Promotion to involve all health professional associations, and especially those of professional nursing, as well as interested consumer groups, in developing national health objectives for the year 2000. The Committee is pleased to learn of the work of the task force on disease prevention and health promotion in establishing the scientific base for prevention interventions, and urges that recommendations address all health professionals involved in primary health care.

The Committee believes it is appropriate for the Office of Disease Prevention and Health Promotion to develop a national plan for the prevention of primary and secondary disabilities, and encourages the Office to begin such an effort in fiscal year 1988.

Physical fitness and sports

The Committee recommends an appropriation of $1,466,000 for physical fitness and sports activities. This is the same as the budget request and $88,000 more than the fiscal year 1987 appropriation.

The Physical Fitness and Sports Program provides staff support and assistance for the President's Council on Physical Fitness and Sports. Through continuing contact with national governing bodies, the Council seeks to enlist the active support and assistance of individuals, civic groups, professional associations, sports groups, and others to promote and improve the health of all Americans through regular participation in physical fitness and sports.

The fiscal year 1988 appropriation will provide program emphasis on developing cosponsored projects designed to train teachers and volunteers in the administration of appropriate exercise programs for various target populations, including older people and the handicapped.

The Committee encourages the President's Council on Physical Fitness and Sports to emphasize the benefits of fitness walking as a fitness activity program. While fitness walking requires no investment in special equipment or clothing, it is an activity that is not limited to any one group. Young people, senior citizens, city dwellers, and country residents all can participate in fitness walking. Its effectiveness in promoting health and preventing disease is well-documented by studies. Minority health

The Committee recommends an appropriation of $3,000,000 for the Office of Minority Health. This amount is the same as the budget request and the comparable appropriation for fiscal year 1987. This is the first fiscal year that funds are being requested in the budget. In fiscal years 1986 and 1987, funds were transferred from other Public Health Service agencies.

The Office of Minority Health was created from the Secretary's Task Force on Black and Minority Health which documented over 60,000 excess deaths per year among Asian/Pacific Islanders, Blacks, Hispanics, and native Americans. The task force identified six causes that contribute to 80 percent of those excess deaths: cancer, cardiovascular disease and stroke, chemical dependency, diabetes, violence, and infant mor tality. The task force developed recommendations to improve the health

of these Americans and reduce the number of excess deaths. The Office of Minority Health is the focal point for the implementation and monitoring of these recommendations and for the formulation and development of policy issues affecting minority health.

The Committee believes that minority community-based organizations are often in the best position to access and help educate minority populations on AIDS. The Committee believes that the Centers for Disease Control should consult with and jointly coordinate AIDS activities with the Office of Minority Health to target AIDS information and education to minorities.

Public Health Service management

The Committee recommends an appropriation of $20,887,000 for Public Health Service management activities. This is $2,104,000 more than the fiscal year 1987 appropriation and $700,000 more than the budget request. The Committee has reduced the amount requested for FERS costs throughout this appropriation by 33 percent, or $792,000.

The Public Health Service management activity provides funding for the offices that support the Assistant Secretary for Health in providing leadership and direction to the Public Health Service [PHS]. In recent years, the programs and responsibilities of PHS have expanded in size and in complexity and Congress has appropriated additional funds to meet these increasing requirements. However, the resources available for management oversight and coordination have not been increased accordingly and, in fact, have been reduced.

The Committee feels that in order to effectively manage the diverse and complex programs of PHS, the staff and dollar resources available to the Assistant Secretary for Health must be restored.

Therefore, the Committee allowance includes $20,887,000 and 320 full-time equivalents for the PHS management activity. The amount will restore the funding to the fiscal year 1987 level and will permit the Assistant Secretary for Health to provide oversight and direction for the health agencies. The Committee allowance includes $1,600,000 and 20 FTE's for the AIDS coordinator staff.

Child survival activities

The Committee concurs with the House in providing a general provision to exempt not more than 50 employees of the Public Health Service from all FTE limitations to assist in child survival activities in underdeveloped countries. It is estimated that there are 10 million preventable deaths of children from vaccine-preventable diseases and dehydration each year in these underdeveloped countries. The Committee has received testimony that the Public Health Service is the only organization with the required talent and expertise to assure success in these programs funded by organizations outside HHS. The Committee does not believe that the PHS should be penalized for assisting in the U.S. foreign policy of providing humanitarian aid to developing countries.

Public Health Emergency Fund

The Committee recommends $5,000,000 for the Public Health Emergency Fund, authorized under section 319 of the Public Health Service Act. The Committee concurs with the House that the Secretary have funds immediately available to him for transfer to an operating agency in the event that an emergency need for funds relating to the acquired immune deficiency syndrome [AIDS] should arise. This would eliminate the need in some cases for either a supplemental appropriation or a reprogramming request. The Committee wishes to be notified if these funds are utilized.

Risk assessment

Within available funds, $500,000 is provided for programs for the study in an academic setting of the medical/scientific basis for assessing risks, the intersection of science and the law, and the implications of these issues on health policy.

RETIREMENT PAY AND MEDICAL BENEFITS FOR COMMISSIONED OFFICERS

1987 comparable appropriation. 1988 appropriation request. House allowance...

Committee recommendation...

$83,768,000

94,176,000

89,176,000

89,176,000

The Committee concurs with the House in recommending an appropriation of $89,176,000 for commissioned officer retirement pay and medical benefits. This is $5,000,000 below the budget estimate and $5,408,000 more than the fiscal year 1987 appropriation.

This appropriation provides for retirement payments to Public Health Service officers who are retired for age, disability, or a specified length of service. In addition, payments are made to survivors of deceased retired officers who have chosen the option of a reduced retirement benefit in order to provide for their survivors. Provision is also made for the medical care of active duty and retired members of the PHS Commissioned Corps and their dependents.

The Committee does not concur with the administration's proposal to change this account from an indefinite to a definite appropriation and the Committee has deleted the request for a reserve fund of $5,000,000. This is an entitlement program and should remain an indefinite appropriation.

HEALTH CARE FINANCING ADMINISTRATION

The Committee recommends $30,046,000,000 for grants to States for Medicaid. This amount is $3,406,000,000 more than the fiscal year 1987 appropriation, $1,926,000,000 more than the administration's budget re

quest, and the same as the House allowance. This amount includes $7,100,000,000 appropriated in fiscal year 1987 as an advance for fiscal year 1988. This recommendation reflects the latest current law estimates and does not assume legislative savings which, at the time of Committee action, had not been enacted.

The Medicaid Program, which is administered by each of the 50 States, the District of Columbia, Puerto Rico, and the territories, provides medical care for certain low-income individuals and families. Federal funds for medical assistance are made available to the States on the basis of a formula which determines the appropriate rate at which State program costs should be matched. The matching rate may range from 50 to 83 percent, depending on the State's average per capita income relative to the national per capita income.

Each Medicaid Program must provide a basic package of medical services including inpatient and outpatient hospital care, health screening services to children under 21, skilled nursing facility care for persons 21 years of age or older, and physician services.

The Committee rejects an administration proposal to prohibit Federal funding for optional targeted case management services authorized by the Consolidated Omnibus Reconciliation Act of 1985.

ADVANCE APPROPRIATION

The Committee has provided an advance appropriation of $8,000,000,000 for the first quarter of fiscal year 1989. This recommendation reflects the latest available current law estimates.

The Committee has provided $25,364,000,000 for payments to health care trust funds. This amount is $263,000,000 less than the administration's request, $529,000,000 less than the House allowance, and $4,632,000,000 more than the fiscal year 1987 appropriation.

The Committee recommendation is consistent with the latest current law estimates for the three mandatory activities which comprise these payments: supplementary medical insurance; hospital insurance for the uninsured; and the Federal uninsured payment. The military service credits appropriation, previously funded under this account, will be made to the Department of Defense beginning in fiscal year 1988.

The Committee has provided $24,889,000,000, which is $263,000,000 less than the administration request and $529,000,000 less than the House allowance, for the payment to the supplementary medical insurance trust fund. This payment provides matching funds for premiums paid by Medicare part B enrollees. The increase of $4,604,000,000 over fiscal year 1987 reflects adjustments related to increases in the cost of services paid for by this trust fund, growth in the enrollee population, and increases to the contingency margin.

The Committee recommendation includes $461,000,000 for hospital insurance for the uninsured, which is the same as the administration's request and the House allowance, and $26,000,000 more than the fiscal year 1987 comparable appropriation. This payment reimburses the hospital insurance trust fund for Medicare benefits to individuals who have not met the insured status requirement.

The recommendation also includes $14,000,000 for the Federal uninsured benefit payment, which is the same as the administration's request, the House allowance, and $2,000,000 more than the comparable fiscal year 1987 appropriation. This payment reimburses the hospital insurance trust fund for the cost of benefits provided to Federal annuitants now eligible for Medicare.

The Committee recommends an appropriation of $102,580,000 for Health Care Financing Administration [HCFA] program management. This amount is $3,170,000 less than the administration's budget request, the same as the House allowance, and $4,175,000 more than the fiscal year 1987 appropriation.

The bill provides $1,411,828,000 in trust funds. This amount is $99,248,000 more than the administration request, $9,750,000 less than the House allowance, and $188,295,000 more than the fiscal year 1987 appropriation. In addition to this amount, $105,000,000 is available in fiscal year 1988 from section 9216 of the Consolidated Omnibus Budget Reconciliation Act of 1985, Public Law 99-272, for this purpose.

Research, demonstration, and evaluation

The Committee has provided $30,000,000 for HCFA research, demonstration, and evaluation activities. This is $6,000,000 less than the administration request, the same as the House allowance, and $2,000,000 more than the fiscal year 1987 appropriation.

HCFA conducts studies and evaluations to measure the impact of the Medicare and Medicaid Programs on health care costs, and to produce information on alternative strategies for reimbursement, coverage, and program management. These studies are conducted with the goal of improving the administration of the Medicare and Medicaid Programs.

The recommended funding level will provide for the continuation of research, demonstration, and evaluation activities, as well as for the startup of new projects, including those mandated by Congress. Medicare contractors

The Committee recommends $1,232,000,000 for Medicare contractors. This amount is $70,200,000 more than the administration request, $130,000,000 more than the fiscal year 1987 appropriation, and the same as the House allowance. This amount includes $105,000,000 appropriated by section 9216 of the Consolidated Omnibus Budget Re