(c) Section 725 (a) of such Act (42 U.S.C. 293e (a)) is amended by striking out "sixteen" and inserting in lieu thereof "seventeen" and by striking out "twelve" and inserting in lieu thereof "thirteen". (d) Section 314 (f) of such Act is amended by (1) inserting "for" before "the expenses of travel" in paragraph (5); (2) striking out "Service" and inserting in lieu thereof "Department" in paragraphs (6) and (8). (e) The amendment made by subsection (a) shall be effective as of November 3, 1966. ACCREDITATION OF NURSES EDUCATION PROGRAM SEC. 12. Section 843 (f) of the Public Health Service Act (42 U.S.C. 298b (f)) is amended by striking out "or a program accredited for the program of this Act by the Commissioner of Education,". MEANING OF SECRETARY SEC. 13. As used in the amendments made by this Act, the term "Secretary" means the Secretary of Health, Education, and Welfare. EXECUTIVE OFFICE OF THE PRESIDENT, Hon. HARLEY O. STAGGERS, BUREAU OF THE BUDGET, Washington, D.C., May 5, 1967. Chairman, Committee on Interstate and Foreign Commerce, House of Representatives, Rayburn House Office Building, Washington, D.C. DEAR MR. CHAIRMAN: This is in response to your request for the views of the Bureau of the Budget on H.R. 6418, a bill cited as the "Partnership for Health Amendments of 1967." The bill authorizes the extension and expansion of the landmark Partnership for Health legislation enacted by the 89th Congress. As the President said in his Health Message, this legislation "is designed to strengthen State and local programs and to encourage broad-gauge planning in health. It gives the States new flexibility to use Federal funds by freeing them from tightly compartmentalized grant programs." It establishes for a number of health programs a single set of requirements, a single authorization, and a single appropriation. H.R. 6418 increases the dollar authorizations for 1968, and extends the program for four additional years with the provisions that such sums as may be necessary would be authorized for appropriation after 1968. The bill also authorizes the Secretary of Health, Education, and Welfare to embark upon a broadened and coordinated program of research, experiments, and demonstrations relating to the development, coordination, and delivery of improved health services. This provision is in accord with the President's directive that the Secretary of Health, Education, and Welfare establish a National Center for Health Services Research and Development. Its aim is the application of the research techniques, which have brought us new knowledge in health and medicine, to the effort of bringing low cost, quality health care to our citizens. A third major provision of the proposed legislation relates to the licensing of clinical laboratories. Such licenses should be issued upon the applicant's agreeing to operate the laboratory in conformance with standards established by the Secretary. The aim of this provision is to improve the performance of clinical laboratories engaged in interstate commerce. Additionally, the bill authorizes the Secretary to enter into agreements with health schools, hospitals, and other health care training facilities to provide for the interchange or cooperative use of personnel, facilities, services, and information, on a reciprocal or reimbursable basis. This provision is designed to increase cooperative activities between the Public Health Service's hospitals and community health facilities and will result in better utilization of scarce professional personnel and expensive facilities. The Bureau of the Budget favors action on H.R. 6418, which is in accord with the President's program. Sincerely yours, DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE, Hon. HARLEY O. STAGGERS, DEAR MR. CHAIRMAN: This letter is in response to your request of March 13, 1967, for a report on H.R. 6418, a bill to amend the Public Health Service Act to extend and expand the authorizations for grants for comprehensive health planning and services, to broaden and improve the authorization for research and demonstrations relating to the delivery of health services, to improve the performance of clinical laboratories, and to authorize cooperative activities between the Public Health Service hospitals and community facilities, and for other purposes. This bill, to be cited as the "Partnership for Health Amendments of 1967," would 1. Extend through fiscal year 1972, with some modifications, the authorizations for comprehensive health planning and public health services grants and for grants to schools of public health which were enacted last year in P.L. 89-749. 2. Broaden, improve, and consolidate the authorizations now contained in sections 314(e) (3) and 624 of the Public Health Service Act for grant and contract support of research, experiments, and demonstrations relating to the development, utilization, quality, organization, and financing of health services and facilities. 3. Authorize the Secretary to cooperate with States and localities in emergency health planning and in providing temporary assistance on a reimbursable basis to meet health emergencies which warrant Federal assistance. 4. Provide for the improvement of clinical laboratory services through the establishment of a Federal licensing program for such laboratories which engage in interstate commerce. 5. Authorize the Secretary to accept volunteer and uncompensated service in the operation of any health care facility or in the provision of health care. 6. Authorize cooperative agreements or arrangements on a reciprocal or reimbursable basis between hospitals and facilities of the Public Health Service and community hospitals and other health care and educational facilities. 7. Provide that not exceeding one percent of the funds appropriated for grants under Sections 314 (d), 314(e), 304 and 309 (c) of the Public Health Service Act shall be available to the Secretary for evaluation of the respective programs authorized by such subsections. 8. Extend without time limitation the current authorization in Section 301 (h) of the Public Health Service Act with respect to research contracts. 9. Delete the current eligibility of employees and noncommissioned officers in the field service of the Public Health Service for medical, surgical, dental, and hospital care at Public Health Service facilities when injured or taken sick in line of duty, and provide that the Secretary is authorized to provide such care on a reimbursable basis for Federal employees and their dependents at remote medical facilities of the Public Health Service where other medical care and treatment are not available. 10. Delete the provision in Section 843 (f) of the Public Health Service Act which currently authorizes the Commissioner of Education to accredit schools of nursing for purposes of participation in programs under the Nurse Training Act. H.R. 6418 embodies the provisions of a draft bill transmitted by this Department to the Congress to implement a number of recommendations by the President relating to public health. We strongly recommend early enactment of the bill. We are advised by the Bureau of the Budget that enactment of this proposed legislation would be in accord with the program of the President. Sincerely, WILBUR J. COHEN, Under Secretary. Hon. HARLEY O. STAGGERS, DEPARTMENT OF LABOR, Chairman, Committee on Interstate and Foreign Commerce, House of Representatives, Washington, D.C. DEAR MR. CHAIRMAN: This is in reply to your request for our comments on H.R. 6418, the "Partnership for Health Amendments of 1967.” We support the proposed bill which would strengthen and extend State and local health programs, and thus carry out the President's recommendations for strengthening our Partnership for Health. The Bureau of the Budget advises that there is no objection to the submission of this report from the standpoint of the Administration's program. Sincerely, W. WILLARD WIRTZ, Secretary of Labor. B-157924. Hon. HARLEY O. STAGGERS, COMPTROLLER GENERAL OF THE UNITED STATES, Chairman, Committee on Interstate and Foreign Commerce, DEAR MR. CHAIRMAN: Your letter of March 13, 1967, requests our comments on H.R. 6418, which, if enacted, would be cited as the "Partnership for Health Amendments of 1967." The purpose of the bill is stated in its title as being to amend the Public Health Service Act to extend and expand the authorizations for grants for comprehensive health planning and services, to broaden and improve the authorization for research and demonstrations relating to the delivery of health service, to improve the performance of clinical laboratories, and to authorize cooperative activities between the Public Health Service hospitals and community facilities, and for other purposes. We offer the following comments for consideration by your committee. Section 3 of H.R. 6418 would provide for the replacement of the existing section 304 of the Public Health Service Act (42 U.S.C. 242b) with new provisions authorizing the Secretary, Department of Health, Education, and Welfare (hereinafter referred to as the Secretary) to make project grants to States and other public or nonprofit organizations, and to enter into contracts with public or private organizations, for the conduct of research, experiments, or demonstrations relating to the development, utilization, and coordination of new or existing services provided by medical facilities and new or existing methods of organization, delivery, or financing of health services. The amount of any grant or contract for construction or acquisition of equipment may not, except in unusual circumstances, exceed 50 percent of the cost of the project as determined by the Secretary. We believe that the committee may wish to include in the bill language, similar to that now provided in legislation applicable to other construction grant programs now authorized by the Public Health Service Act, to provide for the return to the Federal Government of all or a portion of the Federal grant assistance for the construction or the purchase of facilities or equipment in the event such facilities or equipment cease to be used for the purposes for which constructed or purchased. For example, section 624, title VI, Public Health Service Act (which would be repealed by section 3 (b) of H.R. 6418) concerning studies and demonstrations relating to coordinated use of hospital facilities including the construction of units of hospitals or other medical facilities which involve experimental architectural designs or functional layout, provides for the recovery of a portion of the Federal participation if, within 20 years after the completion of construction, the applicant or other owner of the facility shall cease to be a public or other nonprofit institution or organization, or the facility shall cease to be used for the purposes for which it was constructed. Section 4 of H.R. 6418 would authorize the Secretary, at the request of the appropriate State or local authority, to extend temporary (not in excess of 45 days) assistance to States or localities in meeting health emergencies of such nature as to warrant Federal assistance. Also, this section provides that that the Secretary may require such reimbursement of the United States for aid as the Secretary may determine to be reasonable under the circumstances. Rather than to leave this determination to the Secretary's discretion, we believe that the committee may wish to amend the bill to make it mandatory that the Secretary make a formal determination as to the amount, if any, of the reimbursement which would be reasonable under the circumstances. Section 5 of H.R. 6418 would amend the Public Health Service Act to include a new section 353 relating to the licensing of clinical laboratories by the Secretary. The proposed new section 353 (d) (3) would provide that the Secretary may, if he deems it appropriate, require payment of fees for the issuance and renewal of licenses, but the amount of such fees shall not exceed such sum (which in no event may be more than the sum determined by him to be necessary on the average to provide, maintain, and equip an adequate service for the purpose) as the Secretary may by regulation prescribe from time to time. The licensing of the clinical laboratories, in our opinion, appears to be a type of service which would be within the intent of legislation enacted in 1951 (5 U.S.C. 140) which states that it is the sense of the Congress that an agency shall charge a fair and equitable fee for “*** any work, service publication, report, document, benefit, privilege, authority, use, franchise, license, permit, certificate, registration, or similar thing of value or utility performed, furnished, provided, granted, prepared, or issued by any Federal agency * * *." The committee may wish to amend the bill to require that fees for the furnishing of licenses be established pursuant to criteria set forth in 5 U.S.C. 140, rather than leaving the matter to the Secretary's discretion. H.R. 6418 would provide for a number of amendments to section 314 of the Public Health Service Act including extension and expansion of formula grants to States for comprehensive health planning and public health services. As part of our review of formula grants to States for health services, we issued a report to the Congress on our review of financial administration of selected grants for health services made to the State of Indiana, dated September 23, 1966, B-156635. In this report, we pointed out that the use of research expenditures for matching formula control grants by the State, in our opinion, is not in accord with the purpose of control programs which, as stated by the House Committee on Interstate and Foreign Commerce in House Report 2144, dated June 2, 1948, is to bridge the gap between basic research discoveries and their application to the benefit of disease victims. Therefore, in our opinion, there is ample support for the view that the basic research expenditures in question are not valid for matching purposes. Because the Public Health Service expressed the view that in the absence of specific prohibitions to the contrary, such expenditures were legally acceptable and valid for State matching purposes, we proposed in our report that the Congress may wish to consider amending the Public Health Service Act to specifically preclude the use of basic research expenditures as allowable State matching funds for formula control programs. Accordingly, the committee may wish to amend the bill in this regard. Sections 314 (a) (2) (G) and 314(d) (2) (H) of the Public Health Service Act, as amended by section 3 of the Comprehensive Health Planning and Public Health Services Amendments of 1966, Public Law 89-749, concerning grants for comprehensive health planning and public health services, require the State agency to make such reports, in such form, and containing such information as is required by the Surgeon General. Also, sections 314(a)(2) (I) and 314(d) (2) (I) require such fiscal control and fund accounting procedures as may be necessary to assure the proper disbursement of and accounting for funds paid to the States. However, no provision is made in the 1966 amendments or in the current bill requiring a grantee to keep adequate cost records of the projects to which the Federal Government makes financial contributions, nor is there any provision in the 1966 amendments or in the current bill specifically authorizing the Secretary of Health, Education, and Welfare or the Comptroller General to have access to the grantee's records for purposes of audit and examination. In view of the increase in grant programs over the last several years, we feel that in order to determine whether grants funds have been expended for the purpose for which the grant was made. the grantee should be required by law to keep records which fully disclose the disposition of such funds. We also feel that the head of the agency as well as the General Accounting Office should be permitted to have access to the grantee's 80-641-67-2 records for the purpose of audit and examination. We therefore suggest that consideration be given to adding a new section to the bill including such requirements with respect to the grant programs contained in the 1966 amendments and the current bill. This could be accomplished by the following language: "Records and Audit "(a) Each recipient of assistance under this act shall keep such records as the Surgeon General shall prescribe, including records which fully disclose the amount and disposition by such recipient of the proceeds of such grants, the total cost of the project or undertaking in connection with which such funds are given or used, and the amount of that portion of the cost of the project or undertaking supplied by other sources, and such other records as will facilitate an effective audit. "(b) The Secretary of Health, Education, and Welfare and the Comptroller General of the United States, or any of their duly authorized representatives, shall have access for the purpose of audit and examination to any books, documents, papers, and records of the recipients that are pertinent to the grants received under this act." Language similar to that suggested above under other parts of the Public Health Service Act is codified in sections 280b-11, 291d (10) and (11), and 299i of title 42, United States Code. Sincerely yours, FRANK H. WEITZEL, Assistant Comptroller General of the United States. Hon. HARLEY O. STAGGERS, U.S. CIVIL SERVICE COMMISSION, Chairman, Committee on Interstate and Foreign Commerce, House of Representatives, Rayburn House Office Building. DEAR MR. CHAIRMAN: This is in further reference to your request for the Commission's views on H.R. 6418, a bill to amend the Public Health Service Act to extend and expand the authorizations for grants for comprehensive health planning and services, to broaden and improve the authorization for research and demonstrations relating to the delivery of health services, to improve the performance of clinical laboratories, and to authorize cooperative activities between the Public Health Service hospitals and community facilities, and for other purposes. The Commission favors the enactment of H.R. 6418. Its comments are limited to sections 6, 7, and 10 of the bill. Section 6 would add a new section 223 to title II of the Public Health Service Act authorizing the acceptance of volunteer and uncompensated services for use in the operation of any health care facility. Presumably the intent of this is to permit the acceptance of services of "gray ladies", and "candy stripers". The utilization of such volunteers is a common practice in most private hospitals, and there is no objection to the authorization of similar services for Public Health Service facilities, as long as it is understood that these personnel will not be used to occupy positions normally designated for Federal personnel. Section 7 would amend part C of title II of the Public Health Service Act by adding a new section 328 concerning the sharing of medical facilities and resources. Subsection 328 (b) (1) provides authority for the Secretary to enter into agreements or arrangements with schools of medicine and other agencies and institutions for the "interchange or cooperative use of facilities and services on a reciprocal or reimbursable basis." This provision might conceivably be interpreted as authorizing the interchange of personnel between the Public Health Service and non-Federal health facilities. However, the Commission understands that this provision is not intended to be used for personnel interchange and with that understanding, the Commission has no objection to it. Section 10 of the bill would (1) repeal section 322(a) (7) of the Public Health Service Act which authorizes free medical services for civilian field employees of the Public Health Service, and (2) authorize the Secretary to provide medical |