It separately identifies the roles of the Social Security Administration and the Public Health Service. Mr. FOGARTY. You may put it in the record. (The information to be supplied follows:) OPERATING ROLES OF THE SOCIAL SECURITY ADMINISTRATION, THE WELFARE ADMINISTRATION, AND THE PUBLIC HEALTH SERVICE IN CARRYING OUT CERTAIN OF THE HEALTH INSURANCE PROVISIONS OF THE SOCIAL SECURITY AMENDMENTS OF 1965 A. SOCIAL SECURITY ADMINISTRATION The Social Security Administration to have responsibility for policy formulation and the general management and operational aspects of the program, including the following: 1. Relationships with eligible beneficiaries, determinations as to their entitlement to health benefits and the characteristics and duration of services for which benefits may be paid; 2. Establishment, maintenance, and continuing administration of agreements with providers of service for program participation, including furnishing every provider, who so requests it, with a determination (based on a finding and recommendation by the appropriate State agency) as to his compliance or noncompliance with the conditions of participation for providers of service; 3. Determination of the content and scope of activities of payment intermediaries nominated by providers, and of carriers, or other agencies providing benefit payment and other services to the program; negotiation and administration of agreements with those organizations; 4. In consultation with the Public Health Service and the Welfare Administration, formulation of major policies relating to conditions of participation for providers for submittal to the Health Insurance Benefits Advisory Council and subsequent promulgation by the Secretary of regulations relating thereto; 5. In cooperation with the Public Health Service (and the Welfare Administration if a welfare agency is designated) negotiation and approval of agreements for services of State agencies and of initial operating plans and budgets, continued administration of such agreements including consultation on and interpretation of program policies; negotiations regarding staff and other resources to be paid for by the Federal Government under the agreements; approval of budgets and plans, advances of funds, and expenditure reports; and continuing review of State agency operations under the agreements to assure effective and economical administration; 6. Drafting of specifications for regulations, issuance of policy and procedural manuals, and development of systems and methods responsive to the operating needs of State agencies, providers of service, carriers, payment intermediaries, and other public or private organizations with operating responsibilities in the program; 7. Preparation of the required annual report to Congress on the operation and administration of the health insurance program, conduct of appropriate supporting studies of the effects of deductibles and coinsurance provisions, the desirability of modifying the provisions relating to the duration of services, the effect of the program on the security of beneficiaries, etc.; 8. Maintenance of relationships with the Railroad Retirement Board, State welfare agencies which purchase supplementary coverage (with appropriate involvement of the Welfare Administration), and other public and private agencies having an operating relationship with the program; 9. Planning on a continuous basis with the Public Health Service and the Welfare Administration for the conduct of statistical programs to meet the needs of constituents and interested voluntary agencies; collection and analysis of utilization and cost data together with estimates of future costs and their relationship to the tax base; 10. In cooperation with the Public Health Service and the Welfare Administration, and with consultation by other public and voluntary agencies, and authorities on hospital accounting, development of principles of reimbursement and of cost-finding formulas in connection with payment for services and administrative costs incurred by institutions or agencies which participate in administration of the program; 11. Financial management with respect to program operations, including formulation, defense and execution of budgets, arranging for payment to providers or their agents, and to State agencies and carriers for the agreed upon services: maintenance of procedures for accountability and carrying out or arranging for necessary audits (except where audits are performed by staff at the departmental level); but excluding budgeting for headquarters and regional staff of other constituents for expenditures to be authorized from the Federal hospital insurance trust fund; 12. Hearings and appeals provided for in section 1869 (b) and (c) with regard to individuals, institutions, or agencies dissatisfied with certain determinations made under the program. B. PUBLIC HEALTH SERVICE The Public Health Service to have principal responsibility for the professional health aspects of the program including the following program and operating responsibilities: 1. Initiation, professional consultation, and recommendation to the Social Security Administration in development of requirements necessary for health and safety and other guidelines for determining whether hospitals, extended care facilities, and home health agencies meet conditions for participation under the program; and in the development of concepts and policies for utilization review as required in hospitals and extended care facilities; 2. Consultation and advice to States which initiate requests to the Secretary for the approval of higher standards for providers of service than called for in Federal policy and regulations; and in consultation with the Social Security Administration, approval for the Secretary of requests by States for higher standards; 3. Consultation, recommendations, and assistance to the Social Security Administration in the negotiation of agreements with State agencies for their services in certifying and giving consultation to providers; regarding plans and budget requests submitted by State agencies to put the agreements into operation; and in cooperation with the Social Security Administration continued review and surveillance of the professional health aspects of State agency operations; 4. To the extent required under applicable policy, reviews of State agency certifications and recommendations to the Social Security Administration of acceptance (or nonacceptance) of State decisions as to whether providers meet the conditions of participation under the program; 5. Assistance in the professional training of State agency personnel for duties in evaluation of the qualifications of providers of service and in assisting those providers with deficiencies to qualify; 6. Consultation to State agencies in connection with their planning the coordinating of the hospital insurance program activities with other activities related to the provision of health services in the State, and in the development of State plans covering such coordinating functions; and in conjunction with the Social Security Administration reviewing and approving such plans and requests for funds for their implementation to the extent provided under H.R. 6675; i.e.. a "fair share" of the cost of such coordinating activities; 7. Studies of the adequacy of existing personnel and facilities for health care for the aged, methods for encouraging the further development of efficient and economical forms of health care which are a constructive alternative to inpatient hospital care, and in general for studies relating to the organization and utilization of health services, the quality of medical care and health manpower needs; 8. With the participation of the Social Security Administration and the Welfare Administration, studies of fees charged for professional services under the supplemental plan coverage, the nature and effect of fee conventions such as may be incorporated into relative value scales or other methods of arriving at fees. and evaluation of experience from the viewpoint of the reasonableness of charges: 9. With the participation of the Social Security Administration and the Welfare Administration, carrying out activities necessary to the proper functioning of the National Medical Review Committee in studying the utilization of hospital and other medical care services under the program and recommending changes in the way such care and services are utilized and related purposes as envisaged În section 1868 of the bill. C. WELFARE ADMINISTRATION The Welfare Administration to have a primary role in those aspects of hospital insurance and supplementary medical insurance program planning, co ordination, and evaluation as are related to or affect federally aided categorical assistance programs. 1. Participation with the Social Security Administration and the Public Health Service in the development of principles, methods, systems, procedures, and forms for payment of reasonable costs and charges for services and administrative costs incurred by institutions, agencies, or vendors participating in the operation or administration of the program to assure appropriate coordination so that insofar as practicable suppliers of services will not be required to maintain different systems for reimbursement for separate segments of patient care and financing; 2. Participation in the development of concepts, policies, and procedures for utilization review required of hospitals and extended care facilities, as they relate to State welfare responsibilities; 3. Consultation and general and technical assistance in medical assistance administration to State agencies administering medical care plans under titles I, XVI, and XIX of the Social Security Act in planning and organizing for their roles in the program, including identifying appropriate program operational techniques, needs, training, staffs, costs, etc.; and developing a coordinated approach to development of needed medical care resources; 4. Assistance in development of required standards or conditions of participation for providers of medical care and services and formulation of major policies relating thereto; 5. Provision for coordination in all aspects of program administration affecting public welfare agencies; 6. Participation in the development and conduct of studies of the adequacy of existing personnel and facilities for medical care and services, methods for encouraging the further development of economical and effective medical services which are constructive alternatives to inpatient hospital care, and, in general, of studies relating to the organization and utilization of medical care and services and the quality of medical care provided; 7. Assistance in studies of fees charged for professional services under the supplemental plan coverage, the nature and effect of fee conventions such as may be incorporated into relative value studies or other methods of arriving at fees, and devaluation of experience from the viewpoint of the reasonableness of charges; 8. Participation with the Social Security Administration and the U.S. Public Health Service in carrying out activities necessary to the proper functioning of the National Medical Review Committee in studying the utilization of hospital and other medical care and services under the program and recommending changes in the way such care and services are utilized and related purposes as envisaged in section 1868 of title XVIII; 9. Jointly with the Social Security Administration and the Public Health Service development of the scope and content of a program for evaluating federally financed health care programs for the aged, including the nature and content of basic records to be available and systems for data collection, processing, and analysis. SHORTAGE OF TRAINED PERSONNEL AND HOME HEALTH AGENCIES TO CARRY OUT HOME HEALTH SERVICES Mr. FLOOD. I direct your attention to page 1 of your statement, the first sentence of the second paragraph, "Under the health insurance for the aged program, the aged are entitled to several kinds of home health services as part of their benefits." That is an act of Congress. The fact of the matter is that they are not going to get them because there ain't no such services in many, many, or most of the places. This is really what the Congress said and told you to do. But an awful lot of people who are entitled to these services are not going to get them for years because there just are not the services available in many or most of the places. Dr. CASHMAN. Yes, sir, we realize there is a great gap between what the demand will be and what exists, and that is the reason for this program. 53-596-65--14 Dr. SENCER. I had better plead ignorance. This is out of my line. It is a suppressive rather than a curative drug. Mr. FLOOD. There is a depressive effect of quinine, is there not? Mr. FOGARTY. You wouldn't be spending millions of dollars trying to find a new drug if quinine was satisfactory. We don't know how much they have spent on this. Dr. SENCER. Dr. Coatney's group at the National Institutes of Health and one of the big drug firms have spent a lot of time and money on this. Quinine is only a suppressive and won't kill the parasite. Mr. FLOOD. We went from quinine to Atabrine and to these really fancy names. Dr. SENCER. Primaquine, chloroquine, amodiaquine Mr. FLOOD. If I take a small half a glass of quinine water, which they use in mixed drinks, with just merely a trace of quinine, I will immediately develop a rash, a pronounced rash, a scaly rash. Mr. DUNCAN. It is probably the gin, Mr. Flood. Mr. FLOOD. That is the trouble. My doctor said to me-it just so happens I don't drink anything alcoholic and my doctor said the opposite thing my friend said, "If you would have put gin in it, perhaps you wouldn't have had any trouble." If somebody hands it to me at a cocktail party, I take it because the waiters will leave you alone. But the slightest trace will give me this rash. Thank you very much, Doctor. JUSTIFICATION MATERIAL COMMUNICABLE DISEASE ACTIVITIES, PUBLIC HEALTH SERVICE Community immunization grants, increase of $8 million +8,000,000 8,000,000 Vaccines to prevent measles are available and have been available for more than 2 years-yet measles continues, unabated, to take its toll of disability and death among the Nation's children. Each year there are about 4 million cases of measles causing approximately 500 deaths and leading to serious complications such as measles encephalitis, pneumonia, and hearing disorders. The Nation cannot afford to wait for gradual, sporadic application of this new medical tool, and to meet this need for action the Vaccination Assistance Act has been revised and extended. Measles has not suddenly become a more serious disease-it has always been a scourge of childhood. It commands special attention now because modern medical research has provided us with vaccines which can prevent the disease. The barriers to widespread immunization against measles are considered to be the high cost of the vaccine and public apathy. Too many parents are ignorant of the seriousness of the disease and view it as a mild illness which is just an unpleasant part of growing up. Unless immunized, one out of every two children would have measles before entering school-90 percent before leaving schoolrisking the extensive disability and serious sequelae resulting from the disease. For example, measles encephalitis is estimated to occur once in every 500 cases. This is one of the known causes of mental retardation, and mental dullness result |