(The following information was received for the record :)

APPROPRIATIONS REQUESTED UNDER SECS. 314(e), 317 AND PUBLIC LAW 91-695-1971, 1972, and 1973

SEC. 314(d)-HEALTH SERVICES DELIVERY ALLOCATIONS OF GRANTS FOR COMPREHENSIVE PUBLIC HEALTH

SERVICES 1

1 Allocations are awarded to States based on population and per capita income with a minimum program requirement. 2 Authorized by Public Law 91-296.

Mr. ROGERS. Thank you so much. We appreciate your presence here today.

I would like to know what is happening in State plans, too, if you would let us know, get someone to look at them.

Mr. DUNCAN. We have a program which we are working on to get at that kind of information.

(The following information was received for the record:)

THE STATE PLAN FOR PUBLIC HEALTH AND MENTAL HEALTH SERVICES UNDER SECTION 314(d) OF THE PUBLIC HEALTH SERVICE ACT

The Comprehensive Health Planning and Public Health Services Act of 1966, amending the Public Health Service Act, was enacted with the objective of promoting and assuring the highest level of health attainable for every American. The 314 Sections of this Act established the authority for providing support for comprehensive health planning and comprehensive health services, and is known as the "Partnership for Health" program. Under Section 314 (d), formula grants are awarded to State health and mental health authorities for public health services, including the training of health personnel. Such funds are not restricted to use in meeting specific disease problems; they are also meant to offer the States an opportunity to initiate new and different methods of providing health protection where innovation is needed, particularly where health services cannot be supported with existing State or local funds. They may also be used, of course, to support previously-established health services.

In order for the Secretary to be fully aware of the uses to which this grant money is put, and to administer the requirements of the Act and the regulations, the mechanism of a State plan is mandatory.

Under the requirements of the Act, an annual State plan must be submitted to the Secretary. The plan contains detailed and specific information about policies, procedures, and assurances pertaining to the services supported by the State health or mental health agency's annual allotment of Federal funds under Section 314(d) plus the necessary amount of State or local, public or private matching funds. The State agency has the option of including as much of its program as it wishes beyond those services which are supported by the Federal funds made available under Section 314 (d) and the required matching funds. The State agency also has the option of supporting regular, ongoing programs or new, innovative or developmental activities on either a time-limited, project basis or on a continuing basis under the State plan.

Prior to the passage of Public Law 89-749, the States were required to report the use of Federal funds on a program-by-program basis in each of nine categorical formula-grant areas. This requirement was changed with the introduction of 314 (d) when formula grants were consolidated into a block grant program. Thus, as of Fiscal Year 1968, the funds reported as budgeted or expended by State health programs have been a single figure representing 314(d) funds and/or all other monies in any combination.

A simplified approach to the submission of a State plan is now used. Starting with Fiscal Year 1972, the State plan approach provides for the "incorporation by reference" of the documents required by the law and regulations. Simply stated, this means that documents incorporated by reference become a part of the State plan as though fully set forth therein, but are retained in the State agency offices after being reviewed there by Regional Office staff.

Each State plan is reviewed by the appropriate Regional Office of the Department of Health, Education, and Welfare, and approval is granted or suggestions are made for modifications. Upon approval, the State agencies are able to meet the requirements of the Act and regulations by submitting a State plan certification, indicating that all required documents have been reviewed and accepted as a part of the State plan. A State plan budget in summary form is also submitted annually, containing only that information which is essential for award of the allotment of Federal funds to the State agency.

With the adoption of the simplified State plan system, both the Health Services and Mental Health Administration and the State health and mental health agencies recognized that it would be necessary for the State agencies to submit, upon request, certain information to assist HSMHA with program planning, technical assistance, and budget support. Some of this information will be submitted by the State health and mental health agencies in a State Operational and Planning Information Document currently being developed by the Health Services and Mental Health Administration. As a part of this document, it is planned to have the State agencies submit (a) a list of programs, projects or activities to be supported under the Section 314 (d) State plan; (b) the total amount budgeted for each; (c) a brief description of new, developmental or innovative services; and (d) a description of the methods by which services under the plan will be evaluated to determine whether specific objectives have been achieved. Annual progress reports will be an integral part of this document. It is emphasized that the information provided in the accompanying table relative to State plan budgets in Fiscal Years 1968 through 1972, deals only with those programs supported under this plan, i.e., 314 (d) funds and the required matching funds. This information does not show total State health or mental

health department operations. Consequently, fluctuation of amounts reported under this State plan in any given program or classification should not be assumed to reflect increases or decreases in the State agency's total support of any given program or program area.

FEDERAL, STATE, AND LOCAL, PUBLIC AND PRIVATE FUNDS BUDGETED IN STATE PLANS FOR PUBLIC HEALTH SERVICES BY HEALTH PROGRAM AREAS 1

FISCAL YEARS 1968, 1969, 1970, AND 1971-SEC. 314(d), PUBLIC HEALTH SERVICE ACT

1 This table includes the amounts initially budgeted in the State plans for public health services under sec. 314(d) of the Public Health Service Act submitted by the State health and mental health authorities and approved by the regional health directors. These figures do not reflect subsequent budget revisions nor the amounts finally expended for the designated health programs. They also do not reflect the amounts budgeted for the total State health and mental health agency's operations.

2 Fiscal year 1968 amounts are revised to include information available in the community health service from State health departments of 54 State and Territories and from the State mental health authorities of 53 States and Territories. 3 Fiscal year 1969 figures include information available in the community health service from State health departments of 56 States and Territories and from the State mental health authorities in 55 States and Territories.

4 Fiscal year 1970 figures include information available in the community health service from State health departments of 55 States and Territories and from 56 State mental health authorities.

$ Fiscal year 1971 figures include information available in the community health service from State health and mental health authorities in 56 States and Territories.

From the information available, these program classifications could not be broken down into their program components. 7 Included in the amount shown for communicable disease.

8 Included in the amount shown for environmental health.

Includes an unidentified amount of support for sanitary engineering programs.

Mr. ROGERS. Thank you.

Dr. ZAPP. Thank you, Mr. Chairman.

Mr. ROGERS. Dr. Hume and Dr. Webster.

We welcome you to the committee. We appreciate your presence here today.

STATEMENTS OF DR. BRUCE P. WEBSTER, PRESIDENT, AMERICAN SOCIAL HEALTH ASSOCIATION, AND DR. JOHN C. HUME, CHAIRMAN, EXECUTIVE COMMITTEE

Dr. WEBSTER. I am Dr. Bruce Webster from New York. I am chairman, National Commission on Venereal Disease, professor of clinical medicine, Cornell University Medical College, and president, American Social Health Association.

I have a statement here which we have prepared which I would like to submit for the record (see p. 50).

In addition, I have the report of the National Commission on Venereal Disease appointed by the Assistant Secretary of HEW (see p. 107, this hearing), and "Today's VD Control Problem," published recently by the American Social Health Asociation (see p. 143, this hearing).

Mr. ROGERS. We will make these part of the record, Dr. Webster.

Dr. WEBSTER. As has been pointed out, gonorrhea is epidemic. The important factor is that 80 percent of the cases of venereal disease are being treated by practicing physicians. They are only reporting to the State health departments 10 or 12 percent of those. The National Commission felt it was very important that we bring into this picture the various elements of private medicine.

This Commission was appointed a year ago by the Assistant Secretary. It is composed of the American Medical Association, American Osteopathic Association, National Medical Association, and various public health groups concerned with the treatment of venereal disease. We have worked closely with NIH, CDC, NIMH and brought in many consultants. The report was submitted to Dr. DuVal recently. One of the important recommendations in this Commission's report had to do with research.

There is great scarcity of research in the venereal diseases. If a fraction of the work that had gone into polio had gone into venereal diseases, we would probably not be in the position we are in today. So we have urged the need for greater extramural research, that is research. in the medical schools, and the schools of public health. The important problem at the moment is the gonococcus. We need a better diagnostic test. We need to know a great deal more about the organism. Vaccine has recently been developed for the meningococcus, which is closely related. It would seem possible that such a vaccine is possible for the gonococcus.

One of these new approaches has to do with prophylaxis. There is research going on at the moment at the University of Pittsburgh School of Public Health in prophylaxis, with new approaches. They have great trouble funding this. There is need for research in the behavioral sciences to know more about the high risk groups. Why are they in this position? How do we approach them?

We feel also there is need for research into present control methods. Why have they not succeeded in curbing this disease? The National