early forties that appeared to be able bodied, but they were drug users, alcohol users and the necessity arose to get them detoxification. They also were homeless, and thus, shelter would be necessary in order to start them on job training programs, a subject we discussed yesterday with Secretary Dole.

I made the comment after you had responded that I wanted to start early to make the presentation to you on a Philadelphia pilot project, and it has been very frustrating to see the months go by, and it was not until January 26, just a few days ago, there was a request for application issued by the Department of Health and Human Services, under a cooperative agreement for a research demonstration project on alcohol and other drug abuse treatment for homeless persons.

And my concern, Mr. Secretary, and I understand the problems that you have, but if the matter is elevated to an exchange between the ranking member of the subcommittee and the secretary, and it takes from April 10 until January 26 to get a letter out for step one, what are we to do in coming to grips with this terrible problem if it takes this long to do that? And that is the overarching question.

The subordinate question is when are we going to get this project for Philadelphia, but the overarching question is how do we function if when it comes up in this context between you and me and this time interval lapses?

Secretary SULLIVAN. Senator Specter, I think there are a number of issues that are involved in that. I, too, feel the same sense of frustration that it takes so long. But as you know, we do have a very strong commitment to addressing the problems of homelessness, alcoholism, and drug abuse in our society.

In fact, I had the pleasure on two separate occasions to visit facilities in Philadelphia that were addressing the homeless. One was a facility that had come into being as a result of our regional director in the Philadelphia office, who obtained from the Department of Defense through the General Services Administration a facility that had been renovated to serve as a training center and dormitory for homeless alcoholic men. It gave them job training, and this particular facility in south Philadelphia, I think, has thus far had an exemplary record of detoxification of these men. Working with local businesses, they graduate from the program with a job and move out into the community.

That particular program, also, was considering establishing a second such facility in another part of Philadelphia for homeless women as well. Clearly that program seems to be one that is working.

The second visit was to a house that had been established for mentally ill homeless individuals in Philadelphia. That house was being run by the mentally ill homeless individuals themselves. We clearly have an interest in a commitment to that.

As you may be aware, I serve as vice chairman of our interagency task force on homelessness that Secretary Kemp chairs.

Some of the reasons that it takes so long are as follows. First of all, as you know, the appropriations for the current year were only completed late last year, and the time that-

Senator SPECTER. We are not talking about appropriations. We are talking about an application. I want to follow up with you to get the specifics on people being detoxified and finding jobs and having a success rate because frankly that would surprise me if those results are in hand.

But before pursuing that further, let me get the specifics from you as to those two projects. We are not talking about appropriations. We are talking about just getting an application filed, which they cannot do in Philadelphia until they get this response from your Department.

Secretary SULLIVAN. I will be happy to review that specific situation and get back to you with the details because I agree with your concern and we want to do everything we can to move things as rapidly as possible.

[The information follows:]

PROGRAMS FOR HOMELESS

I am aware of the excellent programs in Philadelphia for the homeless. My staff and I have been in contact with your office and the Mayor of Philadelphia, Wilson Goode, to discuss future homeless projects in Philadelphia.

On July 27, 1989, ADAMHA and NIAAA staff met with staff from Goode's office and Maureen Byrnes of your office in response to funding demonstration projects on homeless persons with alcohol and drug problems. At this meeting, we presented Mayor Goode's staff with materials on the two existing demonstration projects in Philadelphia. These two projects are approximately 28 percent of the total funds available at that time. At this time, Department staff also provided technical assistance on developing grant applications.

On September 6, 1989, I wrote a letter to Mayor Goode providing an update on the procedure for additional demonstration grants. In this letter I stated that the Request for Application (REA) would be forwarded to Mayor Goode as soon as it was available.

The process for soliciting, reviewing and making grant awards is designed to expedite the funding of projects for homeless persons and ensure that those programs are of the highest quality. The following is the timetable the Department anticipates following in order to accomplish both of these goals:

-November, 1989: Appropriation;

-January, 1990: Request for Application (RFA) issued;

-April, 1990: Applications due;

-June, 1990: Applications reviewed by independent outside review group and rated on scientific and technical merit;

-September, 1990: Review by National Advisory Council on Alcohol Abuse and Alcoholism;

-September, 1990: Grant awards made.

Senator SPECTER. I really do not think it is an answer to cite other activities which you have undertaken because they are important, and I will review those. As I say, I would be pleased, as well as surprised, if they are as successful as you have indicated.

But in terms of getting a matter on track which you and I have discussed, I want to see what has happened here and how we get it on track. And I have expressed my concern as to the fact that it may be an indicator as to the heavy redtape in the Department generally.

I will return to more questions because I do not want to take up any more time while colleagues are waiting.

Senator HARKIN. Thank you.

Senator Burdick.

Senator BURDICK. Mr. Secretary, for the first time in many years the President's budget proposal contains significant funding for the

National Health Service Corps program. However, the budget also eliminates most of the funding for the health professions program.

HEALTH PROFESSIONS PROGRAMS

Last week I met with hospital administrators from North Dakota who face a significant nursing shortage. I am also told that we have a shortage of mental health care providers throughout the State. North Dakota health professions programs are heavily dependent on Federal funds because of the State's severe economic problems.

In light of these shortages how can we severely cut health programs in the 1991 budget?

Secretary SULLIVAN. Thank you, Senator Burdick. There are a number of things that we are doing to address this problem. While we have indeed reduced the funding overall for health professions programs, the funds that we have in our budget which I believe are around $76 million are focusing on training primary care health professionals as well as addressing the problem of nursing short

age.

The Nursing Commission submitted its report to my office in December 1988. I appointed a committee headed up by Dr. Marie Henry, who is the senior public health official in charge of nursing programs to address and implement a number of the recommendations included in the report.

Some of the recommendations pertained to increasing the professionalism of nursing, improving working conditions, reducing nonnursing responsibilities, seeing that nurses were represented at a high level in the hospital administrative structure, and addressing the problem of salaries for nurses.

We are working diligently to implement these recommendations of the Nursing Commission's report, and I am confident that we will see some positive results.

One other thing regarding rural health, our budget includes an increase in National Health Service Corps funding of $63.9 million for scholarships and loans to individuals who will be targeted for both rural areas and inner cities.

Senator BURDICK. Mr. Secretary, we will look at this next year when you come up and see what progress has been made.

Some officials in my home State have encouraged me to oppose Medicare expansion. They say they cannot afford to pay for more services given their current budget restraints.

Would you tell the committee what you think of the Oregon Medicaid initiative or similar proposals that give the States the flexibility to prioritize certain Medicaid services.

Secretary SULLIVAN. Senator Burdick, we are following the Oregon program with great interest to see how that works. This is an effort to tackle a very difficult problem, and that is given limited resources, how the dollars are best spent. We are watching Oregon to see if this is, first of all, accepted by their citizens; that is, to provide the limited dollars for more primary care, including immunizations as well as not providing funds for transplantation. That represents a very serious issue that involves a number of ethical and other considerations.

We cannot comment beyond that other than to say we are very much aware of it, and we are following it with great interest.

Senator BURDICK. I understand the administration's budget for the National Health Service Corps would cover assistance for 750 students. Do you know how many underserved areas currently have vacancies and if it is significantly more than 750, why the administration is not giving this program higher priority? 750 seems very, very small to me.

Secretary SULLIVAN. Senator Burdick, we agree that there are a number of health priorities that we are trying to address. While we may not have an optimal response to this, is we have turned this issue around, and we do have increased funding for this year.

With the budget we propose for fiscal 1991, we would be increasing the total field strength to around 2,200. We are encouraging the use of other health professionals such as nurse practitioners and physicians' assistants as part of the overall health care team. Nurse midwives can also provide very valuable services in a number of instances.

Senator BURDICK. Agricultural safety is a top concern in North Dakota and other rural States. Last year Congress included report language instructing the Office of Rural Health to focus on agricultural and safety health issues. Do you know if this effort is underway and if so, how is the effort being coordinated with the USDA? Secretary SULLIVAN. Yes, Senator Burdick. Through the Centers for Disease Control we are devoting $12.3 million for farm safety because that is an important part of maintaining the health for rural citizens.

LOW-INCOME HOME ENERGY ASSISTANCE

Senator BURDICK. I am very concerned about the administration's proposal to cut the low-income home energy assistance program, better known as LIHEAP by nearly 25 percent next year.

I receive a great many letters, mainly from senior citizens, about the importance of LIHEAP and the difference it has made in their lives. Where the winter temperatures can be 20 or 30° below zerothat is real temperature-not a wind chill, LIHEAP can literally mean the difference between life and death. I assure you that North Dakotans cannot afford any cuts in LIHEAP. It should be increased at least enough to cover inflation. Instead you are here suggesting that we cut it by nearly one-fourth. Why?

Secretary SULLIVAN. Senator Burdick, this program was first implemented, during the oil shortage-during the years of the oil embargo-and that no longer exists. This was intended from the beginning to be a temporary program during that critical period.

Second, this is a program in which there are widely differing needs in different States and because of that, we feel that it is a program that should be focused more in the States-the demand is

so uneven.

This was never intended to be a permanent program of the Federal Government; it was enacted during the time of the oil embargo.

While the month of December was a cold month throughout the Nation and oil prices went up, the fact is now the oil prices as of a

few days ago were actually lower than on December 1. Those news stories that all of us saw in December no longer apply.

Senator BURDICK. I do not think you ever lived up there in the Northern States, have you?

Secretary SULLIVAN. No, but I have experienced 59° below zero with the wind chill, so I understand.

Senator BURDICK. Mr. Secretary, the administration again proposes to terminate the community services block grant program which received $389 million in the fiscal 1990 appropriation. As you know, these grants are made to States for community action agencies to run programs providing basic survival services to persons in need.

The plan, as you know, is to replace this nearly $390 million program with a single appropriation of $42 million in funds from the McKinney Homeless Assistance Program. Clearly we must fund programs to help the homeless, and I support this wholeheartedly. However, we must not pit one assistance program against another. We need all of them. We must not cut any of them. In seeking to cut out the funding for community service block grants the President is asking us to terminate the funding for the agencies that run 35 percent of the Head Start Programs for which he expresses such an affection.

I also found in your budget justification statement a suggestion that the assistance currently provided by community service block grants could be replaced by some other programs. One program which was mentioned was LIHEAP, the low-income home energy assistance program. Yet the same budget plans to cut one-fourth of LIHEAP's funds. Why does the administration repeatedly seek to terminate CSBG funds, knowing that the public wants this program and Congress wants it?

Secretary SULLIVAN. We believe that the purposes of the block grant program are being served in other areas of the budget, in LIHEAP, and the JOBS Program.

As I mentioned in my testimony, we are proposing full funding, at $1 billion, for the JOBS Program. This represents a significant funding increase and also the increase in our Head Start Program of $500 million that will help. Other Federal agencies, including the Small Business Administration, also help to address those needs as well.

Whereas we propose to eliminate these programs from the community services block grant, they are being served in other areas of our Department, as well as in other Departments. Some of our programs such as the JOBS, which I think was $463 million last year goes to $1 billion in our budget, and the Head Start Program goes from $1,386 million to $1,886 million.

Senator BURDICK. Thank you very much.

Senator HARKIN. Thank you. Senator Bumpers.

Senator BUMPERS. Thank you, Mr. Chairman.

Dr. Sullivan, welcome to-I guess your first appearance before this subcommittee.

Secretary SULLIVAN. Second.

Senator BUMPERS. I missed the first one.

Dr. Sullivan, who is Acting Director at NIH?