140, Sept. 29: Senate concurred in House amendments. LEGISLATIVE HISTORY: P J, 90-574 HOUSE REPORTS: No. 1536 (Comm. on Interstate & Foreign Commerce) and No.1924 (Comm. of Conference). SENATE REPORT No. 1454 (Comm, on Labor & Public Welfare), CONGRESSIONAL RECORD, Vole 114 (1968): duly 12% Considered and passed House. July 27: Considered and passed Senate, amended. Sept.27: Senate agreed to conference report. Oct. 1: House agreed to conference report.