of these activities, and give us a degree of flexibility in marshalling for areas of greatest need the appropriations available for these programs. Nevertheless, to underscore our intention to continue the activities to be consolidated, the draft bill would amend the Partnership to specify these areas expressly. In addition, it would make express our authority to award grants under the Partnership for Health for the operation of health centers and related facilities, including those formerly assisted under programs of the Office of Economic Opportunity which have now been transferred to the Department. We would also amend the Partnership to authorize the use of project grants for amortization of principal, and payment of interest, on loans for facilities or to centers in existence prior to calendar year 1974 for the construction or acquisition of facilities used for program purposes, and for the payment of costs of minor remodeling. Title I of the draft bill would also extend the entire Partnership for Health for three years, through fiscal year 1977. In connection with its extension of the program of formula grants for comprehensive public health services, the bill would eliminate the current statutory reservation of 15 percent of a State's allotment for mental health services. This reservation is inconsistent with the basic concept underlying the Partnership for Health. Under that concept, areas of special national significance were to be provided for through the project grant authority, which permits the precise targeting of Federal assistance to meet identified need. For other areas of health need, the Partnership recognizes that State, rather than national, government is in the best position to determine where funds should be applied, and that this determination may appropriately vary in response to varying State priorities. Accordingly, the Partnership established a formula grant program to assist the States in meeting what they, the States, determined to be their health needs. The earmarking of these grants for specific needs, such as mental health, is, in the context of the purposes of the formula grant, an inappropriate Federal imposition on State decision-making. Title I of the draft bill would also merge into a single advisory committee, to be styled the "National Advisory Council on Health Services", functions now performed by the National Advisory Council on Comprehensive Health Planning Programs, the National Council on Alcohol Abuse and Alcoholism. The new council would also replace the National Migrant Health Advisory Committee, which the Secretary created administratively. The Department does not seek extension of the separate authorities that title I of the draft bill would consolidate, or of the remaining portions of the Community Mental Health Centers Act. The community mental health services program has proven itself and should now be absorbed by the regular health service delivery system. Title II of the draft bill would extend for three years the program of formula grants under the Comprehensive Alcohol Abuse and Alcoholism Prevention, Treatment, and Rehabilitation Act of 1970. Title III of the draft bill would extend and amend the Developmental Disabilities Services and Facilities Construction Act. The amendments are substantially those submitted to the Congress in our letter of March 23, 1973, in two respects. First, we would increase emphasis in the use of assistance under the Act for eliminating the inappropriate placement of persons with developmental disabilities in institutions. Second, we would not seek extension of the currently unfunded program of grants for the construction of university-affiliated facilities. As we said in that March 23 letter, we have been generally pleased with the operation of the Act. Our experience with its programs, however, has led us to the conclusion that some minor modifications in the statutory authority would improve the capacity of the Federal Government and the States to work cooperatively to improve the lives of the developmentally disabled. The enclosed draft bill, in addition to extending for three years the programs authorized by parts B and C of the Developmental Disabilities Act, would amend those programs in ways which we believe will increase their effectiveness. Amendments contained in the bill would eliminate the requirement of Federal approval of construction projects assisted with funds made available to States under part C of the Act. The effect of these amendments would be to simplify the approval process, and thereby decrease the time and funds required, for the construction of needed community facilities. This amendment is in accord with the President's objective of returning responsibility to the States and localities whenever possible. Also in keeping with the Administration's philosophy of greater State responsibility, the bill would delete the 90 percent limitation on the Federal share with respect to any project in a poverty area. We believe the States should judge the needs of their communities. So long as the Federal share limitation with respect to States is met and so long as States meet the State plan provision requiring special assistance to urban and rural poverty areas, each State should be able to apportion Federal funds within the State according to its evaluation of local need. In order to further simplify the administration of the programs authorized under the Developmental Disabilities Act, the draft bill would provide a single Federal share of State expenditures under the Act for planning, administration, services, and construction. Currently, the Federal share for construction is 66% percent, and for other activities it is 70 percent. The amendment would make the Federal share for purposes of all activities under the State plan 70 percent for the fiscal year 1975, 60 percent for the fiscal year 1976, and 50 percent for the fiscal year 1977. Title III of the draft bill would also amend the definition of developmental disabilities by including autism as a disability for which services would be covered under the Developmental Disabilities Act. This would allow for treatment, under the program, of autistic children, whose disability requires treatment similar to that provided to individuals with neurologically caused developmental disabilities. Currently, these individuals are excluded from participation in the program because of the lack of certainty over whether their disabilities are neurologically based. Other amendments contained in the title would provide a minimum allotment of $50,000 to the Virgin Islands, American Samoa, Guam, and the Trust Territory of the Pacific Islands and would include in construction costs the cost of land acquisition. We recommend prompt and favorable consideration of this bill. We are advised by the Office of Management and Budget that enactment of this proposed legislation would be in accord with the program of the President. Sincerely, CASPAR W. WEINBERGER, Secretary. Enclosure. SUMMARY OF THE PROPOSED "HEALTH SERVICES AMENDMENTS OF 1974" The first section of the bill provides the short title: the "Health Services Amendments of 1974". TITLE I-COMPREHENSIVE PUBLIC HEALTH SERVICES AND HEALTH SERVICES 1. Repeal of mental health allocation.-Section 101 would repeal the current requirement of paragraph (7) of section 314(d) of the Public Health Service Act that at least 15 percent of a State's allotment under the section be made available only to the State mental health authority for the provision of mental health services. As a conforming change, we would amend the last sentence of that paragraph, which requires a State to spend 70 percent of the amount of its allotment reserved for mental health services, and 70 percent of the remainder of its allotment, in services in communities of the State, so as merely to require that a State spend 70 percent of its allotment for services in communities. 2. Extension of State formula grants.—Section 102 would extend the Partnership for Health formula grant program, section 314(d) of the Public Health Service Act, for three years, through fiscal year 1977. 3. Extension and revision of project grants.-Section 103 would similarly extend the Partnership for Health project grant program, section 314 (e) of the Act. In addition, the program would be amended so as to authorize expressly (in addition to the current authority to make grants to meet health needs of limited geographic scope or of specialized regional or national significance) the award of grants for the prevention or treatment of alcoholism, for providing or operating comprehensive health services centers, for conducting the migrant health activities now conducted under section 310 of the Public Health Services Act, and for conducting family planning activities now provided for under title X of the Act. Grants under the amended section 314 (e) of the Act, in addition to being available to pay the cost of program operations now assisted under it, would be made available for the payment of installments of principal and interest on loans for facilities or to centers in existence prior to calendar year 1974 and currently used in the program, and for the minor remodeling of those facilities. 4. Consolidation of advisory councils.-Section 104 would amend section 316 of the Public Health Service Act to substitute for the existing National Advisory Council on Comprehensive Health Planning Programs, a new council, the "Na tional Advisory Council on Health Services". The new council would replace, in addition to the CHP body, two other statutory councils: the National Advisory Mental Health Council, and the National Advisory Council on Alcohol Abuse and Alcoholism, both established by section 217 of the Act; and one council established administratively, the National Migrant Health Advisory Committee. The section would substitute the new council for the Mental Health Council in the provision of the Public Health Service Act (section 303 (b)) requiring council approval of mental health project grants, and would limit it to advisory functions. The new council would also be substituted for the CHP Council in the provision requiring that one member of the CHP Council be a member of the National Advisory Council on Health Manpower Shortage Areas (section 329 (e) (1) (E) of the Public Health Service Act). Provisions in the Community Mental Health Centers Act utilizing the Mental Health Council are repealed. No substitution of the new council is proposed. TITLE II—EXTENSION OF ALCOHOLISM FORMULA GRANTS 5. Section 201 would amend section 301 of the Comprehensive Alcohol Abuse and Alcoholism Prevention, Treatment, and Rehabilitation Act of 1970 to extend for three years, through fiscal year 1977, the current program of alcoholism formula grants. TITLE III-DEVELOPMENTAL DISABILITIES 6. Short title.-Section 301 would give title III of the bill a short title, the "Developmental Disabilities Amendments of 1974". 7. Extension of authorizations.-Section 302 of the bill would amend sections 122(b) (relating to authorization of appropriations for demonstration and training grants) and 131 (relating to authorization of appropriations for the formula grant program) of the Developmental Disabilities Services and Facilities Construction Act to authorize the appropriation of such sums as may be necessary to carry out the purposes of those sections for the fiscal year ending June 30, 1975, and each of the next two fiscal years. 8. Minimum allotment for territories.-Section 303 of the bill would amend section 132 (a) (1) of the Developmental Disabilities Services and Facilities Construction Act to provide a minimum allotment of $50,000 for each of the territories. Currently the minimum allotment for the States is $100,000, but there is no minimum allotment for the territories. 9. Elimination of requirements of Federal approval of each construction project.-Section 304 of the bill would amend various provisions of the Developmental Disabilities Services and Facilities Construction Act and the Mental Retardation Facilities and Community Mental Health Centers Construction Act of 1963 to eliminate the requirement of Federal approval of construction projects assisted with funds made available to States under part C (providing for allotments to States on a formula basis) of the Developmental Disabilities Services and Facilities Construction Act. 10. Amendments to Federal share provision.—Section 305 of the bill would amend section 135(b) of the Developmental Disabilities Services and Facilities Construction Act (formerly section 137(b), but redesignated by section 304 (a) of the bill) to provide a single Federal share with respect to any State for planning, administration, services, and construction. Currently, the Federal share for construction is 66% percent, and for other activities it is 70 percent. The amendment would make the Federal share for purposes of all activities in any State 70 percent for the fiscal year 1975, 60 percent for the fiscal year 1976, and 50 percent for the fiscal year 1977. Section 305 of the bill would also delete from the section redesignated as section 135(b) of the Developmental Disabilities Services and Facilities Construction Act the limitation on the Federal share with respect to any project located in a poverty area. Currently, the Federal share with respect to any such project cannot exceed 90 percent. 11. Inclusion of land acquisition costs.-Section 306 of the bill would amend section 401 (e) of the Mental Retardation Facilities and Community Mental Health Centers Construction Act of 1963 to include the cost of land acquisition in the construction costs which may be assisted with funds made available under the Developmental Disabilities Services and Facilities Construction Act. 12. Inclusion of autism.-Section 307 of the bill would amend the definition of "developmental disability" in section 401 (1) of the Mental Retardation Facilities and Community Mental Health Centers Construction Act of 1963 to include in the State program for developmental disabilities individuals suffering from autism. 13. Increasing emphasis on de-institutionalization as a program objective.— Section 308 of the bill would amend section 130 of the Development Disabilities Services and Facilities Construction Act to express as a specific purpose of the Act's program of grants for planning, provision of services, and construction and operation of facilities for persons with developmental disabilities, the purpose of assisting in the elimination of inappropriate placement of persons with developmental disabilities in institutions. Section 134(b)(1)(4) of the Act would also be amended to require the States, in the State plan submitted to the Secretary, to provide assurance that funds will be made available for this purpose. TITLE IV-EFFECTIVE DATE 14. Section 401 of the bill would make it effective with respect to appropriations for fiscal years beginning after June 30, 1974, except that the new health services council would be established upon the bill's enactment. EXECUTIVE OFFICE OF THE PRESIDENT, Hon. HARLEY O. STAGGERS, Chairman, Committee on Interstate and Foreign Commerce, DEAR MR. CHAIRMAN: This is in response to your request of December 11, 1973 for the views of this Office on H.R. 11511, a bill "To amend the Public Health Service Act and related laws to revise and extend programs of health revenue sharing and health delivery, and for other purposes." In testimony before your Committee on February 14, 1974 the Department of Health, Education, and Welfare stated its reasons for recommending against enactment of H.R. 11511. The Department recommended, instead, enactment of the Administration's proposal entitled the "Health Services Amendments of 1974" which has been introduced as H.R. 12892. The Administration's bill would consolidate the separate legislative authorities of a number of categorical health programs under PHS Section 314(e), thus permitting flexibility in management and more efficient use of scarce Federal resources. We concur with the views expressed by the Department in its testimony. Accordingly, we recommend enactment of the Administration proposal in lieu of H.R. 11511. Enactment of H.R. 12892 would be in accord with the program of the President. Sincerely, Hon. HARLEY O. STAGGERS, WILFRED H. ROMMEL, Assistant Director for Legislative Reference. EXECUTIVE OFFICE OF THE PRESIDENT, OFFICE OF MANAGEMENT AND BUDGET, Chairman, Committee on Interstate and Foreign Commerce, House of Representatives, Washington, D.C. DEAR MR. CHAIRMAN: This is in response to your request of February 28, 1974, for the views of this office on H.R. 12892, a bill "To amend the Public Health Service Act, the Developmental Disabilities Services and Facilities Construction Act, and the Comprehensive Alcohol Abuse and Alcoholism Prevention, Treatment, and Rehabilitation Act of 1970, to revise and extend programs of health services, and for other purposes." H.R. 12892 is identical to a draft bill submitted to the Speaker of the House on February 13, 1974 by the Secretary of Health, Education, and Welfare. The bill would consolidate the separate health program authorizations for family planning, migrant health, neighborhood health centers and alcoholism under the Partnership for Health Act in order to permit maximum management flexibility and to continue Federal support for those services pending enactment of a comprehensive health insurance bill. H.R. 12892 would extend the Partnership for Health Act (PHS Section 314(e)) for three years and would also extend the Developmental Disabilities Act, with amendments, for two years. We concur with the views expressed by the Secretary of Health, Education, and Welfare in his transmittal letter. Accordingly, we recommend that the Com mittee give favorable consideration to the bill. Enactment of H.R. 12892 would be in accord with the program of the President. Sincerely, WILFRED H. ROMMEL, Assistant Director for Legislative Reference. Mr. ROGERS. Our first witness this morning is Dr. Charles Edwards, Assistant Secretary for Health of the Department of Health, Education, and Welfare. He is accompanied by Dr. Bertram Brown, Director of the National Institute of Mental Health; Dr. Paul Batalden, Acting Director of Community Health Services at HEW; and Dr. Louis Hellman, Deputy Assistant Secretary for Population Affairs; Mrs. Joan H. Miller, Deputy Assistant Secretary for Legislation (Welfare), DHEW; Mr. Harold O. Buzzell, Acting Director, Health Services Administration, DHEW; Roger O. Egeberg, M.D., Interim Administrator, Alcohol, Drug Abuse, and Mental Health Administration, DHEW; and Mr. Dale Sopper, Legislative Officer, Office of the Assistant Secretary for Legislation, DHEW. We welcome you to the committee. We will be pleased to receive your statement. STATEMENT OF DR. CHARLES C. EDWARDS, ASSISTANT SECRETARY FOR HEALTH, DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE; ACCOMPANIED BY JOAN H. MILLER, DEPUTY ASSISTANT SECRETARY FOR LEGISLATION (WELFARE); HAROLD 0. BUZZELL, ACTING DIRECTOR, HEALTH SERVICES ADMINISTRATION; DR. ROGER 0. EGEBERG, INTERIM ADMINISTRATOR, ALCOHOL, DRUG ABUSE, AND MENTAL HEALTH ADMINISTRATION; DALE SOPPER, LEGISLATIVE OFFICER, OFFICE OF THE ASSISTANT SECRETARY FOR LEGISLATION; DR. LOUIS HELLMAN, DEPUTY ASSISTANT SECRETARY FOR POPULATION AFFAIRS, OFFICE OF THE ASSISTANT SECRETARY FOR HEALTH; DR. BERTRAM S. BROWN, DIRECTOR, NATIONAL INSTITUTE OF MENTAL HEALTH, NATIONAL INSTITUTES OF HEALTH; DR. PAUL B. BATALDEN, ACTING DIRECTOR, BUREAU OF COMMUNITY HEALTH SERVICES, HEALTH SERVICES ADMINISTRATION; AND WILLIAM ESHELMAN, ACTING DEPUTY COMMISSIONER, REHABILITATION SERVICES ADMINISTRATION, SOCIAL AND REHABILITATION SERVICE Dr. EDWARDS. Thank you, Mr. Chairman. We appreciate this opportunity this morning to discuss with you and other members of your committee in general our views on the Federal Government's role in meeting the Nation's health problems and to present, in particular, our proposals for the programs addressed in H.R. 11511, the Health Revenue Sharing and Health Services Act of 1973. Together with the members of this subcommittee, we share the conviction that quality health care be available to all through the most efficient means we can develop. While we may have differing views on how best to achieve this goal or on how to allocate fiscal resources to achieve it, the Congress and the executive branch must work together to build a comprehensive and integrated health system to meet the health care needs of our population. Moreover, we believe that the |