Departments of Labor, Health and Human Services, Education, and related agencies appropriations for 1995 : hearings before a subcommittee of the Committee on Appropriations, House of Representatives, One Hundred Third Congress, second session

1044 Pages·1994·25.5 MB·English

by  United States. Congress. House. Committee on Appropriations. Subcommittee on the Departments of Labor, Health and Human Services, Education, and Related Agencies

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DEPARTMENTS OF HEALTH AND HUMAN
LABOR,
SERVICES, EDUCATION, AND RELATED AGENCIES
APPROPRIATIONS FOR 1995
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HEARINGS *^^m
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BEFORE A iPNpi'U
SUBCOMMITTEE OF THE
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COMMITTEE ON APPROPRIATIONS
HOUSE OP REPRESENTATIVES
ONE HUNDRED THIRD CONGRESS
SECOND SESSION
SUBCOMMITTEE ON THE DEPARTMENTS OF LABOR, HEALTH AND
HUMAN SERVICES, EDUCATION, AND RELATED AGENCIES
WILLIAM H. NATCHER, Kentucky, Chairman^
NEAL SMITH, Iowa JOHN EDWARD PORTER, Illinois
DAVID R. OBEY, Wisconsin C. W. BILL YOUNG, Florida
LOUIS STOKES, Ohio HELEN DELICH BENTLEY, Maryland
STENY H. HOYER, Maryland HENRY BONILLA, Texas
NANCY PELOSI, California
NITA M. LOWEY, New York
JOSE E. SERRANO, New York
ROSA DeLAURO, Connecticut
Michael A. Stephens, Robert L. Knisely, Susan E. Quantius, Mark J. Mioduski,
and Joanne L. Orndorff, Subcommittee Staff
1DiedMarch29, 1994
PART
3
DEPARTMENT OF HEALTH AND HUMAN SERVICES
PUBLIC HEALTH SERVICE
(Excluding the National Institutes of Health)
Page
Health Resources and Services Administration 1
Centers for Disease Control and Prevention 297
Substance Abuse and Mental Health Services
Administration 549
Office ofthe Assistant Secretary for Health/Qv^rview 713
.
Agency for Health Care Policy and Research .//£ll...4 899
Printed for the use of the Committee on Appropriations

DEPARTMENTS OF HEALTH AND HUMAN
LABOR,
SERVICES, EDUCATION, AND RELATED AGENCIES
APPROPRIATIONS FOR 1995
HEARINGS
BEFORE A
SUBCOMMITTEE OF THE
COMMITTEE ON APPROPRIATIONS
HOUSE OP REPRESENTATIVES
ONE HUNDRED THIRD CONGRESS
SECOND SESSION
SUBCOMMITTEE ON THE DEPARTMENTS OF LABOR, HEALTH AND
HUMAN SERVICES, EDUCATION, AND RELATED AGENCIES
WILLIAM H. NATCHER, Kentucky, Chairman»
NEAL SMITH, Iowa JOHN EDWARD PORTER, Illinois
DAVID R. OBEY, Wisconsin C. W. BILL YOUNG, Florida
LOUIS STOKES, Ohio HELEN DELICH BENTLEY, Maryland
STENY H. HOYER, Maryland HENRY BONILLA, Texas
NANCY PELOSI, California
NITA M. LOWEY, New York
JOSE E. SERRANO, New York
ROSA DeLAURO, Connecticut
Michael A. Stephens, Robert L. Knisely, Susan E. Quantius, Mark J. Mioduski,
and Joanne L. Orndorff, Subcommittee Staff
1DiedMarch29,1994
PART
3
DEPARTMENT OF HEALTH AND HUMAN SERVICES
PUBLIC HEALTH SERVICE
(Excluding the National Institutes of Health)
Page
Health Resources and Services Administration 1
Centers for Disease Control and Prevention 297
Substance Abuse and Mental Health Services
Administration 549
Office ofthe Assistant Secretary for Health/Overview 713
.
Agency for Health Care Policy and Research 899
Printed for the use of the Committee on Appropriations
U.S. GOVERNMENT PRINTING OFFICE
79-8790 WASHINGTON 1994
:
ForsalebytheU.S.GovernmentPrintingOffice
SuperintendentofDocuments,CongressionalSalesOffice,Washington,DC 20402
ISBN 0-16-044A34-9
COMMITTEE ON APPROPRIATIONS
DAVID R. OBEY, Wisconsin, Chairman
JAMIE L. WHITTEN, Mississippi, JOSEPH M. McDADE, Pennsylvania
Vice Chairman JOHN T. MYERS, Indiana
NEAL SMITH, Iowa C. W. BILL YOUNG, Florida
SID^fEY R. YATES, IlUnois RALPH REGULA, Ohio
LOUIS STOKES, Ohio BOB LIVINGSTON. Louisiana
TOM BEVILL, Alabama JERRY LEWIS. California
JOHN P. MURTHA, Pennsylvania JOHN EDWARD PORTER. Illinois
CHARLES WILSON, Texas HAROLD ROGERS, Kentucky
NORMAN D. DICKS, Washington JOE SKEEN. New Mexico
MARTIN OLAV SABO, Minnesota FRANK R. WOLF. Virginia
JULIAN C. DDCON, California TOM Delay. Texas
VIC FAZIO, California JIM KOLBE, Arizona
W. G. (BILL) HEFNER, North Carolina DEAN A. GALLO, New Jersey
STENY H. HOYER, Maryland BARBARA F. VUCANOVICH. Nevada
BOB CARR, Michigan JIM LIGHTFOOT, Iowa
RICHARD J. DURBIN, Illinois RON PACKARD, CaUfornia
RONALD D. COLEMAN, Texas SONNY CALLAHAN. Alabama
ALAN B. MOLLOHAN, West Virginia HELEN DELICH BENTLEY. Maryland
JIM CHAPMAN, Texas JAMES T. WALSH. New York
MARCY KAPTUR. Ohio CHARLES H. TAYLOR. North Carolina
DAVID E. SKAGGS, Colorado DAVID L. HOBSON, Ohio
DAVID E. PRICE. North Carolina ERNEST J. ISTOOK, Jr.. Oklahoma
NANCY PELOSI, California HENRY BONILLA, Texas
PETER J. VISCLOSKY, Indiana
THOMAS M. FOGLIETTA, Pennsylvania
ESTEBAN EDWARD TORRES, California
GEORGE (BUDDY) DARDEN, Georgia
NITA M. LOWEY, New York
RAY THORNTON, Arkansas
JOSE E. SERRANO, New York
ROSA L. DeLAURO, Connecticut
JAMES P. MORAN. Virginia
DOUGLAS "PETE" PETERSON, Florida
JOHN W. OLVER, Massachusetts
ED PASTOR, Arizona
CARRIE P. MEEK, Florida
Frederick G. Mohrman, Clerk and StaffDirector
(II)
DEPARTMENTS OF HEALTH AND
LABOR,
HUMAN AND
SERVICES, EDUCATION, RE-
LATED AGENCIES APPROPRIATIONS FOR
1995
Tuesday, April 26, 1994.
HEALTH RESOURCES AND SERVICES ADMINISTRATION
WITNESSES
CraOV. SUMAYA, M.D.,ADMINISTRATOR
JAMES A. WALSH, PH.D., ASSOCIATE ADMINISTRATOR FOR OPER-
ATIONSANDMANAGEMENT
MARILYN H. GASTON, M.D., DIRECTOR, BUREAU OF PRIMARY HEALTH
CARE
FITZHUGH, S.M. MULLAN, M.D., DIRECTOR, BUREAU OF HEALTH PRO-
FESSIONS
AUDREY H. NORA, M.D., DIRECTOR, MATERNAL AND CHILD HEALTH
BUREAU
G. STEPHEN BOWEN, M.D., DIRECTOR, BUREAU OF HEALTH RE-
SOURCES DEVELOPMENT
WILLIAM BELDON, DIRECTOR, DIVISION OF PUBUC HEALTH AND SO-
CIAL SERVICES BUDGETANALYSIS, OFFICE OFTHE SECRETARY
Mr. Smith. This morning we have two interesting hearings, one
on the Centers for Disease Control and the other one on the Health
Resources and Services Administration.
Introduction of Witnesses
Dr. SUMAYA. Thank you, Mr. Chairman and Members ofthe com-
mittee. I am pleased to be here today with my colleagues to discuss
the fiscal year 1995 budget for the Health Resources and Services
Administration.
To my immediate left is Dr. James Walsh, Associate Adminis-
trator for Operations and Management; to his left Dr. Fitzhugh
MuUan, Director of the Bureau of Health Professions; on my far
left is Dr. Audrey Nora, Director, Maternal and Child Health Bu-
reau; on my right is Dr. Marilyn Gaston, Director, Bureau of Pri-
mary Health Care; to her right. Dr. Stephen Bowen, Director ofthe
Bureau ofHealth Resources Development; and on the far right, Bill
Beldon, representing the Office ofthe Secretary.
I have just completed my second month as the HRSA Adminis-
trator. Previous to this, I was Associate Dean for Affiliated Pro-
grams and Continuing Medical Education at the University of
Texas Health Center at San Antonio, Texas.
(1)
Opening Statement
My full statement is being submitted for the record.
I would like to summarize it with three charts. HRSA's budget
request of over $3 billion continues the Agency's preeminent role
in providing primary health care and health education to better
serve the underserved and disadvantaged.
The first chart shows the funding for HRSA since fiscal year
1989. This shows how the Congress has emphasized HRSA pro-
grams since 1989. The focus of this year's increase in the budget
is a continuation of the President's investment initiative for the
Ryan White AIDS Program.
Chart number two shows how the HRSA-Ryan White AIDS Pro-
gram has expanded since it was initially funded in 1991. For
HRSA, we are requesting a $93 million increase above the 1994 ap-
propriation. The elements ofthis proposal include a $39 million in-
crease in HIV Emergency ReliefGrants, providing funds to an esti-
mated 37 to 41 cities. Chart number three shows the location ofthe
current grantees for this program.
A $30 million increase for Part B of the Ryan White Emergency
Act of 1990 is included, providing funds to States and territories
for the operation of HIV-service delivery consortia in the localities
most affected by the epidemic; for the provision of home and com-
munity-based care; for continuation of insurance coverage for in-
fected people; and for HIV treatments that prolong life and prevent
serious deterioration ofhealth.
The requested increase for Ryan White AIDS also includes a $19
million increase for Early Intervention Services providing grants to
federally qualified health centers and nonprofit private entities
that provide comprehensive primary care services to populations at
risk of HIV disease; and a $5 million increase for demonstration
grants to ensure that clinical research and outpatient health care
are accessible and coordinated for the target population of HIV in-
fected children, pregnant women, and their families.
The budget request also includes a $18 million increase for Fam-
ily Planning to provide outreach services to low-income women; to
place more emphasis on prevention ofteen pregnancy and on train-
ing and retention of Family Planning nurse-practitioners; to in-
crease the focus of quality and completeness of services; and to ex-
pand current clinic sites and development of clinics in high need
areas; and a proposal to consolidate the Health Professions authori-
ties in five program areas.
We
will focus existing health professions education programs to
meet needs for primary care providers, health professionals for un-
derserved areas and populations and minority health professionals.
The remaining programs in HRSA will be maintained at the fiscal
year 1994 level.
This will meet our commitment to improving the Nation's pri-
mary health care through Community and Migrant Health Cen-
ters, treatment programs for persons with black lung disease, Han-
sen's disease, AIDS, and a wide variety of other activities dealing
with organ transplantation, vaccine injury compensation and
health care services for the homeless.
In fiscal year 1995, the Health Resources and Services Adminis-
tration will address many opportunities and numerous challenges,
and I believe the budget we are presenting to you will enable us
to take advantage ofthose opportunities and meet those challenges.
At this time, Mr. Chairman, Members ofthe Committee, I would
be pleased to answer any questions that you may have.
[The prepared statement and biography of Dr. Giro Sumaya fol-
lows:]
STATEMENT OF THE ADMINISTRATOR OF THE
HEALTH RESOURCES AND SERVICES ADMINISTRATION
Mr. Chairman and Members of the Committee:
I am pleased to appear before you today to discuss the fiscal year
(FY) 1995 budget request for the Health Resources and Services
Administration (HRSA) . I am beginning my third month as the HRSA
Administrator. Previous to this, I was the Associate Dean for
Affiliated Programs and Continuing Medical Education at the University
of Texas Health Science Center at San Antonio, Texas.
These are challenging times for this agency as the Nation prepares to
take on the responsibility of ensuring that comprehensive health care
is available to all Americans. HRSA is moving fast to be ready to meet
the new challenges.
The FY 1995 budget for HRSA proposes to extend most of our traditional
activities at the FY 1994 appropriation level. In total, we are
requesting over $3 billion and 2,054 direct full-time-equivalent
positions. Our partners in this effort are State and local health
departments, private nonprofit organizations, universities, other
Federal agencies, community and migrant health centers, hospitals and
other health facilities, private insurers, employers, and many other
participants in our nation's public health system. We work hard to
coordinate and combine our efforts with our partners to use most
effectively the resources available to us.
The focus of this year's budget increase is the continuation of the
President's Investment Initiative for the Ryan White AIDS programs and
the Family Planning program. For HRSA, this represents an increase of
$93 million (+16%) above the FY 1994 appropriation for Ryan White and
an $18 million (+10%) increase for the Family Planning Program. These
increases are partially offset by a $15 million decrease to Health
Professions Programs and an $8 million decrease from the Maternal and
Child Health Block Grant set-aside, for a net increase of $88 million.
The elements of this proposal are:
o an increase of $93 million above the FY 1994 appropriation
for funding of the programs authorized by the Ryan White
Comprehensive AIDS Resources Emergency Act of 1990. The
HIV epidemic is a multifaceted national and international
problem. The HRSA's role in this effort includes support
for community based planning, a broad range of primary care
and support services, as well as educational and training
programs. Specific request amounts include:
o A total of $364.5 million for HIV Emergency Relief
Grants (an increase of $39 million -- or 12 percent
-- over the FY 1994 appropriation) providing funds
to an estimated 37 to 41 metropolitan areas with very
high numbers and/or rates of AIDS cases. From 3-7
new metropolitan areas that will be eligible in
FY 1995. These grants fund coordinated outpatient
and ambulatory health and social support services;
o $214 million for HIV Care Grants (an increase of $30
million -- or 16 percent -- over the FY 1994
appropriation) providing fxinds to States and
territories for the operation of HIV service delivery-
consortia in the localities most affected by the
epidemic, for the provision of home and community-
based care, for continuation of insurance coverage
for people with HIV, and for HIV related
pharmaceuticals that prolong life and prevent serious
deterioration of health;
o $67 million for Early Intervention Services (an
increase of $19 million -- or 40 percent -- above the
FY 1994 appropriation) provided grants to federally
qualified health centers and nonprofit private
entities that provide comprehensive primary care
services and preventive health services to people
with HIV and populations at risk of HIV disease; and
o $27 million (an increase of $5 million -- or 23
percent -- above the FY 1994 appropriation) to expand
Part D (Title IV) which supports the creation of
comprehensive, community based care networks for
children, pregnant women, and their families and
ensures that clinical research and outpatient health
care are accessible and coordinated for these
targeted populations.
o $199 million (an increase of $18 million -- or 10
percent -- above the FY 1994 appropriation) for
Family Planning to provide outreach services to low-
income women; to place more emphasis on prevention of
teen pregnancy and on training and retention of
Family Planning nurse-practitioners to increase the
;
focus of quality and completeness of services; and to
expand current clinic sites and development of
clinics in high need areas.
Ix addition to these increases which are included in the President's
budget, HRSA programs will continue more than $2.9 billion in ongoing
program activities including CHCs, MHCs, and the NHSC.
Community Health Centers
The FY 1995 request includes $604 million, the same as the FY 1994
appropriation, to continue support to about 1,500 Community Health
Center sites, providing primary health care services to approximately
6.4 million medically underserved individuals. Residents of
underserved communities may not have access to care because they lack
insurance, live in communities without sufficient health delivery
capacity, have health concerns not met by traditional medical care, or
face other barriers to care. The request includes funding for the case
management approach to perinatal care designed to reduce infant
mortality.
Migrant Health Centers
The FY 1995 request of $59 million for Migrant Health Centers will
continue primary care services to approximately 550,000 migrant and
seasonal farmworkers and their families. This, too, is a group which
finds access to health care difficult because of lifestyle, location,
language, culture, and economic barriers.
National Health Service Corps (NHSC)
The NHSC program is designed to improve the capacity to provide health
services in Health Professional Shortage Areas (HPSA) and improve
access to health care in these areas through the placement and support
of health professionals. The NHSC, and its related recruitment and
retention efforts, play a critical role in the attempt to reduce
shortages of physicians and other primary care providers such as nurse
practitioners and midwives and physicians assistants in the most
difficult to staff areas throughout the country. The budget request of
$44.7 million, the same as the FY 1994 appropriation, will continue
logistical and clinical support for the current and projected field
strength levels.
National Health Service Corps Recruitment
The FY 1995 budget request of $79.3 million for NHSC recruitment, the
same as the FY 1994 appropriation, will support 417 new scholarships,
418 Federal loan repayments to health professionals and health
professions students, and 380 State loan repayment agreements in
exchange for service in the neediest HPSAS.
Maternal and Child Health
The FY 1995 request is $679 million for the Maternal and Child Health
Block Grant Program (MCH) . Given the limits imposed by the
discretionary caps, an $8 million decrease is proposed for the MCH
Special Projects of Regional and National Significance (SPRANS) set-
aside. The request will enable States to continue to provide a wide
range of health services to mothers, infants and children; particularly
those with, low income or limited availability of health services, as
well as provide community health activities and systems development
through setaside programs. While the reduction of $8 million is
targeted to Research and Maternal and Child Health Improvement
Projects, all continuations will be funded. The request includes:
o $574.5 million for State Block grants;
o $93.4 million for special projects of regional and national
significance (SPRANS) in the categories of research,
training, hemophilia, genetic diseases, and maternal and
child health improvement; and
o $11.1 million for the Community Integrated Service Systems
set-aside which supports the development and expansion of
primary care delivery strategies for mothers and children.