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                                                  KtUlUlIAL IYILUIL,,
                                              LEGIc-LATIVE/BUDGET        STORY FOR 1972-1973
          0
   'E.                           Budget/Ap@ropriations                              Legislation/Autho  rl,zation
   @uary, 1972           President's Budget for FY 1973 requests
                         $130.3M for RVP.
   ust 16, 1972          First Labor-HEW Appropriation bill for
                         FY73 vetoed.  Contained $164.5M for
                         PIIP.
   .ober 27, 1972        Second  Labor-HEII Appropriation bill
                         vetoed  - Again $164.5M for RMP.
   @.ober 27, 1972      'Because of the   veto,  a   continuing
                         resolution  (H.J.  Res.  1331   signed
                         Oct.,  26,  1972)  went  into  effect.
                         Permitted appropriation at lovier-of
                         House  or Senate levels in first
                         appropriation  bill  -  i.e..,  $15OM-
                         for DIP which was House figure.
                                                PRESIDENT'S   BUDGET   FOR FY 1974 PROPOSES:
   iaary 29, 1973        (1) 'A reduced amended level of                 (2)  The termination 'of   RMP  in FY74.-
                               $55,358,000 for grants and
                               contracts in FY.1973, and

   rch I,-1973           House Subcommittee on Public
                         Health and Envionment (Rep.
                         Rogers, Chmn.) holds overview
                         hearings on FY74 health budget,
                         with Sec. Weinberger testifying.
   rch 81 1973-                                                          S. 1136, proposing one-year     extension of  12 PHS authori
                                                                         ties due to expire 6/30/73, including P.MP, introduced
                                                                         by Senator Kennedy with 15 of the 16 members of the
                                                                         Senate Labor and Public Welfare Committee cosponsoring.
                                                                         Authorization for RMP kept at $250M.


   'E                             Budget/Appropriations                                    Legislation/Authorization
                                                                           H.R. 5608  introduced in the House by Rep. James
   -ch 14, 1973
                                                                           -Hastings  with the cospons rship of the entire
                                                                                                         0
                                                                           Subcommittee on Public Health-and Environment.  Also
                                                                           extends 12  PHS  authorities  for  one-year,  with  RiliP
                                                                           authorization set at a level of $250M.
   -ch 22, 1973                                                            Hearings were  held  on  S.  1136  by  the  Senate  Health
                                                                           Subcommittee.  Secretary Weinberger testified.
                                                                           Committee  ordered   bill   favorably   reported.   Report
                                                                           #93-87.@
   -ch 27-, 1973                                                           Senate passed  S.  1136,  the  PHS  Extension  Act,  by  a
                                                                           vote  of  72-19  with  RMP   authorization-16vel   of.$250
                                                                           million'for FY 1974.

   rch 27,.1973           House Appropriations Committee held
                          heari.ngs on the FY74 budget relating
                          to RMP - Dr. Sencer, Dr. Margulies
                          testified.
   rch 27-2@,, 1973                                                        Hearings were held on    H.R..5608 by the House
                                                                           Subcommittee on Public Health and Envirohmen-t.
                                                                           Secretary Weinberger testified, as did Rt4P representa-
                                                                           tives.
   1 8, 1973                                                               Oversight hearings on    Regional Medical Programs hold
                                                                           by the Subcommittee on Public Health and.Envirotiment-,-'
                                                                           Testimony  by   Dr.   John Zapp  and  Dr.   Margulies-for
                                                                           HEW; a  panel  of  physicians  involved  in  RI,!P's;-and
                                                                           four   RMP   coordinators.
   y 15,  1973                                                             Representative Hastings (with       all members of the
                                                                           Subcommittee on Public Health       and Environment   Co-
                                                                                  ring) introduced H.  R.  7806  - a new PHS Extension
                                                                           sponso
                                                                           Act bill  -  in  lieu  of  H.R.  5608.. Set RMP authorization
                                                                           for FY 1974 at $159 million.


                                                                              Legislation/Authorization
   TE                          Budget/Appropriations
                                                                    H@.R. 7806 reported  unanimoIsly by.the.H6use Inter-
   y 24,  1973                                                      state and Foreign CommerceuCorrinit,T.'ee.  House Report
                                                                    f93-227.

                        An amendment was added to the second
   y 29,  1973          Supplemental Appropriations bill for
                        FY 1973 (H.R. 7447) in the Senate by
                        a vote of 59-14 which would add an
                        additional $20 million to the FY 1973
                        RMP appropriations
                                                                    House passed H.R. 7806, the PHS Extension bill by a
   @y 31, 1973                                                      vote of 372-1.  The bill would authoriz@.$159 million
                                                                    for RMP in FY 1974.
                                                                    Senate agreed to the  House version of the PHS Extensioi
   ine 5, 1973
                                                                                            ith its 1 vel of $1@9 million
                                                                    Act by a vote of 94-0.  w        e
                                                                    for RMP.

                                                                                            'esident.
                                                                    H.g. 7806 sent to the  Pr
   ine 6, 1973
   ine 81% 1973         Senate Labor-HEW Appropriation Sub-
                        committee held hearings which included
                        RMP 'n terms of the FY74 budget.
   ine 13, 1973         Senate Labor-HEW Appropriation Sub-
                        -comittee again held hearings which
                        included RMP for FY 74.
   une 18, 1973                                                     President signs S. 1136 in,@.o,law as P.L. 93-45, which
                                                                    inc7udes one-year extension of RMP-with authorization
                                                                    level of $159 M.

   une.,19,, 1973       Conferees on Second Supplemental
                        Appropriation bill fo@ FY 73 (H.R.
                        7447) del-ete $20 million added bv
                        Senate for..RMP (H. Rept. #93-29@).


                                Budget/Appropriations                           Legislation/Auth6rization
   rE
   ie 21, 1973          House Appropriations Committee
                        ordered the Labor-HEW Appropriations bill
                        favorably reported (H. Report #93-305).
   ie 26, 1973          House passed H.R4  8871,  the  Labor-HEW
                        Appropriation bill for FY74  by  a  vote
                        of 347-58.  Funds  were  included  for
                        RMP at a level of $81,953,000.
   ly 1, 1973           The President  signed.the  continuing.
                        resolution (H.J. Res. 636) following
                        compromise on the Cambodian Resolution;.
                        Congressional  interpretation  of  the
                         current rate"  under  the  continuing
                        resolution is the more restrictive   of
                        the FY74 House  passed  rate  ($81.935M)
                        and the  current  rate  ($150M).  Thus
                        Congressional interpretation of the
                        continuing rate for RMP would be the
                        FY74 House figure of $81.935M.


                  RELEVANT QUO'RATIONS ON REASONS FOR TEPtiINATIO@l AND COt4TINUANCE OF R14P

                  January 29, 1973 - The President's Budget
                  "No extension beyond June 30, 1973, of.the regional medical program
                    authorities is being request6d.
                    Over a period of 8 years, the Federal   Government,  by means of grant awards
                    and direct staff activities, promoted and developed 56 RMP'S, regional
                    cooperative arrangements among the Mation!.s health care providers and
                    institutions.  Originally established to upgrade the health care of
                    persons threatened by heart disease, cancer, stroke, kidney disease and
                    relbted diseases, the RMP's  in recent,years sought more to improve access
                    to and generally strengthen the health care delivery system.
                    Despite Federal expenditures in  excess  of  $500  million  for,these-'activities
                    however, there is little evidence that on a nationwide basis the RMP's
                    have materially affected  the  health  care  delivery  system.  Further  expender
                    of scarce Federal health resources on this program, therefore, cannot be
                    justified on the basis of available evidence."
                  January 30, IOJ73 - Mateeial Prep,-:ired for DHEW Presentation of President@'s  BLi
                  "The greatest expenditure of RMP funds has been in the area of continuing
                    education and upgrading,training of health personnel'.  It is not an
                    appropriate use of Federal funds to finance continuing education tor
                    professionals generally capable of firianciq_g his  own  education  to  improve
                    professional competence."
                  "As a result  of  various  legislative  and.administrative  decisions  in  recent
                    years, several activities for improving the quality of care previously
                    assigned to RMP are now being supported by other tir'_W organizations such as
                    the special NIH cancer and  heart  initiatives  and  the  system  of  Profes5iona
                    Standards Review Organizations  being  set  up.under  the  Medicare  authorities.

                  March 1, 1973 - President's- MessaSe to Conaress on Human Resources
                  "Regional Medical  Programs  likewise  can  now  be  discontinued.  The  planning
                    function they have performed can  better  be  conducted  by  comprehensive  State
                    planning efforts.,  A second function of these programs, the continuing
                    education of physicians Who are already licensed, is an inappropriate
                    burden for Federal taxpayers to bear.11
                  Martli 22, 1973    Secretary Weinbei-qeris.Testiniony before the   Senate SLib-
                                     co.,i@nittee oii-i-lealth  Coi,-iritte(-, on Lal)or and Public

                  "We are proposin the termination  of  the  Region,-]  Medical  Program  because  We
                    believe that it has not achieved itspronis'e v,,hen it Was  first  enacted  seven
                    years ago, and shows no reasonable chance of doing so in the future.  Frora
                    the outset, the RMP has had great difficulty  in  defining  a  clear  role  for
                    itself.
    'O
                                       I
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          4
                                             covet-iri a limited number  of  major  regions  in  the
                   Originally conceived as .        9
                -'United Stailes, a total of  56  regions  were  funded.  In  34  cases,  the  regions
                   became coterminous  with  State  boundaries.  This  fact  alone  brings  RMP  into
                   direct conflict  with  State-based  and  areaiiide  health  planning,  coordinating
                   and service  programs,  such  as  comprehensive  health  planning.  There  is  no
                                                                                      'f   getting
                   significant evidence that the.RilPls have achieved their goal 0
                   research advances rapidly into regular medical practice.       The    training
                   programs undertaken are  typically  of  limited  scope  and  duration,  and  there
                   is no substantial evidence that  they  have  had  an  effect  on  actual  medical
                   practice.  Further,  we  believe  that  continuing  education  for   physicians
                   should be paid for by  Iphysicians and not by the Federal Government.
                   A major RPiPa'ctivity has been  the  funding  of  demonstration  projects,  but
                   many other HEW programs, and  many  different  Federal,  State  and  local  agericie
                   similarly  fund  demonstration  projects,  thus  adding  to  proliferation  of
                   separate projects.  In  the  final  analysis,  it  has  become  increasingly  appare
                   that Rt'iP's have not succeeded in  developing  the  efficient,  rationa'l  and
                   regional health systems which their original purpose sought."

                   -----------------------------------------------------------------------------

                   March 23, 1973 - Report of the E;eriate Committee on Labor     and  Public  Welfare
                                     on S.1136  Keport 1/93-87

                   "The Committee believes that it is essential and urgent       for it  to  upgrade,
                    improve and delete  when  necessary  the  provisions  of  the  PUblic  Health
                    Service Act  and  the  Mental  Retardation  Facilities  and  Community  Mental
                    Health  Centers  Act.  In  that  complic'ated  process,  which  is  now  underway,
                    the Committee  will  strive  to  consolidate,  recodify,  and  rationalize  those
                    legislative authorities in  a  nianner  consistent  with  the  appropriate  Federal
                    role in respect to the health needs of the American people.
                    The Committee is  hopeful  that  this  major  legislative  undertaking  will  resul
                    in fewer  but  more  productive  health  authorities.  The  Committee  is  convince
                    that this process  cannot  reasonably  be  completed  by  the  time  the  authentic
                    expire June 30, 1973. And  the  Committee  cannot  stand  by  while  the  Executi@,
                    branch  implements  decisions  which  could  effectively  terminate   existing
                    health programs before  Congress  has  an  opportunity  to  work  its  will."
                   May  25, 1973   Report of the House  Committee  on  Interstate  and  Foreign  CoFime
                                   on H.R. T80-6 (Fep-rrt.    9--227)

                   "Th is i sanother  program  which  the'Admi@-stration  has  proposed  to  terminate,
                    saying  that the program has failed  to  meet  its  original  intents;  regional.i2
                    health  se r v i ce s a n d -d i s s-eni i na t i ng - new b.i or,-,ed i ca I . know I c dge. . Fu r t he r , . they
                    feel that the program has wa@,ted  an  excessive  amount  of  money  on  administri
                    costs. The Committee will  be  reviewing  the  future  of  this  program  in-con'-
                    junction with the Comprehensive Health  PI'atining  and  the  Ili]]-Burton  p@gra,-
                    but feels that in the  meantime  the  proposed  6brupt'terniination  is  inappi-opr
                    Further, while some criticism  of  the  regional  medical  program  may  be  justif
                    it i's clear that it has had many individual successes  and  that  many  peor.)Ir-
                    become dependent upon it.    [.adequate provision has not been  made  for  fitidinc
                    alternative sources of            for the successful  parts  or  the  people  depcr
                    on the program. The presc,,it legislation  would  authorize  $159  million  f@oi  t

                                                         2


                     reg-ional medical programs in fiscal year 1974.

                                                                                                -itions  bill
                    June 19, 1973     Conference Report on Second Supplemental            ro)ri,
                                      H.R. 7/-T (I c ort  "'F,3-20,5
                    "Amendment  No.  29.  Delc@tes   appropriations   of   $20,000,000   for-regional   medic
                     programs and $1 5,000,000 for -construction of outpatient fac  i  I  i  ti  es  proposed
                     by the Senate.
                     In  agreeing  to  delete  these  additional  appropriations,  the   conferees   take   n
                     of  the  fact  that  $150,000,000  has  already  been  appropriated  for   fiscal   year
                     for  regional  medical  programs  and  $70,000,000  has  been   appropriated   for   con
                     struction  of  outpatient  facilities.  The  Congress  is   clearly   opposed   to   the
                     termination  of  these  programs.  Legi@lation   to   extend   the   authorizations   fo
                     them  through  June  30,  1974  has  been  passed  by  overwhelming  majorities  in   bo
                     the House of Representatives and the Senate.  The conferees urge that the
                     funds  which  have  been  appropriated  for  the  regional   medical,programs   and   th
                     Hill-Burton  program  be  released  for  obligation,   in   accordance   with   Congress
                     intent."
                    June 21, 1973     Report of the House    Appropriations  Comnittee  on   FY   1974   Labo
                                      HEW Appropriations    -  H.R. 8 77 (Pepc)rt @,; 93-30
                    "Health services planning and development.                  This   appropriation    funds
                     a  group  of  programs  ENCHSR&D  RMP  CHP,  and  Hill-Burton]  whose   common   purpose
                     is to  improve  the  delivery  of  health  care  and  to  make  the  most  effective  us
                     of available resources.
                    "The budget proposed no appropriations for regional medical programs for
                     fiscal year 1974.  The legislative authorization for the regional medical
                     programs has recently been extended through fiscal year 1974 by a nearly
                     unanimous vote of Congress.  While the Committee is aware that some of the
                     regional medical programs may not have       been  as  productive  as  they  should   be
                     others have been highly successful.   In      any  case,  the  Committee   believes   th
                     the original objectives of the regional       medical  programs'are   still   valid,   a
                     that the Department should seek to improve the operations of the programs
                     rather than terminating them.       The  Committee  has  included  in  the  bill  the  s
                     of  $81,953,000  to  conti@ue  the  funding  of  the  regional  medical   programs.   'T
                     Committee urges that every effort be made to strengthen and improve the
                     weaker prograi-7113.

                     Second Supplemental Appropriations Act - P.L. 93-50-July ],-1973
                    "Health  Services  Planning   and   Developmc>nt   For an additional.amount for
                     "Health'services  planning  and  development",  for  carrying  out,   to   the   exte'nt
                     not   other'wise provided, section '1;04 and title IX of the Public.@lealtli       Servi
                     Act, $17,.000,000, to remain available until expanded."
                    The  Senate  Report  (No.  93-160)  plus   floor deb2te indicate that these fund,-;,
                    are for the following items:

                          (1)  $12,0-00,000  to  permit   comp]6tion of the new Cfilldren's Hospital  [,-,'at
                              Medical Center in Washington, D.C.

                                                           3


                      (2) $4,500,000 to meet the initial needs for a childrerils medical center
                                                            I                  :p
                          serving the northwestern regions ol the U.S. "Plans a e now undcrwa,
                          to transform the Children's Orthopedic Hospital Center into a
                          children's regional health service center, comparable to the
                          Children's Medical Cen@'er in Boston.  The committee recognizes that
                          existing facilities are hopelessly outmoded and inadequate and that
                          some corrective action must  be tat-,en iri,,@nediately.  For this reason
                          the Committee recommend,- that $11,500,000 be provided to meet the
                          critical, immediate needs of this facility."

                      (3) $500,000 to 'complete a hospital in northern Vermont - the North
                          Country Hospital and Health Center at Newporti Vermont   by
                          provding additional grants for hospital construction.

                                                   4