The first is in section 56.106 (a) 3, that deals with the aspects of care that have to be delivered. One section requires that four specific aspects of care must be delivered or arranged for, while another section requires that three other services be arranged for. Clarification is necessary to determine which of the services in the first section can be arranged by the project and paid for by the client, and which services must be paid for by the project. A second problem with the regulations is found in the section which allows a project to avoid compliance with the community participation requirements, where there is inconsistent State or local law. In that situation, the project is forced to provide alternate procedures to those which are laid out in the regulations. However, this alternate procedure should be defined as to exactly what it can or cannot include. Otherwise, it can become an empty letter. There is also an unlimited time to remedy the legal disability which is involved, and this time period should also be defined and limited. Mr. SCHNEIDER. Let me say in the questions that the Senator stated he was going to submit to HEW, those two points are covered specifically; so we will have some feedback from HEW on reasonable time and what services will be considered to be required to be delivered by the migrant health program. Ms. GUIDO. I think that is very important. Another problem with the regulations concerns the amendments to the regulations. The regulations were amended so that the board can be elected by, rather than from and by, the community to be served. I believe that this change creates serious problems of paternalism. insofar as it results in the representatives of migrants deciding what kind of care should be delivered to migrants, as opposed to having migrant consumers themselves decide these factors. Finally, the guidelines to the regulations should deal with two additional factors. The first problem refers to continuity of care, which has been recognized by everybody to be a problem, for which there is no obvious solution. The regulations provide that continuity of care should be provided. but they do not say how. The second problem can be solved by instituting a quorum requirement for the board meetings, requiring that 50 percent of the people at the meetings be from those elected by the community, thereby avoiding the situation of railroading the community by not informing them of the meetings, or by scheduling meetings when they cannot possibly attend. The last point that I wish to bring up has already been commented on by Senator Kennedy: That is to give an express preference in funding decisions to community-sponsored projects rather than to State or local public health department projects. Mr. SCHNEIDER. Let me say we do hope to amend the legislation to that extent. Ms. GUIDO. I hope you are successful. I think the community change study which has been mentioned several times today makes it abundantly clear that a community group will provide much more comprehensive care, will be much more likely to provide community participation, and will be more successful in any other quality indicator than any other sponsor. I think it is important to note in this respect that the public health epartments were originally designed to deal with preventive health are, including immunizations and communicable diseases, and thereore to ask them to provide the kind of comprehensive health care that hould be provided under the Migrant Health Act is obviously inap›ropriate. Another problem that must be dealt with in regard to funding deisions is the conflict between a community grant proposal and a grower ›r growers' association grant proposal. In that kind of situation the community group should also be given a preference in funding, because it is obvious that an employer and employee are going to have a conflict of interest, because of the respective positions that they fulfill; and this conflict of interest only adds to the existing problems with migrant health. As the Department of HEW doesn't seem to have any funding preference for community groups, this legislation is all the more necessary. Two examples should suffice to illustrate HEW's attitude. One occurred in the State of Oregon where the Valley Migrant League submitted a proposal statewide. This proposal was made in response to a decision by the regional office that the State should no longer handle the grant. However, the ultimate result was that the State will have the whole grant for the next 6 months, after which the community. group will be given one county. A similar situation has occurred in the Massachusetts and Connecticut area where a growers' association asked for $125,000, while a community group intending to cover both Massachusetts and Connecticut asked for twice that amount. The final decision was to split the grant, thereby giving the community group half of what it wanted and giving the growers association all of what it asked for. Obviously the community could not accept this kind of offer. This has been discussed today, but I think it should be emphasized that technical assistance is absolutely necessary if you are going to have grassroots or community groups forming projects. It is obvious that they will need aid both in writing the proposals and later in implementing them. Although some technical assistance is now provided, it is not entirely clear that it is provided in a nondiscriminatory fashion. Specifically, it was asked that technical assistance be given to a group in Immokalee, Fla., but this assistance was denied on the basis that only the regional offices could give such aid, with full knowledge that the region would not give such aid to this group. The only solution is to provide technical assistance through the Washington office so that local political problems do not enter into the funding decision. Thank you for the opportunity to testify today. Mr. SCHNEIDER. Thank you. The subcommittee stands in recess. (Whereupon, at 2:11 p.m., the hearing in the above-entitled matter was recessed.) Mr. KENNEDY (for himself. Mr. CRANSTON, Mr. DOMINICK, Mr. HUGHES, Mr. JAVITS. Mr. MONDALE, Mr. NELSON, Mr. PELL, Mr. RANDOLPH, Mr. STEVENSON, and Mr. WILLIAMS) introduced the following bill; which was read twice and referred to the Committee on Labor and Public Welfare AUGUST 16, 1972 Reported by Mr. KENNEDY, with an amendment [Strike out all after the enacting elause and insert the part printed in italic] A BILL To extend the program for health services for domestic agricultural migrant workers. 1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 3 That section 310 of the Public Health Service Act is 4 amended by striking out "$30,000,000 for the fiscal year 5 ending June 30, 1973," and inserting in lieu thereof "not 6 to exceed $100,000,000 for the fiscal year ending June 30, 7 1973, $125,000,000 for the fiscal year ending June 30, 8 1974, $150,000,000 for the fiscal year ending June 30, 9 1975, $175,000,000 for the fiscal year ending June 30, 2 1 1976, and $200,000,000 for the fiscal year ending June 30, 2 1977". 3 That section 310 of the Public Health Service Act is amended 4 by striking out "$30,000,000 for the fiscal year ending June 5 30, 1973," and inserting in lieu thereof "not to exceed $60,6000,000 for the fiscal year ending June 30, 1973, $105,000,7 000 for the fiscal year ending June 30, 1974, and $120,000,8 000 for the fiscal year ending June 30, 1975". 9 SEC. 2. Section 310 of the Public Health Service Act 10 is further amended by striking "and" immediately before the 11 clause designation "(ii)" in paragraph (1) and inserting at 12 the end of such clause the following: "and (iii) premiums for a prepaid health care plan eligible for Federal assistance 14 where such clinics or special projects so request. All such 15 clinics, special projects, and prepaid health care plans shall 16 provide out-reach and follow-up services;". 13 17 SEC. 3. Section 310 of the Public Health Service Act is 18 further amended by inserting “(a)" immediately after the 19 section designation and by adding at the end of such sub20 section the following new subsection: 21 "(b) There are hereby authorized to be appropriated 22 $25,000,000 for the fiscal year ending June 30, 1973, $35, 223 000,000 for the fiscal year ending June 30, 1974, and 24 $40,000,000 for the fiscal year ending June 30, 1975, to 25 enable the Secretary to assist in the provision of necessary 3 1 hospital care to domestic agricultural migratory workers and 2 their families.” 3 SEC. 4. Section 310 of the Public Health Service Act is 4 further amended by adding at the end of new subsection (b) 5 the folaring new subsection: 6 “(c) In making grants under this section the Secretary 7 shall give priority to those applicants whose policy-making 8 body is composed of a majority of persons who are consumers 9 of its services, where competing applicants appear to the 10 Secretary of Health, Education, and Welfare to be equally 11 qualified." 2 |