"(2) The Secretary shall then pay to the State, in such installments as he may determine, the amount so estimated, reduced or increased to the extent of any overpayment or underpayment which the Secretary determines was made under this section to such State for any prior quarter and with respect to which adjustment has not already been made under this subsection.

(3) The pro rata share to which the United States is equitably entitled, as determined by the Secretary, of the net amount recovered during any quarter by the State or any political subdivision thereof with respect to services for children with physical or mental impairments furnished under the State plan shall be considered an overpayment to be adjusted under this subsection.

"(4) Upon the making of any estimate by the Secretary under this subsection, any appropriations available for payments under this section shall be deemed obligated.

"(c) The Secretary shall not make payments under the preceding provisions of this section to any State unless the State makes a satisfactory showing that it is making efforts in the direction of broadening the scope of the care and services made available under the plan and in the direction of liberalizing the eligibility requirements for services for children with physical or mental impairments, with a view toward furnishing by July 1, 1970, comprehensive care and services to substantially all individuals who meet the plan's eligibility standards, including services to enable such individuals to attain or retain selfcare."

(d) Section 513(a) of the Social Security Act is amended to read as follows: "(a) A State plan for services for children with physical or mental impairments must

"(1) provide for financial participation by the State;

"(2) provide that it shall be in effect in all political subdivisions of the State, and, if administered by them, be mandatory upon them;

"(3) provide for the administration of the plan by a State agency or the supervision of the administration of the plan by a State agency, except that the State agency serving blind persons may be designated as the State agency administering or supervising the administration of that part of the State plan affecting services for children with visual impairments, and except that the State mental health agency may be designated as the State agency administering or supervising the administration of that part of the State plan affecting services for children with mental or emotional impairments;

"(4) provide such methods of administration (including, after January 1, 1940, methods relating to the establishment and maintenance of personnel standards on a merit basis, except that the Secretary shall exercise no authority with respect to the selection, tenure of office, and compensation of any individual employed in accordance with such methods) as are necessary for the proper and efficient operation of the plan;

"(5) provide that the State agency will make such reports, in such form and containing such information, as the Secretary may from time to time require, and comply with such provisions as he may from time to time find necessary to assure the correctness and verification of such reports;

"(6) provide for carrying out the purposes specified in section 511, including provisions that priority be given to treatment of conditions which may lead to severe physical or mental disability if untreated and to existing conditions of severe physical or mental disability which may be mitigated through adequate treatment;

"(7) provide for cooperation with medical, health, nursing, and welfare groups and organizations and with any agency in such State charged with administering State laws providing for vocational rehabilitation of the handicapped;

"(8) provide that all individuals wishing to make application for services for children with physical or mental impairments under the plan shall have opportunity to do so, and that such assistance shall be furnished with reasonable promptness to all eligible individuals who reside in the State; and "(9) provide for granting an opportunity for a fair hearing before the State agency to any individual whose claim for services for children with physical or mental impairments under the plan is denied or is not acted upon with reasonable promptness."

(e) Section 514 of the Social Security Act is repealed and section 515 of such Act is redesignated as section 514; and the section so redesignated as

section 514 is amended by striking out "services for crippled children" and inserting in lieu thereof "services for children with physical or mental impairments".

(f) Part 2 of title V of the Social Security Act, as amended by the preceding provisions of this Act, is further amended by adding at the end thereof the following new section:

"Definition

"SEC. 515. The term 'Federal impaired children's percentage' for any State shall be 100 per centum less the State percentage; and the State percentage shall be that percentage which bears the same ratio to 45 per centum as the square of the per capita income of such State bears to the square of the per capita income of the continental United States (including Alaska) and Hawaii; except that (i) the Federal impaired children's percentage shall in no case be less than 50 per centum or more than 83 per centum, and (ii) the Federal impaired children's percentage for Puerto Rico, the Virgin Islands, and Guam shall be 55 per centum. The Federal impaired children's percentage for any State shall be determined and promulgated in accordance with the provisions of subparagraph (B) of section 1101 (a) (8); except that Secretary shall promulgate such percentage as soon as possible after the enactment of this part, which promulgation shall be conclusive for each of the six quarters in the period beginning January 1, 1966, and ending with the close of June 30, 1967." Senator ANDERSON. Thank you, Mr. Schloss.

Senator Douglas?

Senator DOUGLAS. No questions.

Senator CURTIS. I want to say I appreciate the opportunity of hearing your testimony. In reference to the permanently and totally disabled within the definition of the Social Security Act, a blind person is not such per se, is he?

Mr. SCHLOSS. Not as far as cash disability insurance benefits are concerned.

Senator CURTIS. Are all of them excluded or does it depend on the circumstance and condition?

Mr. SCHLOSS. As far as cash benefits are concerned, if a blind individual has earnings which could range anywhere from $600 to $1,200 a year, as I indicated, he may be excluded from entitlement to cash benefits.

Senator CURTIS. Perhaps I didn't state my question correctly. Would the disability of blindness alone entile a person to a rating of totally and permanently disabled so far as the Social Security Act is concerned?

Mr. SCHLOSS. At the present time?

Senator CURTIS. Yes.

Mr. SCHLOSS. No, sir.

Senator CURTIS. It would not?

Mr. SCHLOSS. No, sir.

Senator CURTIS. It would have to be accompanied by other disabilities?

Mr. SCHLOSS. No. He would have to be unable to engage in substantial gainful activity.

Senator CURTIS. Yes.

What I am getting at is this: Are there people whose main and perhaps only identifiable disability is the loss of sight, are there some of them who were in occupations and were in circumstances so that this fact alone has qualified them for the disability benefits in social security?

Mr. SCHLOSS. Yes, sir; I believe there are.
Senator CURTIS. But not a great number?

Mr. SCHLOSs. I don't believe that there are-it would be difficult for me to say how many blind people there are on the rolls. I think the last time I checked the figures with the Social Security Administration there were somewhere around 30,000 disability insurance beneficiaries who were blind.

Senator CURTIS. But those statistics wouldn't reveal whether or not they had other disabilities?

Mr. SCHLOSS. They would not; no, sir. This would be the principal disability. It is not infrequent for a blind person to have some hearing impairment, perhaps other disabilities, too. It depends on how his blindness came about. Some injuries would certainly cause other disabilities as well as blindness.

Senator CURTIS. I think the blind are to be commended and their leaders are for the accomplishments and the stress they have placed upon training and rehabilitation and self-reliance. I think it has been a very beneficial thing for our society. In addition to that I think it has helped a great many sightless persons to have a more worthwhile life.

Thank you.

Senator ANDERSON. Thank you very much, Mr. Schloss, for your appearance here this morning.

Mr. SCHLOSS. Thank you, sir.

Senator ANDERSON. We have a brief message here from Congressman James Kee, Democrat, of West Virginia. He has submitted a written statement for the record which he has asked to place in the record, preceding the oral presentation of our next witness, Dr. Judd Chapman.

Without objection, that will be done. (The statement referred to follows:)

STATEMENT OF REPRESENTATIVE JAMES KEE, DEMOCRAT, OF WEST VIRGINIA, ON SUGGESTED AMENDMENTS TO H.R. 6675

Mr. Chairman and distinguished members of the Committee on Finance of the U.S. Senate, it is a privilege to have this opportunity to submit to your committee this statement in support of an amendment to the bill now under consideration, known as the Social Security Amendments of 1965, H.R. 6675. As you are aware, this bill was considered and passed by the House under what is known as a closed rule, which prevented amendments being offered from the floor. It is my hope that your committee will favorably report an amendment to this important legislation which will read substantially as follows:

"Notwithstanding any other provisions of the Social Security Act, whenever payment is authorized for services which an optometrist is licensed to perform, the beneficiary shall have the freedom to obtain such services from either a physician skilled in diseases of the eye or an optometrist, whichever he may select."

Optometry is mentioned in the bill, but there are many places which should be amended in order to make clear the intent of Congress that beneficiaries of the legislation who are entitled to services which could be rendered either by a physician skilled in the diseases of the eye or by an optometrist should be free to choose any licensed member of either profession.

In a bill as voluminous as this one is, it is difficult-in fact, practically impossible to insert the appropriate wording in the various places in order to carry out the intent of Congress and afford the beneficiaries freedom of choice; and it is for this reason that I respectfully suggest that a short section be added to the bill on page 296, to be known as section 409 and worded as set forth in the beginning of my statement. I am in absolute, full, and complete agreement with this proposed amendment.

West Virginia is a State of great beauty and, while the distances are not great, travel is difficult in many places. We have many more optometrists, particularly in the rural areas, than we have ophthalmologists.

It has been my good fortune to be a lifelong friend of Dr. William Greenspon, of my home city, Bluefield, W. Va. He is now a trustee of the American Optometric Association. Last year he received the award as "The Optometrist of the South"; in 1963, the Apollo Award, the highest honor in his profession; and he also was director of the Department of National Affairs of the American Optometric Association.

Dr. Michael A. Krupey, another Bluefielder, and a very close and valued friend to whom I am indebted, is secretary of the West Virginia Board of Optometric Examiners.

Dr. W. Judd Chapman, of Tallahassee, Fla., is also well known to me. Last year he was president of the American Optometric Association; this year he is chairman of its legislative committee and will today testify before your committee on behalf of the association, expressing their views with reference to this legislation.

There are two other amendments which I also respectfully request to be included in the bill and these pertain to the authorization of funds for grants for the health of children. The optometric profession has made substantial contributions in the field of vision care and I am confident that it was an oversight that the authority provided in H.R. 6675 omitted schools and colleges of optometry from this program. The amendments are simple, involve merely the inclusion of the word "optometry" in the appropriate place in line 14, page 150 of the bill, and the other including the word "optometric" on line 12, page 151 of the bill. I appreciate the difficult problem which confronts your committee. However, I strongly believe that the suggested amendments are in the public interest and I hope that following thorough consideration, these amendments will be included in the bill when reported.

STATEMENT OF W. JUDD CHAPMAN, O.D., REPRESENTING THE AMERICAN OPTOMETRIC ASSOCIATION; ACCOMPANIED BY WILLIAM E. MacCRACKEN, JR., COUNSEL

Dr. CHAPMAN. Thank you very much, Senator Anderson. I am going to ask for your permission that the printed statement be entered into your record, and for the purpose of conserving time I am not going to follow that statement verbatim but rather mention certain critical areas which deserve the special attention of this committee. Senator ANDERSON. Without objection, your statement will be inserted in full in the record.

Dr. CHAPMAN. Thank you,

sir.

I am Dr. Judd Chapman, a practicing optometrist from Tallahassee, Fla., and immediate past president of the American Optometric Association.

I have with me at the table this morning Mr. William E. MacCracken, Jr., the Washington counsel of the American Optometric Association.

Senator ANDERSON. And a good friend of many of us.

Dr. CHAPMAN. Yes, sir; I realize that.

Senator DOUGLAS. A very distinguished citizen of Illinois, too.

Dr. CHAPMAN. I might point out, here, that I was tempted a little earlier this morning, when the question arose concerning the matter of method of getting married in Florida, that I was not aware that it was exactly as the one witness had indicated, and if it is true I am going back and search it out.

Senator ANDERSON. We will make no extra charge for that legal instruction.

Senator DOUGLAS. I believe California is included in there.

Dr. CHAPMAN. I would like to point out, gentlemen, that there are 17,000 practicing optometrists in the United States. Our association represents over 13,000 of that number and has an affiliation in 50 States plus the District of Columbia. We are proud also of the 450 commissioned officers-optometry officers-in the Army, Navy, and Air Force. I had the privilege yesterday afternoon of visiting our optometric installation at the Andrews Air Force Base here in Washington.

I would point out, too, that there are many subspecialties of my profession, among them being the concern we have for the visual factors of highway safety. I shall not take the time of the committee to relate others of these specialties because they are included in the printed testimony, but I would like to point out that, just as recently as yesterday afternoon, I had occasion to attend a reception at the National Academy of Sciences where the optometric members of the Armed Forces Committee on Vision submitted testimony and papers which indicated that there needs to be great improvement in the construction and in the design of automobiles for the purpose of eliminating certain hazards which are created by obstructions to the vision of the drivers of these vehicles.

Senator DOUGLAS. That was a hearing before the National Academy of Sciences?

Dr. CHAPMAN. Yes, sir.

Senator DOUGLAS. This is the foremost scientific body in the country.

Dr. CHAPMAN. We consider it to be, sir; yes.

Senator DOUGLAS. And they recognized optometrists as qualified witnesses?

Dr. CHAPMAN. I would qualify this to the degree, Senator, that this was not a matter of testimony. I think I used that terminology. This was an annual meeting of the Armed Forces Committee on Vision of the National Academy of Sciences. It was not a matter of testimony.

Senator DOUGLAS. But they admitted optometrists.

Dr. CHAPMAN. Our members are very prominent on that committee.

Senator DOUGLAS. They read scientific papers?

Dr. CHAPMAN. They read several papers there during this meeting. I only mentioned the one regarding highway safety because we are deeply concerned about that particular one.

Senator ANDERSON. Since there has been a pause or a break, you mentioned one subject here that interests me very much. It says a study of visual-no, I am sorry, the fitting of telescopic spectacles. Dr. CHAPMAN. Yes, sir.

Senator ANDERSON. When Winston Churchill came over here in 1941, Christmastime, in a speech to the American Congress he had a manuscript a yard away from him, put on his glasses and read it perfectly, standing way back moving around as much as he could, and someone told me he had telescopic spectacles.

I. being a little over 6 feet tall, frequently go to speak at places where the podium is down at the waist level and I can't see the cussed thing to save my life and I went to somebody and tried to get telescopic spectacles. I was told you didn't have such a thing.