N Q {:3 N G E R. $3995??? La ‘:40 13/2. ”'"‘” “'7 I Qi§%:§»§i§{°j' /0 Wasit‘\i0n(3$;c0g:n iini'.ue:*s;iI7g' _,_,9,_._..,,;.,, 7., go: 4' .x;‘1-1 E 0 . .. ' '4-:3 ” 5 - M 52:?“ W ' r 3% 3-u.’>«..115«;l9($=-L3’; niversit I souri olu IIIIIIITI III flIWI|ITIiII iuu‘i IIm‘1‘ii\‘IinInII1 I I 010-103860902 SERVICE i : 1 1 i LIBRARY OF CONGRESS HEALTH PLANNING AHENDHEN?S Issuz BRIEF NUMBER IB78010 AUTHOR: Cneiss, Kay Education and Public Welfare Division THE LIBRARY OF CONGRESS CONGRESSIONAL RESEARCH SERVICE HAJOR ISSUES SYSTEE DATE ORIGINATED Qgggggzg DATE UPDATED Q342§g§Q FOR ADDITIONAL IHPORHATION CALL 287-5700 0325 cns— 1 IB7801O upDATr—o3/25/30 I"$§§-2§El§lELQ§ The health planning program (originally authorized under P.L. 93-641) is responsible for allocating health resources rationally to improve access to health care while containing costs. The program has aroused controversy on a number of points. Many governors have viewed the program as a test between States‘ rights and Federal control. some have questioned the legality of private entities controlling public funds without clear lines of public accountability. National health planning guidelines initially stirred protest among those who feared widespread closure of small, rural hospitals if conformance with the guidelines became mandatory. w Recent hospital cost containment bills would involve health planning agencies in efforts to check hospital capital spending and eliminate unneeded facilities. Such considerations sparked debate during review of the program, which received ya 3-year reauthorization under the terms of P.L. 96-79, signed into law Oct. 4, 1979. " §AQE§§QQ§2.A!D PQLECY A§ALX§l§ The National Health Planning and Resources Development Act of 197a (P.L. 93-6&1) combined and significantly revised earlier health planning efforts by establishing a single nationwide network of State and areawide health planning and resources development authorities. The new program was designed to eliminate the overlap and duplication of responsibilities characterizing "e previous health planning programs. It was also intended to improve coordination among the various planning bodies and other entities in the health care system and to tie health resources development to a stipulated wset of priorities and goals embodied in health plans developed and formally adopted by each State and areawide health planning agency. The new agencies were given broader powers than their predecessors, particularly in the areas of regulation, control of Federal funds, review and encouragement of resources development, and actual implementation of plans. : Signed into law on Jan. 4, 1975, the act amended the Public Health Service Act to add a new Title XV - National Health Planning and Development - and a new Title XVI —-Health Resources Development. The new Title XV program replaced previous health planning initiatives authorized under the Regional Hedical Program (P.L. 89-239) and the Comprehensive Health Planning Program (P.L. 89-7&9), while the new Title XVI program replaced the Hill—Burton Hospital Construction program begun in 19u5. , » i The main provisions of the law (prior to the 1979 amendments), as well as related issues that have arisen since enactment, are summarized below: H 1- !ari9.n......a1- §2.i.s1.e..1..i.ee§- fer- .I1.ea.1.Q- El§1.B.I.1..5.-!1.S{.-. The act directed the Secretary of HEW to issue guidelines concerning nationall health planning ypolicy, including standards for supply, distribution, and organization of health resources and a statement of quantified national health planning goals ’ sed on specified national health priorities. A National Council on Health zianning and Development, appointed by the Secretary, was created to advise on development of guidelines, implementation of the overall program, and evaluation of new medical technology. f cRs- 2 1373010 upnmn-03/25/so on Sept. 23, 1977, prelininary national guidelines were published in the Federal Register pertaining to such areas as hospital bed/population ratios, occupancy rates, obstetrical services, pediatric inpatient services, neonatal intensive care, open heart surgery, cardiac catheterization, radiatir therapy, CT (computerized tomography) scanners, and end-stage renal disease. The guidelines recommended that health planning agencies seek a reduction in_ the Nation's bed supply by 1980, from a current estimate of 4.5 per 1,000 to’ an average of 0 beds per 1,000 population. Each health service area was expected to have a minimum hospital occupancy rate of 80%. Over 55,000 comments (by and large highly critical) were received from persons and organizations concerned about the potential impact of the guidelines. some contended that decisionmaking power had been taken out of ‘local hands. Others feared (closure of numerous local hospitals if conformance with the guidelines became mandatory. Congress was deluged with. letters expressing widespread dissatisfaction and confusion (over the elaborate exceptions process established for small rural hospitals unable to conform with the supply and utilization standards. Department spokesmen reiterated that the statute did not authorize planning agencies to force hospitals to close and that agencies were to rely on voluntary action by existing hospitals to close or convert obsolete or unneeded services or facilities. ; On Jan. 20, 1978, revised draft guidelines were published in the Federal Register as proposed regulations. Final regulations were published mar. 28, 1978.v The revised guidelines retained the overall hospital bed/occupancy rate standards, but clarified the exceptions process and emphasized local control. Numerical standards for rural and smalltown hospitals were relaxed somewhat by permitting deviations from the bed ratio and occupancy xstandard if distance to sources of hospital care exceeded a traveltime factor of 30 minutes (the original standards had set #5 minutes) and if the area*s elderly population exceeded 20% of the .national. average (33% in the original proposal). 5 s ! 0 ! 2. ggal§h_§y§t§m§_Ag§ng;g§; The act created a nationwide network of Health Systems Agencies (HSAS) responsible for areawide planning and development in their respective geographic health service areas. Hshs can be either) private, nonprofit corporations (as most of their predecessor Comprehensive Health Planning (CHP) agencies were) or public entities, which are either public regional planning bodies or units of general local government. Public Hshs must have a .separate governing board for health planning composed of resident consumers, health care providers, and others, with the number of public officials represented on the separate body limited to one—third of the total membership. ? During the early phases of the program, 205 Hshs were conditionally designated by the Secretary of HEH. At present, 198 HSAS have received full designation entitling them to perform all of the following functions mandated under law: (1) establish, review, and amend as necessary a health systems plan (HSP) and annual implementation plan (ATP); (2) assemble and analyze data on the health status and needs of area residents, the status and utilization of the area's health delivery system and health resources, etc.: (3) provide technical and financial assistance (through grants) t organizations seeking to implement the HSP and AIP; (4) review and approve or disapprove proposed use of Federal health funds within their health service area; (5) assist State agencies in the certificate-of-need (CON) ‘process by reviewing and recommending for or against proposed capital expenditures and I i cns- 3 113730 10 unnmn-o3/25/so new institutional health services; (6) review the need for existing institutional health services in their respective areas and make recommendations to the States as to the continuing appropriateness of’ such 'isting services; (7) coordinate activities with Professional Standards heview Organizations (PSROS) and other appropriate planning and regulatory entities; and (8) make recommendations to the States for projects to modernize, construct, and convert health facilities in their respective areas. Four Hshs are presently operating under conditional designation agreements, including the HSA for. Los Angeles. During 1979, the HSA originally designated for Los Angeles was terminated and a new, public entity organized in its place. Two health service areas -- for Topeka, Kansas, and Las Vegas, Nevada —+ are presently without any HSA. T Puerto Rico has been exempted under section 1536 of the Act, as amended by the 96th Congress, from the requirements for designation of an HSA.w In moving from conditional to full designation status, certain agencies encountered difficulty with minimal funding in the early years of operation, thus creating problems in recruitingw adequate and competent staff. some agencies, particularly in areas not formerly served by a CHP agency, had to devote full time to organizational development, community involvement, and basic needs assessment. Certain agencies were affected by litigation brought against them, thus delaying other agency activities. § some have questioned the basic structure of the planning program,. feeling that private entities not directly accountable to the public through the electoral process should not have responsibility for allocation of. public funds. Others feel that the terms of the act have made lit difficult for ablic entities to qualify as Hshs. At present, only 25 HSAS, are public entities. some have urged that a certain amount of policy control of public Hshs be given to the parent governing body, while leaving day-to-day administrative operations with the separate governing board for health planning. : I concern has also been expressed as to whether the legislative intent with regard to active consumer participation in Hshs has been, or can be, fully and effectively realized.v The law provides that HSA governing boards must be composed ofaa majority of consumers of health services, with. the remaining members representative of health providers, including physicians, hospitals, insurers, medical schools, etc. Allegations have been made that regardless of their actual numerical weight, consumers remain at _a disadvantage in challenging the technical information and community influence wielded by provider groups. On the other hand, providers too have complained that the impact of the health professional on BSA boards is weakened by the numerous categories of providers that must be represented. Problems have arisen over the definition of the term "indirect provider,“ which prevents certain individuals such as physicians‘ spouses, hospital trustees, board members from community health centers, from participating ‘as BSA consumer representatives. . i The nature of BSA responsibilities has provoked commentary as to whether the planning program contains an inherent conflict of interest. The HSA is viewed by some as not only the planner of care, but the regulator and xrchaser as well. some argue that ‘the ycentralization of controls in a single agency allows too much opportunity for abuse or arbitrary decisionmaking. Other planners feel that the effectiveness of H535 depends mainly on their power of persuasion -- political, public, and financial +- and that local pressures may jeopardize attempts at objective, disinterested 025- 4 113730010 UPDATE-03/25/80 decisionmaking. In at least one case, an HSA has taken its mandate very broadly and included recommendations in its health plan on such controversial issues as smoking, abortion, air bags in automobiles, and gun control. Further concern has been expressed over the extent of BSA duties and t‘ danger of overload, since as sany as 500 proposals a year may fall within the purview of each HSA. 3- §2a:e Health Planning and- Develeenent- Agencies l§§E2é§L; The law provides that a State Health Planning and Development Agency (SHPDA) is to be selected by the governor of each State and designated by the Secretary of ‘HEW. The State agency is responsible for: (1) preparing a preliminary State health plan made up of HSPs of the health systems agencies; (2) assisting a Statewide Health Coordinating Council (SHCC), composed of representatives of each BSA and representatives nominated by the governor; (3) serving, where appropriate, as the designated planning agency under section 1122 of the Social security Act; (a) administering a State certificate-of-need program; and (5) reviewing the need for existing institutional services. The State agency is to be advised by the SHCC, which is actually responsible for final preparation of the State health plan, after consideration of the preliminary plan submitted by the State agency. The SHCC also reviews HSA budgets and grant applications and proposed use of Federal funds allotted to the State under Federal health programs. I All 56 State agencies were conditionally designated by the Secretary, but only 37 have thus far received full designation. The primary obstacle to full designation has been the inability to meet requirements for certificate-of-need programs that apply to new institutional health services yproposed within the State. The State agency must administer the program— a? use sanctions (e.g., denial or revocation of licensure, civil or crimina penalties) to prevent development of unneeded services or facilities. ; According to regulations published in the §gQgg§l_gggi§tg;‘ Jan. 21, 1977 (as amended Apr. 8, 1977), certificate-of—need approval is required for the following: (1) construction, development, or other establishment of a new health facility or health maintenance organization; (2) capital expenditures over $150,000 except for site acquisitions, acquisition of existing facilities, or expenditures solely to terminate or reduce beds or services; (3) changes in bed capacity involving more than 10 beds or 10% of total capacity; (4) new services (except home health services) not offered regularly during the preceding 12-month period; and (5) predevelopment activity costing more than $150,000. [HOTE: These requirements have been amended under the terms of P.L. 96-79. See the conference report 96-309 or 96-419 for an explanation of current provisions. (Regulations have not yet been issued for the new certificate-of-need provisions.] 0 Exempted are home health agencies (when no new construction is involved), outpatient physical therapy, organized ambulatory care facilities, and physicians‘ offices. Some. question whether review extends to medical equipment purchased by an independent practitioner, such as a pathologist or radiologist, and installed in facilities leased to the practitioner by a hospital. Planners consider the last point to be critical. Exemption of equipment in leased hospital facilities could allow the lessee to purchase and install equipment for which a hospital on its own had been denic approval. Some are also concerned about the increasing tendency of hospitals to obtain use of major equipment under various arrangements, such as rental or leasing, that may escape the purview of health planners. Planning authorities fear these practices could jeopardize cost containment efforts by cns- 5 0 IB7801O UPDATE-03/25/80 allowing an uncontrolled proliferation of expensive new" medical equipment such as CT scanners costing upwards of $500,000, regardless of actual need and even contrary to the expressed will of local and State planning agencies. J Concern has also been expressed about the absence of decertification authority over existing, as opposed to new, facilities. Although planning .agencies are to review the "continuing appropriateness" of existing facilities and services, ?ederal law contains no adverse consequences for ya finding of "inappropriateness." Consequently, planning agencies have no power to force existing facilities to reduce, convert, or close down unneeded beds or services and must rely on persuasion and the goodwill of providers to bring about such changes. 4 State agencies have also been concerned about the relatively independent posture of the SHCC. Host governors, in particular, would like to see the SHCC brought more closely into line with the health policymaking system within each state's government. They feel that the SHCC should not have the present authority to refer to the Secretary an adverse finding with regard to a proposed State health plan or proposed use of funds allocated to the States under various Federal health programs. ' 4. Qth§§_gg9yi§;gg§_g§_§hg_gg§: The act also contains authority for: (1) regional Centers for Health Planning, to offer technical assistance and consultation to HSAs and State agencies; (2) area health services development funds, to be used by HSAS in making grants or contracts for projects advancing the goals set.forth in the HSP and AIP; (3) grants to State grate regulation programs; and (H) health resources development under a new Title “VI. As originally enacted in P.L. 93-601, the Title XVI program offered lderal allotment grants, loans and loan guarantees for modernization of medical facilities, construction of new inpatient facilities in areas of recent rapid population growth, and conversion i of existing medical facilities. Special grants were available fort projects to eliminate or prevent imminent safety hazards or to avoid noncompliance with State or voluntary licensure or accreditation standards. Most of the original Title XVI assistance was contingent upon full inplenentation of the Title XV health planning program at tthe State level (including approval of State certificate-oféneed programs). As a consequence, only a few of the projects authorized for health resources development have actually been funded +- namely those involving direct project grants to public hospitals with imminent safety hazards or those in danger of losing accreditation. % The 1979 Amendments (P.L. 96-79) to the health planning law left intact the basic structure of the program as described above. However, significant changes were made in several areas, notably in’ the membership requirements and selection process pertaining to HSAS, health plan requirements, review procedures, certificate of need, and health resources development. In addition, P.L. 96-79 established a new authority under the Title XVI program to provide for grants and technical assistance to hospitals for the discontinuance or conversion of unneeded hospitali services. The 1979 Amendments also provided for a new project grant program for the construction of outpatient medical facilities in medically‘ underserved areas andv the A conversion of existing facilities into outpatient medical facilities or facilities for long term care. A summary of the main provisions of P.L. J-79 can be found in the legislation section of this issue brief. The following chart breaks down authorizations for the health planning program over the next 3 years as authorized by P.L. 96-79, signed by President Carte Oct. n, 1979. 0 ; cns- 6 1373010 UPDATE-03/25/80 TABLE 1. Health planning authorizations (in millions of dollars) EZQQ §1§l EXEZ Grants to health systems agencies $150 $165 $185 Grants to State health planning and development agencies 35 H0 #5 Grants to State rate regulation programs 6 6 6 Grants to regional health planning % centers . 6 8 10 ‘ Grants for area health service . development funds T -- 20 30 Construction grants to hospitals to meet safety, accreditation standards 40 50 50 ' Construction grants to hospitals in g underserved areas or for conversion to ; outpatient or long term care uses -- 15 15 ; Grants to hospitals for discontinuation f or conversion of unneeded services 30 50 75 i Total $267 $355 5336 "" LEEEELAELQE P.L. 96-79 (5. sun, as amended) Health Planning and Resources Development Amendments of 1979. Amends Titles XV and XVI of the Public«Health Service Act to revise and extend the authorities and requirements under those titles for health planning and hhealth resources development. Requires the Secretary of HEW to review annually the standards and goals in the national health planning guidelines. Adds five areas for priority consideration in the development of health planning goals and programs. Expands membership of the National Council on Health Planning. Emphasizes consideration for the strengthening of ,competitive forces in the health services industry, particularly in the actions and decisions of HSAs and SHPDAS. Revises procedures pertaining to review of health service area boundaries. Requires the Secretary to give priority "to applications for designation of health systems agencies recommended by a governor or a SHCC. Permits HSA and SHPDA designation for periods of up to 3 years. Revises formula for establishing the amount of planning grants to H515. Permits the Secretary to increase grants to assist HSAs in meeting extraordinary expenses. Modifies provisions relating to BSA consumer members to require that they be broadly representative of the health -service area and include individuals representing the principal social, economic, linguistic, handicapped, and racial populations and, geographi areas and major purchasers’ of health care. Adds podiatrists, physician assistants, and rehabilitation facilities to provider categories which must be represented on HSAs. Increases percentage of providers who must be direct CRS- 7 IB78010 UPDATE-O3/25/80 providers. Revises definition of direct provider of health care, pertaining to HSA membership. Amends various‘provisions pertaining to HSA governing body membership including selection process for hem members, conflict of terest provisions, residency requirement for providers, personal liability baits, prohibition against use of HSA funds to influence government legislative or regulatory activities, etc. Requires SHCCs to adopt a uniform format for HSPs and AIPs. Describes type of material to be included in HSPS and State health plans. Redefines responsibilities of parent governing body in public Hsns. Amends disclosure and open meetings requirements of Hsns. Requires State health plan to have approval of the governor. Requires State agency to establish a period within which approval or disapproval of {a certificate of need application must be made. Requires certificate-of-need decisions to be consistent nith the State health plan except in emergency circumstances that pose a threat. xProvides for periodic review of certificates of need and withdrawal of approval for lack of progress. Requires certificates to specify the maxixum amount of capital expenditures which may be obligated. Requires approval of certificates for expenditures related to elimination or prevention of safety hazards or for compliance vith licensure or accreditation standards, unless approval would be inconsistent with the State health plan or the facility or service for xwhich the certificate proposed is no longer needed. Extends certificate-of-need provisions to major medical equipment outside the hospital if such equipment is to be used on hospital inpatients. Permits States to extend further such scope of review pertaining to major medical equipment outside the hospital if they currently provide such additional requirements or do so prior to Sept. 30, 1982. Exempts from certificate-ofeneed requirements health maintenance organizations (Hnos) and most facilities providing services primarily to HHO enrollees. Provides for batching of certificate-of-need applications rtaining to similar types of services, facilities, or equipment- Clarifies scope of HSA appropriateness review. Repeals current allotment authority for health resources development activities in the States. Revises purposes for which loans and loan guarantees may be made to the States for health resources development. Establishes new authority for grants and technical assistance to hospitals for the discontinuance or conversion of unneeded hospital services. Establishes a project grant program for construction of outpatient medical facilities in medically underserved areas and conversion of existing facilities into outpatient medical facilities or facilities for long term care. i The senate bill, 5. sun, was introduced Mar. 5, 1979 and referred to Committee on Labor and Human Resources. A House bill, H.R. 3on1, was introduced Har. 15, 1979, and referred to Interstate and Foreign Commerce Committee. Hearings on S. San held Mar. 16, 1979. Hearings held on H.R. 3041 Mar. 28 and 29, 1979. 5. sun reported, amended, by Committee on Labor and Human, Resources Apr. 26’ (S.Rept. 96-96). On Hay 1, 1979, the ’Subcommittee on Health and Environment, House Interstate xand Foreign Commerce, approved for full committee action a clean bill -— H.R. 3917 -- to be introduced in lieu of H.R. 3041. H.R. 3917 reported by ilnterstate and AForeign Commerce Committee Hay 15, 1979 (H.Rept. 96-190). S. San passed by Senate by voice vote Hay 1, 1979. ‘H.R. 3917 passed by House with iamendments July 19, 1979. House agreed to pass 5. sun in lieu, amended to contain language of H.R. 3917. House and Senate conferees net to mark up Ta conference report on the bill during August. The conference report on 5. sun iept. 96-309 in the Senate, Rept. 96-420 in the House) passed by the House Sept. 20, 1979 and by the Senate Sept. 21, 1979. Signed into law as P.L. 96-79 Oct. 4, 1979. L CRS- 8 IB78010 flPDATE-03/25/80 U.S. Congress. House. Committee on Interstate and Foreign Commerce. Subcommittee on Health and Environnent. Health Planning and Resources Development Amendments of 1979. Hearings, 96th Congress, 1st session. Mar. 28 and 29, 1979. Washington, 0.5. Govt. Print. Off., 1979. 772 p. "Serial no. 96-12.". ----- Health Planning and Resources Development Amendments of 1978. ‘Hearings, 95th Congress, 2d session. Jan. 30-31; and Feb. 1-2,7 1978. Washington, U.S. Govt. Print. Off., 1978. Part 1——877 p. "Serial no. 95-93." Part 2--pp879-1552. "Serial no. 95-94." U.S. Congress. Senate. Committee on Human Resources. Subcommittee on Health and Scientific Research. Health Planning Amendments of 1978. Hearings, 95th Congress, 2d session. Feb. 2, 3, and 6, 1978. Washington, 0.5. Govt. Print. Off., 1978. Parts 1 and 2. 1943 p. . _§B9§2§-A§2--Q!§E§§§LQ!AL-2QQQ§§E$§ Kennedy, Edward H. ‘S. 544 —— Submission of Health Planning Amendments of 1979. Congressional record [daily ed.] v. 125, Mar. 5, 1979: 52080-52086. 4 Floor Statement by Senator Richard Schveiker: S2086-S2087. ‘ U.S. Congress. House. Committee on Interstate and Foreign Commerce. Health Planning and Resources Development Amendments of 1979: report to accompany H.R. 3917. giashington, U.S. Govt. Print. Off., 1979. 217 p. (96th Congress, 1st session. House. Report no. 96-190) U.S. Congress. Senate. Committee on Human Resources. Health Planning Amendments of 1979; report to accompany S. 544. Washington, U.S. Govt. Print. Off., 1979. 215 p. (96th Congress, 1st session. Senate. Report no. 96-96) Harman, Henry A. Health Planning and Resources Development Amendments of 1979 (H.R. 3041). Congressional record [daily ed.] v. 125, Har. 15, 1979: H1412-H1414. Several floor statements by cosponsors of H.R. 3041: H1414-1415. A QI§§B-§QNGB§5SiQHAL-AQI-Q! N/A c3s— 9 IB78010 upnirn-o3/25/do ””§QEQLQ§Z-QE.§!§E2§ 0.5. Library of Congress. introduced by Senator Kennedy, and referred to the Committee on Human Resources. Congressional Research Service. National Health Planning and Resources Development Act of 1974, P.L. 93-641 [by] Jennifer 0'Sullivan. 197 5. CBS 4 Feb. 24, hiashington, 1974. 57 p. Report 75-58 ED (LTR75+652) ---- National Health Planning and Resources Development Act (P.L. 93-6&1) -- summary of existing law and its implementation [by] 10/05/79 - S. San signed into law as P.L. 96-79. g 09/21/79 -- Conference report on S. 5Qu.passed by the senate. E 09/20/79 - -Conference report on 3. sun passed by the House. E 09/05/‘I9 -- Conference Report (Rept. 96-419) filed in the House. ROQ/03/79 - Conference report (Rept. 96-309) filed in the Senate. § 08/01/79 - House and Senate conferees net in conference on E 01/19/79 - House passed H.R. 3917, amended. E 03/15/79 -- H.R. 3917 was reported, amended, by the Conmittee E on Interstate and Foreign Commerce (H.Rept. 96-190). 3 05/01/79 - Senate passed 3. sun by voice vote. : I - House Subcommittee on Health and Environnent approved f a clean bill, H.R. 3917, to be introduced in lieu of § H.R. 3001. E 04/26/79 - S. sun was reported, amended, by the Connittee on i Labor and Human Resources (S.Rept. 96s96). ; R / { 03/28/79 — 03/29/79 - Hearings held by Interstate and Foreign Coxmerce g Coamittee on H.R. 3041. ‘ @ 01/16/79 tr Hearings held by Committee on Human Resources on Q S. 540. 0 ; 03/15/79 - H.R. 3on1, the Health Planning and Resources ' .n Development Amendments of 1979, was introduced . by Representative Haxnan, and referred to the Interstate ; and Foreign Commerce committee. i 0 03/05/79 —- s. sun, the Health Planning Anendnents of 1979, was i cas—1o A 1373010 UPDATE-03/25/80 Kay cavalier;“nar.1, 1979. Washington, 1979.% 46 p. cns Report 79—u1 ED -——-— Selected issues involved in health planning under P.L-.. 93-641 [by] Kay Cavalier. June 1, 1977. Washington, 1977 22 p. CR5 Report 77-150 ED (LTR77-2645) LIBRARY on WAS!-AHNGTON UNIVEF-'{SlT‘Y' I gsr. LOl_.}i¥S - Mo, : MU Libraries University of Missouri——Columbia Digitization Information for Congressional Research Service Digitization Project Local identifier CRSIB Source information Format Content type Notes Capture information Date captured Scanner manufacturer Scanner model Scanning system software Optical resolution Color settings File types Derivatives — Access copy Compression Editing software Resolution Color File types Notes Book Text Cover has cut—out to show title on title Page Stamped with property stamp for Washington University including deaccession stamp Some have labels on front page Some have black out markings on front page SuDoc numbers handwritten on front page Some items have very light print Some front pages have colored backgrounds Items not added to University of Missouri collection 20l7 April Ricoh MP C4503 600 dpi grayscale tiff Group 4 600 dpi bitonal tiff