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New Opportunities for the Public to Shape the Nation's Institutional Health Care Services

Published online by Cambridge University Press:  29 April 2021

Mark D. Mandel
Mark D. Mandel*
Affiliation:
Boston University Center for Health Planning; Maxwell School, Syracuse University
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Abstract

The author of this Comment describes how recent federal legislation (P.L. 93-641, signed into law in January, 1975)—and improved scientific techniques for integrating (1) community medical needs assessment, (2) institutional budgeting linked to regional/state health plans, and (3) budget ceilings—have given the public new authority and technology to shape the nation's institutional health services. He urges administrators and trustees of health institutions—both proprietary and charitable—to become aware of recent developments in this area, and says that active consumer and provider participation in Health Systems Agencies and Statewide Coordinating Councils is necessary if the new federal expectations concerning health planning and regulation are to be met. Given the rising costs of medical care, stronger federal control might be forthcoming if the purposes of P.L. 93-641 are not achieved.

Type
Comments
Information
American Journal of Law & Medicine , Volume 3 , Issue 1 , Spring 1977 , pp. 49 - 57
Copyright
Copyright © American Society of Law, Medicine and Ethics and Boston University 1977

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Footnotes

*

Special thanks are given to John A. Norris, J.D., M.B.A., and to Jim McMahon, J.D., who assisted greatly in the preparation of this Comment.

References

1 National Health Planning and Resources Development Act of 1974, P.L. 93-641, 88 Stat. 2225 (1975). The literature on this Act generally refers to it as P.L. 93-641 and cites its public law sections. That convention is followed here. P.L. 93-641 adds Titles XV and XVI to the Public Health Service Act, and is codified at 42 U.S.C. §§ 300k-300t (Supp. V 1975).

2 See Health Resources Administration, Public Health Service, HEW, Pub. No. (HRA) 76-640, Papers on the National Health Guidelines: Baselines for Setting Health Goals and Standards (September 1976).

3 A summary description of P.L. 93-641 is provided in Health Resources Administration, Public Health Service, HEW, Health Planning and Resources Development Act of 1974 (1975).

In brief, P.L. 93-641 creates new state and quasi-public regional agencies to perform new health planning and regulatory functions. In each health service area (such areas are usually regions within states) across the nation, the Secretary of HEW, after consulting with the Governor of the appropriate state, must designate either a private, nonprofit corporation or a public entity as the area's Health Systems Agency (HSA). The HSA must have a governing body of 10 to 30 members, the majority of whom must be consumers and the remainder providers. The governing body may be larger if it establishes an executive committee of not more than 25 which meets the above consumer-provider representation requirements. Governing body members as well as optional sub-area advisory council members must be residents of the health service area and must be representative of the service area population's linguistic, racial, ethnic, and economic characteristics. Included in the governing body must be public elected officials as well as other governmental representatives, who may be either consumers or providers.

A State Health Planning and Development Agency (SHPDA) is to be selected by the Governor of each state and designated by the Secretary of HEW. Unlike the HSAs, the SHPDA has no governing body nor compositional requirements for its membership. The SHPDA must prepare an administrative program for carrying out the health planning and resources development functions of the state.

The Statewide Health Coordinating Council (SHCC) is to be composed of at least 16 members appointed by the Governor. Sixty percent of its members are to be representatives of Health Systems Agencies and at least half must be consumers. The Council is to adopt the state health plan, review the budgets and applications for assistance of the HSAs, and advise the SHPDA on the performance of its functions.

4 See House Committee on Interstate and Foreign Commerce, National Health Policy, Planning, and Resources Development Act of 1974, Report to Accompany H.R. 16204, H.R. Rep. No. 93-1382, 93d Cong., 2d Sess. 63 (September 26, 1974) [hereinafter cited as Health Planning Report].

5 For example, in the greater Boston health systems area the HSA is funded at a level similar to that which it had available when it functioned as a regional comprehensive health planning agency prior to P.L. 93-641. Yet, based on the first nine months of its experience as an HSA, it projects 250 additional reviews annually for § 1513(e) reviews under P.L. 93-641 (including reviews of grants, contracts, and loan guarantees for such programs as Community Mental Health Centers, Public Health Service Act Programs, and Alcholism and Drug Treatment Programs). The fiscal bind resulting from a dramatically increased workload performed with virtually unchanged funding is obvious.

The option of HSAs not performing these 1513(e) reviews for each use of selected federal funds appears to be narrow in light of the following:

While the Committee has given the Secretary authority to make Federal funds available despite a decision by an HSA that the proposed use of such funds would be inappropriate, it does not anticipate that the Secretary will do this with any frequency and [anticipates] that such a use of funds will be treated as an exception and carefully justified by the Secretary.

Health Planning Report, supra note 4, at 64.

6 Quantification of the social and economic impacts measured through these three systems analysis techniques could be a means for addressing issues such as those raised in “environmental impact statements” required by the federal Environmental Protection Agency and, perhaps in the future, in “family impact statements” such as those proposed by Vice President Mondale in campaign speeches.

7 42 C.F.R. § 122.107(c)(2) (1976).

8 42 C.F.R. § 122.107(c)(3) (1976).

9 Experience working with SHPDAs suggests that the federal government has not yet precisely defined the respective roles of the HSP and the SHP. With regard to Rhode Island in particular, which under § 1536 has a single state agency designated to perform both the HSA and SHPDA functions, this distinction needs clarification.

10 § 1513(e)(1); § 1604(f).

11 § 1524(c)(4); § 1513(c)(3).

12 § 1523(a)(2); § 1524(c)(2).

13 § 1524(a)(4)(A); § 1513(f).

14 § 1524(a)(4)(B); § 1513(f).

15 § 1523(a)(6); § 1513(g)(1).

16 § 1604(c)(2)(a); § 1604(f); § 1513(e).

17 § 1524(c)(6).

18 Such experiments were funded by the Social Security Amendments of 1972, P.L. 92-603, § 222, 86 Stat. 1391 (1972).

19 P.L. 93-641, § 1513(g)(1).