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                                                                     RMP  Missouri
                                                                     RM  00  09


                  JULY/AUGUST 1974 REVIEW CYCLE

                  The Missouri May 1 application was approved by the NAC in the  amount  of
                  $2,364,333 (a reduction from the request of $3,010,113).  The funding
                  level was set at $2,246,518.  The request for arthritis pilot center was
                  not approved. Particular attention was cal'ited to the EMS activities
                  which appeared fragmented. The Region advises DRMP  that  the  Governor's
                  EMS Council will forward a letter to provide evidence of EMS  project
                  approvals.  (A restriction was placed on project #119 - PSRO related.)
                  The Region was informed of concerns regarding the proposal for 6 District
                  Liaison Officers to coordinate planning, and is modifying its program
                  budget accordingly.

                  Application:   The Missouri application requests $1,082,381 for 23 projects
                  (twice the initial estimate of $500,000).  To be noted is the shifting in
                  priority areas: Health Manpower Education and Development  is  first,
                  displacing EMS which is now fourth; second and third priority areas
                  relate to ambulatory care and integrated health delivery systems.  Renal
                  disease activities are fifth.

                  The projects are arranged by area of program emphasis in order of
                  priority. The most impressive and those with  greatest  potential  impact
                  are the education and manpower development activities.  The ambulatory
                  care proposals, with the exception of a few, lack cohesiveness and the
                  third priority area include a number of routine base data  activities
                  related to planning. The Region recognizes the  uncertainty  with  regard
                  to the EMS activities.



















                                                                        MCO  7/15/74







                                                                    izi-i 00OD9





                               $3, 01 0,11 3
                   CoiiiiiiLt L (IC II (Izlt i oil: $2,364,333
                                     1)), jll(lj.V.i(IUZI)@         Average & Superior
                   Ov c,. r;i I 1 zi!3 @q
                   (The latter is compared with other RMPS)


                   C 1: @l, t: J (I I
                   Continuity of staff is a major strong feature. Program has  turned  around
                   from heavy bio-engineefing, coniputerized-systems analysis approach to
                   regionalized activities.
                   Program is considered overambitious, especially in view of the short ti  me
                   frame.  Concerns were expressed regarding staff increases for already well
                   staffed central office, and proposed new staff component  activities.  Re-
                   viewers found the request for new staff for coordinating health  resources
                   planning and development of a pilot model, in anticipation of new  Federal
                   legislation, unnecessary.  The data analysis activities proposed for planning
                   purposes lack imagination and appear to be routine.
                   Lengthy discussion involved the numerous EMS proposals: continuation of
                   several ongoing activities and 11 new subcomponents, altogether  requiring
                   about $600,000.  Reviewers expressed concern about the large proportion of
                   funding requested for what appear to be fragmented EMS activities.  They
                   stated that the RMP should be certain that there is a State Plan, to assure
                   that components are coordinated as parts of a comprehensive system.




                   JULY/AUGUST REVI.EI4
                                                           $500,000.
                   Estiiiiated rcqiiest a,, of llay 1974:                      MCO 6/4/74


                   NATIONAL ADVISORY COUNCIL - June 13-14, 1974

                   Council  concurred with Committee recommendation.

                   DRMP funding decision   $2,246,518


                                                                     MCO 7/2/74