Rep. Henry A. Waxman (D-Calif.) and 17 members of the Senate Special Committee on Aging led by its chairman, Sen. John Heinz (R-Pa.) have reopened the controversy over proposals by the Health and Human Services Department to ease certain regulations for 1,500 small hospitals that participate in the Medicare and Medicaid programs.

Throughout the dispute, which has lasted several years, the department has insisted that its proposals to relax some staffing requirements, among other things, are simply designed to streamline the rules and give hospitals more flexibility without reducing the quality of care.

But a coalition of 25 organizations, led by the National Association of Social Workers, has repeatedly charged that some of the proposed changes would substantially reduce the quality of care.

Among the changes the group is concerned about, according to Charlotte Mahoney of the NASW, are the elimination of specific requirements that hospitals provide certain dietary services and discharge planning, as well as the relaxation of requirements that cetain departments, such as occupational and physical therapy, be headed by personnel having advanced degrees and special training.

In a series of letters to the HHS, the most recent on Nov. 29, the 18 members of Congress asked the department to spell out how its periodic surveys of the hospitals will evaluate the quality of care, what weight will be given to different factors, how often surveys will be conducted, how well will the surveyors be trained and what procedures and standards will be used.

After Medicare-Medicaid administrator Carolyne K. Davis responded to earlier letters, the 18 sent in new requests for information.

A Heinz aide said the senator was particularly concerned with problems of discharge planning, because under the new prospective payment system for Medicare, hospitals are under pressure to discharge patients rapidly.

In proper discharge planning, hospital staffers help determine where the patient will go and what further services will be needed to avoid future serious health problems.Heinz was said to want assurances that the changes would not lead to a deterioration of discharge planning.

Mahoney said this week that the coalition was still unhappy with many of the proposed revisions, especially those that reduce advanced degree and training requirements for discharge planning and other departments.

Although it had been rumored that the administration would publish the final regulations by the end of this year, HHS sources said several issues need to be addressed and that there are no plans to publish the final version immediately.

The new regulations would apply to about 1,500 small, mainly rural hospitals. Those who fail to meet the standards set in the regulations could be excluded from the Medicare and Medicaid programs.