Page:United States Statutes at Large Volume 93.djvu/627

 PUBLIC LAW 96-79—OCT. 4, 1979

93 STAT. 595

constructively serve, in accordance with subsection (b), to advance the purposes of quahty assurance, cost effectiveness, and access.". (b) Section 1502 is amended (1) by inserting "(a)" after "1502.", and 42 USC 300k-2. (2) by adding at the end the following: "(b)(1) The Congress finds that the effect of competition on decisions of providers respecting the supply of health services and facilities is diminished. The primary source of the lessening of such effect is the prevailing methods of paying for health services by public and private health insurers, particularly for inpatient health services and other institutional health services. As a result, there is duplication and excess supply of certain health services and facilities, particularly in the case of inpatient health services. "(2) For health services, such as inpatient health services and other institutional health services, for which competition does not or will not appropriately allocate supply consistent with health systems plans and State health plans, health systems agencies and State health planning and development agencies should in the exercise of their functions under this title take actions (where appropriate to advance the purposes of quality assurance, cost effectiveness, and access and the other purposes of this title) to allocate the supply of such services. "(3) For the health services for which competition appropriately allocates supply consistent with health systems plans and State health plans, health systems agencies and State health planning and development agencies should in the performance of their functions under this title give priority (where appropriate to advance the purposes of quality assurance, cost effectiveness, and access) to actions which would strengthen the effect of competition on the supply of such services.". (c) Section 1513(a) is amended (1) by striking out "and" at the end of 42 USC 300/-2. paragraph (3), (2) by inserting "and' at the end of paragraph (4), and (3) by adding after paragraph (4) the following: "(5) preserving and improving, in accordance with section 1502(b), competition in the health service area,". (d) Section 1532(c) is amended by adding at the end the following: 42 USC 300n-l. "(11) In accordance with section 1502(b), the factors which affect the effect of competition on the supply of the health services being reviewed. "(12) Improvements or innovations in the financing and delivery of health services which foster competition, in accordance with section 1502(b), and serve to promote quality assurance and cost effectiveness.". DESIGNATION OF HEALTH SERVICE AREAS

SEC. 104. (a)(1) Section 1511(b)(4) is amended to read as follows: 42 USC 300/. "(4) The Secretary shall review on his own initiative or at the request of any Governor or designated health systems agency the appropriateness of the boundaries of the health service areas established under paragraph (3) and, if he determines that— "(A) the boundaries for a health service area no longer meet the requirements of subsection (a), or "(B) the boundaries for a proposed revised health service area meet the requirements of subsection (a) in a significantly more appropriate manner in terms of the efficiency and effectiveness of health planning efforts, he shall revise the boundaries in accordance with the procedures prescribed by paragraph (3)(B)(ii). If the Secretary acts on his own

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