1 7 INCLUSION OF AUTISM 2 SEC. 7. Section 401 (1) of the Mental Retardation Fa 3 cilities and Community Mental Health Centers Construction 4 Act of 1963 is amended by inserting "(including autism)" 5 after "condition of an individual". 7 SEC. 8. The amendments made by this Act shall be 8 come effective with respect to appropriations for fiscal year 9 beginning after June 30, 1973. Hon. HARLEY O. STAGGERS, COMPTROLLER GENERAL OF THE UNITED STATES, Committee on Interstate and Foreign Commerce, House of Representatives. DEAR MR. CHAIRMAN: You requested our report and comments on H.R. 11511, 93d Congress, a bill which, if enacted, would be cited as the "Health Revenue Sharing and Health Services Act of 1973." Section 203 of the bill proposes to amend title II of the Community Mental Health Centers Act, and section 408 of the bill would add a new part to the Development Disabilities Services and Facilities Construction Act. Proposed section 238 of the first named act (page 40) and section 154 of the last named act (page 57) would provide for maintenance of records by recipients of assistance and audit thereof by the Secretary and the Comptroller General. We recommend that the language below, which is substantially similar but more inclusive, be substituted. (a) Each recipient of Federal assistance under this Act, pursuant to grants, subgrants, contracts, subcontracts, loans, or other arrangements, entered into other than by formal advertising, and which are otherwise authorized by this Act, shall keep such records as the Secretary shall prescribe, including records which fully disclose the amount and disposition by such recipient of the proceeds of such assistance, the total cost of the project or undertaking in connection with which such assistance is given or used, 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. "Sec. "(b) The Secretary and the Comptroller General of the United States, or any of their duly authorized representatives, shall, until the expiration of three years after completion of the project or undertaking referred to in subsection (a) of this section, have access for the purpose of audit and examination to any books, documents, papers, and records of such recipients which in the opinion of the Secretary or the Comptroller General may be related or pertinent to the grants. subgrants, contracts, subcontracts, loans, or other arrangements referred to in subsection (a).” Proposed section 241 of the Community Mental Health Centers Act (page 42, line 4) would provide "that no individual shall be made the subject of any research which is carried out (in whole or in part) with funds under such grants [provided by this act] unless such individual explicitly agrees to become a subject of such research." Since the subject of this portion of H.R. 11511 is construction and operation of mental health centers, it would appear that many persons might not be competent to give knowing consent. The Committee may wish to amend this section of the bill to require "knowing, competent, and explicit consent." Proposed subsections 310 (g) (4) and 330 (d) (4) of the Public Health Service Act (pages 65 and 69, respectively) would require that every reasonable effort be made to collect appropriate reimbursement for its costs from third party reimbursement programs including private health insurance programs. They are silent, however, as to whether attempts should be made to collect from persons not covered by such programs who have the ability to pay for the cost of services. The Committee may wish to modify these sections to provide that persons with the ability to pay shall be charged appropriately for services rendered. Proposed subsection 330 (c) (1) (page 67, line 10) would provide for grants to public and nonprofit private entities to assist in the establishment and initial operation of neighborhood health centers which will serve a medically underserved area or group. A medically underserved area or group is defined as urban or rural area or population group designated by the Secretary as an area or population group with a shortage of personal health services. No guidance is provided as to whether priority should be given to funding "low income" areas or groups with a shortage of personal health services. If it is intended that the income of the area or group be considered in funding projects, it is believed appropriate language should be added to this section. Enclosed for your consideration are some technical or editorial changes which we believe should be considered by the Committee. Sincerely yours, ROBERT F. KELLER, Deputy Comptroller General of the United States. 31-151 O 74 Pt. 1 - 30 Technical or editorial changes to H.R. 11511, 93d Congress. At the places listed, "1973" should be "1974." Page 1, lines 4 and 7; page 2, line 8; page 14, line 9; page 16, line 11; page 19, line 9; page 21, line 1; and page 46, line 4. On page 8, line 23, "for" should be "to provide that." On page 11, line 17, "an" should be inserted after "as." On page 16, line 11, "Centers" should be inserted after "Health." On page 25, lines 15, 16, "designate" should be "designates." On page 27, line 16, "and" should be "any." On page 49, line 14, the period should be outside the quotation mark. On page 60, line 15, the word "organizations" is misspelled. On page 65, line 12, "42" should be "41." On page 67, line 20, "notification" should be "subsection." On page 67, line 25, "conforms" should be "conform." On page 68, line 4, "eliminates" should be "eliminate." On page 68, line 22, there should be a close parenthesis after “(2.” DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE, Hon. HARLEY O. STAGGERS, 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 a report 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." The bill is to be known under the short title as the "Health Services Amendments of 1974." This bill embodies a legislative proposal that we submitted to the Congress, on behalf of the Administration, on February 13, 1974, and is designed to amend certain acts of concern to this Department. For the reasons stated in the enclosed copy of our letter transmitting the draft bill to the Speaker of the House, we urge its prompt and favorable consideration. The Office of Management and Budget advises us that there is no objection to the submission of this report and that enactment of this bill would be in accord with the program of the President. Sincerely, Enclosure. CASPAR W. WEINBERGER, Secretary. Hon. CARL ALBERT, DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE, Speaker of the House of Representatives, DEAR MR. SPEAKER: Enclosed for the consideration of the Congress is a draft bill. "To amend the Public Health Service Act, the Developmental Disabilities Services and Facilities Construction Act, and the Comprehensive Alcohol Abuse and Alcosolism Prevention, Treatment, and Rehabilitation Act of 1970, to revise and extend programs of health services, and for other purposes." The Department now administers separate project grant structures, containing separate appropriations authorizations, (1) to assist in the prevention and treatment of alcoholism (parts C and E of the Community Mental Health Centers Act); (2) to provide health services for domestic agricultural migrants (section 310 of the Public Health Service Act); (3) to render services, disseminate information, and promote research in the field of family planning (title X of the Public Health Service Act); and (4) to provide services to meet health needs of limited geographic scope, and to develop and support new health services programs (section 314(e) of the Public Health Service Act). Title I of the enclosed bill would consolidate these programs under the umbrella of the existing project grant portion of the Partnership for Health. It is hoped that the consolidation will enable us to simplify the administration 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 |