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Zebley is currently the only nationwide class action against the agency. The four cases are:
Stieberger, et al. v. Sullivan, a New York statewide class action which challenges the amount of weight afforded to the treating physician's opinion, among other things. Stieberger actually challenges SSA's acquiescence in circuit court law.
State of New York, et al. v. Sullivan, a New York statewide class action which challenges the Secretary's cardiovascular regulations.
Hyatt, et al. v. Sullivan, a North Carolina statewide class action which challenges the Secretary's standard for evaluating pain.
Johnson, et al. v. Sullivan, an Illinois statewide class action which challenges the Secretary's standard for evaluating nonsevere impairments.
QUESTIONS SUBMITTTED BY SENATOR MARK O. HATFIELD
RESOURCES FOR OUTREACH
Question. How much is requested in your FY 1992 budget for this outreach program and how much will be carried over from FY 1991?
Answer. The FY 1992 request includes $3 million for the SSI outreach project. The budget assumes the $6 million appropriated by the Congress will be obligated in FY 1991. However, as I have said previously, before we spend $6 million in FY 1991, we want to make sure that we are funding projects which are likely to succeed. Once I am satisfied we will get meaningful results, we will fund new cooperative agreements to target needy populations with high levels of nonparticipation in the Supplemental Security Income program and in areas of limited accessibility due to rural location or language barriers.
Question. How many grants and contracts have been awarded at this time?
Answer. SSA awarded 25 cooperative grants totalling nearly $3 million in the fall of 1990.
Question. As a result of this program, how many people have been identified as eligible for SSI benefits? Are all of these people now receiving benefits?
Answer. 23 of 25 cooperative agreements for SSI outreach demonstration projects became operational on October 1, 1990; one began on December 1 and the other on February 1 of this year. The actual outreach from most of these projects began in the second quarter of FY 1991. Although it is too early to have accurate counts of individuals identified as eligibles through these 25 cooperative grants, we have a tracking system in place from which to obtain such data.
Question. I understand that the Administration on Aging and the Health Care Financing Administration are also participating in this effort. How much are these agencies contributing to the cost of the outreach program?
Answer. Through a Memorandum of Understanding signed by the heads of SSA, the Administration on Aging (AoA) and the Health Care Financing Administration (HCFA) in late 1989, agencies' staff coordinated a number of projects on behalf of the elderly. As a result of collaborative effort, AoA awarded 7 grants totaling about $1 million in FY 1990 which focus on SSA's SSI outreach program.
Also, both AoA and HCFA were very supportive of SSA's representative payee outreach effort and helped SSA to identify organizations which would serve as representative payees for persons unable to manage their own funds. AoA and SSA are jointly funding a grant to improve the selection process for representative payees.
Finally, AoA, SSA and HCFA are jointly and individually engaged in a number of efforts to improve client education and access to agency programs and processes, including the development of a pamphlet for joint use containing simple descriptions of each agency's eligibility requirements. These activities will contribute to SSA's efforts to reach the many individuals who are eligible for benefits but have not yet applied for them.
QUESTION SUBMITTTED BY SENATOR HARRY REID
CHRONIC FATIGUE SYNDROME
Question. Nevadans seeking Social Security disability benefits for Chronic Fatigue Syndrome have experienced many difficulties obtaining them, which has resulted in a lot of constituent complaints to my State offices. The Subcommittee on Appropriations asked SSA for a report, by the end of the first quarter of this fiscal year, on disability matters related to chronic fatigue syndrome. Has this report been issued? Can you summarize this report for us?
Answer. The report on chronic fatigue syndrome (CFS) was forwarded to the Committee on March 15, 1991. The report summarizes the medical community's knowledge about this condition. While a number of research initiatives are underway to determine the underlying reasons and causes for the varied manifestations of the disorder, the etiology and pathology of the disorder have not yet been established. Also, there is no standard laboratory test currently available that is specific for the diagnosis of CFS.
Because symptoms alone are insufficient to establish disability · under the law, CFS cases are being carefully adjudicated on a caseby-case basis using the totality of the available evidence-
including a thorough evaluation of the claimant's clinical course and the impact of the disorder on his or her functional capabilities.
The report summarizes SSA's initiatives, including updates of our guidelines for adjudicating such cases and refresher training given to the disability adjudicators who process these cases, and cites our cooperative ventures with other health agencies and the special internal review initiative scheduled for completion this spring.
Senator HARKIN. Thank you. The subcommittee will stand in recess until 10 a.m., Tuesday, March 12, when we will meet in SD192 to hear from the Office of the Assistant Secretary for Health, Agency for Health Care Policy and Research, and Centers for Disease Control.
[Whereupon, at 4:04 p.m., Thursday, March 7, the subcommittee was recessed, to reconvene at 1 p.m., Tuesday, March 12.]
DEPARTMENTS OF LABOR, HEALTH AND HUMAN SERVICES, AND EDUCATION, AND RELATED AGENCIES APPROPRIATIONS FOR FISCAL YEAR 1992
TUESDAY, MARCH 12, 1991
SUBCOMMITTEE OF THE COMMITTEE ON APPROPRIATIONS,
The subcommittee met at 10:07 a.m., in room SD-192, Dirksen Senate Office Building, Hon. Tom Harkin (chairman) presiding. Present: Senators Harkin, Bumpers, Adams, Specter, and Ste
DEPARTMENT OF HEALTH AND HUMAN SERVICES
OFFICE OF THE ASSISTANT SECRETARY FOR HEALTH STATEMENT OF DR. JAMES O. MASON, ASSISTANT SECRETARY ACCOMPANIED BY:
J. MICHAEL MCGINNIS, M.D., DEPUTY ASSISTANT SECRETARY FOR HEALTH (DISEASE PREVENTION AND HEALTH PROMOTION) WILLIAM R. ARCHER, M.D., DEPUTY ASSISTANT SECRETARY FOR POPULATION AFFAIRS
WILLIAM A. ROBINSON, M.D., M.P.H., DIRECTOR, OFFICE OF MINORITY HEALTH
KENNETH J. BART, M.D., M.P.H., DEPUTY DIRECTOR, NATIONAL VACCINE PROGRAM
ANTHONY L. ITTEILAG, DEPUTY ASSISTANT SECRETARY FOR HEALTH MANAGEMENT OPERATIONS
W. HARELL LITTLE, DIRECTOR, DIVISION OF PUBLIC HEALTH SERVICE BUDGET
DENNIS P. WILLIAMS, DEPUTY ASSISTANT SECRETARY, BUDGET, DEPARTMENT OF HEALTH AND HUMAN SERVICES
OPENING REMARKS OF SENATOR HARKIN
Senator HARKIN. Good morning. The Appropriations Subcommittee on Labor, Health and Human Services, and Education will come to order. Í apologize to all of you for being a little late this morning.
This morning we will hear testimony first from Dr. James Mason, Assistant Secretary for Health concerning the 1992 budget request for the Public Health Service. He will be followed by Dr. J. Jarrett Clinton from the Agency for Health Care Policy and Re