assure the state the essential elements of continuing planning and inter-agency program development support. The bill is laudable to the extent that it ties together federal, state, local, public, and private agencies in a more integrated approach to the delivery of essential human services for persons with developmental disabilities.

Title I-Section 130 (page 2)

TITLE AND PURPOSE

The title and purpose of this bill resolve the problem of stigma and narrow categorization of persons by disability, yet protect those, who, by reason of existing law, are now identified by category. The bill's major contribution is the term "developmental disabilities" which clearly provides for multiply handicapped children and adults. Many youngsters who are now the recipients of several labels by reason of their diverse handicaps, such as the blind, retarded, epileptic, emotional disturbed child are not eligible for programs by reason of statutory constraints at the Federal and State levels. Fragmented service, or no service has unfortunately been the rule rather than the exception for the multiply handicapped. The proposed title and purpose will provide new intiative to parents and practitioners to view the handicapped person in more unified terms for both program development and administration. Fragmentation of services for persons who are primarily physically handicapped yet function as retarded through faulty social adaptation are fortunately included in the new definition of "developmental disabilities." While this bill protects the high priority needs of retarded persons, it also provides the states with sufficient latitude to include a variety of developmental disabilities in its state plan according to individual state structure and needs.

The comprehensive nature of this bill, both in definition and administrative scope, reinforces reorganization efforts now underway in Massachusetts to modernize public administrative structures in dealing with multiply disabled persons. An essential part of the modernization of state government in Massachusetts is the development of an integrated administrative and service delivery system for the field of human services. Senate 2846 is consistent with the current plans and activities in Massachusetts. Massachusetts has recognized the need for formal planning and program coordination for the field of retardation and other handicapping conditions at the executive level of government. Within the Office of Planning and Program Coordination, at the executive level, we have a Bureau of Retardation which coordinates the efforts of twelve state agencies for the multiply handicapped retarded. We believe this Bureau to be the first of its kind in the nation and it signifies Massachusett's commitment to planning as an essential prerequisite to the delivery of comprehensive care for multiply disabled people.

We appreciate and support the flexibility given to the states in those provisions which allow the state to determine the administrative structure for program coordination and planning. The provision for continuing planning allocations is long overdue. Recognizing that the nation is spending over 14 billion on health care alone, with less than 3.4 million being spent on planning and program evaluation, suggests that we should strongly support the sections which would provide for block allocations to states to assure on-going planning capability, program development, and needed construction. Continuing to pour money into traditional fragmented approaches, without support for continual reassessment, will not allow for the development-through alternative approaches to resource allocation-of new and more effective solutions to the problems of our severely retarded and disabled.

With your indulgence, Mr. Chairman, I have some recommendations which would modify the proposed provisions and some suggestions for new provisions.

STATE PLANS

First (pages 7 and 8)

S. 2846 should specify in an amendment to Title I, Section 134 that the state authority designated to carry out the planning and supervision of the state plan will have ultimate responsibility and approval power over the participation of public and private agencies who apply for participation in the state plan.

Section 134 (B) (2) should state that the role of the state agency should include the power to approve individual, public and private agency application for

funds through this legislation and that their eligibility to receive funds is contingent on their applications being consistent with the objectives and priorities of the state plan.

We have found through experience in Massachusetts that an applicant who is eligible to participate in many federal programs can circumvent state plans because of the lack of approval power in any single state agency to assure consistency with federally required state plans. The recommended new provisions would be consistent with the new measures in the Intergovernmental Cooperation Act of 1968 which requires state and regional review of grant applications.

STATE ALLOTMENTS

Second (page 3)

Section 132 (a) (1)—Criteria for Determining State Allotment (A, B, C)

Massachusetts is firmly committed to the use of the criterion of "Extent of Need" in determining the level of a state's allocation, as well as the criteria of population (A) and financial need (C).

A general problem the state of Massachusetts finds in many federal programs is, that the reimbursement formulae penalize rather than reward those states that have expended great resources, and have built up a momentum and expectation for service. To the extent that Massachusetts is essentially industrial, urban, and densely populated, it is essential that our unfinished business-the elimination of pockets of extreme social deprivation-be given consideration in determining the scope of federal criteria for documenting a state's need. We would hope that the regulations take into account the continuing urbanization and the concomitant problems it brings for service delivery. Most of our disabled people live in densely populated sections of the central city, or in large state institutions which all too often may be the remnant slums of former generations.

Section 137(b)

PAYMENTS TO THE STATES FOR PLANNING AND SERVICES

Third (page 17)

The inclusion of the private sector in determining the level of state expenditures is a laudable public policy development. This provision will enable the federal and state governments to have a more realistic appraisal of the actual expenditures and benefits derived from both public and private investment policies for developmental disabilities.

The bill should, however, specifically permit a non-public applicant, who has been approved, to be a direct recipient of such federal funds. Such a provision would be vital for us in Massachusetts because of a restriction in our state constitution which prevents the allocation of public funds to private agencies.

CONSTRUCTION, DEMONSTRATION, AND TRAINING GRANTS FOR UNIVERSITY-AFFILIATED MENTAL RETARDTION FACILITIES

Title II-Section 201 (p. 22 of bill)

We applaud the broadening of the training base in Section 202 from "clinical" to "interdisciplinary training." The major thrust in manpower development in the next decades must reflect our recognition that the physically and mentally disabled require training, prevocational and vocational skills, and new educational approaches in close collaboration with the clinician. However, we will attract and hold a manpower pool capable of meeting the range of service needs of handicapped people to the extent that we involve the college student who is committed to human services training, as a meaningful member of the interdisciplinary training team.

MAINTENANCE OF EFFORT

(Page 25)

We strongly recommend that Section 126 should include a provision that the Secretary consult the state planning authority prior to approving any grants under Title II in order to assure that such applications are not inconsistent with obligations and commitments in the state plan.

On behalf of the many interested public and private organizations in the Commonwealth, I thank you for this opportunity to share with you the concerns and hopes of the Governor for achieving necessary and satisfactory federal legislation in this most critical area of human need.

Both Miss Doris S. Fraser, Director of the Bureau of Retardation and I will be pleased to answer questions of you, Mr. Chairman, and the Committee Members, if you so desire.

The subcommittee will stand in recess until 9:30 tomorrow morning. (Whereupon, at 12:55 p.m. the subcommittee recessed, to reconvene at 9:30 a.m. Tuesday, November 11, 1969.)

MENTAL RETARDATION AND OTHER DEVELOPMENTAL

DISABILITIES, 1969

TUESDAY, NOVEMBER 11, 1969

U.S. SENATE,

SUBCOMMITTEE ON HEALTH OF THE

COMMITTEE ON LABOR AND PUBLIC WELFARE,

Washington, D.C.

The subcommittee met at 9:30 a.m., pursuant to recess, in room 4232, New Senate Office Building, Senator Edward M. Kennedy presiding pro tempore.

Present: Senator Kennedy presiding pro tempore.

Committee staff members present: Robert O. Harris, staff director; James Babin, professional staff member to the subcommittee; and Jay B. Cutler, minority counsel to the subcommittee.

Senator KENNEDY. The subcommittee will come to order.

This morning, the Senate Subcommittee on Health concludes its hearings on pending legislative proposals in the area of mental retardation and other developmental disabilities.

The principal bill before the subcommittee is S. 2846, "The Developmental Disabilities Services and Facilities Construction Act of 1969," which I introduced in the Senate in August, and which is cosponsored by Senators Yarborough, Williams of New Jersey, Nelson, Mondale, Eagleton, Cranston, Hart, and Javits.

When the hearings opened yesterday, the first witnesses to testify were four representatives of the Department of Health, Education, and Welfare, who presented the views of the Administration with respect to S. 2846.

Although there is not yet an administration bill before the subcommittee, it is my understanding that such legislation is being prepared and will be introduced during the coming week.

It is my hope, therefore, that once these hearings are completed, the subcommittee will be able to act on this important legislation at the earliest opportunity.

In essence, Assistant Secretary Black and the other representatives of the administration raised three principal issues at yesterday's hearing in connection with the pending legislation. They pointed to the large amounts currently being expended by the Federal Government on other programs for the retarded and they said that the financial commitment in the pending bill should be sharply cut back. They urged us not to expand the program to include other developmental disabili. ties, but to continue to limit the program to those who are mentally retarded. In addition, they urged us to adopt a project grant approach for dispensing Federal funds, rather than the formula grant approach proposed in S. 2846.

A number of other witnesses at yesterday's hearing challenged the views of the administration, and emphasized the serious need to expand the scope and level of spending of our current programs.

Today, we will continue to explore these issues, with special focus on the adequacy of the existing Federal legislation. Several distinguished representatives of national organizations will speak of their deep concern for the need to stimulate greater participation by Federal, State, and local governments in this sensitive and neglected area.

In addition, Dr. Robert E. Cooke of Johns Hopkins Hospital will present a brief demonstration of the progressive approaches that have been developed under the current program of Federal support for university-affiliated facilities for the retarded.

Our first witnesses this morning will be two representatives of the National Association for Retarded Children. I am pleased to welcome you, Mr. Hayes and Dr. Boggs.

Mr. Hayes retired 2 years ago as president of CBS Radio, and he is now devoting his full time to the activities of the National Association for Retarded Children. He has had extensive experience on the Hill before the Subcommittee on Communications, and I am delighted to welcome him today in what I understand is his first appearance before the Subcommittee on Health.

Dr. Boggs is also well qualified to testify on mental retardation. She was appointed by President Eisenhower to the President's National Committee for the 1960 White House Conference on Children and Youth. In 1961, she was appointed by President Kennedy to the President's Panel on Mental Retardation. She has had extensive experience in planning for the prevention and care of the retarded, and we look forward to her testimony this morning.

Mr. Hayes, if you would like to make an opening statement we will be glad to receive it.

STATEMENT OF ARTHUR HULL HAYES, SENIOR VICE PRESIDENT, NATIONAL ASSOCIATION FOR RETARDED CHILDREN; ACCOMPANIED BY ELIZABETH M. BOGGS, PH. D., CHAIRMAN, GOVERNMENTAL AFFAIRS COMMITTEE, NATIONAL ASSOCIATION FOR RETARDED CHILDREN

Mr. HAYES. Mr. Chairman, members of the subcommittee, my name is Arthur Hull Hayes, senior vice president of the National Association for Retarded Children, and a parent. Accompanying me this morning is Dr. Elizabeth Boggs, a past president of NARC and the chairman of our Governmental Affairs Committee.

At the outset, may I express the sincere appreciation of our organization for the opportunity to appear before you today.

I would also like to express, on behalf of our membership, our heartfelt gratitude for your interest, your support and your leadership in the advancement of the cause of the retarded and the otherwise developmentally disabled.

Dr. Boggs will explain in detail our association's position on the provisions of S. 2846, and there is no one better than she to deal with both the theoretical and the substantive nature of this legislation, but I would like to take a little bit of the time allotted to us to tell you