COMMITTEE AMENDMENTS Amendments 1 and 2 make the necessary date changes. Amendment 3: Your committee was unanimous in the judgment that an' authorization maximum for the amount of supplementary Federal grants permitted by this bill should be written into the legislation. The committee concluded that $36,227,000 would meet the requirements for the period during which the supplementary grant program would remain in effect for the District of Columbia under this bill. This amount was supported by particular project justifications set forth in the table, entitled "Construction Needs for District of Columbia Hospitals and Medical Facilities," earlier in this report. Amendments 4 and 6: As reported, these amendments, as set forth on page 1 of this report, would provide clarification of the term "long-term-care facilities" by adding “including extended care facilities." Such amendments would include "extended care facilities" as being available to receive supplementary Federal grants to assist in their construction or modernization along with the categories of facilities covered. These amendments, advocated by the District of Columbia Medical Society, were supported on the basis that the greatest need in health facilities construction in the District is for extended care facilities. Witnesses testified such would relieve the load on general hospitals and thereby reduce hospital costs to the family, the insurers, and the Government. Availability of extended care facilities would permit patients to be released from general hospitals earlier. "Long-termcare facilities" are ordinarily considered in medical terminology to be domiciliary care for the elderly. Addition of "including extended care facilities" to the term "long-term-care facilities" is designed to insure that the two health facility designations will not be improperly confused and to clarify their differing functions. Amendment 5: A technical and clarifying amendment to substitute "Secretary" for "Surgeon General" in the Department of Health, Education, and Welfare. CONCLUSION Public hearings were held August 21, 1967, before the Subcommittee of Public Health, Education, Welfare, and Safety. Supporting testimony was received from the Department of Health, Education, and Welfare, the District of Columbia government, the District of Columbia Medical Society, officials of the Hospital Council of the National Capital Area, and the Washington Hospital Center. No opposition was expressed. Your committee is impressed with the urgency for this legislation because of the manner by which it proposes to mesh with current national programs of Federal aid and its comprehensive approach to orderly and effective implementation of the health care facility planning process and the safeguards included. Therefore, your committee strongly recommends is passage, as amended. SECTION-BY-SECTION ANALYSIS The first section sets out the title "District of Columbia Medical Facilities Construction Act of 1968." Section 2 authorizes total appropriations not to exceed $36,227,000 for fiscal years ending June 30, 1968, 1969, 1970, and 1971 for the Secretary of the Department of Health, Education, and Welfare (hereinafter "Secretary") to make grants to assist in the modernization of public or private nonprofit general hospitals and the construction or modernization of public health centers, longterm-care facilities including extended care facilities, diagnostic or treatment centers, rehabilitation facilities, facilities for the mentally retarded, and communty mental health centers. Section 3 (a) provides that the Secretary may approve grant applications only if an application has been filed under the Medical Facilities Acts (title VI of the Public Health Service Act (Hill-Burton Act) or title II or pt. C of title I of the Mental Retardation Facilities and Community Mental Health Centers Construction Act of 1963), and such application either has been approved under the Medical Facilities Acts and the application is for additional funds, or it would have been approved under these acts except that sufficient funds from District allotments are not available to permit approval. Availability of funds under this bill as required to be considered in connection with the possible approval of applications under the Medical Facilities Act. Section 3(b) directs the Secretary to establish criteria for the order of approval of applications which shall be the same criteria as that developed by the District of Columbia "State agency" pursuant to a plan approved under the Medical Facilities Act. Section 3(c) provides that applications for grants under the bill may be approved only if they comply with the terms and conditions for applications under the Medical Facilities Act, other than the availability of sufficient funds in the District allotment. Section 3(d) provides that applications for grants under the bill may not be approved unless the areawide planning body has an opportunity to review it and that body's recommendations have been considered by the District "State agency" and submitted to the Secretary in connection with the application. Section 4(a) provides that payments shall be made in the manner provided under the Medical Facilities Acts subject to reasonable conditions imposed by the Secretary and section 4(b) specifies that total payments, together with payments under the Medical Facilities Acts, may not exceed (1) 66% percent of the cost of a long-term-care facility including extended care facilities, a diagnostic or treatment center, or a rehabilitation facility; or (2) 50 percent of the cost of any other project. Section 5 provides that conditions for recovery of payments shall be the same as under the Medical Facilities Acts. Section 6 provides that the meaning of terms used in the bill shall be the same as under the Medical Facilities Acts. Mr. SISK. In connection with the District Government's position on these bills, without objection a letter dated February 15, 1967, signed by the then President of the Board of Commissioners of the District of Columbia, Hon. Walter N. Tobriner, will be made a part of the record; and also a later letter, dated May 31, 1968, signed by Thomas W. Fletcher, Assistant to Commissioner Washington, will be made a part of the record. (The letters referred to follow :) GOVERNMENT OF THE DISTRICT OF COLUMBIA, The Honorable The SPEAKER, EXECUTIVE OFFICE, Washington, February 15, 1967. United States House of Representatives, DEAR MR. SPEAKER: The Commissioners of the District of Columbia have the honor to submit herewith a draft bill "To authorize project grants for construction and modernization of hospitals and other medical facilities in the District of Columbia." 1 The first section of the bill gives it the title "District of Columbia Medical Facilities Construction Act of 1967". Section 2 authorizes appropriations for fiscal years ending June 30, 1967, 1968, 1969, and 1970 for the Secretary of the Department of Health, Education, and Welfare (hereinafter "Secretary") to make grants to assist in the modernization of public or private nonprofit general hospitals and the construction or modernization of public health centers, long-term care facilities, diagnostic or treatment centers, rehabilitation facilities, facilities for the mentally retarded, and community mental health centers. Section 3(a) provides that the Secretary may approve grant applications orly if an application has been filed under the Medical Facilities Acts (title VI of the Public Health Service Act [Hill-Burton Act] or title II or part C of title I of the Mental Retardation Facilities and Community Mental Health Centers Construetion Act of 1963), and such application either has been approved under the Medical Facilities Acts and the application is for additional funds, or it would have been approved under these Acts except that sufficient funds from District allotments are not available to permit approval. Availability of funds under this bill is required to be considered in connection with the possible approval of applications under the Medical Facilities Act. 1 Introduced as H.R. 6526 by Chairman McMillan (by request). Section 3 (b) directs the Secretary to establish criteria for the order of approval of applications which shall be the same criteria as that developed by the District of Columbia "State agency" pursuant to a plan approved under the Medical Facilities Acts. Section 3(c) provides that applications for grants under the bill may be approved only if they comply with hte terms and conditions for applications under the Medical Facilities Act, other than the availability of sufficient funds in the District allotment. Section 3(d) provides that applications for grants under the bill may not be approved unless the areawide planning body has an opportunity to review it and that body's recommendations have been considered by the District "State Agency" and submitted to the Secretary in connection with the application. Section 4(a) provides that payments shall be made in the manner provided under the Medical Facilities Acts subject to reasonable conditions imposed by the Secretary and section 4(b) specifies that total payments, together with payments under the Medical Facilities Acts, may not exceed― (1) 66%% of the cost of a long-term care facility, a diagnostic or treatment center, or a rehabilitation facility; or (2) 50% of the cost of any project. Section 5 provides that conditions for recovery of payments shall be the same as under the Medical Facilities Acts, and secion 6 provides that the meaning of terms used in the bill shall be the same as under the Medical Facilities Acts. The purpose of the bill is to authorize Federal assistance for the District of Columbia, supplementary to that now available under various programs provided by the Public Health Services Act, including the Hill-Burton program and Mental Retardation Facilities and Community Mental Health Centers Construction Act of 1963, for modernization of public or nonprofit private hospitals and the construction of public health centers, long-term care facilities, diagnostic or treatment centers, rehabilitation facilities, facilities for the mentally retarded, and community mental health centers. Private nonprofit medical facilities in the District of Columbia have been unable to take full advantage of the Federal programs for two reasons. First, the allocation of funds is based on a formula which takes into consideration the per capita income of the area. The high per capita income in the District of Columbia results in a proportionately lower allocation of funds than would be the case if per capita income in the District were nearer the national average. Presumably, there is an expectation that the high income group will readily contribute toward meeting the non-Federal share of the cost of the project. Experience in the District of Columbia has indicated, however, that this is not the case. Many of the residents of the District are in a very real sense "temporary residents" (although for an indefinite period) whose loyalties in the matter of contributions to the cost of a hospital project are directed more toward projects in their home States than toward those in the District of Columbia. The second reason for the inability of the District of Columbia to take full advantage of these Federal programs is the unavailability in the District of corporate donors, who are in other cities the largest contributors to such projects.2 Consequently, less money can be expected to be collected for medical facilities in the District of Columbia than is the case in other jurisdictions where there is a higher degree of permanency of residence and a relatively high incidence of commercial, manufacturing and industrial activities. Similarly, in the case of public medical facilities in the District of Columbia, the low District allocation of funds under these Federal programs and the substantial percentage of matching funds required from District appropriations have inhibited participation in these programs by the District. One result of the present situation was that the cost of a recent modernization program for D.C. General Hospital was borne almost entirely by District appropriations. As a result of this situation, representatives of the District of Columbia have for some time worked with representatives of the Department of Health, Education, and Welfare on draft legislation, similar to this bill, which would compensate for these special circumstances by making additional Federal funds 2 Survey of Municipal Hospital Facilities by J. B. Steinle (1957), indicating that industrial and commercial concerns account for 70 to 80 percent of all private donations to hospitals. 95-621-68-3 available for District projects and which would increase the percentage of the Federal share for such projects. Section 3(d) of the bill requires review of application for grants by a body found by the Secretary to be a responsible metropolitan areawide planning body. There is presently in existence and operation in this area the Metropolitan Washington Health Facilities Planning Council, an areawide planning body sponsored by the Department of Health, Education, and Welfare. The Commissioners are informed that if there were no such body in existence, the Department of Health, Education, and Welfare would consider the requirement of section 3 (d) inoperative. The Commissioners consider it advisable, however, that the legislative history of the bill reflect this position of the Department of Health, Education, and Welfare, so that there will be no problem arising at a later date. With this understanding, the Commissioners strongly urge the enactment of this bill in its present form. The Commissioners have been advised by the Bureau of the Budget that, from the standpoint of the Administration's program, there is no objection to the submission of this proposed legislation to the Congress. Sincerely yours, WALTER N. TOBRINER, President, Board of Commissioners, District of Columbia. GOVERNMENT OF THE DISTRICT OF COLUMBIA, Hon. JOHN L. MCMILLAN, EXECUTIVE OFFICE, Washington, D.C., May 31, 1968. Chairman, Committee on the District of Columbia, DEAR MR. MCMILLAN: The Government of the District of Columbia has for report H.R. 6526 and S. 1228, similar bills, "To authorize project grants for construction and modernization of hospitals and other medical facilities in the District of Columbia." H.R. 6526 is identical to draft legislation submitted to the Speaker of the House of Representatives by the President of the former Board of Commissioners by letter dated February 15, 1967, a copy of which is attached to this report. For the reasons stated in that letter, the Government of the District of Columbia endorses the enactment of legislation of this nature for the construction and improvement of medical facilities in the District of Columbia. S. 1228, as introduced, was identical to H.R. 6526. It was, however, prior to its passage by the Senate on December 15, 1967, amended to make necessary changes in dates used in the bill, to include references to extended care facilities for clarification purposes, and to establish a $36,227,000 authorization maximum for the amount of supplementary Federal grants. (Senate Report No. 914, December 14, 1967) The Government of the District of Columbia concurs in the amendments made in S. 1228 by the Senate, and recommends that S. 1228 be enacted in lieu of H.R. 6526. If, however, similar amendments were made in the latter bill, the District would also favor its enactment. The Government of the District of Columbia has been advised by the Bureau of the Budget that, from the standpoint of the Administration's program, there is no objection to the submission of this report to the Congress. Sincerely yours, /s/ Thomas W. Fletcher THOMAS W. FLETCHER, Assistant to the Commissioner. (For Walter E. Washington, Commissioner). PURPOSE AND BACKGROUND OF THE LEGISLATION Mr. SISK. It is my understanding that the purpose of these bills is to authorize Federal project grants for the construction and moderniza tion of hospitals and other medical facilities in the District of Columbia. From the standpoint of background, the responsibility of the Federal Government to provide financial assistance for the construction of hospital and other medical facilities in the Nation's Capital has been recognized by the Congress for the past 20 years. In 1946, Congress enacted the D.C. Hospital Center Act (Public Law 648, approved Aug. 7, 1946, 60 Stat. 896) authorizing the appropriation of Federal funds in the amount of $35 million, or 50 percent of the construction costs of the Washington Hospital Center as a replacement for three independent non-profit hospitals. Since that time, several extensions of and amendments to that Act were added until a total of $44.4 million had been authorized, on a matching basis, for construction projects in connection with every public and private hospital in the District of Columbia. That Act expired in 1962. In 1962, Congress enacted Public Law 87-460 (approved May 31, 1962, 76 Stat. 83), authorizing a special Federal grant of $2.5 million as 50 percent of the cost of construction for an addition to George Washington University Hospital. These funds were appropriated and the project has been completed. In addition to these acts, Federal financial assistance for the construction of District of Columbia hospitals has been obtained through two generally applicable Federal programs-the Lanham Act and the Hill-Burton Act. Under the Lanham Act (Title 42, U.S.C. 1521), two D.C. hospitals received a total Federal contribution of $5.655 million, and under the Hill-Burton program (Title 5, U.S.C. 757) a total of $7.194 million in grants was approved through fiscal year 1966, for 27 hospital projects in the city. PRESENT NEEDS Today there is a demonstrated need for the $36,227,000 authorized in the bill for the construction of needed medical facilities in the District, in addition to the $49 million in matching funds which the institutions themselves would be required to provide. I might say right here it is possible there will be an amendment to further increase that, maybe something like $4 million. Under the formula for the allocation of Hill-Burton funds, the District of Columbia will be entitled to only $441,619 in fiscal year 1968, on a matching basis. The demonstrated inability of District resources to meet these capital needs is the same now as when the Washington Hospital Center Act was enacted. The most urgent needs of the D.C. medical facilities today are in the area of extended care. This proposed legislation, in addition to assisting with modernization needs, would provide special incentives to D.C. health care institutions to develop these extended facilities and programs by providing Federal matching funds to the extent of 6623 percent of the construction costs. As to the differences in the two bills which I requested be put in the record, S. 1228, which was approved by the other body on December 15, 1967, differs from H.R. 6526, introduced by Chairman McMillan, in only one major respect. Whereas H.R. 6526 would provide for an "open end" authorization for the appropriations, the Senate amended the |