Haldeman, Dr. Jack, Public Health Service.. Hobby, Hon. Oveta Culp, Secretary of Health, Education, and Kimble, Sam, Public Health Service_ Norton, Dr. John William Roy, North Carolina State health officer-- Rockefeller, Nelson, Under Secretary of Health, Education, and American Medical Association, letter from Dr. George F. Lull, secretary and general manager. Health, Education, and Welfare Department: Appropriations for PHS grants to States by categories, table_ Comparison of State public health grant allotments under exist- Federal grants-in-aid for public health services (appropriations Letter from Hon. Oveta Culp Hobby, commenting on amend- Projected impact of legislative recommendations, fiscal year 1956 Federal grants to States for health and facilities, vocational education, vocational rehabilitation, and maternal and child health and welfare services, table.. Public Health Service grants, chart_ Reduction in public-health grant funds, table. State breakdown of proposed grants to States in 1955 assuming North Carolina State Board of Health, letter from Dr. J. W. R. Information concerning mental health amendment submitted for the American Psychiatric Association, letter from Dr. Daniel Blain, Blain, Daniel, M. D., medical director, American Psychiatric Associa- Elkhart County (Ind.) Association for Mental Health, letter from Information concerning mental health amendment submitted for the Indiana Association for Mental Health: Letter from Joseph R. Brown, executive director.. Letter from Lola K. Sloan, president, Floyd County Chapter___ Louisville and Jefferson County (Ky.) Child Guidance Clinic, letter Mavs, Dr. J. R. Shannon, letter from.. Middlesex County (N. J.) Mental Health Association, telegram from John B. R. Strong, president-- Morris County (N. J.) Association for Mental Health, telegram from New Jersey Neuropsychiatric Association, letter from Dr. Frank P. South Dakota Mental Health Association, letter from Mrs. Inda 83 PUBLIC HEALTH SERVICE ACT (Grant-in-Aid Amendments) THURSDAY, FEBRUARY 4, 1954 HOUSE OF REPRESENTATIVES, COMMITTEE ON INTERSTATE AND FOREIGN COMMERCE, Washington, D. C. The committee met at 10 a. m., in room 1334, New House Office Building, Hon. Charles A. Wolverton (chairman) presiding. The CHAIRMAN. The committee will come to order. The hearing this morning is on H. R. 7397. (H. R. 7397 and reports from Departments are as follows:) [H. R. 7397, 83d Cong. 2d sess.] A BILL To amend the Public Health Service Act to promote and assist in the extension and improvement of public health services, to provide for a more effective use of available Federal funds, and for other purposes. Be it enacted by the Senate and House of Representatives of the United States of America in Congress assembled, That this Act may be cited as the "Public Health Grant-in-Aid Amendments of 1954". SEC. 2. Section 314 of the Public Health Service Act is hereby amended to read as follows: "GRANTS AND SERVICES TO STATES "SEC. 314. (a) There are hereby authorized to be appropriated for each fiscal year, beginning with the fiscal year ending June 30, 1956, such sums for grants to carry out the purposes of this section as the Congress may determine. The sums so appropriated for any fiscal year shall be avilable for- "(1) grants to States to assist them in meeting the costs of public health services; "(2) grants to States to assist them in initiating projects for the extension and improvement of their public health services; and "(3) grants to States and to public and other nonprofit organizations and agencies to assist in combating unusually severe public health problems in specific geographical areas, in the carrying out of special projects which hold unique promise of making a substantial contribution to the solution of public health problems common to a number of States, and in meeting problems of special national significance or concern. The portion of such sums which shall be available for each of such three types of grants shall be specified in the Act appropriating such sums. "(b) (1) From the sums available for any fiscal year for grants to States to assist them in meeting the costs of their public health services, each State shall be entitled to an allotment of an amount which bears the same ratio to such sums as the product of (1) the population of the State and (2) the square of its allotment percentage (as determined under subsection (h)) bears to the sum of the corresponding products for all the States. The allotment to any State under the preceding sentence for any fiscal year which is less than $55,000 (or such other amount as may be specified as a minimum allotment in the Act appropriating such sums for such year) shall be increased to that amount, the total of the increases thereby required being derived by proportionately reducing the allotments to each of the remaining States under the preceding sentence, but with 1 such adjustments as may be necessary to prevent the allotment of any of such remaining States from being thereby reduced to less than that amount. the "(2) From each State's allotment under this subsection for any fiscal year, Surgeon General shall pay to such State an amount equal to its Federal share (as determined under subsection (j)) of the cost of public health services under the plan of such State, approved under subsection (e), including the cost of training of personnel for State and local health work and including the cost of administration of the State plan. "(c) (1) From the sums available for any fiscal year for grants to States to assist them in initiating projects for the extension and improvement of their public health services, each State shall be entitled to an allotment of an amount bearing the same ratio to such sums as the population of such State bears to the population of all the States. The allotment to any State under the preceding sentence for a fiscal year which is less than $25,000 (or such other amount as may be specified as a minimum allotment in the Act appropriating such sums for such year) shall be increased to that amount, the total of the increases thereby required being derived by proportionately reducing the allotments to each of the remaining States under the preceding sentence, but with such adjustments as may be necessary to prevent the allotment of any of such remaining States from being thereby reduced to less than that amount. "(2) From each State's allotment under this subsection for any fiscal year, the Surgeon General shall pay to such State a portion of the cost of approved projects for the extension and improvement of public health services (including their administration and the training of personnel for State and local health work) under the State plan. The Surgeon General shall approve any project for purposes of this subsection only if the State plan approved under subsection (e) includes such project or is modified to include it and only if he finds the project constitutes an extension or improvement of public health services under the State plan or will contribute materially to such an extension or improvement. "(3) Payments under this subsection with respect to any project may be made for a period of not to exceed six years beginning with the commencement of the first fiscal year for which any payment is made with respect to such project from an allotment under this subsection. To the extent permitted by the State's allotment under this subsection, such payments with respect to any project shall be equal to 75 per centum of the cost of such project for the first biennium in such period, 50 per centum of such cost for the second biennium in such period, and 25 per centum of such cost for the last biennium in such period; except that, at the request of the State, such payments may be less than such percentage of the cost of such project. "(4) No payment may be made from an allotment under this subsection with respect to any cost with respect to which any payment is made under subsection (b). "(d) (1) From the sums available therefor for any fiscal year, the Surgeon General shall makes grants to States and public and other nonprofit organizations and agencies for paying part of the cost of combating unusually severe public health problems in specific geographical areas, of carrying out special projects which hold unique promise of making a substantial contribution to the solution of public health problems common to a number of States, and of meeting public health problems of special national significance or concern. "(2) Payments under this subsection may be made in advance or by way of reimbursement for services performed and purchases made, as may be determined by the Surgeon General; and shall be made on such conditions as the Surgeon General finds necessary to carry out the purposes of this subsection. "(3) For the purposes of this subsection Guam shall be deemed to be a 'State'. "(e) The Surgeon General shall approve any State plan (including, with respect to mental health, the plan of the State mental health authority) which is submitted by the State health authority and which meets such requirements as the Surgeon General may prescribe by regulation. "(f) All regulations and amendments thereto with respect to grants to States under subsections (b) and (c) of this section shall be made after consultation with a conference of the State health authorities and, in the case of regulations or amendments which relate to or in any way affect such grants for work in the field of mental health, the State mental health authorities. Insofar as practicable, the Surgeon General shall obtain the agreement, prior to the issuance of any such regulations or amendments, of the State health authorities and, in the case of regulations or amendments which relate to or in any way affect such grants for work in the field of mental health, the State mental health authorities. "(g) Whenever the Surgeon General, after reasonable notice and opportunity for hearing to the State health authority (or, where appropriate, the mental health authority of the State) finds that— "(1) the State plan approved under this section has been so changed that it no longer complies with any requirement prescribed by regulation as a condition of approval of the plan; or "(2) in the administration of the plan there is a failure to comply substantially with any such requirement, the Surgeon General shall notify the State health authority that no further payments will be made to the State under subsection (b) or (c) of this section (or, in his discretion, that furtherpay ments will not be made to the State for projects under or parts of the State plan affected by such failure) until he is satisfied that there will no longer be such failure. Until he is so satisfied the Surgeon General shall make no further payments to such State under subsection (b) or (c) (or shall limit payments to projects under or parts of the State plan in which there is no such failure). "(h) (1) The allotment percentage for any State shall be 100 per centum less that percentage which bears the same ratio to 50 per centum as the per capita income of such State bears to the per capita income of the continental United States (excluding Alaska), except that (A) the allotment percentage shall in no case be more than 75 per centum or less than 33% per centum, and (B) the allotment percentage for Hawaii shall be 50 per centum, and the allotment percentage for Alaska, Puerto Rico, and the Virgin Islands shall be 75 per centum. "(2) The allotment percentages shall be promulgated by the Surgeon General between July 1 and August 31 of each even-numbered year, on the basis of the average of the per capita incomes of the States and of the continental Uuited States for the three most recent consecutive years for which satisfactory data are available from the Department of Commerce. Such promulgation shall be conclusive for each of the two fiscal years in the period beginning July 1 next succeeding such promulgation: Provided, That the Surgeon General shall promulgate such percentages as soon as possible after the enactment of the Public Health Grant-in-Aid Amendments of 1954, which promulgation shall be conclusive for the two fiscal years ending June 30, 1957. "(i) The population of the several States shall be determined on the basis of the latest figures furnished by the Department of Commerce. "(j) The Federal share' for any State shall be equal to the State's allotment percentage, except that the Federal share for States with allotment percentages of more than 66% per centum shall be 66% per centum, and the Federal share for Alaska shall be 50 per centum. "(k) The method of computing and paying amounts pursuant to subsection (b) or (c) shall be as follows: "(1) The Surgeon General shall, prior to the beginning of each calendar quarter or other period prescribed by him, estimate the amount to be paid to each State under the provisions of such subsection for such period, such estimate to be based on such records of the State and information furnished by it, and such other investigation, as the Surgeon General may find necessary. "(2) The Surgeon General shall pay to the State, from the allotment available therefor, the amount so estimated by him for any period, reduced or increased, as the case may be, by any sum (not previously adjusted under this paragraph) by which he finds that his estimate of the amount to be paid the State for any prior period under such section was greater or less than the amount which should have been paid to the State for such prior period under such section. Such payments shall be made prior to audit or settlement by the General Accounting Office and shall be made through the disbursing facilities of the Treasury Department, and shall be made in such installments as the Surgeon General may determine. "(3) The Surgeon General, at the request of the State health authority (or, in the case of mental health, of the State mental health authority) is authorized to reduce a payment to a State by the amount of the pay, allowances, traveling expenses and other costs related to the detail of an officer or employee of the Public Health Service to the State, to one of its political subdivisions, or to a public or other nonprofit organization or agency in the State, when such detail is made for the convenience of and at the request of the State. The amount by which such payments are reduced for such purposes shall be available for the payment of such costs by the Surgeon General. (1) To assist further in the extension and improvement of public health services, the Surgeon General is authorized to train personnel for State and local health work, to detail personnel to Guam and American Samca, and to extend training, |