La. Admin. Code tit. 48 § I-10103

Current through Register Vol. 50, No. 9, September 20, 2024

Section I-10103 - Background

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.

La. Admin. Code tit. 48, § I-10103

Promulgated by the Department of Health and Human Resources, Office of Management and Finance, LR 13:246 (April 1987).

AUTHORITY NOTE: Promulgated in accordance with P.L. 93-641 as amended by P.L. 96-79, and R.S. 36:256(b).