SS HEALTH SERVICES & MENTAL HEALTH ADMINISTRATION REGIONAL MEDICAL PROGRAMS SERVICE por BRATING HANDBOOK FOREWORD (A statement on content and plan for posting “. and updating of information. (Include appropriate address to whom inquiries should be forwarded.) « ony naa TABLE OF CONTENTS . ” rk z a : *% ~~ ~ y X a ? INTRODUCTION Me *s, Chapter I HISTORY AND PURPOSES OF . REGIONAL MEDICAL PROGRAMS On October 6, 1965, the President signed Public Law 89-239. It authorizes the establishment and maintenance of Regional Medical Programs to assist the Nation’s health resources in making avail- able the best possible patient care for heart dis- ease, cancer, stroke and related” diseases. This legis- lation, which will be referred to in these *Guide- lincs as The Act, was shaped b¢ the interaction of four antecedents: the historical thrust toward re- gionalization of health resources; the dévelopment of a national biomedical research community of unprecedented size and productivity; the changing * needs of society; and finally, the particular legis- lative process leading to The Act itself. The concept of regionalization as a means to meet health needs effectively and economically is not new. During the 1930's, Assistant Surgeon Gen- eral Joseph W. Mountin was one of the earliest pioneers urging this approach for the delivery of health services. The national Committee on the Costs of Medical Care also focused attention in 1932 on the potential benefits of regionalization. In that same year, the Bingham Associates Fund initiated the first comprehensive regional effort to improve ‘patient care in the United States. This program linked the hospitals and programs for continuing education of physicians in the State of Maine with the university centers of Boston. Advocates of regionalization next gained national attention more than a decade later in the report of the Commission on Hospital Care and in the - Hospital Survey and Construction (Hill-Burton) Act of 1946. Other proposals and attempts to introduce regionalization of health resources can be chronicled, but a strong national movement toward regionalization had to await the conver- gence of other factors which occurred in 1964 and 1965. One of these factors was the creation of a national biomedical research eflort unprecedented in history and unequalled anywhere else in the world. The effect of this activity is intensified by the swiftness of its creation: at the beginning of World War II the national expenditure for medi- cal research totaled $45 million; by 1947 it was $87 million; and in 1967 the total was $2.257 billion—a 5,000 percent increase in 27 years. The most sig- nificant characteristic of this research effort is the . tremendous rate it is producing new knowledge in the medical sciences, an outpouring which only recently began and which shows no signs of de- cline. As a result, changes in health care have been dranfatic. Today, there are cures where none ex- isted before, a number of diseases have all but disappeared with the application of new vaccines, and patient care generally is far more effective than even a decade ago. It has become apparent in the last few years, however, (despite substantial achievements), that new and better means must also be found to convey the ever-increasing volume of research results to the practicing physician and to meet growing complexities in medical and hos- pital care, including specialization, increasingly intricate and expensive types of diagnosis and treatment, and the distribution of scarce man- power, facilities, and other resources. The degree of urgency attached to the necd to cope with’ these issues is heightened by an increasing public demand’ ‘that the latest and best health care be made available to everyone. This public demand, in turn, is largely an expression of expectations aroused by awareness of ‘the results and promise of biomedical research. In a sense, the national commitment to bio- medical investigation is one manifestation of the third factor which contributed to the creation of Regional Medical Programs: the changing needs of society—in this case, health needs. The deci- sions by various private and public institutions to support biomedical research were responses to this societal need perceived and interpreted by these institutions. In addition to the support of research, wget ee oo the same interpretive process led the Federal Gov- ernment to develop a broad range of other pro- grams to improve the quality and availability of health care in the Nation. The Hill-Burton Program which began with the passage of the previously-mentioned Hospital Survey and Con- struction Act of 1946, together with the National Mental Health Act of 1946, was the first in a series of post-World War II legislative actions having major impact on health affairs. When the 89th Congress adjourned in 1966, 25 health-related bills had been enacted into law. Among these were Medicare and Medicaid to pay for hospital and physician services for the Nation's aged and poor; the Comprehensive Health Planning Act to pro- vide funds to each state for non-categorical health planning’ and to support services, rendered through state and other health activities; and- Public Law 89-239 authorizing Regional Medical Programs. «. The report of the President's Commission on Heart Disease, Cancer, and Stroke, issued in Decem- ber 1964, focused attention on societal needs and led directly to introduction of the legislation authorizing Regional Medical Programs. Many of the Commission’s recommendations were signifi- cantly altered by the Congress in the legislative process, but The Act was clearly passed to meet needs and problems identified and given national recognition in the Commission’s report and in the Congressional hearings preceding passage of The Act. Some of these. needs and problems were ex- pressed as follows: . © A program is needed to focus the Nation's health resources for research, teaching and patient care on heart disease, cancer, stroke and related diseases, because together they cause 70 percent of the deaths in the United States, ¢ A significant number of Americans with these diseases die or are disabled because the bene- fits of present knowledge in the medical sciences are not uniformly available throughout the coun- try. ¢ There is not enough trained manpower to meet the health needs of the American people within the present system for the delivery of health services. . ¢ Pressures threatening the Nation's health resources are building because demands for health services are rapidly increasing at a time when in- creasing costs are posing obstacles for many who require these preventive, diagnostic, therapeutic and rehabilitative services. 2 . CHAPTER I CINTRODUCTORY MATERIAL) ° A creative partnership must be forged among the Nation’s medical scientists, practicing physicians, and all of the Nation's other health resources so that new knowledge can be trans- lated more rapidly into better patient care. This partnership should make it possible for every com- munity’s practicing physicians to share in the diag- nostic, therapeutic and consultative resources of major medical institutions. They should similarly be provided the opportunity to participate in the academic environment of research, teaching and patient care which stimulates and supports medical practice of the highest quality. * Institutions with high quality research pro- prams in heart disease, cancer, stroke, and related diseases are too few, given the magnitude of the problems, and are not uniformly distributed throughout the country. . ° There is a need to educate the public re- garding health affairs. Education in many cases will permit people to extend their own lives by chang- ing personal habits to prevent heart disease, cancer, Stroke and related diseases. Such education will enable individuals to recognize the need for diag- nostic, therapeutic or rehabilitative services, and to know where to find these services, and it will motivate them to seek such services when needed. During the Congressional hearings on this bill, representatives of major groups and institutions’ with an interest in the American health system were heard, particularly spokesmen for practicing physicians and community hospitals of the Nation. The Act which emerged turned away from the idea of a detailed Federal blueprint for action. Specifically, the network of “regional centers” rec- ommended earlier by the President's Commission was replaced by a concept of “regional cooperative arrangements” among existing health resources. The Act establishes a system of grants to enable representatives of health resources to exercise ini- tiative to identify and meet local needs within the area of the categorical diseases through a broadly defined process. Recognition of geographical and | societal diversities within the United States was the main reason for this approach, and spokesmen for the Nation's health resources who testified dur- ing the hearings strengthened the case for local. initiative. Thus the degree to which the various Regional Medical Programs meet the objectives of the Act will provide a measure of how well local health resources can take the initiative and work together to improve patient care for heart disease, cancer, stroke and related diseases at the local level. The Act is intended to provide the means for conveying to the medical institutions and profes- sions of the Nation the latest advances in medical science for diagnosis, treatment, and rehabilitation of patients afflicted with heart disease, cancer, stroke, or related diseases—and to prevent these diseases. The grants authorized by The Act are to encourage and assist in the establishement of re- gional cooperative arrangements among medical schools, research institutions, hospitals, and other medical institutions and agencies to achieve these ends by research, education, and demonstrations of patient care. Through these means, the pro- grams authorized by The Act are also intended to improve generally the health manpower and facil- ities of the Nation. *. ? In the two years since the President signed The Act, broadly representative groups have organized ‘ themselves to conduct Regional Medical Programs in more than 50 Regions which they themselves have defined. These Regions encompass the Na- tion’s Population. They have been formed by the organizing groups using functional as well as geographic criteria. These Regions include com- binations of entire states (e.g. the Washington- Alaska Region), portions of several states (e.g. the Intermountain Region includes Utah and sections of Colorado, Idaho, Montana, Nevada and Wyo- ming), single states (e.g. Georgia), and portions of states around a metropolitan center (e.g. the Rochester Region which includes the city and 11 surrounding counties). Within these Regional Pro- grams, a wide variety of organization structures have been developed, including executive and CHAPTER I REVISED GUIDELINES - Page 3 CINTRODUCTORY MATERIAL) planning committees, categorical discase task forces, and community and other types of sub- regional advisory committees. Regions first may receive planning grants from the Division of Regional Medical Programs, and then may be awarded operational grants to fund activities planned with initial and subsequent plan- ning grants. These operational programs are the direct means for Regional Medical Programs to accomplish their objectives. Planning moves ‘a Re- gion toward operational activity and is a con- tinuing means for assuring the relevancy and appropriateness of operational activity. It is the effects of the operational activities, however, which will produce results by which Regional Medical Programs will be judged. On November 9, 1967, the President sent the Congress the Report on Regional Medical Pro- grams prepared by the Surgeon General of the . Public Health Service, and submitted to the Pres- ident through the Secretary of Health, Education, and Welfare, in compliance with the Act. The ‘Report details the progress of Regional Medical Programs and recommends continuation of the. Programs beyond the June 30, 1968, limit set forth in The Act. The President's letter transmitting the Report to the Congress was at once encouraging and exhortative when it said, in part: “Because the law and the idea behind it are new, and the prob- lem is so vast, the program is just emerging from the planning state. But this report gives encourag- ing evidence of progress—and it promises great advances in speeding research knowledge to the patient’s bedside.” Thus in the final seven words of the President's message, the objective of Re- gional Medical Programs is clearly emphasized. rad Be ee tet ee eo ater Chapter U (INTRODUCTORY MATERIAL) THE NATURE AND POTENTIAL OF REGIONAL MEDICAL PROGRAMS Goal—Improved Patient Care - Chapter [| places the Goal of Regional Medical Programs in its historical context and gives a fuller .perspective to Section 900 of the Act (see, Appen- dix I), which defines the Goal in detil. in abbre- viated form, the Goal is described in the Surgeon General’s Report as “. . . clear and? unequivocal. The focus is on the patient. The object is to in- fluence the present arrangements for health serv- ices in a manner that will permit the best* in modern medical care for heart disease, cancer, stroke, and related diseases to be available to all.” Means—The Process of Regionalization Note: Regionalization can connote more than a regional cooperative arrangement, but for the purpose of Guidelines, the two terms will be. used interchangeably. The Act uses “regional cooperative arrangement,” but “regionaliza- tion” has become a more convenient synonym. A regional cooperative arrangement among the full array of available health resources is a neces- sary step in bringing the benefits of scientific ad- vances in medicine to people wherever they live in a Region they themselves have defined. It enables patients to benefit from the inevitable specializa- tion and division of labor which accompany the expansion of medical knowledge because it pro- vides a system of working relationships among health personnel and the institutions and organiza- tions in which they work. This requires a commit- ment of individual and institutional spirit and resources which must be worked out by each Re- 4 CHAPTER II - REVISED GUIDELINES - Page 4 ’ character. aé gional Medical Program, It is facilitated by volun- tary agreements to serve, systematically, the needs of the public as regards the categorical diseases on a regional rather than some more narrow basis. Regionalization, or a regional cooperative ar- rangement, within the context of Regional] Medi- cal Programs has several other important facets: * It is both functional and geographic in Functionally, regionalization is the mechanism for linking patient care with health research and education within the entire region to provide a mutually beneficial interaction. This in- teraction should occur within the operational activ- ities as well as in the total program. The geo- graphic boundaries of a region serve to define the population for which each regional program will be concerned and responsible. This concern and responsibility should be matched by responsiveness, which is effected by providing the population with a significant voice in the regional program's deci- sion-making process. * It provides a means for sharing limited health manpower and facilities to maximize the quality and quantity of care and service available to the region’s population, and to do this as eco- nomically as possible. In some instances, this may require inter-regional cooperation between two or | among several regional programs. * Finally, it also constitutes a mechanism for coordinating its categorical program with other health programs in the region so that their com- bined effect may be increased and so that they con- tribute to the creation and maintenance of a sys- we we eae ee at 1 _ | Poy tem of comprehensive health care within the entire -region." Because the advance of knowledge changes the nature of medical care, regionalization can best be viewed as a continuous process rather than a plan which it totally developed and then implemented. This process of regionalization, or cooperative arrangements, consists of at least the following ‘ele- ments: involvement, identification of needs and Opportunities, assessment of resources, definition of objectives, setting of priorities, implementa- tion, and evaluation. While these seven elements in the process will be described and discussed sep- arately, in practice they are interrelated, contin- ‘uous and often occur simultaneously. Involvement—The involvement and commitment of individuals, organizationg* and? institutions which will engage in the activity of a Regional’ Medical Program, as well as~those avhich will’ be affected by this activity, must underlie a Regional Program. By involving in the steps of study and decision all those in a Region who are essential to implementation and ultimate success, better solutions may be found, the opportunity for wider acceptance of decisions is improved, and imple- mentation of decisions is achieved more rapidly. Other attempts to organize health resources on a regional basis have experienced difficulty or have (INTRODUCTORY MATERIAL) been diverted from their objectives because there was not this voluntary involvement and commit- ment by the necessary individuals, institutions and organizations. The Act is quite specific to assure this necessary involvement in Regional Medical Programs: it defines, for example, the minimum composition of Regional Advisory Groups. _ The Act states these Regional Advisory Groups must include “practicing physicians, medical center officials, hospital administrators, representatives from appropriate medical societies, voluntary health agencies, and representatives of other orga- nizations, ‘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 pro- gram.” To ensure a maximum opportunity for success, the composition of the Regional Advisory Group also should be reflective of the total spec- trum of health interests and resources of ‘the entire Region. And it should be broadly representa- tive of the geographic areas and all of the socio- economic groups which will be served by the Re- gional Program.’ Identification of Needs and Opportunities—A Regional Medical Program must identify the needs regarding heart disease, cancer, stroke and related diseases within the entire Region. Further, these "it is not the intent of a Regional Medical Program grant to supplant cither Federal oy non-Federal sources of support for various activities related to achieving its purpose. Rather, the Regional Medical Program provides an opportunity to introduce activities which draw upon and effectively link ac- tivities aheady supported, or supportable in the future, through other sources. Current examples of other Federal programs that provide essential inputs into the health re- sources of the Region are: other activities of the National Institutes of Health, particularly the National Heart Insti- ‘tute, National Cancer Institute, and National Institute of Neurological Diseases and Blindness; other constituents of the Department of Health, Education, and Welfare particu- larly the Comprehensive Health Planning and Services Pro- gram in the Office of the Surgeon General, the Bureau of Disease Prevention and Environmental Control, the Bureau of Health Manpower, the Burcau of Health Services, the Social Security Administration, the Office of Education, and the Social and Rehabilitation Service; and other Government agencies, particularly the Office of Economic Opportunity, the Model Cities Program of the Department of Housing and Urban Development, and the Veterans Administration. New sources of possible support for activities related to a Regional Medical Program should be considered during both the plan- ning and operational phases. CHAPTER II - REVISED GUIDELINES - Page 5 (INTRODUCTORY MATERIALS) needs must be stated in terms which offer oppor- tunities for solution. This process of identification of needs and opportunities for solution requires a continuing analysis of the problems in delivering the best medical care for the target diseases on a regional basis, and it must go beyond a generalized state- ment to definitions which can be translated into operational activity. Particular opportunities may be defined by: ideas and approaches generated within the Region, extension of activities already present within the Region, and approaches and activities developed elsewhere which might be ap- plied with the Region. Among various identified needs there also are often relationships which, when perceived, offer even greater opportunities for solutions. The dan- ger of “project vision,” , which is akin to tunnel vision, must be guarded against, | ” In examining the pr blem . of “coronary care, units throughout its Region, for example, a-Re- gional Program may recognize that the more effec- tive approach would be to consider the total prob- Jem of the treatment of myocardial infarction patients within the Region. This broadened’ ap- proach on a regional basis enables the Regional Program to consider.the total array of resources * within its Region in relationship to a comprehen- sive program for the care of the myocardial in- farction patient. Thus, what was a concern of individual hospitals about how to introduce coro- nary care units has been transformed into a project or group of related projects with much greater potential for effective and efficient utilization of the Region’s resources to improve patient care. Assessment of Resources—As part of the process of regionalization, a Region must have contin- uously updated inventory of existing resources and capabilities in terms of function, size, number and quality. Every effort should be made to iden- tify and use existing inventories, filling in the gaps as necded, rather than setting out on a long, expen- sive process of creating an entirely new inventory. Information sources include state and local health planning agencies, hospital and medical associa- tions, and voluntary agencies. The inventory pro- vides a basis for informed judgments and priority setting on activities proposed for development under the Regional Program. It can also be used to identify missing resources—voids requiring new investment—and to develop new configurations of resources Lo mect needs. 6 CHAPTER II - REVISED GUIDELINES - Page 6 ie AA ace a et wT ee Definition of Objectives~A Regional Program must be continuously involved in the process of setting operational objectives to meet identified needs and opportunities. Objeatives are interim steps toward the Goal defined at the beginning of this Chapter, and achievement of these objectives should have an effect in the -Region felt far beyond the focal points of the individual activ- ities. This can be one of the greatest contributions of Regional Medical Programs. The completion of a new project to train nurses to care for cancer patients undergoing new combinations of drug and radiation therapy, for example, should benefit cancer patients and should provide additional trained «mMfanpower for many hospitals in the Re- gion. But the project also should have challenged the Region's nursing and hospitals communities to improve the continuing and in-service education opportunities for nurses within the Region. Setting of Priorities--Because of limited man- power, facilities, financing and other resources, a Region must assign some order of priority to its objectives and to the steps to achieve them. Besides the limitations on resources, factors to consider include: 1} balance between what should be done first to meet the Region’s needs, in absolute terms, and what can be done using existing resources and competence; 2) the potentials for rapid and/or substantial progress toward the Goal of Regional Medical Programs and progress toward regionaliza- tion of health resources and services; and 3) Pro- gram balance in terms of disease categories and in terms of emphasis on patient care, education and research. ~ Loa ‘ . ot 5 . : on oe ace ramer ih ett tren ehedin ne mies Cie ft hee me A ee ee ete CINTRODUCTORY MATERIAL) —_— \-£. CAN A SYSTEM CF NACTEDNA, PRIORITIES BE REFLECTED IN. : . REGIONAL MEDICAL PROGRAMS? tn opening. the discussion, Doctor Hogness suggested that primary consideration would have to be given not only to identification of the broad national goals for Regional Medical Programs, but to some consensus among national experts Jas to the best ways of accomplishing the goals. This would enable the Council ito assign the highest priorities to the activities within individual Regional | Medical Programs which move Programs along those lines. Grant applications would then be considered to reflect entire RMPs and judgements on them based on the'"whole Program's ability to (1) affect the system of patient care, (2) improve the rendering of primary care, (3) be concerned with prevention of disease, (4) contribute to the continuing education of existing manpower and the training of new manpower’, etc.” a cee There was agreement among the members of the Council that any priority system designed for Regional Meddical Programs should have its primary emphasis on methods rather than aims; which are "easily stated and rhetorical" and in the last analysis common _to all efforts in medical care — the alleviation _ of the effects of disease. -’ Council also recognized that in 1 beginning, to. look to priorities based on the suggestions of Doctor.Hogness and others, it would be necessary immediately for them to recognize these priorities in their review and analysis and final recommendation on the funding of Regional Medical Program grants.. Progress in priority development would then need to be shared with the Review Conmittee, site visitors, panel members, and other consultants who participate in the review process; and the guidelines made known to the staffs and Regional Advisory Groups of the 55 Regional Médical Programs, . ---August 26- 27, 1969 Council Minutes There was essential agreement that reallocation could have a’ . _ > + favorable effect only if priorities can be agreed upon for _ ' administration of the program. Doctor Pellegrino suggested the following five steps toward accomplishing these ends: (1) Each | new initial request should be examined carefully to determine whether or not it will improve cooperative arrangements in the Region. (2) Careful attention should be given to the progress oo of Regional Medical Programs and their component projects when oo — they. are reviewed for renewal. (3) Requests for purchase of major. hardware should be closely examined, eliminating all but those which are absolutely essential and for which no other source of : funding is available. (4) Atter;+ should be made to increase, | qd. (whenever possible, the concentration of program effort on the 9 re tone ee eee r sO a oO General Principles _ - ~ Needs of the People and Vendors ‘of héalth care: Regional Medical Programs do not heve authori ty er funds to meet all felt n for health ~~ services to the people or for sustained services to the ‘sens of health () care by direct intervention. Regional Medical Programs are i concentrate on those needs for which voluntary participation by the “s in regionali- zation can affect improvement. Priority ranking of projects in a Regional Medical Program ts to be influenced most importantly by the amount of benefit ‘obtainable for the service population per dollar of Regional Hedical Propran fae ePman & , is . . : Long | orn Support of services: Restonal Medical Programs do not have authoricy or funds for guppert of secvicas. - Each operational project is to be designed to be integrated into the health care System of its Region, and - to be disengaged -from Regional Medical Program funding at the end of its initial project peried of three years or less. Py are fa tling to disen ngage frou Regional Medical Prop ° Of their third yeere may be allowed a reasonable period in which to eo self-supporting or be terminated. ‘ Council recommends no more than 13 to months as a "reasonable period" but refrained from setting a maximum whic might tend to become a customary period. - ms ve e jects in operation that ran support by the ends be ee. . 1 oe 0 ~r eo “24 h Pick-up _ of profects formerly supported from other grant funds: Council reaffirmed its earlicr recocnition that Regional Medical Prosran funds are oy ny g ¥ not intended to rep of other srant pros trough ciscontinuance or reduction e ra other programs may be consid a ining plojects inititeted under nal Medical Program support only to the extent that they: (a ized need fer loeal reglon- elization znd IM PLOVERENE 5 that they are interr athis into the Region's healthrrare system in a vay that will pernic disengare- ment of Regioual Medical” trosrem funding within a short tine, All above from November 9-19, 1970 Council Minutes STATUATORY 6 AUTHORITY *s STATUATORY *THORITY [i -.. Legislative History \ ...-Copy of current legislation (PL 91-515) 4 a¢ ..-Regulations a - eligible Applicant ee .Types of Grants € «»ethe Regional Advisory Group oe «REGULATIONS REGULATIONS REGIONAL MEDICAL PROGRAMS March 18, 1967 Division of Regional Medical Programs National Institutes of Health Public Health Service Department of Health, Education and Welfare MATT. Tinedata nae PT. ATLS1S aa aa ae aa i ne talasnent he a Re AUR te ne eta te — Naan * Up-date per PL 91-515 STATUATORY ‘UIHORITY iS i I. Eligible Applicant Public or nonprofit private universities, medical schools, research institutions and other public or nonprofit private agencies and institutions are eligi- ble to apply for a grant to plan and/or operate a Regional Medical Program, Each applicant must be authorized to represent the agencies and in- stitutions which propose to cooperate in planning for and development of the Regional Program. . Additionally, each applicant must be able to exer- ° cise program coordination and fiscal responsibility (see agreement of affiliation, Chapter LI, p. 14). Finally, each’ applicant in order to be eligible must have designated a Regional Advisory Group to advise the applicant (and those agencies and in- stitutions which propose to cooperate in the Re- gional Medical Program) in the planning and , operation of the Program. *. It may be necessary for the agencies and in- stitutions proposing to cooperate in the Program to create’a nonprofit corporation to act for them as the applicant, to maximize the extent to which elfcctive program and fiscal coordination can be exercised in the implementation of the Regional Program. CHAPTER LIT - REVISED GUIDELINES - Page 8 x Single Grantee—In order to insure regional co- operation, there can be only a single grantce orga- nization for cach Regional Medical Program. CHAPTER III - REVISED GUIDELINES - Page 13 + we We ye, STATUATORY RESPONSIBILITY ; (TYPES OF GRANTS) II. Types of Grants Planning—Section 903 of The Act authorizes the Surgeon General, upon recommendation of the , National Advisory Council on Regional Medical Programs, to make grants Lo assist in the planning and'development of Regional Medical Programs. - Operational—Section 904 of The Act authorizes the Surgeon General, upon recommendation of both the Regional Advisory Group and the Na- tional Advisory Council on Regional Medical Pro- grams, to make grants to assist in the establisliment and operation of Regional Medical Programs. The planning activities which are initially ” - funded under the provisions of Section 903 may ae f 7 be continued and expanded as an integral part of " the operational activities of each Region and as "~ ; suoh may become a part of the Region's oper- ational grant under Section 90-4. However, oper- . ‘ational activities may not be supported from plan- ( 3 a ning grant funds. Recognizing the necessity for each Region to plan ahead, the various Regional Medical Pro- . grams are encouraged to consider their phasing | according to the nature and extent of the activ- ities involved up to a maximum of five years. The commitment for support beyond June 30, 1969, is based upon anticipated renewal of the Regional Medical Program’s authorizing legislation and is predicated on the annual appropriation of - . funds by the Congress. Commitments beyond the terminal dates of legislation—both appropriations and authorizing legislation—are delimited by the phrase, “within the Hmits of available funds,” . written into the regulations and on the award , statements issued by the Division. CHAPTER III ~ REVISED GUIDELINES - Page 8 NOTE: Up-date per PL 91-515 STATUATORY AUTHORITY . TYPES OF GP ‘NTS on ce eee Project Grants for Multiprogram Services Section 910 of the Act authorizes that funds appropriated under this title shall also be available for grants to any public or nonprofit agency or institution for services: needed by, or which will be of substantial use to, any two or more Regional Medical Programs. Grant applications submitted under this section may be received from any Regional Medical Program or eligible institution or agency. If the application is for activities to be carried out in specific Regions, the approval of Regional Advisory Groups of all Regions covered by the proposed activity is required by the Division. ~ of ‘ If the application is from an institution or agency seeking to provide services which may be utilized by two or more Regional Medical Programs, without a specific regional focus, Regional Advisory Group approval is not necessary. The appl?cation mist include evidence documenting the need for the activity by two or more Regions, or show how the proposed service may be of use to two or more Programs. If a Regional GS b57 Medical Program proposes to carry out such activity, the ; application must be approved by its Regional Advisory Group. » COMMMUNICAHON GEVICE designed to speed . ; the exchange of news,” » .| GUIDELINES for Multi-Program Services Project Grants - at nformation and data en Regional Medical Programs Service ional Medical Programs and related activities. September 8, 1970 - Vol. 4, No. 36 A copy of GUIDELINES For Multi-Program Services Project Grants - Regional Medical Programs Service is attached. As noted in Section I ... "The addition of Section 910 to Public Law 90-574, the first extension of Public Law 89-239 which established Regional Medical Programs, provided a new grant authority designed to promote interregional cooperation and facilitate the funding of services needed by, or of substantial use to, any two or more Regional Medical Programs." Since both the legislation for extension of Regional Medical Programs and the appropriations legislation for FY 1971 are still under consideration _ by the Congress, it is not possible to know the extent to which it will be possible to allocate grant funds for Multi-Program Services Project Grants; nor to specifically identify the "areas of national concerns, needs, and priorities" discussed under Purposes on page 2 in the Guidelines. ~ oo STATUATORY AUTHORITY oe ‘ 4 Ill. The Regional Advisory Group ‘The Act specifies that an applicant for a plan- ' ning grant must designate a Regional Advisory Group. The Act also specifies that the Advisory ; Group must approve an application for an oper- ational grant under Section 904. The Advisory Group must include practicing physicians, medical : center officials, hospital administrators, representa- tives from appropriate medical societies, other health professions, voluntary health agencies, and representatives of other organizations, institutions, - . and agencies, and members of the public familiar with the need for the services provided under the Program. [t ‘should also be broadly representative of the geographic area and of the social groups who will be served by the Regional Medical Pro- gram. a ~The Regional Advisory Group should provide ‘ “overall advice and guidance to the grantee in the planning and operational program from the initial steps onward. It should be actively involved in the development of the Regional objectives, as well as . e the review, guidance, and coordinated evaluation ~ of the ongoing planning and operating functions. Cy ' It should be constituted to encourage cooperation x The Regional Advisory Gro ip sho Id provi q rerall ad- . . . ol 8 ry tl UL } T de overa 2 . ‘ . . a i i i i $ anizations, health per- vice and guidance in the planning and operational Program, among the in: trlutions, org: ° * cr from the initial steps onward. It should be actively involved ‘in the review and guidance and in the coordinated evalu- ation of the ongoing planning and operating functions. sonnel, state and local health agencies. It should be concerned with continuing review of the degree of relevante of the planning and = operational It should be constituted to encourage cooperation among the institutions, organizations, health personnel, and state and local health agencies such as the health planning bodies being established under the Comprehensive Health Planning Program, Public Law 89-749 as amended. It should be con- cerned with continuing review of the degree of relevance of the planning and operational activities to the objectives of the Regional Medical Program and particularly with the ef- fectivencss of these activities in attaining the goal of improved putient care. The Advisory Group does nat have direct administrative responsibility for the Program, but the clear intent of the Congress was that the Advisory Group would insure that the Regional Medical Program is planned activities to the objectives of the Regional Medical Program and particularly with the effectiveness of these activities in attaining the objective of im- “proved patient care. Therefore, Advisory Group members should be chosen who will provide a broad background of knowledge, attitudes and experience, To serve these purposes, the Advisory Group should operate under established procedures which insure continuity and appropriate independence of function and advice. It should formally consider what its specific duties and responsibilities shall be, including such things as the frequency of its meet- ings and appropriate methods for the replacing of retiring members. The Advisory Group, through the grantee, must submit to the Division of Regional Medical Pro- grams an annual statement giving its independent evaluation of effectiveness of the regional coopera- tive arrangements (regionalization) established under the Regional Medical Program. and developed with the continuing advice and assistance of @ group which is broadly representative of the health inter- ests of the Region. The Advisory Group is expected to pre- pire an annual statement giving its evaluation of effective- ness of the regional cooperative arrangements established under the Regional Medical Program. CHAPTER II ~ REVISED GUIDELINES - P45 CHAPTER III - REVISED GUIDELINES - Pes 8-9 GRANTRE RESPONSIBILITIES te v! ~ ~ GRANTEE RESPONSTRILITIES ~ ™, ...General Responsibilities .- Accountability .» Discrimination af »» Change in Approved Program ee .. Change of Program Coordinator “% .»-Change of Grantee Organization = ' »++Early Termination of Grant -«-Protection of Individual as Research Subject «Animal Care i ‘ ’ bi ‘ . oe bo General Responsibilities—The grantee is obli- gated, both for itself and each affiliated institu- tion, to administer the grant in accordance with regulations (Appendix 2) and policies of the Division of Regional Medical Programs. Where a policy is not stated or where the institutional ,policy is more restrictive than the Regional Medi- cal Program policy, institutional policy prevails in that institution. , . General Assurances—Specific attention is directed to the requirement to honor the assurances pro- vided in the Act. 7 The recipient of a planning grant must comply with the assurances in Section 903 (b), namely: * reasonable assurances that Federal funds paid pursuant to any such grant will be used only for the purposes for which*awarded and in accord- ance with the applicable provisions of The Act and the regulations thereunger; * =~ * reasonable assurances thatthe applicant will provide for such fiscal control: and fund account.’ ing procedures as are required by the Surgeon-Gen- ug ws oo . an a NOTE: Up-date per PL 91-515 GRANTEE *RESPO” ~-BILITIES = 7 eral to assure proper disbursement of and account- ing for such Federal funds; * reasonable assurances that the grantee will make such reports in such form and containing such information as the Surgeon General may from time to dime reasonably réquire, and will keep such records and afford such access thereto as the Surgeon General may find necessary to assure the correctness and verification of such reports; and * a satisfactory showing that the applicant has designated an advisory group to advise the applicant ,(and the institutions- and agencies par- ticipating in the resulting Regional Medical Pro- gram) in formulating and carrying out the plan for the establishment and operation of such Re- gional Medical Program, which advisory group includes practicing physicians, medical center offi- cials, hospital administrators, representatives from appropriate medical societies, voluntary health agencies, and representatives from other organiza- tions, institutions and agencies concerned with activities of the kind to be carried on under the Program and members of the public familiar with the needs for the services provided under the Program. The recipient of an operational grant must com- ply with the assurances under Section 90-4 (b), namely: ¢ Federal funds paid pursuant to any such grant (A) will be used only for the purposes for which paid and in accordance with the applicable provisions of this title and the regulations there- under, and (B) will not supplant funds that are otherwise available for establishment or oper- ation of the Regional Medica] Program with respect to which the grant is made; , * the applicant will provide for such fiscal control and fund accounting procedures us are required by the Surgeon-General to assure proper disbursement of and accounting for such Federal funds; ® the applicant will make such reports, in such form and containing such information as the Surgeon General may from time to time reason- ably require, and will keep such records and afford such access thereto as the Surgeon General may find necessary to assure the correctness and ver- ification of such reports; and * any laborer or mechanic employed by any contractor or subcontractor in the performance of work on any construction aided by payments pur- CHAPTER IIL - REVISED GUIDELINES - fr cet. aS | deere gota somite: ee GRANTEE RES*°NSIBILITIES suant to any grant under this section will be paid wages at rates not less than those prevailing on similar construction in the locality as determined by the Secretary of Labor in 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 FR. 3176; 5 U.S.C. 1337-15) and section 2 of . the Act of June 13, 1934, as amended (40 U.S.C. 276c) . p 10 a? (Continued from CHAPTER III - REVISED CUIDELINES pe 9) General Responsibilities--The grantee institution is respon- sible for administering the grant in accordance with regul- ations (Appendix 2) and policies of the Division of Regional Medical Programs. This responsibility applies both to itself ‘and to each affiliated institution. When an affiliating institution does. not have an officially stated or an applic- able policy, then the grantee institution policy prevails. For example, if an affiliating. commmity hospital does not have salaried physicians who serve on a fulltime basis and thus has no applicable salary policy, then compliance with Division of Regional Medical Programs guidelines on salaries, as found in Chapter III, Section VII, page 14 (Allowable Direct Costs - A. Personnel Costs), would require use of the salary policies of the grantee institution. Similarly, if an affiliating institution does not have an established travel policy, then the travel policies of the grantee prevail and, in any case, the general ‘restrictions on travel policy apply, in accordance with Chapter III, Section VII, page 16 (Allowable Direct Costs - L. Travel). ADDENDUM TO REVISED GUIDELINES - dtd 2/70 - Page 24 (Reference to Financial Mnagement) GRANTEE RESPONST®{(LITIES "It is the fundamental responsibility of the Regional Medical Program grantee institutions to be responsible and primarily liable for the fiscal and administrative _ aspects of managing a Regional Medical Program. This means that grantees are held accountable for all funds awarded to them and the Federal Government will continue to hold that party fully accountable and responsible," The Regional Medical Programs Service endorses the foregoing statement of policy, and urges the individual Regional Medical a Program and its grantee institution to safeguard its own interest and rights of subrogation against affiliates either by a written contract or an‘agreement of affiliation between itself and affiliates. *. z not , Department of Health, Education, and Welfare attorneys have ruled that no authority currently exists whereby Regional Medical Programs Service or the Regional Medical Programs can vest title to equipment in affiliates at the time purchases are made. This decision was based on the principle that no privity exists between the Federal Government and institutions affiliated with grantecs. Therefore, ‘the option to vest title in these institutions is unavailable. The Regional Medical Programs Service stands ready to assist Regional Medical Programs or grantee institutions in their under- standing of the responsibilities under this policy. However, each ‘Regional Medical Program and grantee is jointly responsible for insuring that its affiliated institution or organization is fully ‘cognizant of the policies and procedures with respect to the’: expenditure of Federal funds. NID 7-10-70 NOTE: Cross reference to Program Management (General Requirements). t designed to speed the exchange of news, nformation and data on ional Medical Programs and related activities. fe Me element ewe Gee ee ee vo GRANTEE RESPONSIBILITIES nan ' LC a a ‘ i Discrimination Prohibited—Section 601 of Title i VI of the Civil Rights Act of 1964, 42 U.S.C. : 2000d, provides that no person in the United States shall, on the ground of race, color, or national origin, be excluded from participation in, be denied the benefits of, or be subjected to discrimination under any program or activity receiving Federal \ financial assistance. Regulations implementing the statute have been issued as Part 80 of Title 45, Codé of Federal Regulations. The Regional Medi- ' cal Programs provide Federal financial assistance - subject to the Civil Rights Act and the regulations. } It is the responsibility of the grantee to insure that each affiliated agency (institution) which pro- poses to cooperate in the Regional Medical Pro- gram is in compliance with Section 601] of Title VI r ” of the Civil Rights Act of 1964. The grantee shall } 7 maintain a copy of the form which insures that at fe each affiliated agency (institution) is in compli- han "ance. Each grant for construction (alterations and renovation) is subject to the condition that the s grahtee shall comply with the requirements of the Executive Order 11246, 30 F.R. 12319 and the applicable rules, regulations, and procedures as prescribed by the Secretary of Labor. CHAPTER III ~REVISED GUIDELINES - Pg Li STATEMENT OF POLICY Re oe gs Supported with Regional Medical Program Funds eve rmer ss Ry¥ a a ea nik et aaa SS aa aaa saa aaa amaaaaasasaasaaaaaaaalas caaaaacacaaaaaséaaaNaaaamaaaaaaasaimasaaasaiaina ian sama ammmmaaamamaamammaasamacaasaammamacaacacaassaassssscasasssccssasaca March 11, 1970 - Vol. 4, No. 12S STATEMENT OF POLICY Sponsors of educational activities funded by Regional Medical Programs may not permit discrimination against applicants on the basis of race, religion, place of employment, or origin of professional qualifications. Applicants to such activities should be selected, invited, or accepted only on the basis of academic .. or other objective qualifications set by the institution or organization responsible for the program. UML ——— “ MMivll, on : Onl, Heart Disease, Cancer, and Stroke _ Office of the Exceutive Director 2 CR A 122 South Michigan Avenue » Room 989/Chicago, Illinois 60603/Telephone 312-939-7307 UNS X . t April 15, 1970 Mr. Edward M. Friedlander | Assistant to the Director Communications and Public Information ; Regional Medical Brograms Service “ Parklawn Building 5600 Fishers Lane Rockville, Maryland 20852 . z ‘, Dear Ed: er wo ~.. Regarding the "Statement of Policy re Meetings Supported with Regional Medical Program Funds," (Special Issue, Vol. 4, No.2S), our Nursing Committee was quick €6 point out that the statement makes no reference to discrimination (> on the basis of age or sex. Since these are two particularly touchy — areas for certain groups, it would be wise to ' include these categories in the policy statement. We would appreciate your attention to this matter. " Yours truly, - é o/, . Pear hers ora Marilyn J. Voss - Public Information Assistant MIV:bd * ~. Change in Approved Program—The Division of segional Medical Programs does not intend to interfere with administrative or program flexibil- ity which serves the objectives of the Regional Medical Programs. If, however, a change is deter- mined by the grantee to be desirable, and if that change would constitute a substantial change in the nature of the Program originally approved, the grantee must consult with the Division of Re- gional Medical Programs, staff. No substantial change in the approved Program can be made without the specific written approval of the Divi- sion of Regional Medical Programs. Requests for such approval must be submitted in an Application for Revision (page 21). os , ’ “ GRANTEE RESPONSIBILITY ~ a Change in Program Period—The Program period may be extended up to 12 months without additional funds, if requested by the grantee before the end of the Program period. Change of Program Coordinator—A change of Program Coordinator or other key official directing the Program requires the written approval by the Division of Regional Medical Programs. Notifica- tion to the Division of Regional Medical Programs of such a proposed change must be signed by at least one of the two persons who signed the orig- inal application or their successors. A curriculum vitae for the newly appointed official should ac- company the notification of change. Change of Grantee Organization—If for any reason the grantee organization proposes to relin- quish its reponsibility for a Regional Medical Pro- gram grant, it must immediately notify the Divi- sion of Regional Medical Programs. For example, _a region may wish to create a non-profit corpora- tion especially for the purpose of becoming the grantee organization. Any change of grantee orga- nization requires that a terminal progress report, an expenditures report, and an invention statement (PHS-3945) be submitted to the Division of Re- gional Medical Programs. If the grantee terminates its responsibility for the Regional Medical Program, the new institu- tion/corporation must submit a new grant applica- tion for the remainder of the program period. The application should include the reasons for transferring the Program and the probable effect of the move on the Regional Program. Administra- tive approval may be given by the Division of Re- gional Medical Programs to continue the Program with a new grantee, Applications, however, that reflect major Program changes will be referred to the National Advisory Council on Regional Medi- cal Programs for recommendation. Early Termination of Grant—(1) By the Grantee—A grant may be terminated or cancelled at any time by the grantee upon written notifica- tion to the Division of Regional Medical Programs stating the reasoris for termination. (2) By the Public Health Service—A grant in whole or in part, may be revoked or terminated by the Surgeon General at any time within the pro- gram period whenever it is determined that the grantee has failed in a material respect to comply with the terins and conditions of the grant. CHAPTER III - REVISED GUIDELINES - Pg 13 | GRANTEE RESP LBILITIES ~ i PROTECTION OF INDIVIDUALS AS RESEARCH SUBJECTS "Nothing in the institutional assurance mechanism should inhibit PHS staff, advisory groups, or consultants from (1) identifying concern for the welfare of human subjects, and communicating thts concern to the grantee institutions, or (2) recommending disapproval of the application if the gravity of the hazards and risks so indicate. This provision applies even if the application or contract in question has been reviewed and approved by a mechanism at the grantee institution which has been accepted by the PHS." (Above quote from a memo to Directors of NIH, HSMHA , and CPFEHS.,, and discussed in a memo, dated 7/25/69 from Deputy Director, RMPS, . - to All Staff) Institutional Assurance Involving Human Sub- jects;An application for a Regional Medical Pro- gram grant which includes investigations involving human subjects will not be accepted for review me unless the Public Health Service has approved a Law plan (known as Institutional Assurance on Inves- ‘tigations Involving Human Subjects, Including Clinical Research and Investigations in the Behav- ioral and Social Sciences) for insuring that the institution conducting the research has complied with the Public Health Service policy concerning research involving human subjects. - It will be the responsibility of the grantee Lo insure that the individual affiliated institution (s) which will be involved in these investigations secure the approval from the Public Health Serv- ice and to provide a copy of the approval to the Division of Regional Medical Programs. A copy of the Instructions for obtaining Public Health Service approval may be obtained by writ- ing the Grants Review Branch, Division of Re- gional Medical Programs, National Institutes of Health, 9000 Rockville Pike, Bethesda, Maryland 20014. x REVISED GUIDELINES ~ CHAPTER III - Pg 11 NOTE: Wording and address up-date ia ics SSS cca aaaaaaaaaaseasammmmasasa seam aaa saaaaesse sama easaaaamaaa esas eases aca saaaaaalaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaamasaaasaaaa sama aamaaaasacmmaasuaacmaaamassmasmmmmauanaasaa sams caescecmmmas Surveys or Questionnaires—Survcys or question- naires ‘arising from and supported by a grant should include a positive statement clearly setting forth that the contents are in no way the responsi- bility of the Public Health Service. They should conform with Bureau of the Budget, Circular #4 A- 40. Publications—Grantees and/or their affiliated in- stitutions may publish materials relating to their Regional Medical Program without prior review provided that such publications carry a footnote acknowledging assistance from the Public Health Service, and indicating that findings and conclu- sions do not necessarily represent the views of the Service. CHAPTER III - REVISED GUIDELINES p jy * 6 ¥t GRANTEE RESPONSIBILITY Patents and Inventions—The Department of Health, Education, and Welfare regulations (915 BLR., Part 6 and 8) provide as a condition that all inventions arising out of the activities assisted by Public Health Service Grants must be promptly and fully reported to the Public Health Service. Any process, art or method, machine manufacture or improvement thereof, may constitute an inven- tion if it is new and useful and would not have been obvious to a person having skill in the art to which it relates. 7 In order for the Public Health Service to carry oul ils responsibility under these patent regula tions, it’is essential that the Service be advised before awarding Government funds of ‘any com- mitments or obligations made by the institutions or by the professional personnel to be associated with the activities carried on under the grant which would be in conflict with the inventions agreement. When submitting an application for a Regional Medical Program, the grantee must pro- vide in letter form either: a. a statement indicating no previous commit- ments or obligations have been made, or b. a detailed explanation of such commit- ments or obligations where they do exist. One such letter will suffice for the named grantce and all affiliated institutions receiving sup- port under the grant. It is the responsibility of the institution named as the grantee on the application to ascertain the facts relating to patents and to report these on behalf of all affiliated organiza- tions in the Repional Medical Program as well as to inform affiliated mstitutions of these responsi- bilities, ‘ In subsequent years an annual invention state- ment form PHS-3915 must be filed whether or not an“invention his occurred. Where there are no inventions to report, a single form PHS—3945 is all that is required for the institution named on the application as the grantee and for all affiliated institutions. Where there are inventions to report, . & separate annuak invention statement must be filed for cach one. Here again, it is the responsi- bility of the grantee to report on behalf of itself and all other afhliated organizations in the Re- gional Medical Program. The Regional Medical Programm grant for the next year will not be issued until the invention statement form PHS-3945 has been received by the Division of Regional Medical Programs. ~_ Animal Care—Each person assigned or ap- + 12 CHAPTER III - REVISED GUIDELINES (MORE) PROCRAM MANAGEMENT x ¢ SE " CTION I - INTRODUCTION '. PROGRAM MANAGEMENT : a ’ vl yo 4 7 4 i \ i 7 4 . . . 7 . e ~ ‘ Lg z " + wee on % 1 eso ne 4 e- : 4 wneetnne Ae > a . 4 t q &. ie - 4 ? o i } 4 f , " 1 . % Ale ms ~ a CT hak tt ee Rt era ete te pt emer ee ee ee en a ‘, PROGRAM MANAGEMENT | i - f . o i we SECTION T « «INTRODUCTION SECTION II «»-GENERAL REQUIREMENTS (Responsibilities of Program Coordinator, Regional Advisory Group, By-Laws,’Relationships td ” Grantee, to DHEW Regional Offices and other Federal agencies and programs; Reports Required; Public . ,° Announcements of Approved Grants, etc.) - of. , SECTION TII~ ” ,..ELIGIBLE ACTIVITIES Definitions . Specific Requirements Central Administration _ Research Demonstrations of Patient Care Categorical Relevance Continuing Education, Training and Manpower Multiprogram Services Exclusions — SECTION IV «» «FINANCIAL MANAGEMENT (List) SECTION V «+PREPARATION AND SUBMISSION OF GRANT APPLICATIONS : (List) ~ oe — FE ee ee i a a PCTS TNR peer nner ata ee ee eee we see ae ee PROGRAM MANACENENT “°° gperton IT (Ceneral Kequ.cements) _ — ae information oCata communieation device designed to speed Regional Medical Programs Service Representatives -- the exchange of news, Department of Health, Education, and Welfare Regional Vermation and data on Offices ; ional Medical Programs ° - and related activities. October 30, 1970 - Vol. 4, No. 49S ; f e cad . Regional Medical Pragranis Service ,has named eight Representatives, and expects to name’the remaining two in the near future, to the Department of Health, Education, and Welfare Regional Offices. ° (Listing on Pages 2 and 3.) It is expected that they will represent Regional Mcdical Programs Service, provide assistance to the individual Regional Medical Programs, participate in site visits for Program review, furnish information to Regional Medical Programs Service, and act as liaison with other Federal agencies. i) In order to develop the best possible operating relationships, each Regional Medical Program is encouraged to provide its Representative with. - A copy of each Program application, for review and comment, at the time it is submitted to the Grants Review Branch of Regional Medical Programs Service. - Copics of correspondence between the Regional Medical Program and the staff of Regional Medical Programs Service. . An invitation to attend the Regional Advisory Group meetings, as well as mectings of special and standing committees and selected staff meetings. The staff of Regional Mcdical Programs Service is asked to provide the appropriate Regional Office Representative with . . . A copy of each grant award at the time it is mailed to the Program, ‘ . - Copies of correspondence concerning each Regional Medical Program for which he is responsible. NOTE: Reference to DHEW Regional Offices. PROGRAM MANACTMENT on Regional Medical Programs, dated November 4, Vernon E. Wilson, M.D., Administrator, HSMHA) SECTION II (Exerpted from letter to Members of the National Advisory Council 1970, signed by (Relationshi, . with DHEW Regional Offices) en TT - _ rg ipee Lhe OO on Be FPS suaki bas been eastened to onach of the tan Renton) Yeo La ot. ~ Offices. That staff will not have cireck recponsibiiiey for, approval ox cisupprovel ef funding fren a pYocreseatie poinge of ofar a 5 ay7 vaAtwes 25s, 4 a a : View, but will have very specific rvesnorsibs fans for fisent . Se tes °. mo ytyts fe < “ , aegistence ip caryying owt the approved respons bd atien du behalf Of the Rational Offices. “ This Will prinearitdy take the usual form of gxeants mays CRON. coe eS ve ee ’ me fueh of thia aay aeq ay 4 S my, Nf raat: - mC 1 : 7 ot _ ben OF Chas enpnasia a9 in an attespt to trprove the comuntleaticon duals es 7 he TYE Pape Stan tenes ba ences, . , Jink betvecn the RiP Coordinates: and the Hopienal Hoalth Pirecter Who has responsibility for awide varhety of Federal health pron . “Exes Iu the sare ECOCraNaALe arogs, . PROGRAM MANAGEMENT SECTION II |. (RELATIONSHIP.-TO OTHER FEDERAL PROCRAMS) { VETERANS ADMINISTRATION DEPARTMENT OF MEDICINE AND SURGERY WASHINGTON, D.C. 20420 March 28, 1968 YOUR FILE REFERENCE: INREPLY REFER TO: 15 CHIEF MEDICAL ‘DIRECTOR'S LETTER NO. 68-18 ~ TO: Directors of Hospitals, Domiciliary, and VA Outpatient Clinics, and Managers of Regional Offices with Outpatient” Clinics | . 'SUBJ: Veterans adninisteation Patticipation in the Regional Medical Programs (RMP) of the Public Health Service 1. Purpose > ' The purpose of this letter is to clarify relationships a between the Veterans Administration and the Regional Medical Qa Programs (RMP) of the Public Health Service, and to provide implementing guidelines. 2. Background The General Counsel's Office of the Department of Health, Education and Welfare has recently offered an opinion regarding the degree of participation of Federal facilities in Regional Medical Programs which now allows clarification of potential VA involvement in those programs. Title IX of the Public Health - Service Act, "Education, Research, Training and Demonstrations in the fields of Heart Disease, Cancer, Stroke, and Related Diseases," (PL 89-239), is the basis for the establishment of the RMP. The purposes of the RMP will be effected via the grant mechanism. RMP grants are to encourage and assist in the ‘establishment of regional cooperative arrangements among medical schools, research institutions, hospitals, and other medical institutions and agencies--to make available the latest advances in the diagnosis and treatment of these diseases. Grant funds will support, through these cooperative arrangements, research, training (including continuing medical education) and related demonstrations of the highest standards of patient care. Through these means the Programs are intended to improve generally the health manpower and facilities of the Nation. (See Guidelines, Regional Medical Programs, DHEW, PHS, NIH, June 1967.) ’ : ( hy c ned x ) — B piekrens ce ee Cig aa a a a eed ee et An - oe PROGRAM MANACTMENT SECTION TI oe Reports—All reports required to be submitted Lo 7 to the Public Health Service should be sent to the . Division of Regional Medical Programs, Public Health Service, Bethesda, Maryland 20014. A. Progress Reports—The grantee is required to submit an annual progress report for each grant. This report (s) should contain sufficient de- tail to inform the reader of the accomplishments with particular respect to the objectives and must . be submitted with the application for continued support. In addition, grantees may be required to supply other information needed for guidance and development of the national program and ure encouraged to report significant .developments promptly at any time. A terminal progress report must be submitted to the Division of Regional Medical Programs within three months of the : f termination of the program period. Specifically, 2. 7 * ' the report must describe the ways in which the ? oe. 7 process of regionalization as described in Chapter ‘* II has moved the Regional Program toward its goal . of improved patient care for all those within the Region suffering from heart disease, cancer, stroke, or related diseases. The report must also include: Q) principal staf! members—names cand positions fe ~. (2) organization of the Regional Medical lw , Program ~ (3) membership and functions of the Re gional Advisory Group (4) names of all cooperating agencies/in-_ stitutions and_ their relationship to the Regional Medical Program (5) description of planning activities (6) description of operational activities, if any : . (7) description of interregional activities, - OS ’ if any . (8) the extent to which the planning and operational activities of the Program are sup- ported by non-Federal funds. B. Regional Advisory Group Reports—The Regional Advisory Group is expected to prepare an annual statement on the effectiveness of the regional cooperative arrangements (regionaliza- tion) established under the Regional Medical Pro- gram. The report, signed by the Chairman of the Regional Advisory Group, signifying its approval, should be submitted to the Division of Regional Medical Programs by the grantee along with the annual progress report. Periodic reviews of grants by the staff of the Division and the Advisory Coun- cil will include consideration of the elfectiveness of the Advisory Group. CHAPTER III - REVISED GUIDELINES ~ Pg 13-14 A cc cS; tc oe SUBJECT : { ee bo PROGRAM MANAGEMENT SECTION II i (Genéral P uirements) . t Grant Announcements to Regional Medical Programs \ In an effort to work out a better method for announcing grants to Regional Medical Programs that would be more mutually effective for both the appropriate Congressmen and Senators on the one hand, and the Regional Medical Programs on the other, Mrs. Dale Kohn of my staff and I met with Mr. Jerry Poole, Deputy Assistant Secretary for Congressional Liaison of the Department of Health, Education, and Welfare in his office on-Wednesday, April 16. Mr. Poole demonstrated a very clear and sympathetic understanding of the problems reflected by the recent examples detailed in our memorandum to him of April 10. He agreed.that a better system could and should be developed to meet the particular needs of the Division of Regional Medical Programs that would also help him fulfill his responsibility of helping to develop relationships between the Department dnd the members of Congress. fy? . As a result, we have worked out the following new policies and procedures which include changes from the current method, painfully evolved over the past three years from the old National Institutes of Health-Public Health Service practice: . Following establishment of the grant figures for an award to a Program by the Division, this office will coritact the Coordinator and his authorized staff person in the office of the Regional Medical Program receiving the grant. In addition to providing then with the figures, we will encourage and work with them to develop appropriate releases and other informational materials in preparation for the announcement that will be made by the Congressional representatives of that Region, and to insure and safeguard that Congressional prerogative. . For Regional Medical Programs purposes, the rule that requires only new grants to be reported to the Congressional Liaison Office will be ignored. In its place will be a judgment made by this office of which grants in terms of dollars and/or political significance are to be forwarded to the Department for reporting to the Congressional delegations. —_ , A bof ous } ( MaRE } . HELP ELIMINATE WASTE : COST REDUCTION PROGRAM -+ NID 6-15-69 to PROGRAM MANAGEMENT SECTION TI 4 . (General + strements) ISSUES AND PROCEDURE: Re Public Announcement of Approved but Unfunded Projects Sr ‘ { July 18, 1969 - Vol. 3, No. 28S - The following are the issues raised: . * . Can these projects Be publicly announced by the Programy as” “approved? . How should the ultimate funding of these projects be announced, be it from reallocation of funds already announced from new funds to be granted, or from funds from other sources? What limitations or requirements are there on such announcements as related to members of Congressional delegations? Nei? Because these types of notification can‘be expected to continue and these issucs continue with them the following procedure has been established: Announcements to special interested or involved Regional. Medical Program publics, or to the general lay public of the Region, of - the “conditional approval" of projects 'favorably acted upon by the National Advisory Council" and " authorized for implementation" may be made by the Regional Medical Programs receiving such notification. However, these Programs are encouraged to use the foregoing quoted phrases (without quotes) along with the fact that no immediate funding is being made to support their projects, and future funding will be dependent upon the availability of sufficient funds. If appropriate, Program officials may detail ~ their plans for either implementing these projects by rearranging other Regional Medical Program funds with Division of Regional Medical Program approval, or involving other funds to get these activities underway. Such announcements, regardless of the form or forms they may take, may be communicated to the appropriate Congressional delegations by the Program officials as a normal part of the total effort to keep the various publics concerned with the Regional Medical Program informed. — oom. PROGRAM MANAGFMENT SECTION II (General Requirements) Miscellaneous— (1) Safety Precautions—The Public Health Service assumes no responsibility with respect to accident, claims or illness arising out of any work undertaken with the assistance of a Public Health Service grant. The grantee institution is expected to take necessary steps to insure or protect itself and its personnel. , (2) Federal Income Tax—Determination ” of a tax status of an individual receiving compen- _ sation in any form from the Public Health Service - grant is the responsibility of the Internal Revenue Service. (3) Military Service~The Public Health Service will not intercede on behalf of an indi- vidual in relation to military status. CHAPTER IIL - REVISED GUIDELINES - Pg 18 oe PROGRAM MANAGEMENT . “SECTION III - ELIGIBLE ACTIVITIES ae wy . 1 : \ 1 i 4 i “t t 4 : PROGRAM MANAGEMENT SECTION III sé ELIGIBLE A. .VI'TIES ' (Definitions) V. Eligible Activities , ; Categorical Emphasis—The focus of Regional - Medical Programs under the authorizing legisla- tidn is on problems of heart disease, cancer, stroke and related . diseases. This broad. categorical ap- proach must be a consideration in the development . /_of specific Program elements under a Regional | iy Medical Prégram. Because of the broad scope of heart disease, cancer, and stroke, it would be diff- cult and perhaps detrimental to some types of “ “medical services and educational activities if a_ rigidly categorical approach were adopted for all . s relevant Program elements. The. emphasis of the *L Program does require that the component ele-. * ments be shown’to have significance for combating . hgart diseasé, cancer, stroke. and related diseases _ through a regional effort intended to improve the care of all those persons within the Region suffering from one of these diseases. However, in some instances, activities which have a-more gen-. eral impact extending beyond the specific prob-. an 7 iems of heart, cancer, stroke and related diseases Nd may need to be supported because they are essen- tial to the achievement of the purposes of Regional Medical Programs. The objective of improved patient care for. those suffering from these categorical diseases will require the full development of the process of regionalization, particularly in the Program's oper- ational phases. Therefore,’ individual, categorical .. activities should be designed and implemented in ways which will insure their regional rather than organizational or institutional identity. Core Support—The central administration and coordination of a Regional Medical Program re- presents the administrative heart of the Program, and as such is an activity eligible for grant sup- port. The salaries of the Program Coordinator and his staff as well as other costs incident to the central administration and coordination of the ‘ Program may be charged to the grant. Research—Research activities which are integral to the purposes and objectives of the Regional Medical Program are eligible for support and their costs may be paid by grant funds. Such research ~~ activities in order to be cligible must contribute to the process of regionalization and the goal of improved patient care the Program seeks to achieve. 19 CHAPLER TTT - REVISED GUIDELTMRS -« Po te Mam. Tt Tee Sate tee oe Dieter Rte ter tle atte ae eee Fe pease ELIGIBLE ACTIVITIES SECTION III ‘ oa (De fin. cions) Demonstrations of Patient Care—Demonstrations of paticnt care may be supported when related to the objectives of the Regional Medical Program. The Act provides that the costs of patient care may be supported only when such care is incident ' to research, training, or demonstration activities encompassed by the purposes of the Program and only if the patient has been referred by a practic- ing physician. Documentation must be provided (see Chapter HI, page 15). Such demonstrations must contribute to the process of regionalization “ “and the goal of improved patient care which the Regional Program is seeking to achieve. Grant * f funds may be used to pay the other costs incident *. to the demonstration activity, including staff and ¢. 7 > equipment. an . ~ |. Wraining and: Continuing Education—Continu- . ing education and training programs for medical, allied health personnel and associated professions ‘ which are part of: integrated comprehensive ap- proaches of enhancing regional capability for the diagnosis and treatment of heart disease, cancer, . stroke, and related diseases are eligible for support. However, it should be emphasized that the primary intent of the legislation in this area is the support of those activities that are beyond those normally accepted as basic preparation for work in the health ficld. If one is to make assessment of needs for educational programs, this assessment must be based on the system of health care, the tole of the learner, and his needs. In medical _ education, attention mrust be focused directly on the questions: “Will this effort to change behavior result, in fact, in the patient receiving the max- .Imum_ benefit of modern knowledge?”. Grant funds may be used for innovative training ap- proaches and the development of new types of . health personnel or new arrangements of health personnel to meet the Region's goal of improved patient care for those suffering from heart disease, cancer, stroke, or related diseases. me C . CHAPTER LTII - REVISED GUIDELINES - Peg 10 NOTE; Up-date eerie ene wa PROGRAM MANAGEMENT SECTION III ELIGIBLE ACTIVITIES (Continuin iducation, Training & Manpower) "...The Council agreed that training was one of the most vital objectives of the Regional Medical Programs, and that there needed to be close collaboration with other programs in meeting the over~ all manpower problem. Also considered were the support of full- time staff in the hospital for education and service purposes, the training of new types of medical manpower, the attraction of personnel to be trained...". a . Council Minutes 2/24-25/66 el . PROGRAM MANAGENEWT SECTION IIT =. - (Specific Requirements) (Concern for Special Populations) 4 Therefore the Council suggested that Regional Medical Programs... - Actively work with metropolitan planning agencies and programs, Undertake appropriate patient care demonstration or other projects in inner-city areas, _, and that the Division of Regional Medical Programs of the National Institutes of Health:.. , e 7 ” . ‘Encourages dévelop, publish and promote a series of pertinent papers on subjects concerning relationships between Regional Medical Programs and urban problems, . Name and call together appropriate national leaders to WS consider how the attention of Regional Medical Programs can best be focused on the urban health issues in metropolitan areas and their inner-cities. - - UID Hey £7 : Targeted for Specific Population Groups "The Council, recognizing the diverse problems of medically disadvantaged consumer groups, both urban and rural, urges that ‘specific planning to meet the health needs of such groups be a function of Regional Medical Programs. , "NOTE: In discussing this matter, the Council expressed its intérest in further discussion of the special problems and appropriate role of Regional Medical Programs in metropolitan communities, especially in high density population areas served by many centers of medical excellence. Such an item will be placed on the agenda for the next meeting." -- February 20-21, 1969 Council Meeting ee a PROGRAM MANAGEMENT SECTION TIT. coronary care unl ‘ t projgets must also meet the followi 3 organizabi et a Feo n q systen 1B c £ er developments c ding da i equipment, er patient service onerations. . 5 1 é _ ' : Training for coronery care units:. Council requested RPS to dastruct all Reylenal Medical Proers aving coronary care unit training projects od 0 2 ? to disengage Regional Yedical Program funding at is of their current PH q aco NZ2ag z. @2 @ roject periods or within a rez naéble eriod thereafte as noted above. r > . ao , zobele coronary care units: Experience with such units: to date has “demonstrated that initial costs are high, and experience to date has not developed ‘capability to predict the degree of success that can be expecte for given coniinations of orgenization,, staff, euqipment, population and to assure geographic coverage and regional cooperation. In icapaaals comparison, it seems likely that the sum-required to demonstrate a mobile . ; unit program would ptoduce greater benefits if invested in a well planned ° preventive program instead. Council asked RHPS to advise Regional Medical Prograns to fund no new mobile coronary care projects. ~ .. November 9-10, 1970 Council Minutes NOTE: Cross-reference to Continuing Education, Training & Manpower : Gi 1 ELIGIBLE. ACTIVITIES SECTION IIL (CATEGORICAL RELEVANCE) Disease Categorical Versus Comprehensive "The Council reaffirms its endorsement of the policies in this regard as set forth in the Regional Medical Programs Guidelines Chapter III, Section V. However, in so doing, it emphasizes that full consideration will be given to applications for activities which pertain to problems in heart disease, cancer, stroke, and related diseases but which also-have an impact on the diagnosis and treatment of other diseases, and/or fulfill a specified objective of the Region." , - -- February 20-21, 1969 Council Meeting ej ” . In considering the matter of the "relevance" of zomponent activities of any Regional Medical Program, the Council generally agreed with Doctor Millikan's statement that rather than being a matter of its direct relationship to one of the disease entities mentioned in Title IX, a project should be reviewed according to five basic considerations: (1) is it a valid scientific experiment; (2) is it a model for educational experience; (3) is it something other than a direct patient service; (4) will it open communications channels for improved local and Regional arrangements that will help to reach the long range goal of the Regional Medical Program; and (5) is it something that should be. replicated in this or another Region? ‘These questions were applied to the specific proposals and recommendations were arrived at accordingly. Council Minutes 12/16-17/69 ae dF NOTE: ELIGIBLE ACTIVITIES SECTION irr / . (Conrinuir Jducation, Trainiag & Manpower) REASONS FORK SEPARATION OF ‘BASIC AND CONTINUING EDUCATION WITHIN REGIONAL MEDICAL PROGRAMS AND EMPHASTS ON CONTINUING EDUCATION Regional Medical Programs has emphasized in the past and continues to emphasize continuing education and training rather than basic education as a means of providing the opportunity "of making avail- able to their patients the latest advances in the diagnosis and treatment of these diseases" for the following reasons: . There still exists a lack of emphasis on continuing education as an important facet in the total educational development of health personnel. - - RMP provides a meaningful regional framework of cooperative activity into which continuing education programs can be incorporated. Continuing education can play a role in develop- ing cooperative arrangements and, conversely, regional cooperative arrangements are essential to the development of continuing eduéation programs. f oo * ’ - RMP, because of its focus on the practitioner and his effect on patient care as well as through its mechanism of "demon- strations of patient care," provides the ideal setting for the connection between acquisition and utilization of knowledge that is the key to the learning process in continuing education. It is the health care needs of his patients that dictate the continuing education needs of the health practitioner and it is his utilization of this continuing education that sets the quality level of his practice. RMP, therefore, has the opportunity to make continuing education relevant to its real purpose-~that of improving the health care of people with heart disease, cancer, stroke and related diseases. '.» As a result of specialization, sub specialization and the development of new technologies, the health establishment has proliferated so that there.are now many different kinds of health professionals. A variety of medical care teams has resulted but continuing education remains largely unidisciplinary. The cooperative arrangements of regional medical programs can provide an excellent base for multidisciplinary inter- professional continuing education with its primary focus-- the care of the patient with heart disease, cancer, stroke and related diseases, - Generally speaking, other agencies exist whose primary efforts are aimed at supporting supply and training of health manpower at the basic and postgraduate level, we eAddendum fo Revised Cuidelines, 2/70 , Pe 14-15 Definitions? PROGRAM MANAGEMENT SECTION ITIL ELIGIBLE AC€IVITE (Continuing Education, Training & Manpower) “s 7 : . : . . wee II. Continuing Education and Training - Definitions Section 900a of P.L. 89-239 authorizes Regional Medical Programs to use, as means of accomplishing its purposes, research and training (including continuing education) and related demonstrations of patient care. While the wording of the law is quite general, it is clear from the legislative history and other sources that the primary educational interest of Regional Medical Programs is in continuing education and training activities. As an operational definition of continuing education, the following has been accepted:. "Those educational endeavors which are above and beyond those normally considered appropriate for qualification or entrance into a health profession or an occupation in the health related fields.'' Generally, activities should,not be designed principally to qualify one for a degree, diploma, or board certification. In . general, standard internship and residency programs would not qualify as "continuing education.'' Continuing education and training activities should lead to-the assumption of new responsibilities in the already chosen career field; update ‘knowledge and skill in the chosen career field, or add knowledgs ‘and skill in a different but basically ‘related health field. ‘addendum to Revised Guidelines, 2/70, Pg 6 CONTINUING EDUCATION AND TRAINING — DEFINITIONS o t ' The primary educational intent of Regional Medical Programs is in continuing education and training. As an operational definition of continuing education, the following has been accepted: "Those educa- tional endeavors which are above and beyond those normally considered appropriate for qualification or entrance into a health profession or an occupation in a health related field." Continuing education activities must not be designed principally to qualify one for a degree, diploma or certification; therefore, internship and residency programs have been excluded from primary consideration. Training designed principally to prepare one for a research career in the biomedical sciences has also been excluded. , Continuing education and training activities should lead to the assumption of new responsibility in the already chosen career field, update knowledge and skills in the chosen career or add knowledge and skill in a different but basically related health field but not provide for career change. In general, therefore, interest is in task~oriented training. (Addendum to Revised Guidelines, 2/70, Pg 15) \ . SECTION vrr - 1 ELIGIBLE ACTIVITIES SECTION LTT III. Criteria . Funding ° _ We have further specified conditions which should be met by the continuing education. or training activity submitted for funding: (1) The activity must be shown to meet documented Regional needs. (2) Evidence should be presented to show that such activities do not already exist or do not exist in sufficient muber. (3) An operational activity must have been approved by the regional advisory group. : (4) In accordance with the provisions of Section 904(b) (1) (B) of P.L. 89-239, the availability of other sources of funding must have been fully explored. | (5) The goal of the activity should be to maintain or improve the quality of practice of health professionals. In general, activities will fall into one of three categories: (a) Maintaining the level of practice of the health © professional (e.g., refresher courses, seminars, conferences, etc.). (b) Improving the level of practice of the health ° “professional (e.g., special training courses in coronary care, cancer therapy, etc.). : (c) Peveloping new areas ‘of interest for the health professional (e.g, training leading to the assumption of new responsibilities in a chosen career field, obtaining knowledge and skills in a different but basically related health field, the ‘development of new types of health professionals, including, for example, the medical planner and administrator. It is recognized, as stated in the revised Guidelines that "grant funds may be used for innovative training approaches and the develcpment of new types of health personnel...."', Such activities and others may require investment in basic training or education. Such activities will be judged on their merit and on the documentation by the Region of the need for such an activity. Exclusions: It should be emphasized that Regional Medical Program funds are not to be used to "supplant funds that are otherwise available for establish- ment or operation....'' (Sec. 904(b) 1, P.L. 89-239). Therefore, generally excluded from funding is training desigmed speci*ically to prepare one for a research career in the biomedical sciences, We urge Regional Medical Programs to become familiar with all available sources of support for education and training, including private as well as other Federal sources, e.g., the National Institutes of Health, the National Science Foundation, and the Department of Defense. It is to be expected that Regional Medical Programs will seek support or help cooperating agencies or institutions seek support for a wide variety of training and education activities, basic and continuing, from several different sources. In many instances, shared funding by a number of cooperating agencies will be appropriate. The Division of Regional Medical Programs may be of help in such cases. -» Addendum to Revised Guidelines - 2/70 Pg 6-7 (Contin ig Education, Training & Manu. we ~~ PROGRAM MANAGEN" “T SECTION III ‘ ELIGIBLE ACTIVE.» iS (Continuing Education, Training & Manpower) CRITERIA FOR FUNDING e- The following criteria have been adopted for determining those continuing education activities most suitable for funding: Neat The activity must be shown to meet documented Regional needs. Evidence should be presented to show that such activities do not already exist or do-not exist in sufficient numbers. 12 The goal of the continuing education activity must be to main- tain or update knowledge and skill in.order to improve ‘the level of practice of the already qualified health professional The activity must relate to the categorical nature of the program and be part of a comprehensive plan to enhance regional capability in the care of patients with heart disease, cancery stroke and related ‘diseases. t% ‘. - ~ RMP funding is not to be used to replace existing sources of support for educational activities. * , .. Addendum to Revised Guidelines, 2/70 Pg 13-14 " -NOTE: See Pes 6-7, Addendum to Revised Guidelines, 2/70 a PROGRAM MANAGEMENT | SECTION III en - ELIGIBLE ACTIVITI : (Continuing Education, Training & Manpower) ~ BASIC TRAINING OF ESTABLISHED ALLIED HEALTH PROFESSIONS “ti, owes Definition om A health. profession will be considered established if a Board of Schools AMA Council in Medical Education, or some similarly recognized mechanism, has been set _up.to approve schools, outline standards for admission, curriculim | requirements and certification procedures and/or if definitive formal educational programs in the particular health occupation have already heen instituted im the educational and training systems of ‘nos-~ pitals, technical schools, junior and senior colleges. Council recommends that no RMP grant funds. be used for the cost of providing basic edu€ation and training in established allied health -proféssions ‘as defined above. Regions are “encouraged, however, to use professional staff assistance corte as well as direct - ‘support™ of special planning studies to encourage educa- Le tional instifutidis in conjunction with clinical resources. to provide new educational and training opportunities in established allied health disciplines and to add new disciplines. gy he on - .. Addendum to Revised Guidelines, 2/70 se BASIC TRAINING | As has been stated previously, support of basic education and training programs in the medical, allied and associated professions is not the primary "target" of RMP and is not, therefore, normally anticipated. The supply and basic training of manpower is more logically the "target" of other Federal agencies such as the Bureau of Health Professions Education and Manpower Training, Office of Education, and Department of Labor. However, because of thé number of applications received by DRMP requesting basic training support in the allied health professions, Division staff divided these pro- posals into three categories, - health careers recruitment, basic training in "established" allied health professions and basic training for the development of new types of health personnel. The February, May and August Councils have taken these under consideration and made the following recommendations: * ..-Addendum to Revised Cuidelines, 2/70 Pg 15 NOTE: Item continues, (Definitions)- i _ PROGRAM NANAGEN ONT SECTION LIT J : ELIGIBLE ACTIV... ZES ' (Continuing Education, Training & Manpower) . Regional Medical Program Support of Recruitment and Basic ’ Training of Health Personnel .as Distinct from Continuing Education and Refresher Training The Council reaffirms its position on this matter and offers the following criteria for interpretation of the definitions set forth in the current Regional Medical Programs Guidelines: Certain criteria have been adopted for deciding whether or not an activity is to be considered as continuing education and training, e.g., activities must in general not be those designed principally to qualify. one for a degree, diploma, or Board certifica- tion; therefore, internship and residency programs have been excluded from primary consideration. ‘The education and/or training activity should lead to the assumption of new responsibility in the already chosen career field, or update knowledge and skill . in a different but related health field. In general, therefore, interest is in. task-oriented training. ¢ == ' Training designed principally as preparation for : a research career in the biomedical sciences have been excluded. It has been stated that Regional Medical Program funding is not to be used to replace existing sources of support for educational vor ‘ ms. ators tim Sos Stapp Y MIE ‘> pote fag Oe wld . i wR, we 7 oO +. The activity must satisfy a documented need of a Regional Medical Program, and must be shown to have a relatively high priority for funding. . Otheravenues of funding must have been explored and found inadequate either by the Region or by the Continuing Education and Training Branch of the Division of Regional Medical Programs. In. many cases, funding is requested for projects because of a lack of available funds by other agencies such as the Bureau of Health Manpower. . The Division of Regional Medical Programs or the Region itself must also explore the possibility of phasing out the Regional Medical Program finding as money becomes available from other sources. Other Federal agencies such as the Office of Education and the Department of Labor are beginning to support parts of recruitment and training activities affecting the health field. The Region or the Continuing Education and Training Branch of the Division of Regional Medical Programs must have explored the possibility of joint funding with other interested agencies. . If the education and training activity has been shown to be necessary to achieving the purposes of a Regional Medical Program, and the above criteria have been met, then the proposed project may be approved for funding. 1/ 2/ 3/ PROGRAM MANAG “ENT. ‘ BECTION IIT. ad ELIGIBLE ACTI. UfIES (Continuing Education, Training & Manpower) ~— Basic Training of Allied Health Personnel The Council recommends that Regional Medical Programs grant funds for basic training!l/ of allied health personnel be limited as follows: . For projects which meet the cripgria for funding which are set forth in the Guidelines®’ and discussed further in the Council recommendations of February 19693/; and . For training related to newly developed technologies or new modalities of diagnosis and treatment for which no standard curriculum is yet recognized and no minimm national standards for certification or licensure are yet established; and which is not generally part of the regular offerings of the health-related educational and - training system of hospitals and/or technical schools, junior and, senior colleges. . ? This restfiction on use of Regional Medical Programs funds will be limited to the actual costs of provision of the training and for payment of student support and assistance. Regions are encouraged to use both professional staff assistance and direct support of special planning studies to encourage educational institutions (technical institutes, public adult education resources, extension programs, junior and senior colleges, and hospitals) in conjunction with the resources for clinical experience, to provide new educational and training opportunities in the established allied health disciplines and to add new disciplines; but only after they are fully identified as essential to. the provision of a recognized service to patients. At the National level, the Division further proposes to encourage the incorporation of these disciplines into the various training and education systems, such as those which set standards, approve curricula, and aid in counselling and recruitment; as well as those which assist in the financing (Federal and non-Federal) of allied health career programs In implementing this recommendation, the Division will ask the Council to consider the various disciplines separately and will base specific limitations on their judgment whether a discipline falls into the category described. Defined for purposes of Regional Medical Program grants as training required for a certificate, diploma, or degree, or which otherwise leads to the fulfillment of the experience and education requirements for initial entry into a health career. Guidelines, Supplement #1 - Expanded Statement on Education § Training, August 1968. 7 News, Information and Data, Volume 3, Number 17S, May 13. 1969, Natiohal Advisory Council Speaks to Six Issues Re Components of Program Activities. Air e o NrAN ee met meal ee Tome eat a ae tte ee ee Te ce ne ee ede ce ce ee ne a vee PROGRAM MANAGEMT™T SECTION TIT Le ELIGIBLE ACTIVI._.S (Continuing Education, Training & Manpower) _— 2. Identification of "established" allied health disciplines. Following the. suggestion of the Council at the May meeting, the staff proposed some further guidelines for development of projects to train ajlied health personnel. The Council reaffirmed its previous position that use of Regional Medical Program funds for the actual costs of basic developed technologies or new modalities of diagnosis and tréatment for-which no standard curriculum is yet recognized. and no minimum national standards for certification or licensure are yet established; and which is ‘not generally part of the regular offerings of the health-related educational and ; training sygtem of hospitals and/or technical schools, junior and senior @dlleges." This guideline was made more specific by the Couneil's. decision to accept the staff's recommendation that an allied health profession will be considered established if a Board of Schools, American Medical Association Council on Medical Education, has been set up to approve schools, define standards for admission, curriculum requirements and certification procedures. training and for student support be limited to "newly \ The three disciplines presented for specific consideration were Inhalation Therapy, Nuclear Medicine Technology, and Radiation Therapy Technology and it was agreed that all these would fall into the group for which basic training support would be dented. ---August 26-27, 1969 Council Minutes ' maroon mov NOE cites oe mess orte bee PROGRAM MANACEMENS SECTION IIT : ~ ELIGIELE ACTIVI. 8 (Continuing Education, Training & Manpower) ~— NEW TYPES OF HEALTH PERSONNEL Both the original and revised Guidelines state that "Grant funds may be used for innovative training approaches and the development of new types of health personnel or new arrangements of health personnel to meet the Region's goal of improved patient care for those suffering from heart disease, cancer, stroke or related diseases.'' Some of these activities may fall into the category of basic education... Definition The definition accepted by Council for the training of new types of health personnel is that training which relates to newly developing technologies or new modalities of diagnosis and treatment for which no standard curriculum is yet recognized and no minimum national standatds for certification or licensure are yet established and which is not generally part of the regular offerings of the health-related educational and training system of hgspitals and/or technical schools, junior and senior colleges." .? ¢ - cs Criteria for Fusding ~ The training activity must satisfy a documented need of a Regional Medical Program, and must be shown to have a relatively high priority for funding. . a -.-Addendum to Revised Guidelines, 2/70, Pe 16 3. Trainine of Physician Assistants After consideration of the background materials which were requested by them and prepared and submitted by staff, the Council agreed that projects relating to the development of non-professional manpower to assist physicians in the direct care of patients (generally referred to as "physician's assistants") -—- including the direct costs-of providing training - and student support -+ may be eligible for funding as part of Regional Medical Programs. . In making this reconmendation, the Council emphasized that this action implied no relative priority for projects of this ‘kind in the spectrum of Regional Medical Program activities, nor the priority of one approach to the training as related to another. .. August 26-27, 1969 Council Minutes vo PROGRAM MANAGEMEN’ SECTION LIL ELIGIBLE ACTIVITIEs’ (Continuing Education, Training & Manpower) ‘ HEALTH CAREERS RECRUITMENT The Council recognized the need for additional health manpower but | because of the time span between recruitment and improved patient | care, it recommended that further support of health careers recruit- | ment projects with Regional Medical Program funds be granted only when a project is related to a clearly focused (specialized) short-range approach to the critical needs of a region, and - as the documented committed support not only of the sponsoring agencies, but of the Region's hospitals, schools, and colleges Whose cooperation is essential for the success of the immediate project and its continuation after Regional Medical Programs support can no longer be,made available; le . ? . Includes a plan for evaluation of the impact of the program on the rate of production of trained health manpower; ’ , . Is directéd at, special population groups, especially those who dé not“usually seek, or have available, opportunities for training o education beyond secondary school;\ * A - . Other sources of funding have been explored,=<#* ~~ *Sub-para graph expanded by correetion to Addendum to Revised Guidelines 2/7 Health Manpower Reciv: tient at, seo aR oe In recognition of the nationwide need for more and more competcnt allied health personnel, the Council reaffirms its policy of support for effective Regional Medical Programs activities directed toward meeting ' those needs. However, a direct relationship between specific recruit- ment efforts at the high school level and increases in qualified health personnel is difficult to demonstrate; and the real impact of a recruitment project on the care of patients is often remote or obscure. The Council, therefore, recommends that further support of such projects with Regional Medical Programs funds be granted only when a project is related to a clearly focused (specialized) short-range approach to the critical needs of a region, and . Has the documented committed support not only of the sponsoring agencies, but of the Region's hospitals, schools, and colleges whose cooperation is essential for the success of the immediate project and its continuation after Regional Medical Programs support can no longer be made available; - Includes a plan for evaluation of the impact of the program on the rate of production of trained health manpower ; . Is directed at special population groups, especially those who do not usually seek, or have available, opportunities for training or education beyond secondary school. oad a ELIGIBLE ACTIV"“TIES SECTION TIT. ° . (Continuing Eu_ection, Training and Manpower) B. Cardiopulmonary Resuscitation Training Projects ; / in Regional Medical Programs a The Council discussion was based on the material presented by staff and on its accultulated experience in reviewing Regional Medical Program applications which contain Cardiopulmonary - _ Resuscitation training projects. There was general agreement on the appropriateness and value of projects to provide training for selected groups of professional and allied health persomel in the techniques of cardiopulmonary resuscitation, as components of Regional Medical Programs, as determined by the level of priority assigned to such projects by individual Regional Medical Programs and their Regional Advisory They were, hewever, unable to arrive at any consensus as to the ? ‘. 7 7 us . peal value of the almost unlimited extension of such training programs to non-medical. perscnnel , particularly when relating the cost of such training (in dollars, facilities, and manpower) to the presently limited funds available for grants to Carryout the purposes of Public Law 89-239 (Education, Research, Training, and Demonstrations in the Fields of Heart Disease, Cancer, Stroke, and Related Diseases). +s sAupust 26-27, 1969 Council Minutes Regional Medical Program grant funding for projects in cardiovascular resuscitation training is to be limited to training activities which are directed principally to medical and allied health personnel who are employed in hospitals and in other in-patient facilities, or in out- patient or emergency facilities operated by or directly related to institutions in which follow-up care is immediately available. Council Minutes 12/17-17/69) THE FOLLOWING POLICY GUIDELINE was restated by the National Advisory Council, Regional Medical Programs Service, at the December 16-17, 1969 meeting. It had been adopted at the August 1969 meeting in regard to a group of pending projects: Cardiopulmonary Resuscitation Training "Regional Medical Program grant funding for projects in cardiovasc- ular resuscitation training must be limited to activities which are directed principally to medical and allied health personnel. Such personnel must be employed in hospitals and other inpatient facilities, or in outpatient or emergency facilities operated by or directly related to institutions which can provide immediate followup care." (Printed in Addendum to ; Revised Cuidelines, 2/70) Minutes of Meeting of National Advisory Caimcit. RPacianal Madi en] Prnorama Canricea PROGRAM MANAGVEUCNT SECTION IIT Sb ee AN a ELICIBLE ACTIV 125 @Gontinuing Educ.tion, freining & Monnovep) Television Production and Network Facilities "Council recommends that all new operational projects requesting major investments or funds for equipment and activities in television be thoroughly studied by Division Staff and expert consultants for consideration for fimding under the new authority for Multi-program Services provided under Section 910. It further recommends that applic- ations for continuation and renewal of previously funded major television activities be reviewed by the same group of expert consultants on the basis of the progress being made in the applicant Region toward its television objectives, and how those activities might be related or expanded to a Multi-program Service." : , -- February 20-21, 1969 Council Meeting +» Acdencum to Revised Guidelines, 2/70, Pe 27 ‘ . & - ‘ 7 * NOTE: Cross-referepce to Maltiprosram-Services. t ~ ~“ Dial Access Audiotape x t "The technique of direct telephone access to pre-recorded tapes on selected topics of interest to physicians and allied health personnel is becoming increasingly popular in Regional Medical Programs. The Council recommends that proposals for projects of this kind meet the ollowing criteria before being referred for review as part of a Regional Medical Programs application: , The application should contain an explanation of the way in which the project fits into the total regional education effort for physicians and other health professionals. Proposed evaluation of the service must involve its receptivity and value to the professionals in their practice. The mere measurement of numbers of the incoming calls is insufficient. When the request includes the establishment of an independent network (in contrast to sharing 4n already established facility), the statement of justification for the hardware investment should include the rationale for a new network as well as a plan for long-term use of the network. There must be a plan (both long and short range) for the development of the tape library, justifying any decision to make rather than share or purchase tapes; for the selection of subject matter; and for the identification of target groups (i.e., physicians, _— nurses, etc.)." as _ =+ May 26-27, 1969 Council Meeting Addendum tn Rawiead Crtdoelinoc DIN Pe 95 ELIGIBLE “EIVITIES SECTION LIT (Continying ‘Education, Training & Manporver ~ V. Other Training Provisions A. Citizenship: The Division of Regional Medical Programs adheres to the policy which provides that only United States citizens and those foreign na- tionals having in their possession a visa permitting permanent residence in the United States may be appointed as trainees on training grants. B. Long-Term Training Appointments: A "Statement of Appointment of Trainee" (Form PHS 2271, PHS-3190-5, .or PHS-4885-2 as appropriate) will continue to be’ required for each appointment or reappointment of a trainee receiving stipend, dependency allowance, tuition costs, or travel from a program supported by the Division of Regional Medical Programs' funds. For each appointment, or reappointment, “the Statement. must be submitted at the time the training period of the individual begins. No obligation for trainee Support may be madé against grant fimd$ until this statement is submitted. If there are changes in the terms of the appointment (e.g., support period, stipend, supplementation, dependency allowance, tuition) an amended Statement of Appointment. is required. C. Reporting of Short-Term Training Programs: Short-term training supported by the Division of Regional Medical Programs' funds will be reported in the aggregate on a regional basis. To be included in such a report are the number of trainees who participated, occupational categories represented, and the grouping of levels of academic preparation of the trainees. August 1968 Sioa oa a ee a +e See os - = = ' ELIGIBIT™ ACTIVITIES SECTION IIT (MULTIPRCGRYM SERVICES) d POLICY ON KIDNEY DISEASE ACTIVITIES ENDORSED BY NATIONAL ADVISORY COUNCIL ON REGIONAL MEDICAL PROGRAMS July 28 - 29, 1970 | nm ‘In recognition of the importance of chronic renal disease as one of the impairments of man,essentially related to heart disease, cancer, and stroke, the Regional Medical, Programs Service, with the advice of the National Advisory Counei:l and a number of recognized experts in the field of nephrology, offers. the foliowing guidelines to Regional Medical Programs for the planning and development of kidney disease activities as components of individual regional programs or as cooperative enter- prises of two or more neighboring Regional Medical Programs. Recognizing the competition for both funds and manpower in the further development of ‘comprehensive kidney disease capabilities within the health care system, the Regional Medical Programs Service and the National Advisory Council will exert their best judgement in allocating the limited anount of funds available for this purpose in FY 1971 and 1972 to Regional Medical Programs which propose the investment of grant funds --- - To encourage wider and more effective cooperative arrangements among selected institutions and re- sources which together can form comprehensive systems of care; and . To strengthen existing institutional resources competent and willing to reach beyond the con- fines of the medical centers within which they exist for development of systems of services and ‘training. @MORE) eeorNID 11-27-70 PROGRAM = NAGEMENT SECTION IIL (MULTIPROGRAM SERVICES) regional medical programs service a me . é . communication device designed to speed == ANNOUNCEMENT: Senior Clinical Traineeships the exchange of news, in Cancer for Post-Residency Physicians aformation and data on eo. ; ional Medical Programs and related activities. - August 24, 1970 - Vol. 4, No. 19 The Senior Clinical Traineeship Program is now the responsibility of the Regional Medical Programs Service, as explained on Page 2 of this issue. | - The center spread announces the latest information on . this post-residency training program for physicians and provides the information for candidates who wish to apply for awards. Please post, route or forward this publication for those who may be interested. XN ‘PROGRAM MANACFMENT SECTION T21 ELIGIBLE ACT. -TIES (Exclusions) ~ THE FOLLOWING RECOMMENDATION was made by the National Advisory Council, Regional Medical Programs Service, at its May 26-27, 1969 meeting. It supplements the preceding paper on Background Information and Amended Statements Concerning Continuing Education and Training: Training of Cytotechnologists “Upon recommendation of the Council, the Division has identified Cytotechnology as an established allied health discipline. Its training programs are approyed by the American Medical Association Council on Education when properly recommended by the .profession, and graduates are certified for practice by a nationally recognized examination administered by the profession. The techniques of exfoliative cytology are now of universally recognized value in screening and diagnosis of pathologic states. r ae - in ¢ Therefgre,-in line with general policy relative to support of established programs and in keeping with above policy guidelines on training, the Council recommends that Regional Medical Programs grant funds not be used for the costs of providing the basic education and training of cytotechnologists, either as a grant for an independent project or as part of a project demonstrating the application of ex- foliative cytologic techniques to patient care." « «+ NID 5-13-69 NOTE: Cross reference to Eligible Activities (C.E.Tng & Mnpwr) 1. RMP funds should not be used to establish or ‘ otherwise support centers for the evaluation of methods of treatment of stroke patients, since ‘sixteen such centers are funded under careful study by the National Institute of Neurological ’. Disease and Stroke. ...March 31-April 1, 1970 Council Minutes NOTE: Cross-reference to Demonstrations of Patient Care ' _— FINANCIAL MAY “EMENT SECTION IV (General Requ.xements) VII. Financial Management General Requirements—Federal funds awarded pursuant to either a planning or operational grant are to be used only for the purposes for which awarded and in accordance with the provisions of the Act (Appendix 1), its regulations (Appendix 2), and these Guidelines. Additionally, Federal funds awarded pursuant to an operational grant may not be used to supplant funds that are other- wise available for the establishment ,or Operation of the Regional Mcdical,Program with respect to: which the grant is made. . . . Funds granted may be used only for services, materials and other items required to carry out the approved program. Circular A-21 of the Bureau of the Budget should be used to the extent prac- ticable in determining allowable costs related to . the grants for Regiortal Medical Programs. Where the Division of Regional Medical Programs re- quires prior approval for items not listed in the approved budget, a written request must be made by the grantee to the Division of Regional Medical Programs in advance of the act which requires the obligating or expenditure of funds. Agreement of Affiliation—By accepting a Re- gional Medical Program grant, the grantee has accepted certain responsibilities enumerated on piges 9-10 of this Chapter. However, the Re gional Medical Program activities will necessitate the- expenditure of grant funds.by a number of different institutions, organizations, and agencies in addition to the grantee. In order to assure ap- propriite accountability for the expenditure of grant funds by these additional agencies, an Agree- ment of Affiliation must be signed by the respon- sible official of each affiliating inistitution (or agency) and by the grantee who represents the Regional Medical Program. Such an agreement will not be required nor appropriate in the con- duct of business with (1) a profit-making orga- nization by subcontract, or, (2) where direct pay- ment is to be made for the use of facilities or for services rendered on behalf of the Regional Medi- cal Program. This agreement, at a minimum, must CHAPTER III, REVISED GUIDELINES, Pe 14 N ' include provision which will insure that the grantee can carry out the assurances required by the Act in Sections 903 (b) and 904 (b) and that the grant funds provided to each affiliated agency will be administered by that agency in accordance with the Act, the regulations and applicable poli- cies of the Division of Regional Medical Programs (see example—Appendix 3). The Division also encourages the Regional Mcdi- cal Program to include in such agreement any provisions relating to the conduct and development of the Regional Medical Programs as may be appropriate and desirable for the achievement of the purpdses of the Program as outlined in these Guidelines, The advice and counsel of the Re gional Advisory Group should be sought in devel- oping such provisions. NN ee oe PINANCTAL M “AGEMENT SECTION IV & ~ STATEMENT OF THE NATIONAL ADVISORY COUNCIL ON REGIONAL MEDICAL PROGRAMS ON SALARIES FOR KEY STAFF MEMBERS The National Advisory Council on Regional Medical Programs has expressed concern about the possibility that salary levels being requested for the key staff of Regional Medical Programs may lead to escalation of salary levels among the Programs and may create difficulties in relationships within and among parti- cipating institutions in a region. This possibility is increased through competition for highly qualified individuals to occupy leadership posts in the staffs of the Regional Medical Programs. The Council believes tHat a general salary escalation for Pro-. gram staff would do harm to the achievement of effective cooper~ ation with the medical institutions and medical personnel within the region and might stimulate competition between regions in- stead of interregional cooperation. The Council would stress, therefore, that applicants and grantees are required to give careful consideration to the salary structure for personnel engaged in the Regional Medical Program to insure a salary scale consistent with that established for similar professional or administrative responsibilities in the applicant institu- tion. If the applicant institution or organization has not previously carried these types of responsibilities the salary scale should bear reasonable and specific comparability to prevailing rates in medical centers or other appropriate in- stitutions in the proposed region. The Council will expect the applications to contain specific justification for salary rates proposed, and the application should define as precisely as possible the relation- . ships in terms of the responsibilities of the program coor- dinator and other key officials to the established major me~- dical professional or administrative officers in the region, No unusual or extraordinary salary level should be established for personnel engaged in the Regional Medical Program acti- vities solely by reason of the institution's participation in the program unless specific justification has been supplied and approval received from the Division of Regional Medical Programs at the time of the award of the grant or subsequently. The Council has asked the staff of the Division of Regional Medical Programs to pay very careful attention to proposed salaries and the justification for these salaries during staff review of applications, negotiations with grantees, and during regular review of the grantees’ progress in implementing the program. ...NID 5«15-67 PROGRAM MANAGEMF* FINANCIAL MANAGL.cNT SECTION Iv (Allowable Direct Costs) oy Allowable Direct Costs— A. Personnel Costs~Salaries and wages of per- sonnel in proportion to the time or effort expended on activities of the Regional Medical Program may be charged to the grant. These costs must be in accordance with applicable institutional policies, and adequate time and effort records must be maintained in order to substantiate these costs. Salaries of personnel whose {ull time is devoted to the Regional Mcdical Program should not exceed the salaries of full-time administrative personnél ‘in positions of comparable responsibility in major medical institutions in the Region. Spe- cifically, if a new corporation is organized to serve as the grantee, it must establish salary policies which apply to its personnel under the above policies and which do not exceed equivalent sal- aries in the major medical institutions in the Re- gion. Any question concerning the appropriateness of particular salaries or exceptions to these policies should be discussed with the Division Staff. B. Consultant Services—Regional Medical Pro- gram grant funds may be used to pay consultant fees and supporting costs such as travel, and per diem in payment for services related to any Pro- gram clement of a Regional Medical Program, providing that these services are the most effective means of accomplishing a particular purpose. ° If consultation is obtained from a sal- aried staff member of the grantee or an affiliated institution, that institution may be reimbursed for a proportionate amount of his regular salary from grant funds. Program records must indicate the total cost and include a statement of activities. (MOPE) «++CHAPTER III, REVISED GUIDELINES, PGs 14-15, FINANCIAL 3 \GEMENT SECRTON TV . ’ {Allowable vsrect Costs} 4 i ' IV. Allowable Direct Costs for Education and Training Activities The following statements amplify those made in Chapter III, Section VII-C of the revised Guidelines: - A. Categories of Training: (1) Training Conferences and Seminars: Presentations which are _ planned for full-time participation for periods from one full day to five consecutive days, or intermittently on a regular basis. — (2) Short-Term Training: Activities which are planned for full-time participation for more than five consecutive days, but not .. more than a single academic session (quarter or semester). (3) Long-Term Training: Activities requiring full-time - participation for more than a single academic session (quarter or semester). a - B. Levels of Training: . “. Determination of the level of stipend is to be based upon the general level of training to be presented. In the case of training designed specifically for teams of physicians and’ancillary personnel, an appropriate stipend level for each general level of participant may be selected, based on educational level attained, experience and current salary level. ~~ (1) Post-High School/Nonacademic: Training which requires completion of a secondary education or having 'an appropriate equivalent background and experience. . (2) Baccalaureate: Training requiring at least some relevant collegiate preparation, but not more than the baccalaureate gree. (3) Graduate: Training which requires at least some relevant post-baccalaureate academic preparation but not more than a doctoral degree. “Training creditable toward the degrees - of M.D., D.D.S., D.O., D.V.M., or similar medical degrees is excluded from support. : (4) Postdoctoral: Training programs designed for holders of a a doctoral degree, or who have had equivalent training. C. Stipends: Stipends are not authorized for training conferences and seminars, but stipends may be paid for short-term and long-term training programs in accordance with the following general policies: If the trainee is employed by an affiliated institution, a Stipend may be paid directly. A maintenance of income principle can be used to determine the amount of stipend. If desired, the trainee's employer can be reimbursed for the amount of the trainee's salary, including the personnel share of benefits paid by the — employer at the time the trainee enrolls in the training being | conducted. .. Addendum to Revised Guidelines, 2/70, Ps 8 (OTE: Amonded language in NID 9-13~76 on “ase ‘following individuals over half of whose support, during the period of FINANCTAL ™*NAGEMENT SECTION IV ‘*F {Allowable oirece Costs) (Contd From Pe 8, Addendum to Revised Guidelines, 2/70, Pe 9} Payments of stipends (followships , scholarships, etc.) should not exceed the amounts presented in the appended schedule. In no case should such payments exceed the amount set by the policy of the training institution for similar training or training requiring similar pre- requisite education. Stipends for short-term training are based on a daily rate and are to be paid only for actual training days (weekends, holiday, etc., excluded) . . Stipends for long-term training which is less than a full ° twelve months are to be talculated on a pro-rata basis, and leave and = holiday policies of the training institution are to be followed. Stipend rates for full-time, long-term postdoctoral training are to be paid according to the, cutrent policy of the training institution. The Division of R gional Medical Programs will not undertake reimbursement at private practice levels. * D. Dependency Allowances: Dependency allowances for those léng-tterm trainees at the Baccalaureate level and higher, who are in training for a full academic year, may be awarded in the amount of $500 (per year) for a dependent Spouse, each dependent child, and each dependent relative, provided that during the trainee appointment the dependent receives more than one-half of total support from the trainee. A dependency allowance may not be claimed for any person who during the. trainee's appointment period will be receiving a fellowship or traineeship stipend under Federal educational assistance program (other than loans), or for whom an allowance will be made as a dependent of any other person during that period. . The Division of Regional Medical Programs has adopted the following dependency schedule and a dependent may now be defined as any of the appointment, is received from the trainee or student: (1) A spouse, (2) A son or daughter of the student, or a descendant of either, (3) A stepson or stepdaughter of the student, (4) Regional Medical Program grant funds may be used to pay consultant fees and supporting costs such as travel and per diemin payment for services related to any program element of a Regional Medical Program. Cohsultants may be selected from both within and outside the grantee or affiliated organization, providing that these services are the most effective means of accomplishing a .particular, purpose. : « ” ” It is expected that grantee organizations will normally have their own policies with respect to use of con- Sultant services; that those policies will apply equally to the use-of consultants paid for by grant funds and that they will include, as a minimum, the standards for documentation described bellow. However, in the absence of such policies, the following documentation in support of the use of consultants must be provided: ~ A statement of the services to be performed and evidence that they cannot be provided by payment of direct salaries to staff members of the grantee or an affiliated institution; ~ A brief description of the process of selection of the individuals most qualified to provide the re- quired services; ~ Evidence that the fee is appropriate considering the qualifications of the individuals, the nature of the services performed, and the amount normally - paid for such services from sources other than Regional Medical Programs. As a general rule, when services of a salaried staff member of the grantee -or-an affiliated institution are to be provided fulltime for periods of two weeks or more, or on a regularly occurring basis through- out the year, the individual should be compensated on a part-time salary basis rather than as consultation. Grant funds may not be used to pay fees and supporting costs to U.S. Government employees regardless of their employment or pay status, ; oe “om my -..Addendum to Revised Guidelines, 2/70, Pe 3 _ ‘NOTE: See NID 10-13-70. - NOTE: Reference to Program Management (Personnel Practices) . . LO t weeps , FROG ENT SECTION TV (Direce Costs Not Allowed) Direct Costs Not Allowed—The following direct costs or charges are not allowable: (1) Honoraria as distinguished from con- “sultant fees - (2) Entertamment (cost of amusenient, social activitics, entertainment and incidental costs thereto, such as meals, lodging, rentals, transporta- tion and gratuities) (3) Pavinent to Federal employces (4) Petty cash funds ; (5) Subgranting (a subgrant is any alloca- tion of grant funds by the grantee to other indi- ‘viduals or organizations for purposes over which the grantee instittition named on the application a © . : . . - : . oo does not maintain scientific and financial responsi- por bility. A grantce may contract for services, but ~ may not subgrant). Ne ~ . .- CHAPTER III, REVISED GUIDELINES, Pg 16 mp tere + Reet aware PICARCTAL MAN Soop LOR vot on 7 Ferg os . ose le », ,Girect Cesis ~3 a oat Sas aA —_ A, Issues rdenriftied “YT. In the mtter of BYP Suor Council considered the history provid Specific projects included in the applications urder review at this... meeting. They believe that under most circumstances it is not necessary or appropriate for Regional Medical Programs grant funds to be used to -. cover the full. costs of both the presentation of short-term training — projects and of stipends and expenses of the participants ects, the carr ri @ number of The majority of projects in this category provide opportunities for up grading and develooment of new skills in special techniques or procedures and are directed to individuels presently employed in health care institutions. Under the circumstances these institutions should, and = in most cases do, make regular provision for this kind of training for their staffs. ‘ ° , coe - ? . f aft, s tne Council therefore retvonmendéd the following changes in policy guidelines regarding payrients to participants in continuing education and training projects (as defined inthe Guidelines Addendum, February \ “1970, page 13) which are supported by Regional Medical Program grant funds. , - _ . - - cc sepspbsdthutsett pina ’steio?s PAT INR Sateen Fo % Tgp Caen ENT RR TES * 1 * . - Regional Medical Program grant funds may not be used for the payment of stipends, either directly or on the "maintenance of income principle," to participants in short-term continuing education and training projects. This does not include training Yor new careers for new types of health personnel. EGR POE OY Soe CAE . Other allowable costs o ff participant's support may be calculated according to the existing Guidelines. Regional Medical Program grant funds may be requested and awarded for per diem and. travel to the extent of 50% of the total amount so derived. The awarded funds may then be paid to.the enrolled trainees as considered appropriate.by the project personnel, depending on the participants‘ ability tc provide these costs for them selves and/or the willingness of their employers to provide them. No single individual may receive per diem or travel allowance at a rate higher than that prescribed by the present Guidelines. : - - . RMP funds may not be rebudgeted, from within or without the. project budget, to increase the total amount awarded for per diem meet travel above the 50% level. |. suty 28-29, 1970 Council Minutes ‘NOTE: See wording of exerpts printed in NID 10-13-70. Cross-reference to Eligible Activities (Manpower and Training) on ee eee ete eee A communication devier designed te speed the exchange af HeWH, EXPANSION OF Policy Change Re Education and Training information and data on Nngety % : i r a] ery egional Medical Programs \ctivities and Consultant Services and related activities. December 15, 1970 - Vol. 4, No. 55S Regional Medical Programs Service herein clarifies a change in policy which was announced and may have been misinterpreted in the October 13, 1970 .- Special Issue - News, Information and Data - Vol. 4, No. 438. "Payment of stipends and other participant costs ... These changes amend, the Expanded Statement of Education and Training Guidelines for Regional Medical Programs i1ssucd in August 1968 and published in Addendum-Guidelines, Vebruary 1970, on pages 5-12, and relate specifically to items C, D, E, F, and I of Section IV. The changes will be effective in awards made on the basis of all new, continuation; and renewal applications submitted on or after February 1, 1971. In connection with long-term training projects..." _+ Payment of stipends and other participant costs for long-term post-doctoral support at the senior resident and post- resident levels, particularly in the clinical sub-specialties of importance in patient management in the diseases targeted by Regional Medical Programs Service, may not be made fron operational grant funds awarded under Section 904 of TitlIe IX of the Public Health Service Act. NOTE: Cross reference to Eligible Activities, Continuing Education, Training & Manpower ey ave “y + eee te yt gy eRe ~ = FISSNSCT AD ARAGEMITY SECTION Iv - g < . ~ - ' a ‘ VED et OR beth Ab etre (th tw we t bo tO g aL the iollowing excerpts Yrom the munutes of the Juy , meeting of the National Advisory Council provide background for the new policy regarding the use of grant funds for trainee stipends: "In the matter of RMP support of short-term training r the Council considered the history provided them by staff, and a number of specific projects. They believe that umder most circumstances it is not necessary or appropriate for Regional Medical Programs grant fimds to be used to cover the full costs of both the presentation of short-term training projects and the costs of stipends and expenses of the participants. - - The majority. of projects in this category provide oppor- . tunities for upgrading and development of new skills in - special techniques or procedures, and are directed to ‘ individuals presently employed in health care institutions. Under the circumstafices these institutions should, and in most cages -do, make regular provision for this kind of . training far their staffs. The Council considered the present Guidelines regarding Regional Medical Program funding of projects of long-term post-coctoral training, at the senior resident and post- - - resident levels, particularly in the clinical sub- speciaities of importance in patient management in the diseases targeted by Regional Medical Programs. As has - been pointed out by both the Review Committee and the Council, requests for support for training of this kind are appearing more and more frequently in Regional Medical Programs applications; because of the increasingly critical shortage of individuals trained in these fields, but also because of the drastic reduction in NIH funding which has ae _ previously been available for this purpose.. The Council unanimously agrees on the importance of maintaining the training programs in these fields in the major teaching centers throughout the nation. They also agree that fimding through Regional Medical Programs would serve to strengthen the essential involvement of these centers of clinical excellence into the framework of cooperative arrangements which form the basis of the Region of which they are a part. It is recognized, however, that the allocation of an amount of funds large enough to make a significant impact, if provided from the present RMP appropriation, would create a serious and inappropriate imbalance in the RMP effort to meet their more varied and (MORE JUUL WOT OG 4ULtty See A DOUCEULONE TE OTE Won rs ewer orien rer crew - = — ore .. NID 10-13-70 —_ -NOTE: Reference to Eligible Activities (Training). PTA LRY AT sae oe : > : PIMANGIAL Bo NOEMMNT BECTTOU DV Payment. of stipends and other purticipant costs . These changes. amend the Expanded Statement of Education and Training Guidelines for Regional Medical Programs issued in August 1968 and published in Addendum-Guideiines, February 1970, on pages 5-12, and relate specifically to 1tems C, D, E, F, and H of Section IV. The changes will be effective in awards made on the basis of all new, continuation, and renewal applications submitted on or after February 1, “1971. m In connection with short-term training projects . Grant funds may not be used for the payment of stipends, either directly or on the "maintenance of income principle," to participants in short-term continuing education and training projects. . Training for new careers for new types of health personnel ‘is net included. f 7 ‘ Other allowable costs“of support of participants may be calculated according to the existing Guidelines. Grant funds may be requested and awarded for 50 per cent of the total amount budgeted for per diem and travel of the trainees. The awarded funds may then be paid to the enrolled trainees as considered appropriate by the project personnel, depending on the participants' ability to provide these costs for themselves, and/or the willingness of their employers to provide them. No single individual may receive per diem or travel allowance at a rate higher than that prescribed by the present Guidelines. Grant funds may not be rebudgeted, from within or without the project budget, to increase the total amount awarded for per diem and travel above the 50 per cent level. “In connection with long-term training projects . . Payment of stipends and dependency allowances to partici- pants in long-term, post-doctoral training may not be 7 made from operational grant funds awarded under Section 904 of Title IX of the Public Health Service Act. N . However, grant funds for the planning or conduct of such training and educational projects may be used for the payment of trainee travel as provided in the present Guidelines. : ««-NID 10-13-70 NOTE: Reference to Eligible Activities (Training) FINANCIAL MANAGEMENT SECTION IV (Allowable Dic.ct Costs) I. Tuition and Fees: Tuition and fees for training activities may be paid from grant funds providing no other charges for the cost of that training are made against the grant. When allowable, only the same resident or non-resident tuition and fees charged to regularly enrolled non- Federally supported students may be charged for trainees. Tuition and fees for courses which satisfy requirements related exclusively to the M.D., D.D.S., D.O., D.V.M., or similar degrees may not be charged . an to a grant. When the courses are creditable to satisfying Ph.D. ‘ . requirements in combination with any of the aforementioned degree: requirements, however, tuition and fees may be charged for those . courses within the combined degree program that are required specifically - for the attainment of the Ph.D. degree. The training must be relevant to, the purposes of the grant. ye. . - z ~- Addendum te Aevised Guidelines,’ 2/76, Te 12 tt - ~ ~ *The Council has recommended a policy which precludes the use of RMP funds Se for basic training in certain established allied healtrh fields, including Se nuclear medicine , bechnology (see Section X A2 of Minutes). ObCR CLE el eG “ cee me so «eeAupust 26-27, 1969 Council Minutes PERANCTAL “7 NSGEMANT SECTION I¥ (Direct Casts Not Allowed) Reunrbursement for travel an‘ other re servine as consultants to kogional Bea rams . . This change further amends the Guidelines regarding the use of grant funds for direct costs of consuitant services as it currently appears in the Addcndun-Guidelines issued in February 1970, page 3, so that... . Grarre tres “ay Fee en oreing costs thinztheckepion for their participation in “the planning or conduct of Regional Medical Program activities. “ . This change is made to promote the cooperation and participation of local Federal Government agencies in Regidnal Medical Programs in instances where an individtal agency cannot provide for this expense. ~~ ~ eee 10-13-70 NOTE: Reference to Program Management. * i : + * (Following is a statement dtd 6-25-70 from GMB regarding reimbursement of costs incurred by Federal employees participating in training activities: 1. A stipend cannot be paid te a Federal cantoyee unless hie is on leave-vithout-nay status from his employing agency. 2. Per dica may be paid to a Federal employee providing he elects not to receive a stipend and the employing agency dogs not provice concurrent per dic. 3. Travel costs may be paid a Feceral employee previding the employing agency does not provide concurrent travel costs. . FINANCIAL MANA ENT SECTION IV (Direct Costs Not Allowed) Consultant Services: Ltr, dated 10-20-76, from Program Coordinator, Tennessee Mid-South RMP, requesting permission to use grant funds to reimburse members of their RAG at $100 per day of attendance at regular RAG meetings. Ltr, dated 11-12-70, signed by the Acting Director, Harold Margulies, M.D., to Dr. Paul E. Teschan in , response states: ",..we have advised the various RMPs that the paymeut of cousultant fees or other remuneration to RAG members should be avoided. It is felt that such service should be freely offered in the spirit of a foluntary contribution to the community and region which are being served. Tt is entirdjappropriate, for example, to reimburse members for travel expenses either on a per diem, actual and necessary, or a mileage basis when such costs are incurred. I would be remiss if I « failed to point out that on occasion there have been exceptions to > the above stated policy, when consultant's funds were earmarked for salary reimbursement to nonprofessional members of the RAG who sustained a loss of salaty due to the absence from their place of employment. Wefdo not feel, howevér, that this exception should be extended to professional personnel...". NORTH DAKOTA REGIONAL MEDICAL PROGRAM ~ co 8/69.1 - Initial operational and renewal of core - Approval in the time oe ' and amounts and with #he conditions réconmended by the site visitors and the Review Committee; and with the added contingency that no funds budgeted for "in-State Consultants" be paid to members of the oo, Planning Committee and other COMULG GEES for their services as - | members of those Broups. . mo +«eAugust 26827, 1969 Council Minutes | ‘ we Tew AT ‘ TYINANOTAL ¥ (Direct Cools Rot Aliowed) October 16, 1970 RH-O0046 ir. G. W. Adans, Jr. Fiscal Officer Georgia Regional Medical Fropran 938 Peachtree Streat Atlanta, Georgia 30309 © Restional Medical Progress. Service policy providas ¢t AU from a Regional “Medical Prdgran grant may not be used for supplem cf stipends and allowances. Therefore, Fiery University is at te reigburse Dr. Pafsons, for her.expenses providing that the fu D a net derived fron either a graht awarded by the Recional Medical e L . e Service or the Hatiobal Institutes of Health, . ae Sincerely yours, GMB: LHPullen:kef RMP. Grant File ‘ ' DPTD File Mr. Giluer - Lavrence H, Pullen Mrs. Silsbee ° , Crants Manerement Officer Mr, Pullen , Grants Management Branch Board/File FERARSTAL FCCUORMEST SECTION IVY (indirect Corts} » Indirect Costs—bidirect costs related to the con- duct of the Regional Medical Program are reim- burseable. To be eHgible for reimbarsement, an indirect cost proposal must be developed by the performing institution in conformity with its established accounting system and subinitted to the Division of Regional Medical Programs. The pro- posal must. identify those administrative services provided to the program during the institution’s fiscal year, the costs of. the services and the busis or methods for apportioning those costs to the Regional Medical Proxram and other activities of the institution. A new proposal must be submitted at the end of each fiscal year. The Department of Health, Education, and ~ Welfare has published separate guides for estal- - lishing indirect cost rates applicable to educational f _ institutions, hospitals, State and local government *? a ° agencies, and other non-profit institutions which fe o7* providé guidelines and criteria for the identifica- ~ 8 tion of indirect costs reimburseable under research grants and contract, and for apportionment of administrative costs to the major operating activ- ities of the institution. The booklets contain cost principles which define direct and indirect costs and provide information on the allowability of - specific items of cost. They describe methods of cost apportionments and allocations, instructions on the development of indirect cost rates and sample indirect cost proposals. Although oriented primarily toward the research activity, the policies and criteria contained thercin are relevant to the . * - Regional Medical Program and should be used as - - a guide. , Institutions performing under Regional Medi- cal Program grants may also be the recipient of grants or contracts under other Federal programs. It is essential that consistent procedures for deter- mining reimburseable costs for similar services be employed without regard to program differences. ‘Additional information and assistance may be ob- tained from the Division of Regional Medical Pro- “grams, National Institutes of Health, Bethesda, ’ Maryland 20014. The Department of Health, . . Education, and Welfare cost guides may be ob- " tained from the Government Printing Office, North Capital between G & H Streets, N.W., Washington, DL. 20402. «CHAPTER TILT, REVISED GUIDELINES, Pg 16 bee rare) [ tC r ¢ f C x f x DIRECT COSTS) 1 7 (il 1969 2 oy 1 ty! 6 el + Hover esetiation Branch rH 1d Rate 4 c 23. chi ‘Div » Cost Policy ear cy, DIEY : Z on Fol o a wo on of Grari Lt ’ gs Ab at “ ot ee a t ec) 9 orm O PY fq fot” bd pad any ‘nod mC) bt oc) ret oo Gos Cc oO CF ert peo | _ we 43 a 3 0 rH OQ nf o wert Kya oe tal a td 0. regard to this of : SAGs wafkit RES Be 41 25, 1969 oo. Oe t ae in erence is Rex una a 1amardn ft a 1S ov & iy prcovio ae ae VYENECE & eo oN Met ww cet bot wt goog 6) 0 Goer ri 4 ised cL mes 8) Da Joe Go oO vo cy ta wel cl a 3 Mt 3 qd oo iw) “ BB 4) a OQ 4 CP et te tet Bat et Eteness oO * a pr nkutions, at wi dated in ate, & for your Ate § wn oO ad a cove a t + 4 a tne an wo ¥ a 0 accoun = we da -has been re . Yen ro Res. Sn, et G been awar HW indi arge™ +. ty ervica c ft is not eo Ma wi “ure :d to any ¢ expenditure re proce ” rd, a Werk Ta ad, wa att ae re a imast ar § { 3 + oe REC u XN ¢ Qo n iid c tf s ent has be a esi pro sree’ eu I s L 4. te co e¢ Ces ¢ a Z ge wu ern Chay "gory oe + 3) s:Gilhakle/t 73. é GUI, Tre % Tt eens he RETA de apa ey yee er FINANCIAL TAGEMERNT SECTION Iv C—Indirect Uests: SUPPLEMENT Chapter ITI, Section VII. Indirect Costs (page 16) with: I. Negotiation of Indirect Cost Rates for Grantee Institutions A. The Division of Grants Administration Policy (DGAP) - Department of Health, Education, and Welfare will establish rates for each . grantee institution which requests indirect cost. B, These rates will be based on proposals submitted by the grantee institution as follows: f 1. If the grantee ,is the recipient of awards under other DEW programs which reimburse indirect cost, it will submit a Single annual submissien to DGAP proposing rates for all DHEW programs. A RMP rate will be established at the time the rate(s) for the other programs are negotiated. In most instances the RMP rate will be identical to the rate used for research and development awards. 2. If the grantee is not the recipient of awards under other to DHEW programs, it must submit a rate proposal for the RMP ~ award together with supporting financial statements. This proposal will be requested by and submitted to the Grants Management Branch - Division of Regional Medical Programs which will review it for completeness and, if adequate, forward it to DGAP for processing. C. When a rate has been established by DGAP, it will be incorporated _. in a rate agreement and identified as being applicable to the RMP grants. D. The DRMP had established a number of rates for provisional use - before the rate setting fumction was’ assumed by the DGAP. These rates will continue to be utilized mtil revised by DGAP in the normal course of business. ~ E, The DRMP will advise the DGAP immediately of any grantee institution under category I.A. for which rates are required but not now available. The DRMP will immediately procure proposals from those institutions under category I.B. for which rates are required but not now available. F, If DRMP makes an award to a new grantee which has an established © research rate with DGAP, it may, with the concurrence of the - grantee institution, utilize the research rate as a_provisional to rate in the initial award in order to fund the grant. . ae ~«.+Addendum to Revised Guidelines, 2/70, Pg 21 see = a Set ah as oo “ - —<— aemiaeronceralerst carcass mmnereuameaCaia Se FE En ea a ee Tee PINAnCTAL WAGCHENT SECTION IV re t gor wt _ a . hep @incivrect — esps) (Gentd from Page 2), Addendum te Nevised Guidelines, 2/70, Pe 223 II. Negotiation of Indirect Costs for Affiliate Institutions A. It will be the responsibility of the grantee institution to establish indirect cost rates with. its affiliated institutions. ‘Affiliated institutions generally will not commmicate directly with the Division of Grants Administration Policy-DHEW regarding the establishment of indirect cost rates for Regional Medical Program grants. The Division of Grants Administration Policy will provide technical advice to the grantee institution upon request. , B. Some grantee institutions do not now possess the resources to establish indirect cost rates with their affiliates. Such - - grantee institutions are expected to develop: the necessary resources. We: appreciate that these resources cannot be developed immediately and. are amenable to an interim, short term arrangement whereby DGAP will, upon request, and the condition that all parties are agreeable; establish rates with the affiliate(s) on behalf of the grantee., DRMP will advise DGAP of such instances and the grantee will instruct the affiliate institution to forward its proposal and supporting financial statements 'to the Grants Management Branch - Division of Regional Medical Programs. - DRMP will review the proposal for completeness and, if adequate, forward it to DGAP. DGAP will conduct its negotiation directly with the affiliate(s). C. Some institutions participating in the Regional Medical Program as affiliates are the direct recipients of grants or contracts under other DHEW programs. In such situations DGAP will establish rates for the RMP grant when it establishes rates for the other program awards. It is understood that this is an arrangement of administrative convenience for all parties involved. If the grantee institution desires to conduct direct negotiations with its affiliate, it may do so DGAP will be advised, however, of the grantee's option, in order that the RMP award may be considered in DGAP's negotiation for the other programs performed by the grantee institution. - The Division of Grants Administration Policy-DHEW has developed cost principles applicable to educational institutions, hospitals, state and local government agencies and other non- profit institutions. The following brochures are enclosed to assist you in developing the required indirect cost rate proposals: t OASC - 1 A Guide for Educational Institutions OASC - 3 A Guide for Hospitals OASC - 4 A Guide for State and Local Government Agencies OASC - 5 A Guide for Non-profit Institutions SECTTON Iv Rebudgeting of Funds—The grantee or affiliated institutions with full knowledge and approval of the grantee may depart from the approved budget and use the funds for other items required for the project, except for the following restrictions: (1) Grant funds may not be used for any some purpose contrary to the regulations and policies of the Division of Regional Medical Programs or the grantee or the afiliated institutions. |, (2) Grant funds may be transferred be- tween budget categories within projects or activ- ities only to the extent that no substantial change in any such project is made by the transfer ésee changes in approved program, page 12). Budget changes between projects or other identified activ- ities however, require written approval of the - Division of Regional Medical Programs. Rebudg- eting should not be done within the period be- tween submission of a continuation application and receipt of the award, and required special justification and written approval from the Divi- sion of Regional Medical Programs under excep tional circumstances. «CHAPTER III, REVISED GUIDELINES, Pg 17 am -. wrt “ ROU oth Rigs vt to yare at 7 : Poactodtesa tbs Pe wa DER UT ; ; SECPLUN Fv APPLICATION FOR PROGRAM REVISION (REBUDGETING OF FUNDS) Under the authority of the Regional Medical Programs legislation, a single grant, based officially Upon a Single budget, is made to each Regional Medical Program. Although this transaction is based upon the financial requirements of a great many program components, each justified and approved separately, its purpose is the support of a total Regional effort. In attaining operational status each Region accepts the obligation to evaluate -the progress of each of the components and assess the total program they comprise. It also has the option of periodically reassigning its available resources - in accordance with emerging plans and priorities. At this crucial time when the amounts of new funding are uncertain and at least . temporarily limited,.it is important for the Program to understand fully the process of rebudgeting--both the opportunities it provides and its limitations. - Based upon its own assessment a Regional Medical Program may propose reallocation of its grant' resources among (1) the direction, planning, and professional service activities of its central staff; (2) funded operational projects;- and (3) projects or staff activities which have ‘been approved by the National Advisory Council. Such reallocation requires prior approval of the Division of Regional Medical Programs and is usually applied for as part of the Type V (non-competing continuation) application. Transfer of funds between budget categories within component budgets may continue to be made without prior approval but only to the extent that it makes no_ substantial change in the approved activity. A Region may propose rebudgeting of funds committed for the continuation year and carryover of fimds unexpended in the year ending. In applying for program révision a Region must fully under- ‘stand the provisions under which appreval of its plans may be granted. . The program components involved in the reallocation--those from which, as well as those into which, the fumds are to be transferred--may not be substantially altered in their purposes, goals, or methodologies. A decision to discontinue a project, short of the time for which it was initially approved and for which funds were committed, must be explained. . Rebudgeting of funds among projects may not serve to increase the general level of funding of the entire program in the current or future years, (e.g. the size of a project staff may not be increased so that the annualized payroll is in excess of the approved budget). - «NID 1+2-70 NE PIRANCTAL HANAGTYERNT SECTION 1V (PURCHASE OF RQUTPNENT) Major Investments in Medical Equipment "The Council agreed that, in order to be considered for final recommendation by it, all applications which include requests for purchase of major items of fixed and moveable therapeutic and diagnostic equipment must include.... A statement of the rationale for charging any or all of purchase price of the equipment to the grant, and of the justification for the proportioning of the shared costs among those involved in the purchase; A proposed plan for accounting and fiscal control of the revenues accruing to the project (see HEW Grants Administration Manual Issuance, Disposition of Grant- Related Income); ee - Adequate evidencé that the project plan, including ‘the acqtiring of the equipment, has been reviewed, and if necessary, approved by the appropriate local planning agencies," . a r- February 20-21, 1969 Council Meeting After re~studying the project, the Council further recommended that the RMP contribution to the acquisition of fixed equipment be limited to not more than half of the total equipment budget of the facility; the portion being roughly equivalent to the amount of use of the equipment for teaching and demonstration. vse August 26-27, 1969 Council Meetihe - ®®Although the Council persists in its unwillingness to further specify its present policy guidelines on expenditure of grant funds for equipment, there was general agreement that each of these two projects has as its Drimary objective the establishment of a service facility for one institution and does not include 4 satisfactory plan for teaching, patient demonstrations and/or extension of services to a population not now well served. The Council recommended that in the context of these projects the purchase of equipment (and thereby the projects themselves) be disapproved. ‘ -+-Agust 26-27, 1969 Council Meeting \ NOTE: Cross-reference to Program Management - Eligible Activities .. TTA ery POR Rt peeve feta 2isemtor h, PANAGIIE Ravtads le Sac eeae F. Alterations and Renovations-To the ex- tent that other sources of Federal and non-Federal funds are not readily available to the applicant for such purposes, ninety percent of the costs of construction, Le., alteration, remodeling and reno- vation of existing buildings (including initial equipment thereot) and replacement of obsolete built-in equipment of the types customarily in- ‘chided in a construction contract may be paid for by operational grant funds. The applicant is re.” quired to furnish a narrative description to indicate the nted, nature and purpose of the proposed alter- ations and renovations, and, in appropriate in- stances, detail the plans and specifications. The amount of the alteration and renovation costs requested as part of a Division of Regional Medi- + * a, 7 * cal Programs grant determines the types of sup- eon porting documents to be submitted by the appli- ‘cant. Applicants are referred to the procedures and regulations set forth in the ‘Regional Medical Programs—Alterations and Renovations Guide,” available on request. CHAPTER ILE, REVISED GUIDELIN. . 1 : ADD. See Chapter III, Section VII. Financial Management, Part F (page 15): REGIONAL MEDICAL PROGRAMS ALTERATION AND RENOVATION GUIDE* (SUPPLEMENT 2) (MORE) Tw mew A&R Guide, dated 7-7-79, : “MENT . SECTION V ~ PREPARATION AND SUEMESSTION OF GRANT APPLICATIONS i PROGRAM MANAGEMENT seas? aninartnavcn tenet nn neato aten nner Oy ~ peocedinen 9 tr t tational & eee ne Copies Ss the Regions z . wa wr {Caen aud cu + = o ant oe ~s ie en 2 + Ge. Progran Aged - 7 ~ ie ork bho HE & his pertains Seem docs not prebil OFLEce one of Prosvan 1 Ls ' fsvard State Tepionel Oritea by . CONG IT to ongeks ft 372 Oc epecial stems a $ 4 wrt yee oe . prosvam row Ge A the Nat Only t be 3 ror outing ty me s “ TF Ov? nt IT RELI ional 2 ag Crs OF ELC LCh 4 é eLta ot fe sey tk i OLS: Peoen a Si be, ca “by Ws Los rad st SAVE © i « RLOLS iemod, Dew daz + & ag ins the VEL groemente will be executed to : to & sincle Yep - : wad ne iBS e © PAT th dees ssa ae Oy ByPEC tnvol ot aed Ae RS TA. aerate e a perticipate in all. ort Vesa Tha Eiger! Aeoagn BEST eeranad Chose. Puy t LCE Ste Bee ke pe of activities will 4 7 al. Advisory Council ~ F870, stoned by REE pth RES ee te baer Sere core to for inforvrcs- qi ft wer waentca WILL be gent te the UR i oo . boy tL Ps. . ' . os £ ; conducted OL vod stax. Steneo and vement 4. Sipe BOL Counesl. i 204 Wua2cn a att probless ox “REVEyano seen PROCESS -(Exerpted from letter to Members. of the National Advisory Council - on Regional ‘Medical Programs, dated November 4, 1970, signed by Vernon Ez Wilson, M,. Des Administrator, HSMHA) r o , 5 . “ m8 2 y Jaeet cay eeee wt + whe eye enoronriate,. tapsonal Office and the Advisory Council where sppropraate, | , . . : woe Te oe ws Soe et , 7 * eer yy +t . 3. The Advisory Council will be responsible : ticipation vill he as he Bhe- Kegehe tonal : i oo ne” toptes of Frogyvenm Applicetions w . ! *: « rw - Se eee 2 the Bostonal Office fron the loon - , comusnt te he 3 ct Ji be gent te the HEY 3 : . : 3 : : « . t — ; : 7 < i oe, ‘Progra Aseistance activities VILL be conducted a feos the NEY Reotonni OfLffea by aroveved statl i : Masiotence and } . 3 Sem eye ‘his pertain g £O_ on + “ docs not proh be epecial tte BEALS uhil partielpatc to all Sf tees : V2.8 BALG eS - . a al a . * OXCUL ed te agoLey ¥ esponsi bal Posy: . 7 7 rd oe] al effica for those PY 8 woich boudack Slee > Sos “° ou eee emer The Council was remire of RMP FY 71 grant f on, certain designated 3 the procedure for devermin the certification of Model this procedure inciudss endorse Chambliss assured the Council that el iry no for further review and approval of Advisory Group and thé National Advisor Also in response to Regional s serve urban posulations need not areas and need not seek review and approval mechanism, onramneerennscnnnrener nt mist enemy, — sc - Se -: NOTE: lal! | | he ed of the administrative earmarking of 3 specific questions, Medical Programs which are planning and submitting projects ‘to jan ti any endorsement or concurrence beyond their ow: REVIPY AND “ PPROVAL ~ Qu, Toe Raw one Bes ioe 8 ULL i -9 million projects which have direct impact neighborhoods. Mr, Chambliss outlined degree of such impact and obtaining offic ials in this regard. Although J Regional officiais, Mr. . the: procedure would entail no authority these projects beyond the lo ocal Regional y Council. : Dr. Margulies explained that hem exclusive ly for Model Cities t ee July 28-29, 1970 Council Minutes cM ATT LORY Totatpweeto worse pi or sa+r, “APY PAY ep} oe GUANT APPLTUAPT OC. nVEbe ADD APP OV 4, - = ie arena fe prem cr eet Ro RRFALERSRCOES ET Exe ane es NaN aa Ce re | designed ta speed = teeter” the exehanse of nuws, PACTS AND SCHEDULE-REVIEW CYCLES OF GRANT APPLICATIONS nformation and daia on Fiscal Years 1971 and 1972 tional Medical Programs “™ and related uctivilies. Novenbe r 2, 1970 - Vol. 4, No. 50S This issue updates the schedule of Regional Medical- Program application review cycles for the remainder of Fiscal Year 1971 and the first half of Fiscal Year 1972, Be It should be noted that .. . ’, Beginning July:1, 19703 Regional Medical Programs Service ingugurated an anniversary review system, which provides for four. review cycles a year. Under this system, ‘each Program will submit a ~ single annual composite application into one of the review cycles shown on Page, 2. ~ . Because this is a transition year, Programs whose anniversary dates are September 1, October 1, November 1, December 1, 1970, and. January 1, "1971, may submit. their continuation applications 45 days prior to their anniversary date. These Programs will be permitted to submit separately, one addi- ae tional application package containing requests for developmental component and/or supplemental and renewal projects in time for the earliest of the. ‘deadlines that they can meet. Re ra Pee rye aren - Pe yar SUOMTESUON Gy ARPLICAGIONS SECTION \ ~ iV. Appiication Procedure a. Schedule Applications to the Division of Regional Medi- cal Programs may be submitted at any time. A date set approximately six weeks prior to each meeting of the Regional Mudical Program Review Com- mitice Is set as the limit for receipt of applications for the review cycle initiated by that meeting. There are usually four such -cycles each year. A calendar of these dates and the dates of all Review Committee and the National Advisory Council meetings is kept current for at least one full year in advance and distributed regularly to all program coordinators. ‘ B. Number of Copies . e ; _. Applicants are requested to submit twenty copies ., Pane of an application. f ee . C. Style 7 > . Applicants should adopt a typographic style / which will permit stapling or binding in a three- ring binder. Each page should be suitable for pho- ‘tographic reproduction. The narrative should be iwped single spacecl to.conserve, space. , EUSbsingle spacer so,conserxe space NES, Pg 21 AE ae abe bd SUPPLEMENT Chapter IV, Section IV. Application Procedure (page 21) with: ~ vee ee FE near eee pe hermes anette "As non-competing continuation applications (previously recommended support-type V) become more complex, an increasing amount of time is required for the staff of the Division of Regional Medical Programs to adequately review them. This fact, coupled with the need that Award Statements for such continuing support arrive prior to the scheduled Starting date of the new grant period, now makes the following policy necessary and effective immediately: ° Programs scheduled to start their next budget period on August 1, 1969 or thereafter, must submit their continuation applications to the Division at least 45 days in advance of that new starting date, rather than the 30 days presently required. Similarly, the Division will advance its schedule for contacting - Regions regarding the submission of their Type V applications." , ‘ = ~ -i-Addendum to Revised Guidelines, 2/70, Pe 23 ~ AGES SECTION V PREPARATION Ann JEMISSTON OF GRART APPLICATIONS - t APPLICATION FOR PROGRAM REVISION (REEUDGETING OF FUNDS) Under the authority .of the Regional Medicel Programs legislation, a single grant, based officially upon a single budget, is made to each Regional Medical Program. Although this transaction is-based upon the financial requirements of a great many program components, each justified and approved separately, its purpose is the support of a total Regional effort. In attaining operational status each Region accepts the obligation to evaluate the progress of each of the components and assess the total program they comprise. It also has the option of periodically reassigning its available resources in accordance with emerging plans and priorities. At this crucial ‘time when the amounts of new funding are uncertain and at least temporarily limited, it is important for the Program to understand - fully the process of rebudgeting--both the opportunities it provides and its limitations. . _ : - q Based upon ‘its “own assessment a’ Regional Medical Program may propose reallocation-of its grant resources among (1) the direction, planning, and professional service activities of its central staff; (2) funded operational projects; and (3) projects or staff activities which have been approved by the National Advisory Council. Such _ reallocation requires prior approval of the Division of Regional Medical Programs and is usually applied for as part of the Type V (non-competing continuation) application. Transfer of funds between budget categories within component budgets may continue to be made without prior approval but only to the extent that it makes no substantial change in the approved activity. A Region may propose rebudgeting of funds committed for the continuation year and carryover of funds wunexpended in the year ending. In applying for program revision a Region must fully under- stand the provisions under which approval of its plans may be granted. The program components involved in the reallocatiun-~-those from which, as well as those into which, the funds are to be ' transferred--may not be substantiadly altered in their purposes, goals, or methodologies. A decision to discontinue a project, short of the time for which it was initially approved and for which famds were committed, must be explained. ° Rebudgeting of fimds among projects may not serve to increase the general level of funding of the entire program in the {Contd} ' ---Addendum to Revised Guidelines, 2/70, Pg 1 | Ne Soe =: - - - = os BOSIAN Malla niren er os PROGK: Mek Maas Fees ae cream ae ALAS oF (Cautd From Fe 1, Addendum tu Revised fufdelines, 2:70, pe 2) current or future years (e.g., the size of a project staff may not be increased so that the annualized payroll is in excess of the approved budget). Funds carried forward from a previous budget period may be used for initiation or expansion of projects or staff activities which can be completed within one year. The temporary increase in the level of funding created by the epprovel of carryover | funds does not constitute a commitment to increase the level of funds for subsequent years. NOTE: Funds remaining Wi ~ expended at the end of a psriod of committed support (i.c., the one, two, or three year program period) generally cannot be carried forward. Due to the complexities of individual Situations, however, Regions planning to request carryover as part of Type II - competing renewal applications are advised to contact the Grants Management Branch. APPLICATION 4 > ? Applicatipn for program revision should, as often as possible, be made as part of the regular Type V (non-competing continuation) application, whether the proposed revision is to be accomplished by rebudgeting or by use of carryover funds. Application for revision submitted at any other time will be considered under special circumstances and after direct discussion with the Division staff. Each such application must be made utilizing the regular face page and budget pages (NIH-925-1 Rev. 5/66); with a budget for each of the projects affected by the revision and a consolidated budget for the entire program. Under no circumstances will such requests be considered following the effective date of the final Report of Expenditures (NIH-925-3) which is due 120 days after the end of each budget period. If a project selected for initiation with rebudgeted funds was originally applied for and approved for more than one year, the application must include not only a budget for that project but a statement explaining how it has been revised to be accomplished within that budget and within the one year for which the request can be considered. Such applications should include a statement concerning proposed sources of support for proposed continuation of the activities. oT , REVIEW . When adequately presented as part of a Type V application, the . Division staff can review and act on such requests for revision in the usual time required for the Type V alone. However, if the staff concludes that the proposed reallocation will result in alterations either in individual grant components or in the nature of the applicant's total program, staff may defer action on the revision request and submit it to the National Advisory Council at its next regular meeting. This can be done without delaying processing ofthe other elements of the Type V application. . ana NOTE: See Financial Management - Rebudgeting of Funds = Page ___ . y aaa lems ceases © GLOSSARY Ae %; APPENDICES oe arr an ens rime “y My \ ; 7 - a " . - ’ 4 : - ~ i tw ‘ ‘ : ‘ od. “oa oF 7 ~ 4 i* , t “In requesting such increases, grantees would have to include in their STATS Se YD + pe Ihe Pe ? COUNCTL-DULEGAT TW) AVTHSRTTY TO STAFF OF RAPS hE A Delegation of Authority by National Advisory Council on Regional | Medical Programs to the Division of Regional Medical Programs Staff for Administrative Changes in Amounts of On-Going Grants On August 28, 1967, the Council approved the following delegations of authority to the Division staf£ to approve increases in amounts for - active grants for the following purposes: - (1) Institution-wide salary increases, social security and other mandatory employer contribution adjustments. ; Be " (2) Extension of grant period with additional funds, at a rate not to . exceed the current rate of support, for a period not to exceed 6 months--in order to prevent hardship to personnel or loss of investment already made under the grarlt, to provide additional time for preparation, review, and approval of a renewal application, or to provide for orderly termination of the grant, Such extension would be reported to the Council. | : (3) Increases of an administrative nature which.do not represent an expansion of the program or change in any significant manner the nature of the program, such as increased costs for equipment, personnel, — travel, rental, and alterations and renovations. Such increases _ would be limited to 15 percent for any budget category and all increases would be reported to the Council. (4) Rebudgeting of allowable indirect costs to direct cost expenditures with an equivalent reduction in the indirect cost allowance (an increase: in, direct costs only, not in total grant amount). justification reasons why the increased costs could not be covered through rebudgeting within the current grant. Pa Division of Regional Medical Programs August 28, 1967 - August 1968 Council extended the above authority for one year. In addition, authority is granted Division staff a program grant period for not longer than six months at the regions’ current rate of support. ‘ pe a” NOTE: See exerpt from Minutes of Council 8/68 expanding authority. rN COUNCEL -DELEGAP"Q_ AUTHORITY TO 1 - of STAFF OF RMPS \W/ ~ Delegation of Authority by National Advisory Council on Regional Medical Programs to the Division of Regional Medical Programs Staff for Administrative Changes in Amounts of On-Going Grants On August 28, 1967, the Council approved the following delegations of authority to the Division staff to approve increases in amounts for active grants for the following purposes: (1) Institution-wide Salary increases, social security and other mandatory employer contribution adjustments. _ 4 ” he (2) Extension of grant period with additional funds, at a rate not to exceed the current rate of support, for a period not to exceed 6 months--in order to prevent hardship to personnel or loss of investment already made under the grant, to provide additional time for preparation, review, and approval of a renewal application, or to provide for orderly termination of the grant, Such extension would be reported to the Council. : (3) Increases of an administrative nature which.do not represent an expansion of the program or change in any significant manner the nature of the program, such as increased costs for equipment, personnel, travel, rental, and alterations and renovations. Such increases would be Limited to 15 percent for any budget category and all increases would be reported to the Council. (4) Rebudgeting of allowable indirect costs to direct cost expenditures with an equivalent reduction in the indirect cost allowance (an increase in direct costs only, not in total grant amount), In requesting such increases, grantees would have to include in their justification reasons why the increased costs could not be covered through rebudgeting within the current grant. Division of Regional Medical Programs August 28, 1967 August 1968 Council extended the above authority for one year, In addition, authority is granted Division staff a program grant period for not longer than six months at the regions' current rate of support. < NOTE? See exerpe from Minutes of Cuuncil &/6S expanding authoricy. - Gy PAGTOVAT Apperson y we bea LODAT, ADVIS. XIV, DELTS\UTON OF AMuonity mp : nena ~ toe re PROCRAUS TO TEE DIVISTON OF RESTOUAL MEDI - a oeeaprepse Se ) o 4 eee ene ee ene = ne Sr cies eee - ae - vr ~ ADMINISTRATIVE CEANGES IN AMOUNTS OF ON-GO — a On August 28, 1967, the Council approved the delegation of authotity to the Division staff to approve increases in amounts for active grants for four general purposes. The second of these. was: "(2) Extension of grant period with additional funds, at a rate not to exceed the current rate of Support, for a period not to exceed six mont: in order to prevent hardship to personnel or loss of investment already made under the srant, to provide additional time for preparatiow, revise: énd approval of a renewal application, or to provide for orderly termin- ation of.the grant. Such extension would be reported to the Council," On August 27, 1968, Council approved the further use of this authority 1. the following cireumstances: C : . - z ‘In the case of grants “which included commitments for a final budget period of 12 full months but which were arbitrarily shortened (and emeu:- concomitantly reduced) by the Division's decision to extend commitments .. longer than 12 months beyond the life of P.L, 89-239 (June, 30, 1969)," ...August 26-27, 1968 Council Meeting . COUNCTL-DELEC 7 “ip AUTEORITY 0 ve . STAFF OF RMPS* - 4 Delepation by the Nattonal Advisory Council to the Division of Regional Medical Programs Staff for Administrative Approval of Minor Expansions in Activities Under Approved Operational Repional Medical Programs The following delegation was approved by the National Advisory Council on August 28, 1967, as the basis for administrative actien by the staff within specified Limits without reference to Council: Staff may approve requests for expansion of ppproved activities ¢ or initiation of activities ancillary to the Regional Medical . Programs -- up to 5 percent of the total direct cost awarded for _the current budget period, but not greater than $50,000 (plus ' ‘indirect costs), -This, annual limit would apply whether it is reached in one on more individual requests, Approval for this delegation of authority would be itneluded in each Council ‘action recommending approval of an operational grant application. Requests must be approved by the Regional Advisory Group and should justify why the increased costs cannot be covered through rebudgeting within the current grant. . * Division of Regional Medical Programs August 28, 1967 August 1968 Council extended the above authority for one year.