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MENTAL HEALTH CENTERS CONSTRUCTION ACT

EXTENSION

TUESDAY, APRIL 4, 1967

HOUSE OF REPRESENTATIVES,
SUBCOMMITTEE ON PUBLIC HEALTH AND WELFARE,
OF THE COMMITTEE ON INTERSTATE AND FOREIGN COMMERCE,

Washington, D.C. The subcommittee met at 10 a.m., pusuant to notice, in room 2123, Rayburn House Office Building, Hon. John Jarman (chairman of the subcommittee) presiding.

Mr. JARMAN. The subcommittee will please be in order. The hearings today are on H.R. 6431, the Mental Health Amendments of 1967, introduced by Chairman Staggers at the request of the administration. This bill would extend the current program of grants for the construction and initial staffing of community mental health centers; would authorize research, training and demonstration project grants to be made to Federal institutions, and would authorize establishment of a contingency account for the Department of Health, Education and Welfare.

This committee has been active in the field of mental health legislation for over 20 years now, beginning with the initial legislation establishing the National Institute of Mental Health.

In 1955, this committee initiated the Mental Health Study Act of 1955 calling for the establishment of a program of research and study of our resources, methods and practices for diagnosing, treating, caring for, and rehabiltating the mentally ill.

A Joint Commission on Mental Illness and Health was established pursuant to this legislation and the Commission made its final report on December 30, 1960. The Commission recommended establishment of community mental health centers to provide care for the mentally ill close to their homes in a community setting:

The report of this Commission was studied by the executive branch and the Congress and in 1963, President Kennedy recommended to the Congress the enactment of legislation providing Federal matching grants for construction and initial staffing of community mental health centers. Hearings were promptly held on this legislation and legislation was enacted in October 1963 authorizing matching grants for construction of community mental health centers.

In 1965, President Johnson recommended the enactment of legislation providing matching grants for initial staffing of community mental health centers; and this legislation became law in 1965.

The authorization for matching grants for construction is due to expire June 30 this year, and the authorization for grants for initial

staffing is scheduled to expire June 30, 1968; therefore, prompt action on this legislation is required in order that orderly planning may continue.

(The bill, H.R. 6431, and department reports thereon, follow:)

[H.R. 6431, 90th Cong., 1st sess. ] A BILL To amend the public health laws relating to mental health to extend, expand,

and improve them, and for other purposes Be it enacted by the Senate and House of Representatives of the United States of America in Congress assembled, That this Act may be cited as the "Mental Health Amendments of 1967".

GRANTS FOR CONSTRUCTION OF COMMUNITY MENTAL HEALTH CENTERS SEC. 2. (a) Section 201 of the Community Mental Health Centers Act (42 U.S.C. 2681) is amended by striking out "and $65,000,000 for the fiscal year ending June 30 ,1967" and inserting in lieu thereof, "$65,000,000 for the fiscal year ending June 30, 1967, $50,000,000 for the fiscal year ending June 30, 1968, and such sums striking out “1967" and inserting in lieu thereof "1972".

(b) Section 207 of such Act is amended (1) by striking out “three”, and (2) by striking out “1967" and inserting in lieu thereof "1972".

GRANTS FOR INITIAL STAFFING OF COMMUNITY MENTAL HEALTH CENTERS

SEC. 3. (a) Section 221 (b) of the Community Mental Health Centers Act (42 U.S.C. 2688a (b)) is amended bp striking out "1968” each place it appears and inserting in lieu thereof "1972”.

(b) The first sentence of section 224 of such Act is amended by striking out "and $30,000,000 for the fiscal year ending June 30, 1968" and inserting in lieu thereof “$30,000,000 for the fiscal year ending June 30, 1968, and such sums as may be necessary for the next four fiscal years". The second sentence of such section is amended by striking out "five" and inserting in lieu thereof "nine".

MISCELLANEOUS AMENDMENTS RELATING TO CONSTRUCTION OF COMMUNITY

MENTAL HEALTH CENTERS

SEC. 4. (a) Section 401 (e) of the Mental Retardation Facilities and Community Mental Health Centers Construction Act of 1963 (42 U.S.C. 2691) is amended by inserting "acquisition," after “new buildings,".

(b) Paragraph (7) of section 204 of such Act (42 U.S.C. 2684), is amended by inserting before the semicolon at the end thereof "and, effective July 1, 1969, provide for enforcement of such standards with respect to projects approved by the Secretary under this part after June 30, 1967".

PROJECT GRANTS TO FEDERAL INSTITUTIONS SEC. 5. Effective July 1, 1968, title V of the Public Health Service Act is amended by adding after section 506 (42 U.S.C. 224) the following new section :

"GRANTS TO FEDERAL INSTITUTIONS "SEC. 507. Appropriations to the Public Health Service available for research, training, or demonstration project grants pursuant to this Act shall also be available, on the same terms and conditions as apply to non-Federal institutions, for grants for the same purpose to hospitals of the Service, of the Veterans Administration, or of the Bureau of Prisons, Department of Justice, and to Saint Elizabeths Hospital.”

ESTABLISHMENT OF A CONTINGENCY ACCOUNT SEC. 6. (a) In order to facilitate the more efficient and effective administration of the programs of the Department of Health, Education, and Welfare, there is hereby created in the Treasury of the United States a contingency account which shall be available to the Secretary of Health, Education, and Welfare without fiscal year limitation for use as provided in this section.

(b) There is authorized to be deposited in the contingency account established by subsection (a), to the extent authorized in annual appropriation Acts, the amount of any general fund appropriation to the Department for a fiscal year (beginning with appropriations for the fiscal year ending June 3, 1967) which, at the end of the period for which such appropriation is available for obligation, remains unobligated, but only to the extent such deposit, when added to the sum then in the account, will not increase such account to more than $50,000,000. The amount so deposited shall be based on estimates made at the time of the termination of availability of the appropriation, with subsequent adjustments (to be made no later than the close of the fiscal year following the year in which the deposit was made) being made to take account of errors in such estimates.

(c) The Secretary is authorized, to the extent provided in annual appropriation Acts, to draw upon the contingency account established by subsection (a) whenever he determines that such action is required to fulfill his responsibilities and that delay pending further appropriations by the Congress would be contrary to the public interest, but only if such withdrawal is required to carry out a purpose which the Secretary determines is significant and only if the need for such withdrawal could not reasonably have been anticipated at the time the Budget was submitted to the Congress. Funds withdrawn pursuant to such a determination may be transferred and merged with the appropriation or appropriations the Secretary determines to be appropriate. Each such determination shall be subject to the following limitations

(1) no amount may be so used during any fiscal year for a purpose for which funds were requested in the Budget for such year but for which funds were not appropriated for such year;

(2) no amount may be so used for any activity or purpose which is not otherwise authorized by law;

(3) the amounts so used pursuant to any such determination for any fiscal year may not exceed $15,000,000 ; and

(4) no amount may be so used in any fiscal year for any purpose if amounts were so used during both of the two preceding fiscal years for the same purpose.

(d) The Secretary shall, at least ten days prior to the use of any funds pursuant to each determination under this section, notify the Appropriations Committees of the Congress of such determination; and on or before July 31, 1968, and on or before July 31 of each succeeding year, the Secretary shall transmit to the Congress a full report on operations with respect to the fund established by subsection (a) during the fiscal year ending on the June 30 preceding such July 31.

DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE,

Washington, D.C., April 5, 1967. Hon. HARLEY O. STAGGERS, Chairman, Committee on Interstate and Foreign Commerce, House of Representatives, Washington, D.C.

DEAR MR. CHAIRMAN : This letter is in response to your request of March 14, 1967, for a report on H.R. 6431, a bill "To amend the public health laws relating to mental health to extend, expand, and improve them, and for other purposes.'

The bill, to be cited as the “Mental Health Amendments of 1967,” would extend or amend the provisions of the Mental Retardation Facilities and Community Mental Health Centers Construction Act of 1963 in four respects :

(1) The authorization for grants for the construction of community mental health centers would be extended for five additional years—through fiscal 1972. For Fiscal 1968, $50 million would be authorized for this purpose, and for each of the remaining four fiscal years such sums as may be necessary.

(2) The authorization for grants for initial staffing of community mental health centers would be extended for four additional years—also through fiscal 1972. For fiscal 1968, $30 million would be authorized for this purpose (the amount now authorized for fiscal 1968) and for each of the remaining three fiscal years such sums as may be necessary.

(3) Section 401 (e) of the Act would be amended to permit construction grant funds to be used for the acquisition of existing buildings as well as for the construction of new facilities.

(4) Section 204 of the Act would be amended to require that-effective July 1, 1969_State plans for the construction grant program shall provide for enforcement of State minimum standards for the operation of such mental health facilities.

In addition to these mental health amendments, the bill includes two other provisions of more general applicability :

(1) Section 5 of the bill would add a new section 507 to the Public Health Service Act which would provide continuing (and somewhat expanded) authority for certain Public Health Service project grants which have heretofore been permitted under provisions of annual appropriations acts. The new section would provide that appropriations to the Public Health Service for research, training, or demonstration project grants shall be available, on the same terms and conditions as apply to non-Federal institutions, for grants for the same purpose to hospitals of the Service, of the Veterans' Administration, or of the Bureau of Prisons, Department of Justice, and to Saint Elizabeths Hospital.

(2) Section 6 of the bill would establish in the Treasury of the United States a contingency account available to the Secretary of Health, Education, and Welfare to meet certain unforeseen needs relating to the program responsibilities of the Department. No new appropriations would be authorized for this purpose, since funds in the account would be accumulated through the transfer of unobligated general funds appropriated to the Department in annual appropriation acts. Both the accumulation of funds in the account and their expenditure to meet contingency needs would be subject to certain statutory limits and conditions, including a limitation to authorizations contained in annual appropriations acts. Full reports to Congress would be required.

The provisions of H.R. 6431 embody legislative recommendations contained in a draft bill submitted by this Department to the Congress on February 28, 1967, to implement the mental health recommendations contained in the President's Message on Education and Health. We strongly recommend early enactment of the bill.

We are advised by the Bureau of the Budget that enactment of this proposed legislation would be in accord with the program of the President. Sincerely,

WILBUR J. COHEN, Under Secretary.

OFFICE OF THE ATTORNEY GENERAL,

Washington, D.C., April 5, 1567. Hon. HARLEY O. STAGGERS, Chairman, Committee on Interstate and Foreign Commerce House of Representatives, Washington, D.C.

DEAR MR. CHAIRMAN : This is in response to your request for the views of the Department of Justice on H.R. 6431, the “Menatl Health Amendments of 1967."

The Mental Retardation Facilities and Community Mental Health Centers Construction Act of 1963, 77 Stat. 284, as amended, 42 U.S.C. 2661, authorizes the Secretary of Health, Education and Welfare to make grants to the States for construction of facilities for the mentally retarded and of community mental health centers. In addition, the Act authorizes grants for university-affiliated facilities for the mentally retarded and initial staffing grants for community mental health centers.

The “Mental Health Amendments of 1967” would extend the appropriation authorization for the Community Mental Health Centers program from 1967 until 1972. Similarly, the program of staffing grants for Community Mental Health Centers would be extended from 1968 until 1972. The definition of "construction” in section 401 of the Act (42 U.S.C. 2691) would be amended to include acquisition of existing buildings and the Community Mental Health Centers program would be amended to require that, after July 1, 1969, States enforce minimum maintenance and operations standards for centers constructed with grant funds. H.R. 6431 would also amend the Public Health Service Act, 58 Stat. 682, as amended, 42 U.S.C. 201 et seq., to make research, training and demonstration project grants under that act available to various federal hospitals.

H.R. 6431 would establish in the Treasury a contingency account for the Department of Health, Education and Welfare, limited to a total of $50,000,000.

Unobligated appropriations of that Department would be deposited in the account and the Secretary of Health, Education and Welfare would be authorized to draw on the account whenever he determines: that such action is necessary to fulfill his responsibilities; that delay pending further appropriations would be contrary to the public interest; that the withdrawal is required to carry out a significant purpose; and that the need for such withdrawal could not reasonably have been anticipated at the time of the Budget submission. Individual withdrawals in excess of $15,000,000 in any one fiscal year would not be permitted, and no withdrawal could be made if Congress had refused to appropriate requested funds for the particular purpose or if withdrawals for the same purpose had been made in the two preceding years. Prior notice of withdrawals would be made to the Appropriations Committee and annual reports on the contingency account would be made to Congress.

The Department of Justice recommends enactment of this legislation.

The Bureau of the Budget has advised that there is no objection to the submission of this report from the standpoint of the President's program. Sincerely,

RAMSEY CLARK, Attorney General.

VETERANS' ADMINISTRATION,
OFFICE OF THE ADMINISTRATOR OF VETERANS AFFAIRS,

Washington, D.C., April 6, 1967.
Hon. HARLEY O. STAGGERS,
Chairman, Committee on Interstate and Foreign Commerce,
House of Representatives, Washington, D.C.

DEAR MR. CHAIRMAN: We are pleased to furnish the following comments in response to your request for a report by the Veterans Administration on H.R. 6431, 90th Congress.

The stated purpose of the bill is "To amend the public health laws relating to mental health to extend, expand, and improve them, and for other purposes." Section 5 of the bill is of direct interest to the Veterans Administration and our comments refer to that section.

Section 5 would amend title V of the Public Health Service Act, effective July 1, 1968, by adding after section 506 the following new section :

"GRANTS TO FEDERAL INSTITUTIONS

"Sec. 507. Appropriations to the Public Health Service available for research, training, or demonstration project grants pursuant to this Act shall also be available, on the same terms and conditions as apply to non-Federal institutions, for grants for the same purpose to hospitals of the Service, of the Veterans' Administration, or of the Bureau of Prisons, Department of Justice, and to Saint Elizabeths Hospital."

We understand that this section was developed and proposed by the Department of Health, Education, and Welfare to overcome a problem that became apparent after passage of Public Law 89-239, enacted October 6, 1965. This law authorized through the new title IX of the Public Health Service Act grants to be made from the Public Health Service appropriations for establishment and operation of cooperative regional medical programs designed to aid in research and transmission of new knowledge and technology on heart disease, cancer, stroke, and related diseases from the Nation's medical centers to the community hospitals. The grant provisions in title IX include "public ... institutions and agencies" but this has not been considered by the administering department as broad enough in this context to include Federal facilities such as VA hospitals.

It seems to us that to assure the effectiveness of the Regional Medical Program the same treatment should be accorded to Federal hospitals in providing grants for purposes directed to the health needs of the Nation as a whole as is afforded all other hospitals. The current exclusion of Federal hospitals works to the disadvantage of both the hospitals and various regions for it prevents an important segment of the national medical care system from fully and effectively participating in planning the regional programs at the formative stage. This is contrary to one of the major objectives of the Regional Medical Program, namely, to foster unified planning and utilization of regional resources.

Under the bill the Public Health Service grants could also be made directly to VA hospitals for research and related activities apart from the Regional Medi

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