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has been a priority under the title IV Aging Research, Training and disrectionary Projects program for the past several years. Grants have been made to Universities and local Aging organizations to improve knowledge about and effectiveness of health education and promotion programs for the elderly.

Question. Along these lines, what role do you believe that the National Institute of Aging should play in this area? Are there initiatives you intend to pursue with NIA in this regard?

Answer. Although the National Institute on Aging focuses more on biomedical research to discover effective prevention and treatment methods for diseases afflicting the elderly, there is much room for cooperation between NIA and the Administration on Aging, which is expert in educating older Americans on healthy lifestyles through its aging network. NIA and AOA have an ongoing Memorandum of Understanding (MOU) that promotes collaboration efforts in health promotion and disease prevention for the elderly. Past projects conducted under this MOU include: a workshop to develop a research agenda on minority aging, a workshop on in-home health and supportive services, and a planning workshop on the consequences of harmful dietary habits. In addition to the MOU, NIA and AOA have already completed two workshops conducted under an FY 1991 Interagency Agreement to identify and address the health needs of the elderly Hispanic population.


Question. Can you share with the Committee what you are doing to ensure that women in this country receive the highest quality mammogram currently possible and whether you have plans to strengthen the interim rule?

Answer. The Department published an interim final rule on December 31, 1990, in the Federal Register, to implement provisions of OBRA 1990 which provide Medicare coverage of screening mammography. This rule contains very strict standards mandated by the law which we consider very important for ensuring safety and quality. Once we have comments on the interim final rule, we will determine whether there needs to be further clarification of the standards.



Question. I'd like to know what you see FDA's role in mammography. Do you have plans to broaden the authority of the FDA to collect data on the type and model of equipment; to ensure that the

mammography machines in use are of sufficiently high
quality to detect even the smallest tumors; or to
provide states assistance in inspecting facilities
to ensure that quality assurance programs are in

Answer. The FDA has a long and successful history in working with the States and professional organizations to assure that medical devices, including machines used for mammography, are both properly made and properly used. As a result of this cooperation, the practice of mammography has improved significantly without FDA infringing on the States' control of medical practice. Specifically, FDA worked extensively with the American College of Radiology to develop an accreditation program for mammography facilities. Since this program has been implemented, the number of facilities successfully meeting accreditation requirements has increased from 65% to 87%. FDA has also added a mammography section to the Radiological Health Science File, a teaching aid whose films form the basis of the American Board of Radiology's certification examination. FDA is also working closely with CDC and NIH to develop the National Strategic Plan for the Early Detection and Control of Breast and Cervical Cancer. Components of this plan include surveillance, quality assurance, and public & professional education.


Question. Can you please explain this apparent inconsistency and tell the Committee when you plan to direct the NIH to proceed with this effort?

Answer. Congress has provided the Department mixed signals concerning the conduct of this study. While the Senate has encouraged us to proceed, the House has prohibited us from moving forward without specific approval. At this juncture, you are correct in noting that NICHD has reserved $3 million in its budget request for work on this project. The FY 1992 funding request will allow us to more fully develop the survey vehicle, train interviewers, and begin the preliminary recruitment and sampling of subjects. The total cost of full implementation is estimated to be $15 to $18 million.


Senator HARKIN. Thank you, Mr. Secretary. The subcommittee will stand in recess until 10 a.m., Thursday, March 7, when we will meet in SD-192 to hear from the Family Support Administration, Human Development Services, and the inspector general.

[Whereupon, at 4:02 p.m., Tuesday, March 5, the subcommittee was recessed, to reconvene at 10 a.m., Thursday, March 7.)





Washington, DC. The subcommittee met at 10:02 a.m., in room SD–192, Dirksen Senate Office Building, Hon. Tom Harkin (chairman) presiding. Present: Senators Harkin, Specter, and Gorton.





Senator HARKIN. The Subcommittee on Labor, Health and Human Services, and Related Agencies will come to order.

This morning we will hear testimony in support of the budget requests for the Family Support Administration, the Office of Human Development Services, and the Office of Inspector General.

We will begin by considering the request for the Family Support Administration. The bulk of the budget here is for entitlement programs, most notably aid to families with dependent children and child support enforcement. In total, the mandatory funding request for 1992 is $12.8 billion or 91 percent of the agency's total request. Needless to say, this subcommittee's focus is primarily on the discretionary programs which total a mere $1.155 billion or 9 percent of the fiscal year 1992 request. For the last decade, the President's budget requests for discretionary programs under this jurisdiction have been remarkably consistent: freeze, cut, or eliminate. This year's request fits that pattern: freeze refugee assistance, cut low-income home energy assistance, and eliminate the community services block grant.

The only program where you have been successful at least partially in achieving the administration's objectives of freeze, cut, or eliminate has been the Low Income Home Energy Assistance Program, although during the 2 years that I have chaired this subcommittee, this slide has been reversed. One notable change in the request is to eliminate all fiscal year 1992 funding for the State legalization impact assistance grants rather than just cutting back, as has been proposed in past years.

Only the entitlement programs of AFDC and child support enforcement are growing. In fiscal year 1992 these programs would grow by 8.3 percent.

The discretionary programs, on the other hand, would be cut by 57 percent. Child care block grants, an important new discretionary program, would be administered this year by the Family Support Administration. Although authorized at $825 million in 1992, the administration has chosen to freeze funding at the $731 million level that we have provided last year for the first year of implementation.

Ms. Barnhart, I understand you have been working diligently with many organizations and child care providers in the field to get this new program started most effectively. You are to be commended for these promising early developments. While I understand you are still in the process of developing regulations, it is my hope there will be a strong emphasis on child development and quality of care issues for all of the child care programs that you administer.

At this point, I will turn to Senator Specter for any opening statement he would like to make.

OPENING REMARKS OF SENATOR SPECTER Senator SPECTER. Thank you very much, Mr. Chairman. I just saw Chairman Harkin at the Subcommittee on Defense appropriations and told him that I would be right along. I wanted to come and join the chairman in welcoming the witnesses here today as we proceed with our subcommittee hearings.

I have to go now to a Judiciary Executive Committee meeting, where we have a loaded agenda. I will do my very best to rejoin you if I can later this morning.

Thank you, Mr. Chairman.

INTRODUCTION OF ASSOCIATES Senator HARKIN. We appreciate that. Thank you very much, Senator Specter.

Ms. Barnhart, again welcome back to the subcommittee. You might for the record introduce your associates who are here and, again, please proceed as you so desire with your statement.

Ms. BARNHART. Thank you, Mr. Chairman. I am joined today by Norm Thompson, who is the Deputy Director of our Office of Financial Management, and by Dennis Williams, who is Deputy Assistant Secretary for Budget with the Department.

Mr. Chairman, I am very pleased to be here and have this opportunity to speak with you and members of the committee. I am pleased to have this opportunity to present the President's budget request for the Family Support Administration for fiscal year 1992. The Family Support Administration as a part of the Department

of HHS is responsible for programs that help some of the most vulnerable people in our society.

For example, we help needy families with a single parent or an unemployed parent who require public assistance to support their children; low-income families who need help with the cost of child care in order to work; and single parents who are unable to make ends meet without financial support from the noncustodial parent.

We also help refugees to our shores who need a helping hand to start a new life here; U.S. citizens and their dependents who have come home from abroad as a result of war, or the threat of war, and are temporarily without money; and, finally, low-income families who need help to pay their heating bills.

Funds appropriated by Congress for the Family Support Administration allow State and local governments and other organizations to carry out a variety of programs to help these vulnerable people.

BUDGET REQUESTS The President's request for the Family Support Administration totals $18.4 billion in budget authority. Let me briefly summarize the programs that are covered by that request.

We are asking for $15.2 billion for family support payments to States. This account funds several major entitlement programs, as you mentioned, Mr. Chairman. The largest of these is aid to families with dependent children, or AFDC, which provides cash assistance to low-income families who are not yet self-sufficient. We estimate needing $12.3 billion for this program.

We estimate we will need $3.2 billion to provide funds for State and local administration of both the AFDC and the Child Support Enforcement Program and for child support enforcement incentive payments to States.

The Child Support Enforcement Program helps establish and enforce support orders, providing essential financial assistance to custodial parents. We estimate that we will collect over $1 billion in child support payments on behalf of AFDC recipients that will help to offset Federal moneys that are spent on AFDC payments.

We estimate that we will spend $1 million in fiscal year 1992 to provide repatriation for American citizens and dependents who have returned from foreign countries as a result of illness, destitution, or war crises.

Funding for several child care assistance programs are included in this account as well. We estimate we will need $433 million in fiscal year 1992 for child care for current AFDC recipients who are participating in the JOBS Program and for former recipients who have left AFDC because of employment or increased earnings and need transitional help with child care expenses.

In addition, we estimate a requirement of $300 million to fund child care for families at risk of becoming AFDC recipients unless they can obtain help to meet child care expenses.

We are requesting close to $745 million for the child care and development block grants and the child care licensing improvement grant programs. These grants to States are to help low-income working families pay for child care and related services, to improve the availability and quality of child care, to improve child care reg

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