Answer. It was not necessary to revise the original space estimates for the Beckley and Welch (W. Va.) offices because of the enactment of the medicare program. The sites for these offices have been acquired. In addition, the first phase of the design work has been completed. The General Services Administration advises that these offices should be in construction by late calendar year 1966. The buildings should be completed in the fall of 1967.

5. Question. Similarly, the award of a design contract for the district office building at Wheeling has been delayed for reasons of space requirements. Has this been settled? Can you supply for the record a report on the design and construction of this building?

Answer. It was necessary to revise the space requirements for the Wheeling (W. Va.) office as a result of the enactment of the medicare program. Added funds were provided in the 1966 supplemental appropriation enacted in October 1965 for a larger office. The site for Wheeling, W. Va., has been selected and the General Services Administration is negotiating its purchase. Space and design criteria have been firmed up and forwarded to the regional offices of the General Services Administration, which will negotiate a contract for architect services. Assuming that the site is acquired by May 1, 1966, and a normal schedule of 7 months for design and 12 months for construction is followed, the building would be ready for occupancy by December 1967.

6. Question. Do you have plans for the construction of other district office buildings in West Virginia?

Answer. No additional locations in West Virginia have been identified as of this date.

7. Question. In regard to the administration of the medicare program, do you foresee a need for additional hospital or nursing home facilities in West Virginia?

Answer. According to Public Health Service data, West Virginia does not now have an adequate number of hospitals or nursing homes. The medicare program will cause some increase in the demand for these facilities. Under the program if existing facilities are expanded or new ones constructed, the program will pay its proportionate share of the operating costs of the enlarged or new facility. In addition, the principles of reasonable cost reimbursement will include payment for depreciation (on new facilities as well as old), interest on capital indebtedness, and interest on current indebtedness. We believe that these reimbursement provisions will contribute toward the needed expansion of health care facilities.

8. Question. Can you supply for the record, the anticipated need for added equipment at West Virginia hospitals and nursing homes to carry out the provisions of the medicare program?

Answer. No. To our knowledge no surveys of hospital and nursing home equipment needs have been conducted in West Virginia. We are, therefore, unable to supply for the record the anticipated need for added equipment in West Virginia facilities.

9. Question. Will the Social Security Administration issue a report on priorities which should be given to States which need the greatest assistance from HillBurton or other Federal aid programs to meet hospital and nursing home needs? Answer. In administering the health insurance program the Secretary has assigned to the Public Health Service the principal responsibility for the professional health apects of the program. This responsibility includes conducting studies of the adequacy of existing facilities for health care of the aged. As part of its ongoing responsibilities, the Public Health Service is responsible for collecting, interpreting, and publishing data concerning the health requirements of the Nation, including the requirements for health care facilities of all types. The Service works closely with the States and communities in informing them of the results of its ongoing studies of the need for facilities, and under the HillBurton program it assists them in planning of health facilities through special project grants and grants for the construction of new facilities or modernization or replacement of existing facilities.

In addition to the Hill-Burton program, West Virginia will be receiving special attention through the Appalachia project.

10. Question. Can you supply for the record the estimated number of persons in West Virginia who may qualify for social security benefits under the terms of the so-called Prouty amendment providing coverage for persons over 72 and who previously had not participated in the program?

Answer. Under the provisions for payment of monthly benefits contained in section 228 of the Tax Adjustment Act of 1966, it is estimated that 4,500 persons in West Virginia can receive benefits which are first payable for the month of October 1966.

11. Question. Again, in regard to medicare, can you supply for the record a report on the availability of medical personnel-both professional and technicians in West Virginia to administer the program?

Answer. We assume here that the question refers to the number of medical personnel available to supply services under the medicare program. The Public Health Service computes the projected need for additional health professional and technical personnel by comparing the number of health care personnel in a State against the average per capita for the United States. The Public Health Service data indicates that West Virginia needs an additional 250 dentists, 2,700 nurses, 500 pharmacists, and 850 M.D.'s to reach the national average. No data are available on how many additional physicians, dentists, and nurses are estimated to be needed as a result of the medicare program.

12. Question. Also, if a shortage of personnel of this type is discovered, will the Social Security Administration recommend training programs to meet this need. Could these programs be started at the high school level?

Answer. As indicated above, the Public Health Service has been assigned the basic responsibility for the professional health aspects of the health insurance program. In carrying out this responsibility, it will review the adequacy of and need for trained health personnel, the utilization of health services, and the quality of health manpower. It will encourage the future development of programs structured to make available the resources and requirements for meeting the needs in those areas. In evaluating those needs, the Service would, as part of its total program, take into consideration the practicability of starting health personnel training programs at all educational levels, including high school. In fact, there currently exist programs of summer employment for high school students aimed at encouraging them to select a health professional career.

The Public Health Service now makes grants in support of several programs aimed at closing the gap in health professional manpower requirements. The Social Security Administration fully endorses these programs which will help to provide trained professional health personnel to assist in meeting the impact of medicare. The program attacks the problem in two ways. One, by increasing the numbers of professionals being graduated each year, and two, by training paramedical and nonprofessional personnel to carry out specific procedures under the supervision of professional personnel, thereby making the professionals' time more productive.

SUBCOMMITTEE RECESS

Senator HILL. All right, anything else any of you gentlemen would like to add?

Mr. FUTTERMAN. No, sir.

Senator HILL. Well, you have brought us an awfully good state ment, and we appreciate it very, very much. We want to thank you. Mr. BALL. Thank you, sir.

Senator HILL. Do you want to say anything, young lady?

Mrs. TYSSOWSKI. No, sir.

Senator HILL. Thank you, all of you, very much.

The subcommittee will now stand in recess.

(Whereupon, at 12:15 p.m., Monday, March 28, 1966, the hearings were recessed until 10 a.m., Wednesday, March 30, 1966.)