Mrs. MILLER. As defined in the regulations we are recommending including autism this year.

Mr. ROGERS. So, you want to put autism in? Are there any other conditions you are going to consider?

Mrs. MILLER. That is the only condition. The others are specifically mentioned, mental retardation, cerebral palsy, epilepsy, or other neurological conditions.

Mr. ROGERS. And the only other is autism?

Mrs. MILLER. We are including that because there is some dispute in that situation.

Mr. ROGERS. Shouldn't the State have any discretion?

Mrs. MILLER. The language reads:

Or to require treatment similar to that required for mentally retarded individuals.

So, it is fairly broad.

Mr. ROGERS. Should the States be able to have any discretion in categorizing "other related neurological diseases"?

Mrs. MILLER. In order to provide minimum limit on the scope of individuals who would be eligible to be served under this act, we felt that this was the best definition.

I think the States do have some flexibility under the definition and the law; the fear is that States may go very far beyond that. Again, this would result in providing programs that are serving people who are served under other programs.

This is our feeling, and I think the National Advisory Council generally concurs with this definition.

Mr. ROGERS. I think it would be well to have set forth in the record what the National Advisory Committee says on that. There is some concern from the States that they are not being allowed proper discretion. As I understand the gist of the program, the administration policy is one where you want all the decisions made there.

Mrs. MILLER. I think there is a disagreement as to which group should be included. As Dr. Brown said, there is a question as to whether autism is neurological. We have asked several groups to study this question and they have differing views.

Mr. ROGERS. If you would let us have the Advisory Council's recommendation, we would appreciate it.

Mrs. MILLER. Yes.

[The Department supplied the committee with several loose leaf books of material including information on this committee request for information. The material may be found in the committee's files.] Mr. ROGERS. I notice you want to change the council in your legislation. I am concerned about this, Mr. Secretary, as I have just received some correspondence that I will take up with you and the Secretary, in which it appears that very obvious political colleges are being demanded for health advisory councils at NIH.

I wish you would look into that and let us know. As I said, I have some correspondence on this matter that I will turn over to you. I think it is affecting the quality of your councils in that some of the people who have been told that they will have to have political clearances say, "Well, I wouldn't serve."

I think it would be a ridiculous situation if we get involved in politics on advisory councils.

Dr. EDWARDS. I agree.

Mr. ROGERS. However, I am afraid it is happening. Has the Digestive Disease Council been appointed yet? I understood names were suggested and the White House sent them back. Maybe the nominees don't have political clearance.

Dr. EDWARDS. The names have been submitted.

Mr. ROGERS. But they have not been accepted. I would like to know who rejects them over there. Would you let us know to whom at the White House you sent the nominees' names, and to whom they were sent to be reviewed and who rejected them?

Dr. EDWARDS. The usual process is to submit names to the Secretary which are reviewed by his Office for Committee Management. Where it goes from there, I am not sure.

Mr. ROGERS. See if you can run that down for us. No one seems to know where they go except they go to the White House and come back rejected.

I want to start pinning down who is instilling politics and trying to mess up health with Republican politics, with all due respect, and I would say the same if it were Democratic.

There have been some examples of this in the past too, but we ought not to consider political clearances when it gets into health, and certainly not in advisory committees.

We want to stop that practice. I think the committee would be unanimous. We intend to pursue that.

You might visit the Secretary and the White House, whomever

you see.

Thank you for your testimony today. If you could get the answers to questions that have been submitted as soon as possible, we would be grateful.

The committee stands adjourned until tomorrow at 10 o'clock. [Whereupon at 12:13 p.m., the subcommittee adjourned to reconvene at 10 a.m., Friday, February 15, 1974.]

31-151 O 74 Pt. 1 - 33

HEALTH SERVICES AND HEALTH REVENUE SHARING

FRIDAY, FEBRUARY 15, 1974

HOUSE OF REPRESENTATIVES,

SUBCOMMITTEE ON PUBLIC HEALTH AND ENVIRONMENT,

COMMITTEE ON INTERSTATE AND FOREIGN COMMERCE,

Washington, D.C.

The subcommittee met at 10 a.m., pursuant to notice, in room 2322, Rayburn House Office Building, Hon. Paul G. Rogers, chairman, presiding.

Mr. ROGERS. The subcommittee will come to order.

We are continuing our hearings regarding legislation proposing special health revenue sharing for 1974.

Our first witness this morning, we are very delighted to have Dr. C. Arden Miller, who is president-elect of the American Public Health Association, and professor of maternal child health at the University of North Carolina.

Dr. Miller, we welcome you and appreciate your being here.

Mr. PREYER. Mr. Chairman, I might add that Dr. Miller is one of our proudest products of North Carolina.

STATEMENT OF DR. C. ARDEN MILLER, PRESIDENT-ELECT, AMERICAN PUBLIC HEALTH ASSOCIATION; ACCOMPANIED BY JEFFREY MERRILL, SENIOR STAFF OFFICER

Dr. MILLER. I have with me Mr. Jeffrey Merrill, whom I would like to introduce. He is a senior staff officer of the American Public Health Association and has assisted me in the preparation of this testimony. As you know, the American Public Health Association encompasses about 50,000 regular and affiliate members with affiliate organizations in each of the 50 States.

We are particularly happy to testify concerning this bill because it concerns itself not only with a number of measures with which we are concerned and provides for their continuation and, in our view, substantial improvement, but deals with them in a package that invites attention to some issues common to all of them.

In our view the proposed legislation represents an effort to achieve a number of different goals: First, it provides continuing congressional authority to existing programs and establishes authorization levels for future appropriations. Second, it redefines the intent of some existing programs and places them within the context of new trends in health care delivery and financing, as in the case of section 314 (d) and revenue sharing. Third, the bill attempts to make major revisions in some of these programs, either through new organizational ap(501)

proaches to, or greater definition of, existing programs. We commend all these efforts, both because they extend important health service programs and because they provide for badly needed changes in some of them.

Last year, I remember, Congress passed a 1-year extension for a number of expiring health authorities. At that time, APHA testified that it supported this blanket extension with the reservation that during the ensuing year detailed examination would be given to many of these programs in order that they might be revised, consolidated, or eliminated, depending on their continued need or relevance to changing priorities and focus in the health care field. In this bill, and in others that the committee has either already addressed or is presently working on, that examination is being achieved and we also commend this subcommittee for those efforts.

Title I of this bill deals with continuation of section 314 (d) of the Public Health Service Act and provides for block grants to the States for the development of improved comprehensive health services to our population. In modern-day terminology, this title is an attempt to establish special revenue-sharing funds for health in order to free the States from the bonds of categorical programing and to allow them to expend funds according to locally perceived priorities. We agree with this concept but wish to express some concerns we have with it:

First, in order for States to achieve anything substantial with funds authorized under this title, and if this is to serve as the basis for health revenue sharing, the level of authorization should be increased. The experience of the States since the original passage of Public Law 89749 has been that the amounts available to them under section 314(d) have not been sufficient to mount any significant efforts either to expand or improve health services or even to assume local responsibility for programs from which HEW has withdrawn its support. We realize that this section does not preclude continued use of other moneys available under categorical programs, but in order to make full use of the latitude that this section was intended to offer, higher authorization is recommended.

Second, this provision, although giving flexibility to the States in expending funds for public health services, had specific guidelines for their use included in the original legislation (sec. 314(d) (2)). We would hope that careful monitoring of these moneys could be carried out through both local and State CHP mechanisms, as well as by the Federal Government. The APHA supports Federal review of locally developed plans in order to confirm their compliance with Federal standards. We further advocate national monitoring of the expenditures and programs developed in order to guarantee their compliance with the approved State plans.

We are pleased to see the continuation and strengthening of the community mental health centers (CMHC) program as developed in title II of this bill. In recent years there has been increasing acknowledgment, by both the Congress and the courts, of the right to treatment of the mentally ill. Recent legal decisions have defined more clearly what that right entails, and the increasing costs of services are forcing us to seek less expensive, new modes of providing treatment for the mentally handicapped. APHA believes that the CMHC pro