Noise Pollution Control**

A program area which encompasses Programs that formulate, on a state- or
area-wide basis and after consideration of constraints and initiatives, how best
to use resources, to achieve priority objectives derived from a study of health
problems and needs against a background of society's goals and missions.
(This type of health planning is distinguished from planning for a health
agency or for a Program operated by a health agency.)

2 Environmental Control and Consumer Protection Services

Two frequently interrelated program areas which encompass programs that
benefit individuals by providing services designed to ensure a healthful en-
vironment and to protect the health, safety and economic well-being of con-
sumers in such areas as food (including feeds), drugs, cosmetics, devices, and
hazardous substances.

3. Facilities Certification and Development

A program area which encompasses Programs that benefit individual and
groups of individuals by ensuring that services are furnished in accordance
with acceptable health care standards. These Programs are directed at organi-
zed providers of direct health care services, of health support services, and,
in some instances, of services that are not primarily for health care purposes
but that have health components. The Programs focus on: establishing,
amending and implementing standards for quality of health care services and
environments; the adequacy of supply of such services; the suitability of their
distribution and use; the reasonableness of their costs; and the proper coordi-
nation among the various levels and kinds of providers of services.

4. Health Manpower Regulation

A program area which encompasses programs that benefit individuals by pro-
viding for the regulation of a health or health-related program (profession or
occupation) by a legally established unit of government through a system of
licensure, registration, certification, permit or similar procedure under statu-
tory control and/or established rules or regulations.

5. Inventory

A listing, by State or Territory, of all Programs and support Units operated
and sponsored by state and local health departments during the Reporting
Period July 1, 1972-June 30, 1973 and all Programs initiated or to be initiated
and terminated or to be terminated during the period July 1, 1973-June 30,
1974. Environmental Control Programs conducted and sponsored by other
than state and local health departments are incorporated into the Inventory
whenever possible. The Inventory, which also indicates the extent of a health
department's responsibility in the conduct of a Program, has been designed to
enable the departments to list for the HPRS Project their Programs and Units

as they are identified in the agencies and to make it possible for the HPRS Project staff to present the universe of all state and local programs in a meaningful national framework.

6. Operational Codes

Codes used to indicate, for each Program and Unit: (1) the placement of
management responsibility for the program or unit; (2) the type of legal
authority under which the program or unit operates, (3) the placement of
financial responsibility for program or unit funding, and (4) private agency
responsibility.

7. Preventive and Personal Health Services

A program area which encompasses Programs that provide services for the di-
rect personal benefit of individuals and groups of individuals. The services
are rendered by providers (physicians, nutritionists, nurses, psychologists,
social workers, etc.) directly to consumers (people). The distinction between
Preventive and Personal Health Services Programs and Mental Health Care
Programs is one of professional emphasis, approach and a few traditional
techniques rather than one of basic relationships between providers and con-
sumers of services. The distinction is made for practical, rather than philosophi-
cal, reasons. Consequently, separate definitions are not provided.
8. Program

A set of identifiable services organized to solve a health or health-related
problem or to meet a specific health or health-related need, provided to or on
behalf of the public by or under the direction of an organizational entity in
a state or local agency, and for which reasonably accurate estimates of re-
sources expended may be obtained. Initiated programs are those that have
been initiated after June 30, 1973, or that are scheduled for initiation prior
to July 1, 1974. Terminated programs are those that have been terminated,
or are slated for termination during the next reporting period, July 1, 1973-
June 30, 1974.

9. Unit

A set of identifiable activities organized to support programs within a state or
local agency, conducted separately from a single program, and for which a
separate budget exists. The "Unit" may offer support, including coordina
tion, consultation and/or supervision to "Programs". As distinguished from a
"Program", a Unit does not provide direct services to, or on behalf of, the
public.

Examples of such units appearing in the 1972 HPRS Inventory are: laboratory
services, nutrition, nursing, medical social services, local health services, statis-
tical services, health education, home health services coordination, division of
legal services, public information office, visual aids, library, administration,
division planning, personnel services, program analysis, central stores, repairs
and maintenance, general services section, training, purchasing, budget and
finance, internal audit, data processing.

35

1

Mr. ROGERS. Thank you for a very thoughtful statement, Mr. Reizen.

I think the committee would be impressed with your argument about title I. Of course, it will require some balancing of funding which you understand.

As I understand, your feeling is that it could be done over a number of years. The committee will give consideration to that and will go over what you have proposed.

Dr. REIZEN. That is a pretty weighty proposal. I believe we would be prepared to defend it.

Mr. ROGERS. Yes; it might be well to have legislative language submitted to the committee to carry out what you are proposing. I think it would be very helpful.

Mr. ERVIN. I Would be glad to work on that detail at any level the staff wishes.

Mr. ROGERS. It would be helpful if you could submit some language to Mr. Lawton, the committee counsel.

[The following proposed language was received for the record:]

PROPOSED REPLACEMENT OF SEC. 314(d)

(1) Authorization of appropriations.

(A) There are authorized to be appropriated $200,000,000 for the fiscal year ending June 30, 1975, $300,000,000 for the fiscal year ending June 30, 1976, $400,000,000 for the fiscal year ending June 30, 1977, and $500,000,000 for the fiscal year ending June 30, 1978, which the Secretary shall use to pay to each State a Federal percentage share of expenditures by the State and its political subdivisions in establishing and maintaining adequate public health services, including the training of personnel for State and local health work.

(B) The sums so appropriated shall be used for reimbursing States and their political subdivisions which have submitted and had approved by the Secretary an acceptable report of required and allowable public health services provided and their cost.

(2) Required and allowable health services shall consist of those services provided pursuant to authorization by State or local government including those services specifically required by this section or by regulation promulgated by the Secretary with the approval of the Public Health Council, and excluding those services specifically excluded by this section or by regulation promulgated by the Secretary with the approval of the Public Health Council. (3) Payments to States.

(A) From funds appropriated under this subsection for a fiscal year, the State shall be paid the Federal share of the expenditures incurred during such year under its report approved under this subsection. Such payments shall be made from time to time in advance on the basis of estimates by the Secretary of the sums the State will expend under the State report, except that such adjustments as may be necessary shall be made on account of previously made underpayments or overpayments under this subsection.

(B) For the purpose of determining the Federal share for any State, expenditures by nonprofit private agencies, organizations, and groups shall, subject to such limitations and conditions as may be prescribed by regulations, be regarded as expenditures by such State or a political subdivision thereof.

(4) Conditions. As a condition to the approval of a grant under this subsection a State must:

(A) Make such reports in such form and containing such information as the Secretary, with the approval of the Public Health Council, may from time to time reasonably require and keep such records and afford such access thereto as the Secretary finds necessary to assure the correctness and verification of such reports.

(B) Pay to its political subdivisions which have submitted an approval report the Federal share of their expenditures in providing required and allowable services.

(C) Provide public health services in accordance with standards prescribed by regulation including standards as to the scope and quality of such services.

(5) Federal share.

(A) The "Federal Share" for any State for purposes of this subsection shall be 100 per centum less than 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 United States; except that in no case shall such percentage be less than 40 per centum or more than 60 per centum and except that the Federal share for the Commonwealth of Puerto Rico, Guam, American Samoa, the Trust Territories of the Pacific Islands and the Virgin Islands shall be 60 per centum.

(B) The "Federal Share" for any State may not exceed a per capita ceiling which shall be a dollar figure equal to its Federal Share multiplied by 10 (e.g., 40% Federal share -.40×10=$4.00) except that in no case shall such per capita ceiling be more than $6.00 nor less than $4.00.

(C) The "Federal Share" shall be determined by the Secretary between July 1 and September 1 of each year, on the basis of the average per capita incomes of each of the States and of the United States for the most recent year for which satisfactory data are available from the Department of Commerce, and such determination shall be conclusive for the fiscal year beginning on the next July 1. The populations of the several States shall be determined on the basis of the latest figures for the population of the several States available from the Department of Commerce.

(6) Maintenance of effort.

The total combined funds of a State and its political subdivisions expended for required and allowable public health services shall be no less in any year than in the year immediately prior to enactment of this section, and until such time as the "Non-Federal Share" of such expenditures equals or exceeds the funds of the State and its subdivisions for such services in such year the "Federal Share" shall be reduced to the amount the State received in the year prior to enactment of this section, plus 75% of the amount by which such expenditures were increased over the amount expended in such year.

(7) Services required, allowable and excluded.

(A) The Secretary with the approval of the Public Health Council shall require as a condition of eligibility under this section that a State or a political subdivision provide the following services to all persons within the State in accordance with standards of scope and quality prescribed by regulation:

(1)

(2)

(3)

(B) The State and, through the State, its political subdivision shall be reimbursed under this section for the "Federal Share" of expenditures of State and local funds for any public health services authorized by the State or its subdivision to be conducted by or under the direction of a State or local public health agency except for the following and any other services specifically excluded by regulation promulgated by the Secretary with the approval of the Public Health Council:

(1) Inpatient care

(2) Outpatient care in hospitals

(3) Services the cost of which is reimbursable from another source such as fees for services or another Federal program

(4) Capital expenditures for facilities

(5) Expenditures used to match other Federal grants

(8) Public Health Council.

(A) The Secretary shall appoint a Public Health Council composed of (1) recognized experts in public health administration, including persons representative of State and local governments, (2) representatives of consumers of public health services, to advise and assist him in administering this section and in evaluating the effectiveness of State and local public health services.

(B) The Council shall advise the Secretary in the development of and approve proposed regulations under this section relating to determining the universe of services for which the Federal government will pay a "Federal Share" and the minimum required standards for such services.

(C) The Secretary shall submit to the Congress on or before January 1 of the year in which the authorization for grants under this section expires, a report of the findings, conclusions and recommendations of the Public Health Council with respect to needed legislation to effectively protect the public health. Members of such committee who are not otherwise in the employ of the United States,