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the infant mortality rate leveled off, and the maternal mortality rate actually increased slightly. In addition, the nature of the infant mortality problem changed. For example, substance abuse among pregnant women has become a primary factor in infant mortality today, which was not the case twenty years ago. Therefore, we believe business as usual is not enough. We plan to utilize a targeted, heavily intensive approach to delivering comprehensive perinatal services in the selected communities in order to achieve further reductions in the U.S. infant mortality rate.

Question. Will rural areas with high infant mortality rates be allowed to compete for these additional funds, or is the new program restricted to large cities?

Answer. Rural areas with high infant mortality are most certainly allowed to compete for Healthy Start funding. The Healthy Start eligibility criteria have been designed in the least restrictive manner possible, including both rural and urban areas while at the same time maintaining the ability of the program to have a significant impact on infant mortality.


Question. Could you give us a progress report on the State Offices of Rural Health?

Answer. There are currently 25 State offices of "focal points" for rural health. We regularly provide these offices with a wide range of information and technical assistance on rural health issues. In turn, we actively seek their hands-on expertise to improve our insight into these issues. We had our first annual state office meeting last year which was very successful. We plan to continue this year and into the future. We are also planning to support a newsletter which will focus on ongoing state programs and policies that are designed to improve access to care in rural communities. We are currently implementing a matching grant program with States to establish State Offices of Rural Health.

Approximately $1.5 million is currently available for grants in FY 1991. The law requires that they perform a number of activities and achieve certain goals. We are working closely with both existing and new state offices to help them accomplish this mission.

Question. What resources do you plan to allocate to the establishment and support of these offices in fiscal year 1992?

Answer. The President's budget would provide approximately $700,000 to support the State Offices of Rural Health grant program in FY 1992.


Question. A number of Senators, who are members of the Senate Rural Health Caucus, wrote to the Secretary last month to express our concern over the criteria that were used last year to fill vacancies in the National Health Service Corps. Apparently, the Department was including particular pathologies as a requirement for placement, although the law specified other criteria to be used. I understand you are currently considering the criteria for this year's replacements in the NHSC. Could you tell us your rationale

for including those criteria last year and what your plans are for this year?.

Answer. The High Priority Opportunity List or HPOL (used for scholarship obligors), the loan repayment list and the volunteer list are developed and used over an eighteen month period. It is made available in the summer preceding the fiscal year for which it used for placements. Therefore the list currently in use was developed prior to the enactment of the current legislation, which contains specific criteria to use in deciding on sites which apply for inclusion on the lists. The criterion employed in evaluating applicant sites for the current list included as one criteria the percent of special populations such as homeless, migrant, perinatal, persons with HIV/AIDS, substance abusers, and the elderly. Additionally, the criteria were that: the site must be part of a system of care; be located in a currently designated Health Professions Shortage Area or HPSA (required by law); must need at least one FTE; the rate of poverty, infant mortality, population to primary care physician ratio, and the percent of minority population; vacancies as a percent of total budgeted staff; and the degree of rurality. The criteria specified in the new law are: the ratio of available health professionals to the number of individuals in the area or population group involved or served by the medical facility or other public facility involved; and indicators of need such as the rate of low birth weight, infant mortality, poverty, and access to primary health services taking into account the distance to such services. The new criteria are currently being employed in the development of lists that will be used beginning July, 1991.

The distribution of sites currently in use which were selected under the old legislation resulted in a HPOL to be used in placing scholarship obligors that is 73 percent rural and a loan repayment list that is also 73 percent rural. It is not likely that the lists issued this past summer would be more rural in their distribution if the new legislation had been in place. Furthermore, there is no reason to expect that the list now under development would be significantly more rural under the new criteria.

It is widely acknowledged that there are shortages of doctors in rural areas and one program that can contribute to a solution of this problem is an expanded NHSC. However, redoing the current placement lists is not a solution and would only have adverse affects on the process (which is at about the midpoint at this time), the obligors and volunteer selecting sites, the sites themselves, and the continuity and integrity of the program.






Senator HARKIN. Our next witness is Sandra S. Parrino, chairperson of the National Council on Disability. Now, we have the National Council on Disability, Sandra S. Parrino, chairperson, and Ethel Briggs, executive director.

The National Council on Disability is an independent agency comprised of 15 members appointed by the President and confirmed by the Senate. It is an advisory body whose mandate is to examine broad-based Federal policies relating to persons with disabilities, and to make recommendations to Congress and the President on how these policies can be improved.

The fiscal year 1992 request is $1.64 million, a 14-percent increase over fiscal year 1991. We are pleased to have you testifying today, Ms. Parrino.

Ms. Parrino, the Americans With Disabilities Act is now law, and I look forward to working with you and the Council in the coming months on its implementation. Thank you for your hard work, and your statement will be made a part of the record in its entirety. Please proceed as you so desire.

Ms. PARRINO. Mr. Chairman, it is a pleasure to be here with you today and to talk about the work of the National Council on Disability. I am accompanied by Mr. John Gannon, a member of the Council and chairperson of the Health Insurance Committee, and our executive director, Ethel Briggs.

An extended version of my testimony has been submitted for the record and, Mr. Chairman, with your permission I would like to summarize my testimony.

Senator HARKIN. Please.


Ms. PARRINO. The National Council on Disability received approximately $1.5 million in fiscal year 1991, and is requesting approximately $1.7 million in fiscal year 1992. I would like to point out that this is a small increase, mostly based on the increased cost of doing business as an agency. This increase allows us to keep pace with the cost of living.

The National Council attempts to develop public policy in a costefficient manner. The 15 presidentially appointed members of the National Council and its staff take very seriously their responsibilities to recommend solid and innovative policy, as well as to carry

out its congressional mandates. As mandated, the National Council on Disability holds four meetings per year. These meetings last 3 or 4 days and are held around the country so that we can give people with disabilities the opportunity of participating in the work of the National Council.

Forums, hearings, or other conferences are usually held in conjunction with the quarterly meetings of the National Council. For instance, this month our spring quarterly meeting will be held in conjunction with the National Conference on Assistive Technology being convened by the California State University at Northridge. In addition, the National Council will be conducting its first public hearing on the financing of assistive technological services and devices for people with disabilities.

As you may recall, the National Council was mandated in the Technology Act of 1988 to conduct a national study on the financing of assistive technology for people with disabilities. This hearing is the first of three to be held within the next 16 months. In October 1992, we will cosponsor with the United Nations an international conference on assistive technology for people with disabilities to be held in New York City.

The purpose of this conference is to present high and low technology for people with disabilities. "Technology Equals Opportunity" is the theme of this conference. We strongly believe that technology has a significant impact upon the lives of people with disabilities; the difference between dependence and independence.


The area of prevention of primary and secondary disabilities continues to be a priority of the National Council, especially the prevention of secondary disabilities. The National Council appreciates the leadership and support of you, Mr. Chairman, in the introduction of the Disabilities Prevention Act of 1991. The members of the National Council eagerly await the passage of this bill and offer our assistance in this endeavor.

The National Council believes that the passage of this bill will ensure the establishment of disability prevention programs focusing on primary and secondary prevention in each of the 50 States and territories. As I mentioned previously, the National Council's primary concern is the prevention of secondary disabilities in that most of the people we represent already have some type of disability.

The National Council recognizes that there tends to be a large amount of misunderstanding among many of the disability-related groups regarding secondary prevention. Therefore, we suggest that one way to address this issue is to have one of the States develop a model program on the prevention of secondary disabilities which can then be replicated in other States.

The National Council continues to enjoy a cooperative working relationship with the Centers for Disease Control. In fact, we are very excited about the National Conference on the Prevention of Primary and Secondary Disabilities that the National Council is cosponsoring with the Centers for Disease Control and the Minority Health Professions Foundation in June of this year.

This conference will focus on the prevention of chronic disabilities, birth defects and developmental disabilities, injuries, and the quality of life. These four working papers will serve as the basis for the development of a national plan for the prevention of disabilities as recommended by the National Council in its 1986 special report, "Toward Independence."

Another priority of the National Council is the financing and provision of personal assistance services for persons with disabilities. We are concerned that for many people with disabilities the Americans With Disabilities Act will be only mere words without personal assistance services such as readers, interpreters, and attendants.

The National Council made recommendations pertaining to this critical need in "Toward Independence" and we have continued to focus on this area of critical need for people with disabilities. The National Council recently held a hearing on this issue, and we are in the process of developing a report with recommendations that will be submitted to the Congress and the President.

Health insurance is of major concern to the National Council, and the Council has initiated an 18-month study in this area. People with disabilities and their families face many barriers in the provision of health insurance based upon the notion of preexisting conditions. The National Council study will address this issue and others related to this problem.

As you know, our enabling legislation, the Rehabilitation Act of 1973 is coming up for reauthorization. The Council has conducted two national hearings on this subject and will shortly be sending Congress a report on its recommendations. The National Council heard from people with disabilities, family members, governmental officials, educators, service providers, and representatives of advocacy and other disability-related organizations concerning their recommendations on how the act can better serve people with disabil


We found that there is a tremendous amount of interest in this act, and individuals are taking the reauthorization very seriously in that they see this as an opportunity to make changes. Mr. Chairman, the National Council looks forward to working with you and your committee on the reauthorization of this most worthwhile piece of legislation.

The National Council is happy to report that we have signed an interagency agreement with the Indian Health Service in order to begin to look at the unique problems faced by native Americans and native Alaskans with disabilities in this country. The National Council continues to be concerned about other minorities with disabilities as well as individuals with disabilities in rural areas.

Furthermore, the Council continues to have a focus on the education of students with disabilities, and we are asking the question: Are students with disabilities receiving a quality education?


On July 26, 1990, President Bush signed the Americans With Disabilities Act into law. The members of the National Council and I would like to thank you for your tremendous efforts on behalf of

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