In addition, the two following methods should be mentioned. The Copper Intrauterine Devices (IUDs), the T and 7, have proved superior to the older devices in effectiveness, retention and diminution of adverse reactions. These devices partially developed with Federal funds, will be on the market shortly.

Mr. ROGERS. How many projects will have to be closed or changed as a result of your 1975 budget?

Dr. HELLMAN. None will be closed. We are going to consolidate projects. We are down to between 300 and 400 projects now with about 3,000 clinics in operation.

Mr. ROGERS. Will the same number of people be covered?

Dr. HELLMAN. No. We will be able to increase the coverage because of third-party payment.

Mr. ROGERS. How much do you expect to get in?

Dr. HELLMAN. We estimate between 15 and 20 percent.

Mr. ROGERS. You can get third-party payments for family planning? Dr. HELLMAN. Yes.

Mr. ROGERS. This is true with most insurance policies?

Dr. HELLMAN. Under the Federal assistance programs, medicaid and the Social Security Act, title IV-A, Aid to Families With Dependent Children.

Mr. ROGERS. But not under any other insurance policies?

Dr. HELLMAN. Under the proposed health insurance plan.

Mr. ROGERS. That is some time off, I presume.

Dr. HELLMAN. I hope it is not too far off.

Mr. ROGERS. That remains to be seen but I don't think we can count on it solving all of our problems this year.

Dr. HELLMAN. I think we have been successful in increasing our third-party payment. I would estimate that by 1976 we can go as high as 35 percent.

Mr. ROGERS. That is excellent. I think from what we hear, the family planning program is successful. Do you think it should be continued?

Dr. EDWARDS. Absolutely. I think Dr. Hellman and his associates have done an outstanding job. It certainly is one of our showcase programs.

Mr. ROGERS. Do you have any new starts for the year?

Dr. EDWARDS. No new starts but it is going to be possible for hospitals to start up new programs under the public assistance programs if they want and certainly under the proposed health insurance programs.

We are in 2,625 counties out of 3,074 counties in the United States right now.

Mr. ROGERS. I wondered, since it has been a success and you demonstrated it so, why didn't we take the same position on family planning as we did on community mental health centers? That has been demonstrated as successful and you don't think we need to do any more. If this is successful, why do we need to do more here?

Dr. EDWARDS. The intent of the programs is different. We are talking about a sector of our population that we recognize as a Federal financial responsibility, the family planning services. The intent of the two pieces of legislation is considerably different.

Mr. ROGERS. It virtually goes to the same category of people. If you analyze the economic groups that are using the community mental health centers, I think you will find that they are very similar to those that are using the services of the family planning.

Dr. EDWARDS. There is a similarity.

Mr. ROGERS. Could we get those facts in the record?

[The following information was received for the record:]

CHARACTERISTICS OF WOMEN SERVED IN ORGANIZED FAMILY PLANNING PROGRAMS

INCOME CHARACTERISTICS

Data on income and family size are available for 800,000 women served in FY 1973 has been used to project the family income level of all individuals served in organized programs.

ESTIMATED NUMBER OF WOMEN SERVED IN ORGANIZED PROGRAMS BY INCOME LEVEL

1 Poverty income for a nonfarm family of 4 in March 1973 was $4,300.

2 125 percent of poverty for a nonfarm family of 4 in March 1973 was $5,375.

3 150 percent of poverty for a nonfarm family of 4 in March 1973 was $6,620.

Note: The table above shows an estimated 2,300,000 of the total 3,200,000 women served by organized family planning programs in fiscal year 1973 were members of families with incomes at or below 150 percent of poverty and that over 50 percent were members of families with incomes less than the poverty level.

Dr. HELLMAN. I would like to add something to what Dr. Edwards has just said.

This is sort of a philosophical statement. We used the categorical family planning program to establish a service capacity where none existed before. We have built a cadre of people and a capacity to provide a medical service. I don't think the Federal Government should permanently provide categorical support for family planning.

Sooner or later family planning is going to have to be phased into the comprehensive health care system where it belongs. I think, therefore, we ought to make plans and develop legislation that is flexible enough to permit the phasing of family planning into the health care system.

Mr. ROGERS. There is no reason why that can't be done now. Wherever you do have funds, you should use them.

Dr. HELLMAN. We have made efforts in that direction.

Mr. ROGERS. I assume you are combining with all other health services where possible?

Dr. HELLMAN. Yes, but a lot of family planning facilities are isolated.

Mr. ROGERS. I understand. This is one of the reasons I was glad to hear you say you support getting programs going and getting emphasis. Often you need to categorize.

Dr. HELLMAN. That is right.

Mr. ROGERS. This is what we have learned in the Congress over a number of years. Many people don't understand that concept yet. Dr. EDWARDS. The integration of some of these programs into the health care system is only going to come when we get a national health plan.

Mr. ROGERS. We understand that. That is why we need to categorize. That is why we have categorized and that is why we will continue to categorize in many areas.

Dr. EDWARDS. What we are arguing for is more flexibility in the categories.

Mr. ROGERS. Mr. Symington.

Mr. SYMINGTON. Mr. Chairman, the hour is late but I wanted to ask, is it really an appropriate Federal role, Dr. Edwards, to assist the States in meeting their health costs? Can we agree that that is an appropriate role of the Federal Government?

Dr. EDWARDS. I would certainly feel that it is an appropriate role,

yes.

Mr. SYMINGTON. So that 314-D has a place. But if so, why shouldn't it be increased at least to offset inflation?

Dr. EDWARDS. As I have said before it is difficult for us to argue specific numbers. This all fits into an overall total number of dollars that we had and we are hopeful that we can maintain at least current funding by the recirculation or bringing into the system third-party payments, management efficiencies, and other economies.

We can always argue why we don't have more dollars. It is difficult for me to argue against that concept for some of these programs.

Mr. SYMINGTON. In working with 314-D or in conceptualizing, do you think perhaps there ought to be some kind of a fixed percentage that it attempts to meet of States' health costs? Should we even be aware of what percentage it is meeting and perhaps try not to let it go below a certain percent or to adhere to a 10-percent level or something like that?

Should you be aware of it?

Dr. EWARDS. That certainly would be a possible approach, but would be difficult because of the great variations in States. We must consider the State requirements, the State effort, et cetera.

Mr. SYMINGTON. Maybe it would be a good idea to mention States. Maybe, for the record, you could give a breakdown of State expenditures for the purposes of meeting health costs over the past 2 or 3 years. That would indicate how much and what kind of escalation they have engaged in and, then, perhaps you could relate to that, their share of the 314-D funds.

Dr. EDWARDS. We can provide that information.

Mr. SYMINGTON. Can you do that by March 1?

Dr. EDWARDS. Yes, we will try. We can easily provide that kind of information.

Mr. SYMINGTON. Thank you.

[The information requested was not available to the committee at the time of printing-October 1974.]

Mr. ROGERS. How much is in the budget for community mental health center's?

Dr. BROWN. Approximately $172 million for staffing of community mental health centers and an additional $27 million for child mental health grants.

Mr. ROGERS. Are there any new starts?

Dr. BROWN. No new starts contemplated.

Mr. ROGERS. Would there be any closures?

Dr. BROWN. No, there will be no closures. There will be a group of graduating centers which have reached their eighth and final year of Federal funding; 32 centers will terminate funding in fiscal year 1974 and 39 centers will terminate funding in fiscal year 1975.

Mr. ROGERS. Will there be any need for financial distress grants perhaps to get the mover some period of adjustments from Federal support to no Federal support?

Dr. BROWN. I would estimate that a third of the centers would be able to continue fully on their own. A third of the centers may have to curtail some services, such as consultation and education services. Perhaps one-third of the centers will have serious financial difficulties, but will not close.

Mr. ROGERS. So it might be well to have some flexibility to have them include some financial distress grants in those instances where they are in financial trouble?

Dr. BROWN. There are three tools available to help those centers: Compassion, technical assistance, and money.

Mr. ROGERS. I notice they don't much care for compassion or technical assistance as much as they do money. I presume you would agree with that?

Dr. EDWARDS. We have to be careful about the compassion. It is not hard to get compassion for our programs but as I said earlier, we don't want any of these good programs to close.

Mr. ROGERS. All right. Dr. Brown, would you comment on some of these new programs? Would you agree with the new definition? Dr. BROWN. For the most part, yes.

Mr. ROGERS. Let us know where you disagree. With the prohibition against growth grants?

Dr. BROWN. No, I don't agree with that prohibition though I do feel priority for new starts is important. So I believe the committee might wish to reevaluate the prohibition against growth grants.

Mr. ROGERS. I think we should have some modifying language with the 5- instead of 8-year cutoff for initial operating money.

Dr. BROWN. Yes, I agree.

Mr. ROGERS. With the consultation and education section which encourages these services.

Dr. BROWN. Yes, because at issue here is how the centers can best support indirect services which are not provided for in third-party financing mechanisms. It is a very special problem having to do with indirect or nonpatient care funding.

Mr. ROGERS. With the State plan section?

Dr. BROWN. Yes.

Mr. ROGERS. Dr. Edwards, I presume if the Congress provides money for new centers, it will be carried out?

Dr. EDWARDS. It certainly will.

Mr. ROGERS. Or will we have to go to court again?

Dr. EDWARDS. No, I think I can speak for the Department that we intend to

Mr. ROGERS [continuing]. Carry out the law and the intent of the Congress?

Thank you.

Mr. HEINZ. Would you yield, Mr. Chairman?

Mr. ROGERS. Yes.

Mr. HEINZ. Dr. Brown, in your judgment, would you receive an abundance of applications to start community mental health centers in those catchment areas not currently served if no construction money and only staffing money were available?

Do you think there would be sufficient local or nonprogrammatically oriented sources of construction money available to communities who wanted to start a community mental health center?

Dr. BROWN. If there is available only a limited amount of dollars, I would use it for funding staffing grants rather than construction grants. However, there are some situations where construction funds would be required before a staffing program could be initiated. For example, if there was not an inpatient ward at the general hospital, to care for psychiatric patients, no amount of creativity could create the needed treatment. Therefore, a certain amount of construction funds are essential, but staffing funds should have priority.

Mr. HEINZ. Thank you.

Mr. ROGERS. I presume that you will carry out the court order release of money for 80 new starts in the community mental health centers and they will go forward?

Dr. BROWN. Yes, they will.

Mr. ROGERS. Mrs. Miller, what objectives are you pursuing with the grants of national significance funded from moneys set aside out of the amount appropriated for State formal grants?

Mrs. MILLER. I can give you some examples of that. There is a child advocacy project where RSA has joined with the Bureau of Education of the Handicapped and NIMH to support child advocacy projects.

There is a legal advocacy which we can describe for the record where the Rehabilitation Services Administration has joined with the Bureau of Education of the Handicapped to support a legal advocacy project. We have provided technical assistance to State councils with a grant to the University of North Carolina. There is a national grant to UCLA for developing an information data base for the developmentally disabled. We have a number of these types of projects.

Mr. ROGERS. I think you could give us the answer to this for the record and the examples of what has happened.

[The information requested was not available to the committee at the time of printing-October 1974.]

Mr. ROGERS. How much will have been obligated for projects of national significance for fiscal 1974?

Mrs. MILLER. About $4 million for 1974.

Mr. ROGERS. What percentage of each year's appropriations for the formula grant was set aside for this purpose?

Mrs. MILLER. I think it is about 9 percent. For 1974, it is 5.2 percent. Mr. ROGERS. What would that amount be in dollars?

Mrs. MILLER. In 1974, it is $1,606,250.

Mr. ROGERS. Are the State planning and advisory councils set up under Public Law 91-517 playing a useful role?

Mrs. MILLER. Yes. I think there has been an evaluation of this effort. and it has been pointed out that these councils have helped in education at State and local levels, especially with State legislatures.

Mr. ROGERS. I have a question I want you to answer about the business whereas you know the administration wanted us to have the law cover the retarded, cerebral palsy, epileptic, plus other neurological conditions found by the Secretary to be related.

That was recommended to this committee in 1970. Now 4 years later, it seems to be silent on what the other conditions are. Can you explain that or give us some explanation?