Louisiana Administrative Code › Title 48 - PUBLIC HEALTH-GENERAL › Part I - General Administration › Subpart 5 - Health Planning › Chapter 101 - Introduction › Section I-10103 - Background

Current through Register Vol. 50, No. 6, June 20, 2024
A. Planning for
				  health care is not new either to Louisiana or to the nation as a whole. Since
				  the earliest days of our nation, federal and state governments have concerned
				  themselves with matters affecting the health and welfare of the American
				  people. However, this health planning activity has intensified dramatically in
				  the recent past, more specifically since the 1960's. During this time,
				  attention has been directed to health problems, health care patterns and
				  attitudes, needed resources and other issues related to health care. This
				  increased intensity of health planning activity brought with it the need for
				  coordination of effort.
B. On
				  January 4, 1975, President Ford signed into law the National Health Planning
				  and Resources Development Act ( P.L. 93-641), thereby bringing together in one
				  package many of the federal government's concerns about health matters. The new
				  law set up a hierarchy of planning efforts at the local, regional, state, and
				  federal levels to stimulate needed changes in the financing, development, and
				  organization of health resources and services. This program is administered by
				  the United States Department of Health and Human Services.
C.P.L. 93-641 combines and redirects the
				  efforts of a number of federally- supported state and local activities involved
				  in the planning and development of health resources across the nation. Many of
				  these programs go back many years and, despite some shortcomings, have
				  contributed much to improving the availability of health services to the
				  American people. A brief history of some of the more important of these past
				  efforts is helpful to an understanding of the goals and aspirations of P.L.
				  93-641 and the directions and emphasis outlined in this planning
				  document.
D. The Hill-Burton Act,
				  passed by Congress in 1946, made available federal loans and grants for
				  hospital construction to overcome shortages stemming from the depression of
				  World War II years. Later amendments to the Act made similar funds available
				  for nursing homes, rehabilitation and ambulatory care facilities, chronic
				  disease hospitals, and the replacement and modernization of existing
				  facilities. Under the Hill-Burton Program, the Louisiana State Department of
				  Health and Human Resources developed and revised, on an annual basis, a State
				  Facilities Plan. This Plan was used to develop priorities and objectives for
				  the allocation of available federal funds for construction of health facilities
				  throughout the state.
E. Additional
				  federally-supported health planning activities began in 1964, when the
				  Hill-Burton Act was amended to provide for federally recognized area-wide
				  health planning agencies. These area-wide agencies functioned on a voluntary
				  basis and were expected to deal with broad based planning for health facilities
				  in their areas. The program was essentially a reaction to the over-construction
				  resulting from the Hill-Burton program. This legislation was replaced in 1966
				  by P. L. 92-603, the Comprehensive Health Planning Program (more commonly known
				  as the "Partnership for Health Act").
F. This "Partnership for Health Act"
				  broadened the area-wide planning concept to include health services and
				  manpower development, as well as facilities construction. An important part of
				  the Act was its emphasis on eliminating unnecessary duplication of health care
				  facilities and equipment. The program established state agencies and local
				  comprehensive health planning agencies to plan for and to promote the rational
				  and orderly development of health resources and services in their respective
				  areas.
G. The Regional Medical
				  Program, enacted in 1965, also had a planning component, but its primary focus
				  was on the development of cooperative arrangements among health care
				  institutions, medical schools, and research bodies as an essential first step
				  in diffusing throughout the health care system the latest improvements in
				  technology and knowledge for the treatment of heart disease, cancer, and
				  stroke, then and now, the three leading killers of Americans. As the Program
				  developed, its emphasis shifted from its original orientation on the three
				  major disease groupings to more broadened concerns with the planning and
				  development of health services. It was inevitable that many of its activities
				  and programs paralleled those which the Partnership for Health (CHP) Program
				  was attempting to carry out.
H. In
				  1971, the Experimental Health Services Delivery System (EHSDS) program was
				  initiated. The EHSDS's were federally funded development efforts directed in a
				  handful of designated states and communities. They were demonstrations of
				  health services management systems under a local, public non-profit corporate
				  structure. Emphasis was placed upon collection of data and the initiation of a
				  management information system for health providers at the community level.
				  These experimental efforts were found to be insufficiently structured to avoid
				  some overlap and supplication of the RMP and CHP efforts.
I. In 1972, the Social Security Act was
				  amended to include Section 1122 of the Act. This Section allowed the Federal
				  government to withhold Medicare and Medicaid reimbursements to a hospital or
				  other type of health care facility for any of the facility's capital
				  expenditures totaling over $100,000 unless a designated state health planning
				  agency (the CHP "a" agency of the state) had given its prior approval. This
				  1972 amendment to the Social Security Act was utilized in many areas of the
				  nation to discourage unneeded facilities and duplication of services.
J. Despite all this activity and interest, it
				  became increasingly evident to concerned individuals and groups, both in and
				  out of government, that all was not well in the health field: costs of health
				  services had been rising rapidly; health resources were, in many instances,
				  limited or lacking and often inappropriately or inefficiently utilized; and the
				  quality of services did not always meet acceptable standards, particularly in
				  areas where health resources were often most limited. But it was also becoming
				  increasingly evident that the major constraint to improving health services was
				  economic. It was these concerns that led to the enactment of P.L. 93-641. And
				  it is the provisions of this law that have given rise to the preparation f this
				  health plan for Louisiana and to the accomplishments that promise to follow
				  from it.
K. An important provision
				  of P.L. 93-641 was the establishment of a network of local health systems
				  agencies (HAS's) throughout the United States. In Louisiana, three agencies
				  were designated as HAS's and began local planning efforts in 1976. However, in
				  1981, congress modified section 1536 of the Act, permitting governors to
				  request that mandated health planning functions be conducted at the state level
				  only, with the assurance that local input into the state health planning
				  process would be maintained. In December, 1981, Governor David Treen elected to
				  exercise this option for the state of Louisiana. The secretary of the
				  Department of Health and Human Services granted this request and, effective
				  April 30, 1982, the State Health Planning and Development Agency was designated
				  to carry out health planning functions in Louisiana.
AUTHORITY NOTE:
					 Promulgated in accordance with P.L. 93-641 as amended by P.L. 96-79, and
					 R.S.
					 36:256(b).