anticipated that implementation of the medical monitoring program will occur in September 1999.

FUNDING FOR THE AGENCY FOR TOXIC SUBSTANCES
AND DISEASE REGISTRY

Mr. Porter: Why is the funding for ATSDR decreased by $12 million (16%) in FY 00?

Dr. Koplan: The President's budget for ATSDR, which is funded through the EPA Superfund program, is $64 million for FY 2000. This figure is consistent with previous years' President's budget requests."

(Clerks note: the response given does not answer the question.)

PEDIATRIC REFERRAL UNITS

Mr. Porter: What are pediatric referral units?

Dr. Koplan: ATSDR is working through its public health partners to establish a national network of Pediatric Environmental Health Specialty Units to address the health needs of the estimated 1.3 million children under the age of 6 living within one mile of Superfund waste sites. The need for such units exists because pediatricians, in general, know little about environmental medicine, and environmental specialists know little about pediatric medicine.

The unique susceptibilities of children to environmental toxins include unique vulnerabilities in the areas of development, dose, height, behavior, and dependency. The proposed network of pediatric units will provide environmental expertise and coordinated service in the areas of medical education and training, consultation, and clinical specialty referrals.

Currently three such units are funded by ATSDR – Harborview Medical Center at the University of Washington in Seattle, the Occupational and Environmental Health Center at Cambridge Hospital in Boston, and the Mount Sinai Pediatric Environmental Health Center in New York. The staff of these units instruct medical students, resident physicians, and Local health care providers about environmental health and the medical interventions that exist for various pediatric age groups. Making effective use of existing resources, they also serve as pediatric environmental medicine clinical consultants and as referral resources for other health care providers.

ATSDR anticipates that these pediatric environmental health specialty units will reduce environmental health threats to children, facilitate access to expertise in pediatric environmental medicine, and improve public health and medical capacity to evaluate the effects of exposures to hazardous substances on children's health.

HOME STUDY

Mr. Porter: What kind of home study materials are provided to USDA for training purposes?

Dr. Koplan: CDC provides self-study distance based courses to meet the training needs of the public health workforce nationwide. The Public Health Training Network (PHTN) is a distance learning system that takes training to the learner. PHTN uses a variety of instructional media ranging from print-based to videotape and multimedia to meet the training needs of the public health workforce nationwide, including FDA, USDA, and state health professionals. One example is the training of public health workers in foodborne disease prevention that will occur through PHTN.

Through the National Laboratory Training Network (NLTN), CDC offers a Public Health Series Course, "Laboratory Investigation of Foodborne Illness," to USDA, FDA, and state and territorial public health laboratories in the active surveillance networks. Through the NLTN, CDC holds focus groups to identify training needs of the group and responds to those needs.

U.S./SAUDI ARABIAN JOINT COMMISSION

Mr. Porter: Briefly describe the U.S./Saudi Arabian Joint Commission and prevention of Musculoskeletal disorders reimbursable agreement with the Department of Treasury.

Dr. Koplan: First, let me clarify that CDC's reimbursable agreement with the Saudi Arabian Joint Commission on Economic Cooperation is not for the prevention of musculoskeletal disorders. Evidently, the term "prevention of musculoskeletal disorders" was inadvertently entered into the Congressional Justification.

CDC's Memorandum of Agreement for reimbursable services with the Saudi Arabian Joint Commission on Economic Cooperation is for the long-term assignment of a Consultant Epidemiologist and periodic short-term consultation to central, regional, and local health officials in Saudi Arabia to: 1) assess public disease reporting structures and facilities on behalf of the Ministry of Health; 2) assist in recruiting and interviewing new candidates for the program at various medical training centers and facilities in Saudi Arabia; 3) assist in organizing and executing an annual introductory course in epidemiology for program trainees, and 4) assist in ongoing guidance of trainees in field

VACCINE FOR CHILDREN PROGRAM

Mr. Porter: What is the most current estimate for the VFC program?

Dr. Koplan: The enacted level for FY 1999 was $566 million. However, CDC's current estimate for FY 1999 has decreased to $528 million due to the implementation of State CHIP plans and the expectation of a contract for rotavirus vaccine to be in place later in FY 1999 than previously anticipated. States estimate that 60,786 children (for one birth cohort) will no longer be eligible to receive VFC vaccine in 1999. CDC estimates that a contract for rotavirus vaccine will begin in April 1999.

The most recent projection for FY 2000 is $545 million and was included in the President's budget. Estimates will be revised as new ACIP recommendations and contract prices are known. CDC will also continue to monitor actual purchase data and projections will be adjusted accordingly.

Mr. Porter: For the record, describe the correlation between the Vaccines for Children (VFC) program and the State Child Health Insurance (s-CHIP) program and the impact s-CHIP will have on future eligibility and funding of VFC.

Dr. Koplan: According to Title XXI, states have the option of implementing three different types of State Child Health Insurance (s-CHIP) plans: (1) a Medicaidexpansion plan, (2) a separate state health insurance program, or (3) a combination of these two options. On May 11, 1998, HCFA sent a letter to State Health Officials to explain the relationship between VFC-eligibility and enrollment in s-CHIP. Specifically, children newly enrolled in Medicaid under Title XXI (i.e., children enrolled in Medicaid-expansion plans) are eligible to receive VFC vaccine, as are all other children eligible for Medicaid. However, children enrolled in separate state health insurance programs (s-CHIP) are not eligible to receive VFC vaccine because they are neither Medicaid eligible nor uninsured (as required under Title XIX). However, States remain able to purchase vaccine for s-CHIP children at federally negotiated contract prices.

Currently, 53 CHIP plans have been developed. Of these, 28 are Medicaidexpansion plans, 14 are separate state insurance plans and 11 are combination Medicaidexpansions and separate state insurance plans. Nearly two dozen plan amendments have been submitted for approval and many of these amendments involve changing a Medicaid-expansion plan into a separate state insurance plan or a combination plan. Moreover, several other states have indicated in their initial plans that amendments would be forthcoming. Therefore, the impact that CHIP will have on future eligibility and funding of VFC depends on the prevalence of Medicaid-expansion plans, separate state insurance plans, and combination plan.

For states implementing Medicaid-expansion plans, children enrolled were VFCeligible prior to enactment of Title XXI (because they were uninsured) and will remain

VFC-eligible after enactment of Title XXI (because they are now Medicaid-eligible); for states implementing separate state health insurance programs, children enrolled were VFC-eligible prior to enactment of Title XXI (because they were uninsured), but will no longer be VFC-eligible after enactment of Title XXI (because they are no longer uninsured, nor are they Medicaid-eligible); and for states implementing combination plans, children enrolled in the Medicaid-expansion component of the plan will remain VFC-eligible, while those enrolled in the separate state health insurance program component of the plan will no longer be VFC-eligible.

Overall, because all CHIP enrollees were VFC-eligible prior to enrollment and only those enrolled in Medicaid-expansion plans will be VFC-eligible after enrollment, sCHIP will result in a decrease in future VFC eligibility and, consequently, future VFC vaccine purchase costs.

ORAL POLIO VACCINE

Mr. Porter: What is the latest recommendation for the use of oral polio vaccines?

Dr. Koplan: Oral polio vaccine (OPV) is no longer recommended for the first two doses of the four-dose routine childhood polio immunization schedule and is acceptable only for special circumstances such as: (1) children of parents who do not accept the recommended number of injections, (2) late initiation of the immunization series that would require an unacceptable number of injections, and (3) imminent travel to polio endemic areas. OPV continues to be recommended for the third and fourth polio doses in the routinely recommended sequential childhood polio schedule, although inactivated poliovirus vaccine (IPV) could be used in place of OPV. OPV remains the vaccine of choice to control outbreaks due to wild poliovirus.

SITE ACQUISITION

Mr. Porter: It was anticipated that the site acquisition needed to provide an adequate security buffer and improved security would be complete this month. What is the status of this acquisition?

Dr. Koplan: With the assistance of the Regional GSA, CDC now has title to 42 of the 44 separate land parcels in the security buffer zone. CDC will complete the acquisition of the remaining two parcels in March 1999, and proceed with petitioning the county to have the public streets within the buffer zone closed and transferred to CDC control.

NON-EMPLOYEE RECEPTION CENTER

Mr. Porter: How much is in your FY 00 facilities request for the non-employee reception center? What is the total cost of this project?

Dr. Koplan: CDC did not include a funding request for the non-employee reception center in the fiscal year 2000 budget request. The total cost of this project is estimated to be $2.5 million.

UNIVERSAL DATA COLLECTION PROGRAM

Mr. Porter: Describe the Universal Data Collection program in further detail including costs and participation rates.

Dr. Koplan: CDC's new Universal Data Collection (UDC) system is designed to monitor the safety of blood products and to track the health of persons with bleeding disorders who are receiving care at any of the 134 federally supported hemophilia treatment centers (HTCs). This system will enable CDC to conduct surveillance for cases of HIV, hepatitis A, B, and C viruses, and Creutzfeldt-Jakob Disease (CJD) among a population receiving large amounts of blood or blood products. Also, this will enable CDC to maintain blood samples from this population in a national repository for rapid tracing and identification of potential or emerging threats to the blood supply. When fully implemented, the UDC system should detect nearly all blood borne infections occurring in persons treated at these HTCs. The system also monitors the effectiveness of CDC's prevention programs for persons with bleeding disorders by collecting prevention outcome data on enrolled patients at the time of their annual comprehensive health care visits to HTCs.

Implementation of the plan was begun in May 1998 as a phased-in process. Since that time, more than 1,600 patients have been enrolled, representing more than 70 of the 134 federally funded HTCs across the country. The participation rate among persons invited to take part in the program has also been excellent, at more than 90 percent. We anticipate that more than 15,000 patients with hemophilia and other bleeding disorders will eventually be enrolled in UDC as the project becomes fully operational. To date, the costs of the project are $0.6 million for a contract to test blood samples for evidence of viral infection and $ 0.4 million to reimburse HTCs for extra costs for supplies to collect blood samples and processing and shipping of samples.

UNOBLIGATED BALANCE

Mr. Porter: The budget shows an unobligated balance of $51 million at the start of FY 1999. Please indicate the sources and amounts of these balances.

Dr. Koplan: The table below displays unobligated balances at the start of FY 1999.

$55,749,434 is the correct Unobligated Balance End of FY 98 for all of CDC appropriations and the $51,023,131 reflected in the FY 2000 CJ is the incorrect unobligated balance for the start of FY 1999.