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The intention of the comprehensive health planning agency is to provide a mechanism for pulling this information together so that the State can have some idea of what the long-range objectives are in the development of resources and services, what their capabilities are, what priorities they might have, what choices there are toward these priorities, given an assessment of their economic development, and of the development of their trained resources and of their facilities.
I think the best way to picture the relationship is to see mental health planning as vertical. It aims at a specific health problem and a specific target population, and it is one of many such vertical health planning functions being carried on simultaneously within a State.
On the other hand, the comprehensive health planning agency has a horizontal role, tying all the vertical plans into a single information sharing and evaluating system, and developing a plan for the total health needs of the total population.
The real function of the comprehensive health planning agency is to collect and then evaluate that information which shows what the health program choices are, whether the objectives are sound, whether they need to be changed.
In a given instance, the mental health agency may be overly ambitious or need some direction. This information would be available through the comprehensive planning agencies to the State government, to the Federal Government, to the private sector—such as Blue Cross or any other group.
So this is the relationship between the specific planning and the comprehensive health planning agency. Mr. JARMAN. Thank
you. Mr. Rogers? Mr. ROGERS. Thank you, Mr. Chairman.
Mr. Secretary, it is a pleasure, of course, to see you again with your associates here. I think the facts that have been presented on the reduction of mental cases actually occupying hospital beds are impressive.
I think we are beginning to make real progress, and this is encouraging, and I commend you and your associates and those from the National Institutes of Health.
There are two or three things I am concerned with in the new request. I notice that where we had previously, I believe, reached a level of $65 million for construction of community mental health centers you are now recommending a reduction of that figure in June 1968 of $15 million.
Could you give us some comment on this? Is it that you don't have enough applications or are we on top of the problem enough where we don't need to go into this program any more?
Mr. COHEN. I think that generally speaking, Mr. Chairman, and Dr. Yolles can amplify, what happens in a construction program in the early years is that the program progresses a little slower than intended as you said, there is a great deal of need for State and local consultation. I think that our original aspirations, projected to the fourth and fifth year from the submission of our original proposals, even somewhat above what we can carry out. I
would have to quite frankly admit that during the preparation of our legislative program, when we had a number of other budget considerations, we were also influenced by a desire not to accelerate construction unnecessarily at a time when interest rates were higher than normal and when there were inflationary pressures.
I would hope now, though, with the program we have presented to you that we could modestly increase the amount of Federal funds in this program to get back upon our original schedule.
Mr. Rogers. That resulted in this particular figure?
Mr. ROGERS. Then you think there are conditions that should be considered by the committee then that might change?
Mr. COHEN. Yes. I think that when you see our revision of our request for authorization for the next 5 years you will see that they will turn out to be a little bit more modest than those we originally submitted in 1963.
We all recognize that it is going to take quite some time to reach our ultimate goal and it is desirable for us to do it in a sound way, enlisting the full support of the communities.
I should also say one other thing: It isn't solely a matter of Federal funds involved here. Once a center is established it is anticipated that the locality will see that it is financed. That means substantial State and local money and money from individual patients and insurance premiums. The locality has to be doubly sure that it can support this operation in the indefinite future.
Mr. ROGERS. I will agree. You have constructed 286, I believe you stated. How many applications do you have on hand?
Do you have applications to warrant this additional appropriation? Is it sufficient? Is it insufficient? Could you give us facts on that?
Perhaps you could submit it for the record.
Mr. ROGERS. Maybe you can comment quickly and then submit the details.
Dr. YOLLES. Our experience is to date that we have been able to use all of the funds available to us and we would expect that this would continue for the next year at least.
Mr. ROGERS. The indications from the applications would indicate this?
Dr. YOLLES. Yes.
COMMUNITY MENTAL HEALTH CENTERS PROGRESS REPORT
During fiscal year 1966 a total of $32.4 million was obligated (FY 65 funds two year availability) representing 93 projects for the construction of community mental health centers. Additionally, $15.2 million was obligated (FY 66) representing 54 projects for the staffing of community mental health centers.
During fiscal year 1967 an additional 33 construction projects and 19 staffing projects have been approved respectively obligating $20 million (FY 66 fundstwo year availability) and 2.6 million. Based upon projects anticipated to be reviewed prior to the close of this fiscal year, June 30, 1967, another 68 construction projects representing $30 million and 58 staffing projects representing $16.5 million will be approved.
Based upon experience to date, we anticipate receiving during fiscal year 1968, 97 construction and 104 staffing applications. These would represent about $60
million for construction and about $30 million for staffing. With the current request for appropriations, $50 million for construction (1967 funds—two year availability) and $20 million for staffing, we would be able to approve approximately 83 of the requests for construction assistance and 66 of the requests for staffing assistance.
Mr. ROGERS. The Chairman has brought out the fact that this committee does not like to use language such as “appropriate such sums as may be necessary," so that I think we need language and specific figures as I think the Department knows.
Now, this contingency account, what precedent is there for setting up a contingency account like this by Federal departments other than for the President!
Mr. COHEN. I will ask Mr. Kelly, our Assistant Secretary, and Comptroller of the Department to handle that.
Mr. KELLY. Mr. Rogers, there are a large number of provisions throughout the Federal Government that either establish contingency accounts or that establish authority to transfer funds from one appropriation to another.
All told, I think we have accounted for about 36 of them.
Mr. ROGERS. How many contingency funds have complete authority other than just notifying ?
Mr. KELLY. The Department of Defense has several contingency funds. One that I am looking at now authorizes the Secretary of Defense to spend an additional $200 million if he determines that such is required in the public interest.
There is also a Department of Defense contingency fund which authorizes the Secretary of Defense to transfer research and development funds and to augment them.
Mr. ROGERS. From his contingency fund?
Mr. KELLY. No. I don't believe so. There is one in the Department of Health, Education, and Welfare and one in the Department of Labor that relates to the contingency of increased workload alone.
In the Social Security Administration we are authorized to augment our funds by $25 million in the event that the workload that is received from claimants exceeds that which the budget estimate was based on.
Mr. ROGERS. I think it might be good to submit that into evidence. (The information requested follows:)
EXAMPLES OF CONTINGENCY FUNDS AUTHORIZED IN FISCAL YEAR 1967
APPROPRIATION ACTS 1. Funds Appropriated to the President Economic Assistance: "Contingency fund: For expenses authorized by section 451(a), $35,000,000."
2. Department of Defense-Contingencies, Defense: "For emergencies and extraordinary expenses arising in the Department of Defense, to be expended on the approval or authority of the Secretary of Defense and such expenses may be accounted for solely on his certificate that the expenditures were necessary for confidential military purposes; $15,000,000: Provided, That a report of disbursements under this item of appropriation shall be made quarterly to the Appropriations Committees of the Congress.”
3. Department of Labor-Bureau of Employment Security, Limitation on Grants to States for Unemployment Compensation and Employment Service Administration : "* * * and of which $12,000,000 shall be available only to the
extent necessary to meet increased costs of administration resulting from changes in a State law or increase in the number of claims filed and claims paid or increased salary costs resulting from changes in State salary compensation plans embracing employees of the State generally over those upon which the State's basic grant (or the allocation for the District of Columbia) was based, which increased costs of administration cannot be provided for by normal budgetary adjustments : * * *"
4. Department of Health, Education, and Welfare Social Security Administration, Limitation on Salaries and Expenses: “* * * Provided further, That $35,000,000 of the foregoing amount shall be apportioned for use pursuant to section 3679 of the Revised Statutes, as amended (31 U.S.C. 665), only to the extent necessary to process workloads not anticipated in the budget estimates and to meet mandatory increases in costs of agencies or organizations with which agreements have been made to participate in the administration of Title XVIII of the Social Security Act, as amended, and after maximum absorption of such costs within the existing limitation has been achieved."
5. Department of Health, Education, and Welfare_Welfare Administration, Assistance for Repatriated United States Nationals: "* * * of which $40,000 shall be apportioned for use pursuant to section 3679 of the Revised Statutes, as amended (31 U.S.C. 665), only to the extent necessary to provide for requirements not anticipated in the budget estimates.”
6. Legislative Branch-Architect of the Capitol, Contingent Expenses : "To enable the Architect of the Capitol to make surveys and studies and to meet unforeseen expenses in connection with activities under his care, $50,000.”
7. Legislative Branch-Library of Congress, Distribution of Catalog Cards, Salaries and Expenses: "Provided, That $200,000 of this appropriation shall be apportioned for use pursuant to section 3679 of the Revised Statutes, as amended (31 U.S.C. 665), only to the extent necessary to provide for expenses (excluding permanent personal services) for workload increases not anticipated in the budget estimates and which cannot be provided for by normal budgetary adjustments."
8. Legislative Branch-Government Printing Office, Office of Superintendent of Documents, Salaries and Expenses : "* * * Provided, That $200,000 of this appropriation shall be apportioned for use pursuant to section 3679 of the Revised Statutes, as amended (31 U.S.C. 665), with the approval of the Public Printer, only to the extent necessary to provide for expenses (excluding permanent personal services) for workload increases not anticipated in the budget estimates and which cannot be provided for by normal budgetary adjustments."
9. Funds Appropriated to the President-Emergency Fund for the President: “For expenses necessary to enable the President, through such officers or agencies of the Government as he may designate, and without regard to such provisions of law regarding the expenditure of Government funds or the compensation and employment of persons in the Government service as he may specify, to provide in his discretion for emergencies affecting the national interest, security, or defense which may arise at home or abroad during the current fiscal year, $1,000,000: Provided, That no part of this appropriation shall be available for allocation to finance a function or project for which function or project a budget estimate of appropriation was transmitted pursuant to law during the Eightyninth Congress or the first session of the Ninetieth Congress, and such appropriation denied after consideration thereof by the Senate or House of Representatives or by the Committee on Appropriations of either body."
10. Department of Agriculture --Agricultural Stabilization and Conservation Service, Emergency Conservation Measures: "For emergency conservation measures, to be used for the same purposes and subject to the same conditions as funds appropriated under this head in the Third Supplemental Appropriation Act, 1957, to remain available until expended, $5,000,000 with which shall be merged the unexpended balances of funds heretofore appropriated for emergency conservation measures."
11. Department of Agriculture_Commodity Credit Corporation, Limitation on Administrative Expenses : "* * * Provided further, That not less than 7 per centum of this authorization shall be placed in reserve to be apportioned pursuant to section 3679 of the Revised Statutes, as amended, for use only in such amounts and at such times as may become necessary to carry out program operation: * * *
12. Department of Agriculture-Rural Electrification Administration, General and Special Funds, Loan Authorizations : "* * * Rural electrification program,
$375,000,000 of which $30,000,000 shall be placed in reserve to be borrowed under the same terms and conditions to the extent that such amount is required during the current fiscal year under the then existing conditions for expeditious and orderly development of the rural electrification program; and rural telephone program, $117,000,00 of which $15,000,000 shall be placed in reserve to be borrowed under the same terms and conditions to the extent that such amount is required during the current fiscal year under the then existing conditions for the expeditious and orderly development of the rural telephone program.
13. Department of Agriculture-Farmers Home Administration, Direct Loan Account : "* * * of which $25,000,000 shall be placed in reserve to be used only to the extent required during the current fiscal year under the then existing conditions for the expeditious and orderly conduct of the loan program."
14. Department of Agriculture-Forest Service, Forest Protection and Utilization: “* * * of which $5,000,000 for fighting and preventing forest fires and $1,910,000 for insect and disease control shall be apportioned for use, pursuant to section 3679 of the Revised Statutes, as amended, to the extent necessary under the then existing conditions: * * *"
15. Department of Defense Military Personnel, Operation and Maintenance, Army: “* * * and not to exceed $3,896,000 for emergencies and extraordinary expenses, to be expended on the approval or authority of the Secretary of the Army, and payments may be made on his certificate of necessity for confidential military purposes, and his determination shall be final and conclusive upon the accounting officers of the Government; * * *"
16. Department of Defense-Operation and Maintenance, Navy: "* * * and not to exceed $10,825,000 for emergency and extraordinary expenses, as authorized by section 7202 of title 10, United States Code, to be expended on the approval and authority of the Secretary and his determination shall be final and conclusive upon the accounting officers of the Government; * * *"
17. Department of Defense-Operation and Maintenance, Air Force: “* * * and not to exceed $3,240,000 for emergencies and extraordinary expenses, to be expended on the approval or authority of the Secretary of the Air Force, and payments may be made on his certificate of necessity for confidential military purposes, and his determination shall be final and conclusive upon the accounting officers of the Government; * * *"
18. Department of Defense Operation and Maintenance, Defense Agencies : ** * * and not to exceed $3,754,000 for emergency and extraordinary expenses, to be expended on the approval or authority of the Secretary of Defense for such purposes as he deems appropriate, and his determination thereon shall be final and conclusive upon the accounting officers of the Government;
19. Department of Defense Research, Development, Test, and Evaluation, Emergency Fund, Defense: For transfer by the Secretary of Defense, with the approval of the Bureau of the Budget, to any appropriation for military functions under the Department of Defense available for research, development, test, and evaluation, or procurement or production related thereto, to be merged with and to be available for the same purposes, and for the same time period, as the appropriation to which transferred; $125,000,000 and, in addition, not to exceed $150,000,000, to be used upon determination by the Secretary of Defense that such funds can be wisely, profitably, and practically used in the interest of national defense and to be derived by transfer from such appropriations available to the Department of Defense for obligation during the current fiscal year as the Secretary of Defense may designate; Provided, That any appropriations transferred shall not exceed 7 per centum of the appropriation from which transferred."
20. Department of Justice — Federal Bureau of Investigation, Salaries and Expenses : "* * * and not to exceed $70.000 to meet unforeseen emergencies of a confidential character, to be expended under the direction of the Attorney General, and to be accounted for solely on his certificate:
21. Atomic Energy Commission-Operating Expenses : ** * * Provided, That of such amount $100,000 may be expended for objects of a confidential nature and in any such case the certificate of the Commission as to the amount of the expenditure and that it is deemed inadvisable to specify the nature thereof shall be deemed a sufficient voucher for the sum therein expressed to have been expended : * * *"
22. Selective Service System-Salaries and Expenses: "* * * Provided, That during the current fiscal year, the President may exempt this appropriation from