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vraft Proposal for a

Health Resources Planning Organization

PURPOSE: The organization proposed is to be a bureau level stencture
Sem ae 4 .
Witnin the Health Resources Administration designed to improve both the

planning and the development of health resources in the nation through

the administration of existing statutory authorities as well as H.R,

 

16204 or substantially similar pending legislation. Legislation current

being considered clearly dictates the need to perform the following

1. Develop, format, promulgate, coordinate, and revise as necessary
a sufficient body of policy, regulations, guidelines, and opera-
tional procedures to facilitate the practice of the legislative
intent, °

2. Provide for the establishment, development, assistance and fiscal

Support of health planning agencies in States and designated

Systems and resources which meet identified needs and eliminate

known deficiencies within their zones of influence.

Br

3. Monitor, assess, evaluate, and regulate within the context o
existing law the progress and practice of the established

agencies.

4. Provide for research, analysis, Synthesis, promulgation of infor.

mation and related steps to assist and encourage health

rey

agencies toward an effective use of health planning expertise iad

methodology,

 

 

 
No
i

ORGANIZATIONAL PHTLOSOPHY: To accomplish its mis sSion, the Central

Office (CO) structure wil ob

a

flat to provide for rapid communication
and active Fesponse to regional staff needs. Such a structure will be
devoid of management layering with clear lines of communication and well
articulated delegations. The Central: Office Structure should also prenots
horizontal] cooperation, communication, and interdependence, and discourage
the formation of "turf" problens. Lastly, the Organization should provide
the capacity for its leadership to delegate authority and responsibility
as completely as possible, and to as low a level in the structure as is
feasible, while retaining an ability to become involved in critical issues
Two facts dictate this philosophy: 1. The Staffing of the Central
Office, in terms of numbers, will be smal]. 2. The program scope is
wide and diverse, Both facts speak for an exceptionally tight knit organi-
zation with maximum use of every position. Much must be accomplished
through the small * group intrapersonal relationship of activity and
interest that in larger organizations is relegated to structural entitle
€.g. program coordination embodied in a "coordination staff". ‘The bureau
Will be strongly centralized from the standpoint of policy and program
coordination, but its operations will be decentralized. The Central-
Office will provide basic policy and programmatic goals, regulations,
and guidelines. The regional staffs will translate these basics into
active assistance to the agencies. The regional staffs will observe
and assess the activities of the agencies and, through synthesis and
Structured reporting to the CO, provide the necessary information to test,
and as necessary, bring about the revision and improvement of Policies and

— regulations. The Central Office/Regional Office (RC) relationship, like that

|
-~53-
of the eye and the hand, is not based on the superiority of. one or the other.
The success of that relationship is dependent on the rapid and accurate
transmission of information which serves the needs of both in order to
attain the goals of the program...
4m8
Structure: See attached chart?
Basic Component Functions:

1. Office of The Bureau Director:

 

Provides executive leadership and direction for the programs and
activities of the Bureau. Specifically: (1) Coordinates the functioning
of the bureau both internally and in the context of other national health
programs; (2) Develops program objectives, alternatives, and policy
positions consistant with broad administration guidelines; (3) Evaluates

program accomplishments; (4) Develops and administers operating policies

and procedures and provides assistance to bureau constituents to achieve

> ~

effectiveness and economy in the management of bureau programs; (5)
Provides selected management services for bureau constituents and carries
out necessary coordination with respect to management services provided
for the bureau by higher headquarters; (6) Serves as principal contact
and advisor to the Department, the Health Resources Administration and
other PHS agencies, The National Council for Health Policy, and other
interested parties on matters relating to planning and development of
health systems (7) Directs and coordinates bureau activities carried
out in support of equal employment opportunity programs; (8) Provides
guidance and assistance to DHEW regional offices in executing the
Bureau's responsibilities for the efficient and effective conduct of
the Bureau's programs; (9) Provides,. through appropriate channels,

information about bureau programs to the general public, health profes-

 
~4-
sions associations, and other interested groups and organizations; (10)
Establishes and coordinates requisite external relationships; and (il)
Plans, develops and maintains a system to ensure coordination, training
and management of clerical services throughout the Bureau.

. . . ves
Policy Coordination Staff ‘

 

Serves as the focus for bureau-wide policy coordination and the
management of controlled correspondence having potential policy involve-
ment or impact. Functioning as one of Bureau Director's primary staff
ares: (1) Coordinates, performs analyses of, and assesses the impact of
diverse program policy on the mission of the bureau; (2) Brings to the
attention of the Bureau Director and Executive Staff policy issues which
have not found resolution at lower levels; (3) Evaluates trends and

indicators of potential policy problems and issues needful of revision

or lateration; (4) Negotiates and maintains a program of planned change

* &

in programmatic policy; (5) Assures that bureau personnel are informed

and kept aware of policy evolution on a periodic basis; (6) Serves as a
focal point for communicating with other HEW components with regard to
policy clearance. In support of its policy coordination functions: (1)
Receives and reviews controlled correspondence and makes action assignments
and follows up to assure timely and appropriate action; (2) Establishes
Standards for and ensures the quality of written communications and is-
suances throughout the bureau; (3) Maintains for the Director a docket of
pending requests and a structured device for insuring timeliness of response;
(4) Establishes and maintains central files for the Bureau Director; (5)

Establishes and assures implementation of bureau and administration corres-

pondence procedures and policies.

 
oon

~5-

Evaluation and Legislation Staff

 

(1) Serves as The Director's primary staff unit and principal source
or advice on program evaluation and legislative affairs; (2) Oversees and/or
conducts communications between the Bureau and higher levels of government

ve
on all matters that involve evaluations of program performance; (3) Main-
tains liaison with other Federal and non-Federal health agencies on matters
within its area of responsibility; (4) Prepares and directs the implementa-
tion of comprehensive program evaluation strategies to obtain needed eval-
uative data; (5) Monitors On-going information systems which produce evalua-
tive data about the Bureau's programs; (6) Identifies problem areas in
‘

achieving bureau and program objectives and recommends actions to be taken
in response to those problems; (7) Monitors, and makes recommendations for

needed change in, legislation affecting the bureau's programs; and (8)

Provides leadership for task oriented problem resolution at the discretion

. ~

of the Director.

Office of Management

 

Plans, directs, and evaluates the administrative management support
activities of the bureau. Serves the bureau by providing or acquiring
Services and resources in the requisite management areas: (1) Plans,
directs, and coordinates those personnel management and training programs
which meet the particular needs of the bureau; (2) Plans, directs and
coordinates property management and procurement programs required for the
bureau's operation; (3) Conducts organization and management surveys and
prepares necessary systems and controls to maintain and further the or-

ganization and management practices of the Bureau: (4) Provides, through

the Office of the Administrator, HRA, a program of financial management

for the bureau, inclusive of budget planning, formulation and execution,

 
~6-
and administration of evalustion set aside funds; (5) Serves as the focal
point in the bureau for the development of ADP systems and policy, planning
and evaluation; (6) Develops procedures for and maintains the bureau's
reports management systems; (7) Coordinates the bureau activities in
management planning and prepares, with requisite inputs, such documents
as the forward plan, OPS, and bureau contributions to higher level plan-
ning activities; (8) Conducts bureau management improvement programs;
(9) Participates in program and legislative planning to assure recogni-
tion of management and resource problems; and (10) Maintains necessary
extra-bureau liaison to acquire clearances and support of its activities.
‘
Office of Operations Monitoring
Provides a bureau focal point for coordination of operations

activities: (1) Plans, directs, and coordinates the bureau monitoring

and assessment programs; (2) Participates in bureau Executive policy

?

formulation by advising on the operational implications of the bureau's
plans and programs; (3) Devises, controls, and operates the necessary
systems of management control and information; (4) Through the operation
of MIS and monitoring activities, provides the bureau with an effective
source for the transmission of routine information; (5) Collaborates with
the program divisions to establish criteria, parameters, and content
of information required for the effective monitoring of program operations;
(6) Maintains close liaison with the Office of Regional Operations (ORO)
HRA; and (7) Provides analytical and advisory capacities where operational
matters involve interprogram conflicts.

Division of Planning Methods and Technology

Provides a bureau and National focal point for the development and

dissemination of technical materials, planning approaches, methodologies,

 
~7-

policies, standards, and guidelines for the appropriate planning of
health resources and scrvices. The subject of such activities include,
but are not limited to: (1) The provision of primary care services

for medically underserved populations; (2) The development of multi-
institutional systems for coordination or consolidation of institutional
health services; (3) The development of medical group practice whose |
services are appropriately coordinated or integrated with institutional
health services; (4) The training and increased utilization of physician
assistants; (5) The development of multi-institutional arrangements for
the: sharing of support services; (6) Improvements in the quality of
health services; (7) Theidevelopment of health service institutional
capacity to provide various levels of care on a geographically integrated
basis; (8) The adoption of uniform cost accounting, reimbursement, and
utilization reporting systems; and (9) Effective methods for educating
the general public on basic personal health care and use of available
health care resources. The division will produce guidelines for the
conduct of planning processes and also will specify the minimum data
needs for determining the health status of residents of health service
areas, for determining the status of health resources and services, and
for describing the use of such resources and services. The Division is
responsible for the establishment, coordination, and consultative direction
of the National Center for Health Planning Information and the Centers
for Health Planning and provides technical assistance and technical
materials to the Health Systems Agencies and state agencies for use

in health planning.

 
oom

Division of Agency Development

 

Provides a Bureau focus for the management and operational develop-
ment of health systems agencies and state agencies: (1) Provides a
central referent and problem resolving source of comparitive information
On agency management and operational development; (2) Prepares prototype
plans of organization and operation of agencies; (3) Provides determinants,
alterations, and interpretations of guides to meet the needs of a broad
variety of agency situations and levels of development; (4) Participates
in the development and maintenance of agency performance standards and
assessment criteria; (5) Provides assistance, information, guides and
interpretation including, but not limited to; guides to incorporation,
revision of by-laws, staffing patterns, personnel policies, organization
models, administration manuals, salary determination, position descriptions,
and agency policy and procedures; (6) Serves as a consultative resource
on agency development matters as they relate to other programmatic divisional
activities; (7) Coordinates activities closely with other program divi-
sions to assure that agency development activities are properly inclusive
of emphases which benefit and further all programmatic activity; and (8)
Participates in establishing MIS reporting that is conducive to agency

development and problem determination and resolution.

 
\
NN

DIVISION OF FACILITIES DEVELOPMENT

serves as the bureau focal point for guidance, assistance, and standard
setting for the construction, modernization and expansion of health care
facilities. (1) Participates, with the Division of Planning Methods and
Technology, in the development and maintenance of criteria, standards and
guidelines to be used by state health planning and development agencies
and health systems agencies in preparing and administering facilities plans;
(2) Coordinates the financial feasibility reviews and project approval
requirements for Section 242 of the National Housing Act and carries comparable
responsibilities for direct loans and loan guarantees administered by DHEW;
(3) Maintains liaison with Treasury, the Federal Financing Bank, HUD, FNMA,
GNMA, and other agencies regarding development of policies and other guide-
lines; (4) Serves as. the Bureau focal point in providing technological
assistance in the operation of health care facilities, by providing leader-
ship in the architectural, engineering, and equipment aspects of the health
facility construction program; providing consultative assistance to repre-
sentatives of foreign governments to federal, state, and local officials
and to the public; conducting studies on the design and construction re-
quirements of health care facilities; and maintaining liaison with State
hospital associations, and professional and technical organizations con-
cerned with the design, construction, and equipping of health care
facilities ‘in order to be aware of technological developments and needs
in order that they may be provided for in minimum construction requirements;
(S) Participates in the analysis of data on the Nation's health care
facility needs and resources, the evaluation of programs in relation to

health care facility needs, the development of measures of adequacy for

 
-~10-

the health care facility system, the developmental analyses in support

of legislative program proposals and appropriation requests for the

Office of Management and Budget and congressional presentations, the pre-
paration and testing of allocation formulae for use in the administration

of the grant, loan, and loan guarantee programs, evaluative studies developed
in the annual evaluation plan; and the conduct of miscellaneous studies
attendant to program development; (6) Collaborates with the Office of
Operations Monitoring in providing guidance for the effective monitoring

of facilities grants and loan programs; and (7) Coordinates its activities

_Wwith programs within the Bureau, the Department and other agencies and

groups concerned with health care facilities.

 

Division of Regulatory Activities

Functions as the focal point for all regulatory activities of supported
agencies: (1) Creates and maintains standards for certificate of need
and 1122 agreements; (2) Prepares, and modifies as needed, criteria and
guidelines for review and approval activities; (3) Serves as a consultative
resource regarding rate review practices, standards and utilization; (4)
Through analysis of review and approval activities, identifies trends and
developments which, through cooperation with Planning Methods and
Technology Division, will assist in priority setting or development of
needed planning reserach; (5) Participates in the development of and/or
reviews programmatic guides, performance standards, and criteria to
provide comment on, or reaction to, regulatory impact; (6) Establishes
minimum standards for adherence to Federal regulations; and creates

models for optimum performance of regulatory intent; (7) Prepares and

 
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revises monitoring criteria for inclusion in the MIS which will provide
requisite information for regulatory assessment and evaluation; (8)
Participates in Executive Staff consideration of policy changes or
programmatic alterations which impact on regulatory activities
and (9) Suggests legislative conSiderations which will further attainment

of regulatory goals.
 

 

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