MAINTENANCE ASSISTANCE

AFDC quality control.—Quality Control staff will continue to review Federal subsamples to validate States' samples and evaluate the effectiveness of the States' corrective action plans. They will provide technical assistance to States' staffs to eliminate procedures which are error producing.

Eligibility process.-Reviews will examine the total eligibility process in depth. This includes the initial contact and determinaton of eligibility, periodic redeterminations, and recipient-welfare office response to changes in circumstances of the recipient. The evaluation method will include factfinding surveys in State agencies. Methodologies successful in reducing error rates will be passed on to other States in the management aids series of publications. The reviews are also expected to support the onging simplification project by identifying areas where Federal regulations are either excessive or unnecessary.

Simplified plan format.-Field staff are providing technical assistance to States in the use of a simplified form for their State welfare plans. All States will use the same format and cover only federally-matched cash assistance programs in this one policy document.

Child support enforcement (title IV-D).—The Office of Child Support Enforcement has been established with a regional office of child support enforcement in each regional office to carry out HEW's responsibilities under the new program. Major efforts in 1977 will be oriented toward (1) providing technical assistance to States to meet their principal requirements as outlined in the regulations and (2) assessing States' compliance.

MEDICAL ASSISTANCE

Early and periodic screening, diagnosis, and treatment.-We will continue to assist the States in implementing the EPSDT program, based upon revised regulations and methods developed in fiscal year 1976, to assure effectiveness of program operations. Penalty regulations are under revision to clarify basic program requirements. To correct data and tracking problems, statistical reporting requirements are being revised, and a general systems design of a State-oriented EPSDT management information system will become operational in 1976.

Utilization review.-We are working with the States in putting into effect a system of controls to assure that only those services which are necessary are provided to those who require them, for only as long as they are required and in the setting most appropriate to their needs. We have identified through national onsite surveys, numerous problems in States' utilization control programs. Until supplanted by PSRO's, our staff will continue to program onsite reviews and provide technical assistance to States' staff to further the improvement noted to date.

Quality control.-The medicaid eligibility quality control program is modeled upon the AFDC quality control program whereby each State selects and reviews a statistical sampling of paid claims and, from this review, determines the level of ineligible recipients, the associated amount of erroneous payments, and their cause and corrective action.

SRS staff has developed training manuals, conducted training sessions for regional and State staff, and is conducting on-site reviews. This effort will be intensified.

Fraud and abuse.—A special branch has been established within the Medical Services administration. A staffing allocation of 11 was assigned to this function in 1975 and an additional 108 positions were approved in the 1976 appropriation. This staff's function is to improve State fraud and abuse surveillance through monitoring, technical assistance, technology transfer, and the development of detection techniques.

SOCIAL SERVICES

Title XX.-Technical and program assistance will be provided to States in the development of their services plans and service delivery mechanisms. Program monitoring and review will be carried out to insure that specific conformity requirements and requirements for Federal financial participation are being met. An annual report on results of ongoing evaluation and a special report on program effectiveness during calendar years 1975 and 1976 will be submitted to Congress.

WORK INCENTIVES

Staff of the WIN program will be working with States to make certain that all WIN registrants are actively engaged in job search activities. Additionally, they will implement changes in program management which will achieve overall reductions in program costs.

SUMMARY

In summary, Mr. Chairman, we are requesting for program administration in 1977, $63,095,000.

Mr. Chairman, this concludes my statement on the program administration appropriation. I will be happy to answer any questions you or members of the committee may have.

SUMMARY OF REQUEST

Mr. WORTMAN. Sir, the request of the Social and Rehabilitation Service for program administration amounts to $63,095,000, an increase of $2.7 million over 1976.

The number of positions that we are requesting for authority is 2,124, no change from 1976, and the money we are requesting from you would buy 1,965 full-time permanent man-years and 58 full-time equivalent or temporary positions.

That is our request, sir, and I should point out that in looking at 1976 we do have, based on appropriation from the Congress, two significant increases in staff: 108 positions for medicaid fraud and abuse and 170 positions for the Office of Child Support Enforcement.

SRS ADMINISTRATION

Mr. FLOOD. Mr. Wortman, I see you are the Acting Director. How long do you expect to be acting?

Mr. WORTMAN. Two more months.

Mr. FLOOD. Is someone being considered for the position?

Mr. WORTMAN. I have been advised there has been another name referred to the White House for this position.

Mr. FLOOD. You know this is one agency particularly where you see a lot of people in acting positions. Is there some special reason for that or what?

Mr. WORTMAN. There were a number of associates of Mr. Dwight who, upon his departure, decided to leave. Three people who were senior staff members of SRS upon his departure decided to move on, so we are in that period where a new Administrator will necessarily appoint his or her own team to those jobs.

Mr. FLOOD. Have you been on board long enough to develop a reorganization plan? You know, of course, every new agency head feels compelled to reorganize?

Mr. WORTMAN. Secretary Mathews' judgment of the matter in SRS was the last thing we need is a reorganization. I would share that view. Mr. FLOOD. This agency no longer administers the vocational rehabilitation program. Why don't you drop the "R" from that title? Mr. WORTMAN. That has been suggested internally in the Department by the Assistant Secretary who now operates that program. I have for the time being resisted that primarily because I think the term rehabilitation has a broader context than just vocational rehabilitation.

We are as committed to helping Americans in need as any of the other particular programs in HEW that may have a target group focus

or as they say, a categorical program. It may be that the name will be changed but I don't think I want to devote a lot of energy to that right now.

Mr. FLOOD. Do you have anything for the record in the nature of the latest reorganization in the agency?

Mr. WORTMAN. I certainly can provide you the organizational statement with functions and duties.

EMPLOYEE MORALE

Mr. FLOOD. No; that is not necessary.

Since you have been on board what is your opinion about employee morale? Is everyone pretty well satisfied?

Mr. WORTMAN. That would not be a true statement. We in the Social and Rehabilitation Service are going through 100 percent reclassification of our positions.

Mr. FLOOD. That is the reason we ask that. We understand that your organization is going through a major personnel reclassification both in Washington and out in the field, and there appears to be threats of a reduction in force affecting many of your employees.

That is your business and we don't want to interfere with it. However, we are concerned about the operation of the program. How serious is the situation?

Mr. WORTMAN. May I clarify one point?

Mr. FLOOD. Yes.

Mr. WORTMAN. We will not have a reduction in force. The nature of the responsibility of SRS and what the Congress has provided will not result in a reduction in force. This is probably how you have heard it. We are talking about some downgrading actions and reduction-in-force procedures are used for bumping rights based on seniority, so you will hear the term used, but it has more to do with a procedural definition than with any actual laying off of employees.

Now let me answer your question more directly. It is undoubtedly true the productivity of this organization has suffered, rather significantly, from having a requirement of going through the reclassification. That is not to say that the job was not necessary. That I can not make a judgment on. But productivity has been affected.

My own view is that we are coming out of that. We have a good chunk of this work behind us, still much to do, but I think we are coming out of that.

In the downgrades, for instance, in Chicago letters did go out to 11 employees for downgrades. In some other regional offices it might even be more than that, but when these things settle down, there are fewer employees who actually get downgraded, in the last analysis, than the initial notification would indicate.

What it does do is create a great degree of uncertainty in an organization, and that is not something with which human beings like to exist.

VACANCIES

Mr. FLOOD. We continue to be concerned about the large number of vacant jobs. Will you insert for the record the current number of vacancies for each one of the organizational units?

Mr. WORTMAN. I will do that.

[The information follows:]

a/ Includes Regional Commissioners, Deputies and Support Staff (Planning, Evaluation Training, Manpower Development, Information Systems and Research and Statistics)

Mr. WORTMAN. We do have a large number of vacancies, and I have undertaken just this last week a number of special recruitment efforts to try to close the gap. We are short on secretaries. We are short at junior professional levels, and some of this has been because of the reclassification, but as we get over that hump I am hopeful that we can more quickly get up to our staff requirements.

STAFFING

Mr. FLOOD. By the way, how many consultants are presently employed by the agency?

Miss PERKINS. We have about three on board right now.

Mr. FLOOD. How does that compare with your level a year ago?
Miss PERKINS. Two years ago it was over 100.

Mr. FLOOD. Wasn't the authority to hire suspended in your agency? Mr. WORTMAN. All hiring and appointment authority was suspended for a while.

Miss PERKINS. For grade 13 and above it was suspended. For the consultants there was a time we did not have the appointive authority. Mr. FLOOD. What about now?

Mr. WORTMAN. Currently, GS-13, 14, and 15 authority rests in the Deputy Assistant Secretary of Personnel for Training. It does not rest in SRS at this time.

Mr. FLOOD. You are not requesting any new jobs for 1977. That is the first time in several years we haven't had a request for new jobs in your agency. Is that because you are a new man in the job or what? Mr. WORTMAN. No. I think these decisions were reached before I became responsible. Of course, we did get some authority from Congress on a couple of the initiatives that we have underway, but basically I think the general view is that until we have settled down, in terms of this reorganization and reclassification, that it is difficult to make judgments about any additional needs.

MEDICAID POSITIONS

Mr. FLOOD. Over the last several years Congress has approved a lot of new jobs for the medicaid program. That was done, of course, largely because of fraud and abuse and other management problems. To what extent do you think these new additional jobs have served to reduce any fraud or abuse in the medicaid program?

Mr. WORTMAN. I see Dr. Weikel just joined us, and he can provide you with the specifics.

But let me say that in my own perspective, a number of jobs that have been provided in the past by the Congress have been used to do important work in information system development.

I, with some background in this, feel the work that has been done on the Medicaid management system by SRS, both in Dr. Weikel's organization and in that of our Associate Administrator for Information Systems, Mr. Weinberg's organization has been outstanding. States that have adopted that system are in much better position to prevent fraud and abuse from occurring. This was in the statement that we gave to the committee a few weeks ago on Medicaid. Just to focus on fraud and abuse in this huge program, without worrying