COMPARATIVE ANALYSIS OF PRES} ro Present Legislation Staggers/Cramer Bills P. L. 90-574 H.R. 14284. . __. . : H.R. 15135 dq. Setting u Separate legislative Retains separate. legis- authorization. for RMP. lative authorization for RMP but also adds a separate authorization for Chronic Disease Pro- grams, , 20 Scope (a) Categorical | Heart disease, cancer, | No change. . Emphasis stroke and related diseases. 3NT AND PENDING RMP LEGISLATION 2 . ‘January 27, 1970 . Rogers Bill. Draft Yarborough Bill Emerging H. R. 14486 Administration Proposal Retains separate. legis- lative authorization for RMP, Adds "other major diseases." \ Retains separate legis- Lative authorization for RMP. Adds "kidney disease, and other major diseases and conditions." Places RMP, CHP, NCHSR&D, NCHS in one title, Title [: and gives them a Oo single statement purpose, a single authorization sect:. with separate appr ation statements. Will emphasize: (1) Closer coor- dination of al? programs to attack health prob-lems, esp. CHP and RMP. —_ (2) Experimentatio: : in 6-12 areas i the development of health care systems. Complete decategor. zation; no specific mention of any disease in particu . .Present Staggers (b) Construction Authority (ce) Additional Emphas es. Limited to "alteration, Major repair, re- modeling and renovation of existing buildings .. « « and replacement of obsolete built~in - . « equipment of existing buildings," up to 90% of cost. ‘Emphasis on making avail- able the latest advances in diagnosis and treatment, and on cooperative arrange- ments for research, training and related demonstrations of patient care. No .change. New emphasis given to optimum utili- zation of manpower and on improving health services for persons residing in areas with- limited health services. Rogers Yarborough Administration No change. Adds prevention and rehabilitation. Adds authority to include "new con- struction of facilities for demonstrations, research, and training when necessary to carry out regional medi- cal programs." Adds prevention and rehabilitation. New emphasis on regionalization so as to improve primary care and its relation- ship to specialized care. New emphasis on improving the quality and enhancing the capacity of available health manpower and facilities, and on im- / proving health services for persons residing in areas with limited health services. No change. Adds prevention, rehabilitation and methods of patient care. Includes a broad {combination of ‘}planning, research, Gevelopment, train: yo and demonstrations patient care. New emphasis on cooperative, planni: and experimentatioc: related to develop: health care system including closer coordination or. in! gration of RMP and CHP planning acti- vities. Present Staggers 3. Non-Interference Clause , Duration - Auttorization Levels (in -millions.) Funding Mechanism To accomplish the goals of the program "without interfering with the patterns, or the methods of financing, of patient care or professional ‘practice, or with the administration of hos- pitals ee . " ene Grants, with two-year availability of funds. No ;change. Three-year extension. Chronic RMP Diseases Total FY'71 $125 .§ 50 §$ 175 FY'72) 150 | 50 200 FY'73 275 _ 50 _ 225 $450. 150 $ 600 Grants for RMP with only one-year availability of funds. Grants and contracts for the new authorization of the. Chronic Disease Programs. Would permit Regions to ob- tain services~in-kind from Federal agencies. (RE Pe reat a oe eee * Rogers Yarborough “Administratic No change. . | Three year extension. FY'71 $ 150 FY'72 200 FY'73-° |_350 “$ 600 Grants, with two-year availability of funds. Would permit Regions to obtain services-in- kind from Federal agencies. ‘No change. Five year extension FY'71 $ 150 FY'72 200 ‘FY'73 250; FY'74 250 FY'75 250 $1100 Includes stipulation that no more than $15 million shall be avail- able for kidney disease activities in FY'71. Provides specific con- tract and separate training grant authority, as well as RMP grant authority, with only one-year availability of funds. Would permit Regions to obtain services-in-kind.. Omits “non-interé clause entirely. Three-year authc tion for. total package, with su sums aS may be necessary. Adds contract authority for th conduct of ccope ‘;clinical and fie. studies and demo: tion. Maintains two-ye: availability of ; Would permit Regi to obtain servicé in-kind. Present | Staggers Funding Mechanism (Con't.) &. Regional Advisory Groups (a) Comsosition health..." Requirement there must: include "practicing physicians, medical center officials, hos—- pital administrators, representatives from appropriate medical societies, voluntary and other health-related agencies " and members of the public..." faniliar with health needs. Adds a provision that the procedures of the RAG must provide a reasonable opportunity for membership on the group to a repre- sentative of any health ir@lated institution which meets certain criteria. =e Rogers Yarborough Administration Specifically includes representatives of state and local health and health planning agencies, Specifically includes representatives of official health and planning agencies, and members of the public familiar with the need for and financing of the services provided under the program. Pro- vides that such public members be sufficient in| number to ensure adequate community orientation. “ Must be reasonable assurances that the applicant will seek other sources of financing for pro- jects under this tit: after a period of initial support whicl the Secretary by regulation determines to be appropriate. Specifically include representatives of official health and ‘health planning agencies Present. Staggers (b) Procedures Relatioaships ee, ‘to Comprehensive Health Planning a Has responsibility for approval of operational grants at regional level, None specified in law. Provides an appeal. mechanism to national level for proposals disapproved by the Regional Advisory Group. For application: to be approved, it requires that Regions must take into consideration the plans of relevant Areawide and State Health. and other planning agencies. Specific review and approval of such agencies is not required, however.. neal reid el ee 1 Rogers Yarborough Administration No chdnge. Before a RAG may recommend approval of an operational grant, opportunity must be provided for applications to be considered by the appropriate Areawide 314(b)) Comprehensive Health Planning agency. No change. pame as Rogers Bill. No change. Before a RAG may recommend approval, applications for establishment and operation of region: medical programs anc for services and facilities covered : such applications must, wnere appropri ate, be referred to the areawide health “ planning agency., if one exists, and to j/ the State*‘heaith / 1 planning agency, for their review and comment as to whethe the grant applicatic is consistent with the planning of thes agencies. — Present Staggers . Rogers 8. National Advisory jAdvisory Council No change. , / Provides for representation Council .{responsible solely on the NAC of: for RMP matters. , Sixteen members~— eS (1) leaders in health care leaders in fields of , administration, or fundamental sciences, community or other public medical sciences, or - affairs. public affairs. At , , least 2 practicing ot (2) persons outstanding in the physicians, one ex- study, diagnosis or treat- pert each for heart , ment of. other major diseases disease, cancer, and \ ‘istroke. ° 9. Seetion 907 - Lists of facilities |No change, ' : No change. Listing of equipped and staffed , , : Advanced to provide the most Facilities ’ Jadvanced methods of , diagnosis and treat- ment in heart disease, cancer and. stroke are , to be established, V : mL, A ‘ 10. Multiprogram Provides for grants “|No change. No change. Services for services needed (Section 910) by, or which will be —_ of substantial use - to, any two or more regional medical. pro- grams. Yaxrborough Administration Provides for representation on the NAC of: (1) (2) (3) leaders. in health care administration. one member outstanding in the study or care of kidney disease. three members of the public. : Adds kidney disease. ~ Provides for both grants and contracts for a broad variety of activi- ties including: (1) activities of use to two or more regional programs. New Advisory Council responsible for policy advice on all pro- grams under this title, and project re- view for RMP, NCHSR&D. and Sections 314(b) anc (c). Membership of 25 to include leaders in fields of fundamental sciences, medical sciences, the organi- zation, delivery and financing of health care, consumer affair: or public and community affairs. Provides authorization either directly or through contracts, to establish and. maintair such lists. Listing expanded to cover — disease in general, including national proportions and trends Provides new contract authority for the con- auct of cooperative elinical and field studies and demon- strations. Present Staggers Muitiprogram Services (Section 910) (Con't.) iil. Chronic Disease Focus None specified in Law. ' Provides a separate part of Title IX for Chronic Disease Programs, con- centrating upon training and clinical demonstration programs in prevention, diagnosis and treatment. in addition to heart disease, cancer and stroke, this covers diabetes, emphysema, kidney disease and other related diseases. Provides specific three- ‘year authority and annual authorization of $50 million for these purposes. Rogers Yarborough Administration No change. (2) (3) (4) (5) development or demonstration projects. collection of epidemiologic data. development of training. conduct of co- operative clinical field trials. No change. No change. i Present Staggers le. General Authorities All authorities and determinations under ‘Title IX, including the awarding of grants to Regional Medical Programs, are exerciséd by the Surgeon General of the Public Health Service. Authorities and determinations exercised by Secretary rather than Surgeon General. Rogers Yarborough Administration Same as Staggers Bill _ Same as Staggers Bill Same as Staggers Bill \.