Health Planning and Resources Development Amendments of 1979

(Measure passed House, amended, roll call #362 (374-45))

Health Planning and Resources Development Amendments of 1979 - =Title I: Revision of Health Planning Authority= - Amends title XV of the Public Health Service Act (National Planning and Development) to direct the Secretary of Health, Education, and Welfare to review annually the national guidelines for health planning promulgated under such Act. Requires the Secretary to determine whether health care delivery systems are meeting the standards and goals set forth in such guidelines and to publish periodically a summary of changes in resources needed to meet such goals. Stipulates that the authority to make such reviews and determinations does not authorize new budget authority before the beginning of fiscal year 1980. Directs health systems agencies (HSAs) and State health planning and development agencies (State Agencies) to provide such data as will enable the Secretary to carry out such duties.

Adds to the list of subjects deserving priority consideration in the formulation of national health planning goals: (1) the discontinuance of duplicative or unneeded services and facilities; (2) the adoption of policies to contain the rising costs of health care delivery; (3) the improvement of mental health care, including eliminating of inappropriate placement of persons with mental health problems in institutions and emphasizing outpatient mental health services by assuring access to community mental health centers; and (4) the development and use of cost saving technology.

Requires that at least one voting member of the National Council on Health Planning and Development be an administrator of a private hospital.

Sets forth a finding that extensive coverage of health services, particularly inpatient services, and the prevailing method of third-party payment for health services have diminished the effect of market forces on the supply of services and have encouraged excessive use of services and facilities. States that the HSAs and State Agencies should perform their functions with regard to the extent to which such market forces appropriately allocate the supply of services.

Revises the procedures for the redesignation of health service area boundaries, including redesignation if the boundaries of the proposed health service area would better meet certain current requirements.

Eliminates the provision which gives priority for designation of health service areas which formerly had an areawide Comprehensive Health Planning Agency under previous health planning authority.

Revises the status of Puerto Rico for the purposes of the health planning program by bringing it under the special provision which allows the State Agency to perform the functions of the HSA.

Extends from one to three years the period of the designation and redesignation of an HSA.

Revises the procedures for the designation and termination of HSAs, including requiring the Secretary to: (1) give priority to an application for HSA designation which has been recommended by the Governor; (2) permit the appropriate State Agency to comment on the performance of an HSA before its designation is renewed; and (3) consult with the Governor and the Statewide Health Coordinating Council (SHCC) before terminating an HSA's designation or allowing the term of an agreement to expire without renewal. Authorizes the Secretary to: (1) terminate a designation agreement with an HSA under certain circumstances after consultation with the National Council on Health Planning and Development; and (2) impose in the renewal of the designation agreement, upon appropriate notice and hearing, such conditions as the Secretary determines are necessary to assure that the agency will meet its statutory requirements.

Revises the criteria for the determination by the Secretary of the amount of the grant to be made in each fiscal year to each HSA. Sets forth a declining per capita funding formula. Increases the minimum planning grants to HSAs. Allows minimally funded HSAs to receive Federal matching funds up to a limit of $200,000 or 25 cents per capital. Stipulates that the Secretary may provide HSAs with pro rata increases in grants for fiscal year 1979 to reflect such increased funding only out of appropriations made after October 1, 1979. Allows grants made to designated State Agencies for regulation and which are unobligated in the fiscal year for rate which they were made to be used in the succeeding fiscal year.

States that the HSA governing body members who are residents of the health service area: (1) shall include individuals representing the principal social, economic, linguistic, handicapped, and racial populations and geographic areas and major purchasers of health care; (2) shall be broadly representative of the health service area.

Permits providers whose principal place of business is in a health service area to be members of such HSA's governing body. Revises the provider categories with respect to HSA governing body composition to require the representation of podiatrists, physician assistants, hospitals, rehabilitation facilities, and an accredited school of medicine which may be in the health service area. Increases from one-third to one-half the proportion of the providers of health care who are members of the governing body or executive committee of an HSA who must be direct providers of health care.

Makes additional revisions in the composition of an HSA governing body, including that the membership consist of individuals knowledgeable about mental health services and representative of: (1) any qualified health maintenance organizations which may be in the health service area; and (2) the Veterans Administration if the area has at least one VA health care facility.

Stipulates that consumers on HSA governing bodies cannot have been "direct" health care providers within the 12 months preceding appointment, instead of "health care providers" as currently provided. Redefines "provider of health care" for purposes of the Act. Requires that subcommittees of advisory groups of HSA boards have a consumer majority.

Directs each HSA to establish and make public a process for the selection of the members of its governing body and any subarea advisory councils which assures: (1) selection in accordance with current composition requirements; and (2) the opportunity for, and encouragement of, broad participation of the residents of the HSA. Requires such process to limit the selection of consumer and provider members by other members of such body or councils.

Extends the immunity from damages currently given HSA employees to the HSA itself, but excepts from such immunity bodily injuries and physical damages to property.

Excepts from the current requirement that HSA governing body meetings be public, meetings dealing with information of a personal nature or relating to the agency's participation in a judicial proceeding.

Requires each HSA to have an identifiable program of providing assistance to the members of a governing body or other decision-making entity. Provides that at least one member of the HSA staff shall be responsible for assisting the consumer members of the HSA governing body. Authorizes HSA governing bodies to make advances to HSA members for reasonable expenses incurred in the performance of HSA duties.

Prohibits the use of Federal funds by an HSA to pay for the personal services of any individuals to lobby on pending legislation at the local, State, or Federal levels.

Stipulates that an HSA which is a public regional planning body or unit of general local government shall be given only a reasonable opportunity to comment on an HSP. Exempts from such stipulation an HSA which was designated and functioning on January 1, 1979, and which is a unit of general local government.

Prohibits any member of a governing body of an HSA or any member of a SHCC from voting on any matter with which such member has any substantial ownership, employment, fiduciary, contractual, creditor, or consultative relationship.

Requires HSA staff to have, to the extent feasible, expertise in financial and economic analysis and disease prevention.

Adds to the functions of a SHCC the establishment of a uniform format for health systems plans (HSPs). Adds to the material to be included in the HSP goals for the delivery of mental health services. Defines "healthful environment" (which an HSA is required to describe in its HSP) as the environment "primarily with regard to health care equipment and to health services provided by health care institutions, facilities, and other providers of health care and other health resources".

Requires the HSP and the Annual Implementation Plan (AIP) to include a statement of changes in personnel, facilities, and other resources which are necessary to meet the agency's objectives.

Requires that each State Agency determine statewide health needs after consultation with appropriate State authorities. Requires an HSA to conduct a public hearing on the establishment or revision of its AIP and to give interested parties an opportunity to submit their views orally and in writing.

Provides for Indian self-determination as related to health planning.

Eliminates the requirement that the HSP of an HSA be consistent with the national guidelines issued by the Secretary, but requires the HSA to submit to the State Agency and the SHCC a detailed statement of reasons for any inconsistencies between its HSP and AIP and such guidelines.

Authorizes the Governor of a State to disapprove the State health plan approved by the SHCC upon a determination that the plan does not effectively meet the statewide health needs determined by the State Agency.

Changes the frequency of the HSA, State Agency, and SHCC reviews from annually to biennially.

Requires plans established under the Comprehensive Alcohol Abuse and Alcoholism Prevention, Treatment, and Rehabilitation Act of 1970 and the Drug Abuse Office and Treatment Act of 1972 to be consistent with the State health plan, and conditions grants made under the Community Mental Health Centers Act on such plan being in effect.

Amends the Community Mental Health Centers Act to direct the State mental health authority to: (1) establish minimum standards for community mental health centers; (2) establish a program for such centers which is based on the need for comprehensive mental health services, consistent with the State health plan; (3) make such reports as the Secretary may require; and (4) designate a State advisory council to aid in carrying out such functions and the health planning provisions of the Public Health Service Act.

Revises the review functions of the SHCCs. Enumerates additional criteria for HSA, State Agency, and SHCC review, including the accessibility to residents of the proposed services.

Specifies the requirements of the certificate of need program established by a State Agency. Applies such program to major medical equipment, institutional health services, and capital expenditures.

Stipulates that the issuance of a certificates of need may not be made subject to any criterion or condition not directly related to a determination of the need for the service, equipment, or expenditure for which the certificate is to be issued. Authorizes a State Agency to withdraw a certificate under certain circumstances. Requires such program to provide an appeals mechanism for review of decisions of a State Agency not to issue a certificate. Authorizes the program to compare and establish priorities for approval of applications. Sets a 90-day time limit for completion of review. Allows a State Agency to delay the beginning of a review or to suspend a review when the applicant has been cited by the Secretary for violations of title VI of the Civil Rights Act of 1964.

Exempts from the certificate of need program, health maintenance organizations and other providers offering services on a prepaid basis, but requires such entities to notify the HSA and the State Agency of the offering of an institutional health service, the acquisition of major medical equipment, or the obligation of a capital expenditure. Stipulates that a certificate of need shall not be required for the acquisition of major medical equipment which will not be owned by or located in a health care facility unless a notice requirement is not met or unless the State Agency finds that such equipment will be used for inpatient services.

Requires an HSA and State Agency to conduct appropriateness review of institutional health services which have been designated by the Secretary of Health, Education, and Welfare, instead of "all" institutional services as currently provided.

Directs the Secretary to make grants to State Agencies to develop programs to reduce excess hospital capacity.

Establishes procedures which allow the Governor of a State to review an HSA decision disapproving a proposed use of Federal funds, and to authorize such use after considering any comments by the State Agency.

Requires each health systems agency to coordinate its activities with any State entity which reviews rates and budgets of health care facilities. Requires HSAs located within the same standard metropolitan statistical area to coordinate their activities.

Directs the Secretary to give each designated HSA within a State an opportunity to comment on the performance of a State Agency before renewing its designation.

Extends from one to three years the period of the designation and redesignation of a State Agency. Revises the procedures for the termination of designated State Agencies, including that the Secretary consult with the National Council on Health Planning and Development. Requires such procedures to be followed before the Secretary may permit the term of an agreement to expire without renewal.

Modifies the current penalty provisions relating to the designation of State Agencies to link the cut-off of funds under certain Acts to the time of the promulgation of certificate of need regulations.

Revises the composition of the Statewide health coordinating councils (SHCC). Provides for proportional representation of interstate HSAs on the SHCC. Authorizes the Governor to select the chairman of the SHCC (with the approval of the appropriate State legislative body). Increases from one-third to one-half the proportion of members of the SHCC who must be direct providers of health.

Extends through fiscal year 1982 authorizations for: (1) planning grants; (2) State health planning and development; (3) rate regulation; (4) centers for health planning; and (5) area health services development funds.

Directs the Secretary to report to Congress on the results of reviews conducted with respect to improvements in health care and restraints on increases in health care costs.

=Title II: Revision of Authority for Health Resources Development= - Amends title XVI of the Public Health Service Act (Health Resources Development) to authorize the Secretary of Health, Education, and Welfare to make loans through fiscal year 1982 for: (1) modernization of medical facilities; (2) construction of new outpatient medical facilities; (3) construction of new hospitals in areas experiencing rapid population growth or a reduction of hospital beds due to merger or closure of medical facilities; and (4) conversion of existing facilities to outpatient or long-term care facilities.

Authorizes the Secretary to guarantee for such period the payment of principal and interest to: (1) non-Federal lenders for their loans to nonprofit private entities for medical facilities projects; and (2) the Federal Financing Bank for loans to nonprofit private entities for such projects.

Authorizes the Secretary to make grants for construction or modernization projects designed to: (1) eliminate or prevent imminent safety hazards; or (2) avoid noncompliance with State or voluntary licensure or accreditation standards, with respect to medical facilities owned or operated by public entities.

Authorizes the Secretary to make grants to public and nonprofit entities for projects for: (1) construction of outpatient medical facilities providing services for medically underserved populations; and (2) conversion of existing medical facilities to provide such services.

Directs the Secretary to assure, by regulation, the effective execution and management of projects carried out under this Act.

=Title III: Program to Assist and Encourage the Discontinuance of Unneeded Hospital Services= - Amends title XVI of the Public Health Service Act (Health Resources Development) to direct the Secretary of Health, Education, and Welfare to establish a new program for providing grants and technical assistance to assist and encourage hospitals to discontinue the provision of unneeded hospital services.

Directs the Secretary to study the effect of such program on the elimination of unneeded hospital services and to report the results of such study to Congress.

Requires the Secretary of Labor to prescribe guidelines for the protection of employees affected by the discontinuance of such services.