HUMAN SERVICES RESTRUCTURING TASK FORCE

December 18, 1997 - Fifth Meeting for 1997

MEMBERS PRESENT

*Denotes full Task Force members

MEETING IN BRIEF

Minutes prepared by Patty Funaro, Sr. Legal Counsel
Organization staffing provided by John Pollak, Committee Services Administrator

1. Administrative Matters.
2. Meeting Format and Results of Local Forums.
3. Task Force Recommendations.
4. Other Task Force Discussion and Recommendations.
5. Task Force Recommendations Relating to the Program Duplication and Resource Utilization Subcommittee.
6. Task Force Recommendations Relating to the Institutions and Facilities Subcommittee.
7. Closing Comments.
8. Materials Distributed and Filed With the Legislative Service Bureau.
9. Materials Distributed and Attached to These Minutes.

TASK FORCE BUSINESS

1. Administrative Matters.

The fifth and final meeting of the Human Services Restructuring Task Force was held on Thursday, December 18, 1997, at the Iowa Farm Bureau Federation, West Des Moines. The meeting convened at 8:40 a.m. and adjourned at 4 p.m. The minutes of the November 25, 1997, meeting of the Task Force were approved as distributed.

2. Meeting Format and Results of Local Forums.

Meeting Format. Co-chairperson Houser noted that the meeting would be facilitated by Mr. Ira Barbell, Senior Associate, Annie E. Casey Foundation. The topics for discussion included Task Force recommendations relating to devolution and a Task Force review of and response to the reports of the Institutions and Facilities and the Program Duplication and Resource Utilization Subcommittees.

Results of Local Forums.

• Representative Ro Foege. Representative Foege submitted and discussed a written summary of public forums which he held in both Cedar Rapids and Iowa City. He noted that approximately 30 people attended each forum. Issues discussed at the two forums included: the need for the system to be driven by outcomes rather than by process or cost considerations; the need for a single set of outcomes and uniform data; the need for the provision of funding for evaluation of programs; the need for prevention as well as crisis intervention services; the need for incentives to promote innovation; the need for the development of decision-making criteria for local governance entities; the disincentives caused by competing for limited resources; the concern of local communities that as local governance is enhanced, the most vulnerable populations will be cut out of the process; ensuring statewide equity while providing local flexibility; defining "local" on a broader basis than the county level, such as a regional level, so that there are not 99 entities in a state/local partnership; eliminating legal settlement; dealing with barriers presented by administrative rules; using a state/local partnership in providing services rather than using a state/out-of-state, for-profit relationship to provide maximum flexibility; not allowing local governance to become an additional barrier; concerns with using mental health institutions as correctional facilities; promoting the use of MHIs as regional training centers or as parent or job training centers; retooling state institutions to be used as local economic development centers; and concerns that with limited or capped funding the most expensive services will consume resources, leaving nothing for prevention. Representative Foege also noted that the participants in the forums appreciated the opportunity and invited the other members of the Task Force to visit their area and discuss these issues.
• Representative Hubert Houser and Ms. Julie Schmidt. Co-chairperson Houser and Ms. Schmidt held two public forums in Council Bluffs and in Red Oak. The forum in Red Oak involved public input from Cass, Mills, and Montgomery Counties. In addition, Ms. Connie Lehan, Pottawattamie County Supervisor, was also present to share comments. Ms. Schmidt noted that at both forums the concern was expressed that providing more authority to the local community does not become just a means of shifting costs to the counties. Issues discussed at the Council Bluff's Forum included that the barriers presented in enrolling a child at Glenwood State Hospital-School (SHS) are too difficult; the idea of allowing the mixture of funds (80 percent local, 20 percent state) used at the MHIs to be used in providing the same services at local hospitals; the need to build capacity at the local community to establish a local governance that is accountable; the concern that devolution would merely create another level of bureaucracy; the need to change the role of DHS staff to reflect the new structure; the need for more dual diagnosis mental health and substance abuse programs statewide; the need for standards for rates and services if flexibility is provided at the local level; and the concern of private providers that they are unable to compete for employees with state institutions.
  Issues discussed at Red Oak included that if moneys are pooled and provided to the local level, the amount will remain constant and financial responsibility for increased demand will shift to the counties and to property taxpayers; concern regarding pooling of resources when various interest groups are already under-funded; the increased stress placed on DHS case managers if the amount of funding remains constant over time regardless of the need; the lack of services in rural communities as compared to urban areas; the barriers presented by the large number of administrative rules; and the desire of private providers to have state institutions privatized to provide a level playing field for private providers.
• Representative Robert Osterhaus. Representative Osterhaus suggested that local media be encouraged to help with collaborative efforts by providing information to draw communities together.

3. Task Force Recommendations.

Mr. Barbell facilitated a discussion regarding Task Force recommendations for devolution. He began by directing the members to prioritize the recommendations so that they can be presented to the General Assembly for action. He utilized the four follow-up strategies developed at the two-day retreat of the Task Force as a basis for the discussion. The four strategies are: utilizing a results-based framework for human services which emphasizes accountability and flexibility; pooling funding and resources; enhancing local governance; and eliminating barriers. Mr. Barbell used the document entitled "Human Services Restructuring Task Force Concepts for Discussion" in facilitating the discussion. The document was prepared by the House and Senate Republican Caucus research staff, Mr. Brad Trow and Ms. Suzanne Johnson, at the direction of the Co-chairpersons. The document is attached and by this reference is made a part of these minutes.

a. Results-Based Framework.

Discussion. Mr. Barbell suggested that as an initial step, the Task Force consider recommending that the General Assembly identify a set of results for the Human Services system, possibly by endorsing those developed by the Council on Human Investment, and then reviewing and identifying a broader set of results for state public policy to be in place by the year 2000. The discussion following this suggestion included:

• If local governance is to be expanded, specific results must be identified to be able to measure progress and to hold local communities accountable.
• The state can set broad parameters for results and then allow flexibility at the local community level in implementing plans and programs to achieve the results. The plan might be a partnership between the state and local governance entity similar to state/county management plans developed for the mental health and developmental disabilities service system.
• Results should be used to measure the impact of programs and services on children and families, and evaluators should ask, "What did you accomplish for a child or family?" not "How did the agency spend money?" or "How well did the agency adhere to a process?"
• The current system measures the process, but the results-based system establishes three things: broad results such as "all children ready to learn;" a set of indicators such as, "If you do X, kids will be ready to learn," and these are indicators for which data is available and which can be measured; and programs and performance measures -- there are a multitude of programs which are chosen to meet the desired results, and each program should have performance measures to measure the success of the individual program in achieving an outcome.
• There is a need to ask if the right mix of programs exists. If the existing programs do not help to achieve the desired results, policymakers should rethink the mix of programs. Availability of specific dollars for specific new programs should not drive the system.
• Once results are identified, a baseline must be established to measure progress.
• Measurements of success or failure must reflect the type of program/service. Both interim and long-range measurements must be established.
• Existing programs that work should not be eliminated due to systems change. The new system should incorporate existing successes. The initial step is to determine what works well. Currently, what is missing from the system is identifying desired results.
• There should be a continuum of services; there is not one program or service which meets all needs.
• There is a need for good "input" into the system if a good outcome is desired, and the input must be provided early in a person's life.

Recommendations. Following discussion, the Task Force recommended:

The General Assembly should identify desired public policy results or broad outcomes by endorsing the state policy objectives established by the Council on Human Investment (CHI), in the 1998 Legislative Session. During the 1998 Legislative Session, at the earliest opportunity, the General Assembly should review the CHI state policy objectives to identify gaps in or changes to these objectives. The review may include the use of technical assistance provided by a national source. The review might be performed by appropriations subcommittees, combined appropriations subcommittees, or a broader group of legislators. Following endorsement of the initial set of public policy objectives, the General Assembly should begin working on the other components of a results focus by identifying progress indicators and by employing professionals to establish program performance measures, with these other components in place for the state by the year 2000.

b. Pooling Funding and Resources, Enhancing Local Governance, and Eliminating Barriers.

In response to an inquiry by Mr. Barbell, the consensus was that there is a desire to move governance of the human services system to the local level. The initial step is to inventory what funding, resources, programs, services, and capacity currently exist.

Discussion. The discussion that followed included all of the following:

• There are a number of existing local governance initiatives with decategorization being level 1 and innovation zones being level 2. If the system is changed, it should change by adding a level 3, and allowing three levels to exist, because all local governance entities need to build capacity at their own pace and the progress made by the two existing levels should not be eliminated.
• Coordination and collaboration between departments should be enhanced and both the legislative and executive branches should be involved in these efforts. The progress made between the departments to date should be built upon and enhanced.
• The role of the state should include eliminating barriers for local communities. Each community is at a different level in building capacity.
• At both the state and local levels, there should be a collaboration of collaboratives. According to community forums and review of state-level groups, the same people are involved in the myriad of state collaborative or local governance entities. At the local level, a broader local governance entity should exist to encompass all of these.
• One way to expand the local governance entity is through expansion of decategorization to other funding streams.
• The name of the local governance entity should reflect its work. In Sioux City, the name of the entity was changed to the Siouxland Human Investment Partnership (SHIP).
• Funding should be committed for multiple years and should be provided in such a way as to eliminate the constant time commitment for grant writing and attendance of meetings to ensure funding.
• Additional local governance entities should begin as pilot projects to measure success and learn lessons before they are expanded statewide. These entities could be viewed as state/local partnerships beyond decategorization or innovation zones. A new pilot program could begin by looking at what funding is currently expended for a certain result, from all sources. Then the local entity would redesign programs/services to attain these results. The new local governance entity would be the next step in the local governance collaboration process which began with decategorization, evolvement to innovation zones, and now would evolve to a new level 3.
• A state board should be established to review the new local governance entities, to measure success, and to compile lessons learned from this level. This board could also provide technical assistance.
• In pooling of funding, local governance entities must inventory the current funding streams and decide which streams could be pooled. Funds should be pooled based upon desired results. Funding for different populations must be considered in determining which funds to pool.
• Every local governance entity must build capacity to be able to understand the system and to have the necessary resources. If a community is not ready to provide local authority and collaboration, the local entity may fail. If desired results are defined, programs can be evaluated and can no longer hide behind a veil of confidentiality which sometimes surrounds human services. The local community and governance entity must evaluate the current situation, identify as a community the programs and services necessary to meet community needs, and find providers to provide the services.
• Funding should be a mixture of state, local, and other funding. The steps in the process include expanding the local governance entity, bringing more money to the table from various sources, and providing for expending moneys and providing services at the local level. Local communities will be at different points in this process.
• The General Assembly should authorize the creation of a local governance entity, which would then be accountable to those who provide funding to achieve the desired, established results. An executive board might be appointed as the accountable, decision-making entity as a subgroup of the larger local governance board. The local community should select the specific members and chairpersons of the governance entity, but the General Assembly should provide parameters for the entity. The leaders of the community should be allowed to emerge. The local governance entity should be a partnership which addresses the issue of what governance does to families not for families. The local entity decides how the local system should function as a policy-making and fiscal entity to achieve the desired results. The local governance structure should report results back to the General Assembly. The incentive could be that the local governance entity retains any savings to reinvest in the community.
• All members of the community should be involved, including businesses and the private sector. However, the private sector is not a bottomless financial supporter. The private sector is just one of the sources which should be included in supporting the local governance entity and plan.
• Core services should be defined for the state. Core services are those services to which every Iowan has a right. The core services should be defined by the three branches of government. The local community then builds on these core services with those additional services which are specific to the local community. The local community must decide how to supplement services to achieve the desired results.
• There is a need for a management information system (MIS) to link the state departments with each other, to link the state system with the local communities, and to link local communities. Research and data must be linked to be able to coordinate and evaluate the system.
• Those with decision-making power should all bring resources, not solely financial, to the table so that they have a stake in achieving the results. The local governance board should not just expend funds, but should develop the community plan and bring resources to the table. The local governance entity should determine the needs of the community and then determine how to resolve those needs.
• Incentives should be provided for innovative approaches and innovative approaches should be given time to work before they are labeled as failures.
• The state and local governance entity should develop a partnership. The existing levels of local governance, decategorization programs and innovation zones, should continue to be used and an additional level should be added to the process to provide for a broader governance entity. Local communities, with state assistance, should determine current funding in reaching a desired goal and that amount of money should be provided for a multiyear period to the local community to provide the programs and services necessary to reach the desired result. The membership of the local governance entity should be prescribed in broad parameters through legislation, but the individuals would be selected locally and additional members could be included. The local governance entity should be a mixture of elected and appointed members.
• Legislation should prescribe broad parameters for local governance in general. The entity should be based upon earlier successes. The parameters should reflect that the local community should engage different partners to work on local problems and that populations that do not usually have power should be included, such as consumers. The governing entity is not just about expending funds, but is about engaging the community in meeting its own needs.
• The role of the state may become one of providing for some core services, providing administrative support, providing technical assistance, and providing for evaluation. The state can also develop the long-term plans for the state as a whole and for local communities so that efforts are not duplicated.
• Various types of pilot programs could be implemented to measure success. For example, decategorization programs could be broadened to include other funding streams or funding could target a specific population, such as children 0-5 years of age.
• A dialogue with the federal government should be initiated to establish a special relationship with the federal government to enable the state to pool funding streams, to overcome barriers of regulations and other federal requirements, and to implement state initiatives. The effort should be coordinated through the Iowa Congressional delegation.
• Existing administrative rules, which create barriers for local governance entities and which limit the collaboration between departments should be identified and addressed to eliminate these barriers.
• A systemwide computer interface should be developed to provide connectivity between departments at the state level, between the public and private sectors, between the state and local communities, and between local communities. The state central unit, information technology (IT), should be directed to move ahead with developing this system. The General Assembly should direct the IT unit or the Legislative Oversight Committee to review the current system and to report any barriers to developing this system and to develop a long-range plan to implement such a system. The system should be research/data linked in a results-based system so that there will be accountability for achieving results.
• The budgeting process should move toward an interdepartmental, results-based system. Given the existing system in which the majority party political caucuses develop budget targets and appropriations subcommittees work with these targets, the system could be redirected in an incremental fashion. Perhaps a new appropriations subcommittee which forms across department lines could recommend certain funding amounts for common desired outcomes. An initial step might be to report to each caucus regarding progress in the budgeting for results process including any changes in the baseline for a particular performance measure. This could encourage the caucus to set priorities based upon desired results rather than specific programs within certain departments.

Recommendations Relating to Pooling Funding, Local Governance, and Eliminating Barriers, as Developed Through Task Force Discussion.

• Overview. Mr. Barbell reviewed the preceding discussion and suggested staff be directed to draft the Task Force Recommendations to reflect the discussion. He noted, without objection, that the majority of the "concepts for discussion" in the document had been addressed in the discussion with changes in emphasis and tone. It was suggested that the following items had not been addressed and due to time constraints would not be included in the final recommendations: 2, 8, 10, 11, 13, and 20. Ms. Arlene Dayhoff expressed concern about understaffing in the field positions of DHS, suggesting item #2 touched on this concern. After further discussion, the items Mr. Barbell suggested were accepted without dissent. The following is a redraft of the concepts.
• Enhance Local Governance. The existing levels of decategorization programs and innovation zones should be retained as the first two levels of local governance. An additional level, which provides for a broadening of local governance, should be established. The new level should be implemented through the use of various types of pilot projects, which could include the extension of decategorization pooling of funds to other funding streams or the development of pilot projects which would focus on a particular sector of the population, such as the population of children 0-5 years of age. The new level would include establishing a state/local partnership through creation of a plan by the local governance entity. The plan would include the desired results and a plan to achieve these results as specified by the local community in the plan. The plan would be developed through an integrated local planning process. A state board could provide for technical assistance, evaluation, and acceptance of plans and evaluation of achievement of results, and compilation of lessons learned from these pilots to assist additional communities in developing local governance.
• New Names. The names and terminology currently used for local governance are not readily understood by the public. Consideration should be given to renaming "decategorization" and "innovation zones."
• Appropriations Process. The appropriations process should include a process for broader communication between representatives of the various human services-related appropriations subcommittees and possibly standing committees. The process should move toward incorporating a results-based system of appropriation rather than using only a program or departmental basis. Initial steps could include reviewing the results identified by executive branch agencies in the "budgeting for results" system which will be available in the 1998 Legislative Session and expanding upon this in the legislative branch.
• Enhanced Federal Relationship. Efforts to develop an enhanced relationship between the state and the federal government should be initiated through involvement of the Congressional delegation. This relationship would assist the state in reducing barriers presented by federal law and regulation, increasing the pooling of funding, and encouraging development of innovative programs.
• State-level Collaboration. At the state level, collaborative efforts should be combined. Collaborative boards, commissions, and other entities which include the same memberships should be combined and should then address the broader spectrum of issues or programs. At the local level, existing entities should be combined and a new governance entity formed which encompasses all of the interests and which will then address the more comprehensive set of needs of the community.
• Administrative Rules. Existing administrative rules that present barriers to local governance or interdepartmental dealings should be identified and eliminated. The new state board, individual departments, or other appropriate entities should be directed to analyze the federal and state rules for these barriers, and to advocate for necessary modifications.
• Information Technology. The state's information technology unit or the Legislative Oversight Committee should evaluate the current state computer systems to determine barriers to and a long range plan for the implementation of a statewide computer interface which would provide for connectivity between state, public, private, and local community users.
• State Board. The existing state boards which oversee local governance efforts relative to human services, such as decategorization and innovation zones, should be encompassed, to the greatest extent possible, by a broader state board. The new board would provide technical and administrative assistance, coordination, and other assistance to local governance entities. The new board would also measure the success of local communities in achieving desired results and would be the entity to whom local governance entities would be accountable. The existing boards which have other functions would continue to provide those other functions and the human services-related functions relative to local governance could be redirected to the new board.
• Staff Role. An analysis of human services staffing should be performed and should take into consideration the new role of staff as governance and provision of services are moved to the local community level.

4. Other Task Force Discussion and Recommendations.

Child Custody/Domestic Abuse. Representative Boddicker used a marker board to present his analysis of the human services system. He employed a cliff analogy in describing how government commits far too many resources to emergency services directed to children who have "fallen off the cliff." It would be more prudent to commit greater resources to a "safety railing" and thereby prevent accidents in the first place. He also employed the analogy of a manufacturing process which uses good quality components and assembles them into a good quality product to make the point that if government provides input for positive outcomes for children at an early age, development processes such as education are much more likely to be successful. Representative Boddicker noted an increased likelihood of lower incomes and other problems in single parent families. He suggested enacting legislation directing courts to consider parent income as well as parenting skills in making child custody decisions. In addition, he suggested review of domestic abuse and child protection provisions for effects of false allegations being used by one parent to discredit the other. Representative Boddicker also suggested that the General Assembly take a proactive approach to increasing the involvement of noncustodial parents in their childrens' lives by examining, for possible revision, the language of existing laws, where needed, dealing with child support, custody, and visitation to guarantee that state law does not discourage a parent from taking a vital role in his or her child's life. The Task Force did not make a formal recommendation regarding these suggestions. Representative Boddicker agreed to submit additional recommendations in writing and following the meeting submitted the following:

• Multi-Year Funding. Representative Boddicker also proposed committing funding on a multi-year basis to local entities. Representative Osterhaus and Senator Freeman concurred, commenting on the resources wasted by agencies in reapplying for funding. There was consensus to include these concepts in the Task Force Recommendations.
• Department Mergers. Senator Freeman expressed interest in possibly merging the departments of human services and public health. Ms. Dayhoff and others noted there was previous discussion of this idea a number of years ago. There was not consensus to include this recommendation in the Final Report.
• Frozen Funding. Ms. Schmidt and others expressed concerns that moving governance to the local level and establishing a state funding stream might later result in the funding stream being capped or reduced thereby leaving any additional costs to the local community. She said if this would occur, property taxes would increase.
• DHS FTEs. Ms. Dayhoff reminded members that DHS field staff full-time equivalent (FTE) positions were drastically cut during state budget shortages early in the 1990s. She expressed concern that current caseloads are dangerously high for sensitive positions dealing with problems such as child protection, foster care, and adoption. She pointed out that DHS field staff will be very important to achieving the success of new local governance initiatives. It was noted that additional positions were provided for the current fiscal year in child protection and it was suggested that consideration of additions may be appropriate during the upcoming budget process.
• Local Governance Performance. In follow-up to Representative Boddicker's previous suggestion about multi-year funding and performance checks, Representative Heaton queried whether other states used any kind of sanction in the event a local governance entity did not perform as expected. Chairperson Houser said he had not hear of any sanctions in his discussions with other states. Ms. Schmidt cautioned about designing incentives and sanctions in a manner so as to not discourage those who are innovative. She suggested adequate time is needed to determine whether new approaches are effective. Mr. Barbell noted Iowa already has shown considerable success and has knowledgeable leaders. He reminded Task Force members that one of the chief reasons for encouraging local governance is to engage local citizens in a commitment to outcomes. Representative Ford stressed the importance of implementing a relevant evaluation process that will ensure providers deliver the desired outcomes.

5. Task Force Recommendations Relating to the Program Duplication and Resource Utilization Subcommittee.

Following discussion, the Task Force approved the report of the Program Duplication and Resource Utilization Subcommittee, as amended which is attached and by this reference made a part of these minutes.

6. Task Force Recommendations Relating to the Institutions and Facilities Subcommittee.

Opening Comments. Co-chairperson Houser, in his capacity as Chairperson of the Institutions and Facilities Subcommittee, provided an overview of the process used by the Subcommittee to visit the two State Hospital-Schools (SHSs), four Mental Health Institutes (MHIs), and the State Juvenile Home. He noted the Subcommittee did not visit the State Training School but instead received a presentation from its Superintendent. Each of the Subcommittee members present provided comments. All were complimentary concerning the open process and discussion.

The Subcommittee's vision statement and draft recommendations were included in the packet distributed at the beginning of the meeting. A copy of this document with revisions marked to reflect changes accepted by the full Task Force is attached and by this reference made a part of these minutes.

Amendments. Co-chairperson Houser explained that Subcommittee members had met informally along with interested citizens the evening before and had collected suggestions for revisions to the report. Staff read the suggestions for changes. Representative Heaton's proposal was accepted for including in recommendation #27 a request for counties to report, in addition to DHS, on the Medicaid program and what changes can be made. In addition, Chairperson Houser distributed a one page document containing six additional items for inclusion in the Subcommittee report, which is also attached.

Discussion. Ms. Dayhoff referred the Task Force to one of the suggestions for changes which requests DHS to propose criteria for determining when a state institution's size is reduced to the point program quality is impaired and the cost is too high. She noted that more than 50 percent of DHS FTEs are employed in institutions and expressed hope that FTEs could be shifted to field staff if institution population numbers are further reduced. Many members noted the high quality of staff and facilities. Others stressed the role of institutions in serving persons who could be served nowhere else. Others pointed to the importance of serving people as close to their families and communities as possible so that these connections are not lost.

Approval of Recommendations. Mr. Barbell summarized the recommendations as calling for legislative changes to the statutory mission statements of the institutions and for the institutions to be entrepreneurial and more responsive in actions to shift to a role of regional resource centers. The recommendations of the Subcommittee and the additional changes were accepted without objection.

7. Closing Comments.

The Co-chairpersons expressed their appreciation for the work of the members of the Task Force and the Subcommittees. They also thanked Mr. Barbell for his services throughout the interim.

8. Materials Distributed and Filed With the Legislative Service Bureau.

a. Minutes of November 25, 1997, meeting.

b. Materials on results-based accountability provided by Mr. Marc Baty, Linn County.

c. Memo from Mr. Marc Baty, providing a proposal for community-oriented governing.

d. A brochure entitled, "Early Childhood Education and Parent Partnerships: An Investment for Iowa," prepared by the Early Childhood Community Coalition and distributed by Dr. James Austin.

e. An analysis of state actions on behavioral health parity prepared by the Health Tracking Service of the National Conference of State Legislatures, and distributed by the Legislative Service Bureau in response to a Subcommittee request.

f. A summary of the public forums held in Cedar Rapids and Iowa City on December 8 and 9, 1997, prepared and distributed by Representative Ro Foege.

g. A summary of the southwest Iowa public forums held in Council Bluffs and Red Oak on December 12, 1997, by Representative Hubert Houser, Representative Brad Hansen, Senator Nancy Boettger, and Ms. Julie Schmidt, submitted by Ms. Schmidt.

h. A letter addressed to Representative Houser and members of the Institutions Subcommittee of the Task Force from Mr. Merv Roth and Mr. Curt Sytsma of Iowa Protection and Advocacy, suggesting legislators hold a public forum and schedule visits to community-based residential and vocational programs for persons with disabilities.

9. Materials Distributed and Attached to These Minutes.

a. Human Services Restructuring Task Force Concepts for Discussion, as distributed.

b. Recommendations of the Program Duplication and Resource Utilization Subcommittee, revision marked to indicate the Task Force's actions.

c. Vision Statement and Draft Recommendations of the Institutions and Facilities Subcommittee and Other Proposed Institutions Recommendations, revision marked to indicate Task Force's actions.

OTHER INFORMATION FOR THIS COMMITTEE:

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