1 Includes capital outlay as follows: 1962, $161 thousand; 1963, $284 thousand: 1964, $285 thousand. 2 Selected resources as of June 30 are as follows: Unpaid undelivered orders, 1961. $6 thousand (1962 adjustments, -$2 thousand); 1962, $269 thousand; 1963, $118 thousand; 1964, $151 thousand. 3 Reimbursements from non-Federal sources above are from the proceeds of sale of personal property (40 U.S. C. 481(c)), for travel concerned with the functions or activities of the Department (71 Stat. 224), for fees for special inspection services (42 U.S.C. 267), and for receipts from pay patients (42 U.S.C. 221). Object Classification (in thousands of dollars) Public Law 86-798 (42 U.S.C. 241(d)) amends the Public Health Service Act to provide for grants-in-aid to universities, hospitals, laboratories, and other public or nonprofit institutions for the general support of research and research training in sciences related to health. The act specifies that this program will be supported with funds provided for research grants through the appropriations for the National Institutes of Health. SAINT ELIZABETHS HOSPITAL General and special funds: (Current, indefinite) SALARIES AND EXPENSES For expenses necessary for the maintenance and operation of the hospital, including purchase of one passenger motor vehicle, clothing for patients, and cooperation with organizations or individuals in the scientific research into the nature, causes, prevention, and treatment of mental illness, [$6,332,000.] such amount as may be equal to the difference between the amount of the reimbursements received during the current fiscal year on account of patient care provided by the hospital during such year and $27,413,000. (24 U.S.Č. 161-221; Department of Health, Education, and Welfare Appropriation Act 1963.) Program and Financing (in thousands of dollars) of the District of Columbia and beneficiaries of the Federal Government, both direct and reimbursable. Programs of Saint Elizabeths Hospital are financed from this appropriation and from reimbursements for care and treatment of sponsored patients. A change from a definite to an indefinite appropriation is proposed for 1964. The purposes of the change are: (1) to give greater stability to the income of the hospital, thus permitting improved management, (2) to increase the financial incentives for the District of Columbia (from which 70% of Saint Elizabeths' patients come) and for the hospital to work out cooperative arrangements for outplacement in lower cost facilities of patients who no longer need to be in a mental hospital, and (3) to provide for the continuation of financing by this appropriation of certain costs-e.g., research and training which are less directly related to patient care. of Columbia financing on a basis more comparable with The changed financing plan would place the District State hospital costs by basing charges for care of District patients on the estimated 1964 median cost per patient day of the upper 10% of State hospitals a cost of $9.49 per day. The total cost of this hospital's operations, including research and training, is estimated at $11.53 per day. An increase in the Hospital's staffing per 100 patients from 55 in 1963 to 60 in 1964 will result from the proposed increase in the Hospital's average employment and the anticipated decline in the patient load. The proposed Saint Elizabeths' 1964 staffing ratio is the ratio which it is estimated will be attained in 1964 by the median of the upper 10% of the State mental hospitals if the upward trend during 1959-61 continues into 1964. Increases in the 1964 appropriation are primarily_the result of (a) a change in the method of financing the Hospital; (b) the full-year cost in 1964 of the increased staff provided on a part-year basis in 1963; (c) significant expansion of the training and research activities; and (d) enactment of the Federal Salary Reform Act of 1962. 2. Training and education... 3. Research.... 804 328 Federal beneficiaries.. Total..... Change in selected resources Total obligations...-- Financing: 1 Advances and reimbursements from (—)— Other accounts.. Non-Federal sources 2 Unobligated balance lapsing. New obligational authority (appropriation) 400 -1,544 -1,688 -1,717 1962 adjust 69 6,332 9,716 ments 1962 1963 1964 1. Operation and maintenance. This activity covers the protective, therapeutic, and rehabilitative programs of the Hospital, maintenance of Hospital buildings, operation of a farm and an employee cafeteria, procurement of supplies and materials, and the provision of necessary administrative services. Actual and estimated average daily patient load is as follows: 1961 6,839 6,660 6,496 2. Training and education. The Training and education program provides multidisciplinary clinical training for professional and ancillary personnel engaged or interested in mental health activities. The numbers of trainees under this program are as follows: 1961 474 188 2 135 135 135 662 Total selected resources-------- Reimbursements from non-Federal sources represent collections from District of Columbia patients (32 D.C. Code 401-416). Saint Elizabeths Hospital provides care and treatment for the mentally ill, trains personnel in the medical, nursing and associated disciplines concerned with the treatment of psychiatric patients, and conducts or cooperates with others in scientific research activities dealing with mental illness. The patient load consists of residents 3. Research. The Hospital plans, develops, and carries out coordinated research programs and projects for the purpose of obtaining a better understanding of the causes of mental disorders, and of the factors bearing upon their development, treatment, and possible prevention. A This appropriation account covers all construction and facility improvement items of Saint Elizabeths Hospital. 1. Construction and equipment, continued treatment building (rehabilitation center).-Plans and specifications for this 450-bed treatment facility are currently being developed with funds appropriated in 1959 and 1962. Construction is expected to start in the latter part of the current year with funds provided in the 1963 appropriation. The facility will replace three smaller buildings constructed during the period 1853-72. 2. Miscellaneous improvements of existing facilities.Funds requested will provide for (a) rewiring and extension of electrical facilities in hospital buildings, (b) alterations of hospital X-ray facilities, (c) establishment of a central sterile supply unit, (d) replacement of steamservice lines, (e) replacement of insect screens in patient treatment buildings, (f) alterations to the tuberculosis building, (g) replacement of sanitary sewers under the laundry road, (h) modernization of dishwashing facilities, and, (i) construction of a small addition to the Hospital powerplant. 3. Construction and equipment, treatment and cafeteria building. This treatment facility, which replaces an antiquated building built in 1871, will house 250 patients and provide food service for these plus 400 patients from two adjacent buildings. Construction is nearing completion, with patient occupancy expected in the latter part of 1963. SOCIAL SECURITY ADMINISTRATION (Trust fund) For necessary expenses, not more than [$280,400,000] $317,900,000 may be expended from the Federal old-age and survivors insurance trust fund: Provided, That such amounts as are required shall be available to pay the cost of necessary travel incident to medical examinations for verifying disabilities of individuals who file applications for disability determinations under title II of the Social Security Act, as amended: Provided further, That $10,000,000 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 after maximum absorption of the costs of such workload within the existing limitation has been achieved. Advances to States, next succeeding fiscal year: For making, after May 31 of the current fiscal year, advances to States under section 221(e) of the Social Security Act, as amended, for the first quarter of the next succeeding fiscal year, such sums as may be necessary from the above authorization may be expended from the Federal old-age and survivors insurance trust fund. (42 U.S.C. 401-425; 70 Stat. 823; 42 U.S.C. 421; Department of Health, Education, and Welfare Appropriation Act, 1963.) Intragovernmental funds: ADVANCES AND REIMBURSEMENTS Program and Financing (in thousands of dollars) Program by activities: 1. Maintenance of earnings accounts. 30,119 30,026 33,460 2. Processing OASI claims.. 3. Maintenance of OASI beneficiary rolls. 4. Processing disability claims and maintain ing beneficiary rolls.. 5. Hearings and appeals.. 6. Actuarial services... 7. Administration.. 8. IRS enumeration project. 6,660 10,000 Research projects (costs-obligations) ------ 44 30 4 The old-age, survivors, and disability insurance program provides protection to about 9 out of 10 working people and their families against the loss of earnings because of old-age, disability and death. Under this program, people in covered employment and the self-employed make tax contributions during their working years to pay for protection for themselves and their families. Employers match the contributions made by their employees. These contributions are deposited in the Federal Old-Age and Survivors Insurance and Federal Disability Insurance trust funds, out of which benefit payments and administrative costs are paid. The volume and nature of the work received by the Bureau of Old-Age and Survivors Insurance has changed significantly during the past 12 years (1950-62) because of various amendments to the Social Security Act which made important changes in the scope and character of These amendments have improved prothe program. tection provided by the retirement and survivors insurance phase of the program and added a disability program which provides for monthly insurance benefits for disabled workers of any age and their dependents. 1. Maintenance of earnings accounts.-Eligibility for insurance benefits and the amount of benefit payments are based on the lifetime earnings records maintained by the Bureau. The volume of earnings record work depends primarily on the level of employment and the rate of labor turnover. The anticipated increase in nonagricultural employment and covered employment in 1963 and 1964 is the chief reason for the expected increase in receipts of earnings items to be posted to workers' accounts. 3. Maintenance of OASI beneficiary rolls. The beneficiary rolls require continuous revision so that benefit checks may be mailed promptly each month to beneficiaries who are entitled to them, and so that checks may be discontinued when eligibility for benefits is interrupted or comes to an end. The number of beneficiaries increased by 1,400,000 in 1962. The rate of increase declines in 1963 and again in 1964 as the effect of the 1960 and 1961 amendments on new claims filings becomes less significant. The amount of benefit payments will continue to rise each year as the number of beneficiaries increases. 4. Processing disability claims and maintaining beneficiary rolls.-The Bureau's district offices receive all disability claims. In most cases State agencies, under contractual arrangements, determine the existence of a disability. The Bureau reviews these determinations to assure uniformity among States. In addition, the Bureau maintains the beneficiary rolls for disability beneficiaries. The estimated volume of applications to be filed by disabled workers will be higher in both 1963 and 1964. The higher estimates reflect two major factors: The size of the insured population will continue to increase. Rates of disability among insured workers will continue at about. the levels indicated by actual experience in the recent past. The increase in the number of disability beneficiaries in current pay status is consistent with the increase in the disability claims load. Benefit payments will rise as the number of beneficiaries increase. Requests for hearings: Received.. Processed. 6. Actuarial services. This activity includes actuarial research and preparation of cost estimates for long-range program planning. direction and management, program planning and re7. Administration. This activity includes Bureauwide search, and general management service functions. project involves work to be performed by the Bureau of 8. Internal Revenue Service enumeration project. This |