[Senate Hearing 112-683]
[From the U.S. Government Publishing Office]
THE FISCAL YEAR 2013 BUDGET FOR
VETERANS' PROGRAMS
=======================================================================
HEARING
BEFORE THE
COMMITTEE ON VETERANS' AFFAIRS
UNITED STATES SENATE
ONE HUNDRED TWELFTH CONGRESS
SECOND SESSION
FEBRUARY 29, 2012
----------
Printed for the use of the Committee on Veterans' Affairs
THE FISCAL YEAR 2013 BUDGET FOR VETERANS' PROGRAMS
S. Hrg. 112-683
THE FISCAL YEAR 2013 BUDGET FOR
VETERANS' PROGRAMS
=======================================================================
HEARING
BEFORE THE
COMMITTEE ON VETERANS' AFFAIRS
UNITED STATES SENATE
ONE HUNDRED TWELFTH CONGRESS
SECOND SESSION
__________
FEBRUARY 29, 2012
__________
Printed for the use of the Committee on Veterans' Affairs
Available via the World Wide Web: http://www.fdsys.gov
U.S. GOVERNMENT PRINTING OFFICE
73-401 WASHINGTON : 2013
-----------------------------------------------------------------------
For sale by the Superintendent of Documents, U.S. Government Printing Office,
http://bookstore.gpo.gov. For more information, contact the GPO Customer Contact Center, U.S. Government Printing Office. Phone 202�09512�091800, or 866�09512�091800 (toll-free). E-mail, [email protected].
COMMITTEE ON VETERANS' AFFAIRS
Patty Murray, Washington, Chairman
John D. Rockefeller IV, West Richard Burr, North Carolina,
Virginia Ranking Member
Daniel K. Akaka, Hawaii Johnny Isakson, Georgia
Bernard Sanders, (I) Vermont Roger F. Wicker, Mississippi
Sherrod Brown, Ohio Mike Johanns, Nebraska
Jim Webb, Virginia Scott P. Brown, Massachusetts
Jon Tester, Montana Jerry Moran, Kansas
Mark Begich, Alaska John Boozman, Arkansas
Kim Lipsky, Staff Director
Lupe Wissel, Republican Staff Director
C O N T E N T S
----------
February 29, 2012
SENATORS
Page
Murray, Hon. Patty, Chairman, U.S. Senator from Washington....... 1
Burr, Hon. Richard, Ranking Member, U.S. Senator from North
Carolina....................................................... 4
Akaka, Hon. Daniel K., U.S. Senator from Hawaii.................. 6
Johanns, Hon. Mike, U.S. Senator from Nebraska................... 7
Brown, Hon. Sherrod, U.S. Senator from Ohio...................... 8
Isakson, Hon. Johnny, U.S. Senator from Georgia.................. 10
Brown, Hon. Scott P., U.S. Senator from Massachusetts............ 10
Boozman, Hon. John, U.S. Senator from Arkansas................... 11
Tester, Hon. Jon, U.S. Senator from Montana...................... 115
Moran, Hon. Jerry., U.S. Senator from Kansas..................... 118
Begich, Hon. Mark, U.S. Senator from Alaska...................... 121
WITNESSES
Shinseki, Hon. Eric K., Secretary of Veterans Affairs;
accompanied by Hon. Robert A. Petzel, M.D., Under Secretary for
Health; Hon. Allison A. Hickey, Under Secretary for Benefits;
Hon. Steve L. Muro, Under Secretary for Memorial Affairs; Hon.
Roger W. Baker, Assistant Secretary for Information and
Technology; and W. Todd Grams, Executive in Charge for the
Office of Management and Chief Financial Officer............... 12
Prepared statement........................................... 14
Response to prehearing questions submitted by:
Hon. Patty Murray.......................................... 25
Hon. Richard Burr.......................................... 41
Response to posthearing questions submitted by:
Hon. Patty Murray.......................................... 126
Hon. Richard Burr.......................................... 155
Hon. Mark Begich........................................... 310
Hon. Johnny Isakson........................................ 312
Hon. Roger F. Wicker....................................... 316
Hon. Scott P. Brown........................................ 320
Independent Budget Representatives
Schrier, William, Western Region National Vice Commander, The
American Legion; accompanied by Tim Tetz, Director, National
Legislative Commission......................................... 326
Prepared statement........................................... 328
Blake, Carl, National Legislative Director, Paralyzed Veterans of
America........................................................ 336
Prepared statement........................................... 337
Hall, Jeffrey, Assistant National Legislative Director, Disabled
American Veterans.............................................. 341
Prepared statement........................................... 342
Zumatto, Diane, National Legislative Director, AMVETS............ 349
Prepared statement........................................... 350
Kelley, Raymond, National Legislative Director, Veterans of
Foreign Wars................................................... 354
Prepared statement........................................... 355
Other Witnesses
Tarantino, Tom, Deputy Policy Director, Iraq and Afghanistan
Veterans of America............................................ 359
Prepared statement........................................... 360
THE FISCAL YEAR 2013 BUDGET FOR VETERANS' PROGRAMS
----------
WEDNESDAY, FEBRUARY 29, 2012
U.S. Senate,
Committee on Veterans' Affairs,
Washington, DC.
The Committee met, pursuant to notice, at 10 a.m., in room
418, Russell Senate Office Building, Hon. Patty Murray,
Chairman of the Committee, presiding.
Present: Senators Murray, Akaka, Brown of Ohio, Tester,
Begich, Burr, Isakson, Johanns, Brown of Massachusetts, Moran,
and Boozman.
STATEMENT OF HON. PATTY MURRAY, CHAIRMAN,
U.S. SENATOR FROM WASHINGTON
Chairman Murray. Good morning and welcome to this morning's
hearing on the Fiscal Year 2013 Budgets and the Fiscal Year
2014 Advanced Appropriations Request for the Department of
Veterans Affairs.
I want to welcome all of our panelists today. I really
appreciate you coming and helping us work our way through these
critical issues for our veterans.
You know, as I do most weeks when I am home, last week I
convened a roundtable discussion with veterans from across my
homestate of Washington. I heard from the very men and women
whose lives this budget is actually going to touch.
While some of the veterans, as always, praised the care and
access they were receiving from the VA, many of them did lay
out concerns that must be addressed in this budget and in
future budgets.
I heard from veterans who still face unacceptably long wait
times for mental health care, are still not getting the type of
mental health care that they need in their own community. I
heard from women veterans who are struggling to receive
specialized care, and I heard from veterans who are just really
fed up with the dysfunction of the claims system.
I also heard from veterans who still find themselves
confronted by obstacles to employment and who told me they are
even afraid to write the word ``veteran'' on their job
application because of the stigma that they believe employers
today attached to that.
Last year's passage of the VOW Hire Heroes Act was a great
first step in tackling these problems and the high rate of
veteran unemployment, but there is a lot of work left to be
done.
As I am sure Secretary Shinseki will talk about, now is the
time to take advantage of the public-private partnerships and
the sea of goodwill that exists in corporate America toward our
veterans today, but doing so will also require beating back
misinformation about the invisible wounds of war.
I am pleased that the Administration has shown real
leadership in engaging private partners in this area, and I
will continue to highlight the tremendous skills, leadership
ability, and discipline that our veterans bring to the table.
I also look forward to learning more today about VA's
involvement with the President's proposed Veterans' Job Corps.
Any way that we can get our veterans both employed and more
involved in bettering our communities is a program worthy of
investment.
As everyone on this Committee knows: with the end of the
war in Iraq and the coming withdrawal of troops from
Afghanistan, the budget challenges will only continue for the
VA.
Last year this Committee held a hearing to explore the
long-term costs of war, and what is 100 percent clear is that
we have an obligation that will continue long after the
fighting is over.
As we review this budget, fulfilling our Nation's
obligation to our veterans not only today but throughout the
course of their lives must be our most pressing consideration.
Now, let me tell you that as a longtime Member of the
Senate Budget Committee and as someone who has seen just how
difficult this year's budget is for many other agencies, when
this budget arrived on my desk I was very encouraged.
Given the current fiscal environment, the VA has done a
good job putting together a budget that reflects a very real
commitment to provide veterans with the care and benefits they
have earned. So, thank you, Secretary Shinseki, for your
efforts in doing that.
I also want to applaud VA's ongoing commitment to end
homelessness. This is an area where you are making real
strides, and I am encouraged to see that the Administration has
again requested an increase in funding for homeless programs.
I am hopeful we will continue to see a significant effort
to reduce the number of homeless veterans and prevent those who
are at risk from becoming homeless, but I also believe the VA
has some real work to do in the area of serving female homeless
veterans.
While VA has done a good job putting together a budget that
works to tackle the challenges that our veterans face, there is
also clearly room for improvement.
For the third year in a row, VA has proposed cuts in
spending for major construction and nonrecurring maintenance.
These continued cuts are deeply troubling given last year was
the first time VA's budget even outlined the Department's
vision for a 10-year construction plan with a price tag that
approached $65 billion.
Yet despite that plan, for the past 2 years VA has
requested only a fraction of the amount that it needs. I am
disappointed at the size of the gap between the funding needed
to bring facilities up to date and the funding requested from
the Congress.
In addition, this budget request proposes a series of
initiatives intended to save money including better controls on
contract health care, better strategies for contracting, and
cutting administrative overhead.
I am pleased to see the VA recognizes the importance of
efficiency, but I have some concerns with those proposals. A
GAO report released on Monday showed many of these initiatives
from last year's budget did not, in fact, generate the savings
that the VA
predicted.
I will review each of the initiatives in this budget with
an open mind, but I want to be clear: our first priority--our
obligation--must be to ensure that we are fulfilling and
honoring our commitment to our veterans.
If the VA fails to meet the proposed cost-saving estimates,
it will have to find a way to make up the difference so
veterans do not end up paying the price.
Medical care collections is another area where VA has to do
a better job of both predicting targets and collecting funds.
It is impossible to build the budget on funding that is not
collected.
Another area of concern to me is mental health care. At a
hearing last year, the VA witnesses acknowledged they may, in
fact, need more resources to meet the high demand for mental
health care. I want a straightforward answer from the VA about
their actual needs and whether the Department's proposed a 5-
percent increase is enough.
Last year I asked the VA to conduct a survey of mental
health providers that revealed significant shortcomings. VA
proposed a plan to fix the problems, and they must complete
those steps as scheduled. But the VA cannot stop with what was
outlined in that initial plan. It must continue to work to find
ways to make real and substantial improvements.
This year we will continue to be aggressive in our
oversight of VA mental health care. Not every veteran will be
affected by invisible wounds; but when a veteran has the
courage to stand up and ask for help, the VA must be there
every single time. The VA must be there with not only timely
access to care but also the right type of care.
Challenges like PTSD or depression are natural responses to
some of the most stressful experiences a person can have, and
we will do everything possible to ensure that those affected by
these illnesses can get the help, can get better, and get back
to their lives.
Finally, like Chairman Miller and Senator Tester and
others, I remain very concerned about the questions surrounding
the effects of sequestration on veterans' health care.
Throughout the Budget Control Act process that established
sequestration, I made it very clear that including VA among
those agencies that would receive automatic cuts is
unacceptable and repeatedly made clear that this should not be
the case.
And although I am confident that all veterans programs
including health care will be protected in the event of
sequestration, I want to make sure you know that I will not
accept anything else. I believe our veterans deserve clarity on
this issue; and if it cannot be provided today, I am going to
continue to work to get it.
In fact, I have already asked the Government Accountability
Office to issue a formal legal opinion to provide some
resolution on this issue.
Secretary Shinseki, as you well know, budgets are a
reflection of our values; and thanks to your work, this budget
request demonstrates a strong commitment to our veterans. While
we are in a position to make sure the VA has the increased
funding it needs, we should also be mindful that the demand for
services is going to continue to increase no matter the number
of troops deployed.
I look forward to working with my colleagues on this
Committee and on the Budget and Appropriations Committees on
which I also sit and, of course, with Secretary Shinseki and
his entire team and the leaders from the veterans' community to
make sure that we keep this long-term commitment.
So, I thank all of you for being here today and my
Committee members, and with that I will turn to our Ranking
Member, Senator Burr, for his opening statement.
STATEMENT OF HON. RICHARD BURR, RANKING MEMBER,
U.S. SENATOR FROM NORTH CAROLINA
Senator Burr. Thank you, Madam Chairman.
Mr. Secretary, welcome. Welcome to your leadership team and
welcome to the veterans' service organizations who are here
this morning.
We are here today to review the President's budget request
for the Department of Veterans Affairs for fiscal year 2013,
which includes a 4\1/2\ percent increase in discretionary
spending.
I continue to believe that it is important that we provide
adequate funding so that veterans of all generations will be
able to receive the benefits and services they have earned and
deserved without hassles or delays, but we also need to analyze
the budget request to ensure that we spend the taxpayers money
wisely and more importantly that the funding will actually lead
to better outcomes for veterans, their families, and their
survivors. As we will discuss today, I have questions about
whether that is the case for several areas of today's budget.
To start with, the budget for mental health care includes
an advanced appropriations request for fiscal year 2014 of $6.4
billion. If adopted, it will represent a 4 percent increase
over fiscal year 2013 and a 66 percent increase over the fiscal
year 2008 level.
But at hearings last year, the Committee heard about the
devastating struggles some veterans face when trying to get
mental health treatment they need from the VA.
In fact, VA's survey of its mental health providers last
year was pretty clear on the problem. Seventy percent survey
respondents indicated they did not have enough mental health
staff to meet the current demand for care. Forty-five percent
indicated that lack of off-hours appointments is a barrier to
care, and 51 percent said it took 30 days or more for a veteran
to be seen for a specialty appointment such as Post Traumatic
Stress Disorder.
Clearly, this is an instance where increased funding has
not translated to better services for veterans. Today I hope we
will get a better understanding of how VA plans to address
these issues, how the requested funding would be used, and
whether it may be time for VA to start looking outside the box
to find solutions to the barriers veterans face in assessing
this needed care.
Another area of concern is the backlog of disability
claims, a pretty common discussion we have in this Committee.
This budget requests a 41-percent increase in staff since 2008,
but let us look at what has happened during that time.
The number of claims pending at the end of the year has
more than doubled. The average number of days to complete a
claim has increased by 26 percent. The quality of decisions has
trended down and is now below 84 percent. According to one
performance measure, there has been a 16-percent decline in the
number of claims completed annually by employees.
Productivity. The appeals resolution time has increased
from 645 days to 747 days, and VA decided hundreds of thousands
less claims than it received.
With statistics like these, it must be a priority to ensure
the initiatives the VA is pursuing to get the situation under
control will actually be effective so that veterans, their
families, and their survivors receive timely, quality decisions
when they seek benefits from the VA.
Another area of the budget I would like to briefly
mentioned is the legislative proposal to spend $1 billion over
5 years on the Veterans' Jobs Corps programs. While I believe
it is important that we help our veterans find meaningful work,
I am interested to learn how VA would suggest paying for this
program and about how it would be structured. So, I hope that
VA will be able to provide us with more details about the
proposed program today.
Madam Chairman, the final item I want to highlight before I
turn it back to you is the continued increase in staff at the
VA Central Office and quite honestly at the VISN level. For
example, since fiscal year 2008 the staff of the VA Central
Office has grown by close to 40 percent and the Office of Human
Resources and Administration has seen an 80-percent increase
over the same period. Also the staff at the VISN headquarters
has increased by 52 percent between 2008 and 2011.
I think we need to ask serious questions about whether this
increase in staffing directly benefit our Nation's veterans,
whether these employees are essential to delivering services to
the veterans who use the VA system, and whether any of the
funds could be put to better use.
The bottom line is that particularly in this time of record
deficits, we need to ensure that when we spend the limited
money as we have we do it wisely and that we make certain that
the veterans are the ones that receive the benefits and
services that have been earned and deserved.
The trend lines are troubling to me. They should be
troubling to this Committee and they should be troubling, quite
frankly, to the VA. I will focus much of my attention on those
today in questions to the Secretary and to his leadership team.
I thank the Chair.
Chairman Murray. Thank you, Senator Burr.
We will now turn to our Senators for opening remarks in
order of appearance. Senator Akaka, we will start with you.
STATEMENT OF HON. DANIEL K. AKAKA,
U.S. SENATOR FROM HAWAII
Senator Akaka. Thank you very much, Madam Chairman, and I
want to say Aloha to Secretary Shinseki and his leadership
staff at the VA. I want to thank all of you for your service to
veterans and, of course, to our country.
I do not need to tell you what you have been hearing that
Secretary Shinseki and the leadership staff has been improving
the services because claims have dropped and that is an
indication of the care and treatment which is our duty to
provide to veterans that is something that we must continually
strive to improve, and you have been doing that.
I am encouraged to see that the total budget request for VA
was $13 billion above last year. I know we have budgetary
constraints, but we owe it to our veterans who have sacrificed
for our country, and you have planned and are moving along and
have been progressing about meeting those needs.
I am glad to see increases in budget requests for mental
health, suicide prevention, and Iraq and Afghanistan veterans'
programs. I am also encouraged by major increases in funding
for homeless vets and women's vets programs.
While budget increases provide opportunities, we all know
that these resources must be utilized with thought and
efficiency in order to best serve our veterans and their
families.
As the Defense Department continues to reduce its
participation in overseas contingency operations and more
veterans come home to their families, VA's capacity to treat
veterans is sure to be tested even more.
Mr. Secretary, we have talked about this, and I know that
you are doing all you can to prepare for the anticipated growth
in the number of veterans seeking VA services.
Secretary Shinseki, I am also very pleased to see that an
important project for Hawaii's veterans which I have championed
for years is in the budget: a much needed care facility in West
Kahului that would alleviate some of the overcrowding at Spark
Matsunaga Medical Center at Tripler Hospital. This proposed
lease will certainly help to meet the needs of our veterans in
Hawaii.
Mr. Secretary, I have been impressed with all that you and
your team have been able to accomplish in the past 3 years. You
have made tremendous strides to improve mental health care,
suicide prevention, homelessness, and help veterans find jobs
among other accomplishments.
However, we know that there are areas where we can improve
the care and services provided to our veterans that they earned
and the most certainly deserve.
So, I look forward to hearing your testimony today, Mr.
Secretary, and continuing to work with my colleagues and VA to
help provide the best care we can to our veterans and their
families.
Thank you very much, Madam Chairman.
Chairman Murray. Thank you very much.
Senator Johanns.
STATEMENT OF HON. MIKE JOHANNS,
U.S. SENATOR FROM NEVADA
Senator Johanns. Madam Chair, Ranking Member Burr, thanks
for holding the very, very important hearing.
Let me just start out and offer an observation, Mr.
Secretary. First of all, I want to say thank you for stopping
by my office a week or 10 days ago. As you know, over the past
few years while I have been here and you have been in your
position, we have had an opportunity to meet on a number of
occasions, and I have always appreciated that.
I come away from those meetings absolutely convinced that
you and your team have the best interests of vets in your heart
and you are trying to do everything you can to deal with all of
the problems that we are going to mention today.
But one of the things that we have found in working with
vets in my Senate office, and it is the reality of the Veterans
Administration, is every veteran has an individual problem that
is not easily solved with one sweeping policy approach or
whatever.
We have found that we really have to sit down with each vet
and talk to them and help them work through that problem. Even
in my Senate office, we have found that we have to staffup to
do that. I have more people in my Senate offices working on the
veterans' caseload than any other caseload that we work on. So,
it is just part of what we have to do.
I think we have a great perspective on what the veterans
need, and you are always willing to bring that to the fore. I
have been in your position before and the complexities of what
you are doing are the norm.
So, I want to start out on a positive note and just tell
you I think your heart is in the right direction, but I do
think as we look at the metrics and the progress we are making,
it is important to see what is working and what is not working
and just simply acknowledge that and try to figure out, is
there something we are missing here?
I also wanted to just mention briefly, and I will not dwell
on this long but it is worth a mention to me. As you know, like
other areas in the country we are struggling with a VA hospital
that was built decades ago. Notwithstanding the kind of heroic
efforts of the staff there and the doctors and the nurses and
the administrative personnel, it is just a very, very difficult
situation.
We are very pleased that we are on the priority list, and
we are making our way to a point at which where we hope we can
solve that problem and replace the facility. I think today we
are like 18, if I am not mistaken. So, I am aware of the fact
that it just does take a while.
We are hoping to work with you and your staff. Maybe there
are some things we can do. There is a serious parking problem.
It is right in the middle of Omaha, and so, maybe there are
some things we can do to move the project forward.
I will wrap up with one last thought. We are seeing some
areas of improvement that I wanted to mention, again hoping to
keep this on a note of, look, you are doing some things that I
think are making a difference.
The first is in the processing of Post-9/11 GI Bill
benefits. In 2011 we at least, I do not know about other Senate
offices, we at least received no complaints about delays or
problems with education benefits. I do not know what we are
doing with education benefits but at least from our experience
something is working.
Whatever model, if I could somehow be transferred to the
disability claims, and I appreciate they are much more
complicated, but that seems to be working. You have had to ramp
that up pretty significantly.
So, I am hoping I can hear some thoughts and maybe there
are some ideas that would work in other areas of the VA system.
We are also hearing veterans express to us that the
expanded access to information via that eBenefits system is
something that they appreciate, they feel good about. I think
all of us have been optimistic and hopeful, maybe that is a
better way of putting it, hopeful that that eBenefits system
would pay benefits. We think it is.
We think as veterans are getting more used to that it is
paying some dividends and hopefully saving some staff time
because people can get information or whatever they are needing
there.
I will just wrap up, and again thank you, Madam Chair, I do
appreciate the opportunity to be here.
Thank you, you and your whole team for the work that they
are doing. My hope is that we can advance the cause because
there is so much more to be done. Thank you.
Chairman Murray. Thank you, Senator Johanns.
Senator Brown of Ohio.
STATEMENT OF HON. SHERROD BROWN,
U.S. SENATOR FROM OHIO
Senator Brown of Ohio. Thank you, Chairman Murray. I
appreciate your leadership on veterans' issues.
Thank you, Secretary Shinseki, and all of you who dedicate
a big part of your lives. It is nice to see you again. Thank
you for coming to Ohio, those of you that have, and the service
that you provide for veterans in my State and for all of us.
It is a good budget. It shows a strong commitment to
veterans. I think when you look at what the advanced
appropriations mark is, a $40 billion, the request with the
advanced appropriations with the $13 billion increase it is
saying the right thing for people who clearly have earned it.
It reflects the understanding that we all have about service to
country.
I applaud the VA for its investments in eliminating the
disability claims backlog. We are all, of course, still very
concerned about that as Senator Johanns said.
We still hear horror stories of 12-, 18-, and 24-month
delays. We should, of course, never tolerate them, and I know
your views about that, Secretary Shinseki. I know that we need
to continue to push and with better trained staff and
improvements in electronic and other processing efficiencies.
Also, on a similar note, the disability rating system
clearly needs substantial improvement. A bum knee in Charlotte
should be treated the same as a bum knee in Cincinnati. The
backlog in disability ratings is in many ways related: fixing
both at the same time makes sense, and I know your commitment
to wanting to do that, and we expect to see results as we move
forward.
I am aware, too, of the funds in this budget to train
outreach coordinators and operate targeted clinics and provide
other services specific to particularly rural veterans but
everywhere who simply do not know enough about veterans
services.
People from the VA, officials from the VA joined me in a
field hearing in Appalachia, two areas of Ohio, Appalachia
Ohio, one in 2007 and one in 2010. We talked about everything
from applying for benefits, and veterans benefits to the
earned-income tax credit. So many low-income veterans do not
know enough about any of those services.
The fact that today I believe there are 30 community-based
outpatient clinics, CBOCs, in Ohio speak to your commitment to
going everywhere to reach veterans not just in the VA centers
in Cincinnati and Chillicothe and Cleveland but well beyond
that. I am very appreciative of that, but the outreach efforts
obviously need to be stepped up, targeted at not just the
demographic of rural Appalachia, but certainly other places
too.
My last point. Our main concern about the Department's
outsourcing of more and more work. The quality of outsourced
work is often subpar. This whole political view that
outsourcing, you know, whether it is selling turnpikes or
selling prisons or outsourcing part of the military, the work
often is subpar.
The cost savings are usually illusory and often the costs
are significantly greater we learn from outsourcing. I mean,
the contractors give political campaign contributions. I am not
saying you are any part of that to be sure, but that happens
too often.
We go places with outsourcing that does not lead to good
government. We also--I think many contractors lack the
dedicated service mentality, if you will, of career civil
servants. It is always popular to beat up Federal employees and
State employees and all of that. We have gone through that
politically in State, after State, after State in this country
and in the Federal Government.
I like the idea. I think an individual's motivation to
serve our veterans as a career leads to better serve contrasts
sometimes to services provided by companies that are motivated
by profits, and some of the most dedicated people that I have
ever met provide service to veterans and have made that their
career. They could make more money somewhere else but they want
to serve.
And this whole idea that outsourcing saves money, enhances
quality is pretty ill founded. The VA and our veterans cannot
simply be viewed as just another client. We see this at the
very basic level of services in places like Dayton, and I
appreciate very much the Secretary's focus on fixing other
problems in Dayton.
But where laundry was outsourced, workers tell me that
sometimes it does not come back clean, and what is the point of
outsourcing if that happens?
If the VA continues to outsource more and more activities,
at some point are we going to reach the point where the VA is a
health insurance provider rather than a health care provider,
and we never should get close to that line.
On a lighter note, thank you for earlier this week--I guess
today is Wednesday, on Monday was the first day, and I was
lucky enough to be there at the Parma Community-Based
Outpatient Clinic when the VA, for reasons that I disagreed but
probably needed to shutdown the VA hospital in Brecksville.
Part of the deal was that they would put this community-based
outpatient clinic, this CBOC, in Parma. It is terrific. It was
crowded the first day. People will use it. It serves an
important population, and I thank you for that.
Chairman Murray. Thank you very much.
Senator Brown of Massachusetts.
STATEMENT OF HON. SCOTT P. BROWN,
U.S. SENATOR FROM MASSACHUSETTS
Senator Brown of Massachusetts. Thank you, Madam Chair.
I want to hear the testimony of the folks. I will be very
brief. I agree with Senator Burr on the job issues and the fact
that we are going to be spending a lot of money, happy to do
it. I want to see how it is going to be paid for, but also
importantly see if there is any duplication overlap. There
seems to be a lot of things happening in that field.
When we have these types of issues, we usually throw
everything against the wall and see what sticks. I want to make
sure that we do it efficiently. We do not just keep throwing
money out there but actually that we have programs. If they are
working, that is improving; if they are not, let us get rid of
them.
I am concerned still about obviously the long timeframe in
filing claims. I will say I am very pleased with what is
happening in Massachusetts with the new blood out there and new
people helping and really seem energized. It helps that we are
in the same building and we have had some great success and I
have made that public in our veterans' hearing that we had on
this very issue, and I know the big elephant in the room is the
one million returning veterans and the obligations we have to
keep them and get them whole, and I am thankful.
I know you have already met with Secretary Panetta to
discuss that VA/DOD mission to make sure that we do not just
have a million new veterans coming.
If they are going to be released, they need to be released
in a thoughtful, methodical manner so you are not overwhelmed
and really just in so deep you cannot get out.
So, I will just stop with that. I look forward to hearing
the testimony. I am going to be going to the floor, Madam
Chair. I have to speak, but then I will be back. Thank you.
Chairman Murray. Senator Isakson.
STATEMENT OF HON. JOHNNY ISAKSON,
U.S. SENATOR FROM GEORGIA
Senator Isakson. I, too, will be very brief because I am
anxious to hear from each of you. But first of all, Secretary,
thank you for taking the time to come to my office 2 weeks ago.
Second, I have two pieces of good news. One is on the jobs
front, and you probably have heard about this; but if you have
not, I wanted to make you aware.
Lewis Jordan, who was the founder of ValuJet and AirTran,
which is now Southwest, has created a foundation called
Gratitude America, which is a web-based platform to match job
needs with veterans; and it has the component that links them
with training for the jobs.
So, it makes the full circle where, if a veteran is looking
for a job, he can search it on the Internet. If he finds a job
he likes but he is not qualified, it matches him with the
closest training facility where he can get the training.
I think it is a great idea, and it is something that is
very important. I appreciate Lewis doing that and I thought you
would want to know.
The second is I want to compliment Director Goldman at the
Dublin VA. I have spent a day in Dublin, GA, last week. He
serves a third of the State--51 counties--and he is trying to
partner with the General, the Commander of Robins Air Force
Base to merge the VA clinics in Perry and Macon, GA, with the
base DOD health care on the base to utilize the facilities,
advantage of having all the imaging equipment and everything
already on the active-duty base and not have to have redundant
cost in staffing to other clinics, which I think is a great
idea to make better health care available but also at a lower
cost to the Veterans Administration and the taxpayers.
I wanted to bring those two pieces of good news to your
attention. Thank you for what you do, and thank you for being
here.
Chairman Murray. Thank you.
Senator Boozman.
STATEMENT OF HON. JOHN BOOZMAN,
U.S. SENATOR FROM ARKANSAS
Senator Boozman. Thank you, Madam Chair, and again very
quickly I just want to thank the Secretary for being here and
the team that he assembled, for your hard work.
Senator Brown mentioned that, you know, that there are a
lot of individuals in the VA that are there because they want
to be and could have other opportunities, and certainly you are
in that category. You have led soldiers and now you are serving
veterans and so we really do appreciate that very, very much.
The other thing I would say is, as Senator Isakson
mentioned, I do appreciate the fact that you are very willing
to work with Congress and very approachable, you and your
staff; and so that is something that is appreciated.
So, we appreciate all that you guys have done in your past
and are looking forward to it your doing a bunch in the future.
I yield back, Madam Chair.
Chairman Murray. Thank you very much.
With that I want to again welcome Secretary Shinseki. Thank
you for coming here today to give your perspective on the
Department's fiscal year 2013 budget and the fiscal year 2014
advanced appropriation request.
Secretary Shinseki is accompanied today by Steve Muro,
Under Secretary for Memorial Affairs; Allison Hickey, Under
Secretary for Benefits; Dr. Robert Petzel, Under Secretary for
Health; and we also have Todd Grams, Executive in Charge of the
Office of Management and Chief Financial Officer; and Roger
Baker, Assistant Secretary for Information and Technology.
Thank you all for joining us today.
Secretary Shinseki, your remarks will, of course, appear in
the record, but we welcome your opening statement.
STATEMENT OF HON. ERIC K. SHINSEKI, SECRETARY OF VETERANS
AFFAIRS; ACCOMPANIED BY HON. ROBERT A. PETZEL, MD, UNDER
SECRETARY FOR HEALTH; HON. ALLISON A. HICKEY, UNDER SECRETARY
FOR BENEFITS; HON. STEVE L. MURO, UNDER SECRETARY FOR MEMORIAL
AFFAIRS; HON. ROGER W. BAKER, ASSISTANT SECRETARY FOR
INFORMATION AND TECHNOLOGY; AND W. TODD GRAMS, EXECUTIVE IN
CHARGE FOR THE OFFICE OF MANAGEMENT AND CHIEF FINANCIAL OFFICER
Secretary Shinseki. Thank you, Madam Chairman, Ranking
Member Burr, distinguished Members of the Senate Committee on
Veterans' Affairs, thank you again. I look forward to these.
This is an opportunity to extend the dialog we have in other
fora, but thanks for this opportunity to present, as the
Chairman said, the President's 2013 Budget and 2014 Advance
Appropriations Requests for VA.
This Committee has a long history of strong support for our
Nation's veterans, and I can speak to that first hand having
worked personally the past three budgets with you.
The President has demonstrated his own respect and sense of
obligation for our 22 million veterans by sending the Congress
once again another strong budget request for VA, and I thank
the members for your unwavering commitment, and I am here to
answer your questions but also seek your support on this budget
request.
I would also like to acknowledge the representatives from
our veterans service organizations who are here today. I would
tell you as we develop our budgets, their insights, their
experience is helpful as we put together our arguments for
resources and as we strive to continuously improve our
programs.
Madam Chairman, thanks for introducing the members of the
panel. I have a written statement which I ask to be submitted
for the record.
Chairman Murray. Without objection.
Secretary Shinseki. This hearing occurs at an important
moment in our Nation's history, not the only one. There have
been others that I could refer to. I am old enough to have
experienced our return from Vietnam and to have witnessed
personally the end of the cold war.
We are again in another period of transition, an important
one. Our troops have returned home from Iraq and their numbers
in Afghanistan are likely to decline over time; and history
suggests, as the Chair indicated, VA's requirements from these
two operational missions will continue to grow for sometime
long after the last combatant leaves Afghanistan, maybe as much
as a decade, maybe even more.
We must provide access to quality care, timely benefits and
services and job opportunities for every generation of
veterans; and the generation at hand is the one that comes home
today from Iraq and Afghanistan.
In the next 5 years, more than a million veterans are
expected to leave military service. This generation relies on
VA at unprecedented levels. Through September 2011, of
approximately 1.4 million veterans who deployed and returned
from operations Enduring Freedom and Iraqi Freedom, 67 percent
have used some VA benefit or service in some way, a far higher
percentage than those from previous wars.
The 2013 budget request would allow us to fulfill the
requirements of our mission. Health *Care for 8.8 million
enrolled veterans, compensation and pension benefits for nearly
4.2 million veterans, life insurance covering 7.1 million
active duty servicemembers and enrolled veterans at a 95-
percent customer satisfaction rating, educational assistance
for over a million veterans and family members on over 6,500
campuses, home mortgages and veteran loans with the Nation's
lowest foreclosure rates, and burial honors for nearly 120,000
heroes and eligible family members in our 131 National
Cemeteries, befitting their service to our Nation.
This 2013 budget request continues the momentum in our
three priorities that you have heard me speak about over the
past 3 years. Increasing access to care, benefits and services;
eliminating the claims backlog; and ending veterans'
homelessness through effective, efficient, accountable use of
the resources you provide.
Access encompasses VA's facilities, programs, and
technology. It is a broad term but there is a lot it
encompasses. This 2013 budget request allows VA to continue
improving access by opening new or improved facilities closer
to where veterans live and providing telehealth and
telemedicine linkages, with connectivity where it is needed, in
veterans homes.
Also VA is fundamentally transforming veterans access to
benefits through a new electronic tool called the Veterans
Relationship Management System. This is an effort to improve
our telephone service.
By collaborating with DOD to turn the current Assistance
Program that we both share into an outcomes-based training and
education program that fully prepares departing servicemembers
for the next phase of their lives; and by establishing a
National Cemetery presence in eight rural areas and better
serving rural and women veterans. I am happy to provide details
later.
We expect that more than 1 million veterans will leave the
military over the next 5 years, potentially all will enroll in
VA. Over 600,000 of them, based on our historical trend, will
likely seek care, benefits, and services from VA in the out
years.
Regarding the backlog, from what we know now, fiscal year
2013 will be the first year in a long time in which our claims
production going out the door will exceed the number of
incoming claims; and the paperless initiative we have been
building for the past 2 years, an automation tool, becomes
critical to reversing backlog growth and increasing quality. We
must not hesitate. Stability in IT funding is critical to our
success.
Homelessness. From January 2010 to January 2011 alone, the
estimated number of homeless veterans declined by 12 percent.
We have created momentum in the homeless program. Much remains
to be done to end veterans homelessness by 2015 and the 2013
budget is a presentation of how we continue to do that.
We are now developing a dynamic homeless veterans registry.
I think you appreciate that much of what we understand about
homelessness is an estimate of real numbers. We are not able to
count everyone out there but it is a statistically valid
process.
In the meantime, over the past 3 years, we have been
building a registry of former and current veterans by name so
we know who they are, what their issues are, where they reside,
and whether they are migratory and move from one VA footprint
to the next.
So, as we think about adjusting the footprint based on what
we see day-to-day, we want to be careful that we are not doing
something that ignores maybe an issue that is going to require
help.
So, building a veterans registry today with over 400,000
names of current and formerly homeless veterans allowa us to
better see, track and understand the real causes of veterans
homelessness. In the years ahead, we think this information
will not only help us more effectively prevent it--that is
where we are headed--not just for veterans, but perhaps for
other communities as well where we have partnered in taking on
the homeless issue.
We look to develop more visibility of the at-risk veteran
population in order to prevent veterans from falling into
homelessness, and this budget supports that plan.
So, Madam Chairman and Members of the Committee, we are
committed to the responsible use of the resources you provide
and the resources we seek in the 2013 budget. I know that has
been a question some of you have posed; but for both the 2013
budget and 2014 advance appropriations requests, we are
committed to the responsible use.
Again thank you for this opportunity to appear before this
Committee.
[The prepared statement of Secretary Shinseki follows:]
Prepared Statement of Hon. Eric K. Shinseki, Secretary,
U.S. Department of Veterans Affairs
Chairman Murray, Ranking Member Burr, Distinguished Members of the
Senate Committee on Veterans' Affairs: Thank you for the opportunity to
present the President's 2013 Budget and 2014 advance appropriations
requests for the Department of Veterans Affairs (VA). For the past
three budget requests, the Congress has supported the very high
priority that the President has placed on funding for programs that
provide care and benefits for our Nation's 22 million Veterans and
their families. This submission seeks your support of the President's
continued high priority support for Veterans who have earned this
Nation's respect and the benefits and services we provide.
We meet at an historic moment for our Nation's Armed Forces, as
they turn the page on a decade of war. Recently, the President outlined
a major shift in the Nation's strategic military objectives--with a
goal of a more agile, more versatile, more responsive military focused
on the future. The President also outlined another important
objective--keeping faith with those who serve as they depart the
military and return to civilian life. As these newest Veterans return
home, we must anticipate their transitions by readying the care, the
benefits, and the job opportunities they have earned and they will need
to smoothly and successfully make this transition.
The President's 2013 Budget for VA requests $140.3 billion--
comprised of $64 billion in discretionary funds, including medical care
collections, and $76.3 billion in mandatory funds. The discretionary
budget request represents an increase of $2.7 billion, or 4.5 percent,
over the 2012 enacted level. Our 2013 budget will allow the Department
to operate the largest integrated healthcare system in the country,
with more than 8.8 million Veterans enrolled to receive healthcare; the
eighth largest life insurance provider covering both active duty
members as well as enrolled Veterans; a sizable education assistance
program serving over 1 million participants; a home mortgage service
that guarantees over 1.5 million Veterans' home loans with the lowest
foreclosure rate in the Nation; and the largest national cemetery
system that continues to lead the country as a high-performing
organization--for the fourth time in a 10-year period besting the
Nation's top corporations and other Federal agencies in an independent
survey of customer satisfaction. In 2013, VA national cemeteries will
inter about 120,000 Veterans or their family members.
The Department of Veterans Affairs fulfills its obligation to
Veterans, their families, and survivors of the fallen by living a set
of core values that define who we are as an organization: ``I CARE''--
Integrity, Commitment, Advocacy, Respect, and Excellence--cannot be
converted into dollars in a budget. But Veterans trust that we will
live these values, every day, in our medical facilities, our benefits
offices, and our national cemeteries. And where we find evidence of a
lack of commitment to our values, we will aggressively correct them by
re-training employees or, where required, removal. We provide the very
best in high quality and safe care and compassionate services,
delivered by more than 316,000 employees, who are supported by the
generosity of 140,000 volunteers.
STEWARDSHIP OF RESOURCES
Safeguarding the resources--people, money, time--entrusted to us by
the Congress, managing them effectively and deploying them judiciously,
is a fundamental duty at VA. Effective stewardship requires an
unflagging commitment to apply budgetary resources efficiently, using
clear accounting rules and procedures, to safeguard, train, motivate,
and hold our workforce accountable; and to assure the proper use of
time in serving Veterans on behalf of the American people.
During the audit of the Department's fiscal year 2010 financial
statement, VA's independent auditor certified that we had remediated
all three of our remaining material weaknesses in financial management,
which had been carried forward for over a decade. In terms of internal
controls and fiscal integrity, this was a major accomplishment. We have
also dramatically reduced the number of significant financial
deficiencies since 2008, from sixteen to two.
Another example of VA's effective stewardship of resources is the
Project Management Accountability System (PMAS) developed by our Office
of Information Technology. PMAS requires Information Technology (IT)
projects to establish milestones to deliver new functionality to its
customers every six months. Now entering its third year, PMAS continues
to instill accountability and discipline in our IT organization. In
2011, PMAS achieved successful delivery of 89 percent of all IT project
milestones. VA managed 101 IT projects during the year, establishing a
total of 237 milestones and successfully executing 212 of them. Of the
25 IT projects that missed their delivery milestone date, more than
half delivered within the next 14 days. Ensuring IT projects meet
established milestones means that savings and delivery of solutions are
achieved throughout development, and that Veterans reap improvements
sooner. By implementing PMAS, we have achieved at least $200 million in
cost avoidance by stopping or improving the management of 45 projects.
VA's stewardship of resources continues with the expansion of our
ASPIRE dashboard to the Veterans Benefits Administration (VBA).
Originally established in 2010 for the Veterans Health Administration
(VHA), ASPIRE publicly provides quality goals and performance measures
of VA healthcare. The success of this approach was reflected in its
contribution to VHA's receipt of the Annual Leadership Award from the
American College of Medical Quality. On June 30, 2011, VBA established
an ASPIRE Web site at http://www.vba.va.gov/reports/aspiremap.asp for
aspirational goals and monthly progress for 46 performance metrics
across six business lines. This new effort expands the Department's
commitment to unprecedented public transparency by sharing performance
and productivity data in the delivery of Veterans' benefits, including
compensation, pension, vocational rehabilitation and employment,
education, home loans, and insurance.
Through the effective management of our acquisition resources, VA
achieves positive results for Veteran-owned small businesses. VA leads
the Federal Government in contracting with Service-Disabled, Veteran-
Owned Small Businesses (SDVOSB). In 2011, more than 18 percent of all
VA procurements were awarded to SDVOSBs, exceeding our internal goal of
10 percent and far exceeding the governmentwide goal of three percent.
Finally, VA's stewardship achieved savings in several other areas
across the Department. The National Cemetery Administration (NCA)
assumed responsibility in 2009 for processing First Notices of Death to
terminate compensation benefits to deceased Veterans. This allows the
timely notification to next-of-kin of potential survivor benefits.
Since that time NCA has avoided possible collection action by
discontinuing $100.3 million in benefit payments. In addition, we
implemented the use of Medicare pricing methodologies at VHA to pay for
certain outpatient services in 2011, resulting in savings of over $160
million without negatively impacting Veteran care and with improved
consistency in billing and payment.
VETERANS JOB CORPS
In his State of the Union address, President Obama called for a new
Veterans Job Corps initiative to help our returning Veterans find
pathways to civilian employment. The budget includes $1 billion to
develop a Veterans Job Corps conservation program that will put up to
20,000 Veterans back to work over the next five years protecting and
rebuilding America. Veterans will restore our great outdoors by
providing visitor programs, restoring habitat, protecting cultural
resources, eradicating invasive species, and operating facilities.
Additionally, Veterans will help make a significant dent in the
deferred maintenance of our Federal, State, local, and tribal lands
including jobs that will repair and rehabilitate trails, roads, levees,
recreation facilities and other assets. The program will serve all
Veterans, but will have a particular focus on Post-9/11 Veterans.
MULTI-YEAR PLAN FOR MEDICAL CARE BUDGET
Under the Veterans Health Care Budget Reform and Transparency Act
of 2009, which we are grateful to Congress for passing; VA submits its
medical care budget that includes an advance appropriations request in
each Budget submission. This legislation requires VA to plan its
medical care budget using a multi-year approach. This approach ensures
that VA requirements are reviewed and updated based on the most recent
data available and actual program experience.
The 2013 budget request for VA medical care appropriations is $52.7
billion, an increase of 4.1 percent over the 2012 enacted appropriation
of $50.6 billion. This request is an increase of $165 million above the
2013 advance appropriations enacted by Congress in 2011. Based on
updated 2013 estimates largely derived from the Enrollee Health Care
Projection Model, the requested amount would also allow VA to increase
funding in programs to eliminate Veteran homelessness, fully fund the
implementation of the Caregivers and Veterans Omnibus Health Services
Act, support activation requirements for new or replacement medical
facilities, and invest in strategic initiatives to improve the quality
and accessibility of VA healthcare programs. Our multi-year budget plan
continues to assume $500 million in unobligated balances from 2012 that
will carryover and remain available for obligation in 2013--consistent
with the 2012 budget submitted to Congress.
The 2014 request for medical care advance appropriations is $54.5
billion, an increase of $1.8 billion, or 3.3 percent, over the 2013
budget request.
PRIORITY GOALS
Our Nation is in a period of transition. As the tide of war
recedes, we have the opportunity, and the responsibility, to anticipate
the needs of returning Veterans. History shows that the costs of war
will continue to grow in VA for a decade or more after the operational
missions in Iraq and Afghanistan have ended. In the next 5 years,
another one million Veterans are expected to leave military service.
Our data shows that the newest of our country's Veterans are relying on
VA at unprecedented levels. Through September 30, 2011, of the
approximately 1.4 million living Veterans who were deployed overseas to
support Operation Enduring Freedom and Operation Iraqi Freedom, at
least 67 percent have used some VA benefit or service.
VA's three priorities--to expand access to benefits and services,
eliminate the claims backlog, and end Veteran homelessness--anticipate
these changes and identify the performance levels required to meet
emerging needs. The 2013 Budget builds upon our multi-year effort to
achieve VA's priority goals through effective, efficient, and
accountable program implementation.
EXPANDING ACCESS TO BENEFITS AND SERVICES
Expanding access for Veterans is much more than boosting the number
of Veterans walking in the front door of a VA facility. Access is a
three-pronged effort that encompasses VA's facilities, programs, and
technology. Today, expanding access includes taking the facility to the
Veteran--be it virtually through telehealth, by sending Mobile Vet
Centers to rural areas where services are sparse, or by using social
media sites like Facebook, Twitter, and YouTube to connect Veterans to
VA benefits and facilities. Expanding access also means finding new
ways to break down artificial barriers so that Veterans are aware of
and can gain access to VA services and benefits. Technology is the
great enabler of all VA efforts. IT is not a siloed segment of the
budget, providing just computers and monitors, but rather the vehicle
by which VA is able to extend the reach of its healthcare to rural
America, process benefits more quickly, and provide enhanced service to
Veterans and their families.
The 2013 budget request includes $119.4 million for the Veterans
Relationship Management (VRM) initiative, which is fundamentally
transforming Veterans' access to VA benefits and services by empowering
VA clients with new self-service tools. VA has already made major
strides under this initiative. VRM established a single queue for VBA's
National Call Centers ensuring calls are routed to the next available
agent, regardless of geography. Call-recording functionality was
implemented that allows agents to review calls for technical accuracy
and client contact behaviors. VA recently deployed ``Virtual Hold ASAP
call-back'' technology. During periods of high call volumes, callers
can leave their name and phone number instead of waiting on hold for
the next available operator, and the system automatically calls them
back in turn. The Virtual Hold system has made nearly 600,000 return
calls since November 2011. The acceptance rate for callers is 46
percent, exceeding the industry standard of 30 percent, and our
successful re-connect rate is 92 percent. Since launching Virtual Hold,
the National Call Centers have seen a 15 percent reduction in the
dropped-call rate. In December 2011, VA deployed ``Virtual Hold
Scheduled call-back'' technology, which allows callers to make an
appointment with us to call them at a specific time. Since deployment,
over 185,000 scheduled call-backs have already been processed.
In December, VA deployed a pilot of its new ``Unified Desktop''
technology. This initiative will provide National Call Center agents
with a single, unified view of VA clients' military, demographic, and
contact information and their benefits eligibility and claims status
through one integrated application, versus the current process that
requires VA agents to access up to 13 different applications. This will
help ensure our Veterans receive comprehensive and accurate responses.
Key to expansion of access is the eBenefits portal--one of our
critical VRM initiatives. eBenefits is a VA/DOD initiative that
consolidates information regarding benefits and services and includes a
suite of on-line self-service capabilities for enrollment/application
and utilization of benefits and services. eBenefits enrollment now
exceeds 1.2 million users, and VA expects enrollment to exceed 2.5
million by the end of 2013. VA continues to expand the capabilities
available through the eBenefits portal. Users can check the status of a
claim or appeal, review the history of VA payments, request and
download military personnel records, generate letters to verify their
eligibility for Veterans' hiring preferences, secure a certificate of
eligibility for a VA home loan, and numerous other benefit actions. In
2012, Servicemembers will complete their Servicemembers' Group Life
Insurance applications and transactions through eBenefits. Also, 2012
enhancements will allow Veterans to view their scheduled VA medical
appointments, file benefits claims online in a ``Turbo Claim'' like
approach, and upload supporting claims information that feeds our
paperless claims process. In 2013, funding supports enhanced self-
service tools for the Civilian Health and Medical Program of the
Department of Veterans Affairs (CHAMPVA) and VetSuccess programs, as
well as the Veterans Online Application for enrolling in VA healthcare.
VA and the Department of Defense (DOD) have broken new ground in
the development and implementation of the Integrated Disability
Evaluation System (IDES). This system supporting the transition of
wounded, ill, and injured Servicemembers is fully operational and
available to Servicemembers as of October 1, 2011. Because of the
complexity of these cases, the Veterans Benefits Administration devotes
four times the level of staffing resources to processing IDES cases
than claims from other Veterans. VA has reduced its claims processing
time in IDES from 186 days in February 2011 to 104 days in
December 2011. The 2013 budget requests an additional $13.2 million and
90 FTE to support IDES enhancements.
The DOD/VA team is further developing programs to enhance the
transition of all Servicemembers to Veteran status. Together we are
transforming the current Transition Assistance Program (TAP) from a
series of discrete efforts to one that uses an outcome-based approach.
This approach will be more integrated and, once complete will be mapped
to the life cycle of every Servicemember, from recruitment through
separation or retirement. In July 2011, VBA launched on-line TAP
courseware, which provides the capability for Servicemembers to
complete the course without attending the classroom session. VA and DOD
also are collaborating on a policy for implementing mandatory TAP
participation.
VA will improve access to VA services by opening new or improved
facilities closer to where Veterans live. The 2013 medical care budget
request includes $792 million to open new and renovated healthcare
facilities, including resources to support the activation of four new
hospitals in Orlando, Florida; Las Vegas, Nevada; New Orleans,
Louisiana; and Denver, Colorado. These new VA medical centers are
projected to serve 1.2 million enrolled Veterans when they are
operational. This budget also includes an initiative to establish a
national cemetery presence in eight rural areas where the Veteran
population is less than 25,000 within a 75-mile service area. In
addition to expanding access at fixed locations, VA is deploying an
additional 20 Mobile Vet Centers in 2012 to increase access to
readjustment counseling services for Veterans and their families in
rural and underserved communities across the country. These new
specialty vehicles will expand the existing fleet of 50 Mobile Vet
Centers already in service by 40 percent. In 2011, Mobile Vet Centers
participated in more than 3,600 Federal, state, and locally sponsored
Veteran-related events. More than 190,000 Veterans and family members
made over 1.3 million visits to VA Vet Centers in 2011.
The Board of Veterans Appeals (BVA) leverages video conference
technology to increase the capability of, and access to, video hearings
to provide Veterans with more options for a hearing regarding their
appeal. The VA is currently upgrading this video conference technology
both at BVA and at VBA regional offices. In 2011, the number of video
hearings increased from 3,979 to 4,355 or 9.4 percent. The Board is
also working with VBA and VHA to allow video hearings to be held from
more locations in the field, which will be more convenient for
Veterans. Initially, the expanded video capability will be used to
reduce the backlog of hearings and the time Veterans have to wait for
them.
We are working harder than ever to reach out to women Veterans.
Women represent about eight percent of the total Veteran population. In
recent years, the number of women Veterans seeking healthcare has grown
rapidly and it will continue to grow as more women enter military
service. Women comprise nearly 15 percent of today's active duty
military forces and 18 percent of National Guard and Reserves. For the
estimated 337,000 women Veterans currently using the VA healthcare
system, VA is improving their access to services and treatment
facilities. The 2013 budget includes $403 million for the gender-
specific healthcare needs of women Veterans, an increase of 17.5
percent over the 2012 level.
VHA regularly updates its standards for improving and measuring
Veterans' access to medical care programs. In 2010, VHA implemented new
wait time measures that assess performance meeting the new standard of
providing medical appointments within 14 days of the desired date,
replacing the previous 30-day desired-date standard. In 2011, 89
percent of medical care appointments for new patients occurred within
14 days of the desired date, an increase of 5 percentage points over
the 2010 level of 84 percent. The President's request for 2013 ensures
we are able to continue to improve our performance in providing this
service.
Access improvements are central to VHAs new Patient-Aligned Care
Teams (PACT) model. VA views appointments as a partnership. We are
implementing a national initiative to reduce costly no-show
appointments. Also, Veterans can manage appointments by visiting
MyHealtheVet Web site, where they can view all of their pending
appointments. In another effort to help Veterans make and keep
appointments, VA is implementing a pilot program that offers child care
to eligible Veterans seeking medical appointments at three VA medical
centers in 2012 and 2013. The first of these facilities, the Buffalo
VAMC, began providing services in October 2011. Each pilot site will be
operated onsite by licensed childcare providers. Drop-in services will
be offered free of charge to Veterans who are eligible for VA care and
who are visiting a medical facility for an appointment.
VA is taking full advantage of technology to expand access to its
medical centers. In 2008, VA established a presence on Facebook with a
single Veterans Health Administration (VHA) page. In 2009, VA
established the Post-9/11 GI Bill Facebook page to raise awareness
about the implementation of this new benefit program. With over 39,000
subscribers (``or fans''), this page serves as our primary ``real-
time'' tool to communicate GI Bill news and directly interact with our
clients. VA also launched a general VBA benefits page, which describes
all of our services. VBA posts to its followers seven days a week and
is followed in 18 different countries and 15 different languages. In
June 2011, VA outlined a Department-wide social media policy that
provides guidelines for communicating with VA online. By November 2011,
VA had established Facebook pages for all 152 of its medical centers.
This event marks an important milestone in our effort to transform how
the Department communicates with Veterans and provides them access to
healthcare and benefits. By leveraging Facebook, VA continues to
embrace transparency and engage Veterans in a two-way conversation. VA
currently has over 345,000 combined Facebook ``fans.'' As of
January 2012, the Department's main Facebook page has over 154,000 fans
and its medical centers have a combined following of over 69,000.
ELIMINATING THE CLAIMS BACKLOG
To transform VA for the benefit of Veterans, we must streamline the
claims processing system and eliminate the claims backlog. We are
vigorously pursuing a claims transformation plan that will adopt near-
term innovations and break down stubborn obstacles to providing
Veterans the benefits they have earned.
As we pursue a multi-focused approach to eliminate the claims
backlog, workload in our disability compensation and pension programs
continues to rise. VA has experienced a 48 percent increase in claims
receipts since 2008, and we expect that the incoming claims volume will
continue to increase by 4.2 percent in 2013, to 1,250,000 claims from
1,200,000 in 2012. At the same time, Veterans are claiming many more
disabilities, with Iraq and Afghanistan Veterans claiming an average of
8.5 disabilities per claim--more than double the number of disabilities
claimed by Veterans of earlier eras. As more than one million troops
leave service over the next 5 years, we expect our claims workload to
continue to rise for the foreseeable future. In 2013, our goal is to
ensure that no more than 40 percent of the compensation and pension
claims in the pending inventory are more than 125 days old. While too
many Veterans will still be waiting too long for the benefits they have
earned, it does represent a significant improvement in performance over
the 2012 estimate of 60 percent of claims more than 125 days old,
demonstrating that we are on the right path.
VA is attacking the claims backlog through an aggressive
transformation plan that includes initiatives focused on the people,
processes, and technology that will eliminate the backlog. We are
implementing a new standardized operating model in all our regional
offices beginning this year that incorporates a case-management
approach to claims processing. It establishes distinct processing lanes
based on the complexity and priority of the claims and assigns
employees to the lanes based on their experience and skill levels.
Integrated, cross-functional teams work claims from start to finish,
facilitating the quick flow of completed claims and allowing for
informal clarification of claims processing issues to minimize rework
and reduce processing time. More easily rated claims move quickly
through the system, and the quality of our decisions improves by
assigning our more experienced and skilled employees to the more
complex claims. The new operating model also establishes an Intake
Processing Center at every regional office, adding a formalized process
for triaging mail and enabling more timely and accurate distribution of
claims to the production staff in their appropriate lanes.
VA is increasing the expertise of our workforce and the quality of
our decisions through national training standards that prepare claims
processors to work faster and at a higher quality level. Our training
and technology skills programs will continue to deliver the knowledge
and expertise our employees need to succeed in a 21st Century
workplace. We are establishing dedicated teams of quality review
specialists at each regional office. These teams will evaluate decision
accuracy at both the regional office and individual employee levels,
and perform in-process reviews to eliminate errors at the earliest
possible stage in the claims process. Personnel trained by our national
quality assurance staff comprise the quality review teams to assure
local reviews are consistently conducted according to national
standards.
Using ``Design Teams,'' VBA is conducting rapid development and
testing of process changes, automated processing tools, and innovative
workplace incentive programs. The first Design Team developed a method
to simplify rating decisions and decision notification letters that was
implemented nationwide in December 2011. This new decision notification
process streamlines and standardizes the development and communication
of claims decisions. This initiative also includes a new employee job-
aid that uses rules-based programming to assist decisionmakers in
assigning an accurate service-connected evaluation. VBA's
Implementation Center, established at VBA headquarters as a program
management office, streamlines the process of innovation to ensure that
new ideas are approved through a governance process. This allows us to
focus on initiatives that will achieve the greatest gains.
VA continues to promote the Fully Developed Claims (FDC) Program.
We believe utilization of the FDC Program will significantly increase
as a result of the public release last month of 68 more Disability
Benefits Questionnaires (DBQs), bringing the total number of DBQs
publically available to 71. DBQs are templates that solicit the medical
information necessary to evaluate the level of disability for a
particular medical condition. Currently used by Veterans Health
Administration examiners, the release of these DBQs to the public will
allow Veterans to take them to their private physicians, facilitating
submission of a complete claims package for expedited processing. VA
plans an aggressive communications strategy surrounding the release of
these DBQs that will promote the FDC program. We also continue to work
with the VSO community to identify ways to boost FDC program
participation and better inform and serve Veterans and their advocates.
This year VA is also beginning national implementation of our new
paperless processing system, the Veterans Benefits Management System
(VBMS). We are implementing VBMS using a phased approach that will have
all regional offices on the new system by the end of 2013. We will
continue to add and expand VBMS functionality throughout this process.
Establishment of a digital, near-paperless environment will allow for
greater exchange of information and increased transparency to Veterans,
our workforce, and stakeholders. Increased use of state-of-the-art
technology plays a major role in enabling VA to eliminate the claims
backlog and redirect capacity to better serve Veterans and their
families. Our strategy includes active stakeholder participation
(Veterans Service Officers, State Departments of Veterans Affairs,
County Veterans Service Officers, and Department of Defense) to provide
digitally ready electronic files and claims pre-scanned through online
claims submission using the eBenefits web portal. VBA has aggressively
promoted the value of eBenefits and the ease of enrolling into the
system. The 2013 budget invests $128 million in VBMS.
ENDING VETERAN HOMELESSNESS
The Administration is committed to ending homelessness among
Veterans by 2015. Between January 2010 and January 2011 homelessness
declined by 12 percent, keeping VA on track to meet the goal of ending
Veteran homelessness in 2015. The VA's Homeless Veteran Registry is
populated with over 400,000 names of current and formerly homeless
Veterans who have utilized VA's Homeless Programs--allowing us to
better see the scope of the issues so we can more effectively address
them.
In the 2013 Budget, VA is requesting $1.352 billion for programs
that will prevent and treat Veteran homelessness. This represents an
increase of $333 million, or 33 percent over the 2012 level. This
budget will support our long-range plan to eliminate Veteran
homelessness by reducing the number of homeless Veterans to 35,000 in
2013 by emphasizing rescue and prevention.
To get Veterans off the streets and into stable environments, VA's
Grant and Per Diem Program awards grants to community-based
organizations that provide transitional housing and support services.
VA's goal is to serve 32,000 homeless Veterans in this program in 2013.
Transitional housing is also provided through the Healthcare for
Homeless Veterans program. Permanent housing is achieved with Housing
Choice Vouchers in the Department of Housing and Urban Development
(HUD)-VA Supportive Housing (HUD-VASH) Program, and by 2013 VA plans to
provide case management support for the nearly 58,000 HUD Housing
Choice vouchers available to assist our most needy homeless Veterans.
Culminating two years of work to end homelessness among Veterans,
the Building Utilization Review and Repurposing (BURR) initiative
helped identify unused and underused buildings and land at existing VA
property with the potential for repurposing to Veteran housing. The
BURR initiative supports VA's goal of ending Veteran homelessness by
identifying excess VA property that can be repurposed to provide safe
and affordable housing for Veterans and their families. As a result of
BURR, VA began developing housing opportunities at 34 nationwide
locations for homeless or at-risk Veterans and their families using its
Enhanced Use Lease (EUL) authority (now expired). The housing
opportunities developed through BURR will add approximately 4,100 units
of affordable and supportive housing to the projects already in
operation or under construction, for an estimated total of 5,400 units.
Although the Department's Enhanced Use Lease authority has expired,
the Administration will work with Congress to develop future
legislative authorities to enable the Department to further repurpose
the properties identified by the BURR process. Beyond reducing
homelessness among our Veterans, additional opportunities identified
through BURR may include housing for Veterans returning from Iraq and
Afghanistan, assisted living for elderly Veterans, and other possible
uses that will enhance benefits and services to Veterans and their
families.
Of all claimants served by the Veterans Benefits Administration
(VBA), homeless Veterans represent our most vulnerable population and
require specialized care and services. The 2013 budget requests $21
million for the Homeless Veterans Outreach Coordinator (HVOC)
initiative, which would provide an additional 200 coordinators
nationwide to expedite disability claims; acquire housing and prevent
Veterans from losing their homes; expedite access to vocational
training and job opportunities; and resolve legal issues at regional
justice courts. These new case managers would significantly improve
outcomes on behalf of the Nation's homeless Veterans. For example, the
initiative would improve the timeliness of disability claims decisions
for homeless and at-risk Veterans by reducing the claims processing
times by nearly 40 percent between 2011 and 2015.
In 2011, VHA hired 366 (or 90 percent of 407 total positions)
homeless or formerly homeless Veterans as Vocational Rehabilitation
Specialists to provide individualized supported employment services to
unemployed homeless Veterans through the Homeless Veterans Supported
Employment Program. Recent initiatives to increase employment of
Veterans in Federal and other public-sector jobs will help to reduce
homelessness and also ensure their families are supported. On
January 18, 2012, VA hosted a career fair for Veterans in Washington,
DC. Over 4,000 Veterans attended this event to explore and apply for
thousands of public and private sector job opportunities.
The VA also helps Veterans obtain employment with education and
training assistance. The National Cemetery Administration (NCA) is
helping to provide employment opportunities for homeless Veterans
through a new, paid Apprenticeship Training Program serving Veterans
who are homeless or at risk of homelessness. The program will be based
on current NCA training requirements for positions such as Cemetery
Caretakers and Cemetery Representatives. Veterans who successfully
complete the program at national cemeteries will be guaranteed full-
time permanent employment at a national cemetery or may choose to
pursue employment in the private sector. The Veterans Retraining
Assistance Program is a joint effort with VA and the Department of
Labor to provide 12 months of retraining assistance. The program is
limited to 54,000 participants from October 1, 2012, through March 31,
2014. Education and training assistance are preventive programs.
Other preventive services programs include the Supportive Services
for Veteran Families, which provides rapid case management and
financial assistance, coordinated with community and mainstream
resources, to promote housing stability. In time, VA will transition
its homeless efforts primarily to prevention. Through coordinated
partnerships with other Federal and local partners and providers, VA
will assist at risk Veterans in maintaining housing, accessing
supportive services that promote housing stability, and identifying the
resources to rapidly re-house Veterans and their dependents if they
should fall into homelessness. This shift to increased preventive
efforts will require us to be much more knowledgeable about the causes
of Veterans' homelessness, about the details of our current homeless
and at-risk Veteran populations, and about creating action plans that
serve Veterans at the individual level.
MEDICAL CARE PROGRAM
The 2013 budget requests $52.7 billion for healthcare services to
treat over 6.33 million unique patients, an increase of 1.1 percent
over the 2012 estimate. Of those unique patients, 4.4 million Veterans
are in Priority Groups 1-6, an increase of more than 64,000 or 1.5
percent. Additionally, VA anticipates treating over 610,000 Veterans
from the conflicts in Iraq and Afghanistan, an increase of over 53,000
patients, or 9.6 percent, over the 2012 level.
Medical Care in Rural Areas
The delivery of healthcare in rural areas faces major challenges,
including a shortage of healthcare resources and specialty providers.
In 2011, we obligated $18.8 billion to provide healthcare to Veterans
who live in rural areas. Some 3.6 million Veterans enrolled in the VA
healthcare system live in rural or highly rural areas of the country;
this represents about 42 percent of all enrolled Veterans. For that
reason, VA will continue to emphasize rural health in our budget
planning, including addressing the needs of Native American Veterans.
The 2013 budget continues to invest in special programs designed to
improve access and the quality of care for Veterans residing in rural
areas. For example, in the remote, sparsely populated areas of Montana,
Utah, Wyoming and Colorado, VA has supported the development and
expansion of a network-wide operational telehealth infrastructure that
supports a virtual intensive care unit, tele-mental health services,
and primary care and specialty care to 67 fixed and mobile sites.
Again, IT investment is the foundation of our work in all of these
areas.
In rural areas with larger populations, funding supports the
opening of new rural clinics, such as the one located in Newport,
Oregon, which serves over 1,200 Veterans. This clinic is a unique
partnership between VA and the local Lincoln County government. The
county government provides clinical space, equipment and supplies,
while VA funds the salaries for the primary care and mental health
providers.
Mental Healthcare
The budget requests $6.2 billion for mental health programs, for an
increase of $312 million over the 2012 level of $5.9 billion. VA is
increasing outreach opportunities to connect with and treat Veterans
and their families in new, innovative ways. In April 2011, VA launched
the first in a series of mobile smartphone applications, the PTSD
Coach. It provides information about PTSD, self-assessment and symptom
management tools, and information on how to get help. VA developed this
technology in collaboration with DOD and with input from Veterans, who
let the development team know what they did and did not want in the
application (app). As of the end of 2011, the app had just over 41,000
downloads in 57 countries. In addition, VA is developing PTSD Family
Coach that will complement the Coaching into Care national call center,
which provides support to family members of Veterans.
In 2011, VA also launched Make the Connection, a national public
awareness campaign for Veterans and their family members to connect
with other Veterans to share common experiences, and ultimately to
connect them with information and resources to help with the challenges
that can occur when transitioning from military service to civilian
society. This is an important effort in breaking down the stigma
associated with mental health issues and treatment. The campaign's
central focus is a Web site, www.MakeTheConnection.net, featuring
numerous Veterans who have shared their experiences, challenges, and
triumphs. It offers a place where Veterans and their families can view
the candid, personal testimonials of other Veterans who have dealt with
and are working through a variety of common life experiences, day-to-
day symptoms, and mental health conditions. The Web site also connects
Veterans and their family members with services and resources they may
need.
Long-term Medical Care
As the Veteran population ages, VA will expand its provision of
both institutional and non-institutional Long-Term Care services. These
services are designed not just for the elderly, but for Veterans of all
ages who have a serious chronic disease or disability requiring ongoing
care and support, including those returning from Iraq and Afghanistan
suffering from traumatic injuries. Veterans can receive long-term care
services at home, at VA medical centers, or in the community. In 2013,
the Long-Term Care budget request is $7.2 billion. VA will continue to
provide long-term care in the least restrictive and most clinically
appropriate settings by providing more non-institutional care closer to
where Veterans live. This budget supports an increase of 6 percent in
the average daily census in non-institutional long-term care programs
in 2013, resulting in a total average daily census of approximately
120,100.
MEDICAL RESEARCH
Medical Research is being supported with $583 million in direct
appropriations in 2013, an increase of nearly $2 million above the 2012
level. In addition, approximately $1.3 billion in funding support for
medical research will be received from VA's medical care program and
through Federal and non-Federal grants. Projects funded in 2013 will
support fundamentally new directions for VA research. Specifically,
research efforts will be focused on supporting development of New
Models of Care, improving social reintegration following Traumatic
Brain Injury, reducing suicide, evaluating the effectiveness of
complementary and alternative medicine, developing blood tests to
assist in the diagnosis of Post Traumatic Stress Disorder and mild
Traumatic Brain Injury, and advancing genomic medicine.
The 2013 budget continues support for the Million Veteran Program
(MVP), an unprecedented research program that advances the promises of
genomic science. The MVP will establish a database, used only by
authorized researchers in a secure manner, to conduct health and
wellness studies to determine which genetic variations are associated
with particular health issues. The pilot phase of MVP was launched in
2011. Surveys were sent to 17,483 Veterans and approximately 20 percent
of those then completed a study visit and provided a small blood
sample. By the end of 2013, the goal is to enroll at least 150,000
participants in the program. Like with so much of VA research, the
impact will be felt not just through improved care for Veterans but for
all Americans, as well.
VETERANS BENEFITS ADMINISTRATION
The 2013 budget request for the general operating expenses of the
Veterans Benefits Administration (VBA) is $2.2 billion, an increase of
$145 million, or 7.2 percent, over the 2012 enacted level. With the
support of Congress, we have made great strides in implementing our
comprehensive plan to transform the disability claims process. This
budget sustains our investments in people, processes, and technology in
order to eliminate the claims backlog by 2015. In addition, this budget
request includes funding to support the administration of other VBA
business lines.
Post-9/11 and other Education Programs
The Post-9/11 GI Bill program provides every returning
servicemember with the opportunity to obtain a college education. As
expected, the Post-9/11 GI Bill program has become the most used
education benefit that VA offers. Just as with the original GI Bill,
today's program provides Veterans with tools that will help them
contribute to an economically vibrant and strong America. In 2013, VA
estimates that 606,300 individuals will participate in this benefit
program. The timeliness and accuracy of processing Post-9/11 GI Bill
claims continues to improve. From 2010 to 2011, VA processing times for
original and supplemental claims improved by 15 days (from 39 to 24
days) and 4 days (from 16 to 12 days), respectively. Over the last two
years, VA has successfully deployed a new IT system to support
processing of Post-9/11 GI Bill education claims. With improved
automation tools in place, VA will be able to begin reducing education
benefit processing staff in 2013.
Vocational Rehabilitation and Employment (VR&E)
The VR&E program is designed to assist disabled Servicemembers in
their transition to civilian life and obtaining employment. The budget
request for 2013 is $233.4 million or a 14.2 percent increase from
2012. The number of participants in the program increased to 107,925 in
2011 and is expected to grow to over 130,000 by 2013.
VA is also expanding VR&E counseling services available at IDES
sites to assist Servicemembers with disabilities in jumpstarting their
transition to civilian employment. In 2012, VA will assign 110
additional counselors to the largest IDES sites, serving an additional
12,000 wounded, ill, and injured Servicemembers. Funds requested in
2013 will support further expansion, adding 90 more counselors to the
program.
In 2009, VA established a pilot program called VetSuccess on Campus
to provide outreach and supportive services to Veterans during their
transition from the military to college, ensuring that their health,
education and benefit needs are met. By the end of 2012, the program
will be operational on 28 campuses. The 2013 budget includes $8.8
million to expand the program to a total of 80 campuses serving
approximately 80,000 Veterans.
NATIONAL CEMETERY ADMINISTRATION
VA honors our fallen soldiers with final resting places that serve
as lasting tributes to commemorate their service and sacrifice to our
Nation. The 2013 budget includes $258 million in operations and
maintenance funding for the National Cemetery Administration (NCA). In
2013, NCA estimates that interments will increase by 1,500 (1.3
percent) over 2012. Cemetery maintenance workload will also continue to
increase in 2013 over the 2012 levels: the number of gravesites
maintained will increase by 82,000 (2.5 percent) and the number of
developed acres maintained will increase by 138 (1.6 percent).
The 2013 Budget will allow VA to provide more than 89.6 percent of
the Veteran population, or 19.1 million Veterans, a burial option
within 75 miles of their residence by keeping existing national
cemeteries open, establishing new State Veterans cemeteries, as well as
increasing access points in both urban and rural areas. VA's first
grant to establish a Veterans cemetery on Tribal trust land, as
authorized in Public Law 109-461, was approved on August 15, 2011. This
cemetery will provide a burial option to approximately 4,036 unserved
Rosebud Sioux Tribe Veterans and their families residing on the Rosebud
Indian Reservation near Mission, South Dakota.
NCA provides an unprecedented level of customer service, which has
been achieved by always striving for new ways to meet the burial needs
of Veterans. In 2011, NCA initiated an independent study of emerging
burial practices including ``green'' burial techniques that may be
appropriate and feasible for planning purposes. The study will also
include a survey of Veterans to ascertain their preferences and
expectations for new burial options. The completed study will provide
comprehensive information and analysis for leadership consideration of
new burial options.
CAPITAL INFRASTRUCTURE
A total of $1.14 billion is requested in 2013 for VA's major and
minor construction programs, an increase of 6.3 percent over the 2012
enacted level. VA is also proposing legislation in 2013 that would
enhance the ability of the Department to collaborate with other Federal
Departments and Agencies, including the Department of Defense (DOD) on
joint capital projects. This legislative proposal would allow
appropriated funds to be transferred among Federal agencies to
effectively plan and design joint projects when determined to be cost-
effective and improve service delivery to Veterans and Servicemembers.
Major Construction
The major construction request in 2013 is $532 million in new
budget authority. The major construction request includes funding for
the next phase of construction for four medical facility projects in
Seattle, WA; Dallas, TX; Palo Alto, CA; and St. Louis (Jefferson
Barracks), MO. Additionally, funds are provided to remove asbestos from
Department-owned buildings, improve facility security, remediate
hazardous waste, fund land acquisitions for national cemeteries, and
support other construction related activities.
Minor Construction
In 2013, the minor construction request is $608 million. It would
provide for constructing, altering, extending and improving VA
facilities, including planning, assessment of needs, architectural and
engineering services, and site acquisition and disposition. It also
includes $58 million to NCA for land acquisition, gravesite expansions,
and columbaria projects. NCA projects include irrigation and drainage
improvements, renovation and repair of buildings, and roadway repairs.
INFORMATION TECHNOLOGY
The 2013 budget requests $3.327 billion for Information Technology
(IT), an increase of $216 million over the 2012 enacted level of $3.111
billion. Veterans and their families are highly dependent upon the
effective and efficient use of IT to deliver benefits and services. In
this day and age, every doctor, nurse, dentist, claims processor,
cemetery interment scheduler, and administrative employee in the VA
cannot do his or her jobs without adequate IT support. Approximately 80
percent of the IT budget supports the direct delivery of healthcare and
benefits to Veterans and their families.
We have made dramatic changes in the way IT projects are planned
and managed at the VA. As described earlier in this testimony, the
Project Management Accountability System (PMAS) has reduced risks by
instituting effective monitoring and oversight capabilities and by
establishing clear lines of accountability. Additionally, we have
strengthened security standards in software development and established
an Identity Access Management program that allows VA to increase on-
line services for Veterans.
The IT infrastructure supports over 300,000 employees and about 10
million Veterans and family members who use VA programs, making it one
of the largest consolidated IT organizations in the world. This budget
request includes nearly $1.8 billion for the operation and maintenance
of the IT infrastructure, the backbone of VA. A sound and reliable
infrastructure is critical to support the VA workforce and all of our
facilities nationwide in the effective and efficient delivery of
healthcare and benefits to Veterans. It is also critical that we
support new facility activations, our major transformational
initiatives, and the increased usage of VA services while maintaining a
secure IT environment to protect Veteran sensitive information.
Improving services for Veterans and their beneficiaries requires
using advanced technologies. For example, VA will continue to utilize
MyHealtheVet to improve access to information on appointments, lab
tests and results, and reduce adverse reactions to medications. The
2013 budget continues an investment strategy of funding the development
of new technologies that will have the greatest benefit for Veterans.
The delivery of high-quality medical care to an increasing number
of Veterans is highly dependent upon adequate IT funding. VA's health
IT investments have, and will continue, to greatly improve the delivery
of medical care with regards to quality, patient safety and cost
effectiveness. This includes transformation of mental health service
delivery through IT enabled self-help, providing data and IT analytical
tools for VA's research community, and creating an open exchange for
collaboration and innovation in the development of clinical software
solutions. Additionally, initiatives focused on ``Care at a Distance''
are heavily reliant on technology and require a robust IT
infrastructure.
The 2013 budget request for integrated Electronic Health Record
(iEHR) is $169 million. The iEHR is a joint initiative with DOD to
modernize and integrate electronic health records for all Veterans to a
single common platform. We must take full advantage of this historic
opportunity to deliver maximum value through joint investments in
health IT. When DOD and VA healthcare providers begin accessing a
common set of health records, iEHR will enhance quality, safety, and
accessibility of healthcare--setting the stage for more efficient,
cost-effective healthcare systems. In 2013, we plan to leverage open
source development to foster innovation and speed delivery for a
pharmacy and immunization solution.
An integral part of iEHR is the Virtual Lifetime Electronic Record
(VLER), which is enabling VA transformation. VLER creates information
interoperability between DOD, VA, and the private sector to promote
better, faster and safer healthcare and benefits delivery for Veterans.
The 2013 budget will ensure continued delivery of enhanced clinical and
benefits information connections and build increased capability to
support women's healthcare. Additionally, we will develop a modern
memorial affairs system for the dynamic mapping of gravesite locations.
The 2013 budget request for VLER is $52.9 million.
In addition, the 2013 budget requests $92 million in the IT
appropriation for VBMS. As noted earlier, the VBMS initiative is the
cornerstone of VA's claims transformation strategy. It is a
comprehensive solution that integrates a business transformation
strategy to address people and processes with a paperless claims
processing system. Achieving paperless claims processing will result in
higher quality, greater consistency and faster claims decisions.
Nationwide deployment of VBMS is on target to begin in 2012 with
completion in 2013.
This budget also includes funding to transform the delivery of
Veterans' benefits. The 2013 IT budget requests $111 million for the
Veterans Relationship Management (VRM) initiative. We will use this
funding to improve communications between Veterans and VA that occur
through multiple channels--phone, web, mail, social media, and mobile
apps. It will also provide new tools and processes that increase the
speed, accuracy and efficiency of information exchange, including the
development of self-service technology-enabled interactions to provide
access to information and the ability to execute transactions at the
place and time convenient to the Veteran. In 2013, Veterans will see
enhanced self-service tools for the Civilian Health and Medical Program
of the Department of Veterans Affairs (CHAMPVA) and VetSuccess
programs, as well as the Veterans Online Application for enrolling in
VA healthcare.
LEGISLATIVE PROGRAM
VA has outlined in this budget a strong legislative program that
will advance our mission to end Veteran homelessness and help Wounded
Warriors by improving our system of grants for home alterations so
Veterans can better manage disabilities and live independently. Our
legislative proposals would also make numerous other common-sense
changes that improve our programs, including provisions that will
reduce payment complexities for both our student Veterans and the
schools using the Post-9/11 GI Bill.
SUMMARY
VA is the second largest Federal department with over 316,000
employees. Our workforce includes physicians, nurses, counselors,
claims processors, cemetery groundskeepers, statisticians, engineers,
IT specialists, police, and educators. They serve Veterans at our
hospitals, community-based outpatient clinics, Vet Centers, mobile Vet
Centers, claims processing centers, and cemeteries. Through the
resources provided in the President's 2013 Budget, VA is enabled to
continue improving the quality of life for our Nation's Veterans and
their families and to completing the transformation of the department
that we began in 2009. Thanks to the President's leadership and the
solid support of all Members of the Congress, we have made huge strides
in our journey to provide all generations of Veterans the best possible
care and benefits that they earned through selfless service to the
Nation. We are committed to continue that journey, even as the numbers
of Veterans will increase significantly in the coming years, through
the responsible use of the resources provided in the 2013 budget and
2014 advance appropriations requests.
______
Response to Prehearing Questions Submitted by Hon. Patty Murray to
U.S. Department of Veterans Affairs
HEALTH CARE
Question 1. As OEF/OIF/OND veterans age over the next 60 years,
what levels of funding will be needed to maintain current health care
service levels?
a. What portion of this is expected to be the result of increased
demand among veterans versus veterans' becoming more sick and having
more complex needs?
Response. The 2011 VA Enrollee Health Care Projection Model (base
year FY 2010), which supports the VA 2013 budget and 2014 advance
appropriations request for medical care, estimates that the total
number of military Servicemembers deployed in support of OEF/OIF/OND
will reach 2.4 million in FY 2015, with the last separation from active
duty occurring in FY 2042. As of 2010, there were 708,000 OEF/OIF/OND
enrollees. Enrollment is expected to increase 62 percent by 2014,
double to 1.46 million by 2020, and increase to 1.7 million by 2031. In
2013, VA has budgeted nearly $3.3 billion for this group of Veterans.
The Model reflects the unique utilization patterns of OEF/OIF/OND
enrollees. For example, OEF/OIF/OND Veterans have an increased need for
hearing and speech exams, dental services, physical medicine,
prosthetics, outpatient psychiatric and substance abuse treatment, and
residential rehabilitation. In addition, as this population ages over
the Model's 20-year horizon, the projections will reflect the higher
utilization of health care services associated with older populations.
For example, the 2011 Model is projecting an increase of over 200
percent in outpatient mental health visits for this population by FY
2020.
Question 2. What impact will the end of the war in Iraq, the
drawdown of troops in Afghanistan, and the reduction of forces across
the military have on VA? What does the FY 2013 budget do to prepare VA
for these impacts, and how is the Department working collaboratively
with DOD to prepare for these changes?
Response. The Department of Veterans Affairs (VA) works closely
with the Department of Defense (DOD) at the local and Departmental
levels to meet the needs of redeploying and transitioning
Servicemembers and Veterans. DOD is still developing operational plans
and details for how they intend to reduce forces over the next five
years. VA is aware of the potential impact the force reduction may have
on VA providing benefits and services, especially at the points of
transition from active duty to Veteran status. VA has been actively
collaborating with DOD on this issue from the Secretarial level on
down, in order to identify any new requirements from a resource or
program perspective.
In addition to this collaboration with DOD, VA has and will
continuously evaluate overall mission requirements through efforts such
as: periodic refresh of the VA Strategic Plan; execution of planning,
programming, budgeting, and evaluation (PPBE) processes through the VA
Office of Corporate Analysis and Evaluation to support strategic
decisionmaking and align resources to achieve VA priorities for
Veterans; and leveraging robust data analysis and predictive modeling
capabilities through the VA Office of Data Governance and Analysis to
support strategic and programmatic planning, as well as policy
development.
The VA budget supports the requirements and needs for the
Department in fiscal 2013 and the advanced appropriation request for
health care in fiscal 2014. The FY 2013 budget includes the impact of
the end of the war in Iraq, and the drawdown of troops in Afghanistan,
but it does not include the impact of the reduction in the size of DOD
troop strength because that specific data is not yet available. Based
upon VA's current analysis, the Iraq and Afghanistan drawdown and the
DOD force reductions will have a negligible impact on the FY 2013
budget.
Question 3. Enrollment and utilization projections.
a. Considering what VA has learned from the addition of a reliance
metric last year to the Enrollee Health Care Projection Model, and
considering CBO's projection that unemployment will be 8.2 percent at
the end of 2012, what does the Department project will be the change in
reliance for FY 2013 and beyond?
Response. Demand for VA health care increased during the economic
downturn, primarily reflected by a small increase in Veteran
enrollment, a small increase in current enrollees moving into Priority
5 or Priority 7, and a significant increase in enrollee reliance on VA
health care. An estimated $1.5 billion is now embedded in the base year
FY 2010 expenditures as a result of the economic downturn from FY 2008
through FY 2010.
The 2011 VA Enrollee Health Care Projection Model's starting point
(FY 2010) reflects the high point of the economic downturn. Because
demand for VA health care is correlated with changes in economic
conditions, the increase in demand associated with the economic
downturn through 2010 is expected to decline as unemployment rates
return to normal levels.
The 2011 Model uses the Office of Management and Budget's (OMB)
November 2011, economic assumptions (unemployment rate forecast) for FY
2011 through FY 2021. OMB forecasts that the rate will come down from
the FY 2010 high of 9.7 percent to 8.7 percent in FY 2013.
Background: The economic downturn mostly impacted Veterans in
Priorities 5 and 7 under age 65. From 2008 through 2010 (the base year
in the 2011 Model):
An estimated 50,000 more Veterans enrolled than
anticipated in a stable economic environment. Enrollment in Priority 5
increased by an estimated 30,000 due to changes in enrollee transition
between priorities.
Responses to the VHA Enrollee Surveys indicate that
outpatient reliance increased from 47 percent to 51 percent from 2007
to 2009 for enrollees under age 65.
b. Please discuss how the concerns raised by GAO in their report
GAO-11-205, Veterans' Health Care: VA Uses a Projection Model to
Develop Most of Its Health Care Budget Estimate to Inform the
President's Budget Request, were addressed in the development of the FY
2013 budget and the FY 2014 advance appropriation request.
Response. In the subject GAO report (GAO-11-205, January 2011), the
GAO described how the VA develops the budget estimates for its health
care program. The GAO report did not contain any recommendations and
did not raise any concerns. The process described in the subject report
was essentially the same process that was used to develop the FY 2013
budget and the FY 2014 advance appropriation request
Question 4. How much money has been obligated thus far for the
caregivers program (Title I--Caregiver Support, of Public Law 111-163)?
Please provide a breakdown of that funding.
a. How many veterans are currently enrolled in the program
Response. As of February 14, 2012, 3,113 approved primary Family
Caregivers were enrolled in VA's Program of Comprehensive Assistance
for Family Caregivers. In order to implement Title I of Public Law 111-
163, VA has obligated the amounts on the chart below.
------------------------------------------------------------------------
1st Qtr FY
FY 2011 2012
------------------------------------------------------------------------
Instruction and Training.................. $3,933,563 $81,422
Travel, lodging, and per diem expensed to $141,832 $24,122
attend training..........................
Lodging and subsistence for VA $60,784 $56,284
appointments.............................
Respite care.............................. $1,308,503 $249,734
Ongoing technical support................. $10,687,172 $3,146,041
Mental Health............................. $6,600 $9,108
Monthly stipend........................... $11,002,530 $16,568,583
CHAMPVA................................... $0 $201,783
-----------------------------
Total................................... $27,140,984 $20,337,077
------------------------------------------------------------------------
The total cost of Sections 101-104 in 2011 was $30.8 million. This
includes additional requirements such as the Caregiver Web site, and
the implementation of other evidence based practices and staffing.
Question 5. What steps have been taken by VA to increase
collections for the MCCF over the past year, including any efforts to
improve identification of billable services? Does the FY 2013 budget
request continue to support efforts to increase collections and improve
identification of billable services, and if so how?
Response. VA has taken multiple steps to increase collections for
the Medical Care Collections Fund (MCCF) focused on identifying more
billable opportunities including:
Deployment of Consolidated Patient Account Centers
(CPACs): VA is transitioning billing and collection activities from
individual medical centers to seven (7) regionally aligned centers of
excellence in an effort to capture more billable opportunities. This
business model demonstrates efficiency through standardized business
processes, performance accountability, and stringent internal controls
to ensure consistency. Four (4) CPACs are fully operational--Mid
Atlantic (Asheville, NC), Mid South (Smyrna, TN), North Central
(Madison, WI) and Florida (Orlando, FL). Three (3) CPACs are being
deployed in Fiscal Year 2012--West (Las Vegas, NV), Central Plains
(Leavenworth, KS) and North East (Lebanon, PA). CPACs are being
deployed one year earlier than mandated by Public Law 110-387.
Recoveries from Fee Care: VA can bill third party payers
for Veterans receiving non-service-connected Fee care with insurance.
In an effort to enhance charge capture for these services, VHA has
deployed reengineered business processes, provided staff training and
developed a process to improve performance in key areas.
Revenue Cycle Enhancement Teams (RCET): RCET visits
identify opportunities to improve billable opportunities at lower
performing facilities by developing action plans and tracking follow up
until completion. Over the past year, more than 30 visits have been
completed across the organization by cross functional teams of experts.
Enhancing Electronic Business Capacity: VA continues to
enhance electronic business transaction capabilities that result in
faster payments. Specifically, VA increased the number of pharmacy
claims transmitted electronically by 43% over the last year and the
amount of revenue collected through electronic funds transfer by nearly
30%.
With regard to FY 2013, VA believes the budget estimate of $2.966
billion for collections, which represents a $199M increase, or 7.2%
compared to FY 2012, supports efforts to increase collections and
improve identification of billable services. This increase includes
$125 million in collections contingent on new authorities found in VA's
submitted legislative proposals that we hope Congress will enact.
Question 6. There have been system-wide shortcomings in human
resources functions including a slow hiring process, downgrading of VA
employees, and others.
a. What steps has the Department taken to identify problems in:
i. local human resources operations; and
ii. the ability of regional or national-level human resources
to create and enforce policy and conduct oversight?
b. Please also provide the results of any reviews or evaluations of
these offices or functions.
c. Please detail progress on any efforts to correct deficiencies
that have been identified, including accomplishments to-date and
offices or personnel responsible.
Response. The VA human resources structure includes centralized
human resources functions of strategic planning, policy development,
and oversight and compliance as well as decentralized human resources
operational functions. Operational functional authorities that have
been decentralized include appointing authority, authority to process
and authenticate notifications of personnel actions, and authority to
effect management-approved employment actions on behalf of officials,
employees, and facilities for which service is provided. With
decentralized operational functions, each Administration Head (i.e.,
the Under Secretary for Benefits, Under Secretary for Memorial Affairs,
and Under Secretary for Health) is delegated the authority to perform
H.R. operations for all employees within their respective
organizations. The Veterans Health Administration (VHA) also provides
operational support for the Office of Information and Technology. H.R.
operations for all other staff offices are performed in VA Central
Office. VA's decentralized operating authority allows for local
decisions that are consistent with statutory and regulatory
requirements but affords flexibility.
Although H.R. operations are largely decentralized, controls are in
place to ensure oversight and accountability. VA's Accountability
System, our official framework for conducting H.R. reviews, is designed
to promote continuous improvement, including corrective action to
address weaknesses/deficiencies and merit system violations. All
accountability activities are reviewed by the Office of Human Resources
Management (OHRM) and appropriate management entities to determine and
implement needed changes to VA's human capital goals and objectives,
H.R. programs and processes, and the accountability system itself. Case
violations involving potential prohibited personnel practices are
referred to appropriate oversight agents--Office of Inspector General,
Office of Special Counsel, Office of Personnel Management (OPM), etc.
Systemic concerns are referred to the Assistant Secretary for Human
Resources and Administration for consideration for Department-wide
action.
a. What steps has the Department taken to identify problems in: i.
local human resources operations; and ii. the ability of regional or
national-level human resources to create and enforce policy and conduct
oversight?
Response. VA's Directive 5024, Human Capital Management
Accountability Systems establishes VA policies for human capital
management (HCM) accountability systems, and outlines responsibilities
for the conduct and review of Human Resources Management (HRM) program
assessments. The VA HRM accountability program is the responsibility of
top VA management, line managers, and human resources officials working
together to ensure Federal and VA's HRM programs, policies and
delegated H.R. authorities are carried out and are in accord with merit
systems principles, Title 5 and Title 38 provisions, or other
applicable laws, rules and regulations related to human resources
management. This is accomplished through OHRM's guided accountability
onsite reviews in a sampling of H.R. offices and the use of an Annual
H.R. Self-Evaluation Instrument for all H.R. offices. The H.R. Self
Evaluation of human capital helps measure VA's performance against the
human capital accountability and assessment framework, which has been
developed by OPM. The H.R. Self-evaluation instrument exists to assist
field facility Directors in conducting yearly, systematic, and internal
facility H.R. self reviews. As part of the accountability program, each
field station conducts an annual HRM self-evaluation as an integral
part of local management's systematic internal review system, to
include the separate Delegated Examining Unit (DEU) assessment at
facilities where such units exist. Documentation used to prepare the
self-evaluation is maintained for review during on-site visits. In
addition to reviews by OHRM, the policy offices within OHRM monitor
policy implementation. Also, through the Human Resources Academy,
competency assessments, career mapping, and both strategic and
technical human resources courses are leveraged to support human
resources professionals.
b. Provide the results of any reviews or evaluations of these
offices or functions.
Response. During 22 onsite assessments in fiscal year 2011, staff
identified both required and recommended actions to enhance program
effectiveness. In general, human resources professionals need to gain
additional competencies to effectively partner and consult with
management in accomplishing their organization's mission. Overall,
assessed facilities were generally cited for administrative and
process-related problems. Compliance errors are mainly the result of
poor procedural or administrative processes and/or inattention to
detail.
c. Detail progress on any efforts to correct deficiencies that have
been identified, including accomplishments to-date and offices or
personnel responsible.
Response. Facilities report to OHRM on required actions 20 days
after receiving the report and every 60 days thereafter. In addition,
H.R. offices are required to outline actions proposed and taken to
close each required and recommended action and provide evidence of how
they are closing each action. OHRM continues to formally verify closure
of the required actions and recommendations stemming from its on-site
assessment visits. Key findings of site visit assessments, including
systemic compliance issues, are reported to local management and VA
leadership, in order to assess and promote continuous improvement in
the overall HC program.
Under the VHA H.R. Delivery Model, which was approved July 14,
2010, Veterans Integrated Service Network (VISN) Human Resources
Officers assess gaps in human resources processes and implement
initiatives to reduce gaps identified. Also, VHA established
Consolidated Classification Units (CCU) in 2010; these CCUs are
providing oversight and ensuring consistency on all classification
actions at VHA medical facilities. To date, 14 CCUs are in place with
the remaining 7 CCUs to be established in the near future. A National
Classification Strategy is underway and work is ongoing to establish a
National VHA Classification Office. In addition, Workforce Management
and Consulting (WMC) has initiated national classification conference
calls that include all VISN classification specialists. This forum
addresses all national and regional classification issues and will
ensure consistency and reduced variation across VHA. In January 2011,
WMC formed a team of H.R. professionals that are collaborating and
coordinating with each VISN H.R. Officer to visit VHA Medical Centers
to review each H.R. program and to provide hands-on consultation and
operational guidance. To ensure compliance with Merit System
Principles, WMC conducted onsite reviews at all VISN 17 facilities and
reviewed classification actions performed by the CCU and found that
current actions are in compliance with OPM classification standards.
Question 7. Please discuss the level of funding requested in the FY
2013 budget to continue implementation of the Amputee System of Care.
Also, please discuss the progress the Department has made in
implementing the Amputee System of Care to date including:
a. Number and type of personnel, as well as existing vacancies.
b. Operational status of each site or team, and expected date of
full operational capability for those sites or teams that have not yet
achieved that status.
c. Discussion of benefits to care or operational efficiencies
expected as a result of providing more prosthetic care by the
Department.
Response. Establishment of the Amputation System of Care (ASoC)
began in 2009 and all sites of care are fully operational, although the
system of care continues to evolve and mature. The vision of the ASoC
is to be a world leader in providing lifelong amputation care.
There is a total of 58 FTE dedicated to the Amputation System of
Care; currently, there are 11 staff vacancies. The number of Amputation
Clinic teams has grown by over 10 percent since the initial rollout in
2009, and amputation rehabilitation care is now available at 111 sites
throughout VHA. All sites are fully operational to provide services
appropriate to meeting the requirements of their designated level of
care. Recruitment efforts are ongoing to fill remaining vacancies by
the end of FY 2012.
The ASoC is comprised of four distinct components of care similar
to the hub-and-spoke model utilized by VA Polytrauma System of Care,
and includes:
Component 1: 7 Regional Amputation Centers (RAC) provide
comprehensive rehabilitation care through an interdisciplinary team and
serve as a resource across the VA system through tele-rehabilitation.
They provide the highest level of specialized expertise in clinical
care and technology and provide rehabilitation and consultation to the
most complicated patients. These facilities include: Bronx, Denver,
Minneapolis, Palo Alto, Richmond, Seattle and Tampa VA medical centers
(VAMC). The staffing supported through ASoC funding at these locations
includes:
- 7 Physician Medical Directors (2 vacancies, currently)
- 7 Amputation Rehabilitation Coordinators
- 7 RAC Prosthetists (6 vacancies, currently)
- 7 Program Support Assistants (1 vacancy, currently)
Component 2: 15 Polytrauma Amputation Network Sites
provide full range of clinical and ancillary services to Veterans
closer to their home. The staffing supported through ASoC funding at
these sites includes:
- 15 Amputation Rehabilitation Coordinators
- 15 Program Support Assistants (2 vacancies, currently)
Component 3: 111 Amputation Clinic Teams provide
specialized outpatient amputation care, and staffing for these teams is
supported by the VAMCs where they are located.
Component 4: 22 Amputation Points of Contact facilitate
referrals and access to services. These VA facilities ensure at least
one person is identified to act as the point of contact for
consultation and assessment, and to refer the patient to a facility
capable of providing the level of services required.
The ASoC has committed an additional 13 FTEE to support the
Servicemember Transitional Amputation Rehabilitation (STAR) Program at
the Hunter Holmes McGuire Polytrauma Rehabilitation Center at the
Richmond VAMC. This residential rehabilitation program was developed
and initiated for Servicemembers and Veterans recovering from
amputations, and who are not yet ready to live independently. This
program has 10 designated residential beds providing post-acute
rehabilitation services, and focuses on community re-integration and
vocational rehabilitation.
The ASoC also utilizes Orthotics and Prosthetic (O&P) Services as
part of the integrated system of VA physicians, therapists, and
prosthetists working together to provide the best devices and state-of-
the art care. The VA O&P Service has over 300 individuals ranging from
fitters to certified orthotists and prosthetists, operating in 78
facilities across the country. Sixty five of these facilities have
national accreditation by the American Board for Certification in
Orthotics, Prosthetics and Pedorthics, or the Board of Certification/
Accreditation International.
One of the benefits of including O&P Service as part of the ASoC
team is that it offers complete care to the Veteran by incorporating
biological factors, socioeconomic factors, social/contextual factors
and psychological factors into unified care. Conversely, the
fragmentation of care and lack of insurance coverage in the private
sector has made it difficult for civilian patients to receive similar
orthotic and prosthetic services.
The VA O&P Service offers Veteran-centered care, whether provision
of that care comes from the VA O&P staff, or through one of more than
600 contracts nationally with accredited local orthotists and
prosthetists. The VA pays the full cost of the prescribed limb as well
as repairs.
The benefits of VA providing O&P Service further extends to the
public sector by advancing development of new technologies, and
education and training of professionals in the field. VA fosters and
initiates interactions with manufacturers to gain access to new
prosthetic and orthotic technology. Often this technology is first
released commercially to the VA, thereby benefiting Veterans with the
newest and most advanced systems. VA O&P clinicians provide feedback to
the manufacturers for modification and enhancements to the technologies
that advance even newer technologies. Further, the Department in
partnership with orthotic and prosthetic academic programs at US
universities and colleges has established 17 residency positions
programs at 10 VA locations for academic year 2013, with three more
sites planned for 2014. This collaboration with the prosthetic
educational system, which includes a contractual training program, will
further strengthen clinical care by providing training courses for VA's
orthotic fitters and serving as a feeder program for newly trained
clinicians.
BENEFITS
Question 8. VBA's Claims Transformation Plan focuses on people,
processes, and technology. What are the projected gains in production,
timeliness and quality anticipated by the various components of the
Claims Transformation Plan? Please provide the data source, summary of
the data, and analysis for projected gains in production, timeliness
and quality.
Response. VBA's Transformation Plan is a people-centric, results-
driven, forward-looking integration of solutions that will ensure total
lifelong engagement with Veterans, Servicemembers, their families and
survivors. Consisting of more than 40 People, Process and Technology
initiatives that are in various stages of implementation the goals of
the Plan are to:
improve claims production 45 to 60 percent, reducing the
claims completion period to within 125 days in 2015
enhance quality and accuracy by 14 percent to achieve a
claims quality of 98 percent in 2015
Performance Gains by Initiative Category (Projected for FY 2012--FY
2015)
People: changing how we're organized and trained to do the work
Productivity Gain: 15-20 percent
Quality Gain: +4 percent
Gains by People Program:
- Intake Processing Centers (IPC): for quick, accurate triage;
Combined with cross functional teams, potential to save 39 days
- Segmented Lanes: cross-trained raters co-located to increase
knowledge transfer, speed, and accuracy; Combined with IPC,
potential to save 39 days)
- Challenge Training: Trainees process 1.3 disability claims
per day at 98% accuracy
Processes: making improvements that result in quality and
timeliness gains
Productivity Gain: 15-20 percent
Quality Gain: +4 percent
Gains by Process Program:
- Simplified Notification Letter (SNL): potential 20% national
gain in productivity could equal 250 thousand more rating cases
per year
- Electronic Disability Benefits Questionnaires (DBQ):
increases capability to submit Fully Developed Claims (FDC) and
reduce average days to complete
Technology: acquiring and refining systems that enable us to do our
jobs better
Productivity Gain: 15-20 percent
Quality Gain: +6 percent
Gains by Technology Program:
- Veterans Benefits Management System: Improves productivity
by 15-20 percent; increases quality by 6 percent
- Veterans Relationship Management: Reduces Veterans' calls by
25 percent and increases client satisfaction by utilizing the
Internet for status inquiries and expanding availability of
self-service functions.
The predicted gains in productivity and quality are estimates based
on existing information and projections developed by field experts. The
Plan is built on a data-driven approach focusing on performance
management and the use of key metrics to enable business decisions that
improve claims processing quality and timeliness and assure
Transformation performance.
VBA's Transformation Plan is executed by the Implementation Center
in VA Central Office--a program management office with dedicated
resources to oversee the implementation of the Transformation Plan
using a governance process to achieve standardization and
sustainability. The Implementation Center has developed performance
measures that will track the impact of the Plan's more than 40
initiatives.
We have already begun the rollout of transformation initiatives. In
February 2012, we began the deployment of the Simplified Notification
Letter (SNL) initiative, a new claims processing initiative that will
significantly increase decision output (150,000 to 200,000 more
decisions per year). The new decision notification process will also
streamline and standardize the communication of claims decisions.
Veterans will receive one simplified notification letter in which the
substance of the decision, including a summary of the evidence
considered and the reason for the decision, are all rendered in a
single document. Testing of this initiative at the St. Paul Regional
Office resulted in productivity increases of 31 percent, while
sustaining a 90-percent accuracy rate, and reductions of 14 days in
average processing time.
We are also transforming our local quality assurance process,
establishing dedicated teams of quality review specialists at each
regional office. These teams will evaluate decision accuracy at both
the regional office and individual employee levels, and perform in-
process reviews to identify and eliminate errors at the earliest
possible stage in the claims process. The quality review teams are
comprised of personnel trained by our national quality assurance
(Statistical Technical Accuracy Review or ``STAR'') staff to assure
local reviews are consistently conducted according to national
standards. An initial focus of these teams is to reduce medical
examination errors, which currently represent 36 percent of our benefit
entitlement quality errors. In addition to quality improvements, the
need for reexaminations will be minimized, thereby reducing claims
processing time in 39-day increments for every reexamination avoided.
Question 9. VBA is relying heavily on IT and specifically the
Veterans Benefits Management System (VBMS) in order to transform the
claims processing system. VA's FY 2013 Budget Submission notes that VA
will begin a nationwide deployment strategy for the Veterans Benefits
Management System in 2012. Please provide:
a. The deployment strategy, plan and timeline;
Response. VBMS national deployment begins in selected regional
offices in July 2012 and will follow a prescribed schedule which will
be integrated with VBA's Transformation Plan. By the end of fiscal year
2012, 16 regional offices will be using VBMS. National deployment is
scheduled to be completed by the end of calendar year 2013.
b. The number and type of claims processed to date using VBMS;
Response. The first two phases of VBMS have been deployed to the
Providence Regional Office and the Salt Lake City Regional Office.
Phase 1 was the initial VBMS prototype. Phase 2 added functionality and
scale, both of which will continue to increase throughout FY 2012. As
of February 16, 2012, VBMS processed to completion 443 of 908
disability compensation claims (49 percent). VBMS is being used to
process most original disability compensation claims in Providence and
Salt Lake. Any supplemental claims received on cases previously
processed in VBMS will also be processed in VBMS.
c. The average time to complete, accuracy rate and number of
appeals filed for claims processed using VBMS.
Response. As of February 16, 2012, the average time to complete a
claim in VBMS was 131 days. Claims processed using VBMS are being
reviewed for accuracy by VBA's national quality review staff,
Systematic Technical Accuracy Review (STAR), in the same manner as all
other claims. VBA recently instituted a special STAR review of claims
processed in VBMS to confirm the validity of the calculator
functionality in VBMS. VBA will be conducting training for the review,
and the accuracy rate specific to VBMS claims will be available upon
completion of training. Ten claims processed in VBMS are under appeal.
Question 10. Employee training has to be one of the major
components of improving the timeliness and accuracy of claims
decisions. Please provide a detailed breakdown of the type of training
being provided to Compensation Service and Pension and Fiduciary
Service employees. What is provided in the FY 2013 budget for training
Compensation Service and Pension and Fiduciary Service employees?
Response. Compensation Service has developed a comprehensive
national training program for claims processors consisting of
standardized training modules for all phases of claims processing and
levels of experience. The 2012 National Training Plan for claims
processors at the intermediate and journeyman experience levels was
released in November 2011.
The Compensation Service requires that each claims processor
participate in a minimum of 80 hours of training. For intermediate and
journeyman level employees, 40 of these hours cover mandatory topics
that provide new guidance to the field and address national quality
issues. The remaining 40 hours consist of 20 hours of technical-
training electives that address local quality issues and 20 hours of
station-determined topics that include courses required of all VA
employees. All training must use nationally approved lesson materials
developed by the Compensation and Pension Service and must be
documented in VA's Talent Management System (TMS).
Entry-level claims processors undergo a robust training program
consisting of three to four weeks of training on basic claims-
processing skills at the employees' home stations, followed by four to
eight weeks of centralized training with a concentration on practical
knowledge application. Veterans Service Representatives (VSRs)
participate in a four-week centralized training program to learn to
develop or promulgate claims, and Rating VSRs (RVSRs) participate in an
eight-week centralized training program to learn to make decisions on
claims, including how to weigh evidence. All students, regardless of
the curriculum, process actual cases under the guidance of experienced
instructors and mentors during this centralized training. Cases are
reviewed by several subject matter experts to ensure the cases are
processed correctly and the students are provided with any necessary
follow-up training and feedback. Our redesigned and expanded 8-week
centralized Challenge Training Program for new claims processors has
achieved dramatic results. On completion of the training, employees
work significantly faster and at a higher quality level. Trainees from
the most recent class averaged 1.33 cases per day with 98 percent
accuracy, compared to the legacy Challenge curriculum, following which
trainees averaged one-half case per day and 60 percent accuracy.
Compensation Service also provides training to claims processors of all
levels through ``Live Meetings'' on emerging topics and initiatives and
web-based training. The Compensation Service also deploys Training
Assistance Teams to field offices to provide on-site training
specifically geared toward improving decision accuracy at that office.
Pension employees are required to complete 85 hours of training
annually through the National Training Curriculum, which includes: 40
hours of mandatory technical training; 20 hours of specific technical
training identified through local quality reviews; 20 hours of
developmental training; and five hours of VA mandated training (e.g.,
Privacy Awareness, Ethics).
New fiduciary employees are provided initial training that consists
of two weeks of instructor-led training and followed by on-the-job
training with an experienced field examiner. New field examiners must
complete computer-based training through the Training and Performance
Support System (TPSS). Additionally, Pension and Fiduciary Service has
developed a three-week centralized training for all fiduciary
personnel. This training is supplemented by VA-mandated training.
We anticipate that this improved training, consistency of delivery,
and progression of employees to journey status will increase accuracy
and productivity beginning in FY 2013.
The FY 2013 budget request supports centralized training for over
1,000 Compensation, Pension, and Fiduciary employees.
Question 11. How many FTE were supported by FY 2011 and FY 2012
funding for the compensation and pension quality assurance program? How
many FTE will be supported in the FY 2013 budget request for the
compensation and pension quality assurance program? How many
compensation and pension decisions were reviewed during each of the
past two fiscal years?
Response. In FY 2011, 61 FTE supported Compensation and Pension
(C&P) Service until the Pension and Fiduciary (P&F) Service was
established in April 2011. At that point, 54 FTE remained on the
Compensation Service's Quality Assurance Staff, while seven FTE were
transferred to P&F Service's Quality, Training, and Site Visit Staff to
conduct quality reviews. Currently, 59 FTE support Compensation
Service's Quality Assurance Program, and we expect no changes in this
staffing for FY 2013. Seven FTE currently support P&F Service's quality
reviews, and this staff will increase to eight FTE in FY 2013.
In FY 2010 and FY 2011, respectively, 32,311 and 38,001
compensation claims were reviewed. In FY 2010, 1,529 pension claims and
4,424 fiduciary claims were reviewed, while in FY 2011, 1,510 pension
claims and 4,047 fiduciary claims were reviewed. As oversight of
fiduciary activities is consolidated from 56 regional offices to six
hub sites this year, P&F Service will review staffing requirements and
sample sizes for quality reviews.
Question 12. Does the FY 2013 budget request for Vocational
Rehabilitation and Education take into account any of the proposed
effects that the ongoing business process re-engineering will have on
staff time or the efficiency of operations?
Response. Vocational Rehabilitation and Employment (VR&E) Service
anticipates a need for additional field staff, which is reflected in
the fiscal year 2013 budget request. VR&E Service expects continued
workload increases of ten percent or higher due to the growth in
disability compensation and pension claims, including claims for the
additional Agent Orange presumptive conditions. This increase in
workload is also due to the increased outreach that will be conducted
by the requested 110 staff who will be housed at the Integrated
Disability Evaluation System sites, and to the expanded entitlement for
certain Veterans under the recently enacted VOW to Hire Heroes Act.
JOINT VA/DOD PROGRAMS
Question 13. Please provide the cost--for both the current and next
fiscal year--of disability examination contracts to support the
Integrated Disability Evaluation System. Provide the costs to VBA and
VHA separately.
Response. The Veterans Health Administration Disability Examination
Management Contract (DEM) contract is a national Indefinite Delivery/
Indefinite Quantity (ID/IQ) contract that has a minimum obligation of
$100,000 per each of the five awarded vendors over the life of the
contract. The base year began in FY 2011 and extends into four option
years. The contract is centrally managed by the Office of Disability
and Medical Assessment (DMA) with contracting officers assigned from
the Denver Acquisition and Logistics Center. The contract is executed
and funded through VAMCs' medical service budget. The contract allows
them to request disability exam services in support of their disability
exam programs, as needed; to include the Integrated Disability
Evaluation System (IDES). The contract resources can be used by VAMCs
to support backlogs or surges in demand for disability examination
requests. For FY 2011, a total of $500,000 was obligated and in FY
2012, $800,000 has been obligated. No funds will be obligated from FY
2013 and beyond. All funds will have to come from the local VAMC's
budget if it elects to use the contract. As of January 2012, no
contract exams have been completed in support of IDES.
VBA's Quality, Timeliness, and Customer (QTC) Medical Services,
Inc., contract has generated 4,649 compensation and pension exams for
the IDES program through the first quarter of FY 2012 at a cost of $5.5
million. VBA estimates that the total cost of IDES exams completed by
QTC in FY 2012 will be approximately $22.3 million. The estimated cost
for all IDES exams to be completed in FY 2013 is $23 million.
Question 14. Please describe the systems in place to monitor the
quality of VHA and contract exams and rating decisions conducted as
part of the Integrated Disability Evaluation System.
Response. IDES ratings, both preliminary and final ratings, are
subject to the same quality assurance process as all ratings prepared
by VBA. This process, called Systematic Technical Accuracy Review
(STAR), utilizes a random sample of claims to assess claims processing
accuracy. Claim reviews conducted at VA regional offices that serve as
IDES Rating Activity Sites (D-RAS) include a sample of IDES ratings.
STAR reviews ten cases monthly from each of three IDES sites
(Providence, Seattle, and Baltimore) and is required to complete the
reviews within five days of receipt. IDES decision documents are held
to the same standard as any other rating and reviewed using the same
criteria.
The VBA medical examination contract specifies that there will be a
quarterly quality review. This quality review determines whether the
contractor has met the standard or acceptable level of performance
(ALP) required by VBA. The contract requires that the completed
examination reports meet VA's Compensation Service worksheet
requirements so that Rating Veterans Service Representatives may use
these reports to complete rating decisions. An ALP of no less than 92%
quality must be met. The VBA Medical Director for Contract Exams and
Compensation Service's rating experts perform these quarterly quality
reviews.
Every quarter, 148 examinations are randomly selected from
completed examinations. The compensation worksheets are used to
evaluate all exam reports. Since each contractor-completed report is
considered a ``product'' that is paid for by the government, it must be
measured against the requirements of the specific worksheet that was
requested by the VA regional office.
As noted above, VHA has not contracted out any IDES exams. However,
if VHA facilities were to contract out IDES examinations, each local
individual health care facility that uses contracted resources is
responsible for 100% review of those examinations that have been
performed by contracted examiners. Moreover, disability examination
requests and associated completed examinations managed by the VAMCs are
randomly sampled and reviewed against seven specific examination
request indicators and nine examination criteria by DMA Quality
Assurance staff. VHA does not monitor the quality of any VBA contract
exams including IDES.
Question 15. What are the resource demands that are envisioned as a
result of the mandatory participation of servicemembers in the
Transition Assistance Program?
Response. The VOW to Hire Heroes Act of 2011 requires VA to provide
the TAP briefings to all separating Servicemembers. VBA currently has
258 FTE providing transition assistance briefings. VA is working with
the Department of Defense (DOD) to determine the number of
installations, number of separating Servicemembers, and methodology for
service delivery.
Question 16. The FY 2013 budget request identified that VA
facilities have over $9 billion in facility condition assessment-
documented deficiencies. Over the last three years, VA's budget
requests for non-recurring maintenance have continued to decrease while
the operating costs per square foot have continued to rise. Given the
realities of aging infrastructure, tight budgets, and projected
utilization increases, what has VA done to mitigate the risks of not
making solid investments in addressing basic facility maintenance
issues?
Response. VA ensures infrastructure needs are being addressed with
the safety and security of our Veterans and employees as our guiding
principle, resulting in obligations of $2.15B in FY 2010 and $1.98B in
FY 11.
The non-recurring maintenance (NRM) discussion is important to be
viewed within the Department's overall efforts to plan for
infrastructure needs. Developed first in the FY 2012 budget process,
the Strategic Capital Investment Planning (SCIP) process is a VA-wide
planning tool VA uses to evaluate and prioritize its capital
infrastructure needs for the current Budget cycle and for future years.
SCIP quantifies the infrastructure gaps that must be addressed for VA
to meet its long-term strategic capital targets, including providing
access to Veterans, ensuring the safety and security of Veterans and
our employees, and leveraging current physical resources to benefit
Veterans.
VA infrastructure funding requirements will continue to be balanced
against other Department and National priorities. SCIP continues to be
a critical and viable data-driven process that identifies all current
and future gaps in safety, security, access, utilization and other
related areas that most affect the delivery of benefits and services to
Veterans. SCIP then evaluates the means, including specific projects
(major, minor, non-recurring maintenance, leasing, or non-capital) to
efficiently mitigate these gaps. SCIP continues to be a realistic
blueprint in that it details a comprehensive methodology to mitigate
all currently-identified capital needs. In a tight fiscal climate, this
blueprint is an essential tool both this year and into the future, as
SCIP projects are prioritized each year to ensure that only the highest
priority projects are included in VA's annual budget request.
VA will continue to update this plan in order to capture changes in
the environment, including evolving Veteran demographics, newly-
emerging medical technology, advances in modern health care delivery
and construction technology, and increased use of non-capital means
(when appropriate) in a continuous effort to better serve Veterans,
their families, and their survivors.
VA is also looking at alternative strategies to traditional capital
approaches to meet our overall needs including the use of:
Tele-medicine
Extended hours for the provision of services on site
Mobile clinics
Care from private sources through contracts or on a fee-
basis
Continuous demographic data validation
Non-construction/capital alternatives
Question 17. In the FY 2012 budget request, VA identified $18.5
million in savings through the Real Property Cost Savings and
Innovation Plan via repurposing assets, demolition and mothballing,
green improvements, increasing telework, and renegotiating GSA Leases.
How much has been saved so far, per category? Is VA on track to achieve
the anticipated level of savings in each category?
Response. The $18.5 million in savings, identified in the FY 2012
budget, was a portion of the overall Real Property Cost Savings and
Innovation Plan that totaled $66 million in VHA savings. The lower
$18.5 million was intended to be the Medical Facilities portion of the
overall savings; however, VA has since updated this cost savings plan
to better account for the savings related to VHA.
In the recently released FY 2013 budget the updated initiatives
that are part of the Real Property Cost Savings and Innovation Plan
have been described, including repurposing assets, demolitions and
mothballing, energy and sustainability, improved non-recurring
maintenance contracting, and reduction in leasing. The total savings
for VHA remain at $66 million; however, it is all classified as Medical
Facilities savings now.
The below table provides a status of the savings achieved through
Q1 FY 2012 for each of the initiatives that make up the $66 million VHA
savings target. VA has saved approximately $48 million of the total $66
million projected VHA savings through Q1 FY 2012. We are on target to
meet the full VHA savings target by end of FY 2012.
------------------------------------------------------------------------
Total
Estimated Savings
Cost Savings Initiative VHA Savings Achieved
(by end of (through Q1
FY 2012) FY 2012)
------------------------------------------------------------------------
1. Energy Savings and Sustainability........ $43 M $36 M
2. Repurpose Underutilized Assets........... $6 M $3 M
3. Demolition or Mothballing................ $3 M $1 M
4. Improved Non-Recurring Maintenance $8 M $2 M
Contracting................................
5. Reduction in Leasing..................... $6 M $6 M
---------------------------
Total..................................... $66 M $48 M
------------------------------------------------------------------------
WOMEN VETERANS
Question 18. A 2010 GAO report identified a number of improvements
that should be made to enhance VA services to women veterans. Included
among these recommendations were facility improvements. Last year, VA
provided a list of improvements that they intended to make over the
course of ten years. Please provide an update on how much was spent, to
date, in FY 2012 on these projects. Please also provide a list of
remaining projects, their costs, and amount requested in the FY 2013
budget to address these projects.
Response. New space and renovations for privacy and women's health
are critical elements in the prioritization process for our
construction programs, with privacy ranking in the top criteria under
safety and women's health ranking in the second highest criteria under
Secretarial priorities. As can be seen in the attached spreadsheet, a
significant amount of funding has been and continues to be targeted
toward privacy and women's health projects. In fact, for VHA's FY 2011
construction programs, privacy and women's health supported over 1/3 of
the available NRM and Minor funding ($884 million out of a total of
$2.5 billion); and privacy and women's health represents almost 60% of
the planned projects with the appropriated and requested FY 2012 and FY
2013 budgets ($1.5 billion out of $2.51 billion). (see attached
spreadsheet)
INFORMATION TECHNOLOGY
Virtual Lifetime Electronic Record (VLER)
Question 19. Tables 10 and 20 of the Virtual Lifetime Electronic
Record Capability Area 1, Concept of Operations v. 2.0 (CONOPS), dated
April 8, 2011, and signed by the VA Deputy Secretary in August 2011,
detail the Go/No Go Criteria and Threshold Measures for nationwide
rollout of VLER.
a. Is the JEC still scheduled to make a Go/No Go decision in
July 2012?
Response. Yes.
b. Based upon the criteria set forth in tables 10 and 20, is VLER
on track for a Go recommendation by the Department?
Response. We are working toward a ``go'' recommendation. Though
some criteria are already met, data is still being collected for other
criteria in anticipation of making the decision.
c. If VLER is on track for a Go recommendation, please detail the
Department's analysis in support of this determination, and if VLER is
not on track for a Go recommendation, please detail the criteria
currently not satisfied and any corrective action(s) necessary to
achieve readiness for a July 2012 Go recommendation by the Department.
Response. Data will be collected through at least March 31, 2012.
VLER Health information exchanges have been successfully deployed at 12
pilot sites nationwide and are in production use. As of Feb 14, 2012,
41,006 Veterans have provided authorization to participate in health
data record exchange through the Nationwide Health Information Network
(NwHIN). A total of 494 electronic health summaries have been retrieved
by an NwHIN private partner from VA supporting the ``treatment''
purpose of use and 982 electronic health summaries have been retrieved
by VA from an NwHIN private partner supporting the ``treatment''
purpose of use. System performance is being monitored. Surveys of
Veterans and clinical users about their perception of VLER Health are
pending. Scalability issues that may impact the timeline and VLER
Health geographic deployment such NwHIN system capacity, automated
interoperability testing for new private sector health information
exchange partners, the availability of successful identity matching
traits, and automated Veteran authorization processes are still being
addressed by VA, the NwHIN Exchange and the HHS Office of the National
Coordinator for Health IT (ONC). The deployment of an ``NwHIN Direct''
project (secure one-way email) is being removed as Go/No Go criterion
for VLER Health as the decision should only address the NwHIN Exchange
bi-directional exchange capabilities. Final Go/No Go criteria reports
will not be available until the conclusion of the Performance and
Measurement and Analysis period, June 11, 2012.
Question 20. Please describe the organizational structure, and
governance and programmatic hierarchies, for the development,
implementation, and rollout of the VLER functional capabilities other
than health, e.g., personnel and military history and benefits; and
delineate the area(s) of responsibility for which VA, DOD and the VA/
DOD Interagency Program Office (IPO) is each responsible.
Response. The VA/DOD Joint Executive Council (JEC), Benefits
Executive Council (BEC), and Benefits Information Sharing/Information
Technology Working Group (BEC IS/IT) provide the structure and
governance for decisionmaking and prioritization of non-health
(benefit) functional capabilities (e.g., Disability Claims
Adjudication). The BEC IS/IT is responsible to jointly develop use
cases and benefit requirements. It recommends priorities, objectives
and metrics to the BEC, who forwards to the JEC for approval. Once
approved, and documented in the VA/DOD Joint Strategic Plan, the
Departments proceed to execute and implement material and non-material
solutions.
The BEC IS/IT meets frequently to review and monitor progress to
ensure delivery of capabilities as jointly planned. Issues are
escalated to the BEC when required. Generally, the IPO only
participates in benefits related capability discussions when health
data is required to adjudicate a claim.
Integrated Electronic Health Record (iEHR)
Question 21. VLER CONOPS, dated April 8, 2011, identifies as a risk
and issue:
Synchronization: iEHR, VLER, and other interagency data exchange
efforts are not synchronized. DOD and VA senior leadership must
establish appropriate authoritative governance and programmatic
infrastructure.
According to the meeting minutes from the SECDEF/SECVA meeting held
on June 23, 2011: ``[t]o ensure the synchronization of iEHR and VLER
initiatives, both efforts will be managed by the iEHR Program
Executive.''
a. Please define synchronization as used in CONOPS and the SECDEF/
SECVA meeting minutes, and as applied to the iEHR and VLER initiatives.
Response. Per the Interagency Program Office (IPO) Charter,
``synchronization'' can be defined per the following:
``* * * Derived Authorities from the Departments. To ensure the
IPO fulfills its purpose and mission, the Secretary of Defense
and the Secretary of Veterans Affairs, respectively, delegate
to the Director of the IPO, their authorities to:
i. Acquire, develop, and implement-to include financial
management, and information technology (IT) systems acquisition
and development-all common DOD/VA EHR and VLER Health systems,
capabilities, and initiatives, as defined by the iEHR and VLER
enterprise architectures.
ii. In collaboration with the HEC and BEC, collect and
integrate the Departments' EHR and VLER Health functional
requirements into program roadmap(s)/integrated master
schedule.
iii. Develop and propose the interagency budget and
acquisition strategies to meet integrated interagency
requirements.
iv. Direct the Departments' personnel resources supporting
related interagency initiatives.''
b. Has such synchronization between the initiatives been achieved?
If not, detail the steps taken, to date, to achieve synchronization.
Response. ``Synchronization,'' per the charter above, is still
being implemented at the IPO. IPO Advisory Board, Leadership, Program
Management and project progress meetings are attended by VLER Health
and iEHR Program Managers and the IPO Technology Director. All have
offices at the IPO and have begun coordination on all levels of program
implementation to ensure progress and coordination on strategies,
planning, and program management activities. At least one IPO technical
office, Standards and Interoperability, is already equally supporting
iEHR and VLER Health with the same leadership staff and using the same
methodologies.
c. What remaining challenges must be overcome before full
synchronization is achieved?
Response. Full synchronization can be achieved when both the
Departments and the IPO move forward with a comprehensive
implementation scope for both iEHR and VLER Health. iEHR planning
documents described in response to question 24 in this document are not
completed and the decision to implement VLER health nationally has not
yet been made. The Departments have made significant progress in
overcoming previous challenges by enhancing IPO's staffing levels and
signing a new IPO charter.
d. Has synchronization been impacted by the delay in hiring a
permanent Program Executive? If so, detail the steps taken to mitigate
this impact.
Response. No. VA executive sponsors for the iEHR, VLER and the IPO
and highly engaged IPO interim leadership appointed experienced senior
program staff in 2011 to begin work toward synchronizing this work in
the IPO.
Question 22. Please describe how investments made in VLER will be
leveraged during development and implementation of the iEHR. For
example, detail how investments in VLER data-sharing capabilities of
foundational health care data and architecture can and will be
incorporated into the iEHR.
Response. The Virtual Lifetime Electronic Record (VLER) enables the
sharing of comprehensive health, benefits, and administrative data
between the Departments of Defense (DOD) and Veterans Affairs (VA) from
the time an individual enters the service until the final benefit is
administered. In addition, VLER supports sharing of health data with
private healthcare providers through the Nationwide Health Information
Network (NwHIN). This comprehensive health data will be foundational to
the integrated Electronic Health Record (iEHR) effort which seeks to
develop and implement shared electronic record (EHR) capabilities in
the Departments. The combination of the comprehensive patient health
data from VA, DOD and private healthcare partners through VLER and the
state-of-the-art EHR tools through iEHR will enable providers at both
Departments to deliver the highest quality of healthcare to
Servicemembers and Veterans.
Question 23. Please report on the status of the ``budget quality''
implementation plan and the iEHR Independent Cost Estimate. For each
document:
a. Has the document gone through concurrence and received all
necessary approvals?
b. If available, please provide a copy of the document.
c. If the document has not yet received final approval, please
provide an expected approval date.
Response: Effective October 27, 2011, based on the re-chartering of
the IPO, DOD and VA initiated activity to establish a joint program
baseline for the iEHR. As a result, the iEHR program is developing
documentation that will contain sufficient program and technical
information for independent cost activity to be completed. This
documentation will be available by the end of the fourth quarter FY
2012.
Question 24. Provide a copy of the iEHR Project Plans and any
related documents (artifacts) including but not limited to: the iEHR
Strategic Plan, Concept of Operations, Program Management Plan, Joint
Master Test Plan, Joint Integrated Master Schedule, Joint Evaluation
Plan for Success, Joint Business and Technical Requirements, Risk &
Issues Management Plan, Communications Plan, Change Management Plan,
and Quality Management Plan.
Response. The iEHR program is in the Planning State. As part of its
focused effort to establish Program Management discipline and
standards, the content of the Program Plans and related documents
(artifacts) noted in this Question For the Record (QFR) will be
contained in program documentation currently in development. As program
documentation becomes available, we commit to sharing final versions
with the Committee. The iEHR FY 2012 Execution Plan and Program
Management Plan are in development. These documents will serve as a
basis for the iEHR organizational Concept of Operations.
ACQUISITION & CONTRACTING
Question 25. The President's FY 2012 Budget Submission for VHA, at
page 1A-4, estimated $355 million in operational improvements and
savings from ``acquisition improvements.''
a. Please identify, by business line, whether such operational
improvements and savings are on track to be realized during FY12.
Response. In its FY 2012 budget submission, VA identified $1.2
billion in operational improvements, of which $355 million was
identified as savings resulting from acquisition improvements.
Individual VISN targets were set as a percentage of FY 2008 spend.
Initial FY 2012 roll-out included initiatives carried over from the
OMB-mandated FY10-11 Acquisition Savings program (OMB Memorandum M-09-
25, Improving Government Acquisition, July 29, 2009). VHA is currently
collecting savings data under these initiatives as appropriate.
Concurrently, VHA convened an interdisciplinary Tiger Team in late
Q1 of FY 2012 to review and revise the VHA-specific acquisition savings
initiatives based, in part, on input received from the Government
Accountability Office (GAO) and the Office of Inspector General (OIG).
That group was chartered with providing recommendations to improve the
program. Specifically, the group has been charged with proactively
addressing anticipated issues from reviews; providing more rigorous
definitions, methodology, documentation, review/internal auditing for
the program; identifying new initiatives; identifying other savings/
avoidance areas not previously captured; removing any carry-over
initiatives that risk double counting with other operational
improvement initiatives; and consolidating initiatives as necessary to
ensure more rigorous methodology. The team recommendations are
anticipated for delivery on or about March 1.
Savings by Service Line
In preliminary analysis, VA has identified initial FY 2012 savings
goals for initiatives as identified in the FY 2010-2011 OMB program.
------------------------------------------------------------------------
OMB Initiative VA Initiative Number Expected 2012 Percentage
Grouping and Title Savings (Goal) of Goal
------------------------------------------------------------------------
26--Reduce VHA $10,000,000 2.82%
Contracts
14--Increase 5,000,000 1.41
Competition VHA
15--Bring Back 10,000,000 2.82
Contracts--COE
13--Consolidated 192,000,000 54.08
Contracting
24--Reverse Auctions 40,000,000 11.27
Utilities
25--Med/PDB 2,000,000 0.56
27--Property 20,000,000 5.63
Reutilization
28--Prime Vendor 1,000,000 0.28
50--Increase 75,000,000 21.13
Negotiation
---------------------------------
Total VA $355,000,000 100.00%
Acquisition Savings
------------------------------------------------------------------------
These savings percentages are considered estimates and will be
revised as necessary. This initiative list does not include any new
initiatives or reporting entities that have been identified as part of
the Tiger Team's review. It is important to note that to ensure that
VISNs have maximum flexibility to achieve goals, yearly savings goals
will be Network-based as opposed to initiative-based. Networks will be
permitted to identify the savings mechanisms/initiatives that best suit
their needs.
b. If VHA will not fully achieve such improvements and savings
during FY 2012, please explain why.
Response. At this time, VHA anticipates meeting the $355 million FY
2012 goal. As of the January report, VHA stood at 7.2% of annual goal.
Upon the adoption of the Tiger Team recommendations, VHA will revise
its monthly reports to include previously unreported initiatives and
reporting offices. Additionally, some reporting mechanisms for current
initiatives provide quarterly reports on or after the 15th of the month
following the end of the Quarter. VHA anticipates that these unreported
initiatives and offices as well as increased reports from existing
initiatives will provide an increased accounting of YTD savings
achieved.
DISCHARGE CHARACTERIZATIONS AND VA BENEFITS AND OTHER POLICIES
Question 26. According to recent reports, certain Veterans
discharged for homosexual conduct pre-Don't Ask Don't Tell (DADT) or
under DADT continue to be adversely impacted by their discharge
characterization. In some instances, LGBT veterans have been denied
access to VA benefits because of their discharge characterization.
With the repeal of DADT, and the adoption of a new regulatory
framework allowing open service, veterans discharged under DADT and
pre-DADT for homosexual conduct may now be eligible for discharge
upgrades and restoration of VA benefits. Please describe:
a. The steps taken by VA to evaluate the number of veterans who
were and continue to be denied VA benefits because of an adverse
discharge characterization under DADT or based upon the pre-DADT
regulatory scheme.
b. The steps taken or that will be taken by the Department to
ensure full restoration of VA benefits to those veterans who would
otherwise be eligible but for their adverse discharge characterization
under DADT or based upon the pre-DADT regulatory scheme.
Response. When an individual files a claim for benefits, the
Veterans Benefits Administration (VBA) is responsible for reviewing the
character of discharge (COD) provided by the military services. An
``Honorable'' discharge is binding on the Department of Veterans
Affairs (VA). Under 38 U.S.C. 5303, a discharge under certain specified
conditions bars eligibility for VA benefits, regardless of the COD,
unless it is determined that the individual was insane when committing
the acts that resulted in the discharge (see 38 CFR 3.354(b)).
In other cases, if the COD is an undesirable discharge, an other
than honorable discharge, or a bad conduct discharge, VBA makes a
determination whether the discharge was under dishonorable conditions
for the purpose of determining benefit eligibility. When making that
determination, VA is bound by the criteria stated in 38 CFR 3.12(d).
Those criteria do not indicate, nor have they in the past, that VA may
find a Veteran ineligible for benefits based on violation of the Don't
Ask Don't Tell (DADT) policy. Because it is not VA policy to terminate
or deny benefits based on violation of DADT, there would be no need to
review cases for these actions.
As stated in 38 CFR 3.12(d)(5), a discharge may be considered to
have been issued under dishonorable conditions if the reason for
discharge was based on: ``Homosexual acts involving aggravating
circumstances or other factors affecting the performance of duty.
Examples of homosexual acts involving aggravating circumstances or
other factors affecting the performance of duty include child
molestation, homosexual prostitution, homosexual acts or conduct
accompanied by assault or coercion, and homosexual acts or conduct
taking place between servicemembers of disparate rank, grade, or status
when a servicemember has taken advantage of his or her superior rank,
grade, or status.'' This criterion does not apply to or address DADT.
If a Veteran received a ``Dishonorable'' discharge from his or her
branch of service based on DADT, the individual would need to apply to
that service department requesting an upgraded discharge.
When VA notifies a claimant of an unfavorable COD determination,
the notification letter includes instructions on how to apply to the
Service Department Discharge Review Board to change the character of a
discharge and how to apply for a correction of military records through
the Service Department Board for Correction of Military Records.
Enclosed with the letter is a copy of the DD Form 293, Application for
the Review of Discharge or Dismissal from the Armed Forces of the
United States, and a copy of the DD Form 149, Application for
Correction of Military Records. The addresses for the Service
Departments are listed on the back of each form.
Question 27. The Department has taken preliminary steps to ensure
that VA is a welcoming place for LGBT veterans and their families.
Please describe in detail the steps taken, and that will be taken, by
the Department to ensure that VA is a welcoming place for LGBT veterans
and their families.
Response. VA is taking steps to ensure that its health care system
is more inclusive through the creation of an Office of Health Equity,
visitation policies, and new training programs. The Department's
recently established Office of Health Equity (OHE) brings focus on its
efforts to provide a more equitable health care system and improve
overall quality of care through health equity. Among many other
projects, OHE will work to eliminate health treatment disparities among
LGBT, women, and minority Veterans. Over the next year, OHE will
implement an integrative action plan to achieve health equity for all
Veterans receiving VA health care services, including LGBT Veterans.
VA's visitation policies are supportive of the rights of Veterans'
same-sex partners, and the right of Veterans to name same-sex partners
as their surrogate decisionmakers. To reinforce the Department's focus
and commitment to equitable visitation rights and the appropriate
implementation of this policy, the Veterans Health Administration's
(VHA) Deputy Under Secretary for Health Operations and Management
required all of VA's network directors and chief medical officers to
ensure all facilities have a written policy in place and that these
policies are consistent with the new Joint Commission definition of
``family.'' The Joint Commission defines ``family'' as a person or
persons who play a significant role in an individual's life. VA is also
developing training programs targeted to mental health and women's
health providers on services for transgender Veterans. The goals of
these programs are to increase awareness of the psychological and
emotional needs of transgender Veterans and address the needs of
different groups of clinical providers.
In terms of benefits, VA awards benefits to all eligible Veterans
and does not discriminate on the basis of sexual orientation.
VA has also created a more inclusive workplace for its LGBT
employees through enhanced policy initiatives, training programs, and
outreach and awareness activities.
The Department added gender identity and parental status
to the list of protected bases in the Secretary's Policy Statement. The
Department also implemented an internal complaint process to provide
formal redress for complaints based on sexual orientation. Most
recently, VA's Diversity Council launched a LGBT work group to address
emerging LGBT issues in the Department's workforce and service
delivery. In addition, VA is adding a survey item in its Voice of VA
Survey to assess perceptions of fairness and treatment of LGBT
employees.
In terms of training, the Department has conducted
training workshops to educate its leadership and workforce on issues of
cultural competency for the LGBT community. VA has also implemented
Mandatory EEO, Diversity, and Conflict Management Training for Managers
and Supervisors covering LGBT diversity. In fiscal year 2011, over
27,000 executives, managers, and supervisors were trained.
Finally in terms of outreach, the Department conducted
outreach and awareness activities focused on LGBT issues. Within the
past year, VA held its third annual LGBT Program to increase awareness
of LGBT issues in the workplace and in our service population.
Additionally, the Department also convened its third LGBT Observance
Program that focused specifically on the needs of LGBT Veterans.
Moreover, VA has engaged the National Coalition of LGBT Health, which
represents over 70 LGBT organizations, in a dialog about emerging LGBT
issues and their impact on VA health care and benefits services.
______
Response to Prehearing Questions Submitted by Hon. Richard Burr to
U.S. Department of Veterans Affairs
GENERAL
Question 1. In connection with the Department of Veterans Affairs
(VA) fiscal year 2011 budget request, VA indicated in response to
questions about the method of travel used by employees of the Office of
the Secretary that ``travel regulations address the allowable modes of
travel for reimbursement purposes, but the predominant method of travel
has and will continue to be commercial airlines'' [emphasis added].
a. For fiscal years 2009, 2010, and 2011, please identify the
number of trips taken each year by senior VA personnel (Presidential
Appointee with Senate Confirmation (PAS), career or non-career General
Schedule (GS) employees, career or non-career Senior Executive Service
(SES) or SES Equivalent, consultant, contractor, etc.) using a military
or other government-provided aircraft.
Response. Total number of trips taken each fiscal year using
military or other government-provided aircraft are as follow:
Fiscal Year 2009--total of 3 trips
Fiscal Year 2010--total of 12 trips
Fiscal Year 2011--total of 4 trips
b. For each trip during those years where a military or other
government-provided aircraft was utilized for travel, please identify:
(1) the purpose of the trip, (2) the destination of the trip, (3) the
duration of the trip, (4) the number and title of any VA employees
(PAS, career or non-career GS employee; career or non-career SES or SES
Equivalent, consultant, contractor, etc.) who were passengers on the
aircraft, (5) the total cost to the Federal Government to operate the
aircraft used for the trip, (6) the amount of any reimbursement VA
provided to the Department of Defense, a military service, or another
government entity in connection with the trip, (7) the justification
for using military or other government-provided aircraft rather than a
commercial airline, and (8) all supporting documentation, the agenda,
and the itinerary related to the trip, as well as copies of any
memoranda, reviews, comments and/or opinions rendered by VA's Office of
General Counsel regarding the trip.
Response. [Extensive supporting documentation is held in Committee
files.]
For fiscal years 2012 and 2013, please identify the number of trips
that have been taken or are expected to be taken by senior VA personnel
(PAS, career or non-career GS, career or non-career SES or SES
Equivalent, consultant, contractor, etc.) using a military or other
government-provided aircraft.
Response. As of March 29, 2012, in fiscal year 2012 VA did not
usemilitary or other government-provided aircraft for any trips. In
fiscal year 2013, VA may use military or other government-provided
aircraft but no estimates are currently available. Cost figures can
only be provided once travel is complete. For every official trip
conducted by the Secretary, a cost analysis is made to determine
efficiencies that may warrant a request for military air. If military
air is requested, the provisions of 41 CFR 101-37 are met using the
appropriate decision process outlined in OMB Circular A-126 and each
request is submitted to the Agency General Counsel for review and
approval.
c. In total, for fiscal year 2012, how much (if any) is expected to
be spent by VA in order to pay for transportation by military or other
government-provided aircraft?
Response. As of March 29, 2012, in fiscal year 2012 VA did not use
military or other government-provided aircraft for any trips. No
estimates are currently available and cost figures can only be provided
once travel is complete. For every official trip conducted by the
Secretary, a cost analysis is made to determine efficiencies that may
warrant a request for military air. If military air is requested, the
provisions of 41 CFR 101-37 are met using the appropriate decision
process outlined in OMB Circular A-126 and each request is submitted to
the Agency General Counsel for review and approval.
d. In total, for fiscal year 2013, how much (if any) is requested
in order to pay for transportation by military or other government-
provided aircraft?
Response. In fiscal year 2013, VA may use military or other
government-provided aircraft but no estimates are currently available.
Cost figures can only be provided once travel is complete.
Question 2. In October 2011, the House of Representatives passed
H.R. 2302, which included a provision that would require VA to submit
to Congress quarterly reports outlining the cost for conferences or
meetings sponsored by VA that have at least 50 attendees or cost
$20,000 or more.
a. During fiscal year 2011, how many conferences or meetings did VA
sponsor that met those criteria and what was the total cost of those
conferences and meetings?
b. During fiscal year 2012, how many conferences or meetings does
VA expect to sponsor that meet those criteria and how much in total is
expected to be expended on those conferences or meetings?
c. For fiscal year 2012, please identify the 25 most expensive
conferences or meetings already sponsored or expected to be sponsored
by VA, the locations of those conferences or meetings, and the purposes
of those conferences or meetings.
d. For fiscal year 2013, what is the total amount requested for
purposes of holding conferences or meetings that meet those criteria
and how many conferences or meetings would that funding level support?
Response. [These questions are repeated and answered in posthearing
questions, section GENERAL, Question 3, a-f.]
Question 3. During fiscal year 2010, VA created the National
Outreach Office in the Office of Public and Intergovernmental Affairs
with the stated goal to ``standardize how outreach is being conducted
throughout VA.'' In follow-up questions to the hearing on the fiscal
year 2012 budget, VA was asked to provide the total amount VA, as an
enterprise, spent on outreach during fiscal year 2010. VA responded by
stating, ``[w]hile we are not currently able to extract the total
spending for outreach across the department for [fiscal year] 2010 and
[fiscal year] 2011, we are working diligently toward that goal for
[fiscal year] 2012.''
a. Please provide the total amount VA spent on outreach during
fiscal year 2010 and fiscal year 2011 and estimates for how much will
be spent during fiscal years 2012 and 2013. The data should include a
breakdown of money spent by VA Central Office, Veterans Integrated
Service Networks (VISNs), Regional Offices, and VA medical centers.
Response. VA created the National Veterans Outreach Office (NVO)
within the Office of Public and Intergovernmental Affairs (OPIA) in FY
2010 to coordinate outreach throughout VA, and to standardize outreach-
related activities. The NVO has made considerable progress in
researching and analyzing VA's outreach programs and activities in
2011, and has already developed a framework to track outreach efforts
that are part of VA's major initiatives. The final frameworkincludes
building a process for VA's administrations (Veterans Health
Administration, Veterans Benefits Administration and National Cemetery
Administration) and staff offices to:
provide Veterans with high-quality products and
information on activities that are consistent;
provide trained outreach coordinators to assist Veterans;
evaluate and develop metrics to measure the effectiveness
of outreach programs; and
track costs associated with outreach programs.
The embedded table, previously provided to the Committee in
March 2012, gives expenditure data on advertising outreach, a component
of VA's outreach efforts. Outreach through advertising is targeted to
helping VA reach Veterans who may be contemplating suicide; struggling
with homelessness, unemployment, or mental illness; for those Veterans
who live in rural areas; to make Veterans aware of available benefits
and services; and VA hiring and recruitment. Table 1 details VA
advertising activities and obligations for the period 2009-2012 and
planned for 2013.
The mechanisms for advertising outreach activities have included
Public Service Announcements, multi-media projects, Internet promotion,
transportation and billboard advertisements. Outreach activities and
events for Homeless Veterans Outreach, Health Benefits Awareness,
Mental Health Awareness, Women Veterans Outreach and Suicide Prevention
Outreach will continue in 2013 using earned media, including news
releases, social media, fact sheets, printed materials, etc. FY 2013
funding to supplement these activities with paid advertising will be
determined as part of the operational planning process.
b. Does standardizing the outreach efforts of VA include
coordinating projects and initiatives at all levels of the
organization? If so, please detail how the National Outreach Office has
met these goals and please describe what new initiatives the office is
undertaking to that end.
Response. Yes, but it is important to note that OPIA only has
supervisory authority over those personnel who are assigned or detailed
to the National Veterans Outreach Office. In addition, hundreds of
other VA employees enterprise-wide assigned to VBA, VHA and NCA are
typically involved in outreach activities on any given day; those
employees work for and respond to their respective chain of command. In
an effort to better coordinate the outreach efforts of all VA
employees, VA established a workgroup made up of representatives from
VHA, VBA and NCA and VA staff offices, including: Centers for Women and
Minority Veterans, Small and Disadvantaged Business Utilization,
Homeless Veterans Initiatives Office, Center for Faith Based and
Neighborhood Partnerships, and others. In 2011, the NVO held workgroup
meetings to solicit input and ideas from headquarters and field
facilities; and built buy-in for development and implementation of the
plan to coordinate outreach activities and initiatives. OPIA held a
national training conference in which ``Outreach Day'' was a major
activity to orient VA's professionals to the outreach plan and obtain
their final comments on developing a series of products and resources
to improve outreach coordination, collaboration and uniformity across
VA. Recognizing the need for centralized outreach management, NVO has
developed the first capability to provide critical and consistent
information to VA's Outreach community:
An intranet site that houses important information to
enhance how VA Outreach coordinators execute outreach including
policies and procedures, the National Veterans Outreach Guide, links to
the Congressionally mandated 2010 Biennial Report to Congress on the
VA's outreach activities, and other links.
An online National Veterans Outreach Guide that provides
best business practices, expert recommendations, proven examples of
successful VA outreach activities in serving Veterans, and lessons
learned. This guide outlines processes for how to conduct outreach
events, track expenditures, measure the success of activities and tap
into key VA resources and contacts, plus so much more.
Next steps include finalizing a proposal for a robust
National Veterans Outreach System (NVOS) which will allow VA Outreach
leaders to populate a series of fields with information about planned
outreach activities. The NVOS will be an interactive tool that allows
users to systematically and uniformly enter, store, organize, view,
retrieve and report outreach-related data easily. The goal of the
database is to provide a more advanced, easy-to-use tool that may
either be used in concert with existing data collection methods or
replace less efficient and effective approaches. It will also provide
the data necessary to extract any number of data pulls including the
costs associated with outreach in a fiscal year and the number of
events executed.
Question 4. During this year's State of the Union, the President
proposed the Veterans Job Corps. The 2013 VA Budget Fast Facts
describes the program as follows: ``A Presidential initiative of $1
billion over the next five years to establish a conservation program
impacting up to 20,000 veterans to protect and rebuild America's land
and resources.''
a. Describe in detail how the initiative would be administered.
Please include information on which other agencies would participate,
what the responsibilities would be of the non-VA agencies, what types
of jobs are envisioned through the initiative, and what criteria would
be used to select participating veterans.
Response. The Veterans Job Corps proposal, which requires
legislative authorization and funding from Congress, will focus on
employment for all Veterans, but will focus on Post-9/11 Veterans. The
initiative will put returning Veterans back to work on projects
building on their military experiences and skills--from serving on
conservation projects to restore and protect public lands and resources
to serving our communities as law enforcement officials and
firefighters.
The Department of Veterans Affairs (VA) will coordinate a Federal
Steering Committee that will evaluate competing proposals from
implementing Federal agencies, and would be authorized to transfer
funding to those agencies for approved projects. VA will serve as the
lead for the Federal Steering Committee, which will be composed of
policy officials representing implementing Federal agencies. The United
States Department of Agriculture (USDA), the Department of Interior
(DOI), National Oceanic and Atmospheric Administration (NOAA) at
Department of Commerce, and the Department of Defense (DOD) Army Corps
of Engineers (ACOE) are envisioned as the implementing agencies that
will execute a range of conservation and infrastructure projects in our
local, state, and national parks, forests, marine sanctuaries, and
other public lands. The Department of Justice and the Department of
Homeland Security are envisioned as the implementing agencies that will
issue grants to local entities to hire Veterans as law enforcement
officials and firefighters.
As proposed, project proposals would be submitted by the USDA, DOI,
NOAA, and ACOE in conjunction with state and local agencies and other
stakeholders. Grants for law enforcement officers and firefighter will
be evaluated using existing program criteria, in addition to the number
of Veterans that can be hired. Federal land management agency projects
would be evaluated using basic threshold requirements, such as whether
the project provides conservation or recreation benefits on public
lands and waters and if the project is ready to be implemented. Other
likely project selection criteria will include the number of Veterans
that can be hired and other benefits to Veterans, such as long-term
career development and educational opportunities. We expect that many
Veterans would be hired by DOI and USDA to address outstanding
maintenance issues in national parks, refuges, forests, and other
Federal public lands, as well as by state resource management agencies
where Veterans can do similar work on state and local lands.
The projects would be implemented through contracts to businesses,
cooperative agreements and grants to non-Federal entities, and direct
hiring of a small number of Veterans for temporary positions. VA will
leverage existing on-line resources to coordinate efforts among
stakeholders and match Veterans with employment opportunities. VA would
also develop a framework for monitoring and evaluating progress to
ensure proper oversight and accountability.
b. Please describe the program in detail, including the amount of
payments, subsidies, and benefits veterans would receive through this
program; how much it would cost per participant; what opportunities
veterans would have to continue working for the Federal agency after
completing the program; and how much of the overall programmatic cost
would go toward administration.
Response. Details of the Program will be finalized as part of the
ongoing discussion between the Administration and Congress on this
proposal. The amount of payments and subsidies, the number of Veterans
served, and the future employment opportunities will depend on the
submissions of projects to the VA-led Steering Committee, that will
disburse funds for the proposals which will provide the greatest
benefits to our Nation's Veterans.
c. If the initiative would require $1 billion in mandatory funding
over the next five years, what VA program changes would VA propose to
offset this funding increase?
Response. All of these proposals are included in the President's FY
2013 Budget.
In September the Administration put forward the American Jobs Act
together with a plan for deficit reduction that had a net savings of $4
trillion. The Administration is willing to work with Congress to draw
on that list to find mutually acceptable pay for options.
Question 5. In 2010, VA began operating the Fast Track Claims
Processing System to process claims for three conditions presumed to be
related to Agent Orange exposure. The fiscal year 2013 budget request
reflects that ``analysis and planning regarding system retirement will
be conducted in [fiscal year] 2012.''
a. To date, how much in total has been spent (from any account) on
developing, enhancing, and operating the Fast Track Claims Processing
System, including funds for contractor support?
Response. To date, $11.3 million has been spent on Fast Track
development, enhancement, and operations.
b. Is any funding (from any account) requested in the fiscal year
2013 budget in order to operate, expand, or retire the Fast Track
Claims Processing System?
Response. The budget request for Fast Track is $1.8 million
annually for operations and maintenance.
c. Since its inception, how many claims have been filed by
claimants on-line using this system?
Response. As of February 24, 2012, 4,288 claims have been filed by
claimants using the on-line system.
d. How many claims have been processed through the Fast Track
system and how long on average did it take to complete those claims?
Response. As of February 24, 2012, 14,933 claims have been
processed through Fast Track. Of these, over 10,000 were incorporated
into Fast Track by Veteran Service Representatives on behalf of the
claimants. The average time to complete Fast Track claims is 135 days.
e. How many Fast Track claims are currently pending and how long on
average have they been pending?
Response. As of February 24, 2012, 26,848 claims were pending for
approximately 125 days on average.
f. What, if any, changes have been made in the manner, means, or
method of implementing the Fast Track Claims Processing System, either
in the field or within the headquarters of the Veterans Benefits
Administration, since it began in 2010?
Response. VA has made the following changes to Fast Track since
2010:
Developed and deployed an easy to use interface for the
input of Disability Benefits Questionnaires (DBQs) for both the public
and VA users;
Developed and deployed a ``Short Form'' to allow VA users
to quickly input essential data into Fast Track since Fast Track is a
stand-alone system which cannot pull data from VA's Corporate database;
and
Added the ability to generate or suppress letters to
Veterans and physicians to allow VA users more flexibility in
corresponding with Veterans and their physicians.
Question 6. In the budget request, VA requested an additional $165
million to the enacted fiscal year 2013 appropriations for medical
care. In briefing slides provided to the Committee staff, VA indicates
this increase in funding request is due to ``[a]nnual update of
actuarial model and long-term care estimates'' and ``[e]nhanced funding
provided to meet facility activations, implementation of the Caregivers
Act, and other strategic initiatives such as ending Veteran
homelessness.''
a. Please provide the Committee with a more detailed justification
for the additional funding request, broken down by program and
initiative.
Response. For FY 2013 there were changes in the adjusted actuarial
estimates for health care, the estimates for long-term care, the
estimates for other health programs (i.e., CHAMPVA), and obligations as
shown below ($ in millions):
Adjusted actuarial estimates... $(1,715)
Long-term care................. (271)
Other health programs.......... (119)
-----------
Total reductions........... (2,105)
Less reduction in obligations.. 110 (detail composition below)
-----------
Total net reduction in (1,995) (detail below)
estimates.
Composition of reduction in
obligations:
Appropriation request 165
increase.
Reimbursement increase....... 50
Collection decrease.......... (325)
-----------
Net reduction in (110)
obligations.
Details of investment of
$1,995:
Zero homelessness............ 892
Activations.................. 448
New Models of Care........... 433
Expand Health Care Access.... 120
Caregivers................... 30
Improve Mental Health........ 20
Other........................ 52
-----------
Total.................... $1,995
===========
b. Please identify which facility (new VA hospital, Community Based
Outpatient Clinic (CBOC), Outreach Clinic, etc.) activations would be
supported with this increase in funding.
VHA Response: The activation funding requested in the FY 2013
Advance Appropriation (FY 2012 President's Budget) was $344 million
plus the activation increase requested in the FY 2013 President's
Budget (see response to question 6a above), which was $448 million.
This equals a total of $792M for FY 2013 activations. The specific
projects making up the $792M are listed in the table below.
Question 7. Under the Veterans Health Care Budget Reform and
Transparency Act of 2009, VA is able to update the current fiscal year
budget estimate for medical care, as well as provide a request for the
following fiscal year advance appropriations for medical care. In the
President's budget request, VA indicates that ``VA was able to re-
invest over $2 billion in both 2012 and 2013 in high priority medical
programs.'' Please provide a detailed breakdown of what programs this
funding was ``re-invested'' in and please detail how this increase in
funding would be utilized for each program.
Response. The data for FY 2013 is provided in response to question
6a above. For FY 2012 there were changes in the adjusted actuarial
estimates for health care, the estimates for long-term care, the
estimates for other health programs (i.e., CHAMPVA), and obligations as
shown below ($ in millions):
Adjusted actuarial estimates.. $(2,559)
Long-term care................ (210)
Other health programs......... (115)
-----------
Total reductions.......... (2,884)
Less reduction in obligations. 698 (detailed composition below)
-----------
Total net reduction in (2,186) (detail below)
estimates.
Composition of reduction in
obligations:.
Appropriation change........ 000
Transfer to Joint DOD-VA (234) (North Chicago)
DemoFund.
Transfer to DOD-VA Fund..... (15) (Health Sharing Incentive)
Contingency not appropriated (240)
Reimbursement increase...... 57
Unobligated balance increase 63
Collection decrease......... (329)
Net reduction in (698)
obligations.
Details of investment of
$2,186:.
Zero homelessness........... 559
Activations................. 831
New Models of Care.......... 610
Expand Health Care Access... 113
Caregivers.................. 43
Improve Mental Health....... 31
Other....................... (1)
-----------
Total................... $2,186
===========
Question 8. The fiscal year 2013 budget request includes $1.352
billion for programs related to prevention and reduction of homeless
veterans.
a. Do the fiscal year 2013 request and fiscal year 2014 advance
funding request require legislative authority to release funding for
these programs?
Response. VA is taking decisive action toward its goal of ending
homelessness among our Nation's Veterans. To achieve this goal, VA has
developed a plan to end homelessness that will assist every eligible
homeless Veteran and Veteran at-risk for homelessness. VA will assist
Veterans to acquire safe housing; needed treatment and support
services; homeless prevention services; opportunities to return to
employment; and benefits assistance. Specific programs which provide
these services include the VA Grant Per Diem Program (GPD), Health Care
for Homeless Veterans Program (HCHV), and the Supportive Services for
Veteran Families Program (SSVF).
VA's FY 2013 budget submission includes requests for authorization
legislation on a number of fronts to reflect this priority, and it is
critical to secure timely enactment to further VA's efforts of ending
homelessness among our Nation's Veterans. In order to achieve its goal,
VA needs the extension beyond 2012 of the HCHV program (38 U.S.C. 2031)
as well as the authorities granted by 38 U.S.C. 2102A, 2033, and 2041.
In addition, VA is asking that Congress increase the amounts authorized
to be appropriated for the GPD Program (38 U.S.C. 2013, 2061) and the
SSVF program (38 U.S.C. 2044). These requests for legislative authority
are included in VA's FY 2013 Budget Submission, Summary Volume
(Volume 1 of 4) at pages 3A-5-3A-6.
b. What metrics were used to determine how much funding is needed
for each program? Please provide any metric templates currently
developed.
Response. VHA Homeless Programs developed a budget request based on
historical allocations, expansion of existing programs using
established priorities, and new initiatives based upon actuarial
modeling of projected workload. Increased funding for homeless programs
is needed to continue existing services, expand existing programs, and
establish new initiatives in order to meet VA's goal of ending
homelessness among Veterans. In determining costs for each of the
services included in the Ending Veteran Homelessness Initiative,
estimates were based on (1) the number of Veterans estimated to need
services, (2) costs of other needed services, e.g., services designed
to prevent homelessness, and (3) costs of case management services
associated with permanent affordable housing programs.
Question 9. In fiscal year 2011, Congress appropriated $799 million
for homeless veterans programs.
Please provide a detailed breakdown of how this money was utilized
within these various programs, the number of veterans who accessed
these programs, how each program was effective in reducing the number
of homeless veterans, and what metrics are used to determine the
effectiveness of these programs.
Response. In the fiscal year (FY) 2011 President's Submission, VA
requested $799 million for homeless Veterans' program initiatives,
along with sustainment funding in the areas of HCHV and Domiciliary
Care for Homeless Veterans (DCHV). Sustainment funding is provided to
VA's medical centers through the Veterans' Equitable Resource
Allocation (VERA) and is handled locally, not by VHA Homeless Programs.
As a result of expanded access and outreach efforts, HCHV sustainment
and DCHV sustainment costs were higher than anticipated in FY 2011,
resulting in a total of $933 million, rather than $799 million, in
funding. With this funding, VA was able to deliver services to
approximately 160,000 Veterans. The table below, drawn from Volume 2--
Medical Programs, page 1L-14 of the FY 2013 Budget Submission provides
more detail).
* $ in Thousands (Chart extracted from Volume 2--Medical Programs,
page 1I-14)
Number of Veterans Accessing Each Program
In FY 2011, VA provided services (both health care and benefits) to
almost 188,000 Veterans who are homeless at risk for homelessness. A
majority of these Veterans (over 160,000) were served by one or more of
VA's specialized homeless programs including:
The HCHV program conducted aggressive outreach and
provided outpatient services to more than 95,000 Veterans and offered
more than 8,100 episodes of contract community-based residential
treatment.
The DCHV program provided intensive residential
rehabilitation and treatment to over 8,000 Veterans.
The Compensated Work Therapy/ Transitional Residences
(CWT/TR) program provided structured transitional housing to
approximately 1,400 Veterans.
The GPD program provided community-based transitional
housing to over 30,000 Veterans.
VA continues to collaborate with the Department of Housing
and Urban Development (HUD) to implement approximately 30,000
supportive housing units aligned with VA case management and supportive
services through the HUD-VA Supported Housing (HUD-VASH) Program.
In FY 2011, 44 Health Care for Reentry Veterans (HCRV)
Specialists saw over 11,000 Veterans in 1,008 of 1,295 (78%) total
state and Federal prisons; Veterans Justice Outreach (VJO) Specialists
saw more than 15,000 Veterans at earlier stages of justice involvement,
for a combined total of over 27,000 justice-involved Veterans.
In addition to these direct service programs for homeless Veterans,
VA launched two homeless prevention initiatives--SSVF and the HUD-VA
Homeless Prevention Demonstration (VHPD) programs; initiated the
Homeless Veteran Supported Employment Program (HVSEP) and supported the
National Call Center for Homeless Veterans.
Program Effectiveness
The 2011 Point-in-Time Estimates of Homelessness: Supplement to the
Annual Homeless Assessment Report published in December 2011, estimates
that on any given night in 2011 there were approximately 67,495
homeless Veterans and that homelessness among Veterans has declined by
nearly 12 percent since January 2010. VA has taken decisive actions
toward its goal of ending homelessness among the Nation's Veterans, and
has developed a continuum of care designed to assist every eligible
homeless Veteran as well as Veterans at risk for homelessness.
With the exceptions of very new programs such as VJO and SSVF,
studies of the effectiveness of VA specialized homeless services have
been conducted. Generally, these studies have been conducted early in
the implementation of the initiatives and have been both observational
and experimental in design. For example, the effectiveness of the HUD-
VASH program was documented in a randomized control trial that compared
HUD-VASH to intensive case management without HUD rental assistance and
to usual VA services.
Such studies are extremely expensive to conduct and generally are
limited to a representative sample of Veterans and the prescribed
timeframe. However, the implementation of all specialized VA homeless
programs is monitored on a continual basis. To further develop
monitoring capacity, VA continues to develop its new National Homeless
Registry. The Homeless Registry will be a real-time data resource for
service providers, VA policymakers, administrators, and researchers. In
addition to data collected with the VA specialized homeless programs,
the Homeless Registry will incorporate VA inpatient and outpatient data
as well as data collected through HUD's national Homeless Management
Information System (HMIS) database. The Homeless Registry is the ``next
generation'' monitoring tool and will provide important documentation
of progress toward VA's Plan to End Homelessness among Veterans.
Metrics
Ongoing monitoring of VA specialized homeless services includes
measures of program structure (e.g., staffing, staffing vacancies,
program costs); program processes (e.g., demographic and clinical
characteristics of program participants, duration of participation in
the different programs); and program outcomes (e.g., housing status,
employment status, provisions for aftercare). Feedback to program sites
in the field is delivered through a series of measures based on
relative performance.
Explicit studies of program effectiveness also include measures of
program structure, process and outcomes. Data collection in those
studies is generally more intensive than during ongoing monitoring and
tends to be longitudinal in nature. For example, the previously
mentioned effectiveness study of HUD-VASH collected a wide array of
measures on each study participant quarterly for a minimum of three
years following program entry.
Specific metrics in place to determine the effectiveness of these
programs:
Number of Homeless Veterans (on any given night), reported
in the Supplemental Chapter on Homeless Veterans in the Annual Homeless
Assessment Report (AHAR).
Percent of vouchers issued to the medical center/facility
that result in a homeless Veteran achieving resident status in Public
Housing Authority.
Percent of Veterans discharged from GPD or DCHV programs
who discharge to an independent housing arrangement.
Percent of Veterans admitted to the HUD-VASH program who
were chronically homeless at the time of admission.
Question 10. The fiscal year 2013 budget request includes $21
million for 200 additional full-time equivalents (FTE) to be Homeless
Veterans Outreach Coordinators (HVOC) in the Veterans Benefits
Administration. The purported purpose of the new HVOCs is to support
VA's goal of ending veterans' homelessness. According to the fiscal
year 2013 budget request, the additional resources in 2013 are intended
to ``accelerate services for an additional 43,000 Veterans and their
families by decreasing the frequency and duration of their episodes of
homelessness'' and ``[t]he resources will also assist veterans and
their family members maintain safe and permanent housing, get connected
to employment opportunities, and improve the overall health care
status.''
a. Please explain how the manner, means, and methods of utilizing
these HVOCs do not duplicate, compete with, and overlay already
existing veteran homelessness outreach programs, initiatives, FTE, and
other resources that are on-going in the Veterans Health Administration
(VHA) VISNs and VA medical centers.
Response. VBA's HVOCs are targeted outreach positions dedicated to
assisting homeless Veterans and Veterans at-risk of homelessness and
their families with their VA benefits, including compensation, pension,
education, vocational rehabilitation, insurance, and housing. One of
their most important functions is to ensure homeless Veterans' claims
are appropriately expedited within the claims processing system. VBA's
goal is to process homeless claims in 75 days. VBA needs these
additional FTE to reach our goal and provide timely benefits to these
Veterans and their families. Although both VBA and VHA conduct outreach
and provide referrals, HVOC duties are specialized and do not duplicate
already existing homeless outreach programs within VHA.
VHA's homeless outreach efforts are directed at health care
delivery and VBA's outreach efforts are focused on benefit delivery.
Both functions are necessary to meet the complex psychosocial, mental
health and health care needs of homeless and at-risk Veterans. VHA and
VBA homeless Veteran outreach staffs work closely to optimize services
to homeless Veterans at VA settings and in the community. Specifically,
VHA's homeless outreach staff is comprised of social workers, other
licensed professionals, paraprofessionals and/or peer specialists. All
have duties specified in either a professional functional statement or
position description. Some of the staff perform outreach duties on a
full-time basis others less than full-time. VHA's outreach efforts
focus on the identification and assessment of homeless and at-risk
Veterans, engagement in VA's health care programs, and referral and
linkages to VA and community benefits. VHA homeless outreach efforts
are accomplished through community partnerships and coordination with
VBA's HVOC's.
b. Please identify where it is anticipated these 200 HVOCs will be
located (i.e., existing Veterans Benefits Administration Regional
Offices, leased space in the community, VA medical centers, CBOCs,
etc.).
Response. HVOCs will have a presence at existing regional offices
and in locations that have high homeless Veteran populations. They will
also spend time at VA medical centers (VAMC), Community-Based
Outpatient Clinics (CBOC), prisons/jails, and Veterans treatment
courts.
Full time equivalent (FTE) allocations at regional offices will be
based on several factors. Our 20 current HVOCs are overworked. Each of
our regional offices that currently has an HVOC will receive a second
HVOC to assist with workload and help sustain our efforts to date. The
remaining 180 FTE will be placed in areas that have the highest
concentration of at-risk and homeless Veterans throughout the country.
VBA will also consider other factors such as Veteran population,
population density, and workload.
c. Please provide the Committee with copies of any veteran
homelessness needs assessment demonstrating the need for these specific
outreach coordinators and that current VA resources in place are not
adequate to address the needs.
Response. VBA is targeting our efforts to reach areas that have a
higher concentration of homeless women, have higher foreclosure rates,
and are rural.
Question 11. In 2009, 2010, and 2011, VA's Board of Veterans'
Appeals published a Veterans Law Review.
a. During fiscal year 2011, how much was spent on the operation and
publication of the Veterans Law Review?
Response. In fiscal year 2011, the total expenditure to publishthe
Veterans Law Review was $23,127.60, spent almost entirely on printing
costs.
b. During fiscal year 2012, how much is now expected to be spent on
operation and publication of the Veterans Law Review?
Response. In fiscal year 2012, the estimated expenditures to
publish the Veterans Law Review (again almost entirely for printing
costs) are approximately $24,500.
c. During fiscal year 2013, how much is requested for purposes of
operating and publishing the Veterans Law Review?
Response. In fiscal year 2013, the requested expenditures for
publication of the Veterans Law Review (again almost entirely for
printing costs) are approximately $26,000.
Question 12. The December 2010 report from the National Commission
on Fiscal Responsibility and Reform included a recommendation to reduce
Federal spending on travel, printing, and vehicles.
a. During fiscal year 2012, how much in total is projected to be
expended by VA on travel costs; how much in total is projected to be
expended on printing costs; and how much in total is projected to be
expended to purchase, lease, operate, or maintain vehicles?
b. For fiscal year 2013, how much in total is requested for travel
costs; how much in total is requested for printing costs; and how much
in total is requested to purchase, lease, operate, or maintain
vehicles?
Response. [These questions are repeated in and answered posthearing
questions, section GENERAL, Question 5.]
Question 13. According to VA's Fiscal Year 2011 Performance and
Accountability Report, VA has ordered 25 electric vehicles in order to
conduct a ``pilot study.''
a. What make and model of electric vehicles were ordered, what was
the total cost to VA to purchase or lease these vehicles, and what was
the total cost to the Federal Government (if different)?
Response. VA is currently scheduled to receive 26 electric vehicles
(EVs) through the General Services Administration's (GSA) EV pilot
program:
5 Think City vehicles
1 Nissan Leaf
20 Chevrolet Volts
VA is paying the same lease cost for these EVs as for a standard
vehicle of a similar class. GSA's pilot program funding covers the
incremental costs of the electric vehicles and the acquisition cost of
charging stations for the participating agencies. Agencies only pay for
the costs associated with installing the charging station at the EV
site.
GSA would have information on the cost to purchase or lease these
vehicles both for VA and Federal-wide.
b. For fiscal year 2013, how much in total is requested for
purposes of this initiative?
Response. No funding is requested
c. How and where will these vehicles be used?
Response. Most of the vehicles are assigned to VHA facilities in
the San Francisco, San Diego, Los Angeles, Detroit and Washington/
Baltimore metropolitan areas. One additional vehicle is assigned to VBA
in Detroit. VA is deploying each vehicle to the most appropriate use at
the selected locations. For example, how the vehicle is used depends on
the distance that needs to be traveled, the number of people that must
be accommodated, whether or not equipment and/or other supplies are
being moved and other related factors.
d. What are the specific objectives of the pilot study and what
benchmarks will be used to determine whether it is successful?
Response. The pilot study is a GSA initiative. GSA's stated
objectives are to determine if EVs are a cost effective option for
Federal fleets, and where and for what kinds of uses. GSA is collecting
data electronically from the charging stations and from the agencies
leasing the vehicles.
e. Please provide copies of the Executive Decision Memorandum (or
comparable document) approving the pilot study and supporting documents
of justification and implementation.
Response. The pilot study is a GSA program in which VA, along with
other Federal departments and agencies, is a participant. VA does not
have access to GSA internal support and approval documentation.
f. What cost comparisons were performed to assess the differential
between the costs of operating an electric vehicle fleet versus other
types of vehicle fleets (gasoline, natural gas, or hybrid)? Please
provide any documentation comparing the costs of electric vehicles with
other types of vehicles (gasoline, natural gas, or hybrids).
Response. Under this pilot, GSA pays all operating expenses for
leased vehicles in their fleet regardless of fuel type.
Question 14. According to VA's Fiscal Year 2011 Performance and
Accountability Report, VA is ``noncompliant with the Debt Collection
Improvement Act of 1996'' because VA does not charge interest or
administrative costs on delinquent debts owed to VA. VA has previously
explained to the Committee that, ``in 1992, the Deputy Secretary of
Veterans Affairs made a decision not to implement the statutory
interest and administrative charges on Compensation and Pension
debts.'' VA has also indicated that ``[t]he majority of debts created
for compensation are due to beneficiary death, incarceration and
fugitive felons.''
a. What is the legal authority relied upon by VA to forego
collecting interest and administrative costs with respect to delinquent
debts?
Response. Please see the decision paper below, which was signed by
then Deputy Secretary Principi in 1992.
b. What is the total amount of debt to VA created in fiscal year
2011 as a result of VA beneficiaries being incarcerated or having
fugitive felon status?
Response. VA tracks fugitive felon and incarcerated beneficiary
cases by year of referral to the field for processing rather than by
year of debt establishment. Although we are not able to provide the
specific debt amounts created by year, we estimate (based on case
tracking and sampling) the average annual amount of debt created for
the years 2003 through 2010 to be $32,121,505.
c. What is the total amount of debt to VA expected to be created in
fiscal year 2012 and in fiscal year 2013 as a result of incarceration
of beneficiaries or beneficiaries deemed to be fugitive felons?
Response. We do not project any significant change. The numbers of
cases referred in recent years have remained constant or declined.
d. If VA assessed interest and administrative costs, in accordance
with the Debt Collection Improvement Act of 1996, on any of those debts
that are or are projected to be delinquent, what would be the total
amount of those assessed charges in fiscal year 2012 and fiscal year
2013?
Response. VA systems are not programmed to handle the charging of
interest and administrative fees. VA is therefore not currently able to
estimate the amount of interest or administrative charges on current or
projected delinquent debt with any degree of accuracy.
Question 15. With respect to VA's fiscal year 2012 budget request,
VA was asked whether the budget request included ``funding for benefits
that are projected to be overpaid and not recouped.'' In response, VA
indicated in part that, ``[a]lthough there is no specific line item for
overpayments in the budget request for the Compensation and Pension
account, these payments are accounted for in the baseline budget
estimates and are not identified as funds that VA does not expect to
recoup.'' VA also indicated that for fiscal year 2012 the Readjustment
Benefits account included ``a net increase of $7.2 million in
obligations associated with overpayments.''
a. For fiscal year 2012, what is the total amount of benefits now
projected to be overpaid?
Response. For Compensation/Pension benefits, we provide the
following projections, which detail the FY beginning balance,
establishments, collection/offsets, write-offs and the ending balance.
(Dollars in millions)
Beginning Balance.......................................... $1,138.7
Establishments............................................. $870.0
Collections/Offsets........................................ $649.1
Write-Offs................................................. $233.0
------------
Ending Balance............................................. $1,126.6
============
Collections/offsets are reflected as a total applied to the entire
portfolio rather than just against new establishments.
Readjustment projections are as follows:
(Dollars in millions)
Beginning Balance.......................................... $334.6
Establishments............................................. $594.0
Collections/Offsets........................................ $557.5
Write-Offs................................................. $12.3
------------
Ending Balance........................................... $358.8
============
Collections/offsets are reflected as a total applied to the entire
portfolio rather than just against new establishments.
b. For fiscal year 2013, what amount is included in the
Readjustment Benefits account for overpayments of benefits?
Response. Please see the response to 15c.
c. For fiscal year 2013, what amount is included in the
Compensation and Pension account (including any amounts in the budget
baseline) for overpayments?
Response. In the recalculation for the FY 2013 President's Budget
request, the Readjustment Benefits account is projecting a net increase
of $24.2 million in obligations associated with overpayments in FY 2012
and $15.2 million in FY 2013. These projections are based on historical
trends and updated each budget cycle. While obligations for the net
increase are incorporated into the budget, these amounts may be
collected in the future and are not identified as funds that VA does
not expect to recoup. Although there is no specific line item for
overpayments in the budget request for the Compensation and Pension
account, these payments are accounted for in the baseline budget
estimate and are not identified as funds that VA does not expect to
recoup.
Question 16. VA's Fiscal Year 2011 Performance and Accountability
Report contains the following information:
One cause of overpayments in both the Compensation and Pension
programs has been the implementation of the Fugitive Felon
program. This program * * * prohibits Veterans or their
dependents who are fugitive felons from receiving specified
Veterans' benefits. The law requires VA to retroactively
terminate awards to Veterans and other beneficiaries from the
date the beneficiary became a ``fugitive felon.'' As of
January 2011, nearly 23,000 fugitive felon cases have been
referred to field stations resulting in a total of nearly $165
million accumulated overpayments which cover multiple warrant
years. VA's Committees on Waivers and Compromises had waived
nearly $22 million in overpayments.
a. To date, how many current or former fugitive felons have had
their overpayments to VA waived?
Response. VA has waived 751 overpayments from 2003 through the end
of 2010.
b. To date, what is the total dollar amount of overpayments to
fugitive felons that have been waived?
Response. The annual average amount of debt waived for the years
2003 through 2010 is estimated to be $2,222,314. Although VBA's current
systems do not allow tracking of waivers at the level of detail to
report actual amounts waived, VA is working to enhance its corporate
systems to support processing and collection of additional financial
and debt data. These system enhancements are projected for completion
within the next 2 years.
c. For fiscal year 2013, what amount is included in the budget
request in order to waive recoupment of overpayments to fugitive
felons?
Response. There is not a specific line item for overpayments in the
budget request for the Compensation and Pension account. The
Compensation and Pension budget model projects caseload, obligations,
and outlays over ten years. Compensation payments are based on combined
degree of disability, and Veterans often receive compensation for
multiple injuries or diseases. Budget forecasts are based on combined
degrees of disability.
Question 17. Under current law, VA is required to reduce, but not
terminate, the compensation payments to certain beneficiaries who have
been incarcerated for more than 60 days.
a. What was the total amount of VA benefits paid to incarcerated
beneficiaries during fiscal year 2011?
Response. Incarcerated Veterans are entitled to a portion of their
benefit payments. Although VA is not able to calculate the actual
amount of benefits paid to incarcerated beneficiaries in FY 2011, we
estimate that $2.6 million was paid based on data from September 30,
2011. At that time, 2,013 incarcerated Veterans were in receipt of
compensation payments. This includes 1,452 Veterans service-connected
in excess of 10 percent as well as 561 Veterans service-connected at 10
percent (or zero percent service-connected and entitled to compensation
under 38 CFR 3.317). Veterans service-connected in excess of 10 percent
received compensation at the 10 percent rate ($123 monthly), and
Veterans service-connected at 10 percent received half of their
compensation at the 10 percent rate ($61.50 monthly). If the number of
incarcerated beneficiaries did not change through FY 2011, VA would
have paid approximately $2.6 million to these Veterans.
b. What is the total amount of VA benefits expected to be paid to
incarcerated beneficiaries during fiscal year 2012?
Response. Please see the response to 17c.
c. What is the total amount included in the fiscal year 2013 budget
for VA benefits expected to be paid to incarcerated beneficiaries?
Response. The Compensation and Pension budget model projects
caseload, obligations and outlays over ten years. Budget forecasts are
based on combined degrees of disability. Although payments to
incarcerated beneficiaries are accounted for in the baseline budget
estimate, specific benefit payments to incarcerated Veterans are not
uniquely identified and forecasted.
Question 18. According to VA's Fiscal Year 2011 Performance and
Accountability Report, VA paid $45 in interest penalties per million
dollars disbursed during 2011.
a. In total, how much did VA pay in interest penalties during
fiscal year 2011?
Response. In total, VA paid $684,778.78 in interest penalties
during fiscal year 2011 while disbursing over $15.1 billion in
payments.
b. In total, how much does VA expect to pay in interest penalties
during fiscal year 2012?
Response. Based on actual interest paid through February 2012, VA
expects to pay $732,584 in interest penalties during fiscal year 2012
while disbursing an estimated $15.9 billion in payments.
c. In total, how much is included in the fiscal year 2013 budget
request in order to pay for interest penalties?
Response. In accordance with the Prompt Payment Act regulations at
5 CFR 1315.10(b)(5), VA did not include interest penalties in the
fiscal year 2013 budget request. Interest penalties are paid from funds
for the program for which the penalty is incurred.
Question 19. VA's Central Office houses a number of different
entities, including the Office of the Secretary, the Office of
Congressional and Legislative Affairs, the Office of Public and
Intergovernmental Affairs, and other support offices.
a. How many employees currently are assigned or detailed to each of
these respective entities within VA's Central Office? Please identify
the status of those employees as permanent or detailed; career or non-
career; and GS, SES or SES Equivalent, or other pay scale. Please
identify the locations (VISNs, VA medical centers, Veterans Benefits
Administration Regional Offices, etc.) from where these employees are
being detailed.
b. If VA's fiscal year 2013 budget request is adopted, how many
full-time equivalents would VA expect to be assigned or detailed from
outside VA's Central Office to VA's Central Office during fiscal year
2013?
Response. [These questions are repeated in and answered posthearing
questions, section GENERAL, Question 7.]
Question 20. For the period October 1, 2010, thru December 31,
2011, please provide a listing (without names or other personal
identifiers) of those VA employees who have been approved to receive,
or have received, Recruitment, Relocation and/or Retention Incentives.
It is requested that the listing include the employee's grade (SES, SES
Equivalent, title 38, GS, etc.); duty station (VA Central Office, VA
Field location--VISN, VA medical center, Veterans Benefits
Administration Regional Office, etc.). Please list the amount approved
for each Incentive category.
a. For those receiving Relocation Incentives, please list the
losing and receiving duty station/location.
Response. The embedded spreadsheet, below, is a listing of
individual Recruitment, Relocation and Retention Incentives paid from
October 1, 2010 through December 31, 2011, by grade. Losing and
receiving duty stations/locations cannot be reported due to system
limitations. Incentives payments have been attributed to the
Administration or Staff Office where the individual was employed on the
date the information was extracted from the Personnel Accounting
Integrated Database (PAID) system. In the case of internal VA employee
transfers, the incentive may actually have been paid by a different
Administration or Staff Office prior to the transfer.
[This extensive information was received and is being held in
Committee files.]
b. For those receiving Retention Incentives, please identify the
level of approving official (i.e., Secretary, Deputy Secretary, Chief
of Staff, Under Secretary, Assistant Secretary, VISN/VA medical center/
Regional Office Director, etc.).
Response. VA does not maintain a central electronic file that
identifies the approving official for each employee's retention
incentives. This information is in locally maintained paper files and
would require several months to compile.
VA Handbook 5007, Pay Administration, Part VI, Recruitment and
Retention Incentives, documents VA's policy as follows:
``a. Retention allowances must be approved by an official at
a higher level than the one recommending the payment. The
authorizing official's signature signifies concurrence with the
determination that an allowance is needed to retain a critical
VA employee and authorization of the allowance percentage.
``b. The Secretary, or designee, is the approving official
for retention allowances for employees occupying positions
centralized to that office.
``c. Administration Heads, Assistant Secretaries, Other Key
Officials, and Deputy Assistant Secretaries, or their
designees, recommend retention allowances for employees
occupying positions in their organization which are centralized
to the Secretary. They, or their designees, approve retention
allowances for employees occupying Central Office (VACO)
positions in their organizations, which are not centralized to
the Secretary; and employees occupying field positions
centralized to their offices.
``d. Facility directors may approve retention allowances for
title 38 and title 5 employees in non-centralized positions
under their jurisdiction provided that the amount of the
allowance, when combined with all other VA payments, does not
cause an employee's total pay to exceed the aggregate limit on
pay.''
The Department is currently updating the incentives policy to
reflect higher levels of approval.
c. For those receiving Retention Incentives within the VA Central
Office, please further identify the specific office (i.e., Office of
Public and Intergovernmental Affairs, VHA Deputy Undersecretary for
Health for Operations and Management (DUSHOM), Veterans Benefits
Administration Compensation and Pension Service, Office of the
Secretary, etc.).
Response. The table below is a summary of Central Office Retention
Incentives paid from October 1, 2010 through December 31, 2011, by
Staff Office and Administration.
d. For those receiving Retention Incentives, please identify, where
applicable, whether the Incentive was being offered because (1) the
employee was likely to leave because of retirement; (2) the employee
indicated an intent to leave for a different Federal position; or (3)
of another authorized reason.
Response. VA does not maintain a central electronic file
documenting the approved reasons for each employee's retention
incentives. This information is in locally maintained paper files and
would require several months to compile.
The Code of Federal Regulations at 5 CFR 575.307 requires VA to
establish the required documentation for determining that an employee
would be likely to leave the Federal service in the absence of a
retention incentive. VA Handbook 5007, Pay Administration, Part VI,
Recruitment and Retention Incentives, documents VA's policy as follows:
``Evidence that the Employee is Likely to Leave Federal
Employment. Each supervisor shall make a separate certification
that an employee, or for group authorizations, a significant
number of employees in the group, is likely to leave Federal.
This certification will only be made when the supervisor is
reasonably convinced that the employee is likely to leave
Federal service. Such a certification may be based on:
``(1) Receipt by an employee, or for group authorizations, a
significant number of employees, of one or more bona fide
offers of employment, as evidenced by a formal written job
offer or affidavit signed by the employee or employees
providing the position and salary being offered, the name and
location of the organization, and the prospective date of
employment; or
``(2) Evidence of high demand in the private sector for the
knowledge and skills possessed by the employee or group of
employees and significant pay disparities between Federal and
non-Federal salaries; or
``(3) A discussion with the employee of the employee's career
plans.''
A supervisor's certification documenting the reason for determining
the likelihood of an employee leaving Federal employment should be
included in each retention incentive case file. However, VA's OIG
November 14, 2011, audit of retention incentives for VHA and VA Central
Office cited case files that lacked documentation to support VA
retention incentive decisions, including supervisors' certifications
that the employees were likely to leave Federal service in the absence
of monetary incentives were missing from some files. VA senior
officials concurred with OIG report recommendations and provided
acceptable corrective action plans which are currently being
implemented.
Employees who intend to leave VA for another Federal position may
be granted a retention incentive only if VA has provided a general or
specific written notice that the employee's position may or would be
affected by the closure or relocation of the employee's office,
facility, activity, or organization, per 5 CFR 575.315(b)(3).
Question 21. Last year, VA was unable to provide the Committee with
information concerning the percentage and number of contracts awarded
by VA's Central Office to service-disabled veteran owned small
businesses (SDVOSBs) and veteran owned small businesses (VOSBs). VA
indicated that a data analysis of VA's service contracts was underway,
preventing a complete response.
a. Based on that data analysis, please provide the Committee with
the percentage and number of contracts awarded by VA's Central Office
to SDVOSBs and VOSBs.
Response. The information follows:
b. Please provide the Committee with details (type, amount, and
purpose) of the current contracts awarded to SDVOSB/VOSBs by VA's
Central Office. Also, please itemize this data by individual offices
within VA's Central Office.
Response. The spreadsheet for questions a and b follows:
Question 22. In the last year, the VA Center for Veterans'
Enterprise (CVE) has been working on eliminating the backlog of SDVOSBs
and VOSBs awaiting certification of their statuses in order to begin
bidding on VA set-aside contracts.
a. How does CVE measure the effectiveness of its communications
with SDVOSBs and VOSBs during the verification process?
Response. Although this is not currently being measured, VA
believes that this will be useful going forward. The CVE Strategic
Communication Plan, which is being developed, will use a number of
tools to measure the effectiveness of its communications with SDVOSBs
and VOSBs. These tools include, but are not limited to, call center
volume, Congressional correspondence volume, telephone and e-mail
surveys, the percentage of initial applications that are denied, the
percentage of initial denials that are overturned, and direct feedback
from Veterans during focus groups and presentations at conferences,
workshops, and other venues attended by CVE leadership.
b. Please provide the Committee with the current number of
companies awaiting verification and the current average time companies
have been awaiting verification once all documents have been submitted
and verified by CVE.
Response. As of April 11, 2012, there are 1,143 companies with
complete applications awaiting verification. The average processing
time for these applications is 61 days.
Question 23. Last year, the Committee learned that VISN 20
contracted with a company called Values Coach, Inc., for $394,000. In a
response to an inquiry from the Committee, VA indicated that VISN 20
hired Values Coach to design a program ``to enhance performance in the
area of customer satisfaction.''
a. For fiscal year 2012, how much was spent across all VISNs on
customer services contracts to enhance customer satisfaction?
b. For fiscal year 2013, how much will be spent across all VISNs on
customer services contracts to enhance customer satisfaction?
c. For the VISN 20 Values Coach contract, please describe the
metrics used to determine whether customer satisfaction changed as a
result of this contract.
d. Please provide a detailed description of the process required to
secure contracts for customer service training to enhance customer
satisfaction.
e. Does the Federal Government (VA, Office of Personnel Management,
etc.) provide coaching services which would train Federal employees to
improve their customer service skills? If so, please describe the
program(s) in detail.
Response. [These questions are repeated in and answered posthearing
questions, section GENERAL, Question 9.]
Question 24. The VA Office of Human Resources and Administration
produced the ``VA Organizational Briefing Book, June 2010.'' Within the
handbook there is a chart reflecting the ``Organization of the
Department of Veterans Affairs.'' The handbook then discusses the
mission, scope, and functions of each subordinate office within VA that
is reflected on the chart. Associated with each subordinate office is a
chart reflecting the respective organizational make-up. Since
June 2010, there have been a number of office reorganizations.
a. Please provide an up-to-date chart for each office that has
undergone any reorganization since the publication of the 2010
handbook. Please note the effective date of the reorganization on the
chart, as well as the total full-time equivalents (SES/SES Equivalent,
GS, career or non-career) assigned to the office as of February 13,
2012.
Response. In November 2011, the Department began an extensive
process to review, revise and update information related to
organizational structures, mission, functions and tasks. Updated
documents will be posted on the VA's Web site when this process is
complete.
b. Please identify any offices currently undergoing reorganization
and the anticipated completion date for the reorganization.
Response. In November 2011, the Department began an extensive
process to review, revise and update information related to
organizational structures, mission, functions and tasks. Updated
documents will be posted on the VA's Web site when this process is
complete.
Question 25. VA has a number of tools available to assist veterans
from losing homes guaranteed through the VA home loan program. In the
unfortunate instances these programs do not work and a veteran goes
into foreclosure or default, VA is required to reimburse the holder of
the mortgage for up to 25% of the purchase price. In order to avoid
incurring large costs to the Loan Guaranty Service and taxpayers, VA
has the authority to purchase the properties from the banks and later
sell the properties instead of paying the guaranty.
VA Clarification: The formula prescribed in 38 U.S.C. Sec. 3732 for
determining how much VA reimburses the holder of the mortgage are more
complex than the process stated in the question. Prior to a foreclosure
on property securing a GI Loan, a VA fee panel appraiser determines the
property's fair market value. This appraisal is reviewed either by the
servicer's certified appraisal reviewer or by VA appraisal staff. To
determine the net value of the property, VA reduces the property's fair
market value by the established cost factor that reflects VA's
estimated loss on property resale and VA's estimated costs for
acquisition, management and disposition of the property.
A holder of a defaulted GI Loan may elect to convey the property to
VA if the net value is greater than the difference between (a) the
total indebtedness represented by the defaulted GI Loan and (b) VA's
maximum guaranty obligation for the GI Loan. Conversely, if the net
value of the property is less than that difference, the holder
generally will have no such option to convey the property to VA, and VA
will pay the guaranty amount to the holder, who will retain title to
the property.
The conveyance of the property does not substitute for the guaranty
liability. The amount of guaranty payment is based on variables such as
net value, total indebtedness, and the foreclosure sale amount.
a. Please provide the number of homes the VA Loan Guaranty Service
has taken possession of during the last five years.
Response. Between October 1, 2006, and September 30, 2011, VA's
Loan Guaranty Service acquired 61,024 properties.
b. How much has VA spent to acquire properties in the last five
years, and how much has VA recouped in sales of those attained property
assets?
Response. VA paid $6.3 billion to acquire 61,024 properties. VA has
recouped $5.3 billion in sales of 59,109 acquired properties during the
same time period.
c. Of the properties that VA has acquired over the last five years,
please detail the number of those properties VA still holds.
Response. As of September 30, 2011, VA had an inventory of 7,038
properties acquired within the last five years.
d. Please detail the plan to dispose of the remaining properties
held by VA.
Response. VA has a management and marketing contract with a
property management service provider, currently Bank of America, to
accept new property assignments and to manage, market, and dispose of
the existing inventory. This has resulted in a decline in the overall
inventory of properties from 10,521 on January 1, 2011, to 7,123 on
September 30, 2011; 7,038 of the total inventory on September 30, 2011
were boarded between October 1, 2006 and September 30, 2011. VA will
continue through its management and oversight of this contract to
reduce this inventory.
Question 26. In the fiscal year 2013 budget request, the National
Cemetery Administration (NCA) proposed a new initiative to expand
burial access to rural communities. The proposal is ``to establish a
national cemetery presence * * * where the Veteran population is less
than 25,000 within a 75-mile [radius].''
a. What are NCA's estimates for usage and burial?
Response. Interment projections in the below table are based on an
analysis of a sample of cemeteries in similar rural locations. More
precise estimates will be determined based on actual usage.
b. The fiscal year 2012 appropriation language requires NCA to
develop cost estimations for five rural cemeteries. Of the eight states
included on the initial list for the new rural initiative, how many
areas within each state meet all the current requirements as proposed
by the rural initiative (population, distance, and lack of current
burial options)?
Response. The table below lists county/city pairs in each of the
eight states. Each city represents a potential focal point for
establishing a National Veterans Burial Ground and meets the criteria
for the Rural Veterans Burial Policy, i.e., there is no open national
cemetery serving Veterans in the state and no more than 25,000
Veterans, who do not have reasonable access to a burial option in a
national or state Veterans cemetery, reside within 75 miles of the
focal point. The area selected within each state for a National
Veterans Burial Ground contains the largest number of Veterans up to
the 25,000 threshold.
----------------------------------------------------------------------------------------------------------------
State County City
----------------------------------------------------------------------------------------------------------------
Idaho Twin Falls Twin Falls
----------------------------------------------------------------------------------------------------------------
Idaho Lemhi Salmon
----------------------------------------------------------------------------------------------------------------
Idaho Teton Idaho Falls
----------------------------------------------------------------------------------------------------------------
Maine Penobscot Millinocket
----------------------------------------------------------------------------------------------------------------
Maine Washington St. Stephen
----------------------------------------------------------------------------------------------------------------
Montana Flathead Kalispell
----------------------------------------------------------------------------------------------------------------
Montana Blaine Lewistown
----------------------------------------------------------------------------------------------------------------
Montana Valley Glasgow
----------------------------------------------------------------------------------------------------------------
Montana Beaverhead Dillon
----------------------------------------------------------------------------------------------------------------
Montana Yellowstone Laurel
----------------------------------------------------------------------------------------------------------------
Nevada Humboldt Winnemucca
----------------------------------------------------------------------------------------------------------------
Nevada White Pine Ely
----------------------------------------------------------------------------------------------------------------
Nevada Esmerelda Tonopah
----------------------------------------------------------------------------------------------------------------
Nevada Elko Elko
----------------------------------------------------------------------------------------------------------------
North Dakota Ramsey Devils Lake
----------------------------------------------------------------------------------------------------------------
North Dakota Mountrail Stanley
----------------------------------------------------------------------------------------------------------------
North Dakota Bowman Bowman
----------------------------------------------------------------------------------------------------------------
North Dakota Cass Fargo
----------------------------------------------------------------------------------------------------------------
Utah Sevier Richfield
----------------------------------------------------------------------------------------------------------------
Utah San Juan Blanding
----------------------------------------------------------------------------------------------------------------
Utah Uintah Vernal
----------------------------------------------------------------------------------------------------------------
Utah Iron Cedar City
----------------------------------------------------------------------------------------------------------------
Wisconsin Marinette Marinette
----------------------------------------------------------------------------------------------------------------
Wisconsin Oneida Rhinelander
----------------------------------------------------------------------------------------------------------------
Wyoming Sweetwater Rock Springs
----------------------------------------------------------------------------------------------------------------
Wyoming Park Cody
----------------------------------------------------------------------------------------------------------------
Wyoming Sheridan Sheridan
----------------------------------------------------------------------------------------------------------------
Wyoming Laramie Cheyenne
----------------------------------------------------------------------------------------------------------------
c. Of the eight states that meet the initial criteria for the new
rural initiative, have any filed paperwork or are awaiting approval for
a state cemetery grant?
Response. Idaho has received and accepted an opportunity offer for
an expansion grant at Idaho State Veterans Cemetery in Boise. The State
is currently working on requirements for funding in 2012.
Montana has received and accepted an opportunity offer for an
expansion and improvement grant for Western Montana Veterans Cemetery
in Missoula and is currently working on requirements for funding in
2012. Another improvement grant for Montana State Veterans Cemetery in
Helena is in the project inventory.
Nevada received an expansion and improvement grant in 2011 for
Southern Nevada Veterans Cemetery in Boulder City. Construction is in
progress. The State has received and accepted an opportunity offer for
an expansion grant for the same cemetery and is currently working on
requirements for funding in 2012. An additional operations and
maintenance grant for the cemetery is in the project inventory. One
grant pre-application for establishment of a cemetery in Fallon has
been submitted but requires matching funds before being considered.
North Dakota was awarded an operations and maintenance grant in
2011 for North Dakota Veterans Cemetery in Mandan.
Maine was awarded two grants in 2011. One was an expansion Grant
for Southern Maine Veterans Cemetery in Springvale. Construction is in
progress. The other was an operations and maintenance grant for Maine
Veterans' Memorial Cemetery Civic Center Drive in Augusta. An
improvement grant for Maine Veterans' Memorial Cemetery Mt. Vernon Road
in Augusta, ME, is in the project inventory. Another improvement grant
pre-application for Northern Maine Veterans' Cemetery in Caribou needs
matching funds before being considered for funding.
Utah had two grants funded in 2011 for Utah State Veterans Cemetery
in Bluffdale. One was an operations and maintenance grant. The other
was an expansion and improvement grant.
Wisconsin has one operations and maintenance grant for Southern
Wisconsin Veterans Memorial Cemetery in Union Grove, WI, that is in the
project inventory.
Wyoming has received and accepted an opportunity offer for an
operations and maintenance grant for Oregon Trail Veterans Cemetery in
Evansville and is currently working on requirements for funding in
2012. Another improvement grant for the same cemetery is in the project
inventory.
Please note that the service area for each proposed National
Veterans Burial Ground does not overlap with a planned or existing
State or Tribal cemetery.
d. According to the fiscal year 2013 budget request, 89% of
veterans were served by a burial option within 75 miles of their
residence in 2011. Of the remaining veterans not served by a burial
option within 75 miles, how many live in the eight states meeting the
initial criteria for the rural initiative? Please detail the
information by state.
Response. Note: These numbers include Veterans expected to be
served by the eight new National Veterans Burial Grounds since they are
not included in the 89% of Veterans currently served.
------------------------------------------------------------------------
Unserved
State Veterans
------------------------------------------------------------------------
Idaho............................................ 54,092
Maine............................................ 7,806
Montana.......................................... 34,594
Nevada........................................... 13,690
North Dakota..................................... 42,962
Utah............................................. 35,687
Wisconsin........................................ 42,654
Wyoming.......................................... 46,607
-----------
Total*......................................... 278,092 1.30%
------------------------------------------------------------------------
* As of 9/30/11
Question 27. During the first session of the 112th Congress, the
Senate Committee on Veterans' Affairs held two hearings on issues
within VA's mental health program. The hearings highlighted the
problems veterans face in accessing needed on-going treatment in mental
health clinics. These hearings also probed the results of a VA survey
of Veterans Health Administration mental health providers who revealed
the problem with veterans accessing care. How does the fiscal year 2013
budget address the issues relating to wait times for appointments, a
lack of availability of follow-up appointments, staffing shortages, and
lack of space in the mental health clinics which were raised in the
Committee hearings?
Response. VA's 2013 budget provides $6.2 billion for mental health
care, an increase of $450 million, or 12 percent, over the FY 2011
enacted level. Over the four-year period from 2009 through 2012, VA
will have spent $21.0 billion on mental health care. VA is expanding
mental health programs and is integrating mental health services with
primary and specialty care thus providing better coordinated care for
our Veteran patients.
On April 19, 2012, VA announced the department would add
approximately 1,600 mental health clinicians--to include nurses,
psychiatrists, psychologists, and social workers as well as nearly 300
support staff to its existing workforce of 20,590 mental health staff
as part of an ongoing review of mental health operations. VA's ongoing
comprehensive review of mental health operations has indicated that
some VA facilities require more mental health staff to serve the
growing needs of Veterans. VA is moving quickly to address this top
priority. Based on this model for team delivery of outpatient mental
health services, plus growth needs for the Veterans Crisis Line and
anticipated increase in Compensation and Pension (C&P)/Integrated
Disability Evaluation System (IDES) exams, VA projected the additional
need for 1,900 clinical and clerical mental health staff at this time.
As these increases are implemented, VA will continue to assess staffing
levels.
On April 24, 2012, VA announced that it has expanded its mental
health services to include professionals from two additional health
care fields: marriage and family therapists (MFT) and licensed
professional mental health counselors (LPMHC).
The two fields will be included in the hiring of an additional
1,900 mental health staff nationwide mentioned above. Recruitment and
hiring will be done at the local level. The new professionals will
provide mental health diagnostic and psychosocial treatment services
for Veterans and their families in coordination with existing mental
health professionals at VA's medical centers, community-based
outpatient clinics, and Vet Centers.
VA has developed qualification standards for employment as LPMHCs
and MFTs and has announced the appointments of mental health and health
science professionals to serve on professional standards boards. The
boards will review applicants for LPMHC and MFT positions in the
Veterans Health Administration (VHA) to determine eligibility for
employment and the government grade level appropriate for the
individual in the selected position. The boards will also review
promotions in these positions.
In FY 2012, VA is following up on the issues raised by the query of
mental health professionals with the Mental Health Action Plan, which
focuses on actions in four areas.
To address scheduling issues, VHA conducted an internal
review of the mental health scheduling process and is also providing
continuing support for the OIG review of the mental health scheduling
process. VHA has added new performance measures in FY 2012 to allow
VISN/VACO leadership to identify and improve processes that impact
timeliness for facilities that are not currently providing timely
follow up for Veterans discharged from inpatient mental health care;
timely provision of enhanced care for Veterans identified at risk for
suicide; timely access to PTSD services; and timely access to eight
sessions of psychotherapy for OEF/OIF/OND Veterans with PTSD . During
FY 2012, VHA is developing additional measures to monitor access for
other types of mental health services for deployment in FY 2013.
Additional efforts are also aimed at improving the scheduling system
overall. The goal of the National Medical Scheduling initiative is to
replace VHA's existing scheduling system with one that allows VHA to
provide more Veteran-centric scheduling, to make the process easier and
more efficient for schedulers, and to more effectively manage
resources. VHA is currently reviewing responses to the Request for
Information (RFI) which was issued to assess the current market for
scheduling replacement options. Next steps may include use of a contest
to identify best practices and ultimately issuance of a Request for
Proposal (RFP).
To address staffing issues, VHA has developed and is
implementing a national mental health staffing model starting in FY
2012. Full implementation of the model will provide VISN/VHA leadership
with a national standard for staffing mental health services. In
conjunction with the utilization projection models used by VHA in
developing the budget requests, expected increases in demand for mental
health services are built into the budget request. Targeted increases
in staffing will be deployed in FY 2012 and FY 2013 as appropriate
based on the mental health staffing model. Additionally, targeted
increases will be provided to address staffing requirements for the
expected increase in C&P /IDES exams.
To address space shortages, VHA has requested that
facilities evaluate both short-term and long-term strategies. Because
of the length of time required to fully develop capital improvement
plans, facilities have identified short-term actions to improve
utilization of existing space such as use of off-hours scheduling, use
of telemental health, sharing of offices for administrative staff,
reallocation of space from programs that have decreased demand to
programs that are increasing in demand as well as planned capital
improvements or minor renovation projects that will open in FY 2012/
2013. Long-term plans include prioritization of capital improvement
plans for mental health space needs and/or leasing space in the FY 2014
SCIP planning cycle. New space and renovations for mental health is a
critical element in the prioritization process for the SCIP process,
with projects supporting mental health needs ranking in the second
highest criteria--Secretarial priorities; safety is the first criteria.
This has been the mental health ranking for the past two SCIP
prioritization cycles, and it is anticipated to remain as such in the
FY 2014 process as well. With this designation in the priority ranking,
a large amount of funding has been and continues to be targeted toward
mental health projects or projects that potentially include mental
health facets. In fact, for VHA's FY 2012 and FY 2013 budgets, mental
health specific projects represent over 13 percent and mental health
plus potential mental health projects represent over 25 percent of the
planned funding with the appropriated and requested budgets ($321
million and $623 million, respectively, out of $2.51 billion.)
To ensure continued identification and improvement to
address barriers to access for mental health care, VHA has initiated
additional quality improvement processes, including the use of site
visits to all VHA health care systems in FY 2012, to collaborate with
facilities/VISNs in identifying opportunities for improvement in care
and best practices for dissemination throughout VA in the provision of
care. The site visits to review mental health programs at all VHA
health care systems are currently in process and are scheduled to be
completed by September 30, 2012. Selected follow-up visits will be
schedule for FY 2013. In FY 2012, VHA is also developing a staff survey
and a Veteran survey for use by facilities in obtaining routine
feedback about perceived barriers to care from front-line mental health
staff and Veterans using mental health services. Also in FY 2012, VHA
leadership has chartered a workgroup to review the mental health
program overall, identify gaps in care, and develop a plan to address
within FY 2012 and FY 2013.
Question 28. Within the President's fiscal year 2013 Budget
Submission, VA listed a ``VA Real Property Cost Savings and Innovation
Plan,'' reflecting savings of $66 million in fiscal year 2013 and $66
million in fiscal year 2014. VHA's portion purportedly includes a
number of initiatives to repurpose vacant and underutilized assets. VA
indicated it has ``identified 166 vacant or underutilized buildings to
repurpose for homeless housing and other initiatives.''
a. Please describe in detail the ``other initiatives'' being
considered by VA and the current status and manner of planning
(contract, internal VA, etc.) for each initiative.
Response. All buildings identified in this section of the VA Real
Property Cost Savings and Innovation Plan have been successfully out-
leased to 3rd parties, having been repurposed using VA's recently-
expired (December 31, 2011) Enhanced-Use Lease (EUL) Authority. While
VA does have other authorities and internal options for repurposing
assets, this section of the cost savings plan focuses on EULs
specifically, because they transfer operational costs to such 3rd
parties for an extended period of time, allowing operational cost
savings to occur while providing value to the VA, Veterans, and local
communities.
VA remains committed to the objective of the EUL program to
effectively leverage and manage its inventory of underutilized
properties through projects beneficial to Veterans, VA, Federal and
state governments, local communities, and American taxpayers. The
Administration will work with the Congress to develop future
legislative authorities to enable this Department to further repurpose
its underutilized properties.
The $66 million in savings is specific to VHA, but is not all
related to the repurposing of vacant or underutilized assets. VA
included other initiatives in the savings plan, such as savings from
green management actions and reductions in leasing, that contribute to
the overall $66 million savings for VHA. These savings will be realized
by the end of 2012 as required by the Presidential Memorandum of
June 2010 for disposing of unneeded Federal real estate. Savings in
2013 and 2014 would be recurring savings from the actions taken by the
end of 2012; no additional actions are included in the plan beyond 2012
in accordance with the Presidential Memorandum.
b. Please provide a list of the locations of these 166
underutilized assets; the proposed or planned purpose for each asset;
and the fiscal year in which the asset is expected to be repurposed to
achieve the purported savings.
Response. The requested information is included in the spreadsheet
below. This information includes permanent housing, transitional
housing, assisted living facilities, and nursing/long-term care
facilities.
Question 29. Following the fiscal year 2012 budget hearing, the
Committee asked a question relating to VA research into the ``health
conditions and risk factors that relate to homelessness and on the
effectiveness of VA homeless services.'' In VA's response, VA provided
the Committee with information about current studies underway and
stated that ``[w]e anticipate preliminary data on most of them to be
available by the end of [f]iscal [y]ear 2011, and final reports by the
end of [f]iscal [y]ear 2012.''
a. Please share any preliminary data VA may have from these
studies.
Response. VA recognizes the importance of studying and
understanding the homeless and at-risk of homelessness Veteran
population. To this end, VA is conducting several ongoing studies in
order to better understand the risk factors related to homelessness and
the effectiveness of VA homeless services. These studies have informed
and will continue to inform VA's strategy to end Veteran homelessness.
VA has already published some of the research findings from studies
that were ongoing during the FY 2012 budget hearings. For example, with
regard to research on homeless risk factors, VA and HUD collaborated on
the Veteran Homelessness: A Supplemental Report to the 2010 Annual
Homeless Assessment Report to Congress (Vet AHAR). The Vet AHAR
describes the extent and nature of homelessness among Veterans. The Vet
AHAR analyzes the demographic characteristics of homeless Veterans,
including race, ethnicity, gender, age, and disability status. These
characteristics are compared to those of other populations including
the non-Veteran homeless population, the total Veteran population, and
the population of Veterans living in poverty. These comparisons
highlight the higher risks of homelessness faced by Veterans,
particularly poor Veterans.
The Vet AHAR found that female Veterans are at especially high risk
of homelessness, and the risk increases considerably if the female
Veteran is impoverished. Female Veterans are more than twice as likely
to be homeless as female non-Veterans, and female Veterans in poverty
are more than three times as likely to be homeless as female non-
Veterans in poverty. Additionally, male Veterans are at a lower risk of
homelessness when compared to their non-Veteran counterparts; however,
male Veterans living in poverty are at greater risk of homelessness.
Furthermore, the prevalence of sheltered homelessness among minority
groups in poverty is very high. More than 18 percent of poor Hispanic/
Latino Veterans, 26 percent of poor African American Veterans, and 26
percent of poor American Indian and Alaska Native Veterans were
homeless at some point during 2010. Young Veterans (between the ages of
18 and 30) are also at high risk of using the shelter system,
especially young Veterans in poverty. Young Veterans are more than
twice as likely to be homeless as their non-Veteran counterparts, and
young Veterans in poverty are almost four times as likely to be
homeless than their non-Veteran counterparts in poverty. Last, homeless
Veterans are largely white men with a disability and between the ages
of 31 and 61. For more information, please find the Vet AHAR at the
following link.
http://www.va.gov/HOMELESS/docs/
2010_AHAR_Veterans_FINAL_10242011.pdf
Additionally, in August 2011, the VA National Center on
Homelessness among Veterans published a study entitled Prevalence and
Risk of Homelessness among U.S. Veterans: A Multisite Investigation.
The principal findings of this study indicate that Veteran status is
associated with a higher risk of homelessness and that a greater
proportion of Veterans were in the homeless population than in either
the general population or the population living in poverty. More
specifically, in terms of age, across the general homeless population
(Veterans and non-Veterans), males had the highest risk for
homelessness in the 45-54 year age group. For females, risk for
homelessness was highest among the 18-29 year age group and risk
declined as age increased. For more information, please find study at
the following link.
http://www.va.gov/HOMELESS/docs/Center/Prevalence_Final.pdf
VA continues to study the effectiveness of VA homeless services.
For example, the VA's National Center on Homelessness among Veterans is
completing a study on Veterans exiting the HUD-VA Supportive Housing
(HUD-VASH) Program and completing a study examining the effectiveness
of a pilot program implementing the Housing First Model at selected
HUD-VASH sites. Preliminary findings from the HUD-VASH Exit Study
reveal that male Veterans with substance use disorders are
disproportionally represented in the negative exits. Additionally,
chronically homeless Veterans admitted to HUD-VASH are able to maintain
housing at similar rates to the non chronic homeless population.
Finally, the most prevalent factor in a negative discharge was failure
to comply with the Landlord/Tenant lease agreements.
b. How has the preliminary data been used to ensure VA is providing
the needed services to reduce the number of homeless veterans?
Response. Throughout the course of these research studies, VA has
used the preliminary and now final data from Prevalence and Risk of
Homelessness among U.S. Veterans: A Multisite Investigation and the
preliminary and now final data from the Vet AHAR to inform VA's
strategic plan for the Ending Veteran Homelessness Initiative. VA
continues to carefully review all major research publications in the
field of homelessness as well as preliminary and finalized VA homeless
research data to ensure VA is effectively preventing and ending Veteran
homelessness.
c. Are the final reports still expected to be available at the end
of fiscal year 2012?
Response. VA is in the process of finalizing several studies and
reports on VA homeless programs and services. For example, VA is
finalizing a report examining the characteristics and trends of
Veterans exiting the HUD-VASH Program. VA is also examining the
effectiveness of the Housing First Model in the HUD-VASH Program by
examining trends, lease up rates, treatment engagement, and the impact
of housing on Emergency Room and acute hospitalization rates.
Question 30. The Secretary of Veterans Affairs recently announced
that the number of homeless veterans dropped by 12 percent from 2010 to
2011, bringing the approximate number of homeless veterans in 2011 to
67,495. Both the President and the Secretary attribute the improvement
to over a billion dollars invested in homeless initiatives by the
Federal Government. The fiscal year 2013 budget request indicates the
goal of reducing the number of homeless veterans to 35,000 in 2013.
a. Please describe what manner, means, and methods, if any, are
currently in place, or will be in place, to specifically identify the
homeless veterans who have been removed from the homeless count in
2011.
Response. The Secretary of VA and the Secretary of HUD announced
that the annual HUD Point in Time (PIT) count decreased by 12 percent
from 2010 to 2011, bringing the number of homeless Veterans on any
given night in 2011 to approximately 67,495. The decrease in the number
of Veterans identified through the PIT count is a positive indicator
that modest but significant gains have been made in reducing Veteran
homelessness. However, it is important to clarify that PIT data is self
reported de-identified data. VA cannot identify Veterans from the PIT
count who have exited homelessness.
b. If there are no tracking methods in place and coordinated and
utilized across VHA and the Veterans Benefits Administration, are there
any plans to develop such a tracking capability?
Response. Through its comprehensive Homeless Registry,VA can
identify homeless Veterans that have exited homelessness. The VA
Homeless Registry is a database and reporting system that provides
longitudinal Veteran-specific, identified information related to
homelessness and at risk for homelessness. The Homeless Registry
provides reports that detail the number of homeless Veterans entering
and exiting VA services including permanent housing. It can also
provide data regarding the Veteran's current engagement with VA
treatment and benefit services that are critical to helping Veterans
obtain and maintain permanent housing. Currently, the VA Homeless
Registry is in field testing, with intent to be fully deployed in
fiscal year 2012.
Additionally, future plans for the comprehensive VA Homeless
Registry include data matching and integration with HUD's Homeless
Management Information System (HMIS). HMIS is a software application
used by HUD-funded Homeless Continuums of Care (CoC) providers to
record and store client-level information on the characteristics and
service needs of homeless individuals and families. Once VA obtains the
appropriate data sharing agreements with the local CoCs, VA will have
an internal and external data system that can monitor prevalence rates
and program effectiveness for our Veterans. Although this full
integration is dependent on communities' willingness to share their
Veteran identified HMIS data with VA, HUD and VA are working closely
with local CoCs to make full data integration a reality.
Question 31. In fiscal year 2011, VA allocated $17 million for non-
recurring maintenance for correcting patient privacy deficiencies. In
the questions for the record following the fiscal year 2012 budget
hearing, VA provided a list of women's projects from the fiscal year
2012 Strategic Capital Investment Planning process.
a. Please provide an updated list of construction projects relating
to correcting patient privacy deficiencies.
Response. The information is in the spreadsheet that follows:
b. In fiscal year 2013, how much is requested to correct patient
privacy deficiencies? Also, please provide a list of facilities that
will receive funding in fiscal year 2013.
Response. New space and renovations for privacy and women's health
are critical elements in the prioritization process for our
construction programs, with privacy ranking in the top criteria under
safety and women's health ranking in the second highest criteria under
Secretarial priorities. As can be seen in the attached spreadsheet, a
significant amount of funding has been and continues to be targeted
toward privacy and women's health projects. In fact, for VHA's FY 2011
construction programs, privacy and women's health supported over 1/3 of
the available NRM and Minor funding ($884 million out of a total of
$2.5 billion); and privacy and women's health represents almost 60
percent of the planned projects with the appropriated and requested FY
2012 and FY 2013 budgets ($1.5 billion out of $2.51 billion).
[Refer to spreadsheet for question 31a.]
Question 32. In fiscal year 2012, VA requested $3.04 million to
continue a ``Health and Wellness Initiative'' started in fiscal year
2011. In response to a question for the record asking how effective
this program has been in promoting healthier employees, VA responded
that ``[p]rogram effectiveness measures will be reviewed at six months
and at the end of the fiscal year.''
a. Please describe the specific objectives of this program and what
benchmarks will be used to measure success. Please provide the
Committee with documents assessing the effectiveness of the program.
Response. The objective of this program is to support the
transformation of the VA into a model employer by providing a program
which supports a healthier workforce. This initiative supports VA
Strategic Goal #4, 4.1 which focuses on improving internal customer
satisfaction with management systems and support services including
operations and business process of Human Resources. Healthier employees
will be better able to provide high-quality service to Veterans and
their families.
Data obtained in FY 2011, which is identified as the baseline year,
will continuously be measured against data obtained in subsequent
years. Data from annual completion of the health risk assessments will
be used to identify programs and measure program effectiveness through
employee self identification of:
a. Absenteeism rates--Days taken off work for non-work related
medical, personal or other reasons. (self reported via the health risk
assessment)
b. Presenteeism rates--Lack of desire to perform assigned duties.
Merely showing up for work (self reported via the health risk
assessment)
c. Improved management of chronic medical conditions (self reported
via the health risk assessment).
d. Increased job satisfaction (determined by satisfaction survey
results). (FY 2012 is the baseline year for this survey.)
Thus far participation has increased 6% in FY 2012 to an overall
participation rate of 16%. The following table presents the baseline
for absenteeism for FY11:
HPLI Absenteeism Report
April 17, 2012
----------------------------------------------------------------------------------------------------------------
Avg
Condition Days N= Age %Pop Per Person Aggregate
----------------------------------------------------------------------------------------------------------------
Allergies...................................... .1731 9516 45.0 33% $432.15 $4,112,386.45
Anxiety........................................ .5369 2453 44.0 8% $1,339.98 $3,286,977.30
Arthritis...................................... .2755 4275 51.0 15% $687.61 $2,939,535.14
Asthma......................................... .2124 2491 46.0 8% $530.16 $1,320,629.52
Autoimmune..................................... .4867 712 48.0 2% $1,214.87 $864,987.86
Back Pain...................................... .5074 3948 47.0 13% $1,266.42 $4,999,808.35
Cancer......................................... .5 790 53.0 2% $1,248.00 $985,920.00
Depression..................................... .5384 3331 46.0 11% $1,343.83 $4,476,294.16
Diabetes....................................... .1861 2137 52.0 7% $464.43 $992,483.11
Diabetes Type 1................................ .3426 135 45.0 % $855.11 $115,439.80
Digestive...................................... .3147 2361 45.0 8% $785.39 $1,854,303.11
Heart Disease.................................. .4571 933 53.0 3% $1,140.99 $1,064,542.73
Hypertension................................... .1443 7122 49.0 25% $360.26 $2,565,737.31
Mental......................................... 1.3971 402 43.0 1% $3,487.26 $1,401,878.10
Metabolic...................................... .1325 2002 47.0 7% $330.74 $662,136.42
Migraines or headaches......................... .5454 3811 44.0 13% $1,361.34 $5,188,079.54
Neck Pain...................................... .3202 3004 47.0 10% $799.34 $2,401,221.88
Periph Vascular Disease........................ .3252 143 53.0 % $811.63 $116,063.71
Pulmonary...................................... .5289 95 52.0 % $1,320.25 $125,423.91
Respiratory.................................... .415 1438 49.0 5% $1,035.81 $1,489,487.67
Seizures....................................... .1879 141 46.0 % $469.11 $66,143.91
Stroke......................................... .1979 96 52.0 % $494.00 $47,423.84
----------------------------------------------------------------------------------------------------------------
HPLI absenteeism results for participants meeting these criteria: Starting: 10/1/2010, Ending: 9/30/2011
Total participants completing an HRA: 28402
LEGEND:
Avg Days = Number of days the average person with this condition misses per 30 days due to the condition--
generally a partial day such as 0.5 (e.g. 1/2 a day).
N = Count of participants with the condition shown.
Age = average age of the stated percent of individuals who responded to the question.
% Pop = Percentage of the total HRA population with the condition. ``Per person'' and ``Aggregate'' figures are
annual costs and assume a labor cost per hour of $39.00
Total absenteeism loss is estimated at: $41,076,903.81
Chairman Murray. Thank you very much, Mr. Secretary. Let me
begin the questions by getting this one off the table. It is on
the issue of sequestration and cuts to spending. Like I said in
my opening remarks, I believe that all VA programs, including
medical care, are exempt from cuts; but there is some ambiguity
between the Budget Act and the existing law.
When I asked the Acting OMB Director to address this issue
during a Budget Committee hearing 2 weeks ago, he said OMB has
yet to make a final determination.
So, I am concerned that by not settling this issue now we
are really failing to provide our veterans with the clarity
that they really deserve to have.
So, while you are here I wanted to ask you: do you believe
that all VA programs, including medical care, are exempt from
any future cuts?
Secretary Shinseki. I think, Madam Chairman, the answer
that the OMB Director provided you is the same one that I
understand. They are still addressing the issue.
For my purposes, I would tell you I am not planning on
sequestration. I am addressing my requirements and presenting
my budget as you would expect me to do.
I think sequestration, in part or in whole, is not
necessarily good policy, and I think the President would argue
that the best approach here is a balanced deficit reduction,
and he believes that the budget he has presented does that and
asks that the Congress look at that budget and favorably
consider it.
Chairman Murray. I think we all hope that that is the
outcome, but we want to provide clarity to our veterans. They
are very concerned about this issue.
Mr. Secretary, last year we talked a lot about mental
health care, and I think we together uncovered a lot of serious
issues best summed up by a veteran that I heard from recently
who uses Ann Arbor Medical Center and had to wait months and
months to get into counseling, but then he had glowing things
to say about his mental health providers once he got in.
So, in order to address those types of issues, the VA has
to be certain it has enough resources to not only keep up with
the increasing number of veterans who are seeking mental health
care, but also to bring down that unacceptably long wait time.
Over the course of the last fiscal year, the number of Iraq
and Afghanistan veterans who are looking for mental health care
went up by about 5 percent. That is about 18,000 veterans every
quarter.
So, I wanted to ask you this morning if you believe the
increase in mental health funding in the budget request is
sufficient to accomplish the goals and keep up with this
increasing demand.
Secretary Shinseki. I believe that the budget, if you look
at the 2013 budget request, I think is adequate for us to meet
what we understand our requirements are in 2013. Are there
issues out there that we will discover between now and the
execution of the budget, I would say if we do, Madam Chairman,
I would be the first to tell you.
Now, you asked us to do a survey and we did. It was very
hastily done. Senator Burr referred to some of the output, the
conclusions out of that survey. Out of 20,000 of our mental
health providers, 319 were surveyed and the results were as
described.
My question of the Veterans Health Administration (VHA) was
did you go to the places that we thought there would be
problems and the answer was yes because we were asked to go
figure this out.
So, I would say we got a pretty pure response. What I think
we need to do is to make sure we are going to take another
broader look here and make sure we understand across the larger
population what our issues are and where there are
opportunities for reallocation or, as it becomes clear, to hire
more people.
I would offer to the Chair, I took a look at what we have
done in mental health over the last four budgets. If we look at
2012 to 2013, it is rather unimpressive. I mean, it is 5
percent and it matches the increase in the medical budget.
But between 2009 and 2013, our increase is 39 percent in
mental health; and if you include the 2014 advance
appropriation, it will go up 45 percent.
Chairman Murray. And that is the result of the number of
soldiers who are coming home with the invisible wounds of war
which is dramatically increasing, correct?
Secretary Shinseki. True, but we are trying to anticipate
that there is going to be a larger requirement here in the out-
years even if we do not have clarity. We are trying to prepare
for that. We want to do a larger survey here as I indicated and
then see what the outcomes are.
But let me turn to Dr. Petzel for any details here.
Dr. Petzel. Thank you, Mr. Secretary.
Madam Chairman, as a result of the hearing that we had
earlier in the year, we have now done two things that are, I
think, important and on point with regard to your question.
One is that we have developed a staffing model. It is the
only staffing model that I know that is available about mental
health. It is in the beginning stages, but it is giving us some
information about what the need might be.
But I think more importantly we are sightvisiting all 152
of our medical centers to look at the access to mental health
services, both the initial appointment and subsequent
appointments for PTSD in-patient program, group or individual
psychotherapy.
And what we are finding is that we do meet the criteria for
the first appointment in most every instance. We are having
some difficulty in some parts of the country making the next
appointment in a timely fashion, getting them, as you mentioned
earlier, into the specialty services. This could be the result
of three things.
One is: do we have enough staff out there? Have we given
enough positions and enough resources? Two is: are those
positions filled? Are they filling those positions in a timely
fashion? And the third is: are we getting the appropriate level
of productivity out of each one of those people?
If we do discover, as the Secretary just mentioned, that we
do have additional needs that are unmet, I can guarantee you we
will be in communication with the Committee about those needs
and for that discussion.
Chairman Murray. OK. I appreciate that. This is a top
priority for us this year.
Secretary Shinseki. I would just share that in fiscal year
2011 we hired about 897 additional mental health professionals
bringing us up to about 20,500 mental health professionals.
So, the interest is there in trying to determine what the
requirement is, and we are not hesitant about increasing those
numbers.
Chairman Murray. Thank you very much.
Senator Burr.
Senator Burr. I thank the Chairman. Since the Chair just
asked about mental health, let me just ask if my information is
correct. In December, the VA polled their facilities and they
found there were 1,500 open mental health positions. Is that
accurate, Dr. Petzel?
Secretary Shinseki. Let me turn to Dr. Petzel.
Dr. Petzel. Could you repeat that number, Senator Burr?
Senator Burr. That December 2011, the VA polled their
facilities and found that there were 1,500 mental health slots
that were unfilled meaning----
Dr. Petzel. Out of 20,500 that is true, yes.
Senator Burr. OK. I just wanted to make sure the
information I had was correct.
Mr. Secretary, I wanted to thank you for something
unrelated to this budget hearing. March 31 in North Carolina we
will have the first in the country Welcome Home Vietnam Vets
Day, an all-day event and I want to thank you for the VA's
cooperation in making sure that the VA presences there to make
sure that we are able to catch those who have fallen through
the cracks, work with those who have problems and will have a
VA mobile presence there as we will from DOD and a lot of
private-sector entities that are working on employment,
placement.
I think this is a very, very special event that is long
overdue and hopefully it will be the first of a total of 50
that are held around this country; and I thank you for the VA's
participation.
I am going to ask for chart number 1 to go up. Earlier I
mentioned a number of performance matrices that seem to be
heading in the wrong direction when it comes to claims
processing; but I want to start by talking about the quality of
VA's decisions on disability claims.
Your goal is to have 98-percent accuracy, but for the past
3 years accuracy nationwide has been about 84 percent; and as
of December 2011, the accuracy rate at regional offices around
the country varies from 94 to 61.
Mr. Secretary, in total how much is VA requesting for 2013
budget to carry out all of those quality initiatives including
the quality review teams at each of the regional offices?
Secretary Shinseki. Thank you, Senator. Let me turn to
Secretary Hickey to answer that.
Ms. Hickey. Thank you, Senator Burr, for your question. I
am glad that you are asking about quality because we are very
focused on both production and quality. It is not a trade for
one or the other.
I cannot give you the very specifics on each one of those
costs, but I can tell you we expect the impact to be
significant in our ability to produce a more accurate and more
consistent response across the board.
Our quality review teams are a critical part of this. For
those of you who may not be aware of what those are, we have
taken our Systematic Technical Advisory Review (STAR) teams,
nationally recognized even by I think by Members of your
Committee staff, based out of Nashville, TN.
We have replicated their skill level, their training, and
what they do every single day now inside every single regional
office across the Nation.
Their responsibility will be not just to check quality at
the end of the process, but to also work closely with our
employees in a training environment to check different parts in
our process where we make most errors and to correct those
issues early.
Senator Burr. At what point on a calendar would you make a
determination as to whether those quality initiatives are going
to work and what indicators would you look at to make that
decision?
Ms. Hickey. Thank you, Senator, for your follow-up
question. I will tell you we have already done that. No
initiative that we have in our transformation plan of the 40
plus initiatives in the people category: how we are organized
and trained to do our work; in the process environment: how we
have adjusted some of our business processes; or in our
technology solutions have not been tried, tested, and measured
for impact before we are implementing them.
So, in fact, on the quality of review teams----
Senator Burr. But at some point you have got to say we are
going to look at it and see if this is working.
Ms. Hickey. We did, sir, absolutely. We did in local pilots
and we just announced this week, in fact----
Senator Burr. So, a year from now when we get together for
the 2014 budget, if the quality has not improved or the
timeliness down, it will have failed?
Ms. Hickey. No, sir, I do not expect the quality not to
have improved. We have some very significant decisions and
initiatives.
Senator Burr. My point is what if it does not.
Ms. Hickey. Sir, then we will adjust as necessary to find
the reasons why. We will tackle that hard, but I do not expect
that to be the answer. I expect us to see improvement in both
quality and production.
Senator Burr. Thank you.
Secretary Shinseki. Senator, if I might, quality is a
function of trained people with the right tools, and we are
working on both items right now.
Senator Burr. My question was simple, Mr. Secretary. At
what point will we determine whether what we have implemented
is working?
Secretary Shinseki. Fair. We will be happy to provide that.
We set a target of ending this issue with backlog in 2015. We
begin fielding the automation tool we have been building for 2
years in 4th quarter of this fiscal year. We expect that the
tool will be rolled out nationally through 2013, in this
budget; and as we do that, we expect both speed and quality to
go up.
Senator Burr. If I could ask the Chair for just one
additional question on this round, and I would call up the
second slide. VA made this projection last year at the budget
hearing. ``Productivity due to the impact of the overall
transformation plan which will rise from 89 annual claims per
direct labor in 2012 to 129 in 2015.''
As you can see from the chart, we talked about productivity
per FTE best year at 79.5 percent. This year we are looking at
73.5 percent. What percentage increase in individual
productivity do you expect from the Veterans Benefit Management
System and what percent do you expect from other initiatives
that are underway at?
Secretary Shinseki. I will turn to Secretary Hickey for the
details. I would say what these charts do not reflect, Senator,
is that in the last 3 years we have taken on some other
projects that are unaccounted for here.
The GI Bill requirement to get that program up and running,
and today we have over 600,000 youngsters in college under an
automated system that did not exist in 2009, and I think we all
recall that first semester we had to do everything manually,
and it was not the prettiest process.
But we did that manually, got 173,000 youngsters in a
school and on their path to the future. At the same time, we
began building this automation tool for the GI Bill. By April
we had the first part of that tool out and fielded and we have
added four or five more versions to make it more productive.
We will get better over time. It is hard for me to give you
a day and a month when this quality factor will meet any of our
expectations but we set on 2015 as the date on which we would
have the backlog solved and the quality at 98 percent. That is
what we are focused on.
I will give you the best way points that we can figure out
but that will be a product of what we are doing to train our
work force and what we are doing to give them the right tools.
We are talking about the right tools now.
But in this same time you are questioning about the growth
in our human resource investments for the Department, we've
focused on training for our 300,000 employees, many of them who
have never been trained on their job, so they can produce what
we expect and that they can leverage these tools.
Ms. Hickey. Thank you, Senator Burr. I would like to first
start by saying thank you to you, Chairman Murray and the
Members of this Committee for unprecedented budget increases
that VBA has enjoyed in the last 3 years.
I think we need to put that in a little context. That 36
percent was used to tackle a 48 percent increase in claims over
the same period of time, and that was to support nearly 12
million servicemembers, veterans, their families, and
survivors; and that is including a net increase in the last
year of half a million new veterans to our rolls using our
benefits and services.
For the second year in a row, we also completed more than a
million claims using those resources. That is 16 percent more
claims per year than we have done in 2008, before that chart
started doing some of those things.
I will tell you and put frankly on the table that we have
paid more than $3.3 billion to Vietnam veterans based on new
Agent Orange presumptive conditions. I thank you for
celebrating our Vietnam Veterans, we put more than $3.3 billion
into the hands of 117,000 of those Vietnam Veterans out there
in the last year.
That had an impact on that line. That impact was that there
were 260,000 other claims in backlog we did not get to. That
also had an impact on FTE because we put two times the FTE
associated with each one of those claims on those very
difficult, complex and old claims.
In addition, we stood up in the same period of time and put
four times the level of FTE to our most wounded, ill, and
injured in our integrated disability evaluation system to get
those folks taken care of right and well the first time. So,
that also had an impact on the line that you laid out in front
of us.
The positive news about all of that is we are nearly done.
We are down to the double digit levels of the Agent Orange
Nehmer cases, 99.9 percent done through those 250,000 cases.
We are now capable of shifting all of those 13 resource
centers we had across the Nation that were hunkered down doing
those Nehmer Agent Orange claims. Tomorrow we are shifting that
all back into normal backlog caseload. It will be focused on
our benefits for discharged veterans. It will be focused on our
Quick Start veterans, and it will be focused frankly on our
oldest cases we have on the books during the month of March.
Chairman Murray. Thank you, Senator Burr.
Senator Akaka.
Senator Akaka. Thank you, Madam Chairman.
General Shinseki, as you know, we often face challenges in
treating our veterans who live in many rural and remote areas.
This is especially true in places like Alaska and Hawaii where
you just cannot get some places by jumping in a car and driving
there.
I know that you are working on an MOU with the Indian
Health Service to find solutions to help provide services to
our Native American veterans, and I commend you and all of your
involvement in these efforts.
Mr. Secretary, can I get your commitment to look into
possible ways of working with the Native Hawaiian Health Care
Systems and the Native American Veteran Systems to provide
services for, in this case, Native Hawaiian Veterans who live
in many of the rural parts of the State of Hawaii?
Secretary Shinseki. Senator, you have my assurance that we
will do our utmost to provide for any of our veterans wherever
they live, including the most rural and remote areas, the same
access and quality to health care and services as we provide to
someone living in a more urban area.
There is a challenge with that but we are not insensitive
to that challenge, and we are working hard to provide VA-
provided services and, where we cannot, to make arrangements,
if quality services exist in those areas, make arrangements for
veterans to be able to participate in those local
opportunities.
We are, I think you know, working and have been now for
some time, on signing an MOU with the Indian Health Service so
that wherever they have facilities and we have a vested
interest, a veteran, an eligible veteran going to an Indian
Health Service facility will be covered by VA's payments. We
are in stages of trying to bring that MOU to conclusion.
We intend to do that. Where tribes approach us prior to the
signing of that MOU to establish from a tribal Nation a direct
relationship with VA because they have a medical facility and
would like us to provide the same coverage, we are willing to
do that but that will be on a case-by-case basis.
Senator Akaka. Thank you.
Secretary Shinseki, staffing shortages continue to be a
problem although there has been progress. Some clinics are
seeing staffing levels below 50 percent causing excessive
waiting times for veterans that need care. I understand this is
an issue you have been working on. As you know, the number of
veterans needing services is growing yearly, and it shows that
you have been making progress.
Can you provide an update to the department's progress to
address staffing levels?
Dr. Petzel. Mr. Secretary, thank you.
Senator Akaka, thank you for the question. We have talked
about mental health earlier and the efforts that we are making
to try to assess whether there is adequate staffing there.
I think you are probably talking about primary care which
is our largest outpatient clinic operation. We treat 4.2
million veterans in our primary care system and that accounts
for the lion's share of our budget expenditures.
We assessed staffing 3 years ago when we began to implement
what we call the Patient Aligned Care Team or PACT program and
have done it again recently, and we are finding that we are now
able to bring up the support staffing and the physician
staffing to reasonable levels associated with the standards
around the country.
I would like to take off-line any information you have
about specific places where there is a 50-percent vacancy rate.
I am not aware of the fact that we have this around the country
so I would be delighted to meet and talk with your staff and
find out where these areas might be so that we can address them
specifically.
Senator Akaka. My time has expired but, Secretary Shinseki,
as we face budget constraints, we must all work to improve our
efficiencies and redouble efforts to look for ways to get the
most for our budgeted resources.
My question to you is: Can you talk about any steps you are
taking to improve the acquisition process at VA and any
efficiencies that you have been able to realize in this area?
Secretary Shinseki. Senator, I would tell you that we have
been working for several years now on restructuring our
acquisition business practices. Three years ago acquisition was
spread throughout the organization.
Now it is consolidated in two centers. One comes directly
under Dr. Petzel and that is for all medical acquisition,
gloves, masks, aprons. We ought to be able to leverage that
into a bulk purchase and get a good price on those kinds of
things.
For everything else we have an Office of Acquisition
Logistics and Construction. We have a director who heads that
office, and everything else governing acquisition is
consolidated under his review.
Both offices work acquisitions and the work of both offices
then comes up to my level, to the Deputy Secretary, as part of
our monthly oversight review process.
Chairman Murray. Thank you. Thank you very much.
Senator Johanns.
Senator Johanns. Thank you.
Mr. Secretary, let me, if I might, visit with you about the
National Call Center. This is something that I think we had
high hopes for. You might have had high hopes for, but I have
to tell you it is not working well. Here is what we are running
into.
The complaints kind of fall into two separate categories.
The first category would be people that call the call center
and no one answers. I mean, it just rings and rings and rings,
and there is no one there.
I will tell you in my own Senate office my staff has run
into this problem where we just cannot get a live person on the
other end of the line.
The second area is you finally get somebody, a live person
to answer the phone, and you get connected with them and they
do not have information. You know, the veteran is or we are
calling in or somebody is calling in, what is going on with my
claim or whatever it is, and you are just not getting a
responsive human being on the other end of the line.
I am guessing what it is is they just do not have access to
the information that we are seeking, and so it seems to me that
we are creating an expectation of service when really there is
not much service there.
I would like to hear your thoughts or whoever's thoughts on
your team about the call center, what are the prospects for
that, are you hearing these problems; and if we are still
committed to the call center, what is in place or what will be
in place to try to solve the issues that I have raised.
Secretary Shinseki. Thank you, Senator. I have tested the
call system myself, and sometimes have been pleasantly
surprised, other times disappointed, but that has been
something I have done for 3 years now; and then demanded that
we go out and fix it.
So, we are in the process of putting a fix in place called
the Veterans Relationship Management System. If the concerns
you are expressing are anything where the experience occurred 6
months ago and longer, I would offer that we have put this tool
in place and changes are occurring weekly, and I will ask
Secretary Hickey to provide some detail.
But I, like you, think when a veteran picks up a phone and
calls VA, there ought to be someone there that answers. Or, if
he or she chooses to come in online, that it ought to have
information that is useful to them that is easily discovered so
they do not have to run through a series of traps to find what
they are looking for.
We owe them, and that is the first step in any service
organization and that is our intent here. So, let me call on
Secretary Hickey.
Ms. Hickey. Senator Johanns, thank you very much for your
question, and I appreciate your comment earlier about
eBenefits. That is actually part and parcel of our multi-prong
approach in our Veteran Relationship Management (VRM)
capability about being able to converse with that veteran in
the time and the method that they choose. We have surveyed our
veterans, and 73 percent of them want to meet us online. So,
eBenefits is part of that solution.
But let me address specifically your questions, first about
no live person. Let me tell you about the two new pieces of
functionality that we have measured outcomes on from our J.D.
Powers' Voice of the Veteran (VOV) Pilot Survey, the first of
which is virtual hold.
It means if a veteran calls us and there is a long waiting
time, they can elect this hold option, hang up the phone,
continue feeding the baby, getting ready for work, doing
whatever it is they need to do, and we will call them back on
cue. Ninety-two percent of our veterans have elected that
option, and we have connected with them.
The second one is our scheduled callback, meaning I cannot
wait on the line with you now but can schedule a time that I
can talk to you, and you will guarantee to call me back. We
have just implemented that one in December.
Between those two, one million veterans have elected those
options. As a result, we have seen clear, demonstrated,
measurable performance. We have a 15-percent improvement in
overall satisfaction on the ability of our veterans to get
through, and we have seen a dropped call rate reduction of 30
percent.
Those are both part and parcel of the new technology and
the new ways we using our Veteran Relationship Management (VRM)
system's capabilities.
In another VRM initiative, previously our call agents would
have had to cycle through 13 different databases to get that
veteran or family member, or survivor the information they
needed.
Today, as we deploy this, and it is critical for our IT
budget, unified desktop puts all 13 databases worth of that
critical information you want to know on one screen, making our
call agent much more effective in delivering a good outcome.
Also built into this is world-class call recording, call
tracking, and data analytics that we are literally using every
single day to improve our service in that environment.
Senator Johanns. I am out of time but if I could just ask
as these things are being implemented, as we are going down the
road here if periodically you could give us on the Committee an
update as to the progress you are seeing because I do think
there is real hope with the call center.
You know, the veteran, at least, can get somebody who can
answer their question, et cetera. So, I would just like to stay
abreast of how they are doing so I do not lose track of it.
Ms. Hickey. I would be very happy to do that, Senator.
Chairman Murray. Thank you very much.
Senator Tester.
STATEMENT OF HON. JON TESTER,
U.S. SENATOR FROM MONTANA
Senator Tester. Thank you, Madam Chairman.
I appreciate seeing Secretary Shinseki and all of the folks
on the panel today.
A special thank you to you, General, for coming to Montana
last summer. The veterans are very appreciative of that as was
I. And you, too, Bob; thank you very, very much for being there
and listening and hearing. So thank you very, very much.
I want to talk a little bit about what Senator Akaka talked
about very, very quickly, and that is the kind of strategies
that the VA is using to recruit folks.
This is not in the GP area. This is an area that is much
more difficult in my opinion, and GP is not easy, but that is
the need for mental health professionals.
As you know, Dr. Petzel--I think you were there when we
opened the facility in Helena--it is a great facility. We still
do not have staffing at this point in time as far as
psychiatrists.
Do you have the adequate amount of flexibility to be able
to go out and recruit--and it can go to the Secretary or to Dr.
Petzel--to be able to go out and recruit and really get folks
in because I am not sure we are there yet?
Dr. Petzel. Thank you, Mr. Secretary, and thank you,
Senator Tester. I am aware of the issues at Fort Harrison. We
have four psychiatrist vacancies. In general, we can recruit
around the country very successfully for psychiatric social
workers, for psychiatric nurse clinicians, and for clinical
psychologists.
The most difficult recruitment for us is the M.D. position
of psychiatrists.
Senator Tester. Yes.
Dr. Petzel. We are not unique. This is an issue that all
health systems around the country face. We are very
competitive, however, in terms of wages, in terms of working
conditions and the other kinds of things that are appropriate,
and are needed for recruitment.
So, I think we are in a position to do the best job we can
of recruiting. I do not know what we could add right now to the
basket, if you will, of things that we have to offer. It is a
matter of identifying the people that want to come to places
like Helena, which is beautiful, by the way.
Senator Tester. Thank you.
Dr. Petzel. In an environment where there just are that
many of them.
Senator Tester. OK. Well, I just think that it has been an
ongoing problem particularly in rural and frontier areas like
Montana, and it is not a problem that I think bodes well for
the veteran who has issues that revolve around mental health
because we all know if we have professional help, quality-of-
life advances and the costs go down.
So, I want to talk about health IT for a second. We can all
agree that advanced appropriations have allowed the VA, I
think, to be more efficient, more effective to deliver quality
health care for our veterans.
However, it is my understanding that the exclusion of
health care-related IT funds and advanced appropriations have
put us in somewhat of a bind. It is hard to deliver quality
care when you cannot make corresponding investments in things
like phone systems that connect to veterans' electronic health
records, allow the VA better to coordinate it.
Can you speak, just speak about this issue and how the
inclusion of health care-related IT funds and advanced
appropriations could improve the quality of health for our
veterans?
Secretary Shinseki. Thank you, Senator. I would just begin
by saying Congress provided us a very unique mechanism called
the advance appropriation, and it is a gift to VA because it
really gives us opportunity for continuous budgeting every year
by submitting two budgets. It gives us two looks at our budget.
So, we submit what we understand our best estimate is as an
advance appropriation and then we come back a year later and we
submit the actual budget and we can make adjustments.
The advance appropriation applies primarily and solely to
health care and so Dr. Petzel has his continuous budget.
Everyone else is on annual budgeting.
Under advance appropriations, we have the budget for
medical services, medical compliance and reporting, and medical
facilities. What happens is when we have a delay, a C.R., it
affects the rest of the budget where IT resides. Dr. Petzel has
his authorization to start building facilities and standing
them up but then we have to wait, as sometimes happens, on a
delay until the IT budget gets released so that now it can
catch up to him.
In a case last year, I think the budget CR lasted until
April so it is a pretty significant period.
We are a bit off stride here and I am trying to figure out
how we can get this together and link up the authorities you
provide along with the budget to do his business and get him
the tools that allow him to see patients. There is no
separation between medical IT and medicine today--that is all
one treatment discussion.
Senator Tester. Well, let us know how we can help you be
more effective in the IT area and I think Chairman Murray and
Ranking Member Burr will help on this, too. I just think that
it is really important in this day and age and----
Secretary Shinseki. Can I just follow very quickly, Madam
Chair, or just add here.
Senator Tester. Go ahead.
Secretary Shinseki. What sometimes happened, as happened
last year, the IT budget is now released in April, and it is a
big number because it is all IT. Well, really in it you have
the paperless system that goes with Secretary Hickey's
operation and you have medical IT that goes with Dr. Petzel's
operation.
I am just trying to be clear here. The piece that I am
concerned about is the medical IT. So, we link decision to do
things for veterans in the medical sense along with the tools
to be able to do that.
What happened last year, as sometimes happens, this large
IT budget gets identified in April and we can now go forward,
and an assessment is made by Congress. Well, it cannot possibly
spend their budget before the end of the year so we lose $300
million in the Congressional budget process at a time when we
really need that funding to marry these two things up.
Secretary Baker can now not deliver what we have already
approved a year before and we are delaying that.
So, I think----
Senator Tester. A timing issue.
Secretary Shinseki. Yes. I think there is a mechanism here
of getting stride on both ideas, and we would be happy to work
with you on it.
Senator Tester. Thank you. I want to thank everybody for
being here today. I will get into the rural cemetery thing with
Mr. Muro, but we will propose those questions in writing. Thank
you all very, very much.
Chairman Murray. Thank you very much.
Senator Moran.
STATEMENT OF HON. JERRY MORAN,
U.S. SENATOR FROM KANSAS
Senator Moran. Madam Chairman, thank you very much.
Mr. Secretary, in 2008 Congress passed the Rural Veterans
Access to Care Act. This was a piece of legislation I was
involved with in my days in the House. It was signed into law.
The program is now referred to as Project ARCH, Access Received
Closer to Home; and that legislation set certain criteria that
if a veteran lived a certain number of miles from an outpatient
clinic or from a VA hospital, the VA would provide those
services locally using a local physician, a local hospital.
My legislation was broad in its initial form. It was
narrowed by Congress to create pilot programs, and the VISN
that Kansas is in was included as one of those pilots.
I have expressed my complaint to the VA before because when
the VA then implemented its pilot program, it did not choose a
VISN as a pilot project. It chose a community.
In my view, we have taken legislation that created a pilot
program and created a pilot program within a pilot program, and
we now have a project ongoing in Pratt, Kansas to demonstrate
whether or not this idea works.
I would love to hear the report of progress being made but
also used this moment as an opportunity to again encourage the
Department to expand this pilot so that you can take more than
one community.
What happens in Pratt, Kansas, which is less than an hour
from Wichita, is significantly different than what happens in
Atwood, Kansas, which is 5 hours from Wichita; and the access
to providers is totally different between those kind of
communities.
So, while I am certainly pleased a pilot program is
ongoing, I am not certain, in fact, I am completely uncertain,
let me say that differently. I am completely certain the VA has
not chosen wisely as it has narrowed the project to a very
small scope to determine how it works.
In that regard, along the same topic of that CBOCs, we have
an ongoing problem similar to what has been expressed in regard
to mental health by Senator Tester, and I understand the
doctor's testimony about the inability to attract and retain
professionals; but it is sure becoming clear to me that we have
that same problem outside of mental health.
Our ability to retain physicians in CBOCs across the rural
Kansas, and I assume across the country, is a huge problem. And
more and more we have nurse practitioners, physician
assistants, that the availability of a physician has become
very limited, and we have many CBOCs now where no physician is
generally present.
And I understand the Secretary's testimony about IT as a
potential solution. We certainly have offered to our VISN to
make certain that we do everything as a Member of the Senate
now to provide VA with the resources to provide the necessary
personnel.
My assumption is my answer will be very similar to what you
told Senator Tester, and it is the same one that I hear from
VISN folks in Kansas is it is not really a resource issue. We
can pay sufficient amounts of money to attract medical
professionals, but we are struggling like everyone else to
attract those professionals.
I have heard that answer for a long time. You said it again
today, Dr. Petzel. In some fashion that cannot be the final
answer. Just because everybody else is struggling to attract
professionals to take care of patients, we can not afford to
allow the VA to have the same--I understand the problem. I do
not mean to be critical in that sense but there has to be
something more than, well, everybody is experiencing this
problem. There has to be a path to a solution.
Secretary Shinseki. I am going to ask Dr. Petzel to address
your question. I would say, Senator, the rural areas are
particularly challenging because of the lack of availability. I
think, and Dr. Petzel said that our tools are really on
reaching out. We want highly qualified, and we want talent. Our
tools are what we are able to compensate and what we are able
to award to recognize performance of good people doing
outstanding work and retaining them through bonuses for the
high-quality ones.
Our tools are limited, but we owe you the best efforts we
can to go after that talent. The biggest challenges are in the
rural communities, and we have to circle our wagons here.
Senator Moran. Mr. Secretary, I appreciate your sentence
that you owe us that. We understand we owe our veterans that
but I would also tell you that Congress, I owe you every tool
possible to help you meet that criteria; and the complaint or
concern I have is that I am not being asked to do something to
solve the problem.
So, what I am asking for is tell us what we can do to
provide the assistance so that when we have a hearing 6 months
from now, or we are back here next year talking about the
budget the answer to whether or not there is a doctor at CBOC
is not that or that we are meeting the mental health needs of
veterans particularly in rural areas is not every health care
provider, every community, every rural State is having the same
struggle we are. Help us help you solve this problem.
Secretary Shinseki. OK. Fair enough.
Senator Moran. Thank you. Dr. Petzel.
Chairman Murray. Dr. Petzel, do you want to very quickly
respond?
Dr. Petzel. I will try to be very quick.
Thank you, Senator Moran. The M.D. issue first. You are
absolutely right that we all have this difficulty in certain
rural parts of the country.
I would say that if you look at our MD situation across the
whole system, we do not have a recruitment problem. It is very
important that we focus on the fact that this is rural America.
Two things that we would like to do. One is that we need to
expand our tuition reimbursement program to be able to provide
an incentive for people to go to rural areas by reimbursing
them for their tuition from medical school.
The second one was an idea that the Secretary had. I do not
want to get into the details of it but to do something like the
military does with their Uniform Services Medical School and
that is recruit people, pay for their medical education with an
obligation to follow on and work with us in particular parts of
the country. Those are two areas that we are trying to explore.
Secretary Shinseki. Thank you, Senator. I will just put a
little finer point on what Dr. Petzel said. I thought that if
we went into areas, rural areas and found a highly talented
youngster, with great potential and targeted that individual
and got them through college and the medical school process,
that they would be going home, and so, in the long run we would
not be facing the retention bonuses and those kinds of things.
You would have provided someone for the long-term as a solution
to that requirement, in that community. That is part of the
discussion here.
Senator Moran. I appreciate your thoughts and please
consider me an ally. We can follow up with the ARCH question at
a later time. Thank you.
Chairman Murray. Thank you.
Senator Begich.
STATEMENT OF HON. MARK BEGICH,
U.S. SENATOR FROM ALASKA
Senator Begich. Thank you very much. I also want to ask
along these same comments that Senator Moran--and I like some
of these ideas that you have just mentioned--so I would be
anxious to participate.
I know in one of our hospitals in Alaska they actually give
a bonus to employees--a pretty significant bonus, up to
$10,000--to recruit and retain nurses because of the high
capacity and the need. So, thank you for offering those ideas.
Let me also say thank you, Mr. Secretary, for the two staff
that you sent up to Alaska. I think it was last week or the
week before, and Chairwoman Murray for sending Committee staff
also.
It is important, as you know, to come up to Alaska to
understand what rural is all about. I know you have been there.
Thank you for your visit and your team's visit. It makes a
difference to the people there but also I think opens the eyes
to a lot of folks how we have to deliver health care in the
most remote rural areas of this country. So, thank you for that
commitment.
Let me, if I can, and I know we have had some
conversations, Mr. Secretary, in regards to the idea of the
Alaska Arrows card and the idea of trying to weave through this
access issue in parts of the country that have limited access
to veterans' care.
In Alaska specifically, as you know, we talk about the
roadless areas, those areas of 80 percent of the communities of
Alaska that do not have access by road. So, when we read, and I
noted your testimony about Internet connect and get the mobile
van out there, there is no mobile van possible. The mobile van
is in the air, and that is the only way to get it.
So, I know we have talked in a very positive vein about how
to create this access, and I just wanted to check in with you
on a kind of update on that. I know we have kind of talked
about the quality of care through our Indian Health Services
which is superior to so much care that has been given today
across the country and it is high quality care.
Tell me kind of where you think we are at at this point. I
know you have been very responsive. I know we have been
badgering you and your team on a pretty regular basis because,
as you have seen, the veterans all they want to do is go across
the street to Indian Health Service clinic to get the regular
checkups as a choice, not as a requirement.
If they choose to go to a VA hospital clinic, so be it. But
if it is across the street, let us make that happen because the
quality of care is equal or in some cases we would argue better
in certain specialties of the VA.
So, what is your latest on that?
Secretary Shinseki. I think that, as you and I have
discussed, I think you will recall that we have put in a policy
that would allow veterans from Alaska to go locally and reduce
the amount of veterans having to travel to the lower 48. There
is a rather robust program underway there.
As I described, we are working with the Indian Health
Service to establish this MOU which would open a lot of
processes especially for Alaskan native veterans.
In the meantime, based on my visit to Alaska, and with the
Alaska Native Tribal Health Consortium, we have established
discussions with them in trying to ensure that however the IHS
MOU progresses that we are ready to provide health to veterans
who are being seen now in the consortium.
Senator Begich. Do you feel that is going in the right
direction with the tribal consortium?
Secretary Shinseki. Let me turn to Dr. Petzel since his
people are in negotiations and discussions.
Senator Begich. OK.
Dr. Petzel. Thank you, Mr. Secretary, and Senator Begich, I
really do sympathize with what you talk about in terms of the
ruralness of Alaska as well as other parts of the country.
While we are waiting for the MOU to be finished, Alaska is
one of two places where we are proceeding with tribal
interactions, and I hesitate to use the word ``pilot,'' to get
specific agreements within a tribal unit in Alaska.
I believe it is the Southeast Alaskan Tribal Association,
we are progressing in getting some arrangements made. It would
be wonderful from my perspective if a veteran could make a
choice and access tribal clinics. If, indeed, that was more
convenient and the care was successful, and that we could work
out the reimbursement arrangement.
I think that is what we are trying to do in Alaska. We have
another effort going on in South Dakota to do that.
Senator Begich. And you feel, I guess the ultimate
question, you feel it is moving in the right direction.
Dr. Petzel. Absolutely.
Senator Begich. Excellent. The last, I have two quick ones.
One is Senate Bill 914 authorizes a waiver that I have
introduced on the collection of co-payments for telehealth,
telemedicine.
I guess the general comment is I know we have about 200
veterans or so. I think about 100 or so are already in the
program in Alaska. I know others across the country. The idea
is, especially with mental health services, telehealth is a
huge winner in a lot of ways. It actually works very
successfully. We have asked that to be waived through this
legislation, the co-pay, so it increases the capacity of
telehealth.
Can either one of you give me a thought, Mr. Secretary, of
supportive, I know any time you take dollars away but my view
is telehealth is just a money saver. And especially with the
shortage of mental health services, this is a potential way to
meld the two problems and create a solution.
Secretary Shinseki. Senator, neither Dr. Petzel nor I are
familiar with this legislation. So, if I may, I will provide
that for the record.
Senator Begich. Absolutely. That is on Senate Bill 914. We
will get you some information on that.
The last comment, if I can, Madam Chair, if I can just add
to my concern, Under Secretary Hickey, actually our last call
was Friday from someone who could not get through on the 800
number. So, it is not old; it is new.
And I know when I was Chair of the Student Loan
Corporation, one of the things we did on that, because we had a
call center. As you can imagine, a lot of people upset when
their loan rates changed or they did not get their payment in
or whatever it might be.
So, we had to go through a whole revamping of the system;
but the metrics we measured by were on a regular basis reported
so we could see where the possibilities are.
You had mentioned that you are going to have or you have a
system that you can see the metrics of success, wait time, call
time, hold time, response, all of those.
I want to echo what my colleague on the other side said
that I would really anxiously want to see that because this is
our number 1 caseload work is around the VA issues.
Second to that within the VA is the 800 number, lack of
response or inadequate response I should say. And that is
current, not 6 months ago or a year ago. This is very current
and customer service is the name of the game, how to make sure
these veterans have the services they need.
Is that something you can provide sooner than later so I
can get a better understanding?
Secretary Shinseki. I am going to dive into those numbers
today based on the testimony.
Senator Begich. Very good. Thank you, and I think the only
solution to your issue on the IT is your whole Department
should be a 2-year budget process instead of 1-year and 2-year.
That is my personal opinion. That would solve a lot of
problems.
Chairman Murray. Thank you very much.
Senator Boozman.
Senator Boozman. Thank you, Madam Chair. I just have a
couple of concerns. The budget request includes operational
efficiencies that are estimated could save $1.2 billion. That
has been done in the past by, you know, various
administrations. Last year's budget request also included
operational efficiencies of just over $1 billion.
In the past, GAO has really questioned, you know, whether
or not those savings have come about. I guess if they do not
come about, how are you planning for the risk? What is your
contingency plan if you do not see a billion dollars in
savings?
Secretary Shinseki. I am going to call on Dr. Petzel to
respond since they looked at his budget for the savings,
anticipated savings, but I can tell you that right off the top,
$362 million was saved because of our conversion to dialysis
services using a Medicare standard pay rate instead of paying
the rates we were being charged previously.
$200 million was in improper payments savings, because we
reduced those. Through the program management accountability
system program office in IT, about $200 million was in savings
because we terminated projects that were not going to deliver;
and then about another $100 million was from the first notice
of death office in which we stopped payment on veterans'
accounts after they passed away. In the past, this has been an
issue with as much as $100 million in overpayments.
And for the future, we agreed to provide as a minimum $173
million in savings, by reducing waste in 2012 and 2013. That is
part of our effort to get at the savings and efficiencies.
Let me just ask Dr. Petzel to provide more detail.
Dr. Petzel. Thank you, Mr. Secretary, Senator Boozman.
The savings let us just go through a little bit of what
went on in 2011. We saved a large amount of money. The GAO
reviewed that and we are still actually negotiating with them
about what they actually found.
The essence is going to be that we, indeed, can validate
the savings that we claimed from the various operational
efficiencies. They do have a legitimate criticism about the way
we measured things and the granularity of the measurement which
we are going to be improving.
For 2013, as the Secretary mentioned, we are going to save
a large amount of money on payments for dialysis. We have
contracts or blanket purchase agreements with virtually every
dialysis center that we use that is going to save us hundreds
of millions of dollars over what we would have expended had we
not been able to do that.
The Medicare rate payment change that occurred with the
regulations allowing us to charge Medicare rates for both the
professional fee and the facility fee is going to save us about
$300 million. That is absolutely money that we know we would
have spent otherwise had we not been able to do that.
In the efficiencies with fee care, again something we can
measure easily, it is going to be over $200 million.
Acquisition fees have about $355 million in savings.
There is a long list, and I am not going to take the time
to go through that, but I am absolutely confident that we will
be able to save this money in VHA.
Secretary Shinseki. Madam Chair, if I may add just one last
comment here. We are going to look at all of this and work it
hard.
I have cautioned that in the end we have to focus on what
makes sense for veterans, and I will use dialysis as an
example. We are after the best prices we can get; and if you
just look at that, you may be encouraged to outsource all of
it.
I have argued that dialysis is something we have to retain
a handle on. We should do a certain amount, a certain portion
of it in-house. Why do I say that? I am just concerned that if
we provide funds and let somebody else take care of dialysis,
we ignore what a medical profession is supposed to do, and that
is, as long as we are doing dialysis, we will have to ask
ourselves what causes it, why do we have to do this, what are
the things on the front end that allow us to deal with
preventing diabetes so that dialysis does not become a fact
that we have to live with. I think the medical profession is
the best at asking those questions and that is why I think
within VA we need to retain a piece of that operation.
Senator Boozman. Very quickly, the President has proposed a
billion dollars in funding for the Veterans Conservation Corps.
He anticipates that that will create 20,000 jobs for veterans.
We all agree that there is a lot of backlog in the work
that needs to be done in the parks and the infrastructure and
those kind of things.
I had the opportunity to be the Chairman and then the
Ranking Member on the Economic Opportunity on the House side
and really worked very closely pertaining to the TAP program
and busy with lots of veterans about their dreams and
aspirations.
I have a lot of concern about spending a billion dollars in
that direction. That is not, you know, kind of the direction
that we were going in the Committee I do not believe. And, like
I said, I visited with lots of veterans and I really do not
know. A billion dollars is a lot of money.
I think that could be, you know, put to good use but for
myself I really do not believe that that is the direction that
we need. I have never heard a veteran express to me that that
is the route that they would like to go.
So, again, I just want to express some real concern in that
regard.
Chairman Murray. Thank you very much, Mr. Secretary.
Obviously we have had a lot of participation by Members at this
time. We have another panel that needs to present today. We
want to give them sufficient time and I have been called the to
the Capitol so I am going to submit the rest of my questions
for the record.
And, Senator Burr, do you have any more comments before the
Secretary leaves?
Senator Burr. Madam Chairman, I am going to submit a
lengthy set of questions. I would ask the Secretary and his
leadership team for a quick response to them lieu of asking a
second round of questions and would make four points to you.
These are disturbing trends that I see from the information
as we analyze the prior year. VA took in 430,000 more claims
than were decided.
Two, appeals that resulted in a decision took 1123 days to
come to fruition. That is disturbing. The VA central office
staffing increase to 40 percent 2008. In that same timeframe
human resource administration increased 80 percent.
For VISNs created in 1995, we envisioned 22 VISNs, a total
of 154 to 220 employees and an annual budget of $27 million.
Today, we have 21 VISNs, roughly 1340 staff and a $165 million
annual cost.
Many of my questions will be reference to these four areas
and I look forward, Dr. Petzel, with you and others to discuss
some of the trends that I see that should raise and do raise
flags for me and hopefully would raise flags for both of you.
Again I thank you.
Secretary Shinseki. May I respond, Madam Chairman?
Chairman Murray. Yes.
Secretary Shinseki. I will be happy to provide the details,
and I, like you, am concerned and watched the growth. There has
been growth of the veteran population. In the last 2 years, we
have added 800,000 veterans to our enrollment. The VA
headquarters is 1 percent of our budget today as it was in
2008, and it is a reflection of accommodating that growth, and
I will be happy to provide the details.
Chairman Murray. Mr. Secretary, thank you very much to you
and your team for accommodating our Committee today. We
appreciate that and ask that you answer the questions that will
be submitted to you by myself and the Members of the Committee
in a timely fashion.
Response to Posthearing Questions Submitted by Hon. Patty Murray,
Chairman, to U.S. Department of Veterans Affairs
Attachment B
Attachment C
(Resuming with Question 8 next)
______
Response to Posthearing Questions Submitted by Hon. Richard Burr to
U.S. Department of Veterans Affairs
general
Question 1. In connection with the Department of Veterans Affairs
(VA) fiscal year 2011 budget request, VA indicated in response to
questions about the method of travel used by employees of the Office of
the Secretary that ``travel regulations address the allowable modes of
travel for reimbursement purposes, but the predominant method of travel
has and will continue to be commercial airlines'' [emphasis added].
a. For fiscal years 2009, 2010, and 2011, please identify the
number of trips taken each year by senior VA personnel (Presidential
Appointee with Senate Confirmation (PAS), career or non-career General
Schedule (GS) employees, career or non-career Senior Executive Service
(SES) or SES Equivalent, consultant, contractor, etc.) using a military
or other government-provided aircraft.
Response. Total number of trips taken each fiscal year using
military or other government-provided aircraft are as follow:
Fiscal Year 2009--total of 3 trips
Fiscal Year 2010--total of 12 trips
Fiscal Year 2011--total of 4 trips
b. For each trip during those years where a military or other
government-provided aircraft was utilized for travel, please identify:
(1) the purpose of the trip, (2) the destination of the trip, (3) the
duration of the trip, (4) the number and title of any VA employees
(PAS, career or non-career GS employee; career or non-career SES or SES
Equivalent, consultant, contractor, etc.) who were passengers on the
aircraft, (5) the total cost to the Federal Government to operate the
aircraft used for the trip, (6) the amount of any reimbursement VA
provided to the Department of Defense, a military service, or another
government entity in connection with the trip, (7) the justification
for using military or other government-provided aircraft rather than a
commercial airline, and (8) all supporting documentation, the agenda,
and the itinerary related to the trip, as well as copies of any
memoranda, reviews, comments and/or opinions rendered by VA's Office of
General Counsel regarding the trip.
Response. [Extensive supporting documentation is held in Committee
files.]
c. For fiscal years 2012 and 2013, please identify the number of
trips that have been taken or are expected to be taken by senior VA
personnel (PAS, career or non-career GS, career or non-career SES or
SES Equivalent, consultant, contractor, etc.) using a military or other
government-provided aircraft.
Response. As of March 29, 2012, in fiscal year 2012 VA did not
usemilitary or other government-provided aircraft for any trips. In
fiscal year 2013, VA may use military or other government-provided
aircraft but no estimates are currently available. Cost figures can
only be provided once travel is complete. For every official trip
conducted by the Secretary, a cost analysis is made to determine
efficiencies that may warrant a request for military air. If military
air is requested, the provisions of 41 CFR 101-37 are met using the
appropriate decision process outlined in OMB Circular A-126 and each
request is submitted to the Agency General Counsel for review and
approval.
d. In total, for fiscal year 2012, how much (if any) is expected to
be spent by VA in order to pay for transportation by military or other
government-provided aircraft?
Response. As of March 29, 2012, in fiscal year 2012 VA did not use
military or other government-provided aircraft for any trips. No
estimates are currently available and cost figures can only be provided
once travel is complete. For every official trip conducted by the
Secretary, a cost analysis is made to determine efficiencies that may
warrant a request for military air. If military air is requested, the
provisions of 41 CFR 101-37 are met using the appropriate decision
process outlined in OMB Circular A-126 and each request is submitted to
the Agency General Counsel for review and approval.
e. In total, for fiscal year 2013, how much (if any) is requested
in order to pay for transportation by military or other government-
provided aircraft?
Response. In fiscal year 2013, VA may use military or other
government-provided aircraft but no estimates are currently available.
Cost figures can only be provided once travel is complete.
Question 2. The fiscal year 2013 budget request includes (1)
funding for 3,380 full-time equivalents (FTE) under General
Administration for VA's Office of the Secretary, Office of Human
Resources and Administration, Office of Policy and Planning, Office of
Operations, Security and Preparedness, Office of Public and
Intergovernmental Affairs, Office of Management, Office of
Congressional and Legislative Affairs, Office of General Counsel, and
Board of Veterans' Appeals (Board); (2) funding for 20,757 FTE under
General Operating Expenses (GOE) for the Veterans Benefits
Administration (VBA); and (3) funding for 262,912 FTE under the
Veterans Health Administration (VHA) Medical Services, Medical Support
and Compliance, and Medical Facilities accounts.
a. For all three of the above FTE account groupings, please
identify how many of the stated number of FTE are ``virtual'' FTE whose
positions are funded by and whose responsibilities support offices at
the VA Central Office level, but the employees are physically located
outside of VA Central Office and in the field. Please display this
information regarding virtual employees by responsible office field
location (i.e., Veterans Integrated Service Network (VISN), VA medical
center (VAMC), VBA regional office, or other office).
b. How much is allocated for these employees' salaries and
benefits?
c. If ``virtual'' FTE located in the field are not included within
the above figures, please explain why they are not so reflected and
under which organizational levels the FTE are reflected.
Response to 2a-c: VA notes that various FTE listed in the embedded
spreadsheets provide support to Veterans or activities in the field
although they report through a VA Central Office organizational
structure.
For the Veterans Health Administration (VHA), several examples
include:
Employees that work in VHA's Consolidated Patient Account
Centers provide medical center billing functions in regional locations
to enhance efficiencies and consistent practices;
Readjustment Counseling staff provide Vet Center
counseling and support in Vet Centers across the country. They are
aligned through Central Office rather than each medical center, to
maximize efficiencies and ensure consistent training and practices.
The Office of Workforce Management and Consulting provides
human resource consultation and operational guidance to the broad VHA
community to ensure an engaged and high-performing workforce to care
for Veterans and their families;
The Employee Education System supports dynamic learning
that contributes to a high-performance VHA workforce serving Veterans;
The National Center for Organization Development offers
organizational assessment and consultation services to VA organizations
nationwide;
The Office of Academic Affiliations conducts an education
and training program for health profession students and residents to
enhance the quality of care provided to Veteran patients within the VHA
healthcare system; and
Many of the ``virtual'' Patient Care Services staff are
part-time clinicians that provide health care to our Veterans at one of
VA's more than 1,400 sites of care.
Beyond VHA, a sample of examples where the work of these employees
supports a combination of field and VA Central Office functions are
provided below:
In the Office of General Counsel (OGC), the ``virtual''
FTE all perform work that supports both VA Central Office and the
field. For example, OGC's ``virtual'' Reports Analysis Planning &
Statistics Division and ``virtual'' OGC budget staff provide support
for OGC's 22 field-based Regional Counsel offices as well as for OGC's
VACO-based Staff Groups. Similarly, OGC's ``virtual'' Knowledge
Management and Professional Development Division staff provides support
for all OGC training and knowledge-management activities, both in VACO
and in the field. In addition, OGC's Eatontown, NJ-based attorneys at
the Technology Acquisition Center support IT acquisition activities for
the benefit of VA facilities in the field as well as in VACO;
In the case of the Veterans Benefits Administration, all
of the virtual employees listed work for VBA Central Office. These
employees provide guidance, training, and oversight to the field.
Outbased locations allow flexibility in recruiting, and program offices
benefit from assigning staff at or near an existing regional office.
Most of these positions do not involve routine travel to Washington, DC
or co-location with Central Office.
The requested information in 2a and 2b is provided in three
attached documents as described below. All offices responding to this
request for data indicated that the data provided does represent
``virtual'' FTE located in the field as requested under 2c. No
``virtual'' employees were reported for the Office of the Secretary,
Office of Policy and Planning, and the Office of Congressional and
Legislative Affairs.
As the question here relates to the ``virtual'' employees for FY
2013, the attached data is a projected estimate for FY 2013 based on
data as of June 2012.
The first spreadsheet (A) labeled ``NonVHA-Report'' contains
responses for all organizations requested by the question, where
applicable, except VHA. Information for VHA is provided in the .pdf
file labeled ``VHAReport'' with an accompanying Station Table key excel
sheet (B) labeled ``Station Table.'' VHA information is organized by
the VHA Central Office Program Office to which the virtual employees
are assigned. Due to technical limitations of the Personnel Accounting
Integrated Database (PAID) system, VHA is unable to provide local duty
station information in conjunction with the virtual employee's VHACO
Program Office assignment.
The spreadsheet (C) labeled ``VHAReport'' includes the VHA
``station code'' that a program office is assigned to and therefore may
not represent the city/state for every employee in that office (e.g.,
some may work from home or in other cities) and may not reflect where
the employees actually sit (e.g., VHACO employees assigned to station
635 Oklahoma City VAMC actually have an office in downtown Oklahoma
City, not at the medical center).
As noted earlier, many of the VHA Central Office employees who are
not in station 101 (VA Central Office) are employees in centralized
functions that are part of Central Office but operate in the field.
This includes VHA's Chief Business Office, with over 5,000 employees,
and VHA's procurement and logistics with over 2,000 employees.
NonVHA-Report
Station Table
VHA Report
Veterans Health Administration, Department of Veterans Affairs
June 2012
----------------------------------------------------------------------------------------------------------------
Number Projected and
Routing of Estimated FY13
Symbol Organization Name Virtual Station Code(s) Total Salary &
FTEE Benefits
----------------------------------------------------------------------------------------------------------------
10A2A Workforce Management and Consulting 197 629, 635, 654 $20,862,819.08
(10A2A)
----------------------------------------------------------------------------------------------------------------
10A2B Employee Education System (10A2B) 376 777 $38,066,180.17
----------------------------------------------------------------------------------------------------------------
10A2C National Center for Organizational 45 539 $5,253,318.45
Development (10A2C)
----------------------------------------------------------------------------------------------------------------
10A2D Academic Affiliations (10A2D) 18 662, 657, 652 $2,811,923.42
----------------------------------------------------------------------------------------------------------------
10A3 Office of Finance (10A3) 85 741 $11,936,781.20
----------------------------------------------------------------------------------------------------------------
10A4B Quality and Safety (10A4B) 58 799, 405, 528, $7,910,115.71
----------------------------------------------------------------------------------------------------------------
10NA1 Emergency Management (10NA1) 94 613, 640, $11,524,772.13
----------------------------------------------------------------------------------------------------------------
10NA2 Procurement & Logistics (10NA2) 2183 308, 358, 459, 460, 481, 483, 493, $192,808,935.46
501, 502, 503, 504, 506, 508, 509,
512, 515, 516, 517, 519, 520, 521,
526, 528, 529, 534, 538, 539, 540,
541, 542, 544, 546, 548, 550, 552,
553, 554, 557, 558, 562, 564, 565,
570, 573, 580, 583, 586, 589, 590,
595, 598, 600, 610, 612, 613, 619,
623, 626, 629, 635, 637, 640, 642,
644, 646, 648, 649, 652, 654, 655,
659, 662, 667, 672, 673, 675, 678,
679, 688, 693, 695, 701, 730, 741,
756, 757, 777
----------------------------------------------------------------------------------------------------------------
10NA8 Occupational Safety & Health 31 657 $3,493,787.15
Management (10NA8)
----------------------------------------------------------------------------------------------------------------
10NB1 CBO Member Services 1075 702, 742 $69,625,011.35
----------------------------------------------------------------------------------------------------------------
10NB2 CBO Purchased Care 909 741 $67,534,071.82
----------------------------------------------------------------------------------------------------------------
10NB3 CBO Revenue Operations 3378 730, 731, 732, 733, 734, 735, 736 $202,937,428.71
----------------------------------------------------------------------------------------------------------------
10NC1 Homelessness (10NC1) 44 518, 541, 561, 640, 642, 673, 691 $5,383,871.19
----------------------------------------------------------------------------------------------------------------
10NC2 Surgical Services (10NC2) 27 648, 554 $2,852,562.44
----------------------------------------------------------------------------------------------------------------
10NC5 Mental Health Operations (10NC5) 281 506, 518, 520, 523, 549, 640, 689, $25,429,255.24
528A5
----------------------------------------------------------------------------------------------------------------
10NC6 Supply Processing & Distribution 1 539 $131,019.89
(SPD) (10NC6)
----------------------------------------------------------------------------------------------------------------
10NC7 Dental (10NC7) 1 688 $259,381.75
----------------------------------------------------------------------------------------------------------------
10NC9 Rural Health Operations (10NC9) 1 402 $74,910.26
----------------------------------------------------------------------------------------------------------------
10P DUSH for Policy and Services (10P) 1 506 $68,654.69
----------------------------------------------------------------------------------------------------------------
10P1 ADUSH Policy & Planning (10P1) 23 573, 695, 741 $2,472,482.37
----------------------------------------------------------------------------------------------------------------
10P2 ADUSH for Informatics and Analytics 385 776 $52,233,196.30
(10P2)
----------------------------------------------------------------------------------------------------------------
10P3 Public Health (10P3) 35 640, 648, 688, 689 $5,628,044.62
----------------------------------------------------------------------------------------------------------------
10P4 Patient Care Services (10P4) 1266 405, 459, 506, 512, 523, 528, 531, $148,395,138.66
539, 541, 549, 552, 554, 558, 573,
578, 580, 581, 583, 586, 590, 595,
598, 603, 608, 612, 630, 631, 636,
637, 640, 642, 648, 652, 656, 660,
662, 663, 678, 688, 689, 691, 695,
700, 760, 761, 762, 763, 764, 765,
766, 770
----------------------------------------------------------------------------------------------------------------
10P6 National Center for Ethics (10P6) 11 663, 630 $1,774,598.68
----------------------------------------------------------------------------------------------------------------
10P7 Health Information (10P7) 199 776 $27,949,107.19
----------------------------------------------------------------------------------------------------------------
10P8 Readjustment Counseling (10P8) 1790 402, 405, 436, 437, 438, 442, 459, $149,285,418.34
460, 463, 501, 502, 503, 504, 506,
508, 509, 512, 515, 516, 517, 518,
519, 520, 521, 523, 526, 528, 534,
534, 537, 539, 540, 541, 544, 546,
548, 549, 550, 552, 553, 554, 557,
558, 561, 562, 564, 565, 658, 570,
573, 575, 578, 580, 581, 583, 585,
586, 589, 590, 593, 595, 598, 600,
603, 605, 607, 608, 610, 612, 613,
614, 618, 619, 620, 621, 623, 626,
629, 630, 631, 632, 635, 636, 640,
642, 644, 646, 648, 649, 650, 652,
653, 654, 655, 657, 658, 659, 660,
662, 663, 664, 667, 668, 671, 672,
673, 674, 675, 676, 678, 687, 688,
689, 691, 693, 695, 740, 756, 757
----------------------------------------------------------------------------------------------------------------
10P9 Research & Development (10P9) 85 508, 558, 618, 644, 688, 792 $10,546,783.98
----------------------------------------------------------------------------------------------------------------
10R Research Oversight (10R) 25 508, 518, 578, 605 $3,704,951.16
----------------------------------------------------------------------------------------------------------------
Total 12624 $1,070,954,521.4
2
----------------------------------------------------------------------------------------------------------------
Question 3. In October 2011, the House of Representatives passed
H.R. 2302, which included a provision that would require VA to submit
to Congress quarterly reports outlining the cost for conferences or
meetings sponsored by VA that have at least 50 attendees or cost
$20,000 or more.
a. During fiscal year 2011, how many conferences or meetings did VA
sponsor that met those criteria and what was the total cost of those
conferences and meetings?
Response. On August 24, 2012, VA provided the Committee with
consolidated training conference data from January 1, 2005 through
July 1, 2012.
b. For fiscal year 2011, please identify the 25 most expensive
conferences or meetings sponsored by VA, the locations of those
conferences or meetings, and the purposes of those conferences or
meetings.
Response. On August 24, 2012, VA provided the Committee with
consolidated training conference data from January 1, 2005 through
July 1, 2012.
c. During fiscal year 2012, how many conferences or meetings does
VA expect to sponsor that meet those criteria and how much in total is
expected to be expended on those conferences or meetings?
Response. On August 24, 2012, VA provided the Committee with
consolidated training conference data from January 1, 2005 through
July 1, 2012.
d. For fiscal year 2012, please identify the 25 most expensive
conferences or meetings already sponsored or expected to be sponsored
by VA, the locations of those conferences or meetings, and the purposes
of those conferences or meetings.
Response. Please see the answer to 3c.
e. For fiscal year 2013, what is the total amount requested for
purposes of holding conferences or meetings that meet those criteria
and how many conferences or meetings would that funding level support?
Response. FY 2013 first quarter executed training conferences and
estimated second quarter data are expected to be provided in VA's
report to Congress as required by Public Law 112-154.
f. For conferences or meeting events that cross fiscal years and
are multi-sessioned (i.e., VA Senior Executive Strategic Leadership
Course), please note the fact that they are sub-parts of a larger
conference or meeting.
Response. On August 24, 2012, VA provided the Committee with
consolidated training conference data from January 1, 2005 through
July 1, 2012. That data provided start and end dates, the training
conference title, location, number of participants, total obligations,
and a web URL where available.
Question 4. During fiscal year 2010, VA created the National
Outreach Office in the Office of Public and Intergovernmental Affairs
with the stated goal to ``standardize how outreach is being conducted
throughout VA.'' In follow-up questions to the hearing on the fiscal
year 2012 budget, VA was asked to provide the total amount VA, as an
enterprise, spent on outreach during fiscal year 2010. VA responded by
stating, ``[w]hile we are not currently able to extract the total
spending for outreach across the department for [fiscal year] 2010 and
[fiscal year] 2011, we are working diligently toward that goal for
[fiscal year] 2012.''
a. Please provide the total amount VA spent on outreach during
fiscal year 2010 and fiscal year 2011 and estimates for how much will
be spent during fiscal years 2012 and 2013. The data should include a
breakdown of money spent by VA Central Office, Veterans Integrated
Service Networks (VISNs), Regional Offices, and VA medical centers.
Response. VA created the National Veterans Outreach Office (NVO)
within the Office of Public and Intergovernmental Affairs (OPIA) in FY
2010 to coordinate outreach throughout VA, and to standardize outreach-
related activities. The NVO has made considerable progress in
researching and analyzing VA's outreach programs and activities in
2011, and has already developed a framework to track outreach efforts
that are part of VA's major initiatives. The final frameworkincludes
building a process for VA's administrations (Veterans Health
Administration, Veterans Benefits Administration and National Cemetery
Administration) and staff offices to:
provide Veterans with high-quality products and
information on activities that are consistent;
provide trained outreach coordinators to assist Veterans;
evaluate and develop metrics to measure the effectiveness
of outreach programs; and
track costs associated with outreach programs.
The embedded table, previously provided to the Committee in
March 2012, gives expenditure data on advertising outreach, a component
of VA's outreach efforts. Outreach through advertising is targeted to
helping VA reach Veterans who may be contemplating suicide; struggling
with homelessness, unemployment, or mental illness; for those Veterans
who live in rural areas; to make Veterans aware of available benefits
and services; and VA hiring and recruitment. Table 1 details VA
advertising activities and obligations for the period 2009-2012 and
planned for 2013.
The mechanisms for advertising outreach activities have included
Public Service Announcements, multi-media projects, Internet promotion,
transportation and billboard advertisements. Outreach activities and
events for Homeless Veterans Outreach, Health Benefits Awareness,
Mental Health Awareness, Women Veterans Outreach and Suicide Prevention
Outreach will continue in 2013 using earned media, including news
releases, social media, fact sheets, printed materials, etc. FY 2013
funding to supplement these activities with paid advertising will be
determined as part of the operational planning process.
b. Does standardizing the outreach efforts of VA include
coordinating projects and initiatives at all levels of the
organization? If so, please detail how the National Outreach Office has
met these goals and please describe what new initiatives the office is
undertaking to that end.
Response. Yes, but it is important to note that OPIA only has
supervisory authority over those personnel who are assigned or detailed
to the National Veterans Outreach Office. In addition, hundreds of
other VA employees enterprise-wide assigned to VBA, VHA and NCA are
typically involved in outreach activities on any given day; those
employees work for and respond to their respective chain of command. In
an effort to better coordinate the outreach efforts of all VA
employees, VA established a workgroup made up of representatives from
VHA, VBA and NCA and VA staff offices, including: Centers for Women and
Minority Veterans, Small and Disadvantaged Business Utilization,
Homeless Veterans Initiatives Office, Center for Faith Based and
Neighborhood Partnerships, and others. In 2011, the NVO held workgroup
meetings to solicit input and ideas from headquarters and field
facilities; and built buy-in for development and implementation of the
plan to coordinate outreach activities and initiatives. OPIA held a
national training conference in which ``Outreach Day'' was a major
activity to orient VA's professionals to the outreach plan and obtain
their final comments on developing a series of products and resources
to improve outreach coordination, collaboration and uniformity across
VA. Recognizing the need for centralized outreach management, NVO has
developed the first capability to provide critical and consistent
information to VA's Outreach community:
An intranet site that houses important information to
enhance how VA Outreach coordinators execute outreach including
policies and procedures, the National Veterans Outreach Guide, links to
the Congressionally mandated 2010 Biennial Report to Congress on the
VA's outreach activities, and other links.
An online National Veterans Outreach Guide that provides
best business practices, expert recommendations, proven examples of
successful VA outreach activities in serving Veterans, and lessons
learned. This guide outlines processes for how to conduct outreach
events, track expenditures, measure the success of activities and tap
into key VA resources and contacts, plus so much more.
Next steps include finalizing a proposal for a robust
National Veterans Outreach System (NVOS) which will allow VA Outreach
leaders to populate a series of fields with information about planned
outreach activities. The NVOS will be an interactive tool that allows
users to systematically and uniformly enter, store, organize, view,
retrieve and report outreach-related data easily. The goal of the
database is to provide a more advanced, easy-to-use tool that may
either be used in concert with existing data collection methods or
replace less efficient and effective approaches. It will also provide
the data necessary to extract any number of data pulls including the
costs associated with outreach in a fiscal year and the number of
events executed.
Question 5. The December 2010 report from the National Commission
on Fiscal Responsibility and Reform included a recommendation to reduce
Federal spending on travel, printing, and vehicles.
a. During fiscal year 2012, how much in total is projected to be
expended by VA on travel costs; how much in total is projected to be
expended on printing costs; and how much in total is projected to be
expended to purchase, lease, operate, or maintain vehicles?
Response.
----------------------------------------------------------------------------------------------------------------
Total Employee Total Printing Total Fleet Grand Total
FY Administration Travel Costs ($ Costs ($ Costs ($ Costs ($
millions) millions) millions) millions)
----------------------------------------------------------------------------------------------------------------
2012 Total VA (Appropriated) $282 $56 $82 $420
----------------------------------------------------------------------------------------------------------------
2013 Total VA (Appropriated) $282 $56 $88 $426
----------------------------------------------------------------------------------------------------------------
To implement Executive Order 13589, ``Delivering an Efficient,
Effective and Accountable Government,'' OMB agreed on a VA cost savings
goal of $173 million annually for all spending categories for fiscal
years 2012 and 2013. The FY 2013 employee travel target spend and
reductions included below are those amounts identified by VA and
approved by OMB for compliance with Executive Order 13589;
additionally, these amounts have been adjusted to meet requirements
related to OMB Memorandum M-12-12, ``Promoting Efficient Spending to
Support Agency Operations,'' and have been approved by OMB. With OMB
approval, no target has been set for executive fleet because the number
of vehicles in VA's fleet is minimal.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Grand Total
Total Travel Total Printing Total Supplies Total IT Mgt Support Target
FY Agency Reduction Reduction Reduction Devices Contracts Reductions ($
Reduction Reduction millions)
--------------------------------------------------------------------------------------------------------------------------------------------------------
2012 VA $56.2 $11.5 $24.8 $11.3 $69.6 $173.4
--------------------------------------------------------------------------------------------------------------------------------------------------------
2013 VA $58.4 $9.7 $72.1 $15.9 $17.4 $173.5
--------------------------------------------------------------------------------------------------------------------------------------------------------
b. For fiscal year 2013, how much in total is requested for travel
costs; how much in total is requested for printing costs; and how much
in total is requested to purchase, lease, operate, or maintain
vehicles?
Response. See above table in 5a.
Question 6. According to VA's Fiscal Year 2011 Performance and
Accountability Report, VA has ordered 25 electric vehicles in order to
conduct a ``pilot study.''
a. What make and model of electric vehicles were ordered, what was
the total cost to VA to purchase or lease these vehicles, and what was
the total cost to the Federal Government (if different)?
Response. VA is currently scheduled to receive 26 electric vehicles
(EVs) through the General Services Administration's (GSA) EV pilot
program:
5 Think City vehicles
1 Nissan Leaf
20 Chevrolet Volts
VA is paying the same lease cost for these EVs as for a standard
vehicle of a similar class. GSA's pilot program funding covers the
incremental costs of the electric vehicles and the acquisition cost of
charging stations for the participating agencies. Agencies only pay for
the costs associated with installing the charging station at the EV
site.
GSA would have information on the cost to purchase or lease these
vehicles both for VA and Federal-wide.
b. For fiscal year 2013, how much in total is requested for
purposes of this initiative?
Response. No funding is requested.
c. How and where will these vehicles be used?
Response. Most of the vehicles are assigned to VHA facilities in
the San Francisco, San Diego, Los Angeles, Detroit and Washington/
Baltimore metropolitan areas. One additional vehicle is assigned to VBA
in Detroit. VA is deploying each vehicle to the most appropriate use at
the selected locations. For example, how the vehicle is used depends on
the distance that needs to be traveled, the number of people that must
be accommodated, whether or not equipment and/or other supplies are
being moved and other related factors.
d. What are the specific objectives of the pilot study and what
benchmarks will be used to determine whether it is successful?
Response. The pilot study is a GSA initiative. GSA's stated
objectives are to determine if EVs are a cost effective option for
Federal fleets, and where and for what kinds of uses. GSA is collecting
data electronically from the charging stations and from the agencies
leasing the vehicles.
e. Please provide copies of the Executive Decision Memorandum (or
comparable document) approving the pilot study and supporting documents
of justification and implementation.
Response. The pilot study is a GSA program in which VA, along with
other Federal departments and agencies, is a participant. VA does not
have access to GSA internal support and approval documentation.
f. What cost comparisons were performed to assess the differential
between the costs of operating an electric vehicle fleet versus other
types of vehicle fleets (gasoline, natural gas, or hybrid)? Please
provide any documentation comparing the costs of electric vehicles with
other types of vehicles (gasoline, natural gas, or hybrids).
Response. Under this pilot, GSA pays all operating expenses for
leased vehicles in their fleet regardless of fuel type.
Question 7. VA's Central Office houses a number of different
entities, including the Office of the Secretary, the Office of
Congressional and Legislative Affairs, the Office of Public and
Intergovernmental Affairs, and other support offices.
a. How many employees currently are assigned or detailed to each of
these respective entities within VA's Central Office? Please identify
the status of those employees as permanent or detailed; career or non-
career; and GS, SES or SES Equivalent, or other pay scale. Please
identify the locations (VISNs, VA medical centers, Veterans Benefits
Administration Regional Offices, etc.) from where these employees are
being detailed.
Response. As of June 2012, 5 employees were detailed to one of the
seven Staff Offices of VA Central Office or the Office of the Secretary
(OSVA). Please see the below table.
------------------------------------------------------------------------
Staff Office/
Office of the Field Office,
Secretary the Administration, or Employee's Employee's
Employee has been Facility Employee is Career Status Pay Plan
detailed to Detailed From
------------------------------------------------------------------------
HRA VHA Employee Education Career GS
System, VHA.
------------------------------------------------------------------------
OSVA Office of Information & Career GS*
Technology/Product
Development, OIT.
------------------------------------------------------------------------
OSVA VHA, Executive Career GS*
Correspondence.
------------------------------------------------------------------------
OSVA VBA, Deputy Under Career GS*
Secretary for Benefits.
------------------------------------------------------------------------
OSVA Office of Management, Career GS
Office of the
Assistant Secretary.
------------------------------------------------------------------------
* Note: Two of the OSVA details ended in July 2012 and one ended in
August 2012.
b. If VA's fiscal year 2013 budget request is adopted, how many
full-time equivalents would VA expect to be assigned or detailed from
outside VA's Central Office to VA's Central Office during fiscal year
2013?
Response. The use of details to one of the seven Staff Offices of
VA Central Office or OSVA in FY 2013 cannot be accurately forecasted.
Detailee requirements are driven by temporary and short-term emergent
workload needs that are not part of the normal budget planning process.
Question 8. For the period October 1, 2010, through December 31,
2011, please provide a listing (without names or other personal
identifiers) of those VA employees who have been approved to receive,
or have received, Recruitment, Relocation and/or Retention Incentives.
It is requested that the listing include the employee's grade (SES, SES
Equivalent, title 38, GS, etc.); duty station (VA Central Office, VA
Field location--VISN, VAMC, VBA regional office, etc.). Please list the
amount approved for each Incentive category.
a. For those receiving Relocation Incentives, please list the
losing and receiving duty station/location.
Response. The embedded spreadsheet, below, is a listing of
individual Recruitment, Relocation and Retention Incentives paid from
October 1, 2010 through December 31, 2011, by grade. Losing and
receiving duty stations/locations cannot be reported due to system
limitations. Incentives payments have been attributed to the
Administration or Staff Office where the individual was employed on the
date the information was extracted from the Personnel Accounting
Integrated Database (PAID) system. In the case of internal VA employee
transfers, the incentive may actually have been paid by a different
Administration or Staff Office prior to the transfer.
[This extensive information was received and is being held in
Committee files.]
b. For those receiving Retention Incentives, please identify the
level of approving official (i.e., Secretary, Deputy Secretary, Chief
of Staff, Under Secretary, Assistant Secretary, VISN/VA medical center/
Regional Office Director, etc.).
Response. VA does not maintain a central electronic file that
identifies the approving official for each employee's retention
incentives. This information is in locally maintained paper files and
would require several months to compile.
VA Handbook 5007, Pay Administration, Part VI, Recruitment and
Retention Incentives, documents VA's policy as follows:
``a. Retention allowances must be approved by an official at
a higher level than the one recommending the payment. The
authorizing official's signature signifies concurrence with the
determination that an allowance is needed to retain a critical
VA employee and authorization of the allowance percentage.
``b. The Secretary, or designee, is the approving official
for retention allowances for employees occupying positions
centralized to that office.
``c. Administration Heads, Assistant Secretaries, Other Key
Officials, and Deputy Assistant Secretaries, or their
designees, recommend retention allowances for employees
occupying positions in their organization which are centralized
to the Secretary. They, or their designees, approve retention
allowances for employees occupying Central Office (VACO)
positions in their organizations, which are not centralized to
the Secretary; and employees occupying field positions
centralized to their offices.
``d. Facility directors may approve retention allowances for
title 38 and title 5 employees in non-centralized positions
under their jurisdiction provided that the amount of the
allowance, when combined with all other VA payments, does not
cause an employee's total pay to exceed the aggregate limit on
pay.''
The Department is currently updating the incentives policy to
reflect higher levels of approval.
c. For those receiving Retention Incentives within the VA Central
Office, please further identify the specific office (i.e., Office of
Public and Intergovernmental Affairs, VHA Deputy Undersecretary for
Health for Operations and Management (DUSHOM), Veterans Benefits
Administration Compensation and Pension Service, Office of the
Secretary, etc.).
Response. The table below is a summary of Central Office Retention
Incentives paid from October 1, 2010 through December 31, 2011, by
Staff Office and Administration.
d. For those receiving Retention Incentives, please identify, where
applicable, whether the Incentive was being offered because (1) the
employee was likely to leave because of retirement; (2) the employee
indicated an intent to leave for a different Federal position; or (3)
of another authorized reason.
Response. VA does not maintain a central electronic file
documenting the approved reasons for each employee's retention
incentives. This information is in locally maintained paper files and
would require several months to compile.
The Code of Federal Regulations at 5 CFR 575.307 requires VA to
establish the required documentation for determining that an employee
would be likely to leave the Federal service in the absence of a
retention incentive. VA Handbook 5007, Pay Administration, Part VI,
Recruitment and Retention Incentives, documents VA's policy as follows:
``Evidence that the Employee is Likely to Leave Federal
Employment. Each supervisor shall make a separate certification
that an employee, or for group authorizations, a significant
number of employees in the group, is likely to leave Federal.
This certification will only be made when the supervisor is
reasonably convinced that the employee is likely to leave
Federal service. Such a certification may be based on:
``(1) Receipt by an employee, or for group authorizations, a
significant number of employees, of one or more bona fide
offers of employment, as evidenced by a formal written job
offer or affidavit signed by the employee or employees
providing the position and salary being offered, the name and
location of the organization, and the prospective date of
employment; or
``(2) Evidence of high demand in the private sector for the
knowledge and skills possessed by the employee or group of
employees and significant pay disparities between Federal and
non-Federal salaries; or
``(3) A discussion with the employee of the employee's career
plans.''
A supervisor's certification documenting the reason for determining
the likelihood of an employee leaving Federal employment should be
included in each retention incentive case file. However, VA's OIG
November 14, 2011, audit of retention incentives for VHA and VA Central
Office cited case files that lacked documentation to support VA
retention incentive decisions, including supervisors' certifications
that the employees were likely to leave Federal service in the absence
of monetary incentives were missing from some files. VA senior
officials concurred with OIG report recommendations and provided
acceptable corrective action plans which are currently being
implemented.
Employees who intend to leave VA for another Federal position may
be granted a retention incentive only if VA has provided a general or
specific written notice that the employee's position may or would be
affected by the closure or relocation of the employee's office,
facility, activity, or organization, per 5 CFR 575.315(b)(3).
Question 9. Last year, the Committee learned that VISN 20
contracted with a company called Values Coach, Inc., for $394,000. In a
response to an inquiry from the Committee, VA indicated that VISN 20
hired Values Coach to design a program ``to enhance performance in the
area of customer satisfaction.''
a. For fiscal year 2012, how much was spent across all VISNs on
customer services contracts to enhance customer satisfaction?
Response. See embedded attachment. Please note the expenditures
reflected for the VISNs in the spreadsheet cover a wide range of
expenditures that fall under the general category of customer
satisfaction efforts including implementation of a system in VISN 6,
for example, that enables the tracking of customer satisfaction at the
clinic level.
Amount Spent on Customer Services Contracts to Enhance Customer
Satisfaction
Department of Veterans Affairs--April 2012
------------------------------------------------------------------------
(b) Amount
(a) Amount Spent Projected to
on Customer Spend on
Services Customer
VISN/NCO Number Contracts for Services
Fiscal Year 2012 Contracts for
to April 2012 Fiscal Year
2013
------------------------------------------------------------------------
VISN 1............................... 0 Unknown
VISN 2............................... 0 Unknown
VISN 3............................... 0 Unknown
VISN 4............................... 0 Unknown
VISN 5............................... 0 Unknown
VISN 6............................... est. 644,630 Unknown
VISN 7............................... 0 Unknown
VISN 8............................... 0 Unknown
VISN 9............................... 0 0
VISN 10.............................. 377250 170000
VISN 11.............................. 0 0
VISN 12.............................. 278950 46100
VISN 15.............................. 0 0
VISN 16.............................. 0 0
VISN 17.............................. 0 0
VISN 18.............................. 0 0
VISN 19.............................. 0 0
VISN 20.............................. 192100 10000
VISN 21.............................. 0 0
VISN 22.............................. 0 0
VISN 23.............................. 58305 53805
----------------------------------
Totals........................... $1,551,235 $279,905
------------------------------------------------------------------------
b. For fiscal year 2013, how much will be spent across all VISNs on
customer services contracts to enhance customer satisfaction?
Response. Please see embedded attachment for question 23a.
c. For the VISN 20 Values Coach contract, please describe the
metrics used to determine whether customer satisfaction changed as a
result of this contract.
Response. Since October 2010, the VISN 20 ``Culture of Change''
Steering Committee has overseen initiatives, including the Values Coach
contract, to assist with transitioning the organization to a more
Patient-Centered Culture. The Committee analyzes employee survey
scores, facilitates educational opportunities for employees, and seeks
improvement in Labor-Management relationships. The Values Coach
contract enabled VISN 20 facilities' staff to improve their adoption of
a patient-centered culture. This was assessed through meetings, town
halls and other venues. The services offered help teach patient-
centered values, Plain Tree and other concepts.
d. Please provide a detailed description of the process required to
secure contracts for customer service training to enhance customer
satisfaction.
Response. The process for securing a contract begins with a clear
requirement, typically established by a program manager. Establishing
the requirement and determining that a contract is required to meet it,
may involve several levels of review and discussion. In VISN 20, the
network leadership adopted an initiative that had shown success in one
of its Medical Centers and extended it throughout the VISN. In this
instance, the requirement identified is the need to enhance client
focus of staff throughout a medical center--this is a cultural change
and requires the support of professionals who have been able to deliver
comparable changes at multiple layers of a hospital organization. In
these instances, it may be suitable for a contractor's services to be
retained by the government. As stated earlier, since October 2010, the
VISN 20 ``Culture of Change'' Steering Committee has overseen
initiatives, including the Values Coach contract, to assist with
transitioning the organization to a more Patient-Centered Culture. The
Committee analyzes employee survey scores, facilitates educational
opportunities for employees and seeks improvement in Labor-Management
relationships.
As it relates to the process to secure contracts, the requesting
office defines their requirement and provides the contracting officer
with procurement and funding documentation. Based on the information
provided and market research results, contracting decides the
acquisition strategy. A solicitation is then created and released to
potential offerors. Upon receipt of the offer, a technical evaluation
panel evaluates the offers based on the evaluation factors in the
solicitation. Following evaluation of the final offerors, contracting
selects the offerors whose proposal is most advantageous and provides
the best overall value to the Government, consistent with the
evaluation factors established in the solicitation. Best value awards
are made against Federal Supply schedules. Contract requirements are
reviewed by warranted Contracting Officers. If required, a legal review
may be performed by OGC.
Once the requirement is established, VHA's contract oversight
process will be applied to securing a contract to meet the requirement.
VHA contracting oversight process focuses on ensuring that all
contracting regulations have been followed. The Integrated Oversight
IL, IL001AL-09-02, guides the contract review process for all of VA
[see attached]. The process for contract review is dependent upon the
contract value. Typically, the higher the dollar value, the more levels
of review, including a review by legal. Contracting oversight ensures
that all requirements of law, executive orders, regulations, and all
other applicable procedures, including clearances and approvals, have
been met (see references FAR 1.602-1 Authority, paragraphs (a) and (b)
provided below).
The contracting office determines if a requestor's requirement is
appropriate and necessary based on the supporting documentation
provided. A contracting officer's role is to be a business advisor in
relation to the procurement strategy and to ensure the proper
contracting regulations are followed. If the requestor requests a
particular brand name, or vendor (sole source) for example, the
requestor is responsible for providing supporting justification/
documentation to the contracting office, and the contracting office is
responsible for approving or rejecting the request based on the
supporting justification/documentation provided. For example, if a
doctor requires a particular piece of equipment to perform a surgery or
an engineer has particular design requirements, contracting will review
supporting documentation provided by the requestor and determine if the
requirements are appropriate and necessary.
Reference:
FAR 1.602-1 Authority, paragraphs (a) and (b), state, contracting
officers have authority to enter into, administer, or terminate
contracts and make related determinations and findings. Contracting
officers may bind the Government only to the extent of the authority
delegated to them. Contracting officers shall receive from the
appointing authority (see 1.603-1) clear instructions in writing
regarding the limits of their authority. Information on the limits of
the contracting officers' authority shall be readily available to the
public and agency personnel. No contract shall be entered into unless
the contracting officer ensures that all requirements of law, executive
orders, regulations, and all other applicable procedures, including
clearances and approvals, have been met.
ATTACHMENTS FOR QUESTION 9D FOLLOW:
e. Does the Federal Government (VA, Office of Personnel Management,
etc.) provide coaching services which would train Federal employees to
improve their customer service skills? If so, please describe the
program(s) in detail.
Response. At VA, Veterans are our customers. Across our
organization we are focused on improving the customer service we
provide to Veterans, their families and their survivors. At the
Department level, VA provides coaching services for the development and
enhancement of executive leadership skills. This coaching heightens the
awareness and emotional intelligence of leaders, which in turn yields
better outcomes for customers, employees, and the organization at-
large. VA Executive coaching is available to newly appointed Senior
Executive Service (SES) members and existing SES who have taken on a
new responsibility level. Coaches are affiliated with the Center for
Creative Leadership, and have many years of experience working with
executives and leaders from a variety of organizations (public and
private). Additionally, there are several opportunities for coaching
embedded in VA Learning University sponsored training.
More broadly, in 2011 the Department announced VA Core Values and
Characteristics that apply universally across all of VA. The Core
Values are the basic elements of how we go about our work--they define
``who we are''--and form the underlying principles we use every day in
our service to Veterans. The Core Characteristics define ``what we
stand for'' and what we strive to be as an organization. The Values are
Integrity, Commitment, Advocacy, Respect and Excellence (``I CARE'').
The Core Characteristics help guide how we will perform our core
mission; they shape our strategy, and will influence resource
allocation and other important decisions made within VA. The
Characteristics are Trustworthy, Accessible, Quality, Agile,
Innovative, and Integrated.
A few examples of the many ways VA focuses on customer service are
included below.
In VBA, all call center agents are required to complete a telephone
techniques training program. This program focuses on effective customer
service and active listening skills, acknowledgement of customers'
feelings, and effective call management techniques. Call center agents
also complete call simulations training, which allows the agents to
apply their skills via role playing scenarios. As part of VBA's
standard quality review process, all call center agents receive a
monthly coaching session where they are provided feedback on their
technical proficiency and how they can continue to strengthen client
contact behaviors.
In the National Cemetery Administration (NCA), the National
Training Center trains leaders and technical experts in operational
standards and measures to ensure our Nation's veterans and their
families are honored with dignity and respect and a final resting place
and lasting memorial. Customer service is also an integral part of NCA
training programs. NCA incorporates customer service modules into the
design for every mission-critical occupation, such as the NCA Caretaker
Training, the Foreman Training and the Cemetery Representative Training
Programs. These programs focus on assessing employee proficiency in
customer service basics, convey the importance of exceeding
expectations, and offer practical applications illustrating the role of
the NCA employees in providing Veterans and their families with the
highest level of customer service.
In VHA, the employee-customer (patient) relationship is at the
heart of the Patient Aligned Care Team (PACT) transformational
initiative. Four regional PACT teams, comprised of patient-centered
care consultants, will facilitate the culture change for patient-
centered care at all VA facilities across the country, within their
designated region. These teams will not only serve as consultants, but
will also conduct training with local staff on the implementation of
patient-centered principles.
Finally, the VHA ``Treating Veterans with I.C.A.R.E.'' program is
designed to enhance the ability of staff to communicate effectively and
compassionately with Veterans in health care settings. Emphasis is
placed on how to connect with the Veteran, appreciate their position as
a customer, respond appropriately with care and empathy, and empower
the patient. This training has standardized materials including
facilitator guides and is designed to be delivered at VA facilities.
VA defers to OPM and other Federal Departments to discuss details
of executive branch-wide coaching and customer service training.
Question 10. In response to questions about VA's fiscal year 2012
budget request, VA indicated that, ``[a]t the end of FY 2010, VA's
total outstanding delinquent debt was $1.3 billion'' and that, of that
amount, ``$784 million was attributable to delinquent benefit debts.''
a. What was the total amount of outstanding delinquent debt at the
end of fiscal year 2011?
Response. Based on the Treasury Report on Receivables (TROR) the
total outstanding delinquent debt for FY 2011 was $1.2 billion.
b. What portion of that amount was debt created in connection with
VA benefit payments?
Response. Based on the TROR benefit debt at the end of FY 2011 was
$732 million.
c. What is the total value of debts for which VA waived recoupment
during fiscal year 2011?
Response. In FY 2011 VA wrote off or waived a total of $247
million.
d. What is the total value of debts deemed uncollectible during
fiscal year 2011?
Response. The total of all uncollectible debts is
$1,198,614,941.11.
e. What is the total amount of delinquent debt projected to be
outstanding at the end of fiscal year 2012?
Response. We do not have a way to provide an estimate of the future
predicted debt level for delinquent debt. However, we can provide an
estimate for new debt established. For FY 2012, we expect to establish
$1.46 billion in new debt.
f. What is the total amount of delinquent debt projected to be
outstanding at the end of fiscal year 2013?
Response. We do not have a way to provide an estimate of the future
predicted debt level for delinquent debt. However, we can provide an
estimate for new debt established. In FY 2013 we expect to create $1.48
billion in new debt.
Question 11. For fiscal year 2013, VA projects to spend $76.4
billion in mandatory funding. According to VA's budget request, that
funding will, in part, be used to pay for items such as medical
examinations, state approving agencies, awards under the Equal Access
to Justice Act (EAJA), and reimbursements to the General Operating
Expenses account for certain costs of administering VA benefit
programs.
a. In total, how much of that mandatory funding will be spent other
than in the form of direct benefits paid or provided to veterans, their
families, or their survivors?
Response. For FY 2013, approximately $273.1 million, or 0.42
percent, of the $61.7 billion for the compensation and pension
mandatory account is for non-direct benefits paid for Veterans and
survivors. Over 99 percent of total obligations in compensation and
pension mandatory funding is attributed to direct benefit payments.
For FY 2013, $32.3 million, or 0.26 percent, of the $12.6 billion
dollar appropriation requested for the readjustment benefits account is
expected to be spent on non-direct benefits provided to Veterans, their
families, or their survivors. Over 99 percent of readjustment benefits
mandatory funding is for direct benefits paid or provided to Veterans
and their families, survivors, and institutes of higher learning.
b. Of that total, please identify how much would be spent for each
category of non-benefit payments, such as the amounts that would be
spent on information technology, on contractor services, or on
personnel expenses.
Response. For the compensation and pension account, the $273.1
million in non-direct benefit payments is outlined below.
$250.6 million for Medical Exam Pilot Program: Public Law
(P.L.) 104-275 authorizes VA to carry out a pilot program over 10
regional offices for examinations with respect to medical disability of
applicants performed by persons other than VA employees.
$13.3 million for Equal Access to Justice Act payments:
Public Law 99-80 authorizes the award of attorney fees and other
expenses to eligible individuals and small entities that prevail
against the government in civil actions for judicial review of agency
action.
$9.2 million for OBRA: The OBRA Act of 1990, Pub. L. 101-508
authorizes VA to perform data matches with the Internal Revenue Service
and Social Security Administration to ensure proper payments are made
to eligible beneficiaries.
For the readjustment benefits account, the $32.3 million in non-
direct benefit payments is outlined below.
$19.0 million for State Approving Agencies: Pub. L. 110-252
increased the maximum funding level for State Approving Agencies to
$19.0 million. State Approving Agencies assess whether schools and
training programs are of appropriate quality for Veterans to receive VA
education benefits while attending them.
$12.8 million for Reporting Fees: Reporting fees are paid by
VA to educational institutions for each person enrolled who is
participating in a VA education program. Pub. L. 111-377 increased the
reporting fee rates from $7 to $12 per enrolled veteran or $11 to $15
per enrolled veteran if educational assistance checks are in temporary
custody of an institution.
$0.5 million for Reimbursement to General Operating Expenses
(GOE): Pub. L. 101-237 and Pub. L. 105-368 authorized reimbursement for
GOE expenses related to outreach and distribution of information to
Veterans regarding education benefits.
OFFICE OF INFORMATION AND TECHNOLOGY
Question 1. The Office of Information and Technology (OIT) has
outlined 16 major transformational initiatives developed to support the
Secretary's goal ``to transform the Department of Veterans Affairs * *
* into a high performing 21st century organization.''
a. What is the total amount VA expects to spend on developing these
16 major transformational initiatives? Please breakout the funding by
initiative.
Response. The Office of Information and Technology (OIT) provides
support to each of the Secretary's 16 Major Initiatives. For FY 2013,
VA has requested $376,810,000 for development. The breakdown of the
development budget by Major Initiative is reflected in the table below.
FY 2013 Budget Submission
(in thousands of dollars)
------------------------------------------------------------------------
Major
Major Initiative Development Marginal Initiative
Sustainment Total
------------------------------------------------------------------------
MI 01--Eliminate Veteran 3,075 879 3,954
Homelessness.....................
MI 02--Veterans Benefits 38,525 53,728 92,253
Management System (VBMS).........
MI 03--Automate GI Bill Benefits..
MI 04--Virtual Lifetime Electronic 49,939 3,000 52,939
Record (VLER)....................
MI 05--Improve Veterans Mental 8,818 310 9,128
Health...........................
MI 06--Veterans Relationship 99,439 11,486 110,925
Management (VRM).................
MI 07--New Models of Health Care 35,724 1,101 36,825
(NMHC)...........................
MI 08--Enhance the Veteran 67,816 3,934 71,750
Experience and Access to Health
care (EVEAH).....................
MI 09--Ensure preparedness to meet 3,025 11,490 14,515
emergent national needs..........
MI 10--Enabling Systems to Drive 4,062 100 4,162
Performance and Outcomes (STDP)..
MI 11--Integrated Operating Model 20,065 13,625 33,690
(IOM)............................
MI 12--a Human Capital Investment 14,640 1,000 15,640
Plan (HCIP)......................
MI 13--Research & Development 18,521 3,665 22,186
(R&D)............................
MI 14--Strategic Capital 1,000 3,162 4,162
Investment Planning (SCIP).......
MI 15--Health care Efficiency..... 4,659 2,000 6,659
MI 16--Health Informatics......... 7,500 1,656 9,156
-------------------------------------
Total........................... 376,808 111,136 487,944
------------------------------------------------------------------------
b. When does VA expect to see these projects moved from the
development stage to activation?
Response. Each Major Initiative contains a unique set of projects
that provide the functionality envisioned by the initiative. Five of
the Major Initiatives are scheduled to accomplish their
transformational goals in FY 2012 (GI Bill/IVMH/STDP/R&D/SCIP).
For each project supporting an initiative, and based on PMAS
principles, customer facing functionality is delivered to the customer
in increments on a 6-month or less basis. Complete project transition
from a development state is uniquely determined by each project's
defined scope of requirements.
c. Once these projects become activated, what will be the costs
associated with operating and maintaining these projects?
Response. For FY 2013, Product Development, under the Major
initiative construct, has budgeted $111 million for the incremental
transition of projects to activation. The marginal sustainment by Major
Initiative is reflected in the chart above.
d. For each of the 16 major transformational initiatives, please
provide the Committee with a detailed description of each of the
information technology (IT) products, software, or other items that
would be the end result of each initiative.
Response. The following list of projects and deliverables is not an
exclusive list. These are some of the key IT projects managed under the
initiatives, although some projects may not be listed. This list of
deliverables does not include non-IT projects and deliverables for the
initiatives.
1. Eliminate Veteran Homelessness (EVH)
Handheld device pilot for use by Homeless Program case and
outreach workers.
- This will provide users the ability to track Veterans
receiving assistance. Deliverables will include the capability
of accessing other VA applications to scheduling, clinical
ancillary programs and mental health via the use of the
handheld device.
The Web-management Toolkit for the Department of Housing and
Urban Development--VA Supported Housing (HUD-VASH)--completed in FY
2012.
- Provides case managers and Veterans access to on-line
resources that will help attain and maintain permanent Veteran
housing, general information, best practices and program
specific data to providers and will be expanded to cover other
Homeless Programs.
Homeless Operations and Management Evaluation System
(HOMES)--
- Completed in FY 2012. Performs case management and tracking
functions for the Homeless Program
In FY 2013, the Homeless Repository will also expand its two-
way interface to more entities and provide those entities with up-to-
date Veteran information. The information shared by VA then will be
used by those entities to address homeless Veteran benefit gaps.
Veteran Re-Entry Matching Service project--collecting and
processing information about incarcerated Veterans designed to address
community reentry needs of incarcerated Veterans by preventing
homelessness.
- Reduces the impact of medical, psychiatric and substance
abuse problems upon community readjustment to decrease the
likelihood of re-incarceration.
2. Veterans Benefits Management System (VBMS)
VBMS deployment is occurring in phases.
Phase 1 was deployed in November 2010 and completed in
May 2011.
- Phase 1 utilized a new electronic claims repository and
scanning solution, as well as new claims processing software
integrating with elements of the current legacy platform.
Phase 2 was deployed in May 2011 and completed in
November 2011.
- Phase 2 validated and refined the VBMS technology solution,
as well as provided additional business requirements for future
technology releases.
- In addition, Phase 2 increased system capacity by adding
more users, stations, claims, and claim types.
In August 2011, VBA began implementing transformation
initiatives to drive consistency, standardization, and improvement in
delivery of benefits.
- VBMS is one of the technology solution components enabling
all claims to be completed within 125 days at 98 percent
accuracy by 2015.
VBMS Major Release 2 was deployed in November 2011.
- Major Release 2 enhanced user interface, claims'
establishment, and rating capability.
VBMS Major Release 3 is scheduled to deploy in July 2012 in
support of national deployment.
Subsequent major and minor software releases are scheduled
through FY 2014.
3. Automate GI Bill Benefits
Since March 2010, Long Term Solution (LTS) has been incrementally
developed to provide Post-9/11 GI Bill benefits in a timely and
effective manner.
Release 1.0 of the LTS, deployed on March 31, 2010, provided
calculations for chapter 33 eligibility, entitlement, and delimiting
date as well as calculations for chapter 33 awards (with no amendments)
including calculation of tuition and fees, Yellow Ribbon, housing,
books and supply, chapter 30 kicker, chapter 1606 kicker, and
calculations for intervals between terms. Interface with VADIR system
(VA's internal database of military data) included.
Release 2.0, deployed June 30, 2010, added capability to
process amended awards to comply with existing requirements in title
38, chapter 36. Interface with WEAMS (system that records school
approval data) included.
Release 2.1, deployed August 23, 2010, provided for a data
conversion from the FET (Front-End Tool) system, initially used to
calculate chapter 33 benefits. All chapter 33 claims processed in LTS
effective R2.1.
Release 3.0, deployed October 30, 2010, added interface with
VAONCE (the system schools use to report enrollment and changes of
enrollment).
Release 4.0, deployed December 20, 2010, provided interface
with the chapter 33 BDN system (the payment system for chapter 33).
Included initial claimant self-service (via eBenefits).
Release 4.2, deployed on March 5, 2011, provided
functionality to implement 60-day requirement deadlines contained
within Pub. L. 111-377.
Release 5.0, deployed June 4, 2011, implemented numerous
additional provisions of Pub. L. 111-377 and also provided a scheduling
feature for housing payments.
Release 5.1, deployed October 17, 2011, completed the
functionality required to address Pub. L. 111-377 including calculation
of benefits for training at non-degree schools, correspondence schools,
flight schools, and for apprenticeship and on-the-job training.
Release 5.11, deployed on December 19, 2011, enhanced the
processing of student debt management issues caused by the
implementation of the tuition and fee payment cap required by Pub. L.
111-377.
Release 5.2, deployed on February 21, 2012, was a technical
release to prepare for automation in Release 6 and to address system
and security requirements that were previously deferred.
Release 6.0, scheduled for July 30, 2012, will provide end-
to-end automation of selected supplemental claims without human
intervention.
FY 2013 activities will include knowledge transfer and
continuation of activities for full sustainment, as well as, subject to
additional funding, development of user functionality for continued
enhancements to the LTS system.
4. Virtual Lifetime Electronic Record (VLER)
Deliverables for VLER are explained in the context of the following
four focus areas:
Nationwide Health Information Network (NwHIN)
a. The key to sharing critical health information is pushing for
interoperability and utilizing the NwHIN standards, allowing agencies
like VA and DOD to partner with private sector health care providers to
promote better, faster and safer care for Veterans.
Warrior Support
b. The VLER Warrior Support Projects ensure that information is
available to end users in a timely fashion to support Integrated Care
for Servicemembers and Veterans of Operation Enduring Freedom,
Operation Iraqi Freed and Operation New Dawn and severely ill and
injured Servicemembers and Veterans
Memorial Affairs Modernization
c. Designed in the 1990s, modernizing and redesigning the Memorial
Affairs Burial Operations Support System (BOSS) will allow VA the
flexibility to adapt to current needs and improve overall stability of
the platform and consistency of services it provides to Veterans and
their families at over 180 locations including 131 VA National
Cemeteries.
Health Information Technology Sharing
d. In 2011, the Bidirectional Health Exchange (BHIE) interface
implemented an application that enables VA providers to select for
viewing DOD neuropsychological assessments and imagery from the DOD
Healthcare Artifact Information Management System. BHIE also
implemented updates to an existing application to enable VA clinicians
to view DOD inpatient notes. BHIE currently is supporting approximately
450,000 monthly health information exchange queries from VA to DOD, at
a rate of over five million per year.
5. Improve Veterans Mental Health
In FY 2012, deliverables include:
Deployment of software to track patients at high risk of
suicide;
Software to identify a patient's principal mental health
provider to all medical staff treating the Veteran;
Deployment of a number of mental health assessment tools to
ensure sufficient information is collected during patient assessments
to make good clinical decisions; and
Deployment of goal setting module in My HealtheVet.
In FY 2013, deliverables include:
Provide a tool for clinicians to assign and distribute
assessment instruments for evaluating the mental health condition of a
Veteran based upon that Veteran's unique treatment and service needs;
Adopt a tool to conduct structured assessments that is used
to manage and evaluate mental health care within primary care settings;
and
Implement a tool to allow the identification of at-risk
Veterans so that proper care may be given at VA health care facilities.
6. Veterans Relationship Management (VRM)
In FY 2012, the VRM initiative made a number of important
achievements that will be leveraged into the next fiscal year.
VONAPP Direct Connect (VDC) 1.0 provides Veterans the ability
to apply for VBA benefits by answering guided interview questions
through the security of the eBenefits portal. Introduced in VDC release
1.0 were guided interviews for the Declaration of Status of Dependents
and Request for Approval of School Attendance.
Virtual Hold and Scheduled Call Back technology was
successfully deployed for all VBA National, Pension, and Education call
centers. Virtual Hold allows callers to hang up rather than wait on
hold and be automatically called back without losing their position on
the call queue. Scheduled Call Back enables callers to schedule a
returned call up to 7 days in advance.
The VRM Customer Relationship Management/Unified Desktop
(CRM/UD) was deployed at the VBA National Call Center (NCC) in St.
Louis. CRM/UD improves the VBA NCC business processes by capturing
caller history, which facilitates first contact resolution, and aids in
personalizing service to Veterans. CRM/UD streamlines data access by
providing a single, unified view of VA clients through one integrated
application versus the current process that requires Public Contact
Agents to access up to 13 applications.
Interactive Voice Response (IVR) enhancements were introduced
allowing VBA to re-record IVR information as needed, eliminating the
need to place change orders with the vendor. Recent changes to the
recordings provided a simplified IVR for callers seeking agent
assistance and enhanced the self-service function to include providing
payment information for Education Chapter 33 participants.
Multiple releases expanded the existing self-service features
available via the eBenefits portal. New functionality includes the
ability to login with a DS Logon using a smart phone, status of an
appeal at the Board of Veterans' Appeals (BVA); access to Post-9/11 GI
Bill enrollment status and enhanced claims status features, and VA
payment history.
The framework for the Stakeholder Enterprise Portal (SEP) was
delivered and will provide a secure, consistent, and seamless entry
point to VA web-based systems and self-service functions for VA's
stakeholders and business partners providing services on behalf of
Veterans.
In addition, VRM has implemented the ability to assign a VA
identifier to active duty military personnel at VA facilities. This
minimizes inaccuracies in identifying a Veteran and decreases the
number of duplicate records.
Critical components of VRM are directed at improving
telephone services through integration of new telephony technologies.
7. New Models of Health Care (NMHC)
This portfolio of multi-year programs is designed to
transform the delivery of healthcare within VA and to position VA as a
leader in the healthcare industry through innovations for both Veterans
and providers.
To help facilitate the redesign of primary care, the Primary
Care Management Module will be reengineered to create a national
database identifying all members of the PACT and tracking of all
patient care providers, both VA and non-VA.
Specialty Care has completed a Multiple Sclerosis Home
Automated Telemanagement (MS Hat) pilot project providing MS patients a
way of monitoring their rehabilitation, providing patients with tele-
rehabilitation, and tracking patient progress in real time.
VA is developing software to track and report abnormal test
results and is also developing a Breast Cancer Clinical Case Registry
to provide immediate access to breast cancer screening results.
To alert providers of pregnancy and lactation status when
prescribing potentially unsafe medication drugs, VA is developing a
notification tool of teratogenic medications within the Computerized
Patient Record System (CPRS).
My HealtheVet (MHV) is a forward-facing web portal that helps
replace a visit-based, hospital-centric model with a Veteran-centric
health care model. Capabilities enhancements have been developed to
support web-based tools to help Veterans, their families, and care
providers increase their knowledge of health conditions, better manage
their personal health records, and communicate with health care
providers in a secure online environment.
The MHV Secure Messaging project improves the clinician-
patient relationship by providing patients and clinicians with the
ability to send non-urgent, secure messages without using email and
risking the exposing confidential information.
The MHV Online Viewing Personal Health Record (PHR) project
will allow Veterans to view and manipulate portions of their PHRs
downloaded from VistA or self-entered. As a result, Veterans' ability
to manage their care will be improved and their PHRs will contain
information from a broader range of VA services delivered. Providers
are more likely to engage and adopt tools containing comprehensive
health information which can be integrated into CPRS.
The MHV and eBenefits Portal Integration (MHVEB) project will
provide VA a Single Sign-On (SSO) capability for MHV. The SSO
functionality will allow users to sign on to the MHV portal from
another eAuthentication-enabled portal, as well as to sign on to
another eAuthentication-enabled portal from the MHV portal.
The MHVEB project will leverage DOD DS Logon Level 2
credentials to provide an SSO capability from eBenefits. Users can map
their eBenefits account to their VA Patient MHV account to seamlessly
navigate to and from their MHV account
The VistA Imaging Enhancements project is part of the VA
System of Records for maintaining electronic medical images and scanned
documents. Work includes providing functionality for capturing,
storing, and retrieving images for clinical use; and promoting VistA
interoperability with commercial medical devices and the delivery of
all patient images to clinicians in any facility.
Various mobile applications are in development, including the
pilot testing for the Clinic-in-Hand project which allows VA the
ability to exchange health-related data with Veterans and their family
caregivers using mobile healthcare applications designed to provide
support and improve Veteran health though interventions targeted at
disease management and prevention. Other mobile applications in
development include Mobile Blue Button, Provider Mobile Apps, hi2
Patient Medication Reconciliation, and a VA Information Application.
The Enterprise Mobile Applications project will develop a
distributed mobile applications development and production environment
to reduce development time, improve code quality, reduce risk to source
systems, reduce application cost, and provide objective metrics.
The Clinical Video Teleconferencing (CVT) project will
develop a national CVT scheduling system to ensure resources at both
ends of a telehealth visit for Veterans and healthcare providers are
coordinated with patients across different VistA scheduling systems and
to provide for workload capture.
The Home Telehealth Capability Enhancements project will use
home telehealth technologies to support Veterans in non-institutional
care settings, thereby reducing hospital admissions, clinic visits, and
emergency room attendances, and improving the quality of care and
standard of living for Veterans.
The Document and Ancillary Imaging application involves
imaging functionality for document imaging, management, and integration
to the medical record, in order to allow clinicians to view high-
quality images and documents.
The Health Risk Assessment project will deliver the Veteran a
systematic approach to collecting information that identifies risk
factors, provides individualized feedback and links the Veteran with at
least one intervention to promote health, sustain function, and prevent
disease.
The National Teleradiology Program (NTP) Enterprise
Infrastructure Engineering project will add fault tolerance to existing
network infrastructure to improve network uptime and minimize
interruption of service in the operation of NTP's mission to provide
convenient and cost-effective radiologic image interpretation service
for VA facilities.
The Patient Advocacy Database will help patient advocates by
feeding information into their tracking database from the VA Inquiry
Routing and Information System.
The Resident Assessment Instrument/Minimum Data Set is used
to assess residents of long-term care facilities, guide the development
of individualized care plans, evaluate the quality of care provided,
and determine workload and Veterans Equitable Resource Allocation
reimbursements. This project will develop software to improve clinical
relevance of assessment items, and improve reporting and quality
measures.
The VA/DOD Image and Scanned Document Sharing Phase 1 project
will provide the capability to scan, store, and display DOD records
that are not electronic so they can be viewed by VA practitioners in
CPRS and will enhance VistA Imaging to allow viewing of DOD radiology
images and scanned document files.
8. Access to Healthcare
Deliverables will focus on the following areas of Healthcare
Access:
In FY 2011, Rural Health created an automated eligibility
determination for program-eligible Veterans within the Electronic
Medical Record via a clinical reminder, which notifies staff when an
eligible Veteran presents for VA services.
- In FY 2012, Rural Health staff will be provided the ability
to manually establish eligibility within the Electronic Health
Record and the ability to generate reports from the electronic
health record for internal and mandated Congressional reports.
During FY 2011, Veteran Point of Service Kiosks were
activated at four pilot sites. Since pilot site activation, kiosks have
successfully checked-in over 90,000 patients.
- During FY 2012, kiosk devices will be deployed to remaining
VISN medical centers and designated Community Based Outpatient
Clinics.
- During FY 2013, enhanced interfaces with authoritative
information systems will be released to improve read/write data
capabilities and streamline facility staff management of kiosk
processes and Veteran responses submitted through the kiosks.
In FY 2011, the Emergency Department Integration System
(EDIS) v1 and Bed Management Solution (BMS), Class III, were deployed
VA-wide. In FY 2012 and FY 2013, both EDIS v2 and BMS v1 will provide
enhanced system capabilities reducing bed wait times, increasing
patient information available to the health care providers, and
integrating a full inpatient flow system.
- In FY 2012, initial deployment of an enhanced and fully
integrated Surgical Quality Workflow Management system will
begin, continuing through FY 2014.
9. Preparedness
In accordance with Office of Management and Budget (OMB)
Memorandum 11-11, VA will continue to implement Homeland Security
Presidential Directive 12 (HSPD-12) during FY 2012 and FY 2013. VA will
complete nearly 100% Personal Identity Verification (PIV) credential
issuance in FY 2012 and begin requiring the use of the PIV credentials
for Logical Access Control System (LACS) interface in FY 2012. The
HSPD-12 compliance program will have two primary efforts that will
continue development into FY 2013.
- VA will complete improvements to the Personal Identity
Verification (PIV) card management system in FY 2012 with two
interfaces to automate Employee Sponsorship and the Background
Investigation portion of the PIV registration process.
Completion of the full development and implementation of both
of those interfaces will run into FY 2013.
- Additionally, in FY 2012, VA will initiate design of the
Physical Access Control Systems (PACS) HSPD-12 Compliant
Enterprise Wide Architecture. The enterprise PACS Architecture
full development and implementation will continue into FY 2013.
The Integrated Operations Center (IOC) and corresponding
continuity of operations (COOP) sites will achieve initial operations
capability at two sites (Sites A and C) during FY 2012 with full
operational capability not realized until FY 2013.
10. Systems to Drive Performance and Outcomes (STDP)
In FY 2012, the STDP initiative will continue to provide VA
leadership with effective and flexible tools to review, analyze, and
project, on an ongoing basis, cost and performance trends that impact/
reflect changes in the budgetary environment, program efficiency and
management priorities. These tools will be expanded in FY 2012 to
address emerging VA Dashboard requirements and increase utilization of
available tools.
11. Integrated Operating Model (IOM)
IOM supports the VA Facilities Management Transformation
Initiative, which will result in increased enterprise performance
through the acquisition, development, and fielding of an enterprise
construction project management system. When completed, the new web-
based software will be capable of document control; collaboration
between designers, managers, construction contractors, developers,
owners, and program officials; and include the ability to run reports
at the project and program level as well as link submittals to possible
future actions such as RFP's and contract modifications.