[Senate Hearing 116-483]
[From the U.S. Government Publishing Office]
S. Hrg. 116-483
VA'S RESPONSE TO COVID-19 ACROSS THE VA
ENTERPRISE
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HEARING
BEFORE THE
COMMITTEE ON VETERANS' AFFAIRS
UNITED STATES SENATE
ONE HUNDRED SIXTEENTH CONGRESS
SECOND SESSION
__________
DECEMBER 9, 2020
__________
Printed for the use of the Committee on Veterans' Affairs
[GRAPHIC NOT AVAILABLE IN TIFF FORMAT]
Available via the World Wide Web: http://www.govinfo.gov
__________
U.S. GOVERNMENT PUBLISHING OFFICE
45-421 PDF WASHINGTON : 2021
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SENATE COMMITTEE ON VETERANS' AFFAIRS
Jerry Moran, Kansas, Chairman
John Boozman, Arkansas Jon Tester, Montana, Ranking
Bill Cassidy, Louisiana Member
Mike Rounds, South Dakota Patty Murray, Washington
Thom Tillis, North Carolina Bernard Sanders, (I) Vermont
Dan Sullivan, Alaska Sherrod Brown, Ohio
Marsha Blackburn, Tennessee Richard Blumenthal, Connecticut
Kevin Cramer, North Dakota Mazie K. Hirono, Hawaii
Kelly Loeffler, Georgia Joe Manchin III, West Virginia
Kyrsten Sinema, Arizona
Caroline R. Canfield, Republican Staff Director
Tony McClain, Democratic Staff Director
C O N T E N T S
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Wednesday, December 9, 2020
SENATORS
Page
Moran, Hon. Jerry, Chairman, U.S. Senator from Kansas............ 1
Tester, Hon. Jon, Ranking Member, U.S. Senator from Montana...... 3
Boozman, Hon. John, U.S. Senator from Arkansas................... 8
Cassidy, Hon. Bill, U.S. Senator from Louisiana.................. 11
Blumenthal, Hon. Richard, U.S. Senator from Connecticut.......... 13
Manchin III, Hon. Joe, U.S. Senator from West Virginia........... 15
Tillis, Hon. Thom, U.S. Senator from North Carolina.............. 16
Hirono, Hon. Mazie K., U.S. Senator from Hawaii.................. 19
Sullivan, Hon. Dan, U.S. Senator from Alaska..................... 20
Loeffler, Hon. Kelly, U.S. Senator from Georgia.................. 22
Sinema, Hon. Kyrsten, U.S. Senator from Arizona.................. 23
WITNESSES
Dr. Paul R. Lawrence, Under Secretary for Benefits, Veterans
Benefits Administration, U.S. Department of Veterans Affairs... 5
Richard A. Stone, M.D., Executive in Charge, Veterans Health
Administration, U.S. Department of Veterans Affairs............ 7
APPENDIX
Moran, Hon. Jerry, Chairman, prepared statement.................. 34
Paul R. Lawrence, Ph.D., Under Secretary for Benefits, Veterans
Benefits Administration and Richard A. Stone, M.D.,Executive in
Charge, Veterans Health Administration Department of Veterans
Affairs, Joint prepared statement.............................. 36
American Federation of Government Employees, AFL-CIO, prepared
statement...................................................... 42
VA's Fourth Mission.............................................. 52
VA'S RESPONSE TO COVID-19 ACROSS THE VA ENTERPRISE
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WEDNESDAY, DECEMBER 9, 2020
U.S. Senate,
Committee on Veterans' Affairs,
Washington, DC.
The Committee met, pursuant to notice, at 9:33 a.m., via
videoconference and in room SD-G50, Dirksen Senate Office
Building, Hon. Jerry Moran, Chairman of the Committee,
presiding.
Present: Senators Moran, Boozman, Cassidy, Tillis,
Sullivan, Blackburn, Loeffler, Tester, Brown, Blumenthal,
Hirono, Manchin, and Sinema.
OPENING STATEMENT OF CHAIRMAN MORAN
Chairman Moran. Good morning, everyone, and welcome to the
hearing on the Department of Veterans Affairs response to
COVID-19 pandemic. All who are here, welcome, and those who are
joining us by technology, we are glad to have you as well.
As we know, this Committee has seen numerous times the
challenges that have been faced. We, as Senators, have seen
lots of challenges in our Nation. But we know, and especially
we know that veterans are not unfamiliar with adversity.
Adversity provides us an opportunity to evaluate
vulnerabilities in our systems, reflect on what has worked, and
to make improvements for the future. Unfortunately, the future
is still with us. COVID has not disappeared, as many of us
thought or hoped it would after a few months.
As we discuss the Department's pandemic response thus far
today I hope to hear what the VA has learned in a number of
areas. The VA faced challenges relating to the administration
of both benefits and disability compensation and pension exams
as well as the provision of timely quality health care. Just
like other health care providers, the VA had to work through
closures due to the virus and difficulties acquiring vital
personal protection equipment. While the VA continues to work
diligently at local levels on behalf of our veterans and while
also fulfilling its fourth mission, VA hospitals and clinics
still face difficulty procuring supplies, finding availability
for veterans' appointments, and making certain that veterans in
rural areas had adequate access to health care.
Many veterans living in rural areas in my State are hours
away from any VA facility. Due to this, I am particularly
interested in the VA's progress regarding broadband agreements
to support increased utilization of telehealth to reach some of
our most vulnerable veterans. We provided the VA with great
latitude in the CARES Act, and I am anxious to make certain
that the VA is using those capabilities to benefit our
veterans.
Dr. Stone, as you know, the challenges related to COVID-19
are not over. I thank you for your work to date. I thank you
for your work as we look into the future, and we want to help
ensure that you have a robust opportunity to serve our veterans
and that we have a frank conversation today about those
efforts, under your leadership, to continue caring for our
veterans.
At the beginning of the pandemic, the VA chose to suspend
veterans' access to Community Care Networks under the MISSION
Act, which the VA did not have the authority to do. While VA
claimed the suspension was done in the best interest of
veterans, it failed to actually give veterans a say in the
decisionmaking process. This completely contradict the MISSION
Act, which specifically places veterans and their providers at
the center of health care decisionmaking processes.
Another justification the VA gave for suspension was the
providers in the Community Care Networks were not accepting
patients. However, during an October hearing of this Committee,
both Optum and TriWest testified they had ample community
providers at the time that were willing to treat veterans.
Today I want to discuss how the VA can best leverage
Community Care Networks to maintain continuity of care during
the crisis as well as better ensure local access to care. While
this pandemic and the demands that it has placed on the VA was
unanticipated, Congress is still expecting the VA to work
toward fully implementing the MISSION Act.
With several vaccines pending, FDA emergency use
authorization, another critical component of our conversation
today, is VHA's preparation for the proper distribution of
COVID-19 vaccines in the coming weeks. It is important that we
work together to smooth the rollout of these vaccines, and I
look forward to hearing the VA's strategy to reach veterans
nationwide.
During this pandemic, I worked with my colleagues to expand
authority and resources for veterans experiencing and at risk
of homelessness. This population is especially vulnerable to
COVID-19, and members of this Committee, myself included, would
like to learn about how VHA's recent initiatives to decrease
the number of veterans experiencing that homeless condition.
Dr. Lawrence, today's hearing is also an opportunity to
discuss work the VBA is now conducting to address C&P backlog
that has accrued due to COVID-19 limitations, both through
internal VA exams or as a contractor.
While we have also learned that those exposed to burn pits
during military service are likely to be more susceptible to
COVID-19, however, claims for these veterans are still denied
at extremely high rates. My colleagues and I, along with the
VSOs, are focused on tackling the many policy issues associated
with health care and benefits for veterans who experience toxic
exposure during military service. This hearing will allow us
the opportunity to examine the many provisions we have passed
to ensure the GI Bill continues during the pandemic, to make
certain veterans' and their dependents' education is not overly
disrupted.
Additionally I am concerned by the rate of unemployed
veterans and veteran spouses, and I look forward to hearing how
VA is working with its agency partner across a Federal
Government to mitigate veterans' unemployment.
The VA has made great strides this year, and I thank them
for that, but the VA has also made some decisions that are
concerning as to how they will impact veterans and families
during this stressful and uncertain time.
Finally, as the Presidential inauguration quickly
approaches, it marks a period of transition for this coming
year. Our country will continue to face COVID-19 pandemic, a
challenge of significant magnitude and consequence, much of
which is still unknown, and we must make certain that all
entities of our Federal Government can continue to work
together to solve these problems. We must make certain that no
matter what the future holds, there will be no lapse in care or
benefits for our Nation's veterans.
Mr. Tester, the Ranking Member, I now yield to you for your
opening Statement.
OPENING STATEMENT OF SENATOR TESTER
Senator Tester. Well, thank you, Mr. Chairman, and I think
this will be the last hearing of this Congress for the VA
Committee, and with that in mind I want to point out that time
flies when you are having fun. At least time flies, and this
year has not been particularly fun. But Mr. Chairman, you have
done a marvelous job over the last year keeping myself informed
and running the VA Committee, and I want to thank you for what
you have done and look forward to working with you and all the
members on the Committee next Congress.
What is interesting when I listen to Senator Moran's,
Chairman Moran's comments, is that many of the things that he
brought up in his opening Statement I will bring up in mine.
And so I guess there is bipartisan concern on a lot of
different fronts here.
But I do want to thank Dr. Stone and Dr. Lawrence for being
here. I know the pandemic, which has stretched on for nearly a
year, and experts are saying the worst is yet to come, has hit
the VA, just like it has hit everybody. You guys run the
largest integrated health care system in the country, and
during the coming weeks you will have the dual responsibility
of caring for sick veterans while distributing a coronavirus
vaccine. Once that vaccine is deemed safe and effective, you
will be distributing it to veterans and staff across this
Nation.
The FDA officials plan to meet tomorrow to discuss
emergency use of the Pfizer vaccine. My understanding is that
the initial dose can be shipped within 24 hours after receiving
FDA authorization. So with the first vaccine shipment
potentially days away, I am troubled that VA has yet to publish
a comprehensive plan detailing how it will allocate and
distribute the vaccine to frontline workers, high-risk
veterans, and other users of the system. Dr. Stone, I need to
know what is causing the holdup of the final plan and what can
be done to help things along.
I am particularly concerned how the VA will reach staff and
veterans in rural locations, where the coronavirus is spreading
rapidly and overcrowding local hospitals. Whether it is a VA
nursing home in Miles City, Montana, or Washington, DC,
veterans and staff need to know there is a vaccine plan in
place that will reach everyone, regardless of where they live
or work.
However, in my State I know there are no pharmacies
currently--no VA pharmacies, I should say, currently equipped
to receive or store the Pfizer vaccine, if approved. So I need
to know a lot more about VA's plan for an equitable and safe
distribution of COVID-19 vaccine, and how veterans and VA staff
in Montana, and in other rural areas across our country, will
be vaccinated against this deadly virus.
I also want to know how the VA intends to educate staff and
veterans on this vaccination plan. These folks need to know
what to expect, when to expect it, and how the VA will notify
them when it is their turn. And in the months it will take to
get everybody vaccinated, VA's management of PPE, bed space,
staffing, and more will continue to be important as this
pandemic stretches on. Dr. Stone, it will be important for us
to hear about the most challenging aspects of the next few
months and what is currently keeping you up at night.
I want to say thank you to VA staff, especially the
frontline workers, who continue to serve our veterans
throughout this crisis. I am also pleased to hear that the
transition process is taking place at the VA. I very much
appreciate the leadership team sharing their knowledge, and
everybody, as far as that goes, their knowledge and insight
with the incoming administration. Now more than ever, a smooth
transition is critical. The incoming administration must know
the toll this crisis is taking on delivery of health care and
benefits to veterans everywhere. So I ask--and I know you
will--continue to work closely with the transition team in the
days ahead.
Just in closing I just want to echo the Chairman's
Statements. I want to thank both witnesses that are here today
for their commitment to veterans. I know it is real. Look, we
have disagreed at times and we are going to continue to
disagree at times. But the bottom line is, I think, that you
folks have my respect for what you have accomplished during
your tenure at the VA. With that, Mr. Chairman, I will kick it
back to you.
Chairman Moran. Senator Tester, thank you, and thank you
for your comments about working together, and I thank you for
the relationship, the friendship, and the efforts, as
colleagues on this Committee, that you have worked with me and
I have worked with you in order to advance a cause we both
share as a huge priority in our times, as a United States
Senator, and I join you in commending and thanking Dr. Stone
and Dr. Lawrence for their efforts, their work, their
commitment, and their dedication to veterans of our country. I
am very grateful to know both of you and I am very grateful for
your service in care of other veterans, and I appreciate you
being here.
I would conclude my comments by indicating this is probably
our last hearing of the year in this Committee, and it is
certainly Caroline Canfield's last hearing as staff director of
this Committee. Caroline came to my office as my military
legislative assistant, and when I became Chairman she agreed to
serve as the staff director for this Committee. She is a
significant component of our ability to accomplish things on
behalf of Kansans and Americans. She is highly professional,
knowledgeable, and dedicated to cause, and works hard each and
every day on behalf of this Committee and on behalf of the
veterans we all choose to serve. So I take this as an
opportunity to thank publicly Caroline and wish her well.
I am almost always annoyed when my staff departs me and
leave our office, but when they are returning to Kansas it is
hard for me to complain. I understand that urge and that draw.
And so Caroline, personally, for me, and for our team, and for
the members of this Committee and their staff, thank you for
your work on our behalf. Caroline, thank you.
We will now turn to our witnesses. I am only checking to
see which one of you have the joy of going first. Dr. Paul
Lawrence, Under Secretary for Benefits at the Department of
Veterans Affairs; Dr. Richard Stone, Executive in Charge for
the Veterans Health Administration at the Department of
Veterans Affairs. Thank you for both being here today. We will
provide, on the clock, 5 minutes for each of you to deliver
your remarks for your testimony today before our Committee.
And so, Dr. Lawrence, you are now recognized for those five
minutes. Thank you.
STATEMENT OF PAUL R. LAWRENCE
Mr. Lawrence. Chairman Moran, Ranking Member Tester, and
other members of the Committee, I will focus my remarks on the
performance of the Veterans Benefits Administration. I will
provide information about the three areas you requested in your
invitation.
First, compensation and pension claims. Since Fiscal Year
18, we have completed an average of 1.4 million claims per
year. We complete these in about 100 days. We carefully monitor
claims over 125 days. These are referred to as the backlog. In
December 2019, due to aggressive management and improved
technology, we reduced the backlog to the lowest ever in VBA
history, 64,000.
The effects of COVID-19 became clear in April 2020. On
April 2nd, VHA stopped in-person C&P exams. Following their
lead, we ordered contract medical examiners to stop in-person
exams. We granted benefits using existing medical records, but
without these in-person exams our completion of C&P claims
slowed down and the backlog grew.
In response to the need for in-person C&P exams, I
appointed one of our most senior leaders to focus solely on
this. In-person C&P exams restarted on June 8th. Today we are
completing approximately 27,000 exams each week. Nonetheless,
having stopped the exams for so long, the inventory of exams,
normally 140,000, has grown by an additional 210,000.
Another key bit of evidence we need to grant benefits is
the veteran's military records. We get these from the NPRC in
St. Louis, which is operated by NARA. With COVID-19, they
stopped providing these records. NPRC reopened in September
2020. We worked with them to allow 50 VBA employees into the
facility to get the needed records. On November 5th, NARA
greatly reduced operating hours in response to local
conditions. We continue to work with them to obtain needed
records, but our record retrieval has slowed.
On July 31st, the backlog of claims was about 200,000. It
has remained at about that level since then, indicating that we
are processing at the rate we are receiving them and at the
rate they are aging over 125 days. Our challenge and focus
today is to reduce the C&P backlog to the pre-COVID-19 levels.
Our plan is to do that by the end of Fiscal Year 21.
Second, education. We completed the reset of the Colmery
technology implementation on December 1, 2019. This enabled the
accurate payment of the monthly housing allowance. For spring
2020, using the new technology and other process improvements,
we completed the GI Bill original claims in 18 days and
supplemental claims in 7 days, well below our targets of 24 and
14 days.
In March 2020, schools shifted to online learning. We
implemented the new laws protecting the monthly housing
allowance, work-study and extension. We raised awareness
through multiple emails to more than 800,000 students, school
certifying officials, and State approving agencies. On November
1, 2020, we completed implementing the information technology
solutions for the remaining sections of the Colmery Act.
With that said, education services IT systems are at their
technical capacity and lack the ability to meet the demands and
service expectations of GI Bill students and stakeholders. I
ask for the opportunity to talk to you further about our plans
to replace these antiquated systems with modern, commercially
approved approach.
Third, veteran readiness and employment. We have been
modernizing VR&E since 2018. Through this modernization, VR&E
implemented systems to enable telecounseling pre-COVID-19.
Plus, when it was needed, we had it in place already and
increased its usage. We successfully implemented the provisions
of the new laws to support VR&E beneficiaries, including
continued payments, extensions, and the ability to restore
benefits.
In summary, I want you to know that I have personally heard
from veterans during COVID-19. In March, I started conducting
telephone town halls with veterans in each State. I have
conducted 107 town halls, covering all 50 States, plus a
dedicated one for each of the major VSOs. I have connected with
over 5 million veterans. I have fielded and answered questions
from 1,600 veterans.
Engagements in the town hall with military sexual trauma
survivors led directly to increasing our emphasis on getting
them assistance and benefits. We have increased resources
focused on MST, increased our team's training, and streamlined
our processes. Engagement with family members and spouses about
survivor benefits also led to action.
We have increased outreach to non-veteran family members so
they can learn about benefits before the veteran passes. We
have engaged with the States to prevent pension poachers, those
who would charge family members to help with their benefits
when such help is available free of charge.
This firsthand experience has energized me and the entire
team at VBA to get our veterans their benefits faster and
better. And to do this we know we need to work together with
the VSOs, the State Department of Veterans Affairs, and most
importantly, the Congress.
Thank you. I look forward to your questions.
Chairman Moran. Dr. Lawrence, thank you. Dr. Stone.
STATEMENT OF RICHARD A. STONE
Dr. Stone. Good morning, Mr. Chairman, Ranking Member
Tester, and members of the Committee. I want to thank you for
the opportunity to discuss the incredible work that VA has done
to combat the COVID-19 pandemic in our facilities, in our
communities, and in service to America's veterans.
The COVID-19 pandemic has challenged our Nation in ways we
never could have imagined, and health care in the VA and across
the United States will never be the same. Health care workers,
including our VA staff, have rightfully emerged as the heroes
of our response effort, as they are on the front lines of our
battle against this deadly invisible enemy. I am privileged to
work with the incredible men and women of the Veterans Health
Administration, who serve our veterans every day. Our health
care workers' dedication, their resilience, and their
innovation in the face of uncertainty and unprecedented
challenges, should inspire all of us.
Procedures we now consider routine were revolutionary only
a few months ago and were implemented only through our
employees' hard work and knowledge. Teams of experts work to
reshape our facilities' physical structures as well as our
policies and procedures to keep our patients and our staff
safe.
Personally, I have learned so very much from this
experience, which I consider one of the most challenging
periods of my personal and professional life. First and
foremost, I learned that as a senior leader I must embrace
vulnerability, I must submit my decisions to constant re-
examination, and I must not hesitate to admit when new and
better information requires us to change course.
Over the past 11 months, I have tried to do exactly that
and I have encouraged my senior leadership team to do the very
same every single day, because the lives of veterans and our
colleagues are at stake. This has allowed us to respond with
unprecedented agility to evolving challenges.
COVID-19 has shown the Nation the capabilities of the VA.
We have continued to pursue all of our missions, first and
foremost of which is caring for veterans, but we have also
continued education and training for medical practitioners and
our leadership in research, including participating in
Operation Warp Speed.
Our fourth mission, backing up the American health care
system, continues to be a significant part of our response to
the pandemic, and until this year we have performed our fourth
mission primarily through local and regional responses to
hurricanes and other natural disasters. This is the first time
in our organizational history that we have mobilized at scale.
We have sent PPE, subject matter experts, and personnel to
almost every State and territory in response to State and
Tribal requests. Our process for keeping VA nursing homes safe
has been replicated across the country to protect America's
most vulnerable citizens. It is my hope that one of the lessons
to come from this pandemic will be that the VA is willing and
is capable of being at the center of the Nation's response to
future disasters.
I learned during my service in the Army that while there is
no substitute for experience, learning from others enhances
each person's capability and our capacity to respond to
challenges. We are facing a public health event unlike anything
medicine has confronted in more than 100 years. In response, we
are listening to our frontline workers, to our supply chain
managers, to our logistics personnel, and to our facility
engineers about how to keep our staff and veterans safe. By
deferring to their expertise, we can rapidly craft policy and
procedures that are effective in responding to COVID-19
pandemic, and should be replicated by the rest of this Nation.
On November 9th, we released our first COVID-19 response
report. This report is a continuation of our pledge to share
best practices and lessons learned with other government
agencies and the private health care system, while the country
fights this disease. It provides an extensive look at the
complexity of our response. It also provides an unvarnished
view of the challenges that we needed to address to fulfill our
mission. The report is available to the public on our website,
and we expect further addendum reports to document our evolving
response to this pandemic, but most importantly, to document
the resilience and dedication of our employees to serving
veterans and the Nation.
Finally, I would like to express my appreciation to each
VHA employee for their tireless effort in serving veterans and
members of the community.
Mr. Chairman, this concludes my testimony, and I want to
thank you for the opportunity to testify before this Committee
today.
Chairman Moran. Dr. Stone, thank you. We have three votes
at 11:00, which is a challenge for us. I know I am going to be
here until the end, but to try to accommodate my colleagues I
am foregoing my round of questioning, at least initially. I
will ask, toward the end, and therefore I recognize Senator
Boozman.
SENATOR JOHN BOOZMAN
Senator Boozman. Thank you. I am all wired up now.
Thank you, Mr. Chairman and Ranking Member Tester, for
holding this hearing. I cannot imagine a more important topic
that we could be discussing right now, taking care of our
veterans during one of the most trying times in our generation
regarding health care.
I have had the opportunity to visit with our frontline
workers in Arkansas at the VA. They are doing a tremendous job,
and I just want to publicly thank them for their dedication,
their steadfast service throughout this time, and again, them
being representatives of the entire system. So I thank them,
and I thank you all for the great work that you all are doing.
The pandemic has led to a backlog of over 200,000 new
disability claims at the VA. I know you were making great
progress prior to this and getting things up to snuff, getting
the backlog down, but unfortunately, due to COVID, we are back
to very high numbers. In addition to not being able to conduct
C&P exams in person, the National Personnel Center is operating
at minimal capacity. These two things are going to continue to
exacerbate the C&P backlog problem that has been building since
March.
Dr. Lawrence, understanding you would like to outsource
more C&P exams from the VHA to contractors, what is your plan
to ensure a high-quality exam and hold contractors
underperforming accountable? Dr. Stone, are you concerned about
contractors providing C&P exams not specializing in MST, PTS,
and brain injury symptoms from being able to accurately
evaluate veterans with these underlying issues? Can either of
you share the analysis and data with me and my colleagues that
informed you to increase the outsource of C&P exams from the
VHA to contractors and the data that suggests this is the best
approach as we go forward?
Mr. Lawrence. Let me start with this one, Okay? We were
authorized by Congress to expand nationwide with the contract
C&P exams in 2017. It was focused on the convenience, the
access to our veterans, and the like. We measure, we give a
survey to every veteran in terms of their satisfaction with the
process, not just the exam itself but the arrangement for the
appointment and any followup.
The surveys indicate that about 92 percent have a positive
experience with us. I do get complaints and I do investigate
some of those. Where we can compare the quality of care in two
special focus reviews, between VHA and the contract medical
examiners, the contract medical examiners came out slightly
ahead. It is a concern for us the quality of the exams, but so
far we have seen that they are very strong and very good, and
they are available.
We are working directly with the contractors to expand
their capacity and locations, for our homebound veterans and
the like, to make sure we can get as many of those going so we
can reduce the claims backlog. Again, this was the same team
that was working with us pre the pandemic, when the backlog was
at the lowest level ever in our history. We anticipate that we
will have the backlog of the C&P exams, which the inventory
right now is normally 140,000. It is at 350,000. We will have
that down to 140,000 by July, and we think that will set us at
a good pace to deal with the claims backlog, which we will have
done by the end of the fiscal year.
Dr. Stone, I will ask you to jump in on the medical
question, please.
Dr. Stone. Senator, VHA will remain part of the delivery of
comp and pen exams. In the first 6 weeks of this year we did
over 26,000 exams. Now you asked a question about our
satisfaction with quality of the exam. The data we have is the
same data that Dr. Lawrence has on veteran satisfaction with
the contracted exams. However, we are required----
Senator Boozman. How about, and I do not mean to interrupt,
but we are going to have votes. How about the lack of knowledge
in some of these various areas? Is that a concern?
Dr. Stone. It is a concern, and we are required, in six
separate areas, to provide exams. One of those includes if
there is a major psychosis or a veteran is hospitalized or if a
veteran was a former prisoner of war, are three of the areas
that require us to continue to work in this area, and to
provide consultations to VBA in areas where they feel that they
need our expertise.
Senator Boozman. Thank you, Mr. Chairman, and again, thank
you all for your hard work. I know that these are extraordinary
times.
Chairman Moran. Senator Boozman, thank you. Senator Tester?
Senator Tester. Thank you, Mr. Chairman, and my questions
are going to be really focused on the vaccine distribution. And
so, Dr. Stone, you are kind of going to be on the Budweiser hot
seat for a little bit here.
We anticipate a coronavirus vaccine is going to be
distributed very soon, in the next few days--approval for that
distribution, I should say. You guys have the largest health
care system in the country. You have got a lot of frontline
workers. There are lot of veterans across this country. And I
am concerned that the VA will be behind the curve.
Why do I say that? You know, the CDC, the States, even IHS
have all released public vaccine plans. To my knowledge, the VA
has yet to do so, and, quite frankly, this is going to be an
undertaking that we have never seen before in this country, and
the VA is a big part of that undertaking.
So can you just explain to me, what is stopping the VA from
putting out a vaccine plan right now? And please do not tell me
that you have not talked about this, because I know better. I
think I know better than that. So why hasn't there been a plan
put out? Why can't we be more transparent about what the staff
and the veterans need to expect?
Dr. Stone. Senator, I appreciate the question. Our vaccine
plan is with the CDC, and that vaccine plan is still dependent
upon our ability to move the Pfizer vaccine, which requires a -
70 degrees Fahrenheit refrigeration and freezing, across the
Nation. We have 37 sites prepared to accept the vaccine.
We submitted an order for 73,000 doses last week. Those
doses will be distributed after the emergency use authorization
is obtained, or at least that is what we are anticipating that
will occur at the end of this week or through the weekend. We
do anticipate that that shipment will occur across the Nation,
and then it will depend upon whether we can secondarily ship
that -70 degree vaccine further. That decision has not been
made by CDC, which is why you have not seen our really robust
vaccine distribution plan.
Senator Tester. You have 37 sites. Are those up for
public--do people know where they are?
Dr. Stone. Yes.
Senator Tester. Do we know where those sites are, No. 1?
Dr. Stone. Yes, sir.
Senator Tester. Okay. And the No. 2, have you been in
contact with the staff at those sites to let them know what the
expectations are going to be once this vaccine reaches those
sites?
Dr. Stone. Every single medical center has done a sandbox
testing, where they walk through the distribution of the
vaccine right up to the point of actually administering the
vaccine in a simulation. We also have 188 sites that will be
able to accept the Moderna vaccine, and those sites, we
actually submitted for 122,000 doses of that, and we look
forward to receiving those in the not too distant future. The
big advantage of that vaccine is its ease of transportation.
But please remember, each of these vaccines will require two
doses, at 21-and 28-day intervals. Therefore, tracking of the
veteran and the employee who receives them is going to be a
herculean effort.
Senator Tester. So I am assuming that the 37 sites for the
Pfizer vaccine, there will be more than that in the end, or is
37 where you are going to be and you are going to use Moderna
to fill out the other part?
Dr. Stone. We have additional 36 freezers that are coming
in for -70 degrees.
Senator Tester. More than the 37? So you will have 73 in
total, Doctor?
Dr. Stone. Exactly.
Senator Tester. Okay. That is good. So you said that you
are going to request 73,000 doses of the Pfizer vaccine, and
120,000 of the Moderna, something about that. How quickly do
you anticipate those are going out, No. 1, and No. 2, is that
adequate? Can you handle them, No. 1; can you handle the
distribution, No. 1; and No. 2, is an adequate amount for the
largest health care system in the nation?
Dr. Stone. It is not an adequate amount, and this will be a
long process for us to reach all 7 million veterans who we
believe will want vaccination from us, as well as all 400,000
employees of the agency.
We do anticipate, sir, weekly distribution, and it remains
to be seen how robust that weekly distribution will be.
Senator Tester. Okay. I have got some other questions for
the record. I will let you go now. Thank you. Thank you both.
We will talk to you soon.
Chairman Moran. Thank you, Senator Tester. Senator Cassidy.
SENATOR BILL CASSIDY
Senator Cassidy. Thank you all. Thank you, Gentlemen.
Dr. Stone, you and I both know that it is going to be
extremely important to track who has been vaccinated. If there
is something, for example, that allows somebody to go on an
airplane without wearing a mask because they have been
vaccinated, there has to be some way to get that information.
The States all have a Federal Government, taxpayer-funded
immunization system, the IIS, the Immunization Information
System. I am told that the VA has not integrated into that. So,
theoretically, a veteran can get a Pfizer vaccine outside the
VA, come to the VA and desire to have the second vaccine, and
you have to go through the process of figuring out what they
have as opposed to logging on. We can go through the
ramifications.
Does VA plan on getting within the IIS, and can you give me
an idea of why we are not, and then--and try and keep your
answers brief because I have a couple more questions, please.
Dr. Stone. The answer is no, our intention is not to tie
into the IIS. We have tied through an API into the CDC website.
That tracking site allows us to order the vaccine. So our
primary connection will be the CDC, and we will submit data on
the utilization----
Senator Cassidy. So if I can, the IIS, though, allows
epidemiologists to figure out how many people in a community
have been immunized. It allows rapid access of a university to
see if somebody has been immunized. The CDC, although involved
with this, does not--obviously it is the State that does it.
Why would the VA not be involved with the IIS since it is such
an important public health tool as well as important for the
individual?
Dr. Stone. So what my epidemiologists have told me is that
the States are connecting the CDC site to obtain our data. Now
I am completely open to re-examining that decision and taking a
look at whether we should connect to the 50 States and
territories separately, in addition to our work that we have
committed to with the CDC.
Senator Cassidy. Okay. I was not aware. We will track that
down. I understand, though, that you are sharing deidentified
data. Is that correct?
Dr. Stone. That is correct.
Senator Cassidy. So if you are sharing deidentified data,
it could not be used to integrate into the IIS. I am not quite
sure how we are really serving the veteran as well as we could
if, when the veteran goes to graduate school and is required to
give proof, instead of logging on as they would if they were
vaccinated some place else, pulling down their record and
showing it to them, instead they have to call the VA and get
the kind of rigamarole of getting records transferred. Why
wouldn't we do the IIS?
Dr. Stone. I am completely open to re-examining the
decision. It was my understanding that IIS was connecting to
the CDC websites using the same APIs we are.
Senator Cassidy. But you wouldn't be able to download
deidentified data. That is the only issue. And IIS has
identified data, which allows me to download my records and
hand them to somebody, should I need it for employment.
Dr. Stone. Senator, my first priority has been to make sure
that I complied with every requirement to get adequate supplies
shipped to us, and this is a methodology in which we
demonstrate our need for future vaccine, and so that has been
the first priority. If IIS is something we should connect with
for good care of the veteran, we will certainly do so.
Senator Cassidy. That is great.
Second set of questions. I see that State veterans nursing
homes are not being inspected, and VA does not have a plan to
inspect them until November 2021. Now I am not quite sure but I
know that--and, by the way, CMS is doing inspections of nursing
homes, and so it seems like this could be avoided. I have been
told by other agencies that some of these essential services
are not being executed because union contracts basically keep
the union workers from having to go out and do things if the
union objects.
Is the reason the VA is not coming up with a plan to
inspect these State-run veterans' homes because of union
contracts or is there another reason why?
Dr. Stone. Sir, I heard this yesterday. This is absolutely
incorrect information. We remain active in our inspection of
nursing homes. We are active today in 100 State veterans'
homes. We inspected veterans' homes in the last quarter.
Now, our work is at substantially reduced because of
safety, in many of these communities, and just like the Joint
Commission has moved to virtual inspections we have been
working our way through virtual inspections. I do recognize the
fact that a contract with a vendor has come to an end and we
are renewing that contract, or recompeting that contract at
this time. That may be where this information came from. But it
is completely unacceptable to me that we would not be in the
State veterans' homes, actively participating as partners, to
make sure that they are providing appropriate care to America's
veterans.
Senator Cassidy. Well, I am out of time so thank you, and
thank you both for your service. I yield back.
Chairman Moran. Dr. Cassidy, thank you. I recognize Senator
Blumenthal.
SENATOR RICHARD BLUMENTHAL
Senator Blumenthal. Thank you both for being here. Thanks,
Mr. Chairman, for organizing this very, very important hearing.
Before I go to my questions about the vaccine I want to
first again express my condolences to the two individuals who
perished at the VA facility in West Haven--I hope you are
familiar with that tragedy--Euel Sims, a longtime employee of
the VA and a veteran, and Joseph O'Donnell both died as a
result of an explosion at the VA facility on November 13th. And
I have been to the facility and I have talked to Al Montoya,
the director. He has told me there is an investigation. I
extend my condolences again to their families and loved ones. I
would like to know how soon we can expect a completion of that
investigation.
Dr. Stone. Senator, I appreciate the fact that you went out
there the day of explosion, or within 24 hours, and the
Secretary and I were there within the next 24 hours, and we
walked the facility, we walked the area. This is a tragedy that
is just unacceptable.
That investigation is not in our hands. It is in OSHA's
hands as well as NIOSH as well as the State inspector's.
Senator Blumenthal. The VA is not conducting its own
internal investigation?
Dr. Stone. That investigation is being done as part of our
safety investigation, yes, and I anticipate the results of that
to coincide with the release of the other Federal and State
investigations.
As you know, this was a steam line that exploded, and we
are going through all of the pieces that led to that, and we
will release that in as transparent a manner as is possible.
Senator Blumenthal. I am told that VA officials were
informed by other employees and possibly by Mr. O'Donnell and
Mr. Sims of maintenance problems at the facility. Are you aware
of those reports?
Dr. Stone. I am aware that there are maintenance issues at
that facility. It is an old building. You actually spoke of
that in your comments. It is an old building. But please
remember that this was distant from the actual care facility.
It actually was in the basement of a maintenance facility. And
I am not aware of that area, where those valves were turned,
even was repaired that day. This was a blunt line that finished
in that basement area, and I just have to wait for the steam
engineers to come back and talk to us about what----
Senator Blumenthal. But you were aware of prior reports
about potential problems that were unaddressed?
Dr. Stone. No, I was not.
Senator Blumenthal. Would you be surprised to learn that
employees actually complained about the life-threatening safety
issues in maintenance of that facility?
Dr. Stone. When I spoke to the VISN director and the
medical center director, they did not relate to me any life-
threatening maintenance issues that had not been addressed.
Senator Blumenthal. Let me ask you about that facility,
because I think we would agree that it is aging and aged and
needs to be, in effect, rebuilt. Would you agree?
Dr. Stone. Yes.
Senator Blumenthal. And would you agree also that this
incident should lift that construction to the very top of
priorities for the VA in its capital projects?
Dr. Stone. I will tell you that managing 6,000 buildings,
the average age of which is over 50 years, I believe that we
are absolutely committed to the West Haven community, to our
partnership with the universities that are there and our staff
that come from those universities, and to the robust number of
veterans that we serve there. You have my commitment that that
will be at the top of the list as we move forward. As you are
aware, we have $350 million worth of construction scheduled for
that site in the 24 months. If we can possibly move that
forward or accelerate that you have my commitment to do it.
Senator Blumenthal. I appreciate that. I would like to
followup with you and make sure that those very encouraging
words are turned into reality, because I think that this tragic
explosion is a sign that we simply cannot allow this facility
to continue to age and threaten the employees who work there,
and as I said, the day of this disaster, in no way does the age
of that facility reflect the first-rate, world-class care that
VA personnel are providing to veterans. They are doing their
jobs, day in and day out, with supreme excellence and caring.
And so I commend your very dedicated workers, employees,
doctors, nurses, clinicians, all of the staff at that facility,
because they are working under very difficult circumstances.
One last question for you. Among the sites that have been
indicated for either the Pfizer or the Moderna vaccines, is
there a public list?
Dr. Stone. Yes, there is, and we will make sure that your
staff has it.
Senator Blumenthal. Can you tell me whether Connecticut is
one of those sites?
Dr. Stone. I do not believe it is on the initial list, but
in your catchment area there are two sites that will receive
the Pfizer vaccine. The question is, is it in the State of
Connecticut? I do not believe the initial five sites are within
the State of Connecticut.
Senator Blumenthal. Where is the nearest to Connecticut?
Dr. Stone. Massachusetts.
Senator Blumenthal. In which part?
Dr. Stone. I think in Boston.
Senator Blumenthal. And that is the nearest to Connecticut
for any vaccine?
Dr. Stone. I think that will be the initial delivery. But I
would have to really--we have executed 83 contracts for dry ice
to enhance our ability to distribute this around the system. I
just do not know, until this weekend, when we get final
distribution criteria from CDC and FDA.
Senator Blumenthal. Well, I am going to ask that
Connecticut be included as one of the sites that the dry ice be
provided, and my staff will be in touch with you about this
issue. Thank you very much.
Chairman Moran. Senator Blumenthal, thank you. With the
gracious cooperation of Senator Tillis I am going to recognize
Senator Manchin. We are not going by presence. We are going by
seniority, because of the nature of the Senators who are
distantly participating. Senator Manchin.
SENATOR JOE MANCHIN
Senator Manchin. I want to thank my dear friend from North
Carolina. I appreciate you, buddy.
Anyway, Dr. Stone, the VA has set, in the Infrastructure
Review Act, AIR, something I strenuously opposed--I think you
all know that--it creates a commission in 2022 to close down VA
facilities across the country. I am very supportive of reducing
waste and other inefficiencies in the VA system, but I have
been against Washington cutting back on health care access to
veterans, especially in rural areas, in rural areas like my
State of West Virginia, which is entirely rural, in the
Appalachian, and fear that may happen.
That is why I introduced a bill with Senator Rounds, also
from the very rural State of South Dakota, to eliminate the AIR
Act commission. I am hearing worrying reports of efforts to
accelerate the AIR Act timeline, which is alarming, given that
we are in the middle of a pandemic, and that would not be the
right time to do it.
So my question would be, the pandemic has made it clear the
valuable role of the medical centers, the VA medical centers,
not only for our veterans but for national stockpile of
emergency supplies and responses, in other words, our national
security. Do you all see the harm that might be shortsighted if
they would start closing, or even going down that pathway?
Dr. Stone. Senator, I am unaware of any effort to
accelerate the AIR Commission, but I do believe that we need a
fundamental recapitalization of the VA system. I mentioned
previously to Senator Blumenthal that our average age of our
facilities is over 50 years. We need to be recapitalized, and
that includes acknowledging the lessons learned of this
pandemic. And the lessons of this pandemic is we are the safety
net to this system and we must acknowledge the fact that rural
hospitals in America are not stable, are going out of business
at unprecedented rates, and we must be that safety net.
Therefore, what I thought was a review looking at where
veterans truly were, has expanded now to acknowledge the fact
that we will need small facilities in remote areas of this
country in order to serve a potential future pandemic as well
as to serve America's veterans.
Senator Manchin. Either one of you could answer this, or
both of you answer. The Pfizer and Moderna vaccines need to be
transported and stored in extremely cold temperatures. I think
we are all concerned about how we are going to get into the
most rural areas. Having a State that is entirely rural, and my
friend from North Carolina, his State is extremely rural in
certain areas, we are thinking that we might not have the
facilities to do that, and to be able to do that, and get the
vaccines transported in a safe manner. What precautions, and
how are you all working with that to make sure that basically
when these vaccines are distributed that we are able to handle
those in these rural areas if we do not have the
accommodations? So either one. Dr. Stone?
Dr. Stone. So as I mentioned previously, we have sandboxed
the entire process to make sure we can handle them safely.
Please remember, Senator, that we are in the midst of our
influenza vaccine distribution and have given over 1 million
doses of the influenza vaccine. So our ability to move these
around the system is well tested as part of our pharmacy
program.
The difficulty here is refrigeration, and that is what I
talked about in -20 and -70 degree freezers, to move these
around. This morning, before we began here, I had a
conversation about our ability to obtain a short-runway
aircraft to go into rural areas, that we could bring small
amounts of vaccine into those rural areas where there are 20,
30, 50, or 100 veterans. I believe we are going to need to have
that kind of creativity and innovation in order to deliver this
effectively and quickly.
Senator Manchin. The last question, very quickly, is
internet access. You know, telehealth, all of that has been
hard to come by in rural areas because we have no internet
service, and then also getting reimbursement for travel. That
has been a big thing with our veterans in rural areas. Has that
been looked into and how they can basically be able to access
that or expedite that, as far as access to the travel expenses?
Dr. Stone. Let me answer the first portion of that, the
internet. There are really some weaknesses in the internet
system in America----
Senator Manchin. We are working on it.
Dr. Stone [continuing]. and we have been trying hard. We
worked hard in Kansas with some of the small providers to see
what we could do to enhance that. It has been a pretty
frustrating area, but we are hoping for the help from FCC to
really work that, and hoping for your help.
Senator Manchin. We have a COVID package, with more help
for that too, and it specifically spells out, in veterans, how
we can help them in those vulnerable areas. How about on
expenses. Are there other ways, since internet is not able to
get their reimbursement, or get their expenses?
Dr. Stone. And yes, we are examining that, and I have been
assured that we have put methods in place to get people's
reimbursement for travel and to make sure that is being done
properly.
Senator Manchin. Very helpful. Thank you.
Dr. Stone. Thank you, sir.
Chairman Moran. Senator Tillis. Thank you.
SENATOR THOM TILLIS
Senator Tillis. Thank you, Mr. Chairman. Gentlemen, thank
you for being here. Thank you for your past and current
service.
If we could go back to the vaccines, you said there are 37
sites, you are going to plus up 36 more for 73. I am kind of
curious. I am curious--did the original 36 sites already have
the ultracold storage, or did you pre-position them? What was
the rationale for the geographic location for the first 37
sites?
Dr. Stone. We moved them around. Most of those are used in
the research community. Some of that research is not being done
where there are large numbers of veterans.
Senator Tillis. So are you all creating like a hub-and-
spoke sort of framework to where we should be concerned less
with where they are physically and more with whether or not
they are optimized for distribution out to other facilities?
Was that the underlying strategy?
Dr. Stone. That is exactly the strategy, Senator.
Senator Tillis. Okay. So the 36 would plug any holes or
create more--or the 36 additional, to create more hubs.
Logistically, after the vaccine goes to the hub, how long
does it--mechanically, so in Senator Blumenthal's case,
Boston--I used to live in Boston. It is not too far from
Connecticut. You have a need in Connecticut, so how does that
work? First you have got the prioritization. You have
stratified at-risk VA employees, at-risk veterans. You are
going to determine that you need to surge a certain amount of
vaccines to Connecticut. So logistically, have you all worked
out how long it is going to take from the time that you have a
stockpile in Boston to the time that you can get it to any part
of Connecticut, if that is the priority need?
Dr. Stone. CDC has not approved secondary transportation
beyond the initial delivery site.
Senator Tillis. Okay.
Dr. Stone. Once we have that, that can be moved using dry
ice that should last for a number of days for transportation.
Senator Tillis. Okay.
Dr. Stone. Once that is then unfrozen, it then has to be
diluted, and once that is done it has to be used within 6
hours.
Senator Tillis. Okay. Do you think that--are there any
areas of concern with the 37 hubs that are in place, the 36--
over what timeframe will the 36 hubs be put into place?
Dr. Stone. Within the next 2 weeks.
Senator Tillis. Okay. So you are going to be--that
underlying infrastructure is going to be tracking roughly to
what we hope is the availability of the Pfizer vaccine. So I
guess the thing I am--with that 73 hubs, are there any areas
where we are serving veterans where you are concerned that
logistically you do not have geographic coverage for the points
of distribution, or do you think that those 73 sites cover the
points of distribution?
Dr. Stone. No, I do not think it is going to cover the
entire nation in the way that it should, and I think I am going
to need the Moderna vaccine and the 200 sites that I will have
from the Moderna in order to reach the rural veteran.
Senator Tillis. I think it would be very helpful for the
members if you could report back, as a question for the record,
what areas of vulnerability we have. And it is not for a desire
to serve them. It is because of the logistical challenges. But
I think that would be helpful so that we are tracking that,
more or less a coverage map for the distribution of the
vaccine, and then Moderna, which is still cold storage but not
super-cold storage.
You know, you mentioned how--I watched both of your opening
Statements in my office, and, Dr. Stone, I think you mentioned
how, you know, things that seemed extraordinary decisions that
you made over the course of the challenge of COVID has now
become standard operating procedure, you know, in terms of the
ways you are doing things differently. How many of those are
authorized under emergency conditions that we need to make sure
stay in place, because they should become part of standard
operating procedure?
And because I am running out of time, Dr. Lawrence as well,
I guess what I would like to hear from you all is what more
does Congress need to do, either through authorities or through
resources, to make sure you can continue to sustain what I
think is a remarkable success story in the way that you all
have dealt with it. You are not perfect, but if I were to match
you up against most major health care systems I would say you
are doing as well or better than the vast majority of them, and
I appreciate you doing that.
So if you could just maybe, for the purposes of the
Committee, talk about what more we need to do, as followup
authorities or followup resources, to backfill maybe depletion
of accounts, just because of what you have had to do to respond
to COVID. That will be my last question.
Dr. Stone. Senator, thank you, and I appreciate this
question because I think we will need more resources. I think
under the CARES Act you gave us $17.4 billion for the health
administration. We have committed right about $8 billion of
that. I think we will consume the rest of it through the
remainder of this fiscal year.
But I do believe there is a lot we cannot see about vaccine
distribution, and I think we are still probably three to 4
weeks ahead of the peak of what we are going to see in this
escalation of cases across the Nation.
One of the authorities that has been absolutely essential
to us is the fact that the Office of Personnel Management gave
us authority to waive many administrative requirements that
have allowed us to hire over 66,000 employees. Should we expire
in those authorities, it will make it very difficult for us to
sustain this work force in the manner that we have. So that is
one area where I would ask you to think about as we go forward.
And, Dr. Lawrence, I will leave it to you.
Mr. Lawrence. Yes, Mr. Chairman, if I might have a minute
here. I know we are at time.
We need to provide better service to our GI Bill students,
the changes in the conditions and the laws. We put forward a
request for $240 million to give them more modern systems so
that when they call we know who they are, when they ask for
computations of information we do it instantly, and we have all
the data to not only service them but as well as to do
oversight. So we put forward a pretty clear request to get
better IT systems for our education service business.
Senator Tillis. Thank you.
Chairman Moran. Senator Tillis, thank you. Senator Hirono.
SENATOR MAZIE HIRONO
Senator Hirono. We are having some technical difficulties
and so the questioners and the responses are frozen, so I will
do my best to proceed. I see that I--yes, I just froze.
So let me start with Dr. Stone. You have been asked a
number of questions. I see that I just got--Okay. You have been
asked a number of questions regarding the vaccine distribution.
I would like to know whether, at a time when transparency and
communication with regard to vaccine distribution is critical
to the hundreds of thousands of veterans all across our country
and our territories, is your current vaccine distribution plan,
including where the sites are, what the priorities are, are
those on a website? And also, is there information on
frequently asked questions on a website right now, and if not,
are you going to put together such a website so that the
veterans can understand what kind of distribution program they
are going to need to follow?
Dr. Stone. Yes. We did post our frequently asked questions,
and we have not posted our sites for distribution yet until we
get approval from the CDC, and I anticipate that this weekend.
But I do have, in front of me, and I am happy to leave with the
staff the listing of all 23 VISNs and what the locations are,
as we anticipate it at this time. But I will firm that up over
the weekend and they will be posted on our websites, where
those sites are.
We did also communicate via text to over 20 million
distribution of the fact that we will be contacting veterans as
we go forward and as the vaccine is made available.
Senator Hirono. Well, I am hearing you say that you will
put together a very user-friendly website that will explain the
priorities for the vaccinations, with as much specificity as
you can, because the communication and transparency of your
program, your vaccine distribution, is going to be critical. So
I am very interested to see what your website looks like.
I know that, again, Dr. Stone, you are very familiar with
what happened at the Yukio Okutsu State Veterans Home, and I do
appreciate VA sending a team out there to help with the
situation, the tragedy there, where 27 people who lived there
lost their lives. And you made some recommendations as to how
this home should proceed. Are you ensuring compliance with the
recommendations made in the report that was generated by your
team?
Dr. Stone. Yes, we are.
Senator Hirono. Are they in compliance?
Dr. Stone. I would have to get an update at this point
about that site, but it is my understanding that they were very
cooperative and very supportive of coming into compliance. As
you know, for a number of weeks we put personnel into that
State veterans home in order to assure that, and every report
that I got while they were there was that they were in
compliance. I cannot comment, as I sit here today. I just have
not had a report in the last few weeks.
Senator Hirono. Are you also engaged in proactive
communication with other VA facilities so that something like
what happened at Okutsu is not repeated in other facilities
that take care of veterans?
Dr. Stone. Unfortunately, Senator, as you know, this has
been repeated in other areas around the country. In every
single site, now more than 100 of the 157 State veterans homes
owned and operated by the States, they have welcomed us into
those homes, and we have actively worked to make sure that
veterans' health and safety is assured to the best of our
ability.
We have also been in hundreds of private nursing homes
around the Nation, that have invited us in to provide training
for their personnel as well as to comment on how to operate
COVID-positive and COVID-negative----
Senator Hirono. I am sorry, Doctor. Your response got
frozen, but I just have one more question.
Telehealth has really been in increasing use in the VA
system. Are there any authorities that you need to enable you
to expand your telehealth capabilities? Do we need to take
further Federal action to enable you to do that?
Dr. Stone. We just posted some regulations that will allow
us to mimic what is done in the Department of Defense with
Federal supremacy. What we do recognize is that the State
licensure of some of our health care professionals is causing
some difficulties in our current authorities when we distribute
personnel as part of an emergency DEMPS deployment or deliver
using your analogy across States.
Senator Hirono. I am sorry. Your response just froze so I
could not hear what you said. We will need to followup with
you, because if there are any barriers to--sorry. We are having
technical difficulties, so we will have to get back to you with
regard to any barriers to your ability to have telehealth be a
way to respond to the veterans' needs. Thank you, Mr. Chairman.
Chairman Moran. Senator Hirono, thank you. Your
difficulties exhibit the difficulties we have with technology.
Senator Sullivan.
SENATOR DAN SULLIVAN
Senator Sullivan. Thank you, Mr. Chairman, and thanks for
your leadership on this Committee. I appreciate it and all that
we are getting done here.
Dr. Stone, Dr. Lawrence, I am going to ask some questions
for the benefit of veterans listening who may not have caught
you full opening Statements. I know the VA is working with the
CDC on finalizing plans for distribution of the COVID-19
vaccine, and I understand that the vaccines will be distributed
at two site locations per region, as determined by that VISN
regional office.
Can you go into detail about how those locations will be
decided, what the prioritization is for receiving a vaccine
among veteran population, and how do you plan to coordinate
with States and other agencies to deliver to a wider
population? I have, of course, a strong interest in Alaska,
where we have a large veteran population, particularly in rural
areas, where health care infrastructure is limited and
traveling to major, you know, cities like Anchorage or
Fairbanks is not always so easy.
Dr. Stone. Senator, the initial distribution is dependent
upon the presence of the refrigeration that will accommodate
the vaccine.
Senator Sullivan. I am sorry. Say that again.
Dr. Stone. The initial distribution was based on the
presence of refrigeration that would accommodate the vaccine at
the appropriate temperature and then was matched to the
concentration of veterans in that area.
Senator Sullivan. So not to interrupt but that is kind of a
0 for 2 for me, because in our rural areas we have a lot of
veterans but it is pretty sparse, and we do not have--we have
very limited refrigeration or even medical facilities. So I
guess that is the challenge then, correct?
Dr. Stone. So I would look for the distribution into the
Alaska area with the Moderna vaccine. We have -20 degree
freezers there. And then we are going to need to do a secondary
distribution of that vaccine, and if you heard my earlier
comments I think we are going to need aircraft to do that.
Senator Sullivan. Okay. Well, it would be helpful. I am
sure Alaska is not the only State similarly situated. I am sure
there are other big rural States--we are the biggest rural
State--and with so many veterans perhaps maybe offline, not as
part of this hearing, my team and I can make sure we are
coordinating well. I have been doing this with General Perna
and others. We have so many unique challenges in Alaska that a
lot of other States do not have, given the size and the weather
and challenges like that.
How about, how well do you think it is going in terms of
your integration and coordination with other Federal agencies,
say, DoD, and States? And I am not just talking Alaska. Of
course I would be interested in Alaska, but whether it is
Kansas or any other place, Arkansas, how do you think that is
going?
Dr. Stone. You know, early in this process and in this
response the Secretary called every Governor in the Nation and
spoke to, I think, more than 46 of them.
Senator Sullivan. Good.
Dr. Stone. That contact opened a methodology that we now
have supported 47 different States in providing VHA services
personnel or consultation, or even PPE, to support the States
across the way. So I think that is going very well.
I think that this is a herculean effort that nobody has
done for 100 years, and even when the Sabin and Salk vaccines
were released I think there is a--I can remember--I am old
enough to remember my parents taking me and driving to get the
vaccine. We are going to have some difficulties reaching rural
areas, but you have our commitment that we will work diligently
until every veteran is delivered this vaccine and we assure the
safety of the population that is enrolled with us.
Senator Sullivan. Good. I appreciate the hard work you guys
are putting into this, you know, the Secretary on down.
Let me ask one final question. How is the VA coordinating
with IHS to make sure that the native veteran and non-native
veteran populations served in those hospitals through the VA
Tribal Sharing Agreements are accurately accounted for in the
VA's vaccine distribution plan? You have some overlap there in
some ways could be good. I think overlap is good, but falling
through the cracks would be bad.
Dr. Stone. Our allotment is not part of the IHS allotment.
Senator Sullivan. Yes.
Dr. Stone. We expect IHS to receive an allotment and we
have expressed to their leadership that we are more than happy
to come in and support them, should they need support-----
Senator Sullivan. Good.
Dr. Stone [continuing]. in providing this. We also have
over 100 agreements with individual Tribes that operate their
own systems, and we extend the same, and extend it today, we
extend the same commitment that we will come and help if they
need support. Every day my deputy, Steve Lieberman, sits with
FEMA and HHS, looking at requests for support in an effort to
assure, at the highest levels of VHA, we are responding
appropriately and as agilely as possible.
Senator Sullivan. Great. Thank you. Thanks for your hard
work on this very important issue. Thank you, Mr. Chairman.
Chairman Moran. You are welcome, Senator Sullivan. You are
such a diligent advocate for Alaska and its unique nature. This
is the first time, though, I ever heard you complain that you
have lack of refrigeration.
[Laughter.]
Senator Sullivan. Well, you notice I mentioned Kansas too.
Chairman Moran. Yes, I appreciate that as well. Thank you.
Senator Sullivan. I did not mention North Carolina, though.
Chairman Moran. Senator Sinema. Senator Loeffler?
SENATOR KELLY LOEFFLER
Senator Loeffler. Thank you all for being part of this
important hearing. I just wanted to followup on my colleague's
question, particularly related to rural areas, and I apologize
if this question has already been asked. So really it is along
the lines of telehealth. Obviously, Congress has granted the VA
the authority to form agreements with telecom companies to make
sure that they can access tele-mental health services. As the
pandemic forced people across the country into isolation,
obviously it is so important that we assure the at-risk
veterans receive the mental health care that they need.
Obviously, connectivity and access in regard to telehealth is
so important for every veteran, but particularly those in rural
and otherwise underserved communities, that my colleague just
mentioned.
Dr. Stone, can you provide us an update on how the VHA is
utilizing this important authority?
Dr. Stone. Senator, I can, and I appreciate the question.
At this time we are delivering mental health services at about
exactly the same rate as we were before the pandemic began.
What has changed is that the vast majority of that is being
done using either video technology or telephone technology. The
receipt of that has been extraordinary on behalf of veterans,
with very high levels of satisfaction, being able to stay in
their home and receive those services.
The only change that we have seen is in group therapy,
which the technology does not accommodate very well or maintain
the level of privacy that veterans have wanted.
We have also distributed over 80,000 iPads to veterans in
remote areas, and we have worked to assure all of the major
carriers now have signed on to allowing us to connect to
veterans without it going against their monthly bill in the
movement of data or text across their systems.
So I am really very pleased with the advances that we have
made in this, and it is a reflection of the fact that the vast
majority of mental health services are now using these
technologies.
Senator Loeffler. Well, that is great to hear, and in terms
of your answer showing such effectiveness I would just be
curious, as a followup, to hear what you might think, how that
might change. Just once we get back to normal, does that allow
you to kind of have a new way to address those underserved
areas and keep that engagement going at a lower cost and more
accessible basis? Are there some learnings going forward?
Dr. Stone. There is, and I would suggest also that the
partnership that we have with Philips, that has allowed us to
develop the Project Atlas that is going into remote areas of
the Nation which literally is a room that we can insert in
facilities like our VSO partners, and has allowed us to deliver
in remote areas where there is not even internet that is
effective.
We are also in partnership with organizations like the
major retailers, like Walmart, where they have developed an
infrastructure that we have been able to piggyback off of and
to work. And we have been down in your State looking at some
remote, what we would call health care deserts, looking at how
we might partner with Walmart to deliver to veterans that just
do not have access to internet ability.
Senator Loeffler. Well, as someone who grew up on a farm
and the family still struggles with that internet connectivity,
I know that means so much to those in rural areas, and
particularly this really urgent need for our veterans. So thank
you for continuing to work on that and make sure--you know, our
State is the fifth-largest for veteran populations and we have
so many needs right now, so thanks for continuing your great
work on that. And I will yield the balance of my time.
Senator Tillis. [Presiding.] On behalf of the Chair,
Senator Sinema will be next. After Senator Sinema we will take
a brief recess pending the completion of votes and the return
of the Chair. Senator Sinema?
SENATOR KYRSTEN SINEMA
Senator Sinema. Thank you so much, Mr. Chair. I want to
thank Chairman Moran and Ranking Member Tester for holding this
hearing. At a time when coronavirus cases are spiking in
Arizona and across the country, it is important for us to
ensure the VA is well equipped to fulfill its mission. So I
want to thank our witnesses for being here and for your
continued efforts to provide care and support to veterans
during this pandemic.
It certainly has not been easy and there have been bumps in
the road, but overall we have heard positive feedback from
leaders in the Arizona veterans' community about the VA's
response in the State.
My first question is for Dr. Lawrence. Arizonans continue
to express concerns that the VA has not taken any action to
ensure that survivors of veterans who die from COVID will
receive the benefits they have earned. I sent a letter, with
Senator Tillis, in July, asking Secretary Wilkie to take
action, and I still have not received an answer.
Many of the illnesses that make individuals more
susceptible to COVID-19 are widespread in the veteran
population, but there are instances where a veteran's death
certificate identifies COVID as the sole cause of death, even
if the veteran had service-connected illnesses that could have
made them more susceptible to the virus. In these cases where
those illnesses are not listed as secondary causes of death,
the survivor will not receive their earned VA benefit.
So in my letter I asked Secretary Wilkie to provide
guidance to VBA claims adjudicators to make this process more
streamlined, including automatically seeking a second medical
opinion in these instances. Given there is so much we are still
learning about this virus, having an automatic second opinion
would standardize the common-sense practice and take a huge
burden off the survivor in an already difficult time.
I have introduced the Ensuring Survivor Benefits During
COVID-19 bill to require VA to do this. My question is, can the
VA do this without legislation?
Mr. Lawrence. So I am sorry to hear that your letter has
not been responded to because I know this is something we take
seriously. And like so much of what has happened during the
pandemic, this is something that was not thought through. We
rely on the death certificates to provide benefits, and I know
that our folks--because others are identifying this too, the
veteran service organizations have brought this to our
attention, and I know that we are reviewing it.
I will have to check in on where the review is, and I do
not want to speak out of lack of knowledge of whether this is
something we can implement through our rules or whether we will
need legislation. I am thinking it is our rules, but let us get
back to you on the do-out on that.
Senator Sinema. Well, I would like us to get back with each
other before the winter holiday, because, of course, I am
concern now that we do not have a process streamlined for
survivors, and if so, if there is not going to be a process
from the VA I would like to get our legislation moved forward
to give you that authority to do so.
My next question is for you and then for Dr. Stone. In
April, the VA announced a number of actions to help ease the
financial burden on veterans during the pandemic by suspending
all actions on veterans debt. The VA website announcing this
action asks veterans to contact the VA to make arrangements.
Other VA announcements suggest that debt relief was
automatically granted.
So I wanted to ask you, was debt relief automatic for both
benefits and health-related debt?
Mr. Lawrence. Let me start with benefits. So debt relief
was automatic for new debts. For debts that were existing you
were to call and arrange the payments you would like to
continue on. We did not want to waive those for folks who
continued to make their payments. So that is how that was done
from a benefit perspective.
Dr. Stone, why don't you answer that one?
Dr. Stone. From a health perspective, Senator, we do not
have authority to waive. We have delayed the collection of
those debts until January, and it remains to be seen whether
the economy will have been stabilized to the point that that is
appropriate. But we do not have authority to waive the debt
collection that will occur. In fact, we sent, this last
weekend, notice to all veterans of what their current balances
were.
Senator Sinema. Well, given the case, the status of the
pandemic right now, I think it is reasonable to assume that the
financial situation in our country will not be significantly
better in January than it is now. So I would like to followup
on this, because I believe that the debt relief should be
automatically granted, and again, some VA announcements have
suggested it to be so. So I would like to get that clarified so
we can provide certainty for our veterans.
My final question is for both Dr. Lawrence and Dr. Stone.
The VHA is sending out information to veterans notifying them
that these debt suspension actions expire at the end of the
year. The VBA has told SVAC staff that the current debt relief
policies will be in place until 60 days from the end of the
national State of emergency, and yet VA's Debt Management
Center has said the current debt relief provisions will end but
that VA will announce a new plan shortly and notify veterans
over a 7-month period.
Is VA continuing these debt suspension actions, and how and
when are you notifying veterans? They need to know now.
Mr. Lawrence. Certainly, I agree. There is some confusion
in the communication coming from the Debt Management Center. So
both Statements are true. We are going to continue to suspend
debts, but what the Debt Management Center is doing is writing
letters to our veterans in January, telling them of their debt,
and offering them three courses of action: one, pay
immediately, if you will; two, talk to us about rearranging the
schedule, and there is some flexibility in how long you can
rearrange your debt; and three, ask for a waiver.
So that is what they are doing in January, and, again, you
can see it incorporates that.
In terms of, you know, providing information to the debt
services, that will not continue until October, at which point
they will rearrange it. So we have talked to our debt
management colleagues to clarify this. I know that they have
been up to talk to your staff about this, to try to get the
right information. But both Statements are true.
Dr. Stone. So let me say, on behalf of the VHA, we did
communicate this last weekend. We have received large numbers
of phone calls from veterans stating that they wanted to use
their flexible savings accounts and wanted to assure that we
were informing them of any debt that they might have. In an
effort to comply with that, we sent out the notice last
weekend. We also, as part of that letter--and we would be happy
to get your staff a copy of it--invited any veterans that
needed special assistance to contact us and we would work with
them. We also made personal contact with any veteran that had a
balance of greater than $2,000, many of which occurred because
of long-term care facility copayments.
Senator Sinema. Thank you, gentlemen. Mr. Chair, I see that
my time has expired. I yield back, and thank you.
Senator Tillis. Thank you, Senator Sinema.
Gentlemen, we are going to take a break. I do want to also
extend my thanks to Secretary Wilkie. I think we should remind
everybody of where the VA was just a couple of years ago, and
17th out of 17 Federal organizations, as the least desirable
places to work. Now you have move up, I think, into about the
top 5 or top 6 category. I want to thank you for the work that
you have done for the pandemic response. It is not perfect but
I again would say it is probably about as good as any
comprehensive health care system in the United States.
And I am going to submit some questions for the record. I
think it would be helpful to the members to understand the hub-
and-spoke strategy, where you do think you have vulnerabilities
in the rural areas and potential remediation strategies for
that. I think that will be helpful for the members. I do not
want to question the underlying infrastructure that you are
putting into place. What we do not want to do is have a hub
move to an area that is suboptimized. What I think our members
want is to make sure that their constituents are covered. So I
appreciate you all getting that back to us. I will submit some
other questions for the record.
We are going to take a brief recess, subject to the call of
the Chair, after the second and third votes are taken, which I
expect to happen momentarily. So thank you all. We will be in
recess.
[Recess.]
Chairman Moran. [Presiding.] The Committee hearing will
reconvene, and thank you, both witnesses, for your willingness
to allow my return from votes. And pleasing perhaps to you is
that we have another vote in 5, 10 minutes. So my questioning
will be brief and I will not expect you, nor do I want to run
one more time from the floor back here. So thank you very much
for your patience. Let me ask Dr. Lawrence a few questions and
then Dr. Stone a few questions.
Dr. Lawrence, although the VBA worked with its contract
vendors to conduct as many telehealth and acceptable clinical
evidence exams during suspension of in-person exams, there, of
course, is still a backlog of exams and claims to be processed.
What is the VBA's strategy going forward to continue enhancing
and expanding access to telehealth and ACE exams to tackle this
backlog? How do you foresee these virtual exams and the ACE
exams will evolve the medical disability exam process?
Mr. Lawrence. We think this is one of the things the
pandemic has really opened our eyes to, is how much can be
done. We want to continue that as much as possible, and we are
working with VHA to expand the list of conditions by which
tele-C&P exams can be done.
We also want to encourage our veterans to get us acceptable
medical evidence. We do not like when they go to a C&P exam and
we could have looked in their records. We encourage them to get
us their medical records. If they will sign a form, we will go
get it in 5 days from their provider. We are very, very good at
that. So we would like to do as much of that going forward as
possible. We are working with the contract vendors to do that,
and that is our plan.
Chairman Moran. Is there any less accuracy related to the
exam in this manner, and are there certain medical conditions
or cases that would still--the preference would be to be seen
in person?
Mr. Lawrence. Yes. So what we do is we limit the expansion
of C&P to make sure we do not have the problems you are
describing about accuracy. Only if it meets the criteria that
you can do it well, and the answer is yes, there are many, and
that is why we have to coordinate with VHA in terms of the
medical protocols, things you just cannot do virtually. You can
understand touch measurement, things like that, but that is
right.
So we are trying to strike the right balance as much as
possible, understanding it will never replace everything.
Chairman Moran. And this discovery, this utilization of
this technique will help in reducing the backlog, in the long
term?
Mr. Lawrence. Absolutely. We want to have more capacity of
our vendors, you know, in-person as well as tele-C&P. So
before, obviously, you would just reschedule, we would wait,
you would reschedule, we would wait. Now if we could do it
online that would be great.
Chairman Moran. Dr. Lawrence, in addition to going through
a name change and rebranding this year, your testimony
illuminated a lot of good information regarding the Veteran
Readiness and Employment, or the VR&E, program's response to
COVID through increased telecommunications. However, in July,
the VA Office of Inspector General issued a management advisory
memorandum to request that VBA examine overpayments by the VR&E
program that were made to schools covering veterans' tuition.
Where is the VA on investigating on how to appropriately
recover those overpayments? Has the VA provided the OIG with
any updates on their efforts to examine and recover those
overpayments?
Mr. Lawrence. I will have to check in on the last part of
your question, how we work with OIG on this. I know we have a
regular cadence with them. I meet with the inspector general
every month and we talk through what is going on in both of our
organizations.
Overpayments and inaccurate payments is something we take
very seriously. We spent the last year working on, you know,
reducing our overpayments, and the last couple of years we
reduced our improper payments by $400 million. I will also
check in on the status of where they are in terms of running
down the processes and tightening it up, and certainly
recovering the monies. So we will take that as a do-out and
talk to your staff about where we are.
Chairman Moran. I welcome your followup on those questions.
Thank you.
Let me turn to Dr. Stone. Dr. Stone, the VA has undertaken
civilian assistance missions in 49 States and territories,
admitted 355 civilians to its hospitals, and provided over
908,000 pieces of PPE to civilian health care facilities as
part of its fourth mission. I say that because I want people to
know that. You would be aware of it.
My questions are, if a civilian hospital CEO or a county
public health director visits with me, they think they need
VA's help in responding to the pandemic in their community,
what steps should they take to get that help?
Dr. Stone. They would go through their State emergency
operations, through their Governor, and then it would come to
us through FEMA. That can be done in an agile manner in that we
quite often will begin to support a local facility as we await
this to come through the State approval from the Governor and
then the FEMA approval.
Chairman Moran. The numbers that I indicated, extended the
involvement of the VA and its fourth mission to civilians. Has
it changed since the facts I outlined? Is something more
happening today with the result of the increase than what those
numbers reflect?
Dr. Stone. A couple of things have happened. No. 1, let me
clarify. It is 908,000 pieces of equipment.
Chairman Moran. I do not know what I said, but that is what
my notes say, 908,000.
Dr. Stone. All right. I appreciate that, sir, and I
appreciate you outlining it. But we also just this week, in New
York, gave ventilators to a private hospital on a lease basis
or on a loan basis, that they were out of ventilators. We have
a large amount of ventilators that we have secured throughout
the pandemic. So we have equipment all over the Nation that we
have given to private hospitals in order to respond to this.
Chairman Moran. Dr. Stone, my conversations with Kansas
hospital CEOs, chief nursing officers, with certainly press
reports, probably the most prevalent COVID-19 story in our
State, in addition to the number of deaths or the number of
positive cases, the spread, is the lack of hospital
capabilities, particularly ICU capabilities, to meet the
demands of the patients, the demands of what now COVID presents
a hospital. The ability, for example, of a small, rural
hospital to find transfer for a patient that needs ICU care is
limited. It takes a long time. There are some who are unable to
be transferred and others it is where hospital personnel in
small hospitals are spending their time trying to find a bed in
Kansas or outside of our State.
In exploring the challenges that those hospitals that have
ICU beds generally available to patients in Kansas but do not
now have the availability, in some instances, perhaps most, it
is not a lack of beds. It is a lack of health care
professionals, the necessary nursing and other staff. So the
shortage is, in significant part, unstaffed beds, and that is
due to those who work in the health care delivery system
testing positive, being home, being isolated, have members of
their family who are in that circumstance, students who are not
in the classroom. There is a lack of professionals, the
necessary people to work in the ICU.
What role, if any, can VA play in providing professionals
to better staff ICU units?
Dr. Stone. Mr. Chairman, the sustainment of the medical
work force across the Nation is the major weak point that we
face today. That work force, as you know, in Italy and in
Spain, as much of 15 percent of the work force went down from
COVID and was unable to work.
What we believe is that in no way can the VA's 175
hospitals staff the 6,000 civilian hospitals in the Nation. Our
best approach is to accept critically ill patients to be
transferred into our facilities. And as you and I are speaking
this morning, I have 1,100 ICU beds that are available across
the Nation.
Chairman Moran. Available as in available beds and staff?
Dr. Stone. Yes. They are available and staffed. I also have
mobile units that can be moved into areas of the Nation. We
just moved from El Paso to Oklahoma City a 30-bed ICU that is
mobile, that will allow us to take some of the strain off the
Oklahoma City and surrounding area. I have multiple 25-bed
modules that can help reduce the stress on civilian hospitals.
But we cannot be a staffing agency. And although we have
tried to do that in many areas, we are just not large enough,
even with 400,000 personnel to care for America's veterans, to
care for the challenge that we are having with now over 1,800
veterans currently hospitalized in either acute or convalescent
care in our facilities. We cannot sustain that operation and
staff other facilities.
Chairman Moran. So, Dr. Stone, let me see if I can put this
in the way I would explain it to someone at home. The VA's
capabilities are not to be a staffing agency, as you say. It is
not to send personnel from the VA to a different hospital. But
there are staffed beds available within the VA that patients
could be transferred to, where they would be cared for in a VA
hospital, with VA staff.
Dr. Stone. That is absolutely correct. Let me just finish
the story. We also, on a med-surg basis, or medical-surgical
beds, I have 3,000 empty beds across the Nation today, and then
the 1,000 that are ICU beds. About 4,000 beds are available
today. And the Secretary, as I mentioned earlier to Senator
Tillis, has reached out to Governors in areas that are really
stressed, saying that we are available and we are more than
happy to enter into discussions on how to get them help for
critically ill citizens that need help, even if they are not
veterans.
Chairman Moran. I read in a press report today, in a small-
town paper not far from my hometown, about a patient who died
with just the inability for that patient to be transferred
someplace else. So it is a serious, acute circumstance. Would
the process by which that can occur be what you described
earlier, through FEMA, emergency preparedness, or is there a
direct way to seek transfer to a VA hospital?
Dr. Stone. Yes. It needs to go through the Governor, but
any medical center leader who needs help, if they call their
local VA director, we will work that, and we will work as
agilely as we can in order to support critically ill Americans.
Chairman Moran. Dr. Stone, I appreciate that answer very
much. I appreciate that you have the capability to respond in
that way.
Let me ask, because it may be the last time, at least, this
year, that you and I have an opportunity for me, at least in a
setting like this, to ask you a question. I want to go back to
CCN contract modifications. You know, we held a hearing, as you
know, in regard to the MISSION Act, in October. During the
hearing, Optum and TriWest both testified that they are
voluntarily building their respective networks to meet MISSION
access standards. While that is something I support, the VA has
a responsibility, in my view, to modify the contracts to ensure
that third-party administrators continue to meet those
standards.
Dr. Stone, why is the VA either has been or it continues to
be hesitant--I do not know which--to modify those contracts
when the TPAs are already building out their networks to meet
the standards?
Dr. Stone. This has been one of the most frustrating areas
in yours and my relationship. I promised you in August I would
get this fixed. It is not fixed yet. I considered it a
shortcoming and I actually spoke to Optum leadership 48 hours
ago, because I anticipated that you might ask me about the fact
that I have not done what I promised----
Chairman Moran. I am sorry that you know me so well.
Dr. Stone [continuing]. I would do. They are about ready to
move forward with moving off of the 180-minute rule that we had
previously. I have been promised by the Community Care
leadership that that modification will go forward, and I am
looking for a date that I can fulfill my promise to you from
now more than 90 days ago.
Chairman Moran. Let me again try to put that in words that
I would understand. What you are telling me is that in the near
future you want to see that the contracts are modified to meet
the standards of the MISSION Act.
Dr. Stone. That is correct. Now I am talking about the 180-
minute rule, the 120-minute rule. There is more than a million
providers in this Nation, more than are participating in
Medicare, that are part of our Community Care delivery network.
I think it is a robust network and I look forward to seeing
how, as we come out of this COVID pandemic, it really serves
the needs of America's veterans.
Chairman Moran. I am not sure whether I like that answer or
not but I will take it under advisement, and we can continue
our conversation about this topic.
We sent a request for information to the VA, asking whether
their Fiscal Year budget request included funding to modify the
contracts. The VA responded that the budget did indeed include
funding for modifications. However, we continue to receive
mixed signals from the VA. Can you confirm whether or not
funding for the CCN modifications, which we are talking about,
were built into your budget request or not?
Dr. Stone. I have been told the same thing you have, and
that is that it was built into the budget.
Chairman Moran. So I guess my takeaway from that is that
when I'm told, or if I'm told that there is insufficient money
for purposes of modifying the contract, if we were to provide
the money requested, that would not be an accurate explanation
for why the modifications could not occur.
Dr. Stone. That is correct.
Chairman Moran. Thank you. I am just almost done, but I
want to bring a story to you, Dr. Stone, of a circumstance in
Kansas, and indicate a desire for your help.
So this is at least the second time, maybe this year, the
second time this year in which the VA has announced the
intention of closing a CBOC in Kansas. And we have tried to be
very cooperative and not--I am trying to choose my words
carefully--not stand in the way of making a good decision, if
that is the best outcome for veterans.
So I would think that a normal response by an elected
official is when we hear something is closing it is an
immediate reaction, ``Oh, you can't do that.'' I am of the view
that if the MISSION Act is fully implemented, and Community
Care is available, there are circumstances in which Community
Care may provide better services to veterans than a CBOC,
particularly a CBOC that struggles to have the necessary
personnel, has a physician only 1 day a week, is only open
several days a week.
So my indication, without conceding any point, I guess, is
that I am interested in cooperating with the VA to accomplish
the goal of replacing a CBOC, or eliminating a CBOC but only if
Community Care Network can be built up to meet the needs of
those veterans who were utilizing the CBOC.
And so I would ask just for your cooperation, your help, or
suggestions of what I might do to make--I know the folks in
this community have reached out to Optum, so those
conversations have started. But it would be nice for me to be
able, it would be useful for me to be able to assure the
veterans in the area of Liberal, Kansas, southwest Kansas, that
the Community Care Network will be fully capable of meeting
their needs on perhaps a more continuing basis, on a more daily
basis than what the CBOC was able to do.
Does that make sense to you and is that something that you
can help me achieve?
Dr. Stone. Sir, you have my commitment. It makes sense to
me and you have my commitment that we will work together to
assure that the veterans of that area of Liberal, Kansas, are
served well.
Chairman Moran. Thank you.
Let me see if anybody has anything else.
And then my usual practice of allowing our witnesses to add
or detract, take something away that you said that you wish you
would not have. Anything that we should know before we conclude
the hearing?
Dr. Stone. We thank you for the courtesy of the Committee,
and we again arrive here today really as representatives of the
400,000 great employees of this agency who continue to do their
work so beautifully throughout the pandemic.
Chairman Moran. Doctors, you always, in your testimony,
your presence before the Committee, make a point of recognizing
those that work with you and for you, and I join you in
expressing my gratitude for their ongoing care and concern for
our veterans, and particularly during the times of COVID-19
pandemic. They have lots of challenges themselves in their own
families, in their own lives, and yet they are willing to try
to help care and cure and heal those that have significant
challenges.
And I thank both of you once again for your service at the
Department of Veterans Affairs. I look forward to continuing to
work with you, and I thank you both for being here today and
discussing the work that you and your Department has done
during these unprecedented and challenging times. We are not
out of the woods yet and we will continue to be your ally and
help and try to provide constructive suggestions that would be
valuable to you as we meet the needs of our veterans.
I would ask unanimous consent that members have five
legislative days to revise and extend their remarks and include
any extraneous material. With that the hearing is now
adjourned.
[Whereupon, at 12:04 p.m., the Committee was adjourned.]
APPENDIX
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Material Submitted for the Hearing Record
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