ia
regional

medical - SPECIAL ISSUE.
programs FOR LIMITED DISTRIBUTION

5 service e news
‘Information
oc ‘data

A communication device

 

 

 

 

 

 

 

designed to speed
the exchange of news, ;
information and data on "FAST" REPORT Re Regional Medical Programs
Regional Medical Programs

 

 

 

and? related activities.

 

October 22, 1970 - Vol, 4, No. 455

Keproduced in this issue is that section of the "FAST" Report of
July 8, 1970 which is concerned with Regional Medical Programs Service.

FAST, an acronym for Federal Assistance Streamlining Task Force,
was a special Department of Health, Education, and Welfare group
working under Frederic V. Malek, former Deputy Under Secretary. This
group was assigned to study grant review procedures of various Depart--
mental agencies and to make recommendations to streamline them by
eliminating "red tape."

The recommendations of this report are currently being studied to
see how they can best be implemented in accordance with the orders of
the Department, the plans of Health Services and Mental Ilealth
Administration and Regional Medical Programs Service, and in the best
interests of the Regional Medical Programs themselves.

 

Distribution: . Coordinators of Regional Medical Programs
Members of National Advisory Council and
Review Committee on Regional Medical Programs
Staff of Regional Medical Programs Service
Regional Health Directors of Department of
llealth, Education, and Welfare Regional Offices

 

U.S. DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE
Publie Health Service « Health Services and Mental Health Administration ¢ Rockville, Marvland 20852
 

July 8, 1970

Regional Medical Program

The Regional Medical Program, administered by the Regional
Medical Program Service (HSMHA-RMPS) , provides grant support
for organizations or groups of organizations or agencies es-
tablished on a regional basis for combatting heart disease,
cancer, stroke and related diseases in a defined geographical
area, (RMP). There are presently 55 RMP's covering the entire

-nation.— (See map).

An RMP generally includes a medical school, clinical research
center and teaching hospital. Some RMP's are incorporated as
separate legal entities. Others consist of confederations of
cooperating groups with a medical society or a medical school
serving aS a fiscal agent. Fach RMP is required to have a

Regional Advisory Group (RAG) which usually functions like a

:

board of directors and sometimes as a technical review group.

The 55 RMP's were set up between 1966 and 1969 under the au-
thority of PL 89-239, enacted in 1965. The law provides grant
support for (a) organizing and establishing regional medical
programs (planning grants), and (b) supporting research,
demonstrations and training projects relating to the various
disease categories (operational grants). All but one region
are now."operational". a

Passage of. PL 89-239 was stimulated by the report of the
Commission on Heart, Cancer and Stroke established earlier
by Congress "to recommend steps to reduce the incidence of
these diseases" which account for over 70% of all deaths in
the U.S. The,Commission was made up of a panel of medical
-experts and distinquished citizens.

The basic purpose of the legislation is to diffuse and dis-
seminate rapidly expanding medical knowledge from the labo-

“ratories and educational institutions to practitioners for
the benefits of their patients.

Purpose -

~ gection 900, Title IX of the Public Health Service Act defines
the goal of the Regional Medical Program (RMP) in detail:

“TITLE IX--EDUCATION, RESEARCH, TRAINING, AND DEMON- |
STRATIONS IN THE FIELDS OF HEART DISEASE, CANCER,
STROKE, AND RELATED DISEASES" _ : :
Purposes

(a) Through grants, to encourage and assist in the
establishment of regional cooperative arrangements
among medical schools, research institutions, and
hospitals for research and training (including con-
-cinuing education) and for related demonstrations of
patient care in the fields of heart disease, cancer,
stroke, and related diseases; ,

(b) To afford to the medical profession and the medi-
cal institutions of the Nation, through such cooper~
ative arrangements, the opportunity of making available
to their patients the latest advances in the diagnosis
and treatment of these diseases; and

(c) By these means, to improve generally the health
manpower and facilities available to the Nation, and
to accomplish these ends without interferring with
the patterns, or the methods of financing, or patient
care or professional practice, or with the adminisr ~
tration of hospitals, and in cooperation with practicr
ing physicians, medical center officials, hospital. ad~
ministrators, and representatives from appropriate _
voluntary health agencies."

The Surgeon General has appointed a National Advisory Coungil
on Regional Medical Programs to assist in the preparation of
regulations and to advise on policy matters concerning the
administration of this Title. The Council consists of the
Administrator of the Health Services and Mental Health Aginp nis
tration and 15 members who are leadérs in the fields of fh
fundamental sciences, the medical sciences and publi¢ affairs,

It should be noted that review and approval of the 55 Regional
Medical Programs is not a matter of periodic competition among
eligible applicants which results in the full funding 9f some
Regional Medical Programs and no funding of others. It is ©

rather a continuing assessment of the progress with which each ©

TTT

individual Regional Medical Program is carrying out.the
purposes of the legislation. .

 

The law authorized Regional Medical Programs for three years.
In 1968, Congress extended the authorization for two more

years.

 
Fiscal year ending: Appropriation:

6/30/66 $24,000,000
6/30/67 43,000,000
6/30/68 53,900,000
6/30/69 56,200,000
6/30/70 93,600,000

There is no apparent national strategy for carrying out the
program. The RMP's initiate projects and submit applications
‘to the Government for review. Reviews are carried out on a

_ project-by-project basis. Statistics for approved projects
by disease category and type of activity are as follows:

 

 

Total
Number Current Percent
Disease’ Activities Funding of total
(thousands)
Heart . 168 $14,872.8 28.0.
Cancer 86 6,978.2 13.0
Stroke 56 6,320.8 12.0
Other 56 5,647.0 11.0
; Number Total Percent
Activity Emphasis Activities Funding of total
, (thousands)
Education & Training 330 28,106.8 53.0
Demonstration of Care 161 18 ,990.6 . 36.0
Research & Development 59 6,091.2 11.0

(Core staff activities support = $40 million).

Examples of. the types of projects funded under PL 89-239 in-

clude: cancer registries, mobile coronary care, training in
coronary care, and bioinstrumentation. .

The number of projects per RMP varies from 3 to 27 averaging
about 10. For obvious reasons the regions which were es-
tablished first generally have more operational projects than
‘those: organized later. There is also considerable variation '
in project emphasis from region-to-region. One region for
example is predominantly involved in projects relating to
instrumentation and electronic hardware. Some are involved
primarily in projects relating. to heart disease.
PL 89-239 is administered by the Regional Medical Program
Service, 4 unit of the Health Services and Mental Health Ad-
ministration. (To avoid confusion, referred to in this
report as HSMHA-RMPS as opposed to the abbreviation RMP used

to. designate grantees) -

Eligible Applicant

Public or nonprofit private universities, medical schools,
research institutions and other public or nonprofit private
agencies and institutions are eligible to apply for a grant |
to plan and/or operate a Regional Medical Program. Bach appli-
cant must be authorized to represent the agencies and insti-
tutions which propose to cooperate in planning for and de-
veloping the Regional Medical Program. Additionally, each

applicant must be able to exercise program coordination and
fiscal responsibility-

The Regional Advisory Group

The Act specifies that each applicant must have designated a “~
Regional Advisory Group (RAG) to advise him in planning and far
operating the Program. The Act also specifies that the Moy
- Advisory Group must approve an application for any operational
grant. The Advisory Group includes practicing physicians,

medical center officials, hospital aaministrators, representa-
tives of other organizations, institutions, and agencies, and
members of the public familiar with the need for the services

provided under the Program.

 

The Regional Advisory Group provides overall advice and gui-
dance to the Regional Medical Program jin the planning and
operating phases of the program from the initial steps onward.
It is actively involved in the development of the regional
objectives, ag well as the review, guidance, and coordinated
evaluation of the ongoing planning and operating functions.

Present Program

Since the signing of the Act, broadly representative groups
have organized themselves to. conduct Regional Medical Programs
in 55 regions which they themselves have defined. Together -
these regions encompass the Nation's population.

The 55 regions first received planning grants (Section 903). —
Each award was based on a narrative escription of the proposed

region including appropriate demographic and descriptive data

 

 
 

supporting the preliminary delineation of the region, back~
ground and history of the proposed organizational structure
and how it will function, the nature of the Regional Advisory
Group and how it was selected and a description of how the
planning activities will contribute to the goal of that
Regional Medical Program.

Of the 55 Regional Medical Programs, all but one have since
achieved operational status (Section 904).

Operational Grant Application

A Regional Medical Program operational grant is made up of a
number of components. The principal one is referred to as

the Program core. It provides the funds for the Program staff
activities, including program direction and coordination of
planning, and professional services to the institutions,
agencies, and ‘individuals that cooperate to make up a Regional
Medical Program. The core component is identified by a
separate budget line item.

The other grant components are generally referred to as.
rojects. The activities they support are individually des-~
Gribed in Regional Medical Program applications and each has
a separate budget. These activities are conducted and ad-
ministered in much the same way as any project grant. Their. .
individual objectives are time limited (usually from one to
three and occasionally five years) and they are undertaken as
an adjunct activity of an institution or agency whose person
nel and facilities they usually share. It is important to
note, however, that the projects which make up a Regional
Medical Program Grant have goals and objectives which are re-
Tated to the goals and objectives of the total Program Grant.

The planning activities initially funded under the provisions
of section 903 may be continued and expanded as integral part
of the operational activities.

Regional Medical Program Review

Applications for initial operational grants (Type I--New)
undergo a rather thorough review at the Regional Medical
Program Grant level. Most of the 55 regions have in addition
to. their statutory Regional Advisory Group, a series of cate-
gorical and other planning and review committees to assist
with the review of operational project proposals. These com-
mittees review and evaluate proposed projects and activities
aN

tn,

6

for their technical or substantive merit prior to final action
by the Regional Advisory Group. Only those favorably recom-
mended or approved by the RAG may be included in the Regional
Medical Program grant application to the Public Health

Service (RMPS).

Federal Review

Upon receipt of the application by the HSMHA Regional Medical
Programs Service all project components contained in the grant
application are subjected to a series of HSMHA Regional Medi-
‘cal Programs Service staff comments and then evaluated by a
technical review panel and the Public Health Service Regional
Medical Program Review Committee (an Advisory Committee com-
posed of non-Federal specialists). Review Committee meetings
are scheduled regularly to review and evaluate the professional
aspects of all 55 Regional Medical Program applications. They
consider reports of Public Health Service staff, outside re-
viewers and site visit teams and recommend time and amount of
support to the National Advisory Council for its consideration
at a subsequent meeting. The Review Committee and Advisory
Council members participate in site visits to RMP.

The final review of applications is by the National Advisory
Council on Regional Medical Programs. The Council considers
fhe recommendations and findings of the Review Committee in-
cluding the full array of material assembled during the entire
review process. The Council's final recommendation, required
by statute before a grant can be awarded, concerns the ap-
plication as a whole and includes a recommendation of an
overall grant amount.

 

 

Awards

After the Council's recommendations are made, the HSMHA Regional >
Medical Programs Service staff informs the applicant and re-
lates the Council's concerns and recommendations in detail.

If the recommended amount has been reduced below the amount
requested for those projects or activities not specifically
disapproved, the applicant must return to its own decision-
making group (Regional Advisory Group), which reassesses pri-
orities, and submits a revised budget to HSMHA Regional Medi-
cal Programs Service showing a redistribution of the recommended
amount among the approved projects or component activities.

-It is on the basis of this resubmitted budget with the projects
it covers that an award is made for the program.

 
 

7

A single grant igs made for a "program period" of three years,
which is made Up of "budget periods" of 12-months each.

Having received such a grant, an "operational re jon" may ap7.
ply at any time for additional funding (Type TiT-supplemental)
to initiate new components oF to expand existing ones- These
applications go through the same review process as described
previously, beginning with the Regional Advisory Group and
with final action recommended by the National Advisory council.

on Applications: at the end of each "budget period"

Continuati PP
of each program award, HSMHA Regional Medical Programs Service -

staff review precedes funding of a continuation award (Type V)-

Renewal A plications: at the end of the "program period" of
the initial operational grant, the entire program of the appli-.
cant region (including all components added by supplemental
grants, regardless of their budget periods) undergoes the com- .
plete review by peers and staff, as for a new application.

The award that is made as a4 result of this review provides for |
the renewal of support of the RMP (Type II) and as such renews,

‘or more accurately, extends the program period--with the

program goals and purposes remaining essentially the same but
with the components changing from time to time.

In summary, new and renewal operational project applications
are generally reviewed as follows:

Grantee Review
1) Application submitted to RMP.

2) Review by RMP staff and RMP technical panel.

3) Copy. of application to 314(b) agency for information.

4) Review by RMP review committee.
5) Review and approved by RAG.
Federal Review

6) Submitted to HSMHA-RMPS.-

7) Grants review branch (GRB) solicits management and techni- |
cal review from RMPS staff.

8) GRB submits package to Technical Review Branch.
8

9) Recommendations submitted to RMP Review Committee (site
visit, if necessary) .-

10) Review Committee recommendations submitted to National
Advisory Council on RMP.

11) NACRMP recommendations submitted to Director, RMPS.

 

12) Director, RMPS, office negotiates approvals to RMP.
13) Director, RMPS, office issues awards.

The findings and recommendations address themselves to the
following issues:

A) Program review at the Federal level.
B) Project review at the RMP level.
C) Policy and procedures documents.

D) Application forms.

 

E) Core staff of the RMP.

F) Periodic reporting procedures.
G) Role of HEW Regional Office.
Findings |

The review process has been a source of concern to HSMHA-RMPS.
A consultant was hired and served for a year as a member of the
staff. During 1968-69, he conducted a study for HSMHA~RMPS
titled."The Review Process for Regional Medical Programs".

This report states that:

"In the spring of 1968, only 13 of the 54 regional
programs had progressed from the planning to the oper-
ational stage. In the spring of 1969, when the total
number of programs had risen to 55, 44 of them were
operational.

Starting with the April-May 1968 review cycle, the

volume of applications for grants began to escalate
sharply. Primarily, applications for initial oper-
ational grants and for operational supplements, the
volume grew to a level which inundated the Division.

 
 

Regions have been allowed to request operational
‘supplements in every review cycle or as often as four
times a year. Consequently, in the last two quarter-

ly cycles of calendar 1968 and the first two cycles

of 1969, the number of applications being presented

to staff, Review Committee and National Advisory Council
ranged between 45 to 75 applications from 35 to 45
regions in each cycle. In addition there were the usual
number of Type V extensions for staff review. This
process of coming of age strained the review process,

at both the Federal and the regional levels, in such a
vay as to make it a crucial subject for study. At the
same time the rushing pace of events made it difficult

to get the proper perspective. Fundamental conditions
which were the basis of recommended change were themselves
being altered with frequency. ,

The overwhelming volume of applications for review is
probably most obvious when they are presented to the
Review Committee. At the January 1969 committee there
were 55 applications from 36 regions and at the April
1969 committee there were 47 ap lications from 33 regions.
in each meeting the applications contained over 200
projects or proposals. In each session the Committee
had to be divided into two panels, each of which re-
viewed roughly one-half of the applications, represented
by a stack of 'phone books! at each member's seat. Even
augmented by some ad hoc members, each panel numbered
only eight persons and a chairman, with the number
dropping as low as five on the afternoon of the second
day. With a few exceptions, even the most complicated

- applications were not considered by the entire Committee,
Inevitably there were differing interpretations of
policy and other inconsistencies jn the two panels. At
neither meeting did either panel learn precisely what
action the other panel had taken prior to adjournment."

The anniversary or annual review system proposed by the Regional
Medical Programs Service and announced t9 the RMP coordinators
May 8, 1970, is a major step twoard the reduction of frequency
of project review of each Regional Medical Program. However,

it does not reduce the annual workload of the Regional Medical
Program or the HSMHA Regional Medical Program Service. There
would still be more than 400 project proposals per year, plus

a 6-month Federal review period for eagh project. In addition,
the RMP could apply for up to-10% of the award as a "de- ,
yelopmental component" to be used tq fund projects during the
period between annual Federal reviews. If the RMP does this,
10

however, it automatically would lose any discretionary use
of carryover funds. Moreover, the Regional Medical Program
would submit a relatively large package of project proposals
only once each year and thereby lose the opportunity to fund
projects when they are most timely.

Project review by the Regional Medical Program is conducted
in most instances very much like the Federal review. Peer
experts and others participate in reviews-in-depth.

Recommendations

It is recommended that an anniversary or triennial review
system be adopted in the following way:

1. Program Review at the Federal level be conducted trienni-
ally by Regional Medical Program Review Committee and National
Advisory Council for Regional Medical Program to include in

depth site visit.

2. Annual Continuation Awards be made on the basis of the
previously approved level of funding for the total program.

3. Applications that involve significant change in program
direction or supplementary funds receive full pederal review
by the HSMHA Regional Medical Programs Service for the pro-

posed program changes.

 

 

 
 

ll
Findings

The present HSMHA-RMPS review system for project applications ..
submitted by the 55 Regional Medical Programs involves the’
full-time efforts of 20 headquarter staff plus the part-time
efforts of at least 20 HSMHA~RMPS and other Federal staff.
These may include the personnel of the Grants Review Branch,
Grants Management Branch and, as needed, Program Assistance
Branch, Continuing Education, Chronic Diseases, Systems Analy-
Sis, etc. Recommendations are then forwarded to the Review
Committee and Council. The process for an application re~
quires about six months. (At least 400 projects are reviewed

each year.)

Recommendations

It is recommended that:

1. RMPS-HSMHA phase out project-by-project technical review.

>. RMPS-HSMHA develop criteria by November 1, 1970 to permit
each RMP to seek qualification as its own project review

agency.

3. Application forms be revised to contain only elements
necessary for review process. ;
12 oy

Findings

Regional Advisory Groups must review and act upon all opera-
tional proposals. Only those favorably recommended or ap-
proved may be included in the 55 Regions’ grant requests to
the HSMHA Regional Medical Programs Service.

The fact that as of January 1970, slightly less than two-
thirds of the proposed operational projects or activities _
presented to Regional Advisory Groups have been approved by
them--1021 out of a total of 1553--provides evidence that the
technical and peer review procedure is being exercised in a
critical, rather than mere rubber-stamp fashion.

Most Regional Medical Programs have, in addition to their
Regional Advisory Groups, a series of categorical and other
planning and review committees to assist with the review of
operational proposals. These committees generally review and
evaluate proposed operational projects and activities for
‘their technical or substantive merit prior to final action

by the Regional Advisory Groups.

Recommendations

It is recommended that: | ft »

ue

‘te
1. Project review and funding responsibility be decentralized
directly to each Regional Medical Program as soon as it meets
established criteria.

 
 

13

Findings

The current guidelines for HSMHA Regional Medical Programs
Service policies and procedures used by the 55 Regional Medi-
cal Program coordinators are inadequate. They are cumbersome,
complex and repetitive. For example, on page 5 of the Guide-
‘lines dated May 1968, there is a functional statement for the >
RAG. This statement is repeated on page 8 of the same docu-~
ment, with only minor modifications. The Addendum dated
February 1970 is not presented in the same order as the origi-
nal. . The coordinator gets no clear statement of Departmental,
Health Services and Mental Health Administration, and Regional
Medical Programs Service policies and procedures from which

he can manage his program without frequent communication to
elements of HSMHA Regional Medical Programs Service to seek
advice in these areas. In addition several of the RMPS have
established their own guidelines which appear to vary as to
the felt needs of the region as stated in the RMP progress
summaries dated April 27, 1970. It is not known what consti-
tuted the source material of these local guidelines. At the ©
recently held Airlie House Conference for the 55 Regional
Medical Programs'. Coordinators and Directors, several coordi-
nators related experiences where the same question was answered
differently by different elements of the HSMHA Regional Medical
Programs Service.

While it is necessary for the Regional Medical Program coordi~
nators to have fully detailed statements of instructions con- —
cerning the types of support permitted under the authority of
pitle IX, too much detail in the application form instructions -
tends to solidify the nature of the program and reduce the
opportunities for innovation.

Recommendations
It is recommended that:

1. HSMHA-RMPS prepare a clearly stated looseleaf policy and
procedures manual for use by RMP staff and RO-HEW staff.

2, The manual contain detailed instructions for application
procedures. —
Findings

The currently proposed application form requires that infor-
mation be supplied repetitively but in different configur~-
ations for detailed project review. The sample reviewed at
the Airlie House meeting May 8, 1970 contained 112 pages of
instructions ana forms. Form No. 7, for example is used at
least five times.

Continuation Reviews: Continuation applications like new.
applications generally exceed the size of major city telephone
-@irectories. One application examined by the Task Force was

5-1/2 inches thick weighing 14 pounds.

These continuation applications are reviewed by an internal
staff committee which has neither fixed membership, rules of
procedure Or criteria for review. Membership varies depending
on the staff available for attendance. Decisions are usually

made on the basis of informal concensus.

If. detailed project review at the Federal level ig eliminated,
there is no need for a lengthy and complex application form

with accompanying complex instructions.

Recommendations

 

It is recommended that:

1. An application form for new and renewals (Types I, Il,
III) be developed consistent with proposed HSMHA master forms.

2. An application form for continuation (Type v) be developed.

 

 
 

15

Findings:
Core staff of the 55 Regional Medical programs performs two
primary functions: (1) Administrative management of the

basic grant and its components, and (2) Operational activities
related to the development, review, and maintenance of projects
and programs. For example, the maintenance of a headquarters
library facility falls under (1) above, while the development
of an areawide library system falls under (2). Of the $93.6
million available funds, $40.4 million is used for core support.
Generally RMP's estimate that 25-35% of total core staff time
is currently spent preparing applications for project-by-_
project review and prior approval correspondence.

Recommendations

It is recommended that:

1. Applications for Regional Medical Program support indicate
clearly the differentiation between core staff support for ,
administrative management and core staff support for other
program functions. This will permit the National Advisory
Committee to evaluate more critically the needs of different
core functions. oo
16 a

Findings

The proposed triennial review of program will no longer en-
able the 55 Regional Medical Programs to provide in a timely
fashion the management information which is requested on the
application form. Thus, there is a need for periodic report-
ing procedures which will obtain from the 55 Regional Medical
Programs, on a regular basis, information which the HSMHA
Regional Medical Program Service can use for its own budget
development program evaluation, etc. All updated expenditures
and budget data for each region should be provided to the
HSMHA Regional Medical Program Service on a continuing basis
rather than "45 days prior to the Region's Anniversary Date
or 120 days after the end of each grant period."

The HSMHA Regional Medical Program Service procedure for the
accountability, control, disbursement and reporting of RMP

- grant funds should be included in the periodic reporting pro-
cedure.

Recommendations
It is recommended that:

“1. Periodic reporting procedures be developed independent aes
of applications for support. a

 
 

17

Findings

It is essential that staff of the Health, Education and
Welfare Regional Offices be knowledgeable about all Federal
programs which in one way or another interlock and be able

to coordinate these efforts. The staff from the Health,
Education and Welfare Regional Offices should work with
Regional Medical Programs so that they may understand problems,
be thoroughly familiar with the projects being considered and
be able to provide opinions to the Regional Medical Programs
and/or the HSMHA Regional Medical Programs Service on the
merits or demerits of any particular project or program.

Recommendations

It is recommended that:

1. Copies of Program applications be sent to the HEW Regional
Office from Regional Medical Programs for information and
comment to be forwarded to HSMHA Regional Medical Program
Service. This activity may facilitate more meaningful coordi-
nation of RMP with other health programs.

2. Copies of award statements be sent to the HEW Regional
Office by the HSMHA Regional Medical Programs Service.

3. Program Assistance activities be conducted from the HEW
Regional Office by appropriate staff. These include attendance
at RAG meetings, review meetings, etc., and the alerting of :
headquarters to any significant changes in programs.

4... HEW Regional Office staff participate in all program re-
view site visits. : i

5. Agreements be executed to assign responsibility to a
single Regional Office for those Regional Medical Programs
which cross HEW Regional boundaries.

 
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18.
19.
20.

21.

22.
23.
24.
25.
26.
27.
28.

Regional Medical Program Map Key’

Maine |
Tri State
Northern New England

Connecticut

Metropolitan~-New York
Nassau - Suffork
Albany

Central New York

. Rochester

Western New York

New Jersey

Greater Delaware Valley
Susquehanna Valley

» Western Pennsylvania
Maryland

D.C,

Virginia

West Virginia
North Carolina
South Carolina

Northeast Ohio

Northwest Ohio

Ohio State

Ohio Valley
Tennessee Mid~South
Memphis

Georgia

Alabama

52.

- Colorado ~ Wyoming = é-
Inter~Mountain

» Hawaii

- Florida
Mississippi

- Michigan
- Indiana

Wisconsin
Tllinois

- Bi+State

Northland (Minnesota) ©
Towa

- Missouri
. Arkansas

Louisiana

- North Dakota
- Nebraska ~- South Dakota’

Kansas

- Oklahoma
Texas

Mountain States

 

New Mexico

Arizona

Washington ~ Alaska
Oregon

California

Puerto Rico.

 

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GLOSSARY

HSMHA-RMPS - Regional Medical Programs Service-HEW.

NACRMP - National Advisory Council for Regional Medical
Programs.

RMPRC - Regional Medical Program Review Committee. -
GRB - Grants Review Branch-HSMHA-RMPS.

PAB ~ Program Assistance Branch-HSMHA~RMPS.

GMB ~ Grants Management Branch-HSMHA-RMPS.

RO-HEW - HEW-Regional Office.

RHD - Regional Health Director-HSMHA

CLO - Congressional Liaison Office-HEW.
RMP - Regional Medical Program-Grantee.

~ Regional Advisory Group-Grantee.
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

   
 

 

 

 

 

 

 

 

 

 

 

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