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I am deeply concerned over the effect its financing provisions will have on the rehabilitation program in California and many other States. Since the State Legislature has already approved the budget for this service in California for the year 1954–55, there will be no further opportunities to appropriate additional amounts to compensate for the loss of Federal funds under the financing formula contained in S. 2759.

If the States are to expand their vocational rehabilitation programs as called for in the President's program for expanded health and rehabilitation services it would be necessary to provide for a basic support program of not less than the amount provided for in 1953–54 and that whatever formula finally adopted that might provide for variable grants not become effective until July 1, 1955.

It also seems reasonable if a variable grant formula is adopted that a floor of at least 50 percent Federal money should be provided until we have had an opportunity to further study the effect of the variable grant principle on the programs in the various States.

One fact to keep in mind is that any grants for extension or improvement and special projects as provided in S. 2759 would not be available until along after the fiscal year has begun and could not be relied upon to make up for cuts in the basic support budget.

Although you may be fully aware of the effects of this legislation as ontlined above, I am taking this opportunity to report that it is being widely discussed throughout this State and, I am sure, in many others that will face similar problems. Sincerely,



Two bills pending in the Congress affect our program:

1. The administration budget for vocational rehabilitation calls for $19,175,00 as compared with $23 million voted for the current year; this conforms to the requirement voted by the last Congress that, beginning with fiscal 1957, 1 Fed. eral dollar would be appropriated for each 75 cents of State money available. The latter stipulation provides Federal funds for 57 percent of the total nt as against the 66 percent previously granted and represents a 14 percent cut.

2. The new administration Vocational Rehabilitation Act uses the IIill-Burton (variable-grant) formula to determine the allocation of funds to each State; this is an old formula in Federal-State programs but new to the vocational

. rehabilitation program. This formula uses two factors: population and per capita income, the amounts varying directly with the population, inversely with per capita income. In effect, the old formula provided funds roughly according to population and Illinois ranked close to the top; the p. c. I. factor, howerer, affects us adversely so that the new formula would result in a drastic reduction for us. However, there is an escalator clause in the bill that limits the redha tion for any one State to 10 percent for the first year, with corresponding steps thereafter until the formula is fully in effert.

The case for Illinois is as follows: if the administration budget goes through. we are sure of a 14 percent cut-from $1,170,000 to $1,007,000: if the admin istration Vocational Rehabilitation Act also passes, we are sure of an additional 10 percent outấto $906,000. This will be a total cut of 22 percent in Federal funds.

The combined Federal-State funds for this year are $1,815,000; with the Feda eral cut the total for next year would be $1.580.000—a reduction of 14 percent To put it another way-the State appropriation would hare to be increased by about $265.000, or 39 percent above the present 675.000, to meet the Federal decrease. To put it still another way, the total reduction would put us, within 4 months, financially back to the amount of money available in 1945, eren disne garding the increase in costs between then and now.

If the Congress will gire States like Illinois where legislature does not meet until next year, 1 more year to make the first fiscal adjustment, and allows ! to make the total transition by stages thereafter, the application of the new formula need not harm our progress.

OLYMPIA, Wash., March 31, 1954. Hon. WARREN G. MAGNUSON, United States Senate,

Washington, D. C. I'nderstand hearings on S. 2759 to start April 5. Oppose method provided in 8 2759 for allotting funds to the States. Under this bill Washington would lose over $200.000 a year by 1957. Approve allotment provision in S. 3039. Services Deed to be expanded. Provision should be made for services to all persons who are public charges and need vocational rehabilitation for return to self-support. Existing law and pending bills are limited in that a person must have a physical or inental disability and be vocationally handicapped. Many unemployed adults who are public charges have no physical impairment but could be returned to self-support through vocational-rehabilitation services. Your help in this inatter will be appreciated.

PEARL A. WANAMAKER, State Superintendent of Public Instruction,

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Providence, R. I., March 31, 1954. Hon. THEODORE FRANCIS GREEN, Senator from Rhode Island, United States Senate Building,

Washington, D. C. DEAB SENATOR GREEN: We know that you and all our Members of Congress from Rhode Island recognize the value of the Federal-State vocational-rehabilitation program to our physically handicapped citizens. Once rehabilitated they become taspayers rather than dependent upon public assistance or their own families. But even more important is the human sense of achievement which makes life worth while, when their potential abilities are released for employment worthy of their best efforts.

We also believe that you are aware that in July 1953 a "sleeper” was added to a Federal appropriation bill, changing the ratio of Federal participation in the costs of the program from roughly 80-percent Federal versus 20-percent State, to a requirement that the State put up 75 cents in order to "command" each Fed. eral dollar provided, beginning in fiscal 1955. This applies not only to “matching" case service expenditures, but to administration, vocational guidance and placement costs (i. e. salaries and overheadl), formerly paid 100 percent out of Federal funds.

Unless the "sleeper" is repealed, both the general and the blind programs for vocational rehabilitation in Rhode Island must be drastically curtailed.

The only alternative is that the State of Rhode Island stem the gap by providing substantial funds over and above those already requested in the State budget for fiscal 1955.

I am enclosing a report showing the importance of the vocational rehabilitation program to the blind of Rhode Island, illustrating the contrast between what could be done for that group before the Barden-La Follette Act of July 1943 had specifically included them in the program, and what has since been accomplished by our undersized but able staff. We hope that you will exert your leadership toward the passage of S. 3039, 838 Congress, 20 session, introduced by Mr. Potter on March 1, 1954, and referred to the Committee op Labor and Public Welfare. This act has the full endorsement of the National Rehabilitation Association. Thank you for all you have done to promote constructive legislation. Respectfully yours,

Mrs. LEONORE Y, GAY, Administrator.

WASHINGTOX, D. C., April 8, 1954. Hon. WILIIAM A. PURTELL, Chairman, Subcommittee on Health, Committee on Labor and Public Welfare,

United States Senate, Washington 25, D.C. DEAR MR. PURTELL: The enclosed statement of the views of the American Osteopathic Association on the vocational rehabilitation amendments of 1954, S. 2759, is respectfully submitted for inclusion in the record of the hearings, in justification of the two amendments proposed therein, as follows:

1. Amend subparagraph (2), on page 17, to conform with paragraph in), page 15, of H, R. 8149, as it passed the House; in particular, that the words "or surgery" be inserted after the word “medicine," line 8, page 17, of 8.270.

2. Page 17, after line 8, insert the following new paragraph :

“The term “person licensed to practice medicine or surgery in the State' and 'corrective surgery or therapeutic treament' and 'hospitalization include osteopathic practitioners or the services of osteopathic practitioners and buspitals within the scope of their practice as defined by State law."

It is my impression that the Department of Health, Education, and Welfare has no objection to the above amendments. Very truly yours,

LAWRENCE L. GOURLEY, Legal Counsel, American Osteopathic Association,

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RELATIONS, AMERICAN OSTEOPATHIC ASSOCIATION Mr. Chairman and members of the committee, my name is Dr. Chester D Swope. I am a practicing osteopathic physician located in Washington, DC, and as chairman of the department of public relations, of the American Oster pathic Association, I am authorized to express the views of the association on the pending bill, S. 2759, cited as the vocational Rehabilitation Amendments of 1954.

We very much appreciate the privilege of submitting this statement.

By the provisions of section 5 (a) of the amended act, S. 2779 assigns to the States the responsibility for “establishment and maintenance of minimum standards governing the facilities and personnel utilized in the provision vocational rehabilitation services.” That the State's responsibility is not er clusive, however, is implicit under section 10, which provides that a "rehabili. tation facility” is one wherein "all medical and related health services are prescribed by, or are under the formal supervision of, persons licensed to practice medicine in the State."

A similar definition of a “rehabilitation facility," in connection with the expansion of the Hill-Burton program, was modified during House considerati 0 of H. R. 8149 in order to assure inclusion of persons licensed to practice osteopathy and surgery (Congression Record, March 9, 1954, p. 2789),

In her testimony before this committee on S. 2758 and H. R. 8149, on March 17, Secretary Hobby expressed agreement with the objective of the House modification of II. R. 8149, and recommended similar modification of S. 278

Testifying on the pending bill, S. 2759, on March 30, Secretary Hobby ret ferred to the interrelationship between the proposed Hill-Burton expansioth and the proposed extension and improvement of the Vocational Rehabilitation Act.

We, therefore, request amendment of subparagraph (2), on page 17, to winform with paragraph (n), page 15, of H. R. 8149, as it passed the House: in particular, that the words “or surgery" to be inserted after the word “medicine.' line 8, page 17, of S. 2759.

A further clarifying amendment is also necessary because the bill definns physical restoration services as including "corrective surgery or therapientia treatment" and "hospitalization,” without any definition of those terms.

Those terms are in the present act, and they have been construed hr the Federal agency in such manner as to preclude the use of the services of osteopathie physicians and hospitals under State programs. For example, per rent Federal regulations permit the States to set the standards for hospita's used in the program (as would be the case by statute under S. 27:59), but the

Federal Manual of Policy issued to the State administrators states: "In reviewing and approving State standards for hospital facilities, the Office of Vocational Rehabilitation will for the present be guided by the list of hospitals approved by the American College of Surgeons." The words "for the present" bare already been in effect for 10 years. Since hospitals staffed by osteopathic pbysicians are approved by the American Osteopathic Association, the Federal recommendation operates to prevent their use by the State agencies.

In order to prevent continuation of a similar Federal recommendation with similar effect under S. 2759, an amendment declaratory of congressional intent to the contrary is essential.

We, therefore, request amendment of S. 2759 by inserting on page 17, after line 8, the following new paragraph :

"The terms 'persons licensed to practice medicine or surgery in the State' and “corrective surgery or therapeutic treatment' and 'hospitalization' include osteopathie practitioners or the services of osteopathic practitioners and hospitals within the scope of their practice as defined by State law."

The Senate agreed to a similar amendment in 1950, but the House failed to act on it. The Committee on Labor and Public Welfare recommended, and the Senate passed, as a part of H. R. 4051, 81st Congress, an amendment to the Vocational Rehabilitation Act reading as follows:

"The terms 'physician' and 'corrective surgery or therapeutic treatment and 'hospitalization include osteopathic practitioners or the services of osteopathic practitioners and hospitals within the scope of their practice as defined by State law."

The bill was reintroduced as S. 1202 in the 82d Congress, sponsored by Senators Douglas, Murray, Hill, Neely, Humphrey, Lehman, Taft, Aiken, and Morse,

In recommending the amendment to the Senate, as a part of S. 4051, in 1950, the Senate committee (Rept. No. 2456) stated :

"By a committee amendment, section 10 is amended by adding a definition that 'physician' and 'corrective surgery or therapeutic treatment' and 'hospitalization' shall include osteopathic practitioners or the services of osteopathic practitioners and hospitals within the scope of their practice as defined by State law. This change would permit the States to use the resources of the osteopathic profession and its institutions. The authorization is similar to that included in H. R. 6000 and to the provisions already in the laws dealing with Federal employees, compensation and veterans' rehabilitation. The committee is advised that osteopathic physicians are licensed under the laws of all the States, and that there are some 300 hospitals staffed by doctors of osteopathy."

In connection with H. R. 6000 (Social Security Act Amendments of 1950, Public Law 734, 81st Cong.), the Senate Committee on Finance (Rept. No. 1669) stated :

"Section 403 (b) of the bill (H. R. 6000) as reported amends section 1101 of the Social Security Act by the addition of a definition of the terms 'physician', ‘medical care', and 'hospitalization. These terms are defined to include osteopathic practitioners and the services of osteopathic practitioners and hospitals within the scope of their practice as defined by State law. The effect of this definition is to leave the states free to utilize the services of the osteopathic profession and its institutions in like manner as they may use the services of doctors of medicine and medical hospitals without fear of being denied approral of their State plans for services under the various titles of the Social Security Act." (Our italic.)

The relevance of the Social Security Act Amendments of 1950 is particularly significant since Secretary Hobby's testimony on S. 2759 stressed the interrelationship of the vocational rehabilitation and social security programs. The Secretary expressly referred to the administration's pending proposal (A. R. 7199) which would result in the referral of thousands of social security insured (OASI) disabled workers annually to the State rehabilitation agencies for medical evaluation purposes and possible prompt steps toward rehabilitation.

It is respectfully submitted that the public interest will be served and the objectives of the legislation advanced by our proposed clarifying amendments, which expressely assure to the States the right of utilization of the licensed professional services of osteopathic physicans or surgeons, and osteopathic hospitals, under the State-Federal vocational rehabilitation program, for the benefit of the physically handicapped.


Washington, D, C., May 12, 1954 Hon. H. ALEXANDER SMITA, Chairman, Committee on Labor and Public Welfare,

United States Senate. DEAR MR. CHAIRMAN: The attention of this Department has been directed to an amendment of the Randolph-Sheppard Vending Stand Act (20 U. S. C., sees. 107, et seq.) proposed by the Department of Health, Education and Welfare as an amendment to S. 27.59, a bill to amend the Vocational Rehabilitation Act en ny to promote and assist in the extension and improvement of vocational rehabilitation services, provide for a more effective use of available Federal funds, and otherwise improve the provisions of that act, and for other purposes.

One of the purposes of the proposed amendment is to provide that preference shall be given to blind persons in the operation of vending stands and rending machines on Federal property.

This Department is in favor of extending every possible assistance to blind persons so far as it can without jeopardizing or interfering with the handling of mails or the orderly conduct of business in post-office buildings. Under authority of present law blind persons are accorded preference in the operation of vending stands in post-office lobbies. The Department has authorized the in. stallation of vending machines in some post-office workrooms where space conditions would permit such action. In some instance, the proceeds from such machines are turned over to the blind person operating a stand in the lobby of the post office, and in other instances the proceeds are turned over to an employees' mutual-benefit committee.

It is our present policy to prohibit the installation of vending machines, as distinguished from vending stands, in lobbies and public corridors of post-office buildings, Government-owned and leased space, due to the inconvenience resulting to the general public and the loss of usable space in many lobbies which are already congested. Also, in view of the congested conditions in post-office buildings generally throughout the country, it is not considered avisable to approve the installation of vending machines in workroom areas at this time. Consideration is, however, given to the installation of vending machines in rooms set aside as employees' lunch and locker rooms where there are adequate space facilities and where there is a definite need for such machines due to the inability of employees to secure food in the vicinity of the post-office building. The profits derived from vending machines installed in these areas of the building to which the public does not have access are permitted, on approval by the Department, to go to a committee representing the employee groups of the post office for the mutual benefit of all the employees.

The very nature of the mail-handling functions are such, however, that this Department must have full authority to exercise discretion in such matters. In regard to the selection of blind persons licensed to operate vending stands in lobbies of post offices, the Department is agreeable to accept those approved by the Office of Vocational Rehabilitation, Department of Health, Education, and Welfare, under conditions agreed upon by that Department and the Post Office Department.

Under the amendments proposed by the Department of Health, Education, and Welfare, all property used for postal purposes would be affected whether it is Government-owned or leased. It would be a mandatory requirement that this Denartment consult with the Department of Health, Education, and Welfare with respect to regulations to be issued governing the operation of vending stands and vending machines hy blind persons.

The Post Office Department, not the Department of Health, Education, and Welfare, is charged with the mail-handling functions of the Government, and is the only department which is acquainted with the service conditions relating to the postal service. Furthermore, the Post Offce Department, not the Denart. ment of Health, Education, and Welfare, is the Department charged with the responsibility for furnishing economical and efficient postal service. Therefore, the Post Office Department should be vested with full authority for making determinations of questions with respect to the installation and operation of vending machines and vending stands in post offices. This need for exclusive jurisdiction is pointed up by the following case.

A representative of the Department of Public Welfare of one State is desirous of having permission granted for a vending stand to be operated by a blind

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