the CCP environment. We are in the process of identifying the cost of this additional training, and will include it in our POM. The dollars required for patient care are calculated on the basis of previous experience and any change in the demographics of our beneficiary population.

Question. For the record, please provide the Committee with data indicating how many trained hospital administrators (with a Master's Degree in business administration of health care management) each of the services currently has, how many are in command positions (both absolutely and as a percentage of available slots), and whether these figures indicate either significant differences between the services or recent trends in any direction.

Answer. A review of all senior Medical Department officers' personnel records is necessary to completely answer all parts of this question, because the requested information is not available in an automated data base. The following information was provided by each Service from data that was quickly available. Historical information was not available, therefore, we are unable to identify trends over time. The Navy and Air Force have officers from all Medical Department Corps assigned as commanding officers of medical facilities. Because of promotion policies, the Air Force presumes that all of their Medical Service Corps (MSC) officers have masters degrees. Navy MSC's are not required to have a masters in business administration or health care management for promotion. Many have other types of masters degrees.

a. Number of Medical Service Corps Personnel with a masters (or higher) degree in business or health care management. (The Navy data below and in (b) is a combination of information currently available or that obtained during a review of this issue performed in April and May of 1991.)

b. Other Corps Personnel with a masters (or higher) degree in business or health care management:

1 29 have masters degrees in either business administration or health services management, 155 have masters of public health.

c. Number of Medical Service Corps Personnel, with a masters degree, in command slots. These are O-5 and 0-6 positions. It is unlikely an Air Force Medical Service Corps officer will be promoted to these ranks unless she/he has a masters degree. therefore, the number of USAF MSC's assigned to command positions is as

sumed to equal the number of USAF MSC's with Masters degrees assigned to command positions.

d. Number of Other Corps Personnel (known or presumed to have a masters degree in business administration or health care management) in command slots:

All Medical Corps: 2 have masters degrees in either business administration or health services management, 6 have masters of public health. 2 Unknown. Mostly medical corps, but also nurse corps and biomedical science corps (USAF). How many of these people have a masters in business administration or health care management is unknown.

LEAD POISONING

Question. Last year, Congress directed the Department to begin dealing with the lead poisoning hazard to military dependent children, caused primarily by the ingestion of lead-based paint and dust. The Committee directed the Department to begin testing all children for lead poisoning, in keeping with the formal recommendations of the Centers for Disease Control, and to create a task force to examine the risk of lead hazards in military housing. Finally, we provided $1 million to support the federal interagency effort to develop safer methods to cleanup lead paint hazards. The Defense Authorization Act included a provision making blood lead tests eligible for reimbursement under the CHAMPUS program.

I have reviewed the Department's plan for both blood testing and abatement and I believe you have made a very good start. As I understand it, your plan calls for blood-lead testing at least 20 percent of military dependent children, with universal testing within five years. The Department's risk assessment and abatement plan calls for surveying housing, child care center, and schools, and dealing with lead hazards identified in the survey.

Cverall, I think this is a good start, but I have some questions: EPA, HUD, NIH, OSHA, and other federal agencies have a well organized "Federal Interagency Task Force" which meets on a regular basis. Has DOD appointed a representative to the task force? Answer. DOD has been represented on the Federal Interagency Task Force by the US Army's Corps of Engineers (COE) Research Laboratory. DOD has tasked the COE's Engineering Housing Support Center (EIISC) at Fort Belvoir to be the Executive Agent for utilizing the $1 million provided by Congress. In addition to the above representative, the Office of the Deputy Assistant Secretary

of Defense for Environment (ODASD(E)) will attend meetings of the Federal Interagency Task Force on as needed basis.

Question. What progress has DOD made with HUD and EPA in coordinating the used of the $1 million we provided to support the interagency effort on new cleanup methods?

Answer. EPA and HUD reviewed DOD's draft policy on the assessment and abatement of lead-based paint (LBP) and the screening of children for lead poisoning. As mentioned above, the EHSC will become more involved with the EPA and HUD. DOD will be establishing a working group to serve as a coordinating body and a sounding board to oversee the expenditure of the $1 million. EPA and HUD will be asked to provide representatives to this working group. DOD, EPA and HUD will work together to produce a product that can be used not only by DOD, but by all of the Federal Agencies.

Question. I understand the actual portion of eligible children to be tested the first year may be higher than 20 percent. How does that work? Will you focus your efforts on children identified as high-risk?

Answer. The 20 percent figure refers to the percentage of children who come in for the twelve month well-baby visit who must have the blood lead testing done as part of a routine visit. One manner in which this can be accomplished is for them to test every fifth child who comes in for the visit.

In addition to this population, children identified as high-risk will also be tested. This population is identified by a questionnaire that is given to all children coming in for treatment. Any question answered in the affirmative puts a child in the high-risk category and leads to testing.

Question. Have you determined what the blood testing program will cost in each of the five years, beginning with fiscal year 1991? How are those costs broken down? How much will each test cost, and how do those costs compare to the civilian sector, where some state labs have projected test costs as low as $10? As testing volume goes up, do you expect the unit cost to go down?

Answer. An exact cost is difficult to measure, since both the number to be tested and the cost for the tests is fluid. Based on stated assumptions, however, the following cost figures are presented:

Based on a dependent population 0-1 years of age of 160,000 and with 20 percent of the well-babies being tested the first year and increasing by 20 percent each year thereafter, and $20 as the cost for a test, the cost would be: 1st year 32,000 well babies at $.6 million, 2nd year 64,000 at $1.28 million, 3rd year 96,000 at $1.92 million, 4th year 128,000 at $2.56 million, and 5th year 160,000 at $3.2 million. In the remainder of the population, assuming that one in six children is at risk, 154,667 children 0-6 years of age would be at risk and that testing would cost an additional $3 million.

There is much variance in the cost of testing. Naval Hospital Bethesda has a contract with the Providence Laboratory in Washington, D.C. with a test list price of $20.05. The Annapolis Medical Clinic uses the Maryland State Department of Health and Hygiene laboratory at $18.03. The WRAMC laboratory indicated it could

run the tests in the first year for $11 and the following year for $7.70. This does not include the cost for shipping and handling.

Question. I have been told all blood samples originally will be sent to Walter Reed Army Medical Center for analysis. Why?

Answer. While for costing purposes, we have explored WRAMC capabilities, it will be up to the individual Services and local commanders to obtain testing at the best price available. The Tri-Service members that were a part of the working group that developed the DoD plans and who will be an integral part of the plans implementation in each Service are well aware of all the testing alternatives.

Question. Have you determined what additional investments will be needed to implement universal screening? For example, do you need additional equipment for blood analysis? Do you need to train more medical technicians?

Answer. The $11 testing figure from the WRAMC laboratory is based on the fact that to do 9000 tests a year requires two machines for a total cost of $30,000, a technician for $30,000, and reagents for $40,000. The machine costs are start-up only, but the technician and reagent costs are recurring and account for the $7.70 testing costs. These additional investments will depend on decisions made by the Services.

Question. When do you intend to notify military families that their dependents are eligible for blood lead testing? When will you issue the notice that CHAMPUS program will pay for blood lead testing?

Answer. Notification of military families will take place as the services implement the program. As part of the notification process, we are planning to produce a public affairs video that will be broadcast on the overseas network. A news release was prepared and released March 27, 1992. The news release is widely distributed to, for example, military organizations including retiree organizations, public affairs offices at each military installation, each editor of base and post newspapers, recruiting commands, all Naval ships, Health Benefits Advisors of each of the Services, etc. Our claims processors have also been notified to process claims for blood level screenings for infants up to the age of two. The effective date of this additional benefit is December 5, 1991, the date this legislation was signed authorizing their benefit.

Question. I understand there is a possibility that DOD could end blood lead testing in certain areas. Why? On what grounds would you decide to forego testing in some areas?

Answer. Such a decision is in accordance with the Centers for Disease control guidelines which state that all children should be screened, unless it can be shown that the community in which these children live does not have a childhood lead poisoning problem. Deciding that no problem exists requires that a large percentage of children be tested. If over a reasonable period of time, communities are seen not to have a problem, it would be appropriate to discontinue the screening.

Question. When will the abatement plan be sent to the base commanders? Will the notice be sent through the services or from the office of Health Affairs? Will your guidance to field commanders be coordinated with the interagency task force.

Answer. The DoD draft policy for the assessment and abatement of LBP and the screening of children for lead poisoning is presently being coordinated with the Military Departments Comments are due to the ODASD (Environment) not later than April 15, 1992. Shortly thereafter, the final policy documents will be forwarded to the Military Departments for implementation by a joint memorandum from the ASD (Health Affairs) and ASD (Production & Logistics).

Question. I notice the abatement plan indicates that two different kinds of x-ray fluorometer (XRF) are recommended for measuring lead in paint on walls. Does DoD currently possess these machines, or does it have plans to acquire them?

Answer. Several of the military installations (bases/post) have procured the XRF's; however, there has not been any mass buy of XRFS. Once the DOD policy is forwarded for implementation, the Military Departments will have to go through the planning, program and budget system (PPBS) for the purchase of the XRFS. Nevertheless, the Army's Environmental Hygiene Agency (AEHA), the Air Force's Armstrong Laboratories and the Naval Environmental Health Center (NEHC) use XRFS as part of their industrial hygiene capabilities. In addition, the Navy will begin a LBP/Asbestor inventory of Naval housing, which will lead to the procurement of several additional XRFS.

Question. As I understand it, the mere presence of LBP does not constitute a health hazard—a more critical variable is actual exposure to lead dust. Will your surveys concentrate on XRF tests to detect lead paint, or on assessments of risk based upon lead wipe tests?

Answer. DoD's policy for the assessment and abatement of LBP and the screening of children for lead poisoning is based on the potential for exposure to lead. DoD's policy uses HUD guidelines for determining the potential for exposure, and, if the potential exists, all methods for evaluating the presence of lead will be used. Ingestion, not inhalation, poses the greatest potential risk to children for lead poisoning. In-place management techniques will also be addressed to prevent painting, peeling and dusting.

Question. Who within the Department will ensure that these building surveys are done?

Answer. DoD's policy for the assessment and abatement of LBP and the screening of children for lead poisoning will be implemented by the Military Departments which will provide instruction to their respective commands with additional guidance. This program is the responsibility of each base commander. At the installation level, the commanders, through their engineering/housing, medical, safety, etc., will actually do the work of identifying, evaluating and controlling the potential exposure to LBP.

Question. Are the services currently equipped for lead hazard abatement? I understand that only two states, Maryland and Massachusetts, have programs to test and certify lead abatement specialists. Is that factored into the equation?

Answer. The Military Departments are aware of the lead hazard abatement in DoD. The AEHA, Armstrong Laboratories and NEHC are equipped to respond to emergency situations and operate certi