thorized, and plans are currently underway to distribute this staff appropriately. MEDICAID RURAL HEALTH INITIATIVES Mr. CONTE. Where are the nine rural health care demonstration models mentioned on page 22 of the justification? Dr. WEIKEL. The nine projects are located as follows: Treasure Valley, Idaho; Yakima Valley, Wash.; Gateway, Ky.; West Virginia; Somerset, Maine; Hanover, N.H.; Glendive, Mont.; Drayton, N. Dak. ; and Cuba, N. Mex. PSRO'S AND MEDICAID Mr. CONTE. How large a role will the Professional Standards Review Organizations play in the medicaid quality control program? Dr. WEIKEL. We assume you are referring to the utilization control program rather than the quality control program. In accordance with Public Law 92-603 PSRO's have binding review authority over services provided in medicaid programs. For this reason PSRO's will play a very large role in medicaid utilization control program. All PSRO's will develop norms, standards, and criteria which will govern in determining what care may be paid for with medicaid funds. U.C. SURVEYS Mr. CONTE. What was learned from the two national on-site validation surveys completed under the Utilization Control program? Dr. WEIKEL. As a result of the two national on-site validation surveys which we conducted in fiscal year 1974 and fiscal year 1975, we were able to identify the areas where States were having problems in meeting the statutory and regulatory requirements of section 1903 (g) of the Social Security Act. We gained considerable knowledge of the State's processes of medicaid utilization control and gained insight on ways and means of implementing utilization control. Following each survey the regional office worked with all States that were found to have deficiencies in their utilization control programs in developing plans of correction for their deficiencies. As a result we were able to provide followup to assist States in improving their utilization control programs. It is important to note that of all the deficiencies identified during the surveys, it has been reported that all have been resolved. TITLE XX Mr. CONTE. How many people are involved in the ongoing evaluation aspects of the title XX program? Mr. WORTMAN. In SRS/PSA there are approximately five professional people involved in the ongoing evaluation of title XX, in the usual sense of the term "evaluation." An additional four PSA professionals are involved in monitoring of title XX. The exact number of persons involved in evaluation of title XX outside SRS/PSA-in the central office, regional offices, and States-is difficult to estimate. In full-time equivalents there are: 3 SRS staff in evaluation, 2 regional office staff in evaluation, 13 regional office staff in monitoring. Mr. CONTE. I have received several complaints about the Federal interagency day care requirements. It is alleged that they are too concerned about numbers and not enough about quality. Would you comment on this conflict? Mr. WORTMAN. There has been a tendency to think of the Federal interagency day care requirements (FIDCR) as pertaining only to adult-child ratios. In fact these requirements cover many aspects of program which effect quality of the day care service. In addition to staff requirements and group size the FIDCR speak to the following areas: Safety and sanitation; location of facilities; educational services-recommended but not required under title XX-social services, health, and nutrition; training of staff; parent involvement; and methods of administration. However, due to the fact that the adultchild ratios are considered to be the most costly requirement to meet and also the most easily measured in terms of compliance they have become the major issue of concern to Congress, to States, and to providers. CHILD WELFARE SERVICES Mr. CONTE. Do any of the child welfare services activities overlap those of the Office of Child Development? Mr. WORTMAN. SRS/PSA has responsibility for administering the grant-in-aid programs for social services to families and children under titles XX, IV-B and, in the island territories, title IV-A. OCD has responsibility for serving as an advocate on behalf of children through a variety of activities. Under the Secretary's reorganization order of July 7, 1969, setting up the two agencies, there are some grey areas in relation to the division of responsibilities of the two offices at both the central and regional levels. This has led to some overlap in research, evaluation, training and technical assistance efforts which has been disconcerting to the State agencies who are the recipients of these efforts. We have and are attempting to minimize this overlap through joint SRS/PSA-OCD central office and regional office agreements related to specific child welfare activities such as foster care and adoption objectives and activities related to child abuse and neglect. SRS/PSA also participates on committees chaired by OCD such as the HEW Committee on Children, Advisory Board to the National Center on Child Abuse and Neglect, and the Intradepartmental Committee on Child Abuse and Neglect. Also each agency reviews and comments on the other's proposed and ongoing projects. SRS/PSA is seeking ways to coordinate efforts at the planning level so that maximum use is made of existing resources which should strengthen Federal developmental projects aimed at improving State and local social services programs to children and their families and avoid overlap and duplication of effort. Mr. CONTE. The justification states that you have accumulated an impressive body of knowledge in the child welfare area. Is any effort made to disseminate this information? Mr. WORTMAN. SRS/PSA has a dissemination plan for sharing with the States important and relevant child welfare research findings, information on exemplary programs, and technical assistance materials of all kinds. For example, materials to State social service agencies and to interested persons either distributed or currently in process include Child Neglect, an Annotated Bibliography (1,500 copies distributed to date; second printing in process); Profile of Neglect, a Survey of the State of Knowledge of Child Neglect (6,400 copies distributed to date; third printing in process); Report of the Bowen Center Demonstration Project in Child Protective Services; What Is Harmful to Children, a Survey of Experts and a Literature Review; Child Abuse and Neglect, Report of a Survey of Public Departments of Social Services; A Guide for Public Social Service Agencies on the Administration and Management of Services to Abused and Neglected Children and Their Families; Runaway Youth, How Are They To Be Served? Training Materials Developed on Protective Services to Abused and Neglected Children and Their Families; Training and Recource Manual for Foster Care Staff and Foster Parents; Training Materials Developed on Services to Runaway Youth; and Training Materials for Social Service Workers Concerned With Support of Early and Periodic Screening, Diagnosis, and Treatment. Mr. FLOOD. Gentlemen, thank you very much. [The justifications which follow have been revised at the request of the committee:] JUSTIFICATION OF THE BUDGET ESTIMATES Appropriation Estimate PUBLIC ASSISTANCE For carrying out, except as otherwise provided, title I, IV, VI,] X, XI, XIV, XVI, XIX, and XX of the Social Security Act, as amended, and the Act of July 5, 1960 (24 U.S.C., ch. 9) [$15,009,400,000 of which $55,000,000 $18,022,200,000, of which $46,000,000 shall be for child welfare services under part B of title IV and not to exceed $60,000,000 shall be for State and local training under titles I, IV, X, XI, XIV, XVI, and XX.1 For making, after [March 31] June 302 of the current fiscal year, payments to States under titles I, IV, [VI], X, XIV, XVI, XIX and XX, respectively, of the Social Security Act, as amended, for the last three months of the current fiscal year (except with respect to activities included in the appropriation for "Work incentives"); and for making after [April 30] July 31 of the current fiscal year, payments for the [period July 1, 1976 through September 30, 1976] first quarter of the succeeding fiscal year 2; such sums as may be necessary, the obligations incurred and the expenditures made thereunder for payments under each of such titles to be charged to the subsequent appropriations therefor for the current or succeeding fiscal year [or the period of July 1, 1976, through September 30, 1976, or fiscal year 1977]. In the administration of titles I, IV (other than part C thereof), [VI]. X. XIV, XVI, XIX, and XX, respectively, of the Social Security Act, payments to a State under any such titles for any quarter in the period beginning [April 1 of the 1 A cap is proposed to the Federal share of States' expenditures for the State and local training activity as opposed to the open-ended nature of the authorizing legislation. 2 Change resulting from a change in the fiscal year. 70-159 O-76-5 prior year] July 1, 19763 and ending [June 30】 September 30, 1977 * [of the current year] may be made with respect to a State plan approved under such title prior to or during such period, but no such payment shall be made with respect to any plan for any quarter prior to the quarter in which a subsequently approved plan was submitted (which was subsequently approved]. Such amounts as may be necessary from this appropriation shall be available for grants to States for any period in [the prior] fiscal year 1976 and the period July 1, 1976 through September 30, 1976' subsequent to March 31, [or that year] 1976. Such amounts as may be necessary This provision reconfirms authority from this appropriation shall be avail-provided in the prior year appropriation able for grants to States for any period in fiscal year 1976 and the period July 1, 1976 through September 30, 1976, subsequent to March 31, 1976. to permit the use of subsequent year funds for grants for the fourth quarter of the current year. * Change resulting from a change in the fiscal year. Editorial change. |