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Additional information-Continued
Telegram from

Avey, Robert G., Spokane, Wash., to Lucia Ford Murphy, Hotel

Shoreham, Washington, D. C., March 16, 1954...,

Gardner, Victoria, member, King County Nursing Home Asso-

ciation, to Hon. Lister Hill, March 19, 1954.

Hewitt, Mrs. John C., Seattle, Wash., tó Hon. Lister Hill, March

19, 1954.

Hill, hel May, Hill Convalescence Home, Seattle, Wash., to

Hon. Lister Hill, March 19, 1954.

Jacobs, Edmund F., executive secretary, Washington Association

of Licensed Nursing Homes, to Hon. Lister Hill, March 18, 1954.
Shane, Norma, Sunset Manor Sanitarium, Seattle, Wash., to

Hon. Lister Hill, March 19, 1951...

Tentative allotments to the States and Territories based on an appro-

priation of $112 million for the fiscal year ending June 30, 1955,

under the Public Health Service Act (title VI), as amended, table..

Tentative allotments for the States and Territories based on an appro-

priation of $150 million for the fiscal year ending June 30, 1955,

under the Public Health Service Act (title VI), as amended, table..

Tentative allotments to the States and Territories for the fiscal year

206

ending June 30, 1955, under the Public Health Service Act (title VI),

as amended, table.

Vocational rehabilitation program.

93

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WEDNESDAY, MARCH 17, 1954

UNITED STATES SENATE,
COMMITTEE ON LABOR AND PUBLIC WELFARE,

SUBCOMMITTEE ON HEALTH,

Washington, D.C.
The subcommittee met at 10 a. m., pursuant to notice, in room P-63
of the Capitol, Senator H. Alexander Smith (chairman of the full
committee) presiding.
Present: Senators Smith (presiding), Purtell_(chairman of the
Subcommittee on Health), Goldwater, Hill, and Lehman.
Also present: Roy E. James, staff director; Melvin W. Sneed and
William B. Reidy, professional staff members.

Senator Smith. As chairman of the Committee on Labor and Public
Welfare, I am calling this meeting to order. I will presently turn it
over to Senator Purtell

, who is chairman of the subcommittee, but I wanted to be here personally to open these hearings on health and to Welcome you here, Mrs. Hobby, with the wonderful program which you are sponsoring. I can assure you that our subcommittee is eager to hear your testimony and the testimony of those with you on this important subject. Širs. Hobby: Thank you, sir. Senator Smith. With that word of welcome, I am glad to turn the meeting over to Senator Purtell who is the able chairman of the Subcommittee on Health of the Committee on Labor and Public Welfare.

Senator PURTELL (presiding). The question of ability will not be proved before the end of these meetings, but I would like to say to you, Senator, that you paid this subcommittee a great compliment and indicated the importance of the work of this subcommittee by appearing here this morning for the opening of these hearings. I know how busy you are and of the many demands upon your time, so I again want to thank you for being with us to preside at this first meeting of this Health Committee. We are going to have, of course, many, many days of hearings.

I would like for the record to show that Senator Cooper would have
been here had it not been necessary for him to be at a meeting at the
Department of Agriculture this morning. I would like to have the
record show that.
The Subcommittee on Health of the Committee on Labor and Public
Welfare will hold hearings beginning today, March 17, on S. 2758,
$ 2759, S. 2778, and S. 3114 which embody the President's health

recommendations contained in his message to Congress on January 18, 1954, and on other bills referred to this

committee dealing with the same subject-matter areas in the field of health.

(Bills S. 2758, H. R. 8149, and S. 1052 are as follow :)

[S. 2758, 83d Cong., 2d sess.) A BILL To amend the hospital survey and construction provisions of the Public Health

Service Act to provide assistance to the States for surveying the need for diagnostic or treatment centers, for hospitals for the chronically ill and impaired, for rel abilitation facilities, and for nursing homes, and to provide assistance in the construction of such facilities through grants to public and nonprofit agencies, and for other purposes

Be it enacted by the Senate and House of Representatives of the United States of America in Congress assembled, That this Act may be cited as the “Medical Facilities Survey and Construction Act of 1934."

SEC. 2. Title VI of the Public Health Service Act is amended by the addition of a new part E to read as follows:

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“Part E-DIAGNOSTIC, TREATMENT, REHABILITATION, AND NURSING FACILITIES FOR AMBULATORY, CHRONIC DISEASE, AND OTHER PATIENTS-SURVEY AND PLANNING

"AUTHORIZATION OF APPROPRIATION "SEC. 641. There is hereby authorized to be appropriated the sum of $2,000,000 to remain available until expended and to be used for making payments to States which have submitted, and had approved by the Surgeon General, State applications for funds for the purpose of surveying the need for diagnostic or treatment centers, hospitals for the chronically ill and impaired, rehabilitation facilities, aad nursing homes.

"STATE APPLICATIONS "SEC. 642. The Surgeon General shall approve a State application for funds di der this part which

“(1) designates as the sole agency for carrying out such purpose, or for supervising the carrying out of such purpose, the State agency designated in accordance with section 623 (a) (1);

“(2) provides for the utilization of the State advisory council provided in section 623 (a) (3), and if such council does not include representatives of nongovernment organizations or groups, or State agencies, concerned with rehabilitation, provide for consultation with organizations, groups, and State agencies so concerned; and

**(3) provides for making an inventory and survey containing all information required by the Surgeon General and for developing a construction program in accordance with section 633.

"ALLOTMENTS TO STATES "Sec. 643. Each State shall be entitled to an allotment of such proportion of any appropriation made pursuant to section 611 as its population bears to the population of all the States, and within such allotment shall be entitled to receive 50 per centum of its expenditures in carrying out the purposes of section 641 in accordance with its application: Provided, That no such allotment to any State shall be less than $2.5,000. The Surgeon General shall from time to time estimate the sun to which each State will be entitled under this section, during such ensuing period as he may determine, and shall thereupon certify to the Secretary of the Treasury the amount so estimated, reduced or increased, as the case may be, by any sum by which the Surgeon General finds that his estimate for any prior periori was greater or less than the amount to which the State was entitled for such period. The Secretary of the Treasury shall thereupon, prior to audit or settlement by the General Accounting Office, pay to the State, at the time or times fixed by the Surgeon General, the amount so certified.

*(b) Any funds paid to a State under this section and not expended for the purposes for which paid shall he repaid to the Treasury of the United States."

Sec. 3. Title VI of the Public Health Service Act is further amended by adding a new part F to read as follows:

PAST F-CONSTRUCTION OF DIAGNOSTIC, TREATMENT, REHABILITATION, AND NIISING FACILITIES FOR AMBULATORY, CHRONIC DISEASE, AND OTHER PATIENTS

"AUTHORIZATION OF APPROPRIATION 61. There is hereby authorized to be appropriated for the fiscal year ng June 30, 195), and for each of the two succeeding fiscal years

"41) $20,000,000 for grants for the construction of nonprofit diagnostic or treatment centers;

"(2) $20,000,000 for grants for the construction of nonprofit hospitals for the chronically ill and impaired ;

"13) $10.000,000 for grants for the construction of nonprofit rehabilitation facilities; and "14) $10,000,000 for grants for the construction of nonprofit nursing homes.

"ALLOTMENTS TO STATES

"Sec. 672. Each State shall be entitled for each fiscal year to an allotment of a sum bearing the same ratio to the sums appropriated for such year pursuant *o paragraphs (1), (2), (3), and (4), respectively, of section 651, as the product of 1 a) the population of such State and (b) the square of its allotment percentage tas defined in section 631 (a)) bears to the sum of the corresponding products Pour all of the States: Provided, That no such allotment to any State for the Cruises of paragraph (1) or (2) of section 651 shall be less than $100,000 and Do such allotinent for the purpose of paragraph (3) or (4) shall be less than cm. Sums allotted to a state for a fiscal year and remaining unobligated il the end of such year shall remain available to such State for the same purpose for the next fiscal year (and for such year only) in addition to the sums allotted to such State for such next fiscal year.

"REGULATIONS AND APPROVAL OF STATE PLANS

Sec. 633. (a) Within six months after this part becomes effective, the Sur. men General, with the approval of the Federal Hospital Council and the Secretary of Halth, Education, and Welfare (hereinafter referred to as the Secretary'), stail revise and supplement the regulations issued under section 622 to provide beral standards of construction and equipment, general standards of adequacy and priority, and requirements comparable to those provided in such regulations *: lo nondiscrimination and persons unable to pay, and as to general methods of administration of the State plan, for facilities for which payments are authorized under this part. After such regulations have been issued, any State desiring to itu advantage of this part may submit, as a revision of, or supplement to, its pan under section 623, a plan for a construction program for diagnostic or treatett centers, hospitals for the chronically ill and impaired, rehabilitation facili.

and pursing homes. The Surgeon General shall approve any such revision of, or supplement to the State plan which is based upon a statewide inventory of Pilati D facilities arailable for such purposes and whichi

"{1) meets the requirements of paragraphs (1), (2), (3), (6), (8) and (9) of section 623 (a): Provided, That if the designated advisory council does not include representatives of nongovernment organizations or groups, or state agencies, concerned with rehabilitation, the plan shall provide for Otsultation with organizations, groups, and State agencies so concerned ;

"12) conforms with the regulations prescribed under section 622 ag revised and supplemented for the purposes of this part;

"13) sets forth, with respect to each type of facility, the relative need determined in accordance with such revised regulations, and provides for the construction, insofar as financial resources available therefor and for maintenance and operation make possible, of such facilities in the order of such relative need ; and

1 di provides that the State agency will from time to time review its cutstruction program for such facilities as a part of its State plan and sub

mait to the Surgeon General any modifications thereof which it considers "IM. The provisions of subsections (b) and (c) of section 623 shall, and the provisions of subsection (d) (except with respect to hospitals) and of subsection

of such section shall not, be applicable to State plans with respect to projects for construction under this part.

Persary,

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"APPROVAL OF PROJECTS AND PAYMENTS-FEDERAL SHARE "SEC. 654. (a) Applications under this part by States, political subdivisions or other nonprofit agencies for (1) nonprofit diagnostic or treatment centers, (2) nonprofit hospitals for the chronically ill and impaired, (3) nonprofit rehabilitation facilities, or (4) nonprofit nursing homes shall be submitted, and shall be approved by the Surgeon General (subject also, in the case of rehabilitation facilities, to the approval of the Secretary) if sufficient funds are available from the State's allotment under this part for such type of facility, in accordance with the procedures and subject to the conditions prescribed in subsection (a) of section 625 and the regulations issued under section 622 as revised and supplemented for the purposes of this part: Provided, however, That (except with respect to hospitals) the assurances required for compliance with State standards for operation and maintenance shall be limited to such standards, if any, as the State may prescribe. Approved applications shall be subject to amendment as provided in subsection (c) of section 625.

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“(b) Procedures and conditions for payments under this part shall be in accord with the provisions of subsection (b) of section 625."

AMENDMENT OF PARTS C AND D OF TITLE VI

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SEC. 4. (a) Subsection (e) of section 625 of the Public Health Service Act is hereby amended to read:

“(e) If any hospital, diagnostic or treatment center, rehabilitation facility, or nursing home for which funds have been paid under this section or under section 654 shall, at any time within twenty years after the completion of construction, (A) be sold or transferred to any person, agency, or organization, (1) which is not qualified to file an application under this section, or (2) which is not approved as a transferee by the State agency designated pursuant to section 623 (a) (1), or its successor, or (B) cease to be a nonprofit hospital, nonprofit diagnostic or treatment center, nonprofit rehabilitation facility, or nonprofit nursing home as defined in section 631 (g), the United States shall be entitled to recover from either the transferor or the transferee (or, in the case of a hospital, diagnostic or treatment center, rehabilitation facility, or nursing home, which has ceased to be nonprofit, from the owners thereof) an amount bearing the same ratio to the then value (as determined by agreement of the parties or by action brought in the district court of the United States for the district in which such hospital, center, facility, or nursing home is situated) of so much of the hospital, center, facility, or nursing home as constituted an approved project or projects, as the amount of the Federal participation bore to the cost of the constrnction of such project or projects." (b) Subsection (e) of section 631 is amended to read :

"le) the term 'hospital (except as used in section 622 (a) and (b)) includes public health centers and general, tuberculosis, mental, chronic disease, and other types of hospitals in which patient care is under the professional supervision of persons licensed to practice medicine in the State, and related facilities, such as laboratories, nurses' home and training facilities, central service facilities operated in connection with hospitals, outpatient departments, and medical rehabilitation and convalescent facilties in which patient care is under the professional supervision of persons licensed to practice medicine in the State, but does not include any hospital

or facility furnishing primarily domiciliary care;". (c) Subsection (g) of section 631 is amended to read:

"(1) the terms nonprofit hospital', 'nonprofit diagnostic or treatment center', 'nonprofit rehabilitation facility', and 'nonprofit nursing home' mean any hospital, diagnostic or treatment center, rehabilitation facility, and nursing home, as the case may be, which is owned and operated by one or more nonprofit corporations or associations no part of the net earnings of which inures, or may lawfully inure, to the benefit of any private share

holder or individual;". (dl) Subsection (h) of section 631 is amended to read:

"(h) the term construction includes construction of new buildings, expansion, remodeling, and alteration of existing buildings, and initial equip ment of any such buildings (including medical transportation faciltiies) ; including architects' fees, but excluding the cost of off-site improvements and, except with respect to public health centers, the cost of the acquisition of land ;".

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