tion where we show a decrease of $217 million. That is made up of a $112 million reduction in Hill-Burton grants, leaving a balance of $85 million for ambulatory care and extended care support. It is exactly the same program we proposed to Congress last year and Congress refused to accept it. We thought we would give it another try. The legislation would expire on the District of Columbia Medical Facilities Act and that would account for elimination of $57 million from the budget. There was last year a $30 million one-time capitalization fund for the new direct program under Hill-Burton. That was a onetime item and would be dropped from the budget. There was a decrease of $18 million in interest subsidy cost. Those items account for $217 million. The loan guarantee fund item shown for 1972 is a supplemental request to provide capital to cover potential defaults of guaranteed loans and is also a one-time non-recurring cost.

I might point out the loan volume anticipated by the budget under Hill-Burton would be over $600 million in 1973. The 1972 budget estimates a loan level of $170 million.

ALLOCATION OF HILL-BURTON FUNDS

Mr. FLOOD. What is the position of the several States with reference to the allocation of Hill-Burton funds by project? There are funds appropriated by the Federal Government. Just what is the State's role?

Mr. CARDWELL. Before Hill-Burton funds may be distributed to the State, each State, including the District of Columbia in this case, has to have a State plan which would determine the priority order for the projects in that State that would be funded with the grant.

Mr. FLOOD. The priorities are determined by the several States. Mr. CARDWELL. That is right. The formula prescribed in the act would determine the amount available to each jurisdiction but the jurisdiction will then determine how it is distributed.

Mr. FLOOD. You mean States by "jurisdiction"?

Mr. CARDWELL. States and the District of Columbia and the territories.

Mr. CARDWELL. Moving over to chart 5, health services delivery, again we are proposing a separate consolidated appropriation.

COMPREHENSIVE HEALTH SERVICES

The formula grants on the partnership for health program are shown at about the same level, $90 million. There is an increase of $13 million in project grants shown in the budget from $104 to $117 million, but here again this is an OEO resource transfer, and the activity for the Government as a whole for those two agencies remains level.

MATERNAL AND CHILD HEALTH AND FAMILY PLANNING

There is an increase in maternal and child health activity of $13 million and one of the most significant increases in the health budget, $49 million for family planning, bringing the total money available to the Health Service and Mental Health Administration to $139 million. This is an item when contrasted with 1971 shows an increase of $100 million. It was $39 million just 2 years ago.

NATIONAL HEALTH SERVICE CORPS

The National Health Service Corps' budget shows a dollar decrease, but this is a technicality as there is really not a program decrease. Mr. FLOOD. What is the National Health Service Corps?

Mr. CARDWELL. This is a program that was authorized a year ago by Congress to utilize the commissioned Corps of the Public Health Service and other personnel to assist local communities in the provision of direct medical services in medically underserved areas generally, the urban and rural poverty areas. The program is just now getting underway this year. That legislation did authorize the collection of fees for services from those who could afford to pay, but the fees under law would go to the miscellaneous receipts of the Treasury, and the budget is proposing some language that would permit any such collections to be credited to this account.

Mr. FLOOD. Is there a floor to determine who must pay, a dollar figure, do you recall?

Mr. CARDWELL. The Secretary, I think under legislation, as I recall, is authorized and required in fact to issue regulations setting forth the rules under which fees might be collected and at what rate.

Mr. FLOOD. Does he set an income figure?

Mr. CARDWELL. He hasn't issued these regulations yet. In fact, I have been put in charge of a group in HEW to recommend to him criteria. for determining a definition of poverty.

Mr. FLOOD. Would the criteria include an income figure?

Mr. CARDWELL. Yes, sir; I think it would.

Mr. FLOOD. When do you think you might give birth to that?

Mr. CARDWELL. It would have to be done by the end of this month. We will be pretty well along by that time.

PUBLIC HEALTH SERVICE HOSPITALS

Before we leave the category of "Health Services Delivery," I skipped over what may well have been one of the most significant

items, and I did it somewhat deliberately because I wanted to give it attention all its own.

The line shows PHS beneficiaries-that is the Public Health Service hospitals and probably the most controversial budget item our Department will have to deal with this year. You recall that last year the budget proposed that all eight of the hospitals and all 30 of the clinics be converted from Federal activities to local activities, depending on

the

Mr. FLOOD. By local, you mean municipal as distinguished from State?

Mr. CARDWELL. A local community could be either city government or private nonprofit, but the conversion had to involve continued service to the community in which the hospital is now.

Mr. FLOOD. Was there a calendar date?

Mr. CARDWELL. At that time, we proposed this would all be accomplished in fiscal year 1972. Congress interceded and said we shouldn't do it by that time. The budget last year decreased the appropriation to fund that activity, but part of that appropriation was restored by Congress. They were short by $5.6 million, and this year's budget does two things that last year's didn't do. It requests a supplemental for 1972 to restore the $5.6 million, so that all the money needed to operate the hospitals will be there. The 1973 budget does the same thing. In other words, it says that in the event we cannot meet the objective of conversion, the budget authority will still be available to finance the projects as Federal projects. This is a significant difference in the way we treated the same item last year. We still have the same objective, but we are funding it differently.

VENERAL DISEASE CONTROL

Under the category "Preventive Health Services," there is a $5 million increase in disease control really covering special VD activities of the Communicable Disease Center in Atlanta, and an increase in their program to develop standards and to maintain surveillance over laboratories that provide technical assistance to practicing physicians.

LEAD-BASED PAINT SCREENING

There is one item Mr. Miller points out we might mention, and the Secretary is going to mention it tomorrow, I am sure. Under "Preventive Health Services," under the heading "Community Environmental Management," there is a level there for 1973 of $29 million. Of that, $9.5 million is for a special program to screen children, essentially in ghetto areas, to determine whether they have been adversely affected by lead-based paints. The program plans to screen 1.5 million children by the end of 1973.

Mr. MILLER. This is a $2 million increase over the 1972 program. Mr. CARDWELL. Going to the National Institutes of Health, this program really devised

Mr. FLOOD. You don't have to be a resident of a ghetto to be a beneficiary do you?

Mr. CARDWELL. No, but that is where the screening will be concentrated. For all practical purposes they are the children who will be

reached. That is where the most dilapidated and oldest buildings are, buildings in which the heaviest concentration of lead would be expected to be found in the paint, and also it is the area where the paint is most likely to be peeling and flaking and consequently where the children are more apt to come in contact with lead-based paint. Mr. MICHEL. What is the number of children?

Mr. CARDWELL. A million and a half by the end of 1973. The estimate is that about 22 million children are at risk around the country. This year's request would get to most of the children in risk.