Health and Human Services United States. Congress. House. Committee on Appro.

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 (Volume Pt. 3) online

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fo 3

DEPARTMENTS OF LABOR, HEALTH AND HUMAN
SERVICES, EDUCATION, AND RELATED AGENCIES
APPROPRIATIONS FOR 1995



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Y4.AP6/1:L 11/995/PT.3 "•■•''-

HEARINGS „.,^ *^^m

BEFORE A iPNpi'U

SUBCOMMITTEE OF THE '^"^'^'^'''"^^^90^-^.



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



1 Died March 29, 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 of the 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 LABOR, HEALTH AND HUMAN

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



1 Died March 29, 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 of the 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



For sale by the U.S. Government Printing Office
Superintendent of Documents, Congressional Sales Office, Washington, DC 20402
ISBN 0-16-044A34-9



COMMITTEE ON APPROPRIATIONS
DAVID R. OBEY, Wisconsin, Chairman



JAMIE L. WHITTEN, Mississippi,

Vice Chairman
NEAL SMITH, Iowa
SID^fEY R. YATES, IlUnois
LOUIS STOKES, Ohio
TOM BEVILL, Alabama
JOHN P. MURTHA, Pennsylvania
CHARLES WILSON, Texas
NORMAN D. DICKS, Washington
MARTIN OLAV SABO, Minnesota
JULIAN C. DDCON, California
VIC FAZIO, California
W. G. (BILL) HEFNER, North Carolina
STENY H. HOYER, Maryland
BOB CARR, Michigan
RICHARD J. DURBIN, Illinois
RONALD D. COLEMAN, Texas
ALAN B. MOLLOHAN, West Virginia
JIM CHAPMAN, Texas
MARCY KAPTUR. Ohio
DAVID E. SKAGGS, Colorado
DAVID E. PRICE. North Carolina
NANCY PELOSI, California
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



JOSEPH M. McDADE, Pennsylvania

JOHN T. MYERS, Indiana

C. W. BILL YOUNG, Florida

RALPH REGULA, Ohio

BOB LIVINGSTON. Louisiana

JERRY LEWIS. California

JOHN EDWARD PORTER. Illinois

HAROLD ROGERS, Kentucky

JOE SKEEN. New Mexico

FRANK R. WOLF. Virginia

TOM Delay. Texas

JIM KOLBE, Arizona

DEAN A. GALLO, New Jersey

BARBARA F. VUCANOVICH. Nevada

JIM LIGHTFOOT, Iowa

RON PACKARD, CaUfornia

SONNY CALLAHAN. Alabama

HELEN DELICH BENTLEY. Maryland

JAMES T. WALSH. New York

CHARLES H. TAYLOR. North Carolina

DAVID L. HOBSON, Ohio

ERNEST J. ISTOOK, Jr.. Oklahoma

HENRY BONILLA, Texas



Frederick G. Mohrman, Clerk and Staff Director



(II)



DEPARTMENTS OF LABOR, HEALTH AND
HUMAN SERVICES, EDUCATION, AND RE-
LATED AGENCIES APPROPRIATIONS FOR
1995



Tuesday, April 26, 1994.
HEALTH RESOURCES AND SERVICES ADMINISTRATION

WITNESSES

CraO V. SUMAYA, M.D., ADMINISTRATOR

JAMES A. WALSH, PH.D., ASSOCIATE ADMINISTRATOR FOR OPER-
ATIONS AND MANAGEMENT

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 BUDGET ANALYSIS, OFFICE OF THE 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 of the 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 of the
Bureau of Health Resources Development; and on the far right, Bill
Beldon, representing the Office of the 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 of this proposal include a $39 million in-
crease in HIV Emergency Relief Grants, providing funds to an esti-
mated 37 to 41 cities. Chart number three shows the location of the
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 of health.

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 of teen 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 of those opportunities and meet those challenges.

At this time, Mr. Chairman, Members of the 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 3 7 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.



Healthy Start Initiative

The FY 1995 request includes $97.5 million, the same as the FY 1994
appropriation, to continue the 15 Healthy Start projects. These
grants will assist in the provision of comprehensive maternal and
infant health care and social services in communities with highest
infant mortality rates in order to reduce the rates by half. Healthy
Start includes a national public education campaign to publicize
simple, practical information on pregnancy and infant health, with
special emphasis on high-risk women of childbearing age and prospective
fathers. These projects should reach the full scope and intensity of
program interventions during this year.

Health Professions

The President's budget proposes to consolidate existing multiple
categorical grant and contract programs under Titles VII and VIII of
the PHS Act into five consolidated programs. Currently, HRSA's health
professions programs are characterized by over 30 separate program
authorizations. The FY 1995 request recommends consolidating and
refocusing existing health professions education programs to meet the
Nation's need to increase the supply of primary health care providers,
to increase the supply of health professionals for underserved areas,
and to increase the supply of minority health professionals.

Vaccine In-jury Compensation Program

The National Childhood Vaccine Injury Act of 198G established a program
to provide compensation for vaccine- related injury or death. The
Administration is requesting $110 million, the full authorization
level, to pay pre-1988 claims. The FY 1995 request seeks $54 million
for payment of post- 1988 claims and $3 million for administrative costs
both to be paid from the National Vaccine Injury Compensation Trust
Fund.

Health Education Assistance Loans (HEJUj)

The HEAL program insures loans provided by non- Federal lenders to
students in health professions schools. The Administration is
requesting $56.6 million to pay claims from HEAL guarantees made prior
to FY 1992. The FY 1995 request also includes a subsidy of $25.3
million to pay the net present value of HEAL claims arising from loans
made in FY 1995 and $2.9 million for HEAL administrative costs.
Finally, the request reflects a ceiling of $375 million on HEAL loans
to be insured in FY 1995 .

AIDS

In addition to the programs authorized xrnder the Ryan White Care Act,
the request includes $16.4 million to continue the AIDS Education and
Training Centers program and $7 million for the AIDS Dental
Reimbursement program.



8



Conclusion

We at HRSA see the coming year as one with numerous opportunities to
move the piablic's health agenda forward. With your assistance, HRSA
will continue to do more for the people who need our help.

Mr. Chairman and men±>ers of the Committee, my associates and I will be
pleased to address any questions or comments you may have on the
specifics of this budget request .



9



NAME:
POSITION:



BIRTHPLACE
and DATE:

EDUCATION :



Biographical Sketch

Ciro V. Sumaya, M.D., M.P.H.T.M.

Administrator, Health Resources and Services

Administration
U.S. Public Health Service
Department of Health and Human Services

Brownsville, Texas, August 1, 1941

B.A. - 1962, University of Texas, Austin, TX
M.D. - 1966, University of Texas Medical Branch,

Galveston, TX
M.P.H.T.M. - 1973, Tulane University,

New Orleans, LA



PREVIOUS
POSITIONS :
1990 - Present:



1987 - 1990:



Associate Dean for Affiliated Programs and Continuing
Medical Education, University of Texas Health Science
Center at San Antonio (UTHSC-San Antonio)

Associate Dean of Continuing Medical Education,
UTHSC-San Antonio



1983 - 1987:



Professor of Pediatrics and Pathology, UTHSC-San
Antonio



1978 - 1983:



1976 - 1977:



1973 - 1976:



Associate Professor of Pediatrics and Pathology,
UTHSC-San Antonio; Consultant, Diagnostic
Virology Laboratory, Bexar County Hospital

Assistant Professor of Pediatrics and Pathology,
University of Texas Health Science Center at
San Antonio (UTHSC-San Antonio) ; Director,
Diagnostic Virology Laboratory, Bexar County
Hospital

Assistant Professor, Department of Pediatrics,
Division of Infectious Diseases, UCLA School
of Medicine, Los Angeles, CA



POST GRADUATE
TRAINING:
1966 - 1967:



1967 - 1969:
1969 - 1971:



Intern, Los Angeles County General Hospital,
Los Angeles, CA

General Medical Officer, Whiteman Air Force Base

Pediatric Resident, St. Christopher's Hospital
for Children, Philadelphia, PA



10



1971 - 1973: Post-graduate fellow in Pediatric Infectious
Diseases and Instructor, Department of
Pediatrics, Tulane University School of
Medicine, New Orleans, liA; Clinic Physician
Tuberculosis Control, New Orleans, LA



ORGANIZATIONS
and

MEMBERSHIPS:
1991 - present:



1990 - present:

1988 - present:
1988 - present:
1987 - present;

1986 - 1989:

1978 - 1984:
1976 - present:



American Academy of Pediatrics Task Force on
Minority Children's Access to Pediatric Care

Texas Medical Association Committee on Rural
Health

Editorial Board of Texas Medicine

National Action Forum on Hispanic Health

Texas Medical Association Subcommittee on
Continuing Medical Education

Consultant, Pan American Health Organization
for development of Hospital Infection
Control Program in Santiago, Chile

Reviewer, Grant Proposals

Kroc Foundation, Santa Ynex, California

Reviewer, Journal of Pediatrics. Pediatrics.
American Journal of Diseases of Children-
Journal of Infectious D iseases. Pediatric
Infectious Disease Journal. Tex as Medicine-
Annals of Internal Medicine. Journal of
Clinical Microbiology



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LEVEL OF SERVICES



Mr. Smith. Well, I notice your increase is 3 percent overall, as



Online LibraryHealth and Human Services United States. Congress. House. Committee on ApproDepartments 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 (Volume Pt. 3) → online text (page 1 of 88)