endorsement.

Often a licensed, practicing physician must provide information to a second state licensing board that has already been provided to one state licensing board. It frequently takes much longer for a practicing IMG to process applications for licensure by endorsement than it does for domestic medical graduates because of the difficulty involved with providing the requisite information to state licensing boards from international medical schools. Document retrieval is often near impossible for IMGS and extensive delays or minimal notice of opportunity for a hearing by a State board are not uncommon.

Currently state medical boards place the burden on the individual physician to prove the equivalency of his or her medical degree. A clearinghouse for applicants records will streamline the process for state-to-state licensing and will limit duplicative state efforts as well as avoid delays for practicing IMGs who seek licensure in a second state. repository will make it easier for states to authenticate and verify educational and training credential for all physicians.

The

The IAAP believes that the role of a national repository for medical licensure applicants' educational backgrounds and credentials will go a long way toward ensuring high quality health care to the American public. The function of a national repository is to promote fairness in medical licensure by expediting the process of licensure by endorsement for international medical graduates as well as for domestic medical graduates.

The IAAP strongly believes that since international medical graduates will be the principal users and payors of a national clearinghouse for medical education documentation, appropriate representatives from the international medical graduate community

should be actively involved in the oversight of the operation and implementation of such a repository.

While we would prefer a federally operated repository in order to ensure fairness, we recognize that there is no need for the federal government to duplicate private sector efforts to create such a repository. For this reason the IAAP supports a

private organization

to

administer the national repository.

However in order to ensure fairness, it is absolutely imperative that a coalition of IMG groups be involved in the process of oversight of the operation and implementation of the national repository. Proper oversight would be assured by the creation of

an HHS advisory council whose function would be to issue recommendations to the Secretary on how to oversee the repository and to monitor the implementation of the repository for its first three years of operation. Legislation has been introduced to create this advisory council which should consist of representatives from the FSMB, ECFMG, IAAP, AMA, a U.S. medical school, an international medical school and any other organizations deemed necessary by the Secretary of Health and Human Services. Should the authorizing committees authorize such an HHS advisory council, it will be necessary for Congress to appropriate the necessary staff salaries and funds for the advisory council.

Mr. Chairman, the GAO report stated that while there is a consensus on the need for the clearinghouse's concept and design all relevant groups "agreed to address basic questions, such as which organization would be best suited for administering the clearinghouse and what types of information it would maintain." Other issues such as the prevention of the potential abuses of a repository and the requisite coordination with state medical boards must be addressed and implemented in a manner approved by all of the relevant interest groups to a repository. This

advisory council will provide the proper forum for these very important issues to be addressed and will ensure that the views of IMGs are properly expressed.

Funding for the actual operation of a national repository for medical credentials is self-sufficient based on fees assessed to physicians who are using the service.

We

are requesting oversight of an advisory council

federal funding for the consisting of 12 members who will make necessary recommendations to the HHS Secretary regarding this new project. All expenses for these members should be paid for by the federal government.

Mr.

Chairman, thank you for the opportunity to discuss the views of the International Association of American Physicians. I would be pleased to respond to any questions you may have.

STATEMENTS OF:

JOHN H. MOORE, JR., PRESIDENT, NATIONAL ASSOCIATION OF REHABILITATION FACILITIES

ROBERT MATHER, ALLEGHENY VOCATIONAL REHAB CENTER, PITTSBURGH, PA

Senator BUMPERS. Mr. Mather.

Mr. MOORE. Mr. Chairman, with your permission, my name is John Moore, and I will precede Mr. Mather just for a moment. Senator BUMPERS. Fine.

Mr. MOORE. I represent the National Association of Rehabilitation Facilities. I direct a private, nonprofit rehab facility in Reading, Pennsylvania.

Our association has already submitted written testimony to the committee recommending appropriations in a number of different pieces of legislation that you are considering. Those are the Rehab Act, the Job Training Partnership Act, Title XX, the Developmental Disabilities Act, the Health Professionals Training Act, and Technical Assistance for the ADA.

I would like to concentrate my comments on the Job Training Partnership Act and tell you why we think our recommendations should be considered.

No. 1, we all know that the disabled are the most unemployed and the most underemployed of all the minorities in this country. Over 70 percent of the disabled are unemployed.

No. 2, one out of two disabled high school graduates become unemployed within 2 years after graduation.

No. 3, currently only 9.6 percent of Job Training Partnership Act participants are disabled.

No. 4, we know that specialty programs for the disabled are often curtailed when funds are short. This is a result of feedback from our members from across the country.

PREPARED STATEMENT

And last, we know that the Americans with Disabilities Act is going to create a tremendous demand for JTPA services in the next year.

I will now pass to Mr. Robert Mather. Thank you.

[The statement follows:]

STATEMENT OF JOHN H. MOORE, JR.

The National Association of Rehabilitation Facilities (NARF) wishes to thank Chairman Harkin and the other members of the Appropriations Subcommittee for allowing us to submit testimony on fiscal year 1992 funding for the Departments of Labor, Health and Human Services, Education and related agencies.

NARF is a national leader in the area of rehabilitation representing over 700 community-based vocational, medical, and residential rehabilitation facilities. The facilities that NARF represents comprise a mix of rehabilitation provider organizations including developmental centers, supported employment programs, Projects with Industry programs, free standing rehabilitation hospitals, acute care hospitals with rehabilitation units, comprehensive outpatient rehabilitation facilities, residential and long-term providers, as well as numerous other programs aimed at assisting people with disabilities.

The community-based rehabilitation facility of today is a flexible, multidimensional entity, providing a full range of valuable services for persons with disabilities. Vocational facilities, in particular, have evolved by diversifying their methods to respond to today's rehabilitation climate-expanding their concerns beyond employment and training and into early childhood education, independent living, transitional programs, and home-care services to name a few.

NARF wishes to request increased funding for those programs which will go a long way toward fully integrating persons with disabilities. Those programs include the Rehabilitation Act; Job Training Partnership Act; Title XX, Social Services Block Grant; Developmental Disabilities State Basic Grant Program; Health Professions Training Act; and technical assistance for implementation of the ADA.

VOCATIONAL REHABILITATION ACT

The Vocational Rehabilitation Act is planned to be reauthorized in this current fiscal year. Although it is uncertain whether a multi-year or one-year extension of the Act will pass, the fact remains that this program is the logical next step, following the passage of ADA, to assist persons with disabilities.

Historically, rehabilitation facilities have maintained a healthy relationship with State Vocational Agencies to carry out many of the provisions of the Act, especially the State Grants Program (Section 110). For over 5,000 facilities across the country which provide services to thousands of persons with disabilities, the State Grants Program provides an excellent funding source to provide vocational training and placement services. Although the dollars to facilities through this Act have decreased over the years, the need for this program to assist persons with disabilities through facilities has not declined. NARF, therefore, requests that the State Grants Program receive a significant increase of funding to $2.5 billion. This would allow State Agencies, rehabilitation facilities and other rehabilitation providers an opportunity to obtain employment for a significantly larger number of persons with disabilities.

Another key component of the Rehabilitation Act is the supported employment program (Title VI, Part C). Supported employment offers persons with disabilities an opportunity to participate in competitive work in integrated, community-based settings. In addition, the program provides the necessary ongoing support for individuals with disabilities to assist them in performing their jobs. Approximately three-fourths of supported employment service providers are rehabilitation facilities. Yet sparse funding for this program means that services cannot meet the needs of all eligible consumers due to lack of funding. Therefore, NARF encourages the subcommittee to increase funding for this program to $60 million. A related need is for technical assistance for the administration of these supported employment programs. NARF recommends $1 million under Title III, Part B, Section 311.

The Rehabilitation Act provides for rehabilitation training grants to states and public or other non-profit agencies and organizations, including facilities, to help ensure that adequately skilled personnel are available to provide services to persons with disabilities. Over the years this program has received small incremental funding. It has not kept pace with the need. NARF recommends $50 million for rehabilitation training in fiscal year 1992 in order to meet the added demand for qualified personnel to work with emerging and underserved persons with specific disabilities. The Projects with Industry program promotes opportunities for competitive employment for persons with disabilities through private industry (Title VI, Part B). For many years now NARF has operated a PWI national grant program. Even though NARF has witnessed a decline in funding for our national grant, we have increased placements by nearly 100 percent from 365 in 1987 to 667 in 1990. NARF believes that the success of this program is due to the unique relationship between businesses and rehabilitation facilities in placing persons with disabilities. Therefore, NARF recommends $50 million for PWI in fiscal year 1992.

There are a number of other programs that would dramatically benefit facilities in assisting persons with disabilities, however funding for these programs has not been realized for many years. They include:

-Technical Assistance Grants (Section 12(a) (1))—to provide facilities with specialized consultation and technical assistance to improve service delivery-requesting $250,000;

-Innovation and Expansion Grants (Title I, Part C, Section 120)—to stimulate the development of new and different services for individuals with the most severe disabilities-requesting $3 million;

-Facility Improvement Grants (Section 302(c))—to analyze, improve and increase professional services through enhanced facility management effectiveness—requesting $3 million.

JOB TRAINING PARTNERSHIP ACT

The Job Training Partnership Act (JTPA) provides job training services to individuals with disabilities through Title IIA and the seven national projects funded under Title IV (Pilots and Demonstrations Account). Rehabilitation facilities have played a key role in seeing that persons with disabilities, as well as nondisabled individuals, receive training through the JTPA program. Currently only 9.6 percent of all participants receiving JTPA services under Title IIA are individuals with disabilities. JTPA funding has not kept pace either with inflation or need. As few as three percent of eligible participants receive JTPA services each year. With rising unemployment and an unstable economy, there will be an increased demand for employment services for persons with disabilities and nondisabled individuals. Therefore, NARF recommends that funding under Title IIA be increased to $1.9 billion (this assumes that pending authorizing legislation in the House and expected legislation in the Senate does not pass

With the passage of the Americans with Disabilities Act, the seven national programs under the Title IV Pilots and Demonstrations Account will play an increasingly critical role in translating the promise of expanded opportunities into actual employment for people with disabilities. These seven national programs have been in the forefront in design and delivery of employment and training services to persons with disabilities. In spite of the fact that funding for this program has not kept pace with inflation, NARF has seen a steady increase in the number of participants placed into employment over the past three years from 959 to 1,171. NARF, therefore, recommends an increase in this program to $39.8 million.

TITLE XX, SOCIAL SERVICES BLOCK GRANT

The Title XX, Social Services Block Grant is a major source of funding for noninstitutional community-based services that serve individuals with disabilities. In many states this program provides the funding that allows individuals to remain self-supporting. Title XX provides a number of services to persons with disabilities including adult training, daycare, homemaker services, financing for group and independent initiatives, as well as personal assistance services. NARF supports pending legislation which would increase the authorization for this program. NARF also supports an appropriation of $3 billion for Title XX in fiscal year 1992.

DEVELOPMENTAL DISABILITIES BASIC STATE GRANT PROGRAM

The Developmental Disabilities Basic State Grant Program provides assistance to States to plan, monitor, evaluate, coordinate, and advocate for comprehensive services and support for people with disabilities. Many DD Councils around the country