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missions, public-welfare departments, and other State and federally supported organizations in the rehabilitation field.
4. Rehabilitation centers should be defined in such a way as to insure that funds will go to centers offering well-rounded programs of rehabilitation services.
5. The Secretary of the Department of Health, Education, and Welfare should have authority to set up regulations to assure provision of services in accordance with professional and business standards.
ADMINISTRATION OF REHABILITATION ON FEDERAL LEVEL
At various times the question arises as to how vocational rehabilitation shall be administered on a Federal level. The viewpoint of the National Rehabilitation Association is that the Office of Vocational Rehabilitation should continue to administer the Federal end of the State-Federal program and that this office shall continue to be in the Department of Health, Education, and Welfare, with its status improved by having it made legally a bureau in the Department. These recommendations are embodied in H. R. 5062, which is before the committee
The question of the administration of the Federal functions in vocational reha. bilitation has been raised a number of times and always with the same results, The first important study along this line was made by the Kelley committee to investigate aid to the physically handicapped in 1946. The report of this committee included a recommendation that OVR remain in the Federal Security Agency and serve as a base for an expanded program for services to the handicapped. The report of the Hoover Commission also stated that the functions of rehabilitation should continue to be administered in this agency. A number of times, the Bureau of the Budget has studied this question and has never yet seen tit to recommend any change. The most thorough recent exploration this matter has received was before the Senate Committee on Public Welfare in 1950. Following these hearings, the committee reported unanimously and the Senate passed, also unanimously a bill containing substantially the administrative provisions that we are recommending today; that is, that OVR remain in the Department of Health, Education, and Welfare, and that it be given bureau status.
We fear the controversy over jurisdiction of the program on the Federal level has prevented the passage of legislation which would improved the rehabilitation of the handicapped. We sincerely hope that this will not be allowed to interfer again this year.
ADMINISTRATION AT STATE LEVEL Present laws require that State boards for vocational education be the administering agencies in the States, except where a State agency for the blind has legal authority to rehabilitate the blind, in which case this agency shall be the rehabilitation agency for the blind. We notice that S. 2759 provides that the agency for administering rehabilitation in the State shall be either the State board for vocational education or a State rehabilitation agency (primarily concerned with rehabilitation). The National Rehabilitation Association feels that administration of the program in the States can be opened up to this degree without jeopardizing the stability of rehabilitation programs.
There are many reasons why State boards for vocational education have been considered the logical authorities to administer rehabilitation. In the first place, they have the experience of administering the program since their inception in 1920. In the second place, State boards for vocational education, which are sometimes the same as State boards of education, are highly respected bodies in all of the States, carrying great prestige. Third, State boards for vocational education are less likely to be hindered by political interference than most other departments of State government. State rehabilitation agencies have a right to be concerned, we believe, what might happen if the administration of the program in the States is thrown wide open. Controversies such as have existed on the Federal level for several years over the administration of vocational rehabilitation could easily follow on a State level. On the other hand, NRA feels that if any State is so much concerned with the progress of rehabilitation that it wants to set up an independent agency to administer the program, that the State should be allowed to do this.
Having set forth in the preceding parts of this testimony an outline of the history and scope of rehabilitation programs in this country and having stated some principles upon which we believe that sound growth can proceed, we shall now undertake to refer specifically to bills which are before this committee for consideration.
AMENDMENTS TO HOSPITAL SURVEY AND CONSTRUCTION ACT (S. 2758) S. 2758 would amend the Hospital Survey and Construction Act to make Federal aid available to the States to assist in the establishment of treatment and diagnostic centers, chronic-illness hospitals, rehabilitation facilities, and nursing homes. We wish to comment on this bill as it relates to rehabilitation facilities. Since 1949, the National Rehabilitation Association has been sponsoring legislation which would make Federal assistance to the States for the establishment of rehabilitation centers possible.
The purposes of S. 2758 appear identical with the purposes of the National Rehabilitation Association sponsored bill S. 2437. Accordingly, we are supporting S. 2758, but would like to make a few comments with respect to certain phases of the bill which we think to be extremely important.
In the House of Representatives, we notice that an effort was made to throw together in 1 fund appropriations for the 4 types of facilities envisaged in this bill. We insist strongly that funds be earmarked for rehabilitation facilities. If this is not done, we fear that the pressure for other types of facilities may result in the neglect of this very important area of unmet need. If, after the categorical approach has been tried for a few years, reasons develop for combining 2 or more of the funds into 1, consideration can be given to this at that time. In the second place, we approre heartily the amendment which was added in the House of Representatives which allows 1 State to assign its allotment of funds to another for the purpose of establishing a facility to serve the handicapped of more than 1 State. Certain types of rehabilitation facilities, particularly the more comprehensive type, may not be needed in everyone of the States. The assignment by one State of its allotment to another should facilitate the establishment of regional facilities. Third, we want to emphasize the importance of maintaining in this piece of legislation the definition of rehabilitation facilities which encompasses both vocational and medical aspects of rehabilitation. In our judgment, the definition of the rehabilitation facility found in S. 2758 is satisfactory. Several times wbile hearings were being conducted specifically on S. 2758, the ques. tion was asked as to whether rehabilitation centers could not be built under the Hospital Survey and Construction Act as it is now written. Such queries seem to question the necessity for additional legislation. It is undoubtedly true that a certain type of rehabilitation center could be built under the present statute. This would be a center which is a part of a hospital, as a hospital is defined in the Hill-Burton Act. It is significant that some of our finest rehabilitation centers in the country could never have been built under this definition. Notable among these are: The Institute for the Crippled and Disabled in New York City, which is not a part of a hospital and which carries on a broad program of vocational training along with medical services; the Woodrow Wilson Rehabilitation Center at Fisherville, Va., which was built in connection with a large vocational-training school, and where physical medicine facilities were brought to the vocationaltraining school, rather than vocational-training facilities being brought to the hospital; and the Okmulgee Rehabilitation Center at Okmulgee, Okla., established by Oklahoma A and M College in connection with a huge vocational school. Again, physical medicine facilities were brought to the vocational school. All such centers, of course, have staff connections with medical institutions.
It is also important to point out that in communities having several hospitals, not all of them could afford to have rehabilitation centers, even if they could be built under the definition of a hospital. Rather than to have several competing rehabilitation centers, it will be preferable in many instances that 1 comprehensive rehabilitation center be built in the community, probably not connected administratively with any hospital, but having staff service from 1 or more hospitals; and this rehabilitation center could then serve patients coming from all of the hospitals in the community.
It is significant, I think, that even with the great need for comprehensive rehabilitation facilities which has been evident for several years, not a single such facility has been established under the present act, although some departments of physical medicine may have been included in teaching hospitals built under it.
One other comment I would like to make, that is, that $10 million a year is very little money to distribute among 48 States for the purpose of establishing rehabilitation facilities. With this allotment base, Connecticut's yearly apportionment would be $73,000, New York, with one of the highest allotments, would have about $450,000 a year, while many of the smaller States would fall in the $50,000 minimum allotment class.
AMENTMENTS TO VOCATIONAL REHABILITATION ACT (S. 2759) This act would replace the present Vocational Rehabilitation Act. The posi. tion of the association is one of general support of this bill. Inasmuch as space will not permit comment on all sections of the bill, it is to be assuined that those not referred to are approved by the association.
THREE TYPES OF GRANTS
The bill provides for three types of Federal grants to the States: A fund for the support of the basic rehabilitation program called “rehabilitation services," a fund for "improvement and extension" projects, and a third fund for "special projects." The association believes that much good can come from having an “improvement and extention” fund to inspire States to enter into areas of rehabilitation in which they are not now serving, and also for the purpose of inspiring them to increase as rapidly as possible their basic rehabili. tation programs. We shall make some comments about the details of this section later in this statement.
We also consider it desirable that the Secretary have funds available to assist in financing special projects which have unique promise of developing rehabilitation as a whole. Again, we feel that the bill is very vague with respect to the definition of such projects and that it would be desirable that further clarification be included in this bill. We also think it desirable that the bill should require that the Secretary of the Department of Health, Education, and Welfare consult with the State rehabilitation agencies before any funds are made available for "special projects” within any given State.
ADMINISTRATION IN THE STATES At the present time the Vocational Rehabilitation Act requires that State plans provide that the State board for vocational education be the sole agency to administer, supervise, and control the State plan, except that a State agency for the blind, having legal authority to rehabilitate the blind, may be designated as the rehabilitation agency for the blind in that State.
The association is supporting the objectives of section 5 (a) (1) of S. 2759 which (1) allow 2 State plans in States having 2 rehabilitation agencies; (2) requires State plans to designate the State board for vocational education or a state rehabilitation agency (primarily concerned with vocational rehabili. tation) as the sole State agency to administer or supervise the administration of the State plan (except for agencies serving the blind). It is somewhat concerned, however, that the term “to administer or supervise" has been substituted for the term "administer, supervise, and control," found in the present act. The reason given for this change is that this language will enable the State board to supervise the administration of local rehabilitation projects. Although we approve the purpose stated, we fear that the same language might be used as a justification for splitting up a rehabilitation program on a State lerel; that is, having the program administered by 2 or 3 different state agencies, with the State board for vocational education supervising such administration, For that reason, we shall submit to the committee language which we feel will accomplish the purposes stated for this section, but would not have the possi. bilities of being interpreted in such a way that it would allow the breakdown of a State program.
STUDIES, INVESTIGATIONS, ETC. The association approves heartily, the provisions of this bill which gives the Secretary the authority to make studies, investigations, demonstrations, and reports with respect to the abilities, appitules and capabilities of handicapped individuals; the authority to cooperate and render technical assistance to the States; the authority to provide short-term training and instruction, including the establishment and maintenance of research fellowships and traineeships; and the authority to disseminate information as the results of such studies, investigations, and demonstrations.
It does not seem to us, however, that this section goes far enough in attempt. ing to meet some of the personnel shortages in rehabilitation. For instance, no provision is made for assistance for training of personnel, other than what is called "short-term training and instruction in technical matters.” It seems to us that authority also should be given to provide scholarships, without reference to the length of training, to persons willing to take training in some of the areas in which their skills will be badly needed.
DEFINITION OF REHABILITATION SERVICES The association approves of provisions of this bill which broaden the meaning of vocational rehabilitation services to include necessary hospitalization without 90-day limitations now existing; tools, equipment, and initial stocks and supplies, books and training materials, any or all of which the States may retain legal title; the acquisition of vending stands and other initial stocks and supplies for use by the severely disabled persons in any type of business and the management and supervision of such homebound and other small business enterprises; and the establishment of public or other nonprofit rehabilitation facilities. These amendments to the definition of rehabilitation services, are, in the main, almost identical to those which have been suggested by the National Rehabilitation Association for several years. The association feels that the removal of these restrictions on rehabilitation services will enable the States to exercise more initiative in providing rehabilitation services and that the broadened definition will result in more effective services to many of the severely handicapped.
FINANCING EXTENSION AND IMPROVEMENT The association approves the provisions found in the bill for allotting "extension and improvement” funds to the States on the basis of population. It recommends, however, that funds allotted to the States and which cannot be used in those States be available for re-allotment to States which have State money available over and above the amount necessary to earn their Federal allotments. It is inevitably true that some States will not be fully prepared to use "improrement and extension" funds available to them, however small such funds might be. To allow the re-allotment of such funds will enable other States to move their programs along further than they might be able to do otherwise.
RANDOLPH-SHEPPARD ACT The Randolph-Sheppard Act, Public Law 732 of the 74th Congress, authorizes the operation of stands in Federal buildings by blind persons. Recently, there has been much confusion with respect to the rights of the blind to operate such rending stands. In a number of areas, competition has appeared to arise for the use of vending stand sites between the blind and Federal employees whose unions are insisting upon the rights of Federal employees to operate concessions for the benefit of their recreation and welfare funds. Even where the blind are operating vending stands, it has been ruled by some of the departments that employee groups can place vending machines in these buildings in direct competition with the vending stands operated by the blind. It appears that it is going to be necessary to have legislation to clarify this situation. Two bills, H. R. 8530 and H. R. 6657 and the Department amendment to S. 2759 are all designed to accomplish this purpose. H. R. 8530 has the support of the National Rehabilitation Association, which maintains; (1) that building administrators should be required to give preference to certified blind persons in granting concessions ; (2) that profits from vending stands in buildings should go to the operator of such concessions; and, (3) that the rights of licensed blind persons to operate such concessions should be extended to all Federal property; and, (4) that the State agency administering the program of rehabilitation for the blind should be the licensing agency for vending-stand operators. We think this committee can render a distinct service by considering these amendments to the Randolph-Sheppard Act along with the amendments to the Vocational Rehabilitation Act. Incidentally, H. R. 6657 and the Department's amendment are both very similar to H. R. 8.530 in most respects.
FINANCING VOCATIONAL REHABILITATION Members of the committee are familiar with methods of financing the proposed expansion of vocational rehabilitation services, which I shall now summarize very briefly as a point of departure for this part of my own statement. Federal funds would be available for three purposes: For the basic support program, called rehabilitation services; for extension and improvement of the program; and for special projects.
Money for special projects will be appropriated to the Secretary of the Depart. ment of Health, Education, and Welfare for paying part of the costs, without specific limitations, of projects undertaken by public and other nonprofit organizations and agencies which hold unique promise for making a substantial contribution to the solution of vocational rehabilitation problems common to all or part of the States.
Funds for the extension and improvement projects will be allotted to the States on a population basis with the Federal Government paying 75 percent of the costs of such projects the first biennium; 50 percent the second biennium; and 25 percent the third biennium, which is as long as any one special project will be financed under this plan. Just what sort of projects would be approved under this part of the act is not clear. For instance, it is not clear whether a State which is now rehabilitating 500 persons a year and wants to rehabilitate 1,000 persons a year could justify this sort of expansion as "extension and improvement." It seems fairly clear, to use another illustration, that a State which is now not engaged in the rehabilitation of the mentally ill could justify an extension and improvement project to enter into this new field. We think it extremely important that the law state clearly that the provision of general rehabilitation services to more people will be considered as extension and improvement.
It seems to be the intention of the bill that "extension and improvement" funds could also be used for the construction of rehabilitation facilities. In this latter nise of Federal funds, it is not clear just what items will be considered State expenditures for matching purposes. For example, if the State buys land and a building, is the purchase price to be considered a State expenditure for rocational rehabilitation for matching purposes? If a private nonprofit is subsidized, are its expenditures for capital improvement or initial staffing to be considered a State expenditure in determining the Federal share payable by the State? Will the expenditure of the private nonprofit in operating the facility and providing vocational rehabilitation services be considered State expenditures under the State plan for Federal grant purposes? It seems to us that such questions should be answered in the act.
The other purpose for which Federal funds will be available is for "rehabilitation services,” the basic rehabilitation program. This program is now financed ander Public Law 113 of the 78th Congress, which provides that the Federal Government shall reimburse the States for 100 percent of expenditures for neces. sary administration, guidance and placement and 50 percent of expenditures for case service. An average Federal share of nearly 70 percent was found neces. sary to finance the program on this basis, but this share has been reduced to about 6.5 percent as a result of Congress' refusal to appropriate funds necessary to carry out the act as written.
S. 2759 would discard this method of financing the basic program and substitute for it allotments based upon population, heavily weighted by per capita income, and a Föderal share based upon relative per capita income of the States. The Federal share would vary from 33.3 in the District of Columbia to 66.8 in Mississippi.
This formula, although embodying many sound principles, does not seem appropriate, without considerable revision, for financing an already existing program which is being financed presently on entirely different principles.
Neither population or per capita income has entered into the allotments or Federal shares for vocational rehabilitation since the passage of Public Law 113 in 1943, and per capita income never has. More important, the application of this formula to vocational rehabilitation at this time will, we fear, make impractical the result the authors of S. 2759 seemed to have in mind, which is to bring about the rapid increase in rehabilitation services, particularly in States where such programs are underdeveloped. Granting that an expanded program is needed in all of the States, we find that there is little, if any, relationship between the amount of rehabilitation services now available in the various States and the ability of the States to provide for themselves, as this is revealed by per capita income tables. For instance, the southeastern States, most of which would benefit to some degree under S. 2759, already have, when considered on a sectional basis, among the best developed programs in the Nation. Conversels, many states whose programs are underdeveloped when considered upon the basis of per capita expenditures for rehabilitation or other objective criteria, will lose heavily under this formula.
Othcials of the Department of Health, Education, and Welfare, in discussing the financing of rehabilitation under S. 2759 tie the three rehabilitation funds