(b) Section 1 of the Public Health Service Act is amended to read as follows: "SHORT TITLE "SECTION 1. Titles I through VIII, inclusive, of this Act may be cited as the 'Public Health Service Act'." SEC. 4. Effective as of July 1, 1963, sections 303 and 304 of the Public Health Service Act are repealed. EXECUTIVE OFFICE OF THE PRESIDENT, BUREAU OF THE BUDGET, Washington, D.C., March 22, 1963. Hon. OREN HARRIS, Chairman, Committee on Interstate and Foreign Commerce, DEAR MR. CHAIRMAN: This is in response to your request for the views of the Bureau of the Budget on H.R. 3688, a bill to provide for assistance in the construction and initial operation of community mental health centers, and for other purposes. This bill would authorize appropriations for Federal grants to assist in the construction and initial operation of comprehensive community mental health centers. The bill would carry out recommendations of the President pertaining to mental illness in his special message to the Congress on mental illness and mental retardation. As the President indicated in his message, if a broad new mental health program such as he has suggested is enacted, it will be possible within a decade or two to reduce the number of patients now under custodial care in State mental institutions by 50 percent or more. Accordingly, the major purpose of the President's proposals is to encourage the development of comprehensive community mental health centers "which will return mental health to the mainstream of American medicine." You are advised that enactment of H.R. 3688 would be in accord with the President's program. Sincerely yours, PHILLIP S. HUGHES, Assistant Director for Legislative Reference. COMPTROLLER GENERAL OF THE UNITED STATES, Hon. OREN HARRIS, Chairman, Committee on Interstate and Foreign Commerce, DEAR MR. CHAIRMAN: Your letter of February 22, 1963, acknowledged February 25, transmitted copies of H.R. 3688 for our comments. The bill is to provide assistance in the construction and initial operation of community mental health centers. Title I of the bill provides in accordance with the format of the Public Health Service Act, authorization for grants by the Secretary of Health, Education, and Welfare for the purpose of assisting public and nonprofit agencies in a program of constructing community mental health centers. The grant program authorized is for the 5-year period beginning July 1, 1964, and ending June 30, 1969. Title II of the bill authorizes grants for the establishment and initial operation of comprehensive community health centers to public and nonprofit agencies or organizations who have constructed such facilities under grants made under title I. These grants specifically are to assist in meeting the cost of initial staffing of community mental health centers and are to be in reducing amounts for each year of operation for a total period of 4 years and 3 months after commencement of operations. This Office has no special information concerning the subject matter of the proposed legislation and, therefore, we have no recommendation to make on the merits of the bill. In our review of the proposed legislation, however, we observed certain matters which we feel should be brought to the attention of the committee. Section 102(c) provides that, at the request of any State, a specific portion of its allotment under title I of the proposed bill may be added to the allotment of the State under title II of the Mental Retardation Facilities Construction Act of 1963 (H.R. 3689) if certain conditions are met. This authority could result in weakening the effectiveness of the budgetary and appropriation processes because substantial Federal grants could be used by the States in amounts that might vary considerably from the amounts that would be included in the Federal appropriation for each program. Consideration should be given to the placing of specific limitation on the amounts of allotments eligible for transfer between the two programs. Also we should like to point out that this subsection, by its reference to title II of the Mental Retardation Facilities Construction Act of 1963, which referenced "act" is presently in bill form, would be without effect in the event the referenced "act" failed of enactment. We are making similar comments in our report to your committee on S. 3689 respecting like provisions. Title II of the bill provides for grant assistance to meet the costs of initial staffing of the comprehensive community mental health centers the construction of which is to be assisted under title I of the bill. However, the bill does not define "initial staffing" in terms of the types of costs that would be eligible for Federal assistance nor does it indicate the extent to which fees received by the operators of the centers are to reduce the Federal grants for initial staffing. We suggest that these matters be specifically covered in the bill. The proposed legislation providing grant assistance for construction of centers under title I does not appear to embrace any community mental health centers already under construction. Additionally the grants provided under title II for the initial staffing costs appear to cover only agencies which have received Federal assistance under title I and would not benefit agencies otherwise operating mental health centers. No provision is made in the bill nor in legislation applicable to other grant programs now authorized by the Public Health Service Act, as amended, to require a grantee to keep adequate cost records of the projects to which the Federal Government makes financial contributions, or specifically authorizing the Secretary of Health, Education, and Welfare or the Comptroller General to have access to the grantee's records for purposes of audit and examination. In view of the increase in grant programs over the last several years we feel that in order to determine whether grant funds have been expended for the purpose for which the grant was made the grantee should be required by law to keep records which fully disclose the disposition of such funds. We also feel that the agency as well as the General Accounting Office should be permitted to have access to the grantee's records for the purpose of audit and examination. We therefore suggest that consideration be given to amending the bill to include such requirements with respect to the proposed new program, or preferably to an amendment of the Public Health Service Act to cover all grant programs therein authorized. The latter could be accomplished by the following language: "RECORDS AND AUDIT "(a) Each recipient of assistance under this Act shall keep such records as the Secretary of Health, Education, and Welfare shall prescribe, including records which fully disclose the amount and disposition by such recipient of the proceeds of such grants, the total cost of the project or undertaking in connection with which such funds are given or used, and the amount of that portion of the cost of the project or undertaking supplied by other sources, and such other records as will facilitate an effective audit. "(b) The Secretary of Health, Education, and Welfare and the Comptroller General of the United States or any of their duly authorized representatives shall have access for the purpose of audit and examination to any books, documents, papers, and records of the recipients that are pertinent to the grants received under this Act." In administering the above provision we do not contemplate making a detailed examination of the books and records of every recipient of a grant, or even a major part of them. However, selective checks may be made to provide reasonable assurance that grant funds are being properly applied or expanded. Sincerely yours, JOSEPH CAMPBELL, Comptroller General of the United States. Hon. OREN HARRIS, DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE, Chairman, Committee on Interstate and Foreign Commerce, DEAR MR. CHAIRMAN: This letter is in response to your request of February 22, 1963, for a report on H.R. 3688, a bill to provide for assistance in the construction and initial operation of community mental health centers, and for other purposes. This bill embodies a legislative proposal submitted to the Congress by this Department and designed to carry out the President's recommendation for the development of comprehensive community mental health programs contained in his message to the Congress on mental illness and mental retardation. (A copy of our letter of February 11, 1963, to the Speaker is enclosed herewith.) For the reasons stated in the President's message and in our letter to the Speaker, we strongly urge enactment of this bill. A 5-year estimate of the cost of this bill, as required by Public Law 801, 84th Congress (5 U.S.C. 642a), was transmitted to you on March 4, 1963. Sincerely, WILBUR J. COHEN, Assistant Secretary. Washington, February 11, 1963. DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE, Hon. JOHN W. MCCORMACK, DEAR MR. SPEAKER: I am enclosing for your consideration a draft of a bill to provide for assistance in the construction and initial operation of community mental health centers, and for other purposes. This legislative proposal is designed to carry out the President's recommendations for the development of comprehensive community mental health programs contained in his message to the Congress on mental illness and mental retardation. The draft bill would authorize inauguration of Federal grant programs aimed at stimulating and assisting States and communities in developing communitycentered mental health programs. Title I authorizes construction grants to provide the basic facilities required for such programs. Title II authorizes short term operating grants to help ease the financial impact on communities which undertake the initiation of comprehensive community health programs. TITLE I-CONSTRUCTION OF COMMUNITY MENTAL HEALTH CENTERS Title I would establish a 5-year grant program to assist in the construction of public and other nonprofit community mental health centers-i.e., facilities for the prevention, diagnosis, or treatment of mental illness or for the rehabilitation of persons recovering from mental illness. Appropriations of such sums as Congress may determine would be authorized during the period July 1, 1964, through June 30, 1969. Funds would be allotted among the several States on the basis of population, extent of need for community health centers, and the financial need of the respective States, with a minimum of $100,000 for any State. States would be given the alternative of varying the Federal share of the costs of construction of projects, on the basis of standards set by the State, between 45 percent and 75 percent or of choosing a uniform Federal share which would not be less than 45 percent and could go as high as 75 percent for some States for all projects in the State. Applications would be submitted to the Secretary of Health, Education, and Welfare after approval by the State agency designated to administer the State plan for purposes of this title of the bill. A State advisory council, composed of representatives of State agencies, and of nongovernment organizations or groups, concerned with planning, operation, or utilization of community mental health centers or other mental health facilities, as well as representatives of consumers of services provided by such centers or facilities, would consult with the State agency in carrying out the State plan. The plan would have to set forth a construction program based on a survey of need for the centers and provide for construction in accordance with relative need for the centers insofar as permitted by available financial resources. The State plan would also have to meet several other requirements set forth in the 98493-63-3 bill, such as requirements for proper and efficient methods of administration, hearings for unsuccessful applicants, and standards for maintenance and operation of facilities. Eligibility for grants would be limited to projects which alone, or in conjunetion with other facilities owned or operated by the applicant, or affiliated or associated with the applicant, will provide, principally for persons residing in or near the particular community or communities in which such center is situated those essential elements of comprehensive mental health services which the Secretary prescribes in accordance with regulations. The priority of projects to be approved would be based on the relative need of the different areas in the State, and special consideration would be given to those projects which will be part of or closely associated with a general hospital and projects which alone, or in conjunction with other facilities owned or operated by the applicant or affiliated or associated with the applicant, will provide comprehensive mental health services for a particular community or communities. TITLE II-INITIAL STAFFING OF COMPREHENSIVE COMMUNITY MENTAL HEALTH CENTERS The provisions of title II have a dual objective. First, they recognize that the shifting of focus in the prevention and treatment of mental illness to community centered programs will require the development of new or revised methods of financing such services, and that during this transitional period some temporary operating aid to communities will be required. Second, these provisions are designed to stimulate and encourage the establishment of comprehensive, coordinated mental health services. One of the primary reasons for focusing on community centered programs is that it is only in such programs that services for persons at different stages in a progressive care program can be effectively provided and coordinated. Since the initiation of such a comprehensive community program will place the greatest financial burden on the community for the operation as well as the construction of mental health centers— special project grants to meet part of the initial staffing costs of such centers are authorized by this title. Eligibility for project grants for this purpose would be limited to facilities for which a grant has been made under title I, operated by public or nonprofit agencies which will provide—as a minimum-diagnostic services, inpatient care, outpatient care, and all day care for the mentally ill persons. The provisions relating to duration and amount of grants underscore the concept of temporary Federal aid, with no continuation of Federal operating assistance after the center has been fully established as a going concern in the community. For the first 15 months of the center's operation the Federal grant may not exceed 75 percent of the staffing costs of the center, and for the following 3 years the Federal participation in such costs may not exceed 60 percent, 45 percent, and 30 percent, respectively. To assure coordination between this grant program and certain mental health project grants authorized under the Public Health Service Act, provision is made in this title for consultation by the Secretary with the National Advisory Mental Health Council in the development of regulations concerning eligibility of institutions and the terms and conditions for approving applications. OTHER PROVISIONS The third title of the draft bill consists of definitions and conforming amendments. Among these provisions is an amendment to the Public Health Service Act which would increase the number of appointed members of the Federal Hospital Council from 8 to 12 so as to assure the inclusion of persons familiar with mental health facility needs and administration. The provisions of this proposed legislation are essential to the launching of a major national effort to replace our traditional method of isolating the mentally ill in large custodial institutions with community programs which can prevent or arrest mental illness in its early stages, reduce the time and cost of inpatient treatment, and facilitate the early rehabilitation of mental patients. The enactment of these proposed new authorities-which will supplement and reinforce the research, training, and other provisions of existing law relating to mental health-will provide the statutory foundation for one of the most dramatic and satisfying victories in our conquest of the major diseases and impairments of man. I shall appreciate it if you would refer the enclosed draft bill to the appropriate committee for consideration. The Bureau of the Budget advises that enactment of this proposed legislation would be in accord with the program of the President. Sincerely, ANTHONY J. CELEBREZZE, Secretary. Hon. OREN HARRIS, DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE, Chairman, Committee on Interstate and Foreign Commerce, DEAR MR. CHAIRMAN: By letter dated February 11, 1963, we transmitted to the Speaker of the House of Representatives a draft bill to provide for assistance in the construction and initial operation of community mental health centers, and for other purposes. This legislative proposal, introduced as H.R. 3688, has been referred to your committee for consideration. Enclosed are estimates of appropriations, expenditures, and personnel required during the first 5 years of the program authorized by the bill. Chairman, Committee on Interstate and Foreign Commerce, DEAR CONGRESSMAN HARRIS: This is in further reply to your request for our comments on H.R. 3688, a bill to provide for assistance in the construction and initial operation of community mental health centers, and for other purposes; and H.R. 3689, to assist States in combating mental retardation through construction of research centers and facilities for the mentally retarded. We wholeheartedly favor enactment of these bills which are designed to stimulate action at all levels of Government in combating mental illness and retardation. As the President pointed out in his special message to the Congress on February 5, 1963, "We as a nation have long neglected the mentally ill and the mentally retarded. The neglect must end, if our Nation is to live up to its own standards of compassion and dignity and achieve the maximum use of its manpower." We note with approval that the bills contain adequate labor standards protection for laborers and mechanics employed on the federally assisted construction projects which they authorize. |