percentage of the cost of the project with respect to which a grant is made hereunder shall be 90 per centum thereof for the first year following the first day of the first month for which a grant is made, 80 per centum thereof for the second year thereafter; 70 per centum for the third year thereafter; 60 per centum for the fourth year thereafter; and 50 per centum for each of the next six years thereafter. "SPECIALIZED FACILITIES "SEC. 243. (a) Grants from appropriations under section 261 may also be made for projects for construction, operation, staffing, and maintenance of specialized residential and other facilities, such as halfway houses, day-care centers, and hostels, for treatment of homeless alcoholics requiring care in such facilities. "(b) Such grants may be made only with respect to facilities which (1) are affiliated with a community mental health center providing at least those essential elements of comprehensive community mental health services which are prescribed by the Secretary, or (2) are not so affiliated but with respect to which satisfactory provision (as determined by the Secretary) has been made for appropriate utilization of existing community resources needed for an adequate program of prevention and treatment of alcoholism. "PROJECTS ELIGIBLE UNDER REGULAR PROGRAM "SEC. 244. Nothing in this part shall be construed to preclude approval under parts A and B of a grant for a project for a facility or initial staffing thereof for the treatment of alcoholics but in determining the amount of any such grant under such part there shall be excluded from the cost of the project an amount equal to the sum of (1) the amount of any other Federal grant which the applicant has obtained, or is assured of obtaining, with respect to the project which is to be financed in part by a grant or grants under this part, and (2) the amount of any non-Federal funds required to be expended as a condition of such other Federal grant. "PAYMENTS "SEC. 245. Payments of grants under this part may be made in advance or by way of reimbursement, and on such terms and conditions and in such installments, as the Secretary may determine. "SHORT TITLE "SEC. 246. This part may be cited as the 'Alcohol Rehabilitation Act of 1968." PART B-NARCOTIC ADDICTION SEC. 302. The Community Mental Health Centers Act (42 U.S.C. 2681, et seq.) is further amended by inserting after part C (added by section 101 of this Act) the following new part: "PART D-NARCOTIC ADDICT REHABILITATION "PROGRAM OF TREATMENT "SEC. 251 (a) Sums appropriated pursuant to section 261 shall be available for grants to any public or nonprofit private agencies and organizations to assist them in projects for constructing, operating, staffing, and maintaining treatment centers and facilities (including posthospitalization treatment centers and facilities) for narcoatic addicts within the States. "(b) The grant program authorized by subsection (a) shall, insofar as it deals with the kind of activities authorized by parts A and B of this title, be carried out consistently with the grant programs under such parts A and B except to the extent, in the judgment of the Secretary, special consideration make differences appropriate. "TRAINING AND EVALUATION "SEC. 252. The Secretary is authorized, during the period beginning July 1, 1968, and ending with the close of June 30, 1970, to make grants to any public or nonprofit private agencies and organizations to cover part or all of the cost of (A) developing specialized training programs or materials relating to the provision of public health services for the prevention and treatment of narcotic addiction, or developing in-service training or short-term or refresher courses with respect to the provision of such services; (B) training personnel to operate, supervise, and administer such services; and (C) conducting surveys and field trials to evaluate the adequacy of the programs for the prevention and treatment of narcotic addiction within the several States with a view to determining ways and means of improving, extending, and expanding such programs. "PROJECTS ELIGIBLE UNDER REGULAR PROGRAM "SEC. 253. Nothing in this part shall be construed to preclude approval under parts A and B of a grant for a project for a facility or initial staffing thereof for the treatment of narcotic addicts, but in determining the amount of any such grant under such part there shall be excluded from the cost of the project an amount equal to the sum of (1) the amount of any other Federal grant which the applicant has obtained, or is assured of obtaining, with respect to the project which is to be financed in part by a grant or grants under this part, and (2) the amount of any non-Federal funds required to be expended as a condition of such other Federal grant. PAYMENTS "SEC. 254. Payments under this part may be made in advance or by way of reimbursement, and on such terms and conditions and in such installments, as the Secretary may determine." PART C-GENERAL AUTHORIZATION OF APPROPRIATIONS FOR REHABILITATION OF ALCOHOLICS SEC. 303. The Community Mental Health Centers Act (42 U.S.C. 2681, et seq.) is further amended by inserting after part D (added by section 201 of this Act) the following new part: "PART E-GENERAL PROVISIONS "AUTHORIZATION OF APPROPRIATIONS FOR REHABILITATION OF ALCOHOLICS AND NARCOTIC ADDICTS "SEC. 261. (a) There are authorized to be appropriated for the fiscal year ending June 30, 1969, and the next fiscal year such sums as may be necessary for project grants for construction, operation, staffing, and maintenance of facilities for the prevention and treatment of alcoholism (including specialized residential adn other facilities) under part C or the prevention and treatment of narcotic addiction under part D. Sums so appropriated for any fiscal year shall remain available for obligation until the close of the next fiscal year. "(b) There are also authorized to be appropriated for the fiscal year ending June 30, 1971, and each of the next seven fiscal years such sums as may be necessary to continue to make grants with respect to any project under part C or D for operation, staffing, or maintenance of any facilities if such a grant was made thereunder with respect to such project from appropriations under this section for the fiscal year ending June 30, 1970, or any prior year, except that grants under such part may not be made with respect to any project after such grants have been made with respect to it from such appropriations for eight fiscal years. "PROGRAM EVALUATION "SEC. 262. Such portion of any appropriation under this title for any fiscal year ending after June 30, 1968, as the Secretary may determine, but not exceeding 1 per centum thereof, shall be available to the Secretary for evaluation (directly or by grants or contracts) of the programs authorized by this title." OPERATION AND MAINTENANCE GRANTS UNDER COMMUNITY MENTAL SEC. 304. Part B of the Community Mental Health Centers Act is amended by adding after section 224 (42 U.S.C. 2688d) the following new section: "FACILITIES RELATING TO REHABILITATION OF ALCOHOLICS OR NARCOTIC ADDICTS "SEC. 225. In the case of any community mental health center which includes (to such extent as may be determined in accordance with regulations) facilities for the prevention and treatment of alcoholism or narcotic addiction, the purposes for which the portion of the grant under this part which relates to such facilities may be made, the percentage of the cost to be met by such portion of the grant, and the duration of such portion of the grant shall, subject to limitations in such regulations, be determined as though the grant is being made for operation, staffing, and maintenance of facilities under part C, in the case of facilities for prevention and treatment of alcoholism, or part D, in the case of facilities for the prevention and treatment of narcotic addiction." USE OF ALLOTMENTS FOR COST OF ADMINISTRATION SEC. 305. Section 403 of the Mental Retardation Facilities and Community Mental Health Centers Construction Act of 1963 (42 U.S.C. 2693) is amended by adding at the end thereof the following new subsection: "(c) (1) At the request of any State, a portion of any allotment or allotments of such State under part A of title II shall be available to pay one-half (or such smaller share as the State may request) of the expenditures found necessary by the Secretary for the proper and efficient administration during such year of the State paln approved under such part; except that not more than 2 per centum of the total of the allotmens of such Sate for a year, or $50,000, whichever is less, shall be available for such purpose for such year. Payments of amounts due under this paragraph may be made in advance or by way of reimbursement, and in such installments, as the Secretary may determine. "(2) Any amount paid under paragraph (1) to any State for any fiscal year shall be paid on condition that there shall be expended from State sources for such year for administration of the State plan approved under such part A not less than the total amount expended for such purposes from such sources during the fiscal year ending June 30, 1968." DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE, Hon. HARLEY O. STAGGERS, Chairman, Committee on Interstate and Foreign Commerce, DEAR MR. CHAIRMAN: This letter is in response to your request of March 6, 1968, for a report on H.R. 15758, a bill "To amend the Public Health Service Act so as to extend and improve the provisions relating to regional medical programs, to extend the authorization of grants for health of migratory agricultural workers, to provide for specialized facilities for alcoholics and narcotic addicts, and for other purposes." This bill embodies the legislative proposal contained in a draft bill submitted by this Department to the Congress on March 4, 1968, to implement the recommendations on extension and improvement of regional medical programs contained in the President's March 4, 1968 Message on Health. The bill also includes the legislative proposal contained in that draft bill relating to temporary extension of the program of grants for health services for migratory agricultural workers. In addition, H.R. 15758 embodies the legislative proposal contained in the draft bill submitted by this Department to the Congress on February 8, 1968, to implement the recommendations on prevention and treatment of alcoholism and narcotic addiction contained in the President's February 7, 1968 Message on insuring the public safety and meeting the challenge of crime in our society. (This last mentioned proposal was also included in H.R. 15281, on which we reported to your Committee on February 26, 1968.) We urge early enactment of this proposed legislation. The Bureau of the Budget advises that enactment of this proposed legislation would be in accord with the program of the President. Sincerely, WILBUR J. COHEN, Acting Secretary. DEPARTMENT OF AGRICULTURE, Hon. HARLEY O. STAGGERS, Chairman, Committee on Interstate and Foreign Commerce, DEAR MR. CHAIRMAN: This is in reply to your letter of March 6, requesting our views on H.R. 15758, a bill "To amend the Public Health Service Act." This Department favors enactment of that portion of the bill which would provide grants for the health of migratory agricultural workers. We are not commenting on remaining sections of the bill which are more appropriately the interest of other departments. The bill would extend authorization to continue programs of the Public Health Service Act relating to the health of migratory agricultural workers for an additional two years, through June 30, 1970. The Act provides grants for medical diagnosis and treatment, immunization, and family health, nursing, and sanitation services. We believe that these programs are in the public interest, and we are particularly concerned that steps already taken to improve the much needed health services for migratory agricultural workers and their families should be included. The Bureau of the Budget advises that the enactment of this proposed legislation would be in accord with the President's program. Sincerely yours, Hon. HARLEY O. STAGGERS, ORVILLE L. FREEMAN, Secretary. THE GENERAL COUNSEL OF THE TREASURY, Chairman, Committee on Interstate and Foreign Commerce, DEAR MR. CHAIRMAN: Reference is made to your request for the views of this Department on H.R. 15758, "To amend the Public Health Service Act so as to extend and improve the provisions relating to regional medical programs, to extend the authorization of grants for health of migratory agricultural workers, to provide for specialized facilities for alcoholics and narcotic addicts, and for other purposes." Only Title III of the bill is of concern to the Treasury Department. Title III would amend the Community Mental Health Centers Act to authorize grants to public or nonprofit private agencies or organizations for: (1) the construction, operation, staffing and maintenance of facilities for the prevention and treatment of alcoholism and of specialized residential and other facilities for the treatment of homeless alcoholics requiring care in such facilities; and (2) the construction, operation, staffing and maintenance of treatment centers and facilities for narcotic addicts within the States, and for the development of specialized training programs or materials relating to the provision of public health services for the prevention and treatment of narcotic addiction, and for the evaluation of such programs. The President, in his message on the Challenge of Crime to our Society, urged enactment of legislation which would provide federal leadership and assistance to States and localities in developing non-jail atlernatives for the handling of alcoholics and asked the Secretary of Health, Education, and Welfare to increase the activities of his Department in the area of rehabilitation of drug addicts, and in alerting young people to the threat addiction poses to their lives. Title III of H.R. 15758 would carry out these recommendations of the President. The Department recommends enactment of Ttitle III of H.R. 15758. The Department has been advised by the Bureau of the Budget that there is no objection to the submission of this report to your Committee and that enactment of the proposed legislation would be in accord with the program of the President. Sincerely yours, FRED B. SMITH, General Counsel. Mr. KYROS. I understand our first witness this morning will be Dr. Philip R. Lee, Assistant Secretary for Health and Scientific Affairs in the Department of Health, Education, and Welfare. Dr. Lee. STATEMENT OF DR. PHILIP R. LEE, ASSISTANT SECRETARY FOR HEALTH AND SCIENTIFIC AFFAIRS, DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE; ACCOMPANIED BY RALPH K. HUITT, ASSISTANT SECRETARY FOR LEGISLATION; DR. RALPH Q. MARSTON, DIRECTOR, DIVISION OF REGIONAL MEDICAL PROGRAMS; DR. STANLEY F. YOLLES, DIRECTOR, NATIONAL INSTITUTE OF MENTAL HEALTH; AND HELEN JOHNSTON, CHIEF, MIGRANT HEALTH BRANCH, BUREAU OF HEALTH SERVICES Dr. LEE. Thank you, Mr. Chairman. Mr. ROGERS (presiding). I might say that the committee is pleased to have you with us, and particularly since your new duties have been stated by the Secretary to be coordinator for health, and "Mr. Health" for the Government. We are delighted to have you with us in this capacity today, and we are pleased to have your associates. We will be glad to hear your statement. Dr. LEE. Thank you, sir. Accompanying me are Miss Johnston, Dr. Marston, and Dr. Yolles. Mr. Ralph Huitt is with us this morning also. Mr. ROGERS. We are glad to see Mr. Huitt here. Dr. LEE. Mr. Chairman and members of the Subcommittee on Health and Welfare, it gives me great pleasure to appear before you today in support of the Health Services Act of 1968, which contains an extension and improvements to the Heart, Cancer, and Stroke Amendments of 1965, an extension of the Migrant Health Act of 1962, as amended in 1965, the transfer of authorities now in section 402 of the Narcotic Addict Rehabilitation Act of 1966 to the Community Mental Health Centers Act, and the establishment of a program to assist communities to improve treatment services to alcoholics, the latter two programs to be known as the Alcoholic and Narcotic Addict. Rehabilitation Amendments of 1968. These programs are all designed to carry forward our commitment to make the best health services available to all Americans. In his special message to Congress on health in 1965, President Johnson stated: Our first concern must be to assure that the advance of medical knowledge leaves none behind. We can-and must-strive now to assure the availability and accessibility of the best health care for all Americans, regardless of age or geography or economic status. Although much has been accomplished in the last 3 years, much remains to be done. We must remove the barriers of discrimination that have so long barred the alcoholic and the narcotic addict from receiving truly comprehensive care a discrimination based on diagnosis, which is just as intolerable as discrimination based on race. The migrant worker suffers from not only the disadvantages of language, poverty, and geography, but often the even more difficult |