Appropriateness Review

P.L. 92–603, 42 U.S.C. §1320a–1.

P.L. 93–641, 42 U.S.C. §300k et seq.

H.R. Rep. NO. 93–1382, 93d Cong., 2d Sess. (1974); S. Rep. NO. 93–1285, 93d Cong., 2d Sess. (1974).

P.L. 90–174, 42 U.S.C. §241 et seq.

H.R. 12053, 93d Cong., 1st Sess. (1973).

H.R. 16204, 93d Cong., 2d Sess. Sections 1413(g) and 1423(a)(5)(1974); S. 2994, 93d Cong., 2d Sess., Sections 1413(h)(1) and 1423(a)(4)(1974).

120 Cong. Rec. S20,062–63 (Nov. 25, 1974).

120 Cong. Rec. H11,847–48 (Dec. 13, 1974).

P.L. 93–641, Section 1513(g), 42 U.S.C. §300/–2(g) (HSA) and Section 1523(a)(6), 42 U.S.C. §300m–2(a)(6) (SHPDA). It should be noted, however, that the regulations require both HSAs and SHPDAs “to the extent practicable” to “make recommendations for remedial action.” 42 C.F.R. §§122.508(d) and 123.608(d). See note 49 and accompanying text, infra.

P.L. 93–641, Section 1513(g), 42 U.S.C. §300/–2(g) (HSA). SHPDAs were required to complete their findings with respect to appropriateness within one year after receiving the recommendation of a health systems agency. P.L. 93–641, Section 1523(b)(3), 42 U.S.C. §300m–2(b)(3).

42 C.F.R. §122.104(b)(9).

42 C.F.R. §122.107(c)(15).

Notice of Proposed Rulemaking, Health Systems Agency and State Agency Reviews of the Appropriateness of Existing Institutional Health Services and of Proposed New Institutional Health Services, 43 Fed. Reg. 21274–82 (May 16, 1978).

Final Regulations, Health Systems Agency and State Agency Reviews of the Appropriateness of Existing Institutional Health Services, 44 Fed. Reg. 71754–73 (Dec. 11, 1979). The final regulations are to be codified in Title 42, C.F.R., as a new Subpart F to Part 122, §§122.501–122.508 (HSAs), and as a new Subpart G to Part 123, §§123.601–123.608 (SHPDAs). Hereinafter, references to the final regulations will be cited as they will appear upon codification.

P.L. 96–79, Health Planning and Resources Amendments of 1979, amending Titles XV and XVI of the Public Health Service Act, 42 U.S.C. §300k, et seq.

See the “Supplementary Information” published with the final regulations, 44 Fed. Reg. 71754, col. 2 (Dec. 11, 1979).

This change was made in both Section 1513(g)(1), 42 U.S.C. §300/–2(g)(1) and Section 1523(a)(6), 42 U.S.C. §300m–2(a)(6).

E.g., North Carolina, North Carolina Appropriateness Review Work Program (Feb. 1980–Dec. 1983).

E.g., Pennsylvania, Appropriateness Review Regulations (proposed), 28 Pa. Code §501.5, Services Scheduled for Review, 10 Pennsylvania Bulletin 1695, 1698 (April 26, 1980).

42 C.F.R. §123.603(b)(2).

42 C.F.R. §122.503(b)(2); see also U.S. Department of Health and Human Services Program Policy Notice No. 80–03, January 16, 1980, p. 6, second paragraph (hereinafter referred to as “Program Policy Notice No. 80–03”).

42 C.F.R. §§122.505 and 123.605.

42 C.F.R. §122.505; see Section 1513(g), 42 U.S.C. §§300l–2(g).

42 C.F.R. §123.605; see Section 1523(a)(6), 42 U.S.C. §300m–2(a)(6).

Criteria shall be developed after consultation with other planning and health planning agencies in the region and state; notice must be given of the availability of proposed criteria; opportunity must be afforded for public comment; and adopted criteria must be distributed to affected persons. 42 C.F.R. §§122.504 and 122.305 apply these requirements to HSAs and 42 C.F.R. §§123.604 and 123.406 impose them on SHPDAs.

Program Policy Notice No. 80–03, supra note 21, p. 5, last paragraph.

Section 1513(g)(3), 42 U.S.C. §300l–2(g)(3) applies to HSAs and Section 1523(a)(6), 42 U.S.C. §300m–2(a)(6) applies to SHPDAs.

42 U.S.C. §300n–1(c).

Section 1532(a), 42 U.S.C. §300n–1(a).

Program Policy Notice No. 80–03, supra note 21, requires that the appropriateness review function must be initiated, in general, not later than June 11, 1980.

The federal government is apparently not immune from this temptation. Compare the appropriateness review criteria set forth in 42 C.F.R. §123.607 with the criteria for certificate of need and review of new institutional health services set forth in 42 C.F.R. §123.409.

The National Guidelines for Health Planning set forth, inter alia. Standards Respecting the Appropriate Supply, Distribution, and Organization of Health Resources, 42 C.F.R. §121.201 et seq.

42 C.F.R. §121.207(a).

Pursuant to 42 C.F.R. §123.104(b) (11), SHPDAs must require health care facilities and HMOs to supply such statistical and other information on health and health care as the agency finds necessary for its purposes.

42 C.F.R. §123.603(b)(3).

Section 1513(b)(1), 42 U.S.C. §300l–2(b)(1); see also 42 C.F.R. §123.603(b)(3).

42 C.F.R. §123.605(a)(3).

42 C.F.R. §123.603(b)(3).

43 Fed. Reg. 21275, col. 2 (May 16, 1978).

44 Fed. Reg. 71761, col. 1 (Dec. 11, 1979).

Id., at col. 3.

Id., at col. 2.

Id., at col. 3. This view is based on the language of §1513(g) apparently limiting HSA recommendations to “the appropriateness in the area” of the services being reviewed, 42 U.S.C. §300l–2(g).

H.R. Rep. NO. 96–309, 96th Cong., 1st Sess., p. 88 (1979).

42 C.F.R. §123.605(a)(10).

H.R. Rep. NO. 96–309, 96th Cong., 1st Sess., p. 88 (1979). Interestingly, the Committee Report cited to justify that statement of Congressional intent (H.R. Rep. NO. 93–1382, 93d Cong., 2d Sess., p. 79 (1974), cited in the “Supplementary Information,” 44 Fed. Reg. 71754 (Dec. 11, 1979)) was specifically disavowed by Representative Paul Rogers, Chairman of the Subcommittee who developed the bill and was its floor manager. For the Secretary to cite the repudiated language in support of optional sanctions is, at best, misleading.

120 Cong. Rec. H11, 847–48 (Dec. 13, 1974).

44 Fed. Reg. 71754, col. 3 (Dec. 11, 1979).

Section 1523(a)(6), 42 U.S.C. §300m–2(a)(6).

44 Fed. Reg. 71754, col. 3 (Dec. 11, 1979).