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within the Alcohol, Drug Abuse and Mental Health Administration incorporate alcohol as well as drug prevention. Most drug abusers are poly-drug abusers and in many cases alcohol is one of the many drugs they are abusing. Through the Office of Treatment Improvement we are working toward providing comprehensive drug treatment which includes addressing alcohol abuse.
Question. Is it your intention that the $99 million proposed in the ADAMHA budget for "capacity expansion" would be directed to alcohol, drugs, or both?
Answer. The Capacity Expansion program will expand the availability of comprehensive drug treatment services. However, as most drug abusers are poly-drug abusers, their treatment will address all the substances they abuse, including alcohol as appropriate.
Question. I your view, what would it cost to make significant inroads in expanding the capacity to treat alcohol and other drug problems?
Answer. Significant inroads to treat drug and alcohol abuse can only be achieved through a partnership between Federal and State governments, communities and the private sector. Since 1989, the Department's budget for drug treatment has nearly doubled, and I believe that the new $99 million Capacity Expansion Program in my FY 1992 budget is a significant effort in this direction.
Question. Mr. Secretary, as you recall, last year the conference committee provided $15 million for extramural construction, with report language in support of completion of the mouse production facility at the Jackson Laboratory. I understand that you have agreed to issue a competitive request for applications for a mouse production facility for up to $10 million. Is this correct?
Answer. After consultation with me and other senior HHS staff, the Acting Director of NIH decided to issue a Request for Applications for construction of a large-scale mouse production and mutant characterization facility. There will be an open competition for up to 75 percent of the allowable costs (not to exceed $10 million) of a requested project.
Question. Mr. Secretary, buried deep within the budget for the NIH is a request of $13.4 million for phase I design work for a 15 year upgrade and reconstruction of the Warren G. Magnuson clinical Center. This project is expected to cost over $800 million and may well approach $1 billion by the time
the project is completed. Mr. Secretary, this is probably the biggest single camel's nose under our appropriations subcommittee tent this year.
have you reviewed the need for this very expensive and significant upgrade of the clinical center?
Answer. NIH has sought the assistance of the Arm Corps of Engineers to evaluate the NIH facility needs in general and the clinical center specifically. Following completion of this evaluation a final determination of how to proceed with respect to modernizing the clinical center will be made. But please keep in mind that the clinical Center is over forty years old. It was designed and built in a different technological age, yet still remains the largest research hospital in the world. Whether we improve the current facility or replace it, the cost will be significant.
VACCINE INJURY COMPENSATION
Question. Apparently, many more claims petitions than anticipated have been filed against the National Vaccine Injury Compensation Fund. The estimates for paying these claims run as high as $3 billion.
How many claims have been filed for the preOctober 1, 1988, vaccinations, and when do you anticipate these claims will be settled?
Answer. A total of 4,047 pre-October 1, 1988 vaccine injury claims have been filed. The recent Vaccine and Immunization Amendments of 1990 extended the time the claims Court has to review the pre-Octobe claims by 180 days, allowing for a total of 420 days.
Question. What is the history of payment on claims so far, and what are the projected costs for payment of the new claims?
Answer. As of March 12, 1991, 149 pre-October 1, 1988 cases have received judgements for compensation. The total amounts awarded for these claims has been $93.9 million. Estimates for the remaining claims are not available at this time. The Department currently is reviewing the claims to determine a sound estimate.
Question. What is the Administration's position on settling these claims: will the Department be submitting a supplemental?
Answer. The Department is currently working to derive a sound estimate on the cost of the preOctober 1, 1988 vaccine injury claims. Once this estimate is derived, we will review options for handling the claims.
Question. To date, AIDS has claimed more American lives than the Vietnam War. The National Commission on AIDS projects an additional 200,000 deaths over the next four years, increasingly among women and children, IV drug users, and minority populations.
Your FY 1992 budget proposes a modest increase in AIDS funding, all of it directed to research. The budget proposes level funding of Ryan White AIDS care programs in FY 1992 without an increase even for inflation.
Do you believe the budget reflects the right balance in funding between research and health care services?
Answer. Yes, I believe my budget reflects the right balance in funding between AIDS research and services. However, while we have continued funding of "Ryan White" activities at the same level provided by Congress in FY 1991, we remain concerned about piecemeal, disease-specific approaches to financing health care services. It should also be noted that our projected costs for caring for AIDS patients through the Medicaid and Medicare programs will approach $1.36 billion in FY 1992, an increase of over $300 million from FY 1991.
Question. What was the funding level proposed in the original HRSA budget submission, and what level of funds for Ryan White did your budget submission to OMB propose?
Answer. The HRSA and HHS budgets were originally developed prior to the passage of the Ryan White Comprehensive Care Act. Therefore, neither the HRSA nor the Department budgets included funding specifically for the "Ryan White" activities.
Question. The recent case of the Florida dentist who appears to have infected some of his patients with HIV has renewed concerns about HIV testing of health care workers. What is the Department's position on HIV-=virus testing for doctors, dentists, nurses, and other health workers?
Answer. CDC continues to emphasize adherence to its guidelines for preventing the transmission of HIV and other blood borne pathogens in the health care setting. These guidelines promote following universal precautions, including proper cleaning of instruments and preventing blood contact between patient and health care worker. on February 21 -22, CDC held an open meeting to review current information on the risks of transmission of HIV and other blood borne pathogens during invasive procedures and to assess the implications of these risks. Participants of the
meeting have been provided time to submit written comments about the meeting. Once these comments have been received, CDC will begin a deliberative process of reexamining and updating the prevention guidelines for health care workers performing invasive procedures. Once the Department has approved the draft, guidelines, the Department will provide a 60 day period for submitting public comment before issuing any final guidelines.
Finally, in FY 1992, the Department is requesting $29.2 million to continue information and education projects related to preventing HIV transmission in health care workers.
Question. How much time will title x providers have to decide whether they will comply with the 1988 regulations?
Answer. If the Supreme Court upholds the regulations, the Department will allow 30 days for each grantee to provide assurance of compliance, and another 30 days to implement compliance. A longer period for compliance may be authorized in the small number of cases where compliance requires a grantee to obtain new facilities or to redesign their accounting systems. While this may seem a short time period, grantees have had three years to consider and plan for the implementation of these regulations.
Question. If any Title x providers refuse to comply, does the Department plan to discontinue funding them -- and if so, how will you ensure that Title X services will be continued without interruption?
Answer. We believe that few if any Title X grantees will refuse to participate in the program if the Supreme Court upholds the regulations. Should a grantee decide to drop out of the program, however, there will be little difficulty in transferring the funding to a new grantee in an orderly manner.
PREVENTION/PUBLIC HEALTH SYSTEM
Question. Perhaps one of the most important components of our health care system for meeting the Health Objectives for the Year 2000 is a strong public health system. As you know, a number of reports, including a report by the Institute of Medicine, have found that our public health system is in disarray and that there is a lack of federal leadership. What additional steps are needed to build a state and federal public health infrastructure so the Health Objectives for the Year 2000 can be met?
Answer. Our budget request for fiscal year 1992 for the Centers for Disease Control emphasizes the need to strengthen the public health infrastructure. CDC proposes to expand the Preventive Health Services Block Grant by 12 percent, or to a level of $101.5 million. This should begin to enable State health departments to fulfill the Institute of Medicine charges to develop policies to assure the delivery of preventive health services.
A second aspect of building this infrastructure is to strengthen CDC's ability to provide leadership. Progress toward achieving the Year 2000 objectives must be measured, more than one-fourth of 1990 objectives could not be measured. This is the reason CDC is seeking a $15 million increase, or 21 percent, for the National Center for Health Statistics. Added data collection capacity and enhanced automation and analytical approaches will strengthen CDC's excellence in infectious and chronic diseases, and occupational and environmental health, to meet the challenges of the future.
HEALTH OBJECTIVES FOR THE YEAR 2000
Question. Has the Department developed a comprehensive plan laying out for each objective which changes in Federal programs or increases in Federal funding should be made so that we can achieve in the Year 2000 what we did not achieve in 1990?
Answer. The Public Health Service is engaged now in developing such an "implementation plan" that will show for each priority area of Healthy People 2000_what allocations of resources are being focused to achieve the Year 2000 objectives and what issues need special attention. This plan is slated to be completed in late 1991 and will be updated periodically throughout the decade.
Question. Goal 21.4 of the Year 2000 Objective states: financing and delivery of clinical preventive services so that virtually no American has a financial barrier to receiving, at a minimum, the screening, counseling, and immunization services recommended by the U.S Preventive Services Task Force. . What steps is the Department taking or will it recommend be taken to meet that objective?
Answer. Recent statutory changes have expanded Medicare and Medicaid preventive services for specific screening and immunization services, such as Pap smears and mammography. States, however, have broad discretion to limit the amount, duration, and scope of services.
The Department is looking for opportunities within its own service delivery programs as well as working with State and community agencies and professional