Igo itilill *11@lql If 74 DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE Public Health Service Regional Medical Programs Page No. Appropriation language ................................... 75 Appropriation language changes ........................... 76 Amounts available for obligation ......................... 77 Obligations by activity .................................... 77 Obligations by object .................................... 78 Summary of changes ....................................... 79 Significant items in House and Senate Appropriations Committee reports ...................................... 81 Authorizing legislation .................................. 82 Table on estimates and appropriations .................... 83 Justification: General statement ................................... 84 1. Grants for regional medical programs ............ 85 2. Direct operations: (a) Professional and technical assistance ...... 89 (b) Review and approval of grants .............. 90 (c) Program direction .......................... 91 75 Appropriation Estimate REGIONAL MEDICAL PROGIRAM,S To carrv out title IX of the Act, [$58,814,000] $68,922,000, of which [$53,900,000] $62,900,000 shall re- main available untif June 30, [1969] 1970, for such grants pursuant to such title as may be authorized by laiv. (Addi- tional authorizing le ' lation to be proposed.) 7G i 0 Appropriation Language Changes This appropriation estimate anticipates extension of the legislative authorization for appropriations which expires with fiscal year 1968. 0 I* 7 DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE PUBLIC HEALTH SERVICE Regional Medical Programs Amounts Available for Obligation 1968 1969 Appropriation .................................. $58,814,000 $68,922,000 Unobligated balance brought forward ............ 25,900,338 30,900,000 Unobligated balance carried forward ............ -30,900,000 .......... Total ..................................... 53,814,338 99,822,000 Obligations by Activity 1968 1969 Increase or Page Estimate Estimate Decrease Ref. Pos. Amount Pos. Amount Pos. Amount Grants: 85 Regional medical programs .......... $48,900,338 $93,800,000 +$44,899,662 Direct operations: 89 Professional and technical assistance ........ 33 2,958,000 51 3,314,000 +18 +356*000 90 Review and approval of grants ......... 42 7121000 56 905,000 +14 +193,000 91 Program direction.. 70 1,216,000 91 1,803,000 +21 +587,000 Total obligations ..... 145 53,786,338 198 99,822,000 +53 +46,035,662 Unobligated balance reserve ... 4 28,000 .......... -4 -28,000 Total, obligations and reserve ......... 149 53,814,338 198 99,822,000 +49 +46,007,662 Obligations by Object Increase 1968 1969 or Estimate Estimate Decrease Total number of permanent positions ... 145 198 +53 Full-time equivalent of all other positions ............................ 6 6 Average number of all employees ....... 137 175 +38 Personnel compensation: Permanent positions ................. $1,346,000 $1,828,000 +$482,000 Positions other than permanent ...... 51,000 51,000 ....... Other personnel compensation ........ 15,000 15,000 ....... Total personnel compensation ..... 1,412,000 1,894,000 +482,000 Personnel benefits .................... 134,000 188,000 +54,000 Travel and transportation of persons.. 190,000 240,000 +50,000 Transportation of things .............. 9,000 12,000 +3,000 Rent, communications and utilities .... 43,000 63,000 +20,000 Printing and reproduction ............. 31,000 423,000 +111)000 Other services ........................ 154,000 184,000 +30,000 Project contracts ................... 2,375,000 2,545,000 +170,000 Payment to "National Institutes of Health management fund .............. 485,000 763,000 +278,000 Supplies and materials ................ 23,000 49,000 +26,000 Equipment ............................. 30,000 42,000 +12,000 Grants, subsidies, and contributions.. 48,900,338 93,800,000 +44,899,662 Total obligations by object ...... 53,786,338 99,822,000 +46,035,662 79 Summary of Changes 1968 enacted appropriation ............................... $58,814,000 Unobligated balance brought forward to 1968 .............. 25,900,338 Unobligated balance carried forward to 1969 .............. -30,900,000 Unobligated balance, reserve ............................. -28,000 1968 total estimated obligations .................... 53,786,338 1969 estimated obligations .......................... 99,822,000 Total change ................................... +46,035,662 Base Change from Base Increase Positions Amount Positions Amount A. Built-in 1. Annualization of new positions authorized in 1968 .................... ... ....... ... $90,000 2. Annualization of 1968 pay increase costs ............. ... ....... ... 16,000 3. One additional day of pay in 1969 .................... ... ....... ... 13,000 Subtotal, built-in ........ ... ....... ... 119,000 B. Program 1. Grants ..................... ... $48,900,338 ... $44,899,662 2. Professional and technical assistance ....... 33 2,890@-000 18 257,000 3. Review and approval of grants .................. 42 641,000 14 176,000 4. Program direction .......... 70 870,000 21 306,000 Subtotal, program ......... 145 53,301,338 53 45,638,662 C. Centrally furnished services from the National Institutes of Health management fund: (a) Professional and technical assistance ................. ... 68,000 4,000 0 fj Base Change from Base Increases Positions Amount Positions Amount C. Program--continued (b) Review and approval of grants .......... ... 71,000 ... 8,000 (c) Program direction.. 346,000 266,000 Subtotal, management fund .... ... 485,000 ... 278,000 Total net change requested .... 145 53,786,338 +53 +46PO35,662 Explanation of Changes Grants for regional medical programs - It is estimated that 24 of the 54 Regional Medical Programs will have entered their operational phase during 1968. The increase of $44,899,662 will be used primarily to initiate 30 new operational programs and to provide second or third year-funding to those programs already established. Professional and technical assistance - The program increase of 18 new positions and $257,000 includes: @50,000 for a contract program of operations research begun in 1967; $50,000 for contracts to be awarded to universities to increase the supply of trained personnel in the fields of continuing education, educational research, and evaluation of continuing education in the health sciences; $157,000 for additional positions necessary for providing assistance to regional personnel in the planning, development and operation of their programs. Review and approval of grants - The program increase of 14 positions and $176,000 is required to bring the functions of grants review and grants management to adequate staffing levels in 1969, during which all regions are expected to request operational grants. Program direction - The program increase of 21 positions and $306,000 will permit support of contracts to carry out planning and evaluation studies to identify and investigate issues related to future program developments and to formulate measures of performance by which regional operations may be evaluated; expansion in the communication and information programs which link the regional programs, the Division, and the general public; and increased requirements for centralized administrative services, including management analysis and contract administration. Significant Items in 81 House and Senate Appropriations Committee Reports Item Action taken or to be taken 1968 House Report No action required 1968 Senate Report 1. The Committee directed that 1. See remarks below. $2,000,000 be used for professional education in the diagnosis and treatment of emphysema, chronic bronchitis and other pulmonary diseases which are closely related to disorders of the heart and circulatory-system. (Pages 49 and 50 of Senate Report). 1968 Conference Report 1. Amendment No. 31 states "It 1. The Division staff is will be expected that the activities negotiating with Regional Medical for which the Senate increase for Programs to implement programs 'Chronic diseases' was earmarked under each of the categories of be performed under the appropriation coronary care units in small 'Regional Medical Programs' to the hospitals, control of hypertension, maximum extent determined to be community programs for stroke feasible by the National Institutes detection and treatment, and of Health". (Page 7 of Conference pediatric pulmonary centers. Report) Also under negotiation are plans to implement programs of professional education in the diagnosis and treatment of emphysema, chronic bronchitis and other pulmonary diseases. The intent of Congress will have been carried out by the award of grants for these purposes to several regions by June 1968. All such awards will be funded only after appropriate review and approval by the National Advisory Council on Regional Medical Programs. Authorizing Legislation Legislation 1969 Authorization Public Health Service Act Title IX, Education, Research, Training, and Demonstrations in the Fields of Heart Disease, Cancer, Stroke and Related Diseases .................. 1/ 1/ Authorization expires in FY 1968. Extension of the authorization has been requested in the Surgeon General's Report to the President and Congress, dated June, 1 7. PUBLIC HEALTH SERVICE ACT The Public Health Service Act, Title IX, Education, Research, Training, and Demonstrations in the Fields of Heart Disease, Cancer, Stroke and Related Diseases, Sec. 900. The purposes of this title are-- "(a) Through grants, to encourage and assist in the establishment of regional cooperative arrangements among medical schools, research institutions, and hospitals for research and training (including continuing education) and for related demonstrations of patient care in the fields of heart disease, cancer, stroke, and related diseases; "(b) To afford to the medical profession and the medical institutions of the Nation, through such cooperative arrangements, the opportunity of making available to their patients the latest advances in the diagnosis and treatment of these diseases; and "(c) By these means, to improve generally the health manpower and facilities available to the Nation, and to accomplish these ends without interfering with the patterns, or the methods of financing, of patient care or professional practice, or with the administration of hospitals, and in cooperation with practicing physicians, medical center officials, hospital administrators, and representatives from appropriate voluntary health agencies. Sec. 901. (a) There are authorized to be appropriated $50,000,000 for the fiscal year ending June 30, 1966, $90,000,000 for the fiscal year ending June 301 1967, and $200,000,000 for the fiscal year ending June 30, 1968, for grants to assist public or nonprofit private universities, medical schools, research institutions, and other public or nonprofit private institutions And agencies in planning, in conducting feasibility studies, and in operating pilot projects for the establishment of regional medical programs of research, training, and demonstration activities for carrying out the purposes of this title. Sums appropriated under this section for any fiscal year shall remain available for making such grants until the end of the fiscal year following the fiscal year for which the appropriation is made." 83 Regional Medical Programs Budget Estimate House Senate Year to Congress Allowance Allowance Appropriation 1966 $25,000,000 N.C. $25,000,000 $25,000,000 1967 $45,024,000 $45,004,000 $45,004,000 $45,004,000 1968 $64,314,000 $54,314,000 $64,314,000 $58,814,000 1969 $68,922,000 "I -3 Regional Medical Programs Estimate Budget to Bureau Estimate House Senate Year of Budget to Congress Allowance Allowance Appropriation 1966 $25,000,000 $25,000,000 N.C. $25,0009000 $25,000,000 1967 $92,047,000 $45,024,000 $45,004,000 $45,004,000 $45,004,000 1968 $140,600$000 $64,314,000 $54,314,000 $64,314,000 $58,814,000 1969 $91,131,000 $68,922,000 84 Justification Regional Medical Programs Increase or 1968 Estimate 1969 Estimate Decrease -fos. Amount Pos. Amount Pos. Amount Personnel compensation 3 19 (, and benefits ............... $1,546,000 $2,082,000 +53 +$536,000 Other expenses .............. ... 52p240,338 ... 97,740,000 +45,499,662 Ili (I Total .................. 53,786,338 4% 99,822,000 +53 +46,035,662 lq3 General Statement The Regional Medical Programs seek to assist the Nation's health institutions'and professions in capitalizing on the rapid advances of scientific medicine in the prevention, diagnosis, treatment, and rehabilitation of patients with heart disease, cancer, stroke or related diseases. The authorizing legislation asserts the grants are to assist in establishing regional coopera- tive arrangements among medical schools, research institutes, hospitals and other health institutions and agencies so that the health professions and their medical institutions will have available the latest advances in diagnosing and treating these diseases. Grant funds will support cooperative arrangements for research, training (including continuing medical education), improvement of patient care as well as the health manpower and health facilities of the Nation. The budget request for 1969 of $99,822,000 is an increase of $46,035,662 over the funds available in 1968. This increase is to be used primarily for the support of additional operational grants and for continued support of the on-going activities in the 54 regions. OSi