0







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                                                                                Telephone 725-0680
                                                                                 Area Code 901



                         MEMPHIS REGIONAL MEDICAL PROGR'AM
                          FOR-HEART DISEASE, CANCER AND STROKE

                                1300 MEDICAL CENTER TOWERS
                                   969 MADISON AVENUE
  AES W. CULBERTSON, M.D.,       MEMPHIS, TENNESSEE 38104
  rogr,am Coordinator


  ,AES W. PATE, M.D.,
  :hoirmon, Central Committee                        April 21, 1971







          Harold Margulies, M. D., Director
          Regional Medical Programs Service
          Parkl-awn Building-  Room 11-05
          5600 Fishers Lane
          Rockville, Maryland  20852

          Deat Dr. Margulies:

                            On February 24 I sent to you a memorandum
          including eleven vignettes on programs or activities which we
          have that relate to the new national directions ftr Regional
          Medical Programs as stated in the narrative portion of the
          FY-1972 Presidential Budget.

                            After I returned from the recent meeting of
          RNP Coordinators in Atlanta, I asked our information officer to
          6xamine our program with respect to activities that appear to
          relate to items in the President's recent health message.  For
          your information I am enclosing his report in a memorandum
          dated April 7 in which he summarizes fourteen activities of
          the,Memphis Regional Medical Program which we believe are perti-
          nent in this regard.  We have been working on new directions and
          new emphases in the Memphis Regional Medical Program since the
          second Airlie House Conference in May of 1970.  I believe that we
          are now in a position to demonstrate some substantial results of
         .these ef forts.


                            This brings very best regards to you.

                                          Yours sincerely,




                                               W. Culbertson, M. D.



          JWC:hm
          Encl.






                                                                                       telephone 725-0680
                                                                                        'Area Code 901



                            MEMPHIS REGIONAL ML'--DICAL PROGRAM
                 FOR HEART DISEASE, CANCER, STROKE AND KIDNEY DISEASE

                                  1300 MEDICAL CENTER TOWERS
                                     969 MADISON AV@@NUE
   W. CULBERTSON, M.D.             MEMPHIS, TENNESSEE 38104
  irom Coordinator & Director


  5 W. PATF, M.D.
  irmon, Planning Board                  MEMORANDUM

     TO:             Dr. James W. Culbertson, Pro-ram Coordinator

    .PROM:           Clayton Braddock Information Officer

     SUBJECT:        New Directions for Memphis RMP


     DATE:           April 7, 1971

            This should be considered a supplement to my memorandum of February 17.
     To indicate the increase in the tempo of activity in our program, I should point out that
     most of the following either developed or came to the fore since that memorandum was
     written.
    0       The new information presented here is divided into simple groups under the
     following headings: Innovative health-care delivery systems, the accessibility of hea_ 1
     care, the manpower crisis, and new project proposals. The last group,of course, have
     not completed the review process, but have substantial merit and are described as
     indicators of significant ferment among Memphis RMP's constituency.

     INNOVATIVE HEALTH-CARE DELIVERY SYSTEMS

     Model Health Service System-- L-i the past few days, the mayor and other officials of the
     City Of Corinth, iMiss. , have invited Memphis RMP to coordinate and assist in the
     development of a model health service system in a 10-county area around that city,
     participatin- in the venture with other federal a-encies such as Housing and Urban Development
                0                                   t3
     and the Appalachian Regional Commission. No opportunity and challenge has elicited
     such enthusiasm and excitement from members of the core staff.

     Health Maintenance -- To continue its deep interest in Health Maintenance Organizations,
     Memphis RMP is completing plans to provide special training in the HMO program to
     selected members of the core staff. These persons will provide consultation to interested
     groups in the region, including a number of physicians who have requested information.
     We have invited an HMO specialist from the re,-lonal office in Atlanta to speak to the
     Memphis RMP staff and some staff members will attend a conference on HMOs in
        oxi, Miss., on April 21 and 22.

     Health Delivery Management -- Although our involvement in the proposal to create
     Health Systems Mana-ement, Inc., was sketched briefly in the February 17 memorandum,





      catalytic role Nvliich included stimulti@ for the o'ricdnal idea, major assistance in research
       nd formal writin.- of the proposal.  This pro.-ram now has a deep commitment to the
      *concept of IISM, Nvliich is a local version of the Experimental Health Services Plannino,
      and Development System.  Memphis RMP is mal@- firm plans for the eventual fruition
      of HS.LNI, includin- a substantial role as the evaluative arm of the proposed agency.  HSM
      as proposed, would achieve "an integrated health care system (for the three-county,
      area of Metropolitan Mempliis)-xvhich will provide access to and equity of health services,
      the containment of unit and a(T(Tre,,Tate costs, and the maintenance of quality services.
      The application has been submitted by this pro-ram's Reaional Advisory Group and an
      initial site visit has been completed.

      Health Advisory GrouDs -- Memphis RMP is actively engaged in oro-anizin- such aroups
      in areas where they do not now exist.  A major interest of this pro-ram is to make such
      groups advisory bodies to as many health a-encies as possible in any -iven area, municipal,
      ,county, state and federal.  One outstanding example is the North Mississippi District
      No. 1 Health Advisory Group, which is in the process of bein- formed now in a six-count-y
      area.  This -roup Nvill serve as advisors to Memphis RMP,  the Mississippi Reoional
      Medical @,ouram, the Mississippi Comprehensive Health Planning Acr
                 t>                                                       ency, and possibly
      the Appalachian Regional Commission.  Memphis RMP staff again, was the catalyst
      in obtaining the a-,reement from both Mississippi RMP and Mississippi CHP to use the
                      0
      services of the new health advisory group.

      ACCESSIBILITY OF HEALTH CARE

            enc  Health Personnel Act -- Coincidin- with the aims and -oals of this Act,
                                                  0                   ZD
      the Memphis RMP is movin- in several directions to make health care more available
                                C>
      to the inner city sick poor.  The pro,-,ram has received requests from agencies in our
      region, including the Memphis and Shelby County Health Department and Wesley House
      (a stru-  ' g but effective neighborhood health center) for information about the EHP
           "glin
      Act.  Wesley House has asked for assistance in findin- and recruitin- personnel to
                                                          t>            t>
      work at the health center.  This program has developed and made available to the
      community highly qualified staff resource personnel iA this field who are already
      at work in the community.


      Consumer Educa
                     tion


      A. Because of the serious need in this area, a consultant has been retained to identify
      the regional needs in consumer education and the techniques which will be required to
      meet those needs.

      B.  Community and health leaders in Paraaould, Ark., have requested Memphis RMP
      in recent days to help them develop a consumer education project to meet the needs of
      12 Northeast Arkansas counties.

      The Sick Poor -- Since late February, Memphis RMP has been servin- as advisor
                                                                         0           y
      &ncy to a new organization established to help persons in poor Memphis neighborhoods
      rrparticipate more fully in the creation and direction of health and welfare efforts
      designed to help them.  Leadin- the new organization are the Memphis chapter of the
                                  C)
      @Tational Wplfnrt- 'Ri(y'ht.,z Oranni7nfiny, -n-nrl fkn lXt^-I, T----4-,,,- /IIYT'KT\







                                                   -3-
      *HE MANPOWER CRISIS

      The Memphis RMP, in cooperation with health  providers  at  the  University  of  Tennessee
      Medical Units and leaders of the consumer community, has requested Secretary John
      A. Volpe of the Department of Transportation to include the Memphis Mid-South
      rea,.on  in  the  MAST  air-ambulance  pro-ram.  Although  the  present  MAST  proaram  has
      been limited to five sites, the proposal to include Memphis will be considered when expansion
      studies are completed.


      iN'E, W PROJE C TS


      The following new proposals, now in the early phases of  the  review  cycle,  are  described
      here, not only because of their own merits as potential demonstrations of effective health
      care techniques but because they also touch on many aspeP-ts of the new catalytic
      ferment described above.


      Leari,iin!,y Center -- As an additional component in the development of a  regional  medical
      information networl,., it has been proposed that a satellite learning center be  established
      at Jackson, Tenn.  The center would serve as a branch of Memphis RMP's Reaional
      Information System operatin-, out of the University of Tennessee Medical Units Library.
      This existing information pro-ram has been one of  the  richest  contributors  to  Memphis
         P's growing number of supporters and friends.

      C6ntinu@@ - Education (Physicians) -- The proponents, the Tennessee Medical Association,
      seek the coordination by some centralized office of all continuing medical education in
      Tennessee.  This central office would not be directly involvedin education, but it would
      serve as a catalyst, identifyin- needs and resources.  It,would encourage continuing
      education in general, especially "self education", and would assist in the evaluation
      of existing and proposed programs in the state.

      Improvement of Nursing Care -- This proposed projectis designed to "identify expectations
      for current and projected functions of nurses" in the reoion and to "assist nurses in
      gaining competencies to meet.these expectations. 11  Procrram  approach  'mcludes  collab-
      oration vv ith administrators and physicians and preparation of nurses to assume expanded'
      roles in health care delivery.

      Nursing In-Service Education-- Central to this proposal are facts -leaned from a
      regionwide survey by Memphis RMP staff showin- (1) the -reat desire of nurses for
      such in-service education (2) that no formal mechanism- exists for development of
      in-service education of this nature and (3) while most institutions  have  someone  assigned
      to this task, few have formal preparation for the job.

      Decentralized Health Services--This proposal would supplement existin- preventive
                                                                               Z>
      &vices by installing primary care operations in  certain  existing  neighborhood  clinics.
      Terrsons served would be ambulatory patients with  minor  complaints,  relyino,  primarily
      on clinical nurses and other paramedical personnel.   Such a project would also serve
      a@-, A        nnrl rp-f,-.rrnl fnt-.Illif-v rplioiri-no- than n"@ocii"a f"n@ 0;@r nf 'N/Tn@nk4o T-T^,-n4+,31,,









                           SUBCOMMITTEE ON LABOR AND HEALTH, EDUCATION
                               AND WELFARE, AND RELATED AGENCIES
                                 COMMITTEE ON APPROPRIATIONS
                                       92YI) CONGRESS









                                             Democrats

                             Daniel J. Flood (Pennsylvania) - Chairman
                             William H. Natcher (Kentucky)
                             Neal Smith (Iowa)
                             W. R. Hull, Jr. (Missouri)
                             Robert (Bob) Randolph Casey (Texas)
                             Edward J. Patten (New Jersey)



                                            ReRublicans

                             Robert H. Michel (Illinois)
                             Garner E. Shriver (Kansas)
                             Charlotte T. Reid (Illinois)
                             Silvio 0. Conte (Massachusetts)


                                             Robert M. Moyer, Clerk
                                             Henry A. Neil, Clerk







                                        LABOR-WELFARE SUBCOMMITTEE OF THE
                                           HOUSE APPROPRIATIONS CO M TTEE
                                                      92ND CONGRESS












                                                         DANIEL J. FLOOD (Democrat)  of Wilkes-Barre
                                                         Pennsylvania.   Born in Hazleton, Pennsylvania,
                                                         November 26, 1903.   Received early education
                                                         in    public    schools     of     Wilkes-Barre,     Pennsylvania,
                                                         and St. Augustine, Florida.   Graduate of
                                                         Syracuse    University,    A.B.    and     M.A.     degrees,
                                                         and later attended Harvard Law School and
                                                         Dickinson Schoo   o         aw,  Carlisle, PehsylvaniA,
                                                         graduating    in    1929    with    L.L.B.    degrees.    Admitted
                                                         to the bar of various State and Federal Courts
                                                         in   1930.   Attorney    for    Home    Owners'    Loan    Corpor-
                                                         ation 1934-35  Deputy Attorney General for
                                                         Pennsylvania    and    Counsel     for     Pennsylvania     Liquor
                                                         Control    Board,    1935-39;    Director,     Bureau     of
                                                         Public     Assistance     Disbursements,      State      Treasury,
                                                         and    Executive    Assistant    to     State     Treasurer,
                                                         Pennsylvania,     1941-44;     married     Catherine      H.
              Dini6i J. Flood                            Swank   on   September   24,   1949;    member    of    many
              o-,P Plilke.9-Barre (lith Dist.)           local civic,  fraternal, beneficial, and social
              D,--mo(,.rat - l@lth term                  societies.   Elected to 79th,  81st,  82nd,  84th
                                                         Congress and re-elected to succeeding Congresses.
                                                         Former Vice Chairman of Special Committee to
                                                         investigate Katyn Massacre (murder of Polish
                                                         officers by Russians).   Also member of Subcom-
                                                         mittee on Defense,  Committee on Appropriations.














                                                                                                           2





                                          WILLIAM H, NATCHER (Democrat) of Bowling  Green,
                                          Warren County, Kentucky; born in Bowling  Green,
                                          Kentucky, educated in the public schools of
                                          Bowling Green, Kentucky, and high school at
                                          Ogden Preparatory Department; A.B. degree,
                                          Western Kentucky State College, Bowling  Green,
                                          Kentucky; L.L.B. degree, Ohio State  University,
                                          Columbus, Ohio; married to Miss Virginia  Reardon,
                                          of Bowling Green, Kentucky, on June 17, 1937;
                                          two daughters: Celeste White, 26, and Louise
                                          Lewter, 22; practicing attorney, Bowling  Green,
                                          Kentucky, since March 18, 1934; Federal  concili-
                                          ation commissioner 1936-37 for Western  District
                                          of Kentucky; elected county attorney of  Warren
                                          County in 1937 and served three four-year  terms,
               Iv@il.liam H. Natcher      elected Commonwealth attorney of the 8th  Judicial
                     rr(,,en (.9d Dist.)  District, composed of Allen and Warren  Countries,
                        10ti! term        in 1951 and served until August 15, 1953,  having
                                          been elected to Congress; Baptist; member of
                                          Kiwanis club, Odd Fellows, Americal Legion
         Post 23, and 40 and 8 Mammoth    Cave Voiture 1146; past president of the  Bowling
         Green Bar Association; past president of the Young Democratic Clubs of
         Kentucky ' 1941-46; during World War II served in the United States Navy  from
         October 1942 to December 1945; elected to the 83d and succeeding  Congresses,
         Also member of Subcommittee on Agriculture, and Subcommittee on District of
         Columbia (Chairman), Committee on Appropriations.




           NEAL SMITH (Democrat) of Altoona,  Iowa;
           born March 23, 1920, at Hedrick,  Iowa;
           married Beatrix Havens, two children,
           Douglas and Sharon; farmer and lives  on
           farm near Altoona,  Iowa;  engaged  in  the
           practice of law in Des Moines, Iowa;
           graduated  Drake  University  Law  School;
           attended  @'ssouri  University  College  of
           Liberal Arts and Syracuse University
           Schools of  Public  and  Business  Adminis-
           tration; 4-H Club  member  and  leader  for
           ten years, farm operator since 1937
           except for time  and  armed  services  and
           some of the time in college; spent     four
           years in World War II, citations include             ?4eal Smith
           nine battle stars, Air Medal, 4 Oak Leaf             Of )47,to6)na (Iltk D@@@t.11
           Clusters, and Order of the Purple Heart;
           elected  National  President  Young  Demo-
           cratic Clubs of America 1953--served
           usual two-year term 1953 to 1955; former chairman, Polk County Board of Social
           Welfare (a nonpaying  civic  board  which  distributed  several  million  dollars
           per year to needy families and elder citizens); former assistant county attorney
           for Polk County, Iowa; member of Disabled American Veterans, Masonic Order, and
           various farm, school, and  service  organizations;  elected  to  86th  and  succeed-
           ing Congresses. Also  member  of  Subcommittee  on  State,  Justice,  Commerce,  and
           the Judiciary, Committee on Appropriations; and Select Committee on Small Business.


                                                                                         0







         W. R. HULL, JR. (Democrat) of Weston,
         Missouri; born in Weston, Platte County,
         Missouri, April 17, 1906;  widower;
         children, Mrs. Susan Hudson and  W. R.
         Hull 3d; elected to the 84th Congress
         and succeeding Congresses.  Also member
         of Subcommittee on Agriculture, Com-
         mittee on Appropriations.








                                                        W, R. Hull, Jr.
                                                        oF Weston (6t7i Dist.,
                                                                 9t7,z term










                                           ROBERT (BOB) RANDOLPH CASEY (Democrat)  of
                                           Houston, Texas; born in JoDlin,  Missouri,
                                           July 27, 1915, son of Sam R. and Mabel  E.
                                           Casey; moved to Houston, Texas, in 1930,  and
                                           graduated from San Jacinto High School;
                                           attended the University of Houston and the
                                           South Texas School of Law at night; was admitted
                                           to the State bar of Texas in 1940; opened law
                                           office in Alvin, Texas, and served as city
                                           attorney and also a member of the school board;
                                           returned to Houston as an assistant  district
                                           attorney in Harris County, in charge of the
                                           civil department; in 1948 was elected to  the
                                           State house of representatives and served  in
                                           the regular and special sessions of the  51st
                 Bob Casey                 Legislature; elected county judge of Harris
                 of Houston (22d Diet.)    County in 1950 for a two-year term; re-elected
                 Do,-qoo.rat - 7th term    in 1952 and again in 1954 for a four-year term;
                                           member, First Christian Church; married Hazel
                                           Marian Brann on August 13, 1935, and have ten
         children--Hazel Mary, Robert, Jr., Catherine, Bonnie, Mike, Shawn,  Bridget,
         Eileen, Timothy, and Kevin; elected from the newly created 22d district to
         the 86th Congress and succeeding Congresses.  Also member of Subcommittee on
         Legislation, Committee on Appropriations.






                                                                              4

















                                                            N
                                           EDWARD JAMES PATTE  (Democrat),of Perth
                                           mboy, Nj.; born in Perth Amboy, August 22,
                                           1905; graduated from Newark State College,
                                           Rutgers Law School, L.L.B., and Rutgers
                                           University, B.S. ED.; member of Eagles,
                                           Moose, Elks, Kiwanis, Knights of Columbus,
                                           National Conference of Christians and Jews,
                                           Chamber of Commerce, and NAACP; lawyer,  1927;
                                           teacher public schools, 1927-34; mayor of  the
                                           city of Perth Amboy, 1934-40; county clerk  of
                                           Middlesex County, 1940-54; campaign manager
                                           for Robert B. Meyner, 1953 and 1957; secretary
                                           of state of the State of New Jersey,  1954-62;
                     ILI                   president, Salvation Army Board; past president
                                           of the Middlesex Bar Association; chairman  of
                                           the Middlesex County Democratic Committee,
          Edward J. Patten                 1934-36; member of the Democratic State
          of Perth Amboy (15th Digt.)      Committee and member of American Judicature
          Democrat - 5th term              Society; recipient of "Outstanding Citizenship"
                                           award from American Heritage Foundation and
                                           Blnai B'rith's "Brotherhood" award; married
                                           February 22, 1936, to Anna Quigg of South Amboy,
                                           N.J.; one daughter, Catherine M.; elected
                                           to the 88th Congress November 6, 1962;
                                           reelected to the 89th, and succeeding Congresses.
                                           Also member of Subcommittee on Military
                                           Construction




























                                                                             5







            ROBERT H. MICHEL (Republican) of Peoria,
            Illinois.  Born March 2, 1923, in Peoria,
            Illinois.  Graduate of Peoria Public
            Schools and Bradley University, B -S.
            1948, business administration.  Served
            in the enlisted ranks during World War II;
            awarded the Bronze Star, Purple Heart, and
            four battle stars.  Married, foux children.
            Elected to the 85th and succeeding Congresses.
            Also member of Subcommittee on Agriculture,
            Committee on Appropriations.                        Robp-rt !I. Michel
                                                                of !,(Peoria (1 8th Dist.)
                                                                Republican - 8th te-

                                              GARNER E. SHRIVER (Republican) of Wichita,
                                              Kansas. Born July 6, 1912,  in  Towanda,
                                              Kansas; married in 1941, three children.
                                              Attended public schools of Towanda and
                                              Wichita; graduate of University of
                                              Wichita in 1934 (post-graduate  study
                                              at University of Southern California  in
                                              1936) and Washburn Law School,  L.L.B.
                                              degree, in 1940.  Engaged in law
                                              practice since 1940; served for  three
                                              years in the U.S. Navy as an  enlisted
                                              man and officer during World War  II;
                                              State representative 1947-51 and State
                                              Senator 1953-60; member of  American,
                                              Kansas and Wichita bar  associations,
                                              Veterans of Foreign Wars, American
                                              Legion, National Sojourners, Albert
                Garner E. Shriver             Pike Masonic Lodge, Wichita  Consistory,
                of Wichita (4th Dist.)        De Molay Legion of Honor, and  College
                -!?P-pubLican - 6th tem       Hill Methodist Church; elected to  the
                                              87th Congress November 8, 1960 and
                                              succeeding Congresses.  Also member of
                                              Subcommittee on Foreign Operations,
                                              Committee on Appropriations.


            CHARLOTTE T. REID (Republican) of Aurora,
            Illinois; attended public schools of Aurora
            and Illinois College at Jacksonville, Illinois;
            under the name of Annette King, served as
            staff vocalist on NBC and appeared as a
            vocalist for three years on Don McNeill's
            radio program; active in civic and political
            affairs; married to Frank R. Reid, Jr. (now
            deceased), in 1938; two sons, Frank R. Reid III
            and Edward Tompson Reid; and two daughters,
            Patricia (Mrs. George Lindner) and Susan Reid;
            elected to the 88th and succeeding Congresses.
            Also member of Subcommittee on Foreign Operations,
            Committee on Appropriations.                             Charlotte  T.  Reid
                                                                     of Aurora (15th Dist.)
                                                                     RepubZican  -  5th   term












                                             SILVIO  0.  CONTE   (Republican)   of   Pittsfield,
                                             Mass.;  born  in  Pittsfield  November   9,   1921,
                                             son  of  Mr.  and  Mrs.  Ottavio  Conte;   attended
                                             public  schools  in  Pittsfield   and   the   Pittsfield
                                             Vocational  High  School,   graduating   in   1940;
                                             machinist  at  General  Electric   Co.   in   Pittsfield
                                             before  joining  the  Seabees  in  World  War   II;
                                             served  in  Southwest   Pacific;   attended   Boston
                                             College and Boston College Law School,
                                             graduating  in  1949;  admitted  to  the  bar.  same
                                             year;  in  November  1950  elected  to  the   Massa-
                                             chusetts  State  Senate;  served  as   Senator   from
                                             Berkshire District 1951-58; served as chairman
                                             of  Senate  committees   on   Constitutional   Law,
                                             Insurance, Judiciary, and as chairman of
                                             Legislative   Research   Council,    Specia    Commission
                                             Investigating  Health  and   Welfare   Trust   Funds,
                                             Commission  on  Fish  and   Game,   Commission   Investi-
                                             gating  Accident   and   Health   Insurance,   Commission
                                             Investigating  the   Increase   in   Tank-Wagon   Prices
                                             of  Gasoline  and  Fuel  Oil,   Commission   Studying
                                             Blue   Cross-Blue   Shield,   Commission    Investigating
                                             Discriminatory   Practices   in   Fraternities   and
                                             Societies in Massachusetts Colleges and
                                             Universities; selected by Massachusetts Junior
                                             Chamber  of  Commerce  as  outstanding   young   man
            Silvio 0. Conte                  of the year in 1954; member of platform
            of P-,"ttsfir,-ld (Ist -T)ist.)  committee  at   the   Republican   National   Convention
            ReT,ub'@ican ?th tem             in  1960  and  1964;  director  of  the   Pittsfield
                                             Girls'  Club;  director   of   Hillcrest   Hospital;
                                             member of Berkshire Bar Association, Massachusetts
                                             Bar Association, Federal Bar Association;
                                             maintains congressional office at 7 North
                                             Street,   Pittsfield,   Massachusetts;   married   to
                                             the  former  Corinne  Duval,   four   children,   elected
                                             to  the  86th  and   succeeding   Congresses;   delegate
                                             to Republican National Convention; 1968,
                                             member of Platform Committee; member of Appro-
                                             priations Committee; Subcommittees on            easury-
                                             Post  Office;  Foreign   Operations   and   Transpor-
                                             tation;  Select  Committee   on   Small   Business;
                                             Joint Commission on the Coinage; Migratory
                                             Bird Conservation Commission.





                                                                                            7







                                       APP,'L30P@@TIOI"iS

                                                    Hous e
                                 Labor-Health, E@@@Uca-t@,ion, and ',,4'elfa.,re

                                                Der.iocrp4-S
                              Daniel J. Flood (Pennsylv@-nd-a)      Chaix7aan
                              Williani 11. llatclier (Ker-tucky)
                              Neal S.T-i,,ith (Iowa)
                              W. R. liull, Jr. (Missouri)
                              Robe@,, (Boo) Randolph Casey (Texas)
                                             -L'Ien (lie-,, Jersey)
                              Edward J. Pat

                                               Republicans
                              Robert H. I-,Ijchel (Illinois)
                              Garner E. Shr4.ver (r,,ansas)
                              Charlotte T. Re@d (Illinois)                 t
                              Sil,,r4Lo 0. Conte (I,!assachusetts)






    0













    0













    0






                 CREATER DELAII-@'Al@J,7@ VALLEY: Dani.el John Flood (D),   es-Barre,
                                        Pennsylvania (Distri@ct 11)


                 I.    BACT,GROUND

                       A.  Grantee or Si-)oi7isor:  tJniversi.ty City Science Center
                       B.  Coordinator:   George 1,. Clai7,ijfler, l@,I.D.
                       C.  Boundaries:  eastern Pennsylvania, southern New Jersey,
                                         a,-id state of         c@
                       D   IliFtorv
                           1   Initial plaiini,n@, rate     1,@p i--:L I 1 9 6 7
                           2   Operational st@itu!-,'  April 1.969



                       A.  Support t@l-@roi-ioh FY 70: $7,303,000
                       B.  FY 71 level of si-@,ppol-t:: $.2,-I-G-.  (projected)
                       C.  Total support to date:  $9,4i2,357


                III. OR@t,IZATIO@l

                       A.  Regiollal@ Advisory Group
                           1. Chai.rrian:  1%7il.lia;R F. KelloiT, TI.D.
                           2. Co:@i-position (51 members)
                              a.  12 practicing I)Iiysicians
                              b.  10 medical center officiD.I.,,@
                              C.  8 hospital administrators
                              d.  3 voluntary health agency representatives
                              e.  2 other health workers
                              f.  10 public health officials
                              g.  6  members  of  the  public

                       B.  Core staff:  53.51 FIE



                  IV.  OPI@-V-,T-i-O@IAL ACTIVITIES
                       The Region currently has ni-7-ie.ongoiii,@, operational activities with
                         total funding lc,,7el- of           in direct costs.              nurses
                       -In coi-onar,,7 care unit operation accounts for 30% of these fui@ds;
                       most of the balance ($IJI4,000) is in two projects which concern the
                       establishment of     3. Ira @o   di-sea@L@.,_cen.ter,@;, on.e for pediatric pulmonary
                       disease.  The remaining four activities include the school for
                                                            -il dise
                       radiotlierapeutic technology,     ren,     -ase  retraining and reactiva
                       tion of women physicians, and general intensive care training for
                       nurses.









                V.   SEI,ECTED PEGIO@'@Y@L Clij',Pl@CTFRISTS

                     A.  Populat@toii: 8.5 mil.1-ic)n -- 92% white
                     B.  Ilea]-th resqurccs
                         1. 5 r@,edical schools
                         2. 165 silort-terin, non-federil. hospitals with 40,000
                            beds; 47/'. (76) of these involved in the P\Ml
                         3. 13, 'JOO prac tici-,,I(,, plays icii,@ -, (,@l. 1). 's and D. 0. 's)
                            28,500 registered iiursc@s


               VI.   ILLUSTI@ATIC)@',ITS OF ACTIVITY


                     The basic purpose of the Intensive Care Training Program was      to
                     provide instruction i-n nursing              of patients with acute
                     conditions, such as those arisi-Tic., from diseases of the heart, luii,,s,
                     kidneys, central. nervous systeir,. A totci-l- of 32 Registered Nurses
                     were trained in two el-even-week Gener-@il. Intensive Care Nursing
                     Courses.  At the completion of both eleven-week courses, written
                     evaluations of the entire course were completed by all. trainees.
                     It was the consensus that the course was richly successful and
                     that the objectives were niet to a high degree.




      v



                        KENTUCKY (01410 @IAJLEY l@IP).  William 1-1. N@i.tcher. (D),



                  BACKGROUND

                  A.  Grantee or Spon.sor:  University of Kentucky Research Fotmdatioii
                  B.  Coordinator:  1,Villian, @IcBeatli, M.D.
                  C.  Boundaries:  Most of Kentucky's 101 counties, 21 Indiana
                      counties, 16 Ohio counties, and 2 latest Virginia counties.
                  D.  History
                      1.  Initial planning award:  January 1967
                      2.  Operational status:  Januar)r 1969

              II. @,TING

                  A.  Support through FY70:  $2,660,000
                  B.  -n'71 leirel. of support:  @3i.@
                  C.  Total support to date:  $4,00@,188

             III.

                  A.  Regional i@dvisory Group-
                      1.  Chairman:  Donald 1. Lo@rry, Cincinnati, Ohio
                      2.  Composition (38 members)
                          a.  10 practi.ci-no physicians
                          b.  8 medical center officials
                          c.  7 hospital administrators
                          d.  1 other health worker
                          e.  3 public health officials
                          f.  9 members of the public
                  B.  Core staff:  16.23 F-TE


              IV. Pl@OGRANl PRIORITIES

                  A.  Health manpower
                  B.  AmbulatorN, care
                               I
               V. OPEPATIO.'QAL ACTIVITIES:  The region currently has seven funded
                  activities in the amount of $81.7,100 direct costs.  Patient care
                  demonstrations comprise 35% )@ tried funds; more the  S(Y-,6 is
                  directed toward continui@) education and training.  On@p-i,oject is
                  concerned with stroke rehabilitation.  'I'h@@ia@nder are not related
                  to specific diseases but deal in such areas as multiphasic screening,
                  rural home health care demonstrations, drug information services,
                  and directors of medical education.  Both the multiphasic screening
                  and the home health care activities are directed toward disease
                  control in the indigent population.







                VI.  SELI,"C'I'L-D l@,'GIONAL CH,"vPACI'EPISI'ICS

                      A.  Populati.on.:  6 million -- 71% urban
                      B.  Ilealtl-i resources
                          1.   3 medical schools
                          2.   lS7 short-term,  iioii-Federfil,  hospitals  with  22,679  beds;
                               12% (19) of these i-iwol-iTed in the R@,IP
                          3.   5900 physicians (i@ff) I s @id D. 0. Is)
                               17        0
                                 .,188 reai-stoi-ed iatirses,

              vii.    ILLUSTRATIO,\'S OF ACTIVIFY

                      A full spectrum of home health  services  is  i-,o,,v  available  to  a
                      rural. population of 75,000. The ac,-c@cl, the cliron.ici.1-1), i.11, the
                      disabl.ed, aiid the poor ire iiu,,i receiving the f-ul-1. rall('e of nursin,(,Y,
                      ph,@sibt]-ieral.)@T, laboratory, and  social  services.  As  one  local
                      physician expressed the impact of this project:  "The patients
                      are now aett iiag better  care  than  I  alone  could  give  them.  The),
                      really see us all interested in their  @,,:olfqre  -irid  for  the  first
                      time since I have been practicing medicine, I am really functioning
                      as part of a  team.  This  home  ciro  program  has  made  iTie  practice
                      better n,@edicii-ie."

                      The Thrust Col-r@@giittec gives top priority to iiiiiipoa,or in the
                      ambulatory care area.  The development and efj.octi-ve utilization
                      of q@il.liiry ,,-)ersonn,-l     brought about better accessibility
                      to people in  4 solatod, areas.  'I'J-lroti(7]a this iric@chaiii,s)Ti, a. series of
                      '@ocal meetings were held Keith the benefit of joint sponsorship by
                      area-wide CoiliT)rohensiire flea-Ith Planning  bodies  throughout  t  e
                      IZogion.  These @,@,Tc-re special, local discussion meetings in which those,
                      individuals and institution--, interested and i.nvol.ved ii-i ambulatory
                      care manpower concerns provided substantial input to further
                      develop the program Thrust.  The meetin(Ts served to inform local
                      interests of the O@,R%,IP priority and to stimulate interest and secure
                      response  from  local  participants  concerned   about   the   manpower
                      problems of ambulatory care delivery.
















                                                         2






                                      Neal ]@.di,,Ta,i-d Siiitli (1)) , Al-tooiia (Fifth 1.):Istrict)


                  I    B@NCKGI,!P)tJIND

                       A.   Grantee or SI)onsoi-:   Iowa Ui-iivers:i.ty Col'Leo,e of Nledici-ne
                       B.   Coordinator:  I-larry  IVcinber(,-,   @I.D.
                       C.   Boundaries:  Cote-rntinous           state
                       D.   Ilistoi-)r:
                            1.   Initial. planning grant:  Decei-ftl)or 19@')6
                            2.   Operational   status:    July    1-968



                       A.   Supoort tlirouoli 1--@70:   82,247,000
                       B.   FY71 level of support:                    (projected)
                       C.  Total support to date:           $2)94.7,888

               III.   OR@C@IZY@TI'O'@\,

                       A.   Regional Advisor),, Group
                            1.   Chairman:   Kenneth Barroiqs, Des @loi.i-ios
                            2.   Composition.:   (47 members total)
                                                          TSIC@LCUIS
                                 a.   20 practicing pl-i-N
                                 b.   4 medical   center    official,,;
                                 C.   2 hospital administrators
                                 d.   4 voluntary health .i,geiic-@, representatives
                                 e.   9 other bcal-tli workers
                                 f.   1 public lioa,'Lth official
                                 g.   7 members of the public

                       B.   Core staff:   16.00 F-TE


                 IV.   OPER@FIONAL A(,-TIVITIES

                       Iowa F@%,nl has a total of eight ongoing activities with a funding
                       level of @@441,000 in direct costs.  Of that amount, over half
                       is directed to five programs concerned with training personnel
                       in the treatment of heart disease.   StroRe activities account for
                       most of the remaining fluids; tTi&-Fr major purpose is train.i.ncT
                       personnel in the comprehensive iiiii-i.acement of the stroke patient.

                  V.   SELEC'I'L-D PEGIOlq.AJ, CI-IAW@CFERISTI.CS

                       A.   Population:   2.8 Diillion -- 53% urban, 99% white
                       B.   I-lealth resources
                            1.   Iowa Uni@rersity College of Medicine
                            2.   Coll.ege of Osteopathic @,ledi.ciiie and Surgery
                            3.   130 sliort-teriEl non-Feder@il hospitals with 14,562 beds;
                                 62% (81) of these involved with the R@,111
                            4.   2 ,800 practicing physicians (I,,I. 1). 's and D. 0. I s)
                                 10,000 active registered nurses









                                     OF ACTIVITY

                     To achieve the fullest impact, the Iowa Regional- @ledical-     Progrwi
                     (IR%T) is liel.l-)ii-i- local           plain.       oivn health services
                     program.  To this end, they have foi-ir           Consultants ij]-io travel.
                     around the state and         with local institutions, organizations,
                     and individuals to help assess c-,,,@isti.ii.g Health resources, identify
                     needs, and develop proarais to iricet those needs.

                     Approxii,i@,tely eiohtN (80) perce,.it of the 143 pejioral hospitals in
                     Ioi%ra have               in a training  T)roc3Ir(<iiii in cii-di-opi-i'l-iiiojiary
                     resuscitation (CPR)      Uid-er the @ie@,is of the loi,;a Ileart Association,
                     utilizi.-i-ic, uni.fon,-t standards accordinEy to recoTiffnendati-ons made by
                     the American Ile@irt Association, over 16,000 profoss@i-onal and a@l-lied
                     health personnel liw,,e received trai        uii.(I(@i- this progr@aiii.  One of
                     the spin-offs of this -,orojec-L is than there is Currently :iii e)-nl)hasis
                     on worling i@,ith tiio Coll-,I,  -tit), Co!-]-egos in @iii. attempt to have CPR
                     courses inide a part of the standard ciiri-i-cij]-Ljj,@i for health related
                     fi-olds.







               MISSOURI:  William Raleigh liull, Jr. (D), Winston, Missouri (District 6)



               I.  BACKGROLPI@D


                   A.  Grantee or Sponsor:  University of Missouri School of Medicine
                   B.  Coordinator:  Arthur Rikli, M.D.
                   C.  Boundaries:  coterminous with state, excluding St. Louis area.
                   D.  History
                       1. Initial planning grant:  July 1966
                       2. Operational status:  April 1967



               II.  FUNDING


                   A. Support through l,Y 70:  $18,240,000
                   B. FY71  level-  of support:       @,O.@ (projected)
                   C. Total support to date:  $20,091,610



              III. ORG@NIZA.TION


                   A. Regional Advisory Group
                       1. Chair,,-@.-@,ri:  Nathan J. St--ark, Kansas City
                       2. Composition (12 i@leinbers)
                          a. 5 practicing physicians
                          b. 1 medical center official
                          c. 1 hospital administrator
                          d. 5 members of the public

                   B.  Core staff:  47.60 FTE


               IV. OPERATIONAL ACTIVITIES


                   The Region currently has underway 20 operational activities with
                   a direct cost funding of about 2.7 million dollars.  Programs
                   related to heart, cancer and stroke share about 40% of the
                   available funds; those with no specific disease target account
                   for a little over 50%.  Funds are eveiilv divided between conti-nu-
                   ing education and patic@nt cF  3ro-i--.iLil-S.  Missouri rIIP has set
                   a high priority on cooperative-activities -- 40% of their
                   operational funds support activities which have as their objective
                   the coordination of health services.



               V.  SELECTED REGIONAL CHARACTERISTICS


                   A. Population:  3,000,000   50% urban, 95% white











                   B. Health Resources
                      1 . one medical school.
                      2.  119 short-term, i-ioii-federal hospitals with 20,581
                          total I)eds; 67% (81) of these are involved in RMP
                          planning and activities
                     .3.  6557 physicians (,\ID's and DO's)
                          9291 active registered nurses (1.2,092 total)

              VI.  ILLUSTRATIONS OF ACTIVITY


                   A major new concept in the delivery of heart treatment has been
                   implemented at St. John's Hospital in Springfi.eld by the Missouri
                   RMP.  The system provides coi-qpreLic@nsive adT,,ii.ssioii-to-discliart-De care
                   for all high risk cardiovascular patients in the hospital popu-
                   lation within a single progressive care division.  A  catalytic
                   outcome of the project was smaller community hospitals throughout
                   the Ozarks upg3-adinc, cardiovascular care facilities, with at I-east
                   18 of the 35 hospitals in the area now ].i@-ivi..nc, improved care
                   facilities completed, under construction or in the active p aniiiiig
                   stage.  The project also established Sprinofield ,is a subregions
                   teaching center for nurses and pl-ly@.,lC@Laii,,,-, leading to a second
                   project, now underway which will double the state's  output  of
                   trained cardiovascular nurses, both graduate and licensed practical

                   nurses.


                   One hundred and two medical iristallat-17.oris are now,telephonically
                   coianc@cted by the "lar-e-st party line in the world" -- the continuing
                   education-telecture project of the Missouri @'iP. Series of programs
                   have been produced not only for physicians buti also for nurses,
                   dentists, lab technicians, dieticians, X-ray technicians and
                   hospital administrators.  A September, .1-970 count showed 352
                   physicians, @44 nurses, 209 dentists, 196 medical technicians, 115
                   dieticians, 473 food service supervisors, and 140  occupational
                   therapists participa t4 ng.







                            TEXAS:  Robert    R. Case@, (1))  Houston (District 29.)



                 I.  BACKGROI.,M

                     A.   Grantee or Sponsor:  tJiilversit)r of Texas System
                     B.   Coordinator: Charles NIcCo.-I.1,  @@I.D.
                     C.   Boundaries:  coteniinous with state
                     D.   History
                          1.  Initial planning grant:  January 1966
                          2.  Operational.   status:   July   1968

                II.  FU@NDING

                     A.  Support  throiioh  FY70:   j@6,61,13,000
                     B.  FY71 level of support:                 0
                     C.  Total   support   to   date:   $9,110,900

              III.   ORG,,VNIZATIONT

                     A.  Regi,oi-ial Advisory Groul-)
                          1.   Chairman:  N.C. ilialitower, M.D., Temple
                          2.   Composition (50 members)
                               a.  14 practicing physicians
                               b.  18 medical center officials
                               c.  4   hospital   admiii.strators
                               d.  3 voluntary health agency representatives
                               e.  3 other health i,,,orhers
                               f.  2  public   health   officials
                               g.  6 members of the public

                     B.  Core staff:  24.04 1--TE

                IV.  OPERATIO'QAL ACTIVITIES:  The region is currently conducting 21
                     operational activities i@ith $1,41S,300 in di-rect costs.  Nino
                     programs (34% f-LLads) a-re in the area of cancer, while heart
                     disease activities account for only 6% of available funds.  A
                     substantial portion (39-) of funds goes to support rehabilitation
                     activities; about 25% support prevention and screening programs.
                     The primary functional emphasis of the Texas l@NIP is patient care
                     demonstrations, i@hich account for almost 2/3 of the funds allocated.
                     Most of these funds support activities directed at improving
                     health care for indigent groups.

                 V.  SELECTED RL-GIOI@ CHAI@CTF.RISTICS

                     A.   Population: 11 million -- 65% urban, 88% ivliite
                     B.   Health resources
                          1.   4 medical schools
                          2.   493 short-term  ' non-fed.'eral hospitals with 43,380 total
                               beds; 14% (67) of these involved in the PM
                          3.   11,700 physicians (i@-ID's and L)Ols)
                               18,000 active registered nurses (30,000 total)









                  VI.    II,LUSMkTION@c@' OF ACTT117ITY
                         One of tl-,e -Diore sipiiificant      projects in  the  'I'(@,xas  regioi).  li,@  b-cei-i
                         the                       of a pro@@-@. aimed at tlio I)re@reiition of niorbiditv
                                                              z@
                         and Mortality from cc-i-vi-cal c-micer.   Applicat-i-oii of exfol.i,ative
                         cytolo,,Yv s--reenii(-, is tal<ii-i(y pl@i(-(-,, -,it 109 satellite cl-i-T).ics  iLuicle-r
                         the aeuis of tl,-ie    Souti,@@@sten-i i'@Ic,,dical Scliool  at  Sa.-a  Ai-itoni-o.  ,'@p-
                         proxir,,-,tel-@,- 3,700           are beiiiE., perf-oiiil,,,(l each ri(@iitli i@.i-tli over
                         39,000                     space July 1968.   11-roliiiil'.nary fi.iidi-i-ic-,s indicate
                         th@it tl-i,@ j.)rogTam is @'iiidiiig r,-;ore, P-i-id earlier l,osioiis i,,,itil ]]lore
                         fax,,or,-,ble outlook tl,.aii expected.








                               NEW JERSEY:  Edward J.  Patten (D)
                                             Perth        District 15)



              I. BACKGROUND

                 A.  Grantee or Sponsor:  New Jersey Joint "-omittee
                 B.' Coordinator:  Alvin A. Florin, M.D.
                 C.  Boundaries:  coterminous with state
                 D.  History
                     1.  Initial planning grant:  July 1967
                     2.  Operational status:  April 1969

             II. FLJNDING

                 A.  Support through FY70:   $3,342,000
                 B.  FY71 level of support:   $          (projected)
                 C.  Total support to date:   $4,578,255

           III.   ORGANIZATION

                 A.  Regional  Advisory  Group
                     1.  Chairman:  Richard J. Cross, M.D., Brunswick
                     2.  Conposition (24 members)
                         a.  7 practicing physicians
                         b.  4 medical center officials
                         c.  2 hospital   administrators
                         d.  2 voluntary health agency representatives
                         e.--4 public  health  officials
                         f.  1 other health worker
                         g.  4 members of the public
                 B.  Core staff:  25.50 FrE

             IV. OPERATIONAL ACRIVITIES:  The region currently has eight ongoing
                 operational activities with direct cost funding of  609,000.  Heart
                 disease, cancer, and multicategorical disease programs each r ceive
                 about a-t ir  ok the available fun s@.  Continuing education is the
                 pr:Lmary focus of two activities and ov@2S% of funding; better
                      wer utilization  supported by almost 40% of the total funds,
                 is the major aim o    another 4 programs.  Close to half of the NJMIP's
                 operational monies  goes  for the support of inner city programs for
                 indigent- blacks.

             V.  SELECM REGIONAL CHARACMRISTICS

                 A.  Population:  7 million --  89% urban, 91% white
                 B.  Health resources-
                     1.  2 medical schools
                     2.  105 short-term, non-federal hospitals with 23,829 beds;
                         58@o (62) of these hospitals involv6d in R4P planning and
                         activities.
                     3.  9,054 physicians (M.D.Is and D.O.'s)
                         23,758 active nurses (38,654  total)










              ITI.    ILLTJSTPATIO'.NS 01@' ICFI@TlTv.
                      With i-,ioi-e than 85%  of  ',\Ieii,  Jersey  cancer  patients  being  treated  in  com-
                      munity or generali- hospi-L@il-.s  of  500  beds  or  less,  it  is  the  ai.in  of  the
                      Neii  Jersey  R,,![?  -  TLLDor  Conference  Boards  to  bYi-TI.g  the  most  up-to-date
                      medical  information  to  the  practiciii(y  -rl-i)7sician.   responsible   for   cancer
                      patient  care.  'llius  four  @.i,-,rocnients  oF  affiliation   have,   been   executed
                      i@iti-i ei(,@.teeii hospitals ijid negotiations are currently Lu-iclon@-@ay i@Tith
                      six  additional  hospitals.  iNlo-re  than   10   000   patients   have   been   brought
                      under team revi-ev,r of tire status of their                 treatm@ont   moc'Les    and
                      -rehabi-litatioi@ plan.  B,,r i'@i@ircli 1972, it i@s anticipated that 43 Illospital-q
                      will- be totally                             -i3uitial @id-rni-ssi-oii.s for cancer.
                                      ,icT an esti.iii@3.ted 15,00(
                      An objective of the project is to establish joi.iit tumor conference boards
                      for t-v%ro or more hospitals.   In ',,.Ii-ddlesex           a   demonstration    of    a
                                                                     4- .I.IC,  I
                      joint corifc    ce board i.s planned for  LI          tcf  @; Ceneral Hospital
                      (ongoing) and @,,Iidcliesex Hospital.  'I'h.c-, encouraging factor in SUI?POrt of
                      a joint program  for  these  ti@o  institutions  is  the  recent  p-ro,c,yrai-a  %,iial-
                      gan,ation of radiation therapy services in St. Peter's Hospital to serve
                      botl-i hospitals.

                      New Jersey l@l,,'P has provided staff and technical assistance to the
                      nine fede-rally-d,@si,(,)TiatcJ        Ci-ti-es   Programs   through   the   assiaTiment
                      of f-ull-titiie lJrl)aT-i Stealth Coordinators.   In each city the IJ-rbaii
                      Coordinator hel-.os  plan  Vince,  or(ymlizo  facilities  and  iiaiil,)oi%,or  resources
                      to increase the effectiveness of local health care delivery systems.
                      This  project,  no,,@  ill  its  second  year  of   operation,   serves   a   population
                      of   200,000   disadvantaged   residents.   'Bio   projects    have    been    developed
                      (but  unfunded  as  yet)  to   organize   providers   of   service   and   health   care
                      facilities into a coffprcliensive care program especially directed at
                      servi-ng the disadvantaged u-id others Without regular sources of medical
                      care .  The  first,  at  @l-i-ddl-osex  General  Hospital,'  i@as  desisted   to   serve
                      a patient population of 4,000 persons with a program of preventive
                      medi@ci-iie and treatment utilizing a                   f@,tjiii.ly  health  care  team.
                      'Ihe project incl-udes multiple funding from @,L-di-cai-d, PJedicare, hospital
                      resources and the  R@,,IP.  A  second  program  at  No@ivai-k  Betli  Israel.  NIedi-cal
                      Center  proposes  to  serve  a  pati.-,nt  population  of  I.S@000   persons   i.i-i   a
                      lot%, income area of Nov!ark.






                           BI STATE:    Robert Michel (P@), Peoria (District IF))




                1.   BACKGROU@,'D

                     A.  Grantee or Sponsor:  Washington university, St. Louis
                     B.  Coordinator:  William Stoneman III, M.D.
                     C.  Boundaries:  sections of Missouri and Illinois which
                                       are organized around-St. Louis as their
                                       medical  trade   center
                     D.  History:
                         1.  Initial  pla@,ning  grant:  April 1967
                         2.  Operational  status:  July  3-969


                II.   FULNDING

                     A.  Support  through  ]Tf  70:   $1,948,000
                     B.  FY 71 level of support:     @-,-25(@-9
                     C.  Total  support  to   date:   $3,198,279



                III. ORGANIZATIOIT,


                     A.  Regional Advisory Group:
                         1 . Chairi),ian: G. Di-incan )3aiiip,.an publisher) St. Louis
                         2.  Cc)-iiiposi-tion (77 members)
                             a. 18 practicing physicians
                             b. 13  medical  center  officials
                             c. 17 hospital- administrators
                             d. 4 voluntary health agency representatives
                             e. 2 other health workers   -
                             f. 5 public health officials
                             g. 18 members of the public

                     B.  Core staff:  18.26 FTE.



                IV.  OPERATIONI-@ ACTIVITIES

                     The Region is currently supporting  :@ivt operational activities
                     in the amount of  -)@3Z,600 direct costs.  The primary disease
                     targets (60%); are cancer and stroke.  In terms of function,
                     most of the activity  (73/.  funds)  is  in         care demonstrations
                     only L7,@ goes for the.suDDort of continiiiiia education and training
                     activities.  Two projects which account for a little over 40%
                     of available funds support programs designed to improve health
                     care of the-indigent population.







               V.  SELECTED REGIONAL CHARACTERISTICS

                    A.  Population:  4.7 million     80% urban
                    B.  Health resourses
                        1. 2 medical schools
                        2. 141 short-term, noii-federal hosp itals with 23,444  beds;
                           9%(I.2) of these involved in PIIP planning and activities.
                        3. 5021 physicians (M.D.'s and D.0's)


              VI.   ILLUSTRATIONS OF ACTIVITY


                    Helping to solve the manpower problem is  a key program of the
                    Bi-State Region.  In this connection the Bi-State- P@TIP (Missouri
                    and Illinois) obtained a Tiaiver from the Missouri- Council on
                    Higher Education so as to make it possible for  non-high  school
                    graduates to enter junior colleges for training as a.ide-level
                    heal.th workers.  This is a part of Bi-State TS larger effort  of
                    getting all neighborhood health personnel in the Region to work
                    together in assessing their manp@wer needs and taking  steps  to
                    meet them.


                    in terms of direct patient care, the Bi-State RMP has established
                    an intensive care facilty at St. Louis City Hospital to  serve  an
                    estimated 400 medically indigent stroke victims from  the  inner
                    city each year. There has also been established,  as  an  integral
                    part of the project, a much-needed training unit for  the  purpose
                    of instructing approximately 1.00 nurses from the Bi.-State Region
                    in the critical early management of acute stroke.' In addition, this
                    project has treated cooperative arrangements among existing long-
                    term care centers for stroke and set up a practical teaching program
                    for therapists concerned with rehabilitation and, when necessary,
                    custodial care of stroke victims throughout the  Bi-State  area.









                                                         wi
                      KANSAS:  Garner  E.  Shriver  (R),  chita (First  District)


               I.  BACKGROUND
                   A.  Grantee or Sponsor:    University of Kansas Medical Center
                   B.  Coordinator:    Robert Brown, M.D.
                   C.  Boundaries:  coterminous with state
                   D.  History
                       1.  Initial   planning grant:  July 1966
                       2. @Operational status:  June 1967

              II.  FLJNDING
                   A.  Support through    FY70:  $4,810,000
                   B.  FY71 level of support:  $,l,          (projected)
                   C.  Total support to date:  $6,163,159

            III.     ORGANIZATION

                   A.  Regional Advisory Group
                       1.  Chairman:  Russell C. Mills, Ph.D., Kansas City
                       2.  Composition (19 members)
                           a.   7 practicing physicians
                           b.   3 medical center officials
                           c.   3 hos  ital  administrators
                                     p
                           d.   1 voluntary health,,aaency representative
                                                      C,
                           e.   1 other  health   worker
                           f.   1 public health official
                           g.   3 members of the public
                   B.  Core staff:  60.97 FTE
              IV.  OPERATIONAL ACRIVITIES:    Kansas RMP currently has 17 funded
                   operational activities.    The level of support for t@ese in direct
                   dosts is  about  $870,000, 90% of which supports activities in
                   continuing edu ation and impower utilization.  About 18% of the
                   @s are being expende       in-the -area of heart disease; most of
                   the remainder does not support specific disease-related activities
                   but programs,of a more general nature, such as a medical library
                   system, general education program, health data bank and dietician
                   training.

               V.  SELECIED   REGIONAL   CHARACRERISTICS
                   A.  Population:  2,200,000        61% urban, 95% white
                   B.  Health resources
                       1.  1  medical  school
                       2.  147 short-terrm, non-Federal hospitals with 11,500 total
                           beds; 14% (21) are involved with RMP planning and activities.
                       3.  2,628 physicians (MD's and D.O.'s)
                           6,509 active registered nurses (10,154 total)








            VI.  ILLUSTRATIONS OF ACRIVITY

                 A unique attempt to alleviate the shortage of health manpower  is
                 being' carried out by the Kansas Regional Medical Program.  Many
                 registered nurses for one reason or another were not working  and
                 the KRMP established a program to promote the re-entry of
                 registered nurses into the Region's health care system.  For  the
                 past,,@wo years, the Kansas program has offered six three-week
                 training courses. One hundred and thirty-three nurses  have  been
                 trained and are employed in the 17-hospitals in Kansas City.
                 Over 100 of the 133 nurses are employed on a full-time basis  and
                 33 of'this number hold supervisory positions.






                        ILLINOIS:  Charlotte Reid (R),  Aurora (District 15)
                                   Robert Michel (R), Peoria (District 18)



              I.   BACKGROUND

                  A.  Grantee or  Sponsor:  Illinois  Regional  Medical Program, Inc.
                  B.  Coordinator:  Morton Creditor, M.D..
                      Boundaries:  in general, coterminous with the   state; some
                      conflict with Bi-State RMP  in  Southern  Illinois
                  D.  History
                      1.  Initial planning grant:  July 1967
                      2.  Operational status:  February 1970

             II.  FLJNDING

                  A.  Support  through  FY70:  $3,280,000
                  B.  FY71 level of support:            3   (projected)
                  C.  Total support to date:  $4,712,333

            III.   ORGANIZATION

                  A.  Regional  Advisory  Group
                      1.  Chairman:  Ogelsby  Paul,  M.D.
                      2.  Composition (29 members)
                          a.  7 practicing physicians
                          b.  8 medical center officials
                              5 hospital   administrators
                          d.  3 voluntary health agency representatives
                          e.  1 other health worker
                          f.  2 public  health  officials
                          g.  3 members of the public
                  B. Core staff  --  34.99  FrE

             IV.  OPERKTIONAL ACTIVITIES:  The Region is currently supporting seven
                  operational activities in the amount of almost $600,000 direct costs.
                  Monies are fairly evenly divided among heart, cancer, @d stroke
                  activities.  Interestin ly, no activities have continuing education
                                          9 , -
                  and training ds,a  major  emp          e patient care demonstrations
                   particularly screening) account for almost 3/4 ot available funds.
                  'About 65% of the funds support activities Sion-sored by voluntary
                  health agencies.

              V.  SELECTED REGIONAL CHARACTERISTICS
                  A.  Population:  10.6 million -- 81% urban, 89% white
                  B.  Health resources
                      1.  5 medical schools; 1  college  of  osteopathy
                      2.  256 short-term,  non-Federal  hospitals  with 49,122 total
                          beds; 6% (16) of these are  involved  in  RMP planning and
                          activities.
                      3.  14 372 physicians (MD's and DO'S)
                          20,254 active registered nurses








            VI.  -ILLUSTRATIONS OF ACFIVITY

                 The Illinois RMP has established extensive relationships and
                 coordination with Comprehensive Health  Planning.  IRW  is  using
                @@core,staff and support resources, available under its grants, to
                 assist CHP subregions to establish voluntary  planning  councils.
                 Through contractural arrangements with local  planning  councils,
                 IRMP is assisting in the support-of staff to help develop CHP
                 programs in the North Suburban-Hospital Association for Health
                 Resources, the Mid-South Side Comprehensive Health Planning
                 Comittee, and the Springfield-Ceiltral Illinois Health Care Planning
                 Council.

                 The Valley Project in Illinois is for the development of a compre-
                 hensive, family-oriented health care system for the residents  of
                 the Valley Community.  The program development began as a request
                 for services, since there were no health care services available
                 in the community.  This project has brought the University of
                 Illinois College of Medicine and the co     ity together in a
                 cooperative role, plus provided a chance to identify new and pre-
                 viously unexplored ways of achieving comprehensive  health  care,
                 including involvement in developing a prepaid comprehensive health
               ;',care system with the Illinois State Health Department and training
                 'and education programs for the development of health care teams.






               ALB@,@y: siliri.o Coii-Le (R), Pittsfield, @,,I@issaclatisetts (District 1)


               I.  BACKG@ROUND

                    A.  Grantee or Sponsor:  Albany @ledical (college
                    B.  Coordinator:  Fra-.ql@ @l. I-Voolscy, Jr. , M.D.
                    C.  Boundaries:  21 eastern New Yorl- counties, 2 Vermont
                                     counties, and Berl@slii-re count), :In lvlassa-
                                     chusetts; some ovei:-Li.T,) with Northern New
                                     Ei-l,o,land and (central New Yorl@ 11@,iPS.
                    D.  History:
                        1.  Initial PI-druiin(r Grant:  Ji-ij,,,e 1966
                        2.  (4Derational- Status:  Y@I)ril- ]@967


               II. FTJ-.NTDING
                    A.  Support throuch FY 70:  $4,436,000
                                     C.
                    B.  Current I-Y '171 level of support:
                    C.  Total support to date:  $S,351,910




                    A.  Reaional. Advisory Group
                        1.  Chairman:  Harold C. Wigc)c--,i-s, Ph.1)., Sc.D., Albany
                        2.  Com])osition (28 members)
                            a.     5  racti-cing pi-)vsici,-jns
                                     p            I
                            b.     10 medical. center officials
                            C.     3 hospital administrators
                            d.     2 voluntary health agency representatives
                            e.     5 public health officials
                            f.     2 other health worriers
                            (Y.    member of the public
                            t-I
                    B.  Core Staff:  37.2S F.T.E.


               IV.  OPERATIOINU ACTIVITILS:  The Al.bqny PM-' is prosentl.), conducting
                    10 operational activities with direct cost funding of $303,800.
                    go-st of these funds are suppoi-t-i.iic, programs in coi@ti..Tlulnp
                                                                           Oil    8
                    educat.Oii (53%) and.        cle-ve].OT@),-C]','t, cllld Utl a@-i. (3 %)
                    In terms of disease emphases heart disease is tile, ceiitri.1
                    focus of the program, accou-ntin-g--f-.o-r--.a-l-iiio-s-f 40% of available
                    funds; all of these activities are directed  to  Coronary  care
                    unit training for physicians and nurses.  Almost-. half o
                    A            are supporting programs for the establishment
                    and maintenance of electroniceoimnwi-i-catiaiis networks for
                    training and patient care.









                V.  SELL,C7]@-.D RFGIOINPJ, ClbkRACTE-RISTICS

                     A.  Population:   2 million -- S4% urban
                     B.  Health Resources
                         1.   I medical school
                         2.   72 sliort-tenti, non-federal 1-iospi.t@ils with 8,486
                              beds; 64% (46) involved in f@\LT,  pl,aiiiij.jic,  ijid  activities
                         3.   2849 pjl)7Slcians (@,I.D. 's and D.O. 's)
                              8,806 active nurses (14,334


                VI.  ILLIJSTIV@TIO-'\TS OF ACI'IVI'IY

                     The Alban,,, l@c,(-,i-onal Medical Prograiii has  qs  one  of  its  primary
                                   C7
                     objectives tile -'ll,;Illrovelnent of  care  of  patients  with  acute
                     myocardial i.iafarction  tiyou,yh.  support  o  u-i  oc_ticatiojia  conI.)o-
                     neiit of a sul)reoi.oiial coronary care          at   the   Berkshire
                     Medical Center in Pittsfield, 1,@lassacliusetts.  'riicz,, major efforcs
                     are to train health persorii-icl,                i-itirses, in intensive
                     coronary  care.  To  date  82  nurses  have   received   2S   hours   of
                        ' incT at the Berksi-iire Center.  Forty three i-iurses were@frcit,
                     train    ,
                     the Pittsfield General Unit.

                     Over  and  above  gradual   realization   of   improved   patient   care
                     throuol-i training of health personnel -,in coronary  care,  a.  major
                     friiif)e benefit has been obtaii-iod as i by-prod,,ict of the project.
                     Under the leadership of the j@ll)-aiy Rc-ioi-i@il iN!edi.cal. Pi,ogrlill
                     core stallfs' loii(,-standijio barrier to effective c6nni-uiica-tion
                     has been overcome  in  greatest  part.  A  close  ivorkin.0  relation-
                     ship has been  developed  with  official  and  voluntary  health  -ind
                     key health professionals in all local- hospitals.  This relation-
                     ship may lead to greater  understanding,  sl@ia.ring  of  community
                     needs and -resources, and  involvement  of  other  members  of  the
                     total region.


                     A major aim of  the  Albany  Regional  Medical  Program  is  to  serve
                     as a facilitator or convenor of cojiffiii.,u-iity organizations or
                     group to solve local or reg-i-oi-ial  health  problems.  An  example
                     of this type of activity is evidenced 1)), the jU@41)  co-re  staff
                     providing advice and counsel to the COM'I',UTlity Medical Core
                     Program to explore new systems of @I)ealtli care dolivel-)7  jll
                     iiuier-city and  rural  areas  lacking  adequate  medical  care.
                     This i-i-ivolv@,qent has resulted in the  establishment  of  the
                     Albany Northside Health Center -in the Al.ban), innei--city  w,  ic
                     will serve  some  6,000  persons  with  comprehensive  health  care.
                     When fully operational, the  Center  Will.  be  staffed  by  three
                     physicians,  six  nurses  and  various  aides,  including  approxi-
                     inately 50 people hired from the  local  community.  The  Al-bai-iy
                     Center will be  the  first  of  four  such  facilities  planned,
                     ultimately providing services to about 25,000 people.






   0




























    0








                                          Regional@Medical      Programs



                   Budget Summary


                                                                (Dollars   in   thousands)     1972
                                                       1970             1971
                                                   Estinate           Estimate            Estimate
                   Activity  or Subactivit-y     Pos.  knount        Pos.  Amount        Pos.     Amount

                   Regional  Medical    Programs
                      Grants  .....            . 55   1/   78,202    56  1/   70,298     56  1/   75,000
                                     ...........
                     @Direct operations    ..... 98       1,301      91       1,799      91       1$851

                   Technical assistance &
                      disease control
                      Regionalization
                         activities   .......... 27       1,526      50       2,543      50       2t576
                      Smoking and health     ... 29       2,239      29       2,172      29       2,189
                      Kidney disease    ........ 38       4s4Ol      38       4,096      38       4$118

                   Program   direction   &
                      management services     ... 88      2p833      67       1,498      67       1,537
                            Total   ............  280      90,502    275      82,406    275       87$271


                   1972 Program         ar
                         $34,500,000    re serve  for  operational  and  planning  grants   in   1971
                   will  become  available  for  obligations  in  1972.  $5,000,000   of   it   has
                   been   ear marked for construction of a regional cancer center in the
                   Northwestern  part  of  the   United   States.





                   1/  Represents regions.

                   1/  56  includes   South   Dakota










                                           Regional Medical Programs



                 I.  Budget Summary


                                                               (Dollars in thousands)
                                                       1970               1971                 1972
                                                     Estimate           Estimate           Estimate
                     Activity or Subactivity      Pos.  Amount       Pos.  Amount        Pos.  Amount

                     Regional   Medical   Programs:
                        .Grants    ................. 55 1/ $78,202    56 1/ $70,298      56 1/ $75,000
                        Direct Operations    ...... 98     1,301     91       1,799      91       1,@51


               II.  1972 Program Summary


                           In  order  to  insure  maximum  benefit  from  the  restrictive  funding
                     in 1972 there will be a re-examination of all Regional Medical Programs
                     with a view to reducing and redirecting funds from areas which appear
                     less than clearly related to the goals and objectives of RMPS.

                          A further refinement of the Anniversary Review process will be
                     accomplished through a triennial review by the National Advisory
                     Council.  Additionally, this activity will continue to provide Health
                     Services  data  to  the  Regional  Medical  Programs  as  required  for  their
                     planning and operational programs.





                     1/  Represents regions.

                     1/  56 includes South    Dakota6








                                         Regional Medical Programs



            I.  Budget Summary

                                                           (Dollars in thousands)
                                                1970               1971               1972
                                             Estimate            Estimate              Estimate
                 Activity  or  Subactivity   P6s.   Amount      Pos.  Amount        Pos.     Amount

                 Technical   assistance   &
                    disease control:
                    Regionalization
                        activities   ...... 27      $1,526      50    $2,543        50     $2,576
                    Smoking & health    ... 29       2,239      29     2,172        29     2.189
                    Kidney disease    ..... 38       4,401      38     4,096        38     4,118

                           Al

           II.  1972 Program Summary


                      In  the  Kidney  Disease  Program  the  three  "limited   care   dialysis"
                 projects  are  to  be  completed  in  1972.  These  projects   involve   testing
                 ways  to  provide  chronic  hemodialysis  at  a  level  between  the   hospital
                 and  the  patients'  home.  Good  dialysis  candidates  who   are   not   eligible
                 for  home  training  will  be  provided  dialysis  therapy  in  low   overhead-
                 low  cost  facilities.  In  1972  initial  steps  will  be  taken  on  a  long-
                 range  program  to  develop  interrelated  kidney  programs  aimed   at   pro-
                 viding therapy for the 10,000 best medical candidates for dialysis
                 and transplantations.
                      The  National  Clearinghouse  for  Smoking  and   Health   will   continue
                 its three phase program of research, community program development
                 and  public  education.  Attention  will  be  focused   on   continuing   and,
                 where possible, strengthening its programs of teacher training and
                 community interagency councils.  Research and development will be
                 continued  in  the  area  of  smoking  cessation,  and  field  testing   of
                 cessation techniques will be intensified, for use both in group
                 situations and in physician-patient counseling.

                      The Regionalization Activity will continue to provide assis-
                 tance  in  responding  to  the  individual  needs  of  the  Regional   Medical
                 Programs.  Continuing  education   for   health   professions   will   continue
                 to  hold  a  place  in  the  interests  of  local  Regional  Medical  Programs.
                 Other objects of widespread concern and high priority among the
                 Regional  Medical  Programs   are:   efficiency-in   application   of   multi-
                 phasic  screening  and  other  early   detection   and   preventive   examinations
                 cooperative   coronary   care   and   hypertension,programs;   emergency   medical
                 services  and  efficiency  in  general   out-pqtient   or   ambulatory   services.









                                    Regional Medical Programs




                Budget Summary


                                                         (Dollars in thousands)
                                               1970             1971             1972
                                             Estimate         Estimate         Estimate
                Activity or Subactivity    Pos.  Ainount    Pos.  Amount     Pos.  Amount

                Program direction &
                  management services ...  88   $2,833      67   $1,498      67     $1,537


            II. 1972'Program Summary


                     This program will continue to support activities designed to
                evaluate the effectiveness of the Regional Medical Program grants
                and contracts program.  Also will conduct studies designed to improve
                overall productivity in order to meet the mounting workload with the
                present limited staff.









                          HEALTH SERVICES AND @TFNTAL HEALTH ADMINISTRATION


                                      Regional Medical Programs

                                ,Program Purpose and Accomplishments


       Activity:  Grants

                                              1972
                                                        Budget
            1971                                       Estimate
       Pos.      Amount          Authorization      Pos.     Amount


       Budget  Authority
         --    $891500,000         $150,000,000           $40,500,000

       Obligations
         --    $70,298,000                                $75,000,000

       Purpose:  Funds are used for grants to develop     cooperative  arrangements  for   the
       regionalization of  health  resources;  enhance  the  capabilities  of  providers  of
       care at community level; and  improve,the  quality  of  health  care  and  strengthen
       the health care system.

       Explanation:  Applications for grants are submitted by each Regional Medical Pro-
         am.  Applications are reviewed in Review Committee and by Council for a proval
                                                                                      p
          funding.

       Accomplishments in 1971-. In 1971 there has  been  not  only  the  development  of  a
       staff to generate, plan  and  implement  new  and  appropriate  activities,  but  also,
       the establishment of  certain  specific  projects  designed  to  achieve  improved  usd
       of current health facilities  including  resources  such  as  X-ray,  laboratory  and
       out-patient services; development and expansion of new services such as coronary
       care  units,  multiphasic  screening,  rehabilitation  and  cancer  registries;   in-
       creased and improved distribution of both old types of manpower such as/'physicians,
       nurses and technicians and new  types  of  manpower  such  as  physician  assistants.

            A series of Regional Medical Program generated activities at both the
       regional and national level are now  beginning  to  provide  some  patterns  for  im-
       proving certain critical areas of  the  health  care  system  and  thereby  making  a
       higher quality of care widely available to more people, especially those in rural
       areas and in the inner  cities.  In  1971,  the  one  remaining  region  will  become
       operational.

       Objectives for 1972:  In order to insure maximum benefits from the'funds available
       in 1972, there will be a reexamination of all 55 Regional Medical Programs with a"
       view to reducing and redirecting funds from areas which appear less than clearly,,@,
       related to  goals  and  objectives  of  Regional,Medical  Programs  Service.  It  is"
       expected that such activities will include improved and expanded service by
       existing physicians, nurses and other allied health personnel-; increased utiliza-
         on of'new types of allied  health  personnel;  new  and  specific  mechanisms  that
     46ovide  quality  control  and  improved  standards  and-decreased  costs  of  care  in
       hospitals; provide early  detection  of  disease;  implement  the  most  efficient  use
       of all phases of health care  technology,  and  play  the  necessary  catalytic  role









                          HEAI,Tli SERVICES l@D @fF@,NTAL IIJ@'ALTII'AI)TfTNIST@\TTON


                                     Regional Medical Programs

                                 Program.Purpose and Accomplishments


             Activity:  Direct Operations



                                                   1972
                                                            Budget
                1971                                       Estimate
             Pos.    Amount         Authorization       Pos.     Amount


             91   $1, 799,000             ---           91   $1,851,000


             Purpose: Evaluates, processes and awards grants; provides the principal
             point of contact between the Service and the individual Regional Medical
             Programs for assisting in the development and implementation of cooperative
             program arrangements.

             Explanation:  Applications from Regional Medical Programs are reviewed by
             special consultants, other Federal. agencies and Service staff and are then
             analyz6d and integrated for presentation to Review Committee.  A written
             summary of Committee review and other material is provided for presentation
             to Council.


             Accomplishments -.Ln 1971:  A new system for review and award is being
             implemented for each Regional Medical Program.  This system, knoiqn as
             Anniversary Review, will be applied to all annual continuations and/or
             renewals as well as new applications.  Its purpose is to have each @IP
             reviewed as a whole program rather than on the basis of individual projects.

             Objectives for 1972:  A further refinement of the Anniversary Review
             process will be accomplished through a triennial review by the National
             Advisory Council.  Additionally, this activity will continue to provide
             Ifealth Services data to the 55 Regional Medical Programs as required for
             their planning and operational programs.







                          HEALT]I SERVICES A!iD MENTAL I-IEALTH Al),,IINTSTRkTION


                                     Regional Medical Programs

                                 Program Purpose and AcCORIDlisliments

           Activity: Technical'Assistance and Disease Control



                                                 1972
                                                          Budget
               1971                                      Estimate
           Pos.    Amount         Authorization     Pos.        Amount

           117   $8,811,000           ---           117      $8,883,000


           Purpose: Regionalizat4-on activities provide assistance in the planning,
           development and coordination of programs which provide continuing educa-
           tion and pilot demonstrations aimed at improving the availability and
           quality of health care.

                The Smoking and Health Program provides leadership and direction
           for a national program to reduce death and disability due to smoking.

                The Kidney Disease Control Program plans, develops, field tests,
           coordinates, and supports pilot programs which can reasonable be expected
           to improve the quality of personal health care for patients suffering
           from renal disease.

           Explanation:  All programs support studies directed toward improving the
           efficiency and capability of the health care system through  cooperation
           with hospitals, health professionals, medical schools and official and
           voluntary health agencies. They develop, test, and evaluate  methods  of
           disseminating and applying knowledge and provide information, guidelines
           and technical assistance to regional groups, States, and local  communities.

           Accomplishments in 1971:  During 1971 the Regionalization Activity continues
           to provide assistance to the 55 Regional Medical Programs in planning,
           development, and implementation of their programs.  Emphasis has been placed
           on local determination of need, development of cooperative  arrangements
           for improvement of health services, deployment of resources, and  evaluation
           of results.


               In the Smoking and Health Progr am the major accomplishment of 1971  was
           the passage of the Public Health Cigarette Smoking Act which strengthened
           the warning label and provided for the bannina of all cigarette  commercials
           on radio and television as of January 2, 1971. A further  indication  of
           progress has been the continued decline in the consumption of cigarettes.

               In the Kidney Disease Program key information on  improved  organization
           of care for terminal kidney patients is coming from studies under way at
           seven project sites for kidney organ procurement programs.  These studies
           are reducing technical problems related to the procurement, preservation
           and transportation of cadaver organs.











                           HEALTH SERVICES AND MENTAL HEALTH ADMINISTRATION


                                      Regional Medical Programs

                                  Program Purpose and Accomplishments


         Activity:  Program Direction and Management Services

                                                   1972
                                                          Budget
             1971                                        Estimate
         Pos.    Amount            Authorization       Pos.    Amount

          67    $1,498,000                              67   $1,537,000


         PurEose:  Provides direction, leadership, and management services for the Programs
         of HSIIIIA assigned to the Regional Medical Programs Service.

         Explanation:  Develops and coordinates policy, plans, directs, and evaluates the
         administrative management activities of the Service.

         Accomplishments in 1971:  This activity is exploring various methodologies for
         evaluating the effectiveness of Regional Medical Program grants and contracts and
         is improving the Progra,@n's Management Information System in order to provide top
         management with better data for operating the Service.

         Objectives for 1972:  During 1972 this activity will continue to support activi-
         ties designed to evaluate the effectiveness of the Regional Medical Program
         grants and contracts program.  It will also conduct studies designed to improve
         overall productivity in order to meet the mounting workload with the present
         limited staff.






    0














   0













    0














                                  Appropriation Estimate



                                REGIONAL MEDICAL PROGRAMS



                   To carry out title IX, sections 402(g), 403(a) (1), 433(a),

              and, to the extent not otherwise.provided, 301 and 311 of the
              Public Health Service Act, [$106,502,000 of which  $89,500,000

              shall remain available until June 30,, 1972 for grants pursuant
              to such title ix] $52,771,000.














                               Explanation of T,anguage Changes




                     Under Public Law 91-515, title IX of the Public Health

                Service Act is amended to delete two-year grant funding

                authority.






   0














   0













    0







                              DEPART'@IENT OF IIEALTII, EDUCATIO@L,,', A-ND V@TEI,FAI@E.

                            HEALTH SERVICES AND MENTAL HEALTH ADMINISTRATION

                                        Regional Medical Prograriis

                                    Amounts Available for Obligation


                                                                  1971               1972

             Appropriation   . . . . . . . . . . . . . .      $106,502,000       $52,771,000

             Real transfer from:

                "High6r education facilities loan
                 fund" @r9
                 increased -pay costs)   . . . . . .  .  .         488,000           ---

             Comparative transfers to:

                "Office of the Administrator" .               -     50,000           ---
                "Comprehensive health planning
                    and services 11 . . . . . . . .  .  .  .  -     39,000           ---
                "Disease control"   . . . . . . .  .  .  .    -  2,793,000
                "National health statistics"  .               -  2,500,000           ---

             Subtotal, budget authority    . . . . .  .  .    101,608,000         521771,000
             Uftobligated balance, start of year .    .  .     15,298,000         34,500,000

             Unobligated balance, end of year     . . .  .    -34,500,000            ---
                 Total, obligations    . . . . . . .  .  .    $82,406,000        $87,271,000











                                              obligations by Activiti/

                                                 1971                   1972                 Increase or
           Page                               Estimate                Estimate                  Decrease
           Ref.                             Pos.     Amount        Pos.     Amount           Pos.     Amount

            Rep-ional medical
              p        s:
            (a)  Grants  ........           --      $70,298,000    --        $75,000,000   --      +$4,702,000
            (b  'Tir    t
                    operations..            91     1,799,000       91       1,851,000           +     52)000

            Technical
              assistance and
              disease control-
            (a)   Regionalization
                        activities.....     50     2,543,000       50       2,576,000           +     33,000
            (b)   .;mok-ing
                               ........     29     2,172,000       29       2-1@9.OOQ           +     .17,000
            (c)   Kidney  disease   ...     38     4,@'-'c6.OOO    38       4@.iia,ooo          +     12,000
                        subtotal   ....     117    8,811,   000     117     8,883,000           +     72,000

            Program direction
              and management
              services     ............     67     1,498,000       67       @,537,000           +     39,000
            Total obligations     .....     275     $82,406,000     275      $87,271,000        +$4,865,000










                                                                                         Increase or
                                                      1971              1972
                                                    Estimate            Estimate          Decrease


                Total number of permanent
                   positions   . . . . .  .  .  .     275               275

                Full-time   equivalent   of   all
                   other positions    . . . .  ..      52                52

                Average number of all
                  employees   . . . .  .  .  .  .     295               295                 ---






                Personnel compensation:

                  Permanent positions     .  .  .  $3,716,000         $3,970,000         + $254,000

                  Positions other than
                    permanent   . . .  .  .  .  .     275,000           319,000          +    44,000

                  Other personnel
                    compensation     . .  .  .  .      57,000           57,000                ---

                       Subtotal, personnel
                        compensation   .  .  .  .   4,048,000          4,346,000         +  298,000

               Personnel benefits      .  .  .  .     388,000           410,000          +    22,000

               Travel and transportation
                of persons    . . . .  .  .  .  .     329,000           329,000               ---

               Transportation of things.               40,000           40,000                ---

               Rent, communications and
                 utilities    . . . .  .  .  .  .     386,000           386,000               ---

               Printing and reproduction              267,000           267,000               ---

               Other services     . .  .  .  .  .    444_,OOO           444,000               ---

                 Project contracts     .  .  .  .   6,098,000         5,941,,OOO            157,000

               Supplies and materials                  69,000           69,000                ---

               Equi                                                                           ---
                   .pment           .  .  .  .  .      39,000           39,000

               Grants,   subsidies   and
                  contributions     . .  .  .  .. 70,298,000          75@000@000        +4,702,000

               Total obligations by






   0














    0














    0







                                               Summary of ClianRes



                                                                                         $82,406,000
         1971 estimated obligations    ........................................

         1972 estimated obligations    ....................             ...........       87,271,000

                       Net Change  ...........................................            +4,865,000


                                                           Base                    Change   from   Base
                                                       Pos.     Amount             Pos.          Amount


         Increases:


            A.  Built-in:
                 1,  Annualization of 1971
                     Health Insurance
                     Contribution (PL    91-418)                                         +        4,000

                 2.  l@Ti@hin-grade pay
                     increases  ................                                         +    157,000

                 3,  Annualization of increased                                          +    159,000
                     pay costs ....



            B.  Program:
                 I . Operational and planning
                     grants ...................               $70.,298,000               +   Zi,702,000
                                  Total,, increases                                      +    5,022,000



         Decreases:

            A.       ram:                                                                -    157,000
                 1.  Project contracts   .......

                                                                                         -    157,000
                            Total, decreases



         Total, net change   .................                                           +$4,865,000









                                                    Sununar)7 of Changes


          19-71 budget authority   .......................................         ...         $101,608,000

          1972 budget authority    ...........................................                   52  771   000

                       Net change  ..........................................                   -48,837,000-




                                                                 Base                    Change   from    Base
                                                            Poq,      Amount             Pos.           Amount


         Increases:


             A.  Built-in:
                  1.   AnnualizaLion     of 1971
                       Health     Insurance
                       Contribution     (PL 91-418).....                                       +         4,000

                  2.   Within-grade     pay increases..                                        +    157,000

                  3.   Annualization     of increased
                       pay costs      ...................                                      +    159,000

                                     Total, increases..                                        +    320,000



         Decreases-


            A.  Program:
                  1.  Operational and planning
                       grants     .....................             89,500,000           --    -49,OOOJIOOO

                  2,.  Project contracts   ..........                                          -    157,000

                              Total, decreases     ....                                        -49,157,000



        Total, net change    ...............      .....                                        -48,  83  7,000








                                          E-,<I)Ianation of Clianf,,es



          Increases:


             A.  Built-in:


                      An increase of $4,000 is included for annualization of health
                 insurance benefits under Public Law 91-418.


                      $157,000 is included for within-grade pay increases.

                      $159,000 is included for annualization of increased pay costs.

             B.  Program:

                      The difference between Budget Authority and estimated obligations
                 reflects $34,500,000 placed in reserve in 1971 and being made available
                 in 1972.

                      Estimated total obligations for grants is $75,000,000, an increase
                 of $4,702,000 over Fiscal Year 1971.  Of the total grant obligations
                 $5,000,000 has been earmarked for construction of a regional cancer center
                 in the Northwestern part of the United States.



          Decreases:


             A.  Program:

                      Project contracts have been decreased by $157,000 to provide funds
                 for within-grade pay increases.













                                            Explanation of Transfers



                                                        1971
                                                       Estimate                   Lu  ose


          Real transfer from:


             Higher education facilities
               loan fund" (                        +   $488,000              Increased  pay   costs.
               for increased pay costs)


          Comparative transfers to:

            "Office of the Adriinistrator"         -     50,000              For  consolidation   of
                                                                        the HSMHA Library and
                                                                        Grants Management Program.

            "Comprehensive health
               planning and services"              -     39,000              Transfer of function to
                                                                        Regional Office operations

            "Disease control"                      -2,7 93  000              Transfer  of   National
                                                                        Nutrition Program.

            "National health statistics"           -2,500,000                Transfer for Health
                                                                        and  Nutrition   Examination
                                                                        Survey.






    0













    0





                                I








    0











                             Significant Items   in House and Senate
                                          ons Committee. Rel)orts


         Item                                              Action taken or to be taken


         1971 Conference ReT)ort


         Research and demonstr


           1.       Committee deleted language proposed
               by the Senate to earmark funds (page 7
               of Conference Report).

           2.       Conferees agreed that of the amo.unt  2.       The amount  appropriated
               appropriated in excess of the amount           in excess of the amount  pro-
               proposed by the House, $3,000,000  would       posed by the House has  been
               be for research and demonstration  proj-       placed in  reserve.  However,
               ects on early care for suspected coro-         Regional Medical Programs
               nary patients. $2,000,000 would  be  for       are currently conducting
               research, training, and demonstration          coronary care research and
               projects in the field of kidney disease,       demonstration projects at  a
               and $5,000,000 would be for construction       $7,000,000 to $9,000,000
               of a regional cancer center in the North-      level and kidney projects  at
               western part of the United States  (page       a level of nearly  $1,500,000.
               7 of Conference Report).                       An additional $3,400,000  in
                                                              contracts is going into
                                                              direct support of 40  projects
                                                              in the kidney disease  control
                                                              area. It is  anticipated  that
                                                              plans for the cancer  center
                                                              will have progressed  suffi-
                                                              ciently so that the $5,000,000
                                                              will be obligated in 1972.






    0













   0













    0





                                           Au    -1 -1@rlE I
                                             tl)ori                 11





                                                                           19 72
                                                                                      Appropriation
         Legislation                                      Authorized                    requested

         Public Health Service Act


           Title IX -- Education, Research,
             Training, and Demonstrations in
             the Fields of Heart Disease,'
             Cancer, Stroke, Kidney Disease,
             and other Related Diseases   .......          $150,000,000                $40,500,000



                                          PIJBLIC HEALTH SERVICE ACT


         The Public Health Service Act, Title IX, Education, Research, Training and
         Demonstrations in the Fields of Heart Disease, Cancer, Stroke, Kidney Disease,
         and other Related Diseases.


         "Sec. 900.  The purposes of this title are--
              "(a)  through grants and contracts, to encourage and assist in the establish-
         ment  of  regional  cooperative  arrangements  among  medical  schools,  research  insti-
         tutions, and hospitals for research and training (including continuing education),
         for medical data exchange, and  for  demonstrations  of  patient  care  ill  the  fields
         of heart disease,  cancer,  stroke,  and  kidney  disease,  and  other  related  diseases;

              "(b)  to afford to the medical profession and the medical institutions of the
         Nation  through  such  cooperative  arrangements,  the  opportunity  of  making  available
         to their patients  the  latest  advances  in  the  prevention,  diagnosis,  and  treatment
         and rehabilitation of persons suffering from these diseases;

              11(c) to  promote  and  foster  regional  linkages  among  health  care  institutions
         and providers so as  to  strengthen  and  improve  primary  care  and  the  relationship
         between specialized and primary care; and

              11(d) by these means,  to  improve  generally  the  quality  and  enhance  the
         capacity of the health  manpower  and  facilities  available  to  the  Nation  and  to
         improve health  services  for  persons  residing  in  a.reas with limited health
         services, and to  accomplish  these  ends  without  interfering  with  the  patterns,  or
         the methods of  financing,  of  patient  care  or@Drofessional  practice,  or  with  the
         administration  of  hospitals,  and  in  cooperation  with  practicing  physicians,
         medical  center  officials,  hospital  administrators,  and  representatives   from
         appropriate voluntary health agencies."
              Sec.  901(a)  There  are  authorized  to  be  appropriated  $50,000,000  for  the
         fiscal year ending June 30,  1966,  $90,000,000  for  the  fiscal  year  ending  June  30,
         1967, $200,000,000 for the  fiscal  year  ending  June  30,  1968,  $65,000,000  for  the
         fiscal year ending June 30, 1969, $120,000,000 for the next fiscal year,
         $125,000;000 for the fiscal  year  ending  June  30,  1971,  $150,000,000  for  the
         fiscal year ending June  30,  1972,  and  $250,000,000  for  the  fiscal  year  ending
         June 30, 1973,  for  grants  to  assist  public  or  nonprofit  private  universities,
         medical  schools,  research  institutions,  and  other  public  or  nonprofit  private
         institutions and  agencies  in  planning,  in  conducting  feasibility  studies,  and  in






          research, training and demonstration activities for carryi.p
                                                                          -n., out the purposes  of
          this title and for contracts to carry out the purposes of this title.  Of the
          sums appropriated linder this section for the fiscal year ending June 30, 1971,
          not more than $15,000,000 shall be available for activities in the field of
          kidney disease. Of  the  sums  appropriated  under  this  section  for  any  fiscal  year
          ending after June 30, 1970, not more than $5,000,000 may be made available in
          any such fiscal year for grants for new construction.  For any fiscal year ending
          after June 30, 1969, such portions of the appropriations pursuant to this section
          as the Secretary may deterrnine,-but not  exceeding  1  per  centLin  thereof,  shall  be
          available to the Secretary for evaluation (directly or by grants or contracts)
          of the program authorized by this title.,,

                                            "MULTIPROGRAM SERVICES

                "Sec. 910.   (a)To facilitate interregional cooperation, and develop improved
          national capability  for  delivery  of  health  services,  the  Secretary  is  authorized
          to utilize funds appropriated under  this  title  to  make  grants  to  public  or  non-
          profit private  agencies  or  institutions  or  combinations  thereof  and  to  contract
          for--
                 (1) programs, services,  and  activities  of  substantial  use  to  two  or  more
          regional medical Drograms;

                "(2) development,  trial-  or  demonstration  of  methods  for  control  of  heart
          disease, cancer, stroke, kidney disease, or other related diseases;

                "(3) the collection and study of  epideitiiologic  data  related  to  any  of  the
          diseases referred to in paragraph (2);

                11(4)  development of training specifically related to the prevention,
          diagnosis, or treatment of any  of  the  diseases  referred  to  in  paragraph  (2),  or
          to the rehabilitation of persons suffering from any of such diseases; and for
          continuing programs of such training where shortage of trained personnel wou d
          otherwise limit application of knowledge and skills important to the control
          of any of such diseases; and

                11(5)  the conduct of cooperative clinical field trials.


           "(b)  The Secretary is authorized to assist in meeting the costs of special
          projects for improving or developing new means for the delivery of health
          services concerned with the diseases with which this title is concerned.

           "(c)  The  Secretary  is  authorized  to  support  research,  studies,   investigations,
          training, and  demonstrations  designed  to  maximize  the  utilization  of  manpower  in
          the delivery of health services."






                                     Authorizing Legislation


    0
                                                                1972
                                                                           Appropriation
       Legislation                                 Authorized                requested

       Public Health Service Act


         Title IX -- Education, Research,
           Training, and Demonstrations in
           the Fields of Heart Disease,
           Cancer, Stroke, Kidney Disease,
           and other Related Diseases ........     $150,000,000            $40,500,000










                                                              Public Law 91-515
                                                       glst Congress,  H.  R.  17570
                                                                October 30,  1970



                                    To  ainen(I  titles III and IX of the Public  Ilealth  Service  Act  so  as  to  revise,
                                       extend,  and  iiuprove  the  programs  of   research,   investigation,   education,
                                       training, and  demonstrations  authorized  thereunder,  and  for   other   purpos@.
                                       Be  it  enacted  by  the   Senate   and   Houge   of   Representati-ves   of   tire
                                    United States of A7?nerica in Co?igress asse?iz bled,                                  Public Health
                                                                                                                           Service Act,
                                    TITLE,      I-@'iMENDMENTS      TO      TITLE      IX       OF       TIIE       PUBLIC amendments.
                                                            IIEALTH SERVICE ACT
                                       SFc.  1.01.  This  title  may  be.  cited   as   the   "Heart   Disetse,   Ctiieer, Citation of
                                    Stroke, and I-Zidiiey Disease Amendii-ients of 1970@).                                 title.
                                       SEC.'102.  Section  900   of   the   Public   Health   Service   Act   is   amended 79 Stat. 926.
                                    to read as follows:                                                                    42 USC 299.
                                                                        cipuRiloslEs

                                       "SEc. 900. The purposes of this title ar@
                                             (a)  tlirouzil  Lrraiits  ,tiid  contracts,  to  encourage  and   tssist   in
                                         the   @tablislii@ip,@t   of   regiolitl   cooperitive   arrangements    ',IDIOIlg
                                         medical   schools,   research   institutions,   and   liospitils   for   research
                                         and   training   (including   continuing    education),    for    medical    dtta
                                         exclianl,e.  :tjid  for  demonstrations  of  patient  care  in  the   fields   of
                                         heart      ais,ease.   cancer,   stroke,   and   kidney    disease,    and    other
                                         related diseases-,                                                                84 STAT. 1297
                                            "(b) to ,iffoi-(Uto the medical profession an           lie  niedicLl  illsti- 84 STAT. 1298
                                         tiltioiis   of   tlie   N,,ttioil,   through   such   cooperitive   arrangements,
                                         the  opportunity  of  makiiiL,  a@ailable,  to   Clicir   patients   the   latest
                                         advances   in   tli@   prevention,   diagnosis,   and   treatment   and   i,elil-
                                         bilit,atioii of pers6Ds suffering from these dis@q-,w;
                                           -"(@)   to   promote   -,in(I   foster   regional   linkages   among    lieilth
                                         care  institutions  and  proiridei-s  so  ,ts  to  streiiathei).  and  III-iprove
                                         primary   care   and   the   relationship   between   s   ecialized   and    pri-
                                         mar.v care; and
                                            "((I)  by   these,   means,   to   improve   generally   the   quilit-y   Iiid
                                         enhance   the   capacity   of   the   health   maiipo-,vpr    ,tiid    facilities
                                         available   to   th@   N@tioli   -,uid   to   improve   health    services    for
                                         Pei-soiis     idii-i_ff  in  areas  with  limit-ed  health   services,   and   to
                                         @coml)lish    th@    ends    without    interferiiio-    with    the    patterns,
                                         or   the    methods    of    financing,                                 fessional
                                         practice,  or   with   the   a(iministr
                                         atioii   with   practicing   pliysicia:
                                         tal     administrators,     and     rej
                                         voluntary health agencies."
                                       SFc. 103. (a)(    1)  Th@   first   sentence   of   section   901   (a)   of   such Appropriations.
                                    Act   is   amended   by   striking   out   "and"   immediately   after   "Julie    30, 82 Stat. 1005.
                                    1969,",    and    bv    inserting    immediately    before     11,     for     grants" 42 USC 299a.
                                    the  follonvilig:    $125,000,600  for  the  fiscal  year  ending   June   30,   1971,
                                    $150,000,000  for  the  fiscal  yeir  ending   June   30,   1972,   and   $250,000,000
                                    for the fiscal y@ir elidingfuiie,30, 1973".
                                       (2)                       Siichfirstsentenceisfurtliernmendedbystrikingouttheperiod
                                    aft'er'lltitle"  and  inserting  in  lieu  thereof  "ana  for   contracts   to   carry
                                    out the purposes of this title."
                                       (3)   @ue@   section   901(a)   is   amended   by   striking   out    the    second Funds, limi-
                                    sent@nce and inserting in lieu thereof the- following: "Of the, sums tation.
                                    appropriatedujidertlifssectionforthefisca-I                   earendfngJuii(,,30,1971,
                                                                                         ly
                                    not  more  than  $15,OWOW  shill  be  -,available  for   activities   in   the   field

                                         52-067 0







                                                                Pub.      Law       91-515                                   October         30,         1970
                                                                of  kidney  disease.  Of  the  suii-is  appropriated  uiid(@i-  this  section   for   any
                                                                fiscal  Ve,@r  ciidiii  tifter  June  'iO,   1970,   not   more   than   $5,000,000   may
                                                                                      9
                                                                be   inside   available   ill   Illy   such   fiscal   year   for   griiiits   for    new
                                                                constructions'
                                       79 Stat. 926;            (b)  Section  901   of   such   Act   is   further   aiiiei.ided   by   adding   at   the
                                       82 stat. 1006.           end thereof the following new subsection:
                                       42 USC 299a.             "  (e)  At  the  request  of  any  recipient  of  a  gr@int   under   this   title,   the
                                                                ayineiits  to  such  recipient,  may  b@  reduced   by   the   fair   market   value   of
                                                                                      upplies,  or  services  furnished  bN,   the   Secretary   to   such
                                                                                      s
                                                                                      the ,imount  of  the  p'      allowance,      traveling       expenses,
                                                                                      sts  in  connection  Witter,,  the  detail'of  all  officer  or  cm-
                                                                                      overiiment   to   the   recipient   when   sucli    furnishing    or
                                                                                      the  case  may  be,  is  for  the  convenience   of   tnd   Fi   the
                                       84 STAT. 1298                                  recipient   and   for   the   purpose   of    carryina    out    the
                                       84 STAT                        al    iiiedica    pro am   to   which   the   grant   under   this   titl@is   made."
                                       42 USC                           104.       See ion                      Act   is   ai-nended   by    striking    out
                                                                            diagnosis,                                                                  cer,
                                                                                                                                                             or
                                                                            -and,   at   i
                                                                            nd   iiisertii                                                              osis,
                                                                treatment,   and    relial                                                                     I
                                                                or kidney disease and, at the opti                                                      ated
                                                                diseases,
                                                                 (b)  Section 902(f)  is -,imeiided by strikiiia out "includes"                         ,Liid
                                                                iii@riing   in   lieu   thereof   "means   new    constriction    of    facilities    for
                                                                demonstrations,   research,   find    training    when    necessary    to    Carry    out
                                                                reLioilal      medical
                                                                                      Progr'(I'bn@s@@) of such Act is amended-
                                       42 USC 299o.'               EC.   105.    SeCti )n 90.3
                                                                        (1)         b.!   i   'It "'I      tar
                                                                                      y strk              un   _y  beiltli,,tgeiicies,  and"   and   insert-
                                                                                          'go
                                                                     ing  il@  lieu  th   reof            itary or   official   health   agencies,    lieLlth
                                                                     Planning agenc@Cs, @iidll;,
                                                                        (2) byiiisertingimmeaiatelv,,tft,er"tindertheprogram                       !5,   Avliere
                                                                     it  first   appears   therein,   the   foli,owing:    (iiicl uding as an e          officio
                                                                     member;   if   there   is   located   in   such   region   one   or   more   hospitals   or
                                                                     other    health    facilities    of    the    Veterans'    Administration,    the     indi-
                                                                     vidual    whom    the    Administrator     of     Veterans'     Affairs     -,ball     have
                                                                     designated   to    serve    on    such    advisory    group    ,is    the    representative
                                                                     of      the      htals   or   other   h(yalt,li   care   facilities    of    such    Admiii-
                                                                     istrationosriieh      are       located
                                                                                      , b                  in such region)"; ,tjid
                                                                        (3)   by    str                 ed   for   the,   services    'provided    under    the,
                                                                     program"        an                    eu   thereof   "need   for   ,tnd   fiiitiicijig   of
                                                                     the       services                    r   t    I)roLrr,,im,    @ind    -.which     advisory
                                                                     group   sliall   I                    um     r     to     insure     adequate     community
                                                                     orientation    (as     determiti4     dbv the Secretary)".
                                                                  Svc.  106.  That   part.   of   the   second   sentence   of   s@tioii   904   (b)   of   such
                                         42 USC 299d.           Act           preceding                    is amended b   strikiiilz out                "section
                                                                90.3 (b)  (4)         and                                                             (tseetioii
                                                                903(b)(4)lif                                                                             llecom-
                                                                mendation,          for                                                              or     non-
                                                                profit          private                                                                 coml)re-
                                                                hensive        regioiii                                                                 referred
                                                                to   in    section    3    c                                 icli    the    reaional     medical
                                                                ir)rograni          for   the         ii  ioii  is  made   will   be   located,   and   if   the
                                                                al)@licatioi-i".
                                         National Ad-             SEC.   107.   (a)   Section   905(a)   of   -,iicli   Act   is   ftniended    to    read    as
                                         visory            co-oil follows:
                                         on Regional              "SEC.   905.   (a)   The    Secretary    may    ,tppoint,    without    re    ird    to    the
                                         Medioal Pro-           civil service laws, a National Advisorv Council on Regioi                             'L%Tedical
                                         gr-ss 0                Programs.    The     Council     sball     consist-of     the     Assistant     Secretary     of
                                         42 U C 299a            Ifealth,Fducttion,aiidWelfareforHe-,iltliaiidScientificAffairs,wb(i









                                 October 30,  1970                    - 3               Pub.        Law         91-515
                                                                                                                   84  STAT. 1300
                                 shall  1)(@,  the  Chairman,  the   Chief   -Aledical   Director   of   the   Voter-,Ili','
                                 Administration  who  shall   be,-tii   ex   officio   member,   and   t,iveiit.N   iiielit-
                                 ).)ei-s, not otliei--%vis(,, in the  i@cgttl,,ir  full-time  enii)lov  of  tli(@  1)'iiited
                                 States,  who  are  leaders  in  tli(@  fields  of  the  fuiid:iiii(@iital   sciences,   the
                                 medical scieii(-e.,3, li(@altli c,,treidiiiiiiistr@,itioji, oi-        At    least
                                 two  of  the  appointed   members   sliill   be   I)r,,icticiiik   physicians,   oileglitll
                                 be  outstanding  in  the  study  or  I)ealtli  care  of  )ei,,,,oiis   stifferill,-,   from
                                 heart disease, one shall be outstanding in the       stll, , oi@  lieiltli  care  of
                                 persons suffering from cancer, one              be oiitstii)(linL' in tl)e staid
                                                                                                                 y
                                 or  health  care  of  persons  suffering  froii-i  stroke,   one   sliill   be   oittstand-
                                 ilig   in   the   stiidi   or   health   cal-(@,   of   persons   suffering   from   kidney
                                 disease,,  two  shall  be  outstanding  in  the   field   of   pi-en-eiitioii   of   heart,
                                 disease,  cancer,  stroke,  or  kidney  disease,   ijid   foiii-   shall   be   iiieii)bers
                                 oi. the Public."
                                    (b)   Of   the   persons   fil-4   al)poii)ted   under   @,ctioii    905(a)    of    the Tertn of
                                 Public  ITealtli   Service   Act   to   serve   as   the   four   additional   members   of Office -
                                 the   Natioiial   Advisory   Council   oil    Re-aional    \Iedical    Pj'ogriiiisiiitl)or-
                                 iz(@d by the ,ti)ieiidiiient made by subsection (a) of this section-
                                         (1)  one shall serve for     ,t term of oiie, ye,,ii-,
                                         (2)  one shall serve for     t term of two years,
                                         (.3)  one shut serve for i terii-i of three             Iiid
                                         (4) one shall serve for      a term of four -years,
                                 as d(-@sigii@ited bv the Secretar    of Ile,,iltli,  Ediicitioii,  ai)d  11'elf@ire  at
                                 the time of appointment.
                                    (e)         '.NfeiiibersoftlieNitt,ioii-,tl.@dvisoryCotiii(,,iloiil'o@l-ioiitl'-\Tedical
                                 Pr@@i,-ttms  (otliei-  than  the  Surgeon  General)  ill  ofli(.C@   oil   the   dite,   of
                                 enactment,  of  this  Act  shall  (continue  in  ofli(-e  in  accordiiii(,c@   %vitli   the
                                 teri)i of office for wl)icli they Avei-e list appointed to the ('oiiiieil.
                                    SFc. 108. Section 907 of such Act  is  'Lineiided  by  strikiii(_Y  ollt  '@Or 79 Stat. 930.
                                 -;troke,," and iiisertiiig in lieu thereof "stroke, or ki(fi)ey                   42 USC 299g.
                                    SFc. 109. Section  909(,t)  of  such  Act  is  ;intended  by  inserting  "'Oi' 42 USC 299i.
                                 contract" qfter "grant" each place it appears tliet,eii).
                                    Src,. 110. (a) S-c-etion 910 of such Act is  amended  to  i-e@id  Is  follows: 82 Stat. 1006.
                                                                                                                   42 USC 299J.
                                                          @;,Aft'I,TIIIR(X.RA31 SERVICES
                                    ,@SFC. 910. (,,I) 'ro  facilitate  interregional  cooperation,  and  dei-elol)
                                 improved national  capability  for  delivery  of  health  services,  the  Seei-e-
                                 tar@ is iutliorized to iitilize funds appropriated under this title  to  iiiall-e
                                  i-aiits to public oi- nonprofit private -,agencies  oi-  institutions  or  coni-
                                 I)inations thereof and to contract for-
                                         11(i)  prolyraiiis,  services,  and  activities  of  substantial  use  to
                                      two or inorowregioiial niedicil programs;
                                       1  "(2)  development,  trial,  or  demonstration  of  -methods  for   coii-
                                     ;'trol of heart disease, cancer, stroke, kidnev disease, or  otliei,  related
                                      diseases;
                                         11(3) the collection xncl studv  of  c))ideilliolo(,ic  datt  related  to
                                                                                            LI
                                      an            iseases    referred
                                         -v @@ the d                  to @ii parigrapl,
                                                d@yelol)i@ent of  traiiiin-  specificall@l,,,;Iated  to  the  pre-
                                      vention,  diagnosis,  or  treatment  of  aii@  of   tlie'diseases   referred
                                      to in parayi-iil)li (2), or  to  the  rehabilitation  of  persons  suffering
                                      froiyi  any  of  such  diseases;  and  for  continuing  programs   of   such
                                      trainiiia  where   shortage   of   traiii(@d   personnel   would   otherwise
                                      limit   ai),placation  of  knowledge  and  skills  important  to  the  control
                                                     1  diseases;   and
                                                     oiitltict of Cooper,,itive clinical field trials.
                                                            is authorized to assist  in  meetinc_r  the  costs  of
                                 Si                    improving  or  developing  ne%v  meins   for   the   deliv-
                                                          concerned with  the  diseases  with.  which  this  title










                                                                                                                               tober        30,         1970
                                                            Pub.  Law 91-515                              4                  Oc
                                    84 STAT. 1301
                                                                "(c)  The  Secretary  is ititlioi-ized          to     support      reseLrcli,      studies,
                                                            ini,esfigatiolis,     training.      and      demonstrations      designed      to      maximize
                                                            the utilization of iiian@6wer in the delivery of health services."
                                                                SEc.  111.   (.,,i)   The   Heading   to   title   IX   @f   such   Act   is   .imended   by
                                                            striking      out      "STROl@E,      ANI)      RELATED       DISEASES"       ,tnd       insert-
                                                            ilia      in      lieu      thereof      "STROKE,      KIDNEY      DISEASE,      AND       OTHER
                                                            IZi@2L.A.TED DISEASES".
                                    42 USC 299b-                (b)     Sections     902(a),     903(a),     903(b     1     9                 905      (b),
                                                            906  (@),  906,  ?07,  and   909   (a)   of   such   Act   @as   i
                                    299g, 299i.             provisions    or    this    Act)    are     each     further     a
                                                            "Surgeon    General,",    each    place     it     ippears     the
                                                            thereof        "Secretary".
                                                                               @,IENDMENTS'rO TITLE III OF THE
                                                                                      HEALTH SERVICE ACT
                                                                                 AIRCII A--ND I)F,-i%ioisrRATIO.NS IIFLATING T(
                                                                                         FACILI'flES    A@ND     ERVICES
                                   61 Stat. 534.                              a) (1) Section 304 (a) of the Public, Health
                                                            is 11
                                   42 I)SC 242b,                I       e(l-
                                                                            by inserting "(1)" immediately after                           304.  (a)
                                                                                             ting    clauses     (1)     ,iild                (A)     n
                                                                   (B),                      iid
                                                                                                    clauses      (A),       (B              as       clauses
                                                                     (C
                                                                (2)                                             ende
                                                                                                  (b)))         iiseri          lieu  thereof  11  (2)   11;
                                                                   and
                                                                                                      S         1)) eEL         e   it    appears    therein
                                                                   aii@i       I is]                    ''this sub    I      on
                                                                (3)    Se        3,                   ct   is   -,iinc   f-@d-
                                                                     (A)   by    s                        and  sei-tiiig  in  lieu   thereof   "   (3)   11;
                                                                   and
                                                                     (B)  by str                      s see         each   place    it    appears    therein
                                                                   and inEeiting                          this.-,            tioii".
                                                                (b)  Section 304                          urtlierimeiided    by     adding     after     the
                                                            provision  thereof                            as      paragraph      (3)      by      subsection
                                                            (a) (3) (A) of this
                                                                                                                             section:
                                                                      "Systems                                               th Care Plans
                                                                "(b)(1)(A)          The           ry                         through     -utilization     of
                                                            the   systems   analysis    iptt-liod,    p                      care      systems      designed
                                                            adeq@iately    to    meet    the     health iiee                 American       @ople.       For
                                                            pur6oses    -of     the     preceding     sentence,     the      stems      analysis      method
                                                            means    the    analyti.@@l    method     by     ivhich     v,,tri means    of     obtaining     a
                                                            desired   result   or.@oal   is   associated   with    the    cost nd     benefits     involved.
                                                                "(B)    The    Se@iet-,iry    shall    complete    the    deve      ent   of    the    plans
                                                            refe'rr@    to    iij@iibl)aragraph     (A),     -,vithin     such                  e    necles-
                                     R                          tr               iii  to sul      t't@      the       Congress                       Septem-
                                      eport to              s  -V to enal>fc I  n               )mi
                                     Congress.              her-    30,    19,71,    a    report    thereon    which     shall                  plan      so
                                                            developed in terms of-
                                                                     @i)    the    number    of     people     -ivho     woulo                 nder      the
                                                                   i))'an;
                                                                   /   "(ii)   the   kind   and   type,   of    health    care                       covered
                                                                   under   the   I)Iin;
                                                                     C((iii)   the   cost   involved   in   carrying   out   i      a
                                                                   costs would be financed;






    0














   0











                                                                     I


    0









                                           Regional Medical Programs






                         Budget
                        Estimate             House           Senate
            Year       to   Congress      Allowance         Allowance          Appropriation

            1966       $25,000,000          N.C.  1/        $25,000,000          $25,000,000

            1967        45,024,000          $45,004,000      45,004,000           45,004,000

            1968        64,314,000           54,314,000      64,314,000           58,814,000
            1969        68,922,000          N.C.  1/         68  922,000          61,907,000

            1970  2/   100,000,000          76 000  000     100,000,000          ioo,0002000

            1971  2/   96)502,000            96,5022000     ll5iOOO,OOO          1062502,000

            1972  2/   52, 771,000




            1/ Not considered.

          .2/ Includes programs previously supported under the appropriation '@Chronic
                 diseases," for comparability.





                                                                     DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE

                                                                   Health  Services and Mental Health Administration

                                                                                 History of 1972   Estimate


                                                                         1972                         Department     OMB reduction
                                                      Estimate         Department                       reduction       from
                                      1971               to             Estimate     President's     from agency      Department
                                Appropriation        Department          to OMB         Budget          request,      Submission                                    Posi-
           e-:) ro riation            (a)                (b)                (c)                            e              (f)                                        tions     Amount


        @gio-.ial Medical
         Pro-rams               $106,502,000        $91,697,000       $91,617,000     $52,771,000       $80,000      $38,846,000       Department reductions:
                                                                                                                                         a.   Program    direction
                                                                                                                                                & management
                                                                                                                                                services .......              $80,000
                                                                                                                                              Total,    Department
                                                                                                                                                reductions  .....             $80,000


                                                                                                                                       OMB reductions:
                                                                                                                                         a.   Grants ...........        $39,000,000
                                                                                                                                         b.   Direct    operations     +      57,000
                                                                                                                                         c.   Kidney ...........       +      17,000
                                                                                                                                         d.   Smoking  &   health.     +      13,000
                                                                                                                                         e.   Regionalizatio@
                                                                                                                                                activities  .....      +      43,000.
                                                                                                                                         f.   Program    direction
                                                                                                                                                & management
                                                                                                                                                services .......       +      24,000
                                                                                                                                              Total,  O,4B
                                                                                                                                                reductions  .....       $38,846,000





                                                                                                           February 9, 1971


                                                               Budget History - Grants
                                                                    (In thousands)


                                                       FY   1966    FY   1967   FY   1968      FY   1969      FY 1970       FY    1971     FY   1972

       Authorization        .......................      $50,000    $90,000      $200,000        $65,000      $120,000       $1251POOO      $150,000

       Appropriation:
         Grants        ............................       24,000     43,000      53,900         56,200        73,500         89,500         40,500 a,


       Add:
         Balance brought     forward from
         previous year        .....................       ---        21,934   b/ 25,900         36,1.65       20,000         15,298         34,500

       Less:
         Amounts held in reserve by BOB        ....       ---        21,000   -  30,900         20,000        15,000         34,500

       Amount available for obligation        .....       24,000     43,934      48,900         72,365        78,500         70,298         75,000

       Less.
         Amount obligated - Grants       ..........        2,066     27,052      43,635         72,365        78,@           70,298         75,OOG

       Lapse:
         Grants        ............................       ---        11,982     c/  ---           ---           ---             ---           ---


       Balance carried forward        .............       21,934        4,900       5,265         ---                           ---           ---





       a/   Appropriation request.

       b/   Available through December 31, 1966.

       C/   These funds were appropriated for fiscal year 1966, available for obligation
            until December 31, 1966.  They lapsed on that date.