[Senate Hearing 117-231]
[From the U.S. Government Publishing Office]
S. Hrg. 117-231
HEARING ON PENDING LEGISLATION
=======================================================================
HEARING
BEFORE THE
COMMITTEE ON VETERANS' AFFAIRS
UNITED STATES SENATE
ONE HUNDRED SEVENTEENTH CONGRESS
FIRST SESSION
__________
JUNE 23, 2021
__________
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
47-277 PDF WASHINGTON : 2023
COMMITTEE ON VETERANS' AFFAIRS
Jon Tester, Montana, Chairman
Patty Murray, Washington Jerry Moran, Kansas, Ranking
Bernard Sanders, Vermont Member
Sherrod Brown, Ohio John Boozman, Arkansas
Richard Blumenthal, Connecticut Bill Cassidy, Louisiana
Mazie K. Hirono, Hawaii Mike Rounds, South Dakota
Joe Manchin III, West Virginia Thom Tillis, North Carolina
Kyrsten Sinema, Arizona Dan Sullivan, Alaska
Margaret Wood Hassan, New Hampshire Marsha Blackburn, Tennessee
Kevin Cramer, North Dakota
Tommy Tuberville, Alabama
Tony McClain, Staff Director
Jon Towers, Republican Staff Director
C O N T E N T S
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JUNE 23, 2021
SENATORS
Page
Tester, Hon. Jon, Chairman, U.S. Senator from Montana............ 1
Tillis, Hon. Thom, U.S. Senator from North Carolina.............. 5
Hassan, Hon. Margaret Wood, U.S. Senator from New Hampshire...... 8
Moran, Hon. Jerry, Ranking Member, U.S. Senator from Kansas...... 9
Murray, Hon. Patty, U.S. Senator from Washington................. 11
Brown, Hon. Sherrod, U.S. Senator from Ohio...................... 15
Tuberville, Hon. Tommy, U.S. Senator from Alabama................ 16
WITNESSES
Panel I
Mark Upton, MD, Acting Assistant Under Secretary of Health for
Community Care, Veterans Health Administration, Department of
Veterans Affairs
Accompanied by: Gerard Cox, MD, Assistant Under Secretary for
Health for Quality & Patient Safety; Clifford Smith, MD, Deputy
Director, Office of Mental Health Operations; and Theresa
Gleason, PhD, Director, Clinical Science Research & Development
Service........................................................ 2
Panel II
Joy Ilem, National Legislative Director, Disabled American
Veterans....................................................... 17
Kathryn Monet, Chief Executive Officer, National Coalition for
Homeless Veterans.............................................. 19
Mario A. Marquez, Director, Veterans Affairs and Rehabilitation
Division, The American Legion.................................. 21
APPENDIX
Hearing Agenda
List of Pending Bills............................................ 35
Prepared Statements
Mark Upton, MD, Acting Assistant Under Secretary of Health for
Community Care, Veterans Health Administration, Department of
Veterans Affairs............................................... 39
Joy Ilem, National Legislative Director, Disabled American
Veterans....................................................... 80
Kathryn Monet, Chief Executive Officer, National Coalition for
Homeless Veterans.............................................. 101
Mario A. Marquez, Director, Veterans Affairs and Rehabilitation
Division, The American Legion.................................. 107
Questions for the Record
Response to questions submitted by:
Hon. Jerry Moran............................................... 131
Statements for the Record
Tammy Barlet, Associate Director, National Legislative Service,
Veterans of Foreign Wars of the United States.................. 137
Lisa Robin, Chief Advocacy Officer, Federation of State Medical
Boards......................................................... 143
Kate Hendricks Thomas, PhD, Marine Corps veteran, Researcher,
University of Alabama Center for Evaluation Adjunct Faculty,
George Mason University's Department of Global and Community
Health......................................................... 145
Melissa Jackson, President, National Association of State
Veterans Homes................................................. 149
Nursing Community Coalition...................................... 154
David Benton, RGN, PhD, FFNF, FRCN, FAAN, Chief Executive
Officer, National Council of State Boards of Nursing........... 157
Paralyzed Veterans of America.................................... 160
HEARING ON PENDING LEGISLATION
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WEDNESDAY, JUNE 23, 2021
U.S. Senate,
Committee on Veterans' Affairs,
Washington, DC.
The Committee met, pursuant to notice, at 3:19 p.m., in
Room SR-418, Russell Senate Office Building, Hon. Jon Tester,
Chairman of the Committee, presiding.
Present: Tester, Murray, Brown, Blumenthal, Hassan, Moran,
Tillis, Blackburn, and Tuberville.
Chairman Tester. I want to call this meeting to order.
Before we get to my opening statement I just want to make
one thing really abundantly clear. We have rules in this
committee, when we want a testimony, we want it in before the
deadline, not after the deadline. There is a reason for that.
The reason for that is that both Jerry Moran and myself have
some really amazing staff members that are able to scrutinize
that testimony and get some questions driven by what that
testimony says.
If the first time we see a testimony is a period not long
enough for us to look at that testimony, that is a problem.
Next time, I will be much more pointed and a lot more mad
if this happens. This is a professional outfit. You are a
professional outfit. Rules are not made to be broken, in my
opinion. They are made to be attended to. So I just want to say
that to begin with. I hope I have made myself clear, thank you,
and I hope that anybody from the VA that is listening to this,
I hope I have made myself clear to them too. Okay?
We want to help you. We cannot help you if we do not know
what the hell you are thinking. Okay? All right. Thank you very
much.
Senator Moran will be here in a few minutes. I am going to
start with my opening statement, and hopefully he will be here
by the time I finish.
OPENING STATEMENT OF CHAIRMAN TESTER
Chairman Tester. Good afternoon. I want to thank you all
for joining us today to hear views from the Department of
Veterans Affairs and veteran service organizations on 21 bills
pending before this committee. Even before the pandemic,
organizations working to support our nation's most vulnerable
veterans told us they need bigger lifeboats as they could not
fully support the existing population of veterans experiencing
homelessness.
In April, we hosted a roundtable with VSOs on homeless
veterans advocacy. We heard firsthand about the challenges they
face in facilitating a productive conversation with VA, HUD,
Department of Labor about what needs to be done to address
them. Included on today's agenda is my bill, the Building
Solutions for Veterans Experiencing Homelessness Act. Every
section of this legislation came out of a request made during
that roundtable. This bill makes permanent COVID-related safety
nets that have become essential to providing the most effective
care and support to unhoused veterans and their families. These
requests are not wish list items but concrete changes advocates
have said are absolutely necessary in the fight to effectively
end veteran homelessness. In fact, the Department is on record
requesting some of the items in my bill from Congress.
Given this, it is disappointing that the VA has not
provided views on my bill for this hearing, despite having had
the text since May 24th. My expectation is VA will address this
delay in views expeditiously.
Also on our agenda today is S. 1467, the VA Medicinal
Cannabis Research Act, a bill that I worked on with Senator
Sullivan that expands the research on alternative treatments
for veterans who suffer from the seen and unseen wounds of war.
A survey conducted by the American Legion tells us that 22
percent of veterans who responded already use cannabis to treat
a medical condition. Our bill would help the VA get the
necessary data to fully evaluate this treatment and educate
veterans on the outcomes of using medicinal cannabis to treat
certain conditions.
Once again, I want to thank our witnesses for being here
today, and I mean that. Thank you. If we work together we can
fulfill our promise to our veterans. We can reassure them that
when they fight for us, we are going to fight for them, and
guarantee they get the benefits that they deserve.
With that we are going to be in recess until Moran shows
up.
[Recess.]
[The pending bills referred to by Chairman Tester appear on
page 35 of the Appendix.]
Chairman Tester. We will just go ahead. You guys start your
testimony. The rules are that your full written statement will
be put in the record, so if you can pare that written statement
down to five minutes I would appreciate it.
PANEL I
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STATEMENT OF MARK UPTON ACCOMPANIED BY
GERARD COX; CLIFFORD SMITH; AND
THERESA GLEASON
Dr. Upton. Thank you, Chairman Tester and Ranking Member
Moran and members of the committee. We appreciate you inviting
us here today to present our views on bills covering many
critical topics. Joining me today, I just would like to say
thank you to Dr. Gerry Cox, Assistant Under Secretary for
Health for Quality & Patient Safety; Dr. Clifford Smith,
Director of Field Support and Analytics, Office of Mental
Health and Suicide Prevention; and Dr. Theresa Gleason,
Director of Clinical Science Research & Development Service
here in the Veterans Health Administration. I would also like
to thank our VSO colleagues who will be part of the second
panel. We truly appreciate what you do.
Mr. Chairman, I would like to start by just acknowledging
your comments in the beginning. VA apologizes to the committee
for our late submission of the testimony. We know that you
depend on VA's views and pledge to work with you during and
after this hearing to ensure you have the information that you
need.
I will not be able to touch on all the bills in the agenda
during these brief opening remarks, but our written testimony
contains detailed comments on all but two of them, and I want
to assure you that VA stands ready to engage with you on all of
these bills.
VA has made mental health care and suicide prevention top
clinical priorities, and we truly appreciate the committee's
partnership on this important work. VA supports S. 544, that
would establish an annual Buddy Check program. We appreciate
the intent but cannot offer our support, however, for S. 613
and S. 951, both regarding therapeutic use of service dogs, due
to different but overlapping concerns on both bills that we
would be happy to discuss today.
Outreach during the transition to civilian life is
critical, which is the subject of S. 1198, the Solid Start Act.
This bill codifies vigorous outreach programs that we are doing
now on a number of fronts. We do note some issues that are
shared in our written testimony and certainly would be happy to
discuss.
As the number of women veterans enrolling in VA health care
increases, VA must be prepared to meet their needs. We
appreciate the inclusion of reproductive health legislation on
today's agenda. VA supports additional authorities to improve
and expand these services, and a detailed analysis of S. 1280,
the Veteran Families Health Services Act, is in our written
testimony, including technical concerns and open questions, and
we are eager to work with the committee to go through this in
detail.
Let me assure this committee that nothing is as important
to us as protecting the safety of the veterans who entrust us
with their care. That must be paramount every hour of every day
for VA. We support, with some suggestions, S. 539, the VCR Act,
regarding the use of video cameras to monitor patient safety.
S. 372, the Ensuring Quality Care for Our Veterans Act,
involves clinical reviews of the quality of hospital and
medical services. We appreciate the committee's commitment to
ensuring that veterans receive the safest and highest quality
care possible, but do have concerns about the effectiveness of
layering new requirements on top of existing review processes
and mechanisms. We are eager to collaborate with the committee,
however, as partners in patient safety.
VA remains committed to a strong, thriving, direct health
care system, augmented by a robust and high-quality Community
Care Networks. Veterans deserve and demand a strong VA health
system tailored to their needs and a robust Community Care
Network to supplement that system. The Guaranteeing Healthcare
Access to All Personnel Who Served Act would make some
fundamental changes to VA Community Care authorities, including
codifying access standards now set by regulation.
We are concerned that it would eliminate VA's flexibility
to react to changes in market conditions and other emerging
issues, as well as preempt VA's ongoing intensive analysis of
the access standards outlined in the MISSION Act. The bill
would also directly mandate these access standards in our
contracts with community providers, and we believe there could
be disruptive, unintended consequences from that change and
that network adequacy is an issue that requires the ability to
adapt to changes in market conditions and emerging needs of our
veteran population. There are other significant changes that
would greatly affect VA's delivery of health care that we would
be happy to discuss with the committee.
VA supports, with some technical changes, the Veterans'
Emergency Care Claims Parity Act, and is glad to support S.
727, the CHAMPVA Children's Care Protection Act.
Our country's most sacred obligation is to prepare and
equip the troops we send into harm's way, and to care for them
and their families when they return home. The Building
Solutions for Veterans Experiencing Homelessness Act is a
package of provisions to buttress VA's efforts to support
veterans in need of assistance. While VA has not been able to
conclude views on this bill, there are many worthwhile concepts
in this legislation, and we are eager to work with you, Mr.
Chairman, and the committee on technical assistance in the
meantime.
VA supports the Improving Housing Outcomes for Veterans
Act, which would help coordinate best practices and other
information on homelessness programs among homeless providers
and VA medical center staff. We do note some duplications in
the bill's provisions, however.
Finally, VA is glad to support S. 1040, which would expand
eligibility to VA health care benefits to World War II veterans
that are not otherwise eligible.
I want to re-emphasize that we greatly appreciate the
partnership of this committee and the time to discuss these
important bills with you today. This concludes my statement,
and we look forward to your questions.
[The prepared statement of Dr. Upton appears on page 39 of
the Appendix.]
Chairman Tester. I appreciate that. I appreciate your
comments on the testimony too. We will hold you to it.
As I pointed out in my testimony, there was no comments
given on S. 2172, which is a bill that I am particularly fond
of, but may not be perfect. When can I anticipate your comments
on that bill?
Response: Comments were provided to SVAC Majority staff (Tess
Wrzesinski) during a phone call with VA SMEs on June 30, 2021,
and will continue with a follow-up call (and/or written TA)
upon receipt of the revised version of the bill.
Dr. Upton. Mr. Chairman, first off, as a frontline VA
health care provider, the work that we do in VA to help
homeless individuals is so important to me, so I truly
appreciate that, just at the outset. I think one of the unique
parts of being a VA provider is when I am taking care of a
medical issue that is compounded by homelessness we are able to
help both, which is very, very key.
In terms of the exact timeline, sir, I know we are actively
working on that and will certainly be glad to take that for you
after this hearing today. But you should receive that soon, and
that is certainly our commitment.
Chairman Tester. That would be good. Yes, I think it is
really important.
Look, I do not want to bring up old issues, but we did a
hearing on toxic exposure and the VA did not do any comments on
any of those bills, for whatever reason. And quite frankly, we
are paying for that right now. We are paying a price for that.
And so just keep in mind that if there are bills out there, all
you have got to do is say, ``Yep, I like it,'' or ``No, I
don't, and here is why.'' That is it, and it is really
important.
I have a question for you, Dr. Upton, and it has nothing to
do with any of the bills. It has to do with the adequacy of our
dental network in Montana, and I want to thank you for looking
into that adequacy. My understanding of it is that of the 13
dental providers in the CCN serving Great Falls, just 7, a
little over half of the dental providers are willing to make
appointments for veterans, meaning roughly half of VA's
directory of dental providers, developed by contractors, was
unusable for the fourth-largest city in Montana, maybe the
third.
Unfortunately, this is not an isolated issue, and one that
should be reviewed nationwide, so the contractors are
accountable for network adequacy and veterans are able to know
what their actual options are for dental or medical care within
the community.
What can the VA do to execute better the oversight of these
networks?
Dr. Upton. Thank you, Mr. Chairman, and just to echo both
my role as a frontline doctor, as I mentioned before, as well
as the head of Community Care in the Veterans Health
Administration, ensuring that veterans have access to the care
they need, it is critical. It is personal to me and it is our
fundamental priority.
The CCN contracts that you reference are a substantial step
forward in the care for our veterans and in the work that we do
with Optum and TriWest, our focus is to get it right the first
time. But there are certainly some things that we have learned,
implementing large contracts in the midst of the pandemic, and
my focus as well as our partners that we work with is when an
issue gets identified, which I truly appreciate the VA Montana
staff, your staff, relaying that to us, we take it seriously,
we acknowledge it, we work to make it better, as well as work
on large-scale initiatives.
So a lot of nuances to that, that I am happy to share with
you, sir, and your committee, but the fundamental answer is I
hold myself to a very high standard, our office as well as our
contractors, and we are committed to ensuring that we get this
right on all fronts, and I am happy to keep you and the
committee updated on that.
Chairman Tester. Okay. Thank you. Senator Tillis.
SENATOR THOM TILLIS
Senator Tillis. Thank you, Chairman Tester. Thank you all
for being here to testify. As you know, Senator Fischer and I
have been working on complementary legislation that seeks to
provide veterans with access to proven alternative treatment
models such as therapeutic training of service dogs, and in
some instances, pairing veterans with such service dogs.
I am somewhat disappointed that the VA's testimony today
raises a number of issues that have already been discussed and
agreed-upon by the House's unanimous package of Representative
Stivers' PAWS for Veterans Therapy Act. While I wish the VA
would have accounted for these changes, which I believe
resolved the majority of the outstanding concerns, I do want to
raise a few specific questions that you outlined in your
testimony. And, Chairman Tester, we got this information, or
the feedback, just a couple of hours ago.
So when we have limited time I always hate it when members
say, ``Give me a yes or no answer,'' but to the extent you can
give me a yes or no answer on some of these concise questions I
would appreciate it.
Your testimony states, ``Although possibly helpful to a
limited number of veterans, the therapeutic medium of training
service dogs does not have an adequate basis of evidence.''
Isn't it true that the VA has already conducted Train the
Trainer Program at Palo Alto, VA?
Dr. Smith. Correct. There is a program at Palo Alto.
Senator Tillis. And isn't it the purpose of vital programs
to test out these innovative approaches so we, as policymakers,
can gather additional outcomes and data?
Dr. Smith. Correct.
Senator Tillis. And the VA's testimony also casts doubt on
the efficacy of pairing service dogs with veterans experiencing
post-traumatic stress, but isn't it true that the VA's own
study recently found a reduction in severity of PTSD symptoms
and suicidal ideation and behaviors in veterans paired with
service dogs?
Dr. Smith. There is not enough scientific evidence to
support that broad conclusion.
Senator Tillis. I will follow up on that with questions for
the record.
Moving on to quality standards, which was outlined in the
PAWS for Veterans Therapy Act that was unanimously passed by
the House. You raised concerns that the standards and quality
of partner service dog training organizations, yet isn't it
true that the VA already has standards for seeing eye dogs?
Dr. Smith. The VA uses the two accrediting organizations as
their main bodies, correct.
Senator Tillis. And isn't it true that those standards are
defined in regulations and not in statute?
Dr. Smith. I believe that is correct.
Senator Tillis. You know, the PAWS for Veterans Therapy
Act, which unanimously passed the House last month, in a
cooperation on a bipartisan basis, requires any participating
organization to be--these are the words--``accredited with
demonstrated experience, national scope, and recognized
experience in training of service dogs, as determined by the
Secretary.'' Are you suggesting that the VA would set standards
that are inadequate or lesser than those it currently uses?
Dr. Smith. We would use the standards of the two
accrediting bodies.
Senator Tillis. Don't you agree that calling out specific
accrediting bodies would hamstring the VA's ability to make
future adjustments to maintain program integrity and quality?
When I was a coder I called that hard coding. We wanted to give
the VA flexibility. Would you agree that it would make more
sense to give the VA flexibility?
Dr. Smith. Well, we appreciate that intent at flexibility.
We want to maintain the highest of gold standards, and those
two organizations are the gold standard.
Senator Tillis. Isn't it true that the VA worked directly
with the House sponsors to arrive at a mutually agreeable
standard in the PAWS for Veterans Act?
Dr. Smith. Subject matter experts have been working with
the House, correct.
Senator Tillis. Now with VA authorities with regards to
service dog pairing, VA's testimony states that Section 4 of my
bill was duplicative because VA already has the authority to
provide a service dog to a veteran, regardless of whether a
veteran has mobility impairment. Has the VA ever used that
authority?
Dr. Smith. I am aware the Secretary has that authority. I
believe it has been----
Senator Tillis. They have not used it. I do not believe
they have, and we can make sure you can submit those
specifications for the record, at least based on our best
research.
Isn't it true the VA's implementing regs are more limiting
than the underlying statute?
Dr. Smith. I would have to take that for the record.
Response: The Department does not "place a service dog with a
Veteran," although VHA Clinical Offices may provide
recommendations for Veterans with various disabilities as to
whether or not a service dog is appropriate for them as a
Veteran seeks to obtain a service dog from a service dog
provider.
VHA (Rehabilitation & Prosthetic Services) administers the
veterinary health benefit for Veterans with approved service
dogs that have been obtained from Assistance Dogs International
or International Guide Dog Federation training organizations.
Currently, this benefit extends to guide dogs (for visual
impairment), hearing dogs (for deafness), and mobility dogs
(for mobility disorders due to physical or mental health-
related disorders).
Senator Tillis. In our judgment it is. This section simply
seeks to get VA to update its implementing regulations to
reflect congressional intent. Unfortunately, the VA has ignored
this spirit of the law, and instead applied its own narrow
approach.
So in my remaining time, you know, here today are a series
of concerns with respect to how the VA will execute the
legislation. I firmly believe the VA has the tools and
authorities necessary to make this program a success, and 435
of my House colleagues, and I will also say many of my
colleagues in the Senate, agree. We have waited too long to
provide the treatment, and I would like to move forward on it.
Thank you, Mr.--I almost called you Mr. President--thank
you, Chairman.
Chairman Tester. I would never forgive you if you did that.
Thank you, Senator Tillis. Senator Hassan.
SENATOR MARGARET WOOD HASSAN
Senator Hassan. Well, thank you, Chair Tester and Ranking
Member Moran. Thank you to all of our witnesses for being here
today and for your service. And I am going to direct these
questions to you, Dr. Upton, and if you want to ask other
panelists to chime in, please do.
Every year, 200,000 servicemembers transition from military
to civilian life. The majority are in the 18- to 34-year-old
age range, which also has the highest veteran suicide rate.
That is why I introduced bipartisan legislation with Senators
Cramer and Cassidy to strengthen and make permanent the Solid
Start Program, which as you know, is the VA initiative that
aims to contact every veteran multiple times by phone in the
first year after they leave active duty, to check in and help
connect them to VA programs and benefits.
So can you please speak to how Solid Start's early and
consistent contact with new veterans is critical to their well-
being?
Dr. Upton. Absolutely, Senator, and we in VA completely
agree that that transition from active duty service into our
system is a very important transition period and one that
should be taken with as much support as possible.
There are a lot of components to that, that relate to
mental health, and so I am going to turn to Dr. Smith to touch
on that quickly.
Senator Hassan. Yes.
Dr. Upton. I appreciate that.
Senator Hassan. Thank you.
Dr. Smith. Senator, we appreciate that bill and many of the
aspects within that. I am aware of your commitment for those
transitioning servicemembers. Broadly, our Solid Start Program
is already incorporating many of the things you raise in the
bill. There are some places we would appreciate further
discussion for clarity. But overall, the current proposal is
consistent with our implementation of the three phone calls
within the first year. It is of critical importance to do all
we can for that engagement of those servicemembers.
Senator Hassan. Well, I think it will make a real
difference, as you all have said, to mental health supports for
our veterans, and that is why I think it should be made
permanent, and I look forward to continuing to work with you on
it.
Let's go on to the Buddy Check program, because veterans
need outreach in a lot of different ways, and the American
Legion's Buddy Check volunteer initiative is important because
it connects veterans directly with other veterans. I introduced
bipartisan legislation with Senator Ernst to build on the
American Legion's efforts by directing the VA to designate 1
week per year as Buddy Check Week, to organize outreach events
and educate veterans on how to conduct peer wellness checks.
So, Dr. Upton, and I think probably Dr. Smith too, can you
please speak to how Buddy Checks, which are volunteer led,
could complement the VA's efforts to support veterans' mental
health?
Dr. Upton. Yes. I will just say thank you for that, and we
wholeheartedly agree. That bill, and because it is mental
health specific, I will turn to Dr. Smith, but thank you.
Dr. Smith. Thank you, Senator. We agree it is a great
opportunity. We do many outreach activities now, Mental Health
Month, for example, focusing on communications to not only VA
enrollees but non-enrollee veterans. Buddy Check is another
opportunity. I do think it is an opportunity to think broadly.
It is not just a mental health issue. It is a community issue.
We should be aware of our buddies. And so that is how we would
approach it, moving forward, is it is not just a mental health
focus. It is a veteran focus. It is about community.
Senator Hassan. Yes, and it is also about different
veterans with particular different needs or experiences being
able to find each other----
Dr. Smith. Absolutely.
Senator Hassan [continuing]. And that is something I am
hearing from women veterans, particularly in rural parts of my
state. So I will look forward to working on that with all of
you.
I want to follow up on the line of questioning that Doctor,
Senator Tillis--I just made you a doctor, Senator--Tillis was
talking about, because we need innovative solutions to address
veteran suicide and post-traumatic stress disorder.
So as you may know, I support legislation like Senator
Tillis' and like Senator Fischer's PAWS Act, which would
establish a 3-year program at the VA where the Department would
provide grants to eligible service dog organizations to pair
more veterans with service dogs.
So what I think you are hearing from Senator Tillis, and
what I would like some commitment on here, is we currently
understand that the VA, just this morning, indicated it does
not support these bills, but can we have your commitment that
the VA will implement it as Congress intends by providing a
legitimate avenue through the VA to provide service dogs to
veterans with PTSD?
Dr. Smith. Thank you, Senator. Absolutely. You know, we are
aware, and we agree with the deep commitment to intervening in
veteran suicide. We have to think big, think creatively. It is
an opportunity to continue thinking big. I know, in addition to
the two Senate versions there is a House version. We look
forward to those continued conversations with our subject
matter experts, staffers and yourself personally. We are
committed to that.
Senator Hassan. There are a lot of members of both sides of
the aisle who are getting a lot of briefings and information
that indicates that these would be really valuable pairings,
efforts, and it really does support veterans with PTSD. So what
you are hearing from us is a real desire, even if you have some
differences, if it passes, that we get to work and do this in
the way that Congress intends. Thank you.
Chairman Tester. Thank you, Senator Hassan. Senator Moran
for an opening statement.
OPENING STATEMENT OF SENATOR MORAN
Senator Moran. Chairman, thanks for your accommodation.
There are two hearings that I am the Ranking Member of going on
at the same time, and a third one that I needed to attend, but
I think I am with you for the rest of the afternoon, and I am
not sure that you will find that pleasing but I am here for the
duration.
Dr. Upton and our VSO witnesses that are here today, I say
good afternoon to you and I am looking forward to hearing from
each of you regarding the legislation before us. Today we have
22 bills for consideration, with most relating Veterans Health
Administration. In recent years, Congress has passed
significant reforms to modernize the system to be more
effective, streamlined, and most importantly, veteran centered.
These changes have yielded positive results with more veterans
having a favorable opinion of VHA.
Integral to these reforms has been greater choice and
flexibility among our veterans. Putting greater control into
the hands of veterans through the VA MISSION Act has helped
improve the VA and make certain that veterans have timely,
reliable access to care.
In addition to the MISSION Act, the Commander John Scott
Hannon Act, that Chairman Tester and I introduced, is enhancing
veterans' care by building upon innovative suicide prevention
services, expanding veterans' access to mental health care,
bolstering VA's research efforts, and increasing VA
accountability on all mental health and suicide prevention
services.
Despite these recent achievements, gaps remain. My bill,
Guaranteeing Healthcare Access to Personnel Who Served Act, or
GHAPs Act, would work to close those gaps by ensuring certain
and consistent coverage to veterans who get their care through
the VA.
When introducing the GHAPs Act it was important to me to
solicit support from all VSOs and veteran service
organizations, large and small. Too often, in important
legislation that impact veterans, only a few select groups are
given the opportunity to discuss. With the GHAPs Act, my staff
and I made it a priority to talk with numerous organizations
which serve veterans across America. I am grateful to have the
support of larger VSOs, such as the American Legion and Vietnam
Veterans of America, and the smaller VSOs, such as the Alaska
Native Veterans Association, the National Association of Black
Veterans, and the American Ex-POWs, as well as the support of
important stakeholders such as the American Red Cross and the
National Association for Rural Mental Health.
In addition to GHAPs Act, I look forward to discussing my
VA Supply Chain Resiliency Act, which would address VA's supply
chain process, particularly during emergency periods. As we saw
during COVID-19 pandemic, it is crucial that the VA have robust
plans in place to take into account interdepartmental
cooperation and to make certain the system has adequate and
appropriate distributed resources in times of emergency.
On the remaining legislation on today's agenda there are a
number of important bills from my colleagues that address
critical topics such as patient safety at the VA medical
centers, the VA Solid Start Program, alleviating veteran
homelessness, and VA provider accountability. On this last
subject, I am pleased to co-lead the bipartisan effort with
Senator Manchin to ensure that only verified and credentialed
providers are permitted to treat our nation's veterans.
Lastly, I would like to speak to our veterans directly. For
your service you deserve a system that works for you. Whether
you live in rural America or urban America, Indian country, or
overseas, your service to our country must be matched by this
committee and the Department of Veterans Affairs.
I look forward to hearing testimony of each of the bills
today, which I missed hearing it but I have it in writing, and
I look forward to determining how we can work together to
better serve our American veterans.
Mr. Chairman, I will ask my questions at a later time, and
I yield back.
Chairman Tester. Thank you, Senator Moran. Senator Murray.
SENATOR PATTY MURRAY
Senator Murray. Thank you very much, Mr. Chairman. I do
want to talk a little bit about the two bills that I have on
the agenda today, which would improve the lives of veterans in
Washington State and across the country.
The first one is the Planning for Aging Veterans Act. It
will require the VA to develop a strategy to address long-term
care needs of veterans to guide our future investments. The
bill would make improvements to VA's oversight of State
Veterans Homes and provide geriatric psychiatric assistance to
veterans in these facilities, which can improve the lives of
veterans living with traumatic brain injuries or memory loss.
The second bill is the Veteran Families Health Services
Act. It is critical for so many of our veterans with
infertility, trying to realize their dream of having children.
I have been fighting for the provisions in this bill to become
law for almost a decade, because America's veterans deserve
comprehensive health care benefits from the VA after their
service to the country, and that includes fertility treatments.
This legislation is needed because VA's current authority to
provide fertility treatment, such as IVF, is limited. This bill
would make VA's authority permanent and expand access to these
services in a way that would meet the needs of veterans across
my state and the entire country, and I really appreciate VA's
technical assistance on this bill. I do have a few questions
for the witnesses, and Dr. Upton, I want to start with you.
VA's existing authority to provide IVF is unnecessarily
restrictive and means that many of our veterans do not have
access to fertility programs they need to start a family. For
example, VA's existing IVF policy prohibits the use of donated
gametes. How common is it for private sector fertility
providers to allow the use of donors?
Dr. Upton. Thank you for the question, Senator, and as an
internist myself and not a women's health expert I am happy to
take that specific question for the record. But what I can say,
as someone who executes the IVF contracts in the community as
well as works closely with their women's health experts, they
are very appreciative of many aspects of your bill and the need
to create more of an equitable playing field and align more of
our care with health care standards. And I think that will
likely be aligned with that, but we are happy to confirm and
report back.
Response: Allowing the use of donated gametes would be a
standard of in-vitro fertilization practice for private sector
fertility providers.
Senator Murray. Well, VA's existing authority to provide
IVF comes from appropriations that have been enacted by
Congress each year. How does not having permanent authority
affect VA's ability to plan ahead, to educate VA providers, and
make sure there is continuity of care for our veterans?
Dr. Upton. I will have to take that one for the record as
well, Senator, but I will say that there are many pieces in the
bill that we support and very much appreciate.
Response: Appropriation laws have expirations tied to the
fiscal year cycle. VA has not been able to assure Veterans that
the episodes of IVF care they are entering into will be
authorized beyond a given fiscal cycle. The process of IVF
treatments can easily require months of examinations,
medication cycles to enhance ovulation, and specific scheduling
of retrieval treatment attempts. In addition, Veterans may make
decisions about pregnancy attempts based on the potential
expiration of benefits rather than on what timing is best for
their family.
Senator Murray. Well, I would say for my colleagues on the
committee and in the Senate and everywhere else, that if they
do not have permanent authority then it is very hard to help
our veterans plan for the families that they deserve. They
served our country. They were injured, which made limited
opportunities for them to have children, a dream many people
ought to have, including our veterans. And so we need to enact
a full, comprehensive bill here that will allow them to get
that, and for the people who are providing it to be able to
give them the kind of education that they need to make sure
that they can plan for their families.
Dr. Upton, I have spoken at previous hearings about the
Planning for Aging Veterans Act and the importance of the VA
preparing for the future long-term care needs of veterans. As
the Department makes decisions about infrastructure and
staffing, the VA has provided a lot of support to State
Veterans Homes throughout the COVID-19 pandemic, and I hope the
relationship between State Veterans Homes and the VA remains
strong. However, the process of entering into sharing
agreements between medical centers and individual State
Veterans Homes can differ widely from state to state. Some VA
medical centers are able to reach an agreement with a state
home in a timely manner. Others, it takes years to get an
agreement put together.
Can you describe for the committee how the lack of a
standardized process to enter into these agreements can affect
access for residents to State Veterans Homes?
Dr. Upton. Thank you, Senator, and I just completely agree
with the need for an important plan and partnerships as our
veteran population ages. The partnership we have with our State
Veterans Homes are critical, and we have certainly worked
closely with them throughout the pandemic, as you know.
Our technical experts specifically related to those sharing
agreements would be happy to comment on that, and I know they
have in our testimony. But my assumption is they are very
important and we appreciate your help improving that, and we
will get you a formal answer as well.
Response: VA Medical Centers follow an internal VHA Directive
1660.01, Health Care Resources Sharing Authority--Selling, that
has the defined process. A selling sharing agreement is used
when a State Veterans Home (SVH) is required to provide a
service under the federal regulation and they seek that service
from the VA Medical Center.
An agreement does not have any impact on the SVH admission
process.
Senator Murray. Thank you very much. I appreciate that.
Thank you, Mr. Chairman.
Chairman Tester. Senator Moran.
Senator Moran. Chairman, thank you again. Dr. Upton, again
thank you for being here. My staff and I have repeatedly shared
our concerns with the Department regarding issues for veterans
in rural and highly rural areas in obtaining high-quality
virtual care from the VA during the pandemic. The primary
answer we have received from the VA on that is their solution
is that the Department is giving 5G-enabled iPads to veterans,
though connectivity barriers continue to persist for veterans
in VA care who reside in rural and highly rural areas.
Do you have anything more besides giving iPads to veterans
and the ATLAS partnership that you can share with the committee
on how the VA is trying to find innovative solutions for our
rural and highly rural veterans?
Dr. Upton. I appreciate that, Senator, and certainly we
share the commitment to helping highly rural veterans,
particularly in Kansas and across the country, who face those
concerns. As you mentioned, our group who oversees telehealth
and connected care have been very dedicated to doing that,
offering 99,000 internet-enabled tablets, cellphones, as well
as working with major telecommunication companies to help
address what we call the digital divide, which is very
critical.
I think there is still more work to do, both within VA and
in the private sector, and we would look forward to partnering
with you, Senator, on additional efforts to bridge that divide.
Senator Moran. Dr. Upton, thank you. Let me ask about
access standards. To paraphrase Dr. Matthews' testimony, on
April 2019, at an SVAC hearing, the VA conducted a broad span
market analysis of public and private sector plans as well as
its own data to create access standards. She also testified the
VA hoped to stick with an industry standard so that veterans
might have a reasonable expectation of when they could actually
receive care.
Do you agree with Dr. Matthews' sentiments, and do you
still believe the VA did well when crafting access standards?
Dr. Upton. I appreciate that, Senator, and I worked for Dr.
Matthews during the time and I know there was a very thoughtful
review that has been done. I would say that we are very
committed to implementing the MISSION Act and providing the
utmost best access to our veterans. We do feel that there needs
to be a review at this point, as outlined in the MISSION Act,
to truly understand those impacts. And the honest answer is,
Senator, that those access standards went live and about 8
months into that the pandemic hit, and so there is still much
more to be learned, and we are committed to working with you to
do that and ensure that access is available to veterans.
Senator Moran. Doctor, let me go back to what I think is
the crux of my question. Dr. Matthews outlined the process that
you went through, that she went through, the Department went
through, to develop those access standards. The way she
described it, in my view, was very positive. My question is, do
you agree that the process that the VA went through was an
appropriate process to determine the access standards?
Dr. Upton. Having been a part of that process as well,
Senator, I think it was very thorough, using the best industry
information we had at the time. But as I believe Dr. Matthews
said at the testimony, and elsewhere too, there was still a lot
to be learned and a lot of parallels in industry for the
similar standards that we were building. But we did a very
thoughtful analysis at the time.
Senator Moran. Thank you for that answer. Dr. Upton, in
regards to Community Care and the access standards review next
year, is it possible that a review could result in new access
standards with longer wait times and drive times than what is
currently in regulations?
Dr. Upton. I will say that the Secretary is committed to
making this the absolute best that it can be for veterans. I
would not expect that to occur, but we are doing a very
thoughtful analysis with veteran experience, outcomes, and wait
times at the center of that, and we will be very transparent
throughout that process.
Senator Moran. If that was the outcome, would you consider
that something that would be negatively affecting veterans?
Dr. Upton. I would say that we absolutely do not want
anything that would negatively affect veterans, Senator.
Senator Moran. Is there anything preventing the VA from
relaxing access standards as a result of the review?
Dr. Upton. As I mentioned earlier, we are very committed to
a transparent process, and in the current process that would
involve regulation, which involves public comment, VSO comment,
working with our congressional colleagues, and nothing will
happen without a very transparent advanced notice, in
collaboration with important committees like yours, Senator.
Senator Moran. The possibility then exists for relaxing
standards that would create longer wait times?
Dr. Upton. I would say that that would certainly--anything
that would negatively impact wait times for veterans would
certainly not be our intent, Senator, and anything that we do
will be very well thought out, based on evidence, and
transparent throughout the whole process.
Senator Moran. Dr. Upton, my staff has repeatedly shared
our concerns about conflicting access standards and regulations
and access standards in our CCN contracts. Has the VA modified
Region 1 for contracts to incorporate MISSION Act access
standards?
Dr. Upton. Senator, as I have committed to your staff as
well as to Senator Tester's staff, my initial focus has been to
address the needs of highly rural veterans, similar to your
State, in Kansas, and we are in advanced stages of modifying
that highly rural drive time standard to substantially reduce
that, and we would look forward to continue working with you
and the committee on other potential avenues.
Senator Moran. That would then be incorporated into the
existing contracts?
Dr. Upton. That is correct, sir.
Senator Moran. Thank you, Dr. Upton. Thank you, Chairman.
Chairman Tester. Senator Brown.
SENATOR SHERROD BROWN
Senator Brown. Thank you, Mr. Chairman and Ranking Member
Moran, for the good work you do together in running this
committee. We have worked for years to strengthen veterans'
health care, both in the VA and in the community. Young adults,
as you know, age out of CHAMPVA coverage at 18, and if they are
a student they age out at 23, understanding that ACA, people
age out at 26 for private sector health care insurance plans.
We are recovering from the worst pandemic in 100 years. Now
is the time to right the wrong and correct this oversight from
10 years ago. We made the change for TRICARE. We should do the
same for CHAMPVA, which is what my CHAMPVA Children's Care
Protection Act of 2021 would do. No parent or child should face
the additional mental burden of worrying about their health
care coverage.
Dr. Upton, from watching your head nod I assume you agree
that CHAMPVA beneficiaries should have parity with TRICARE
beneficiaries?
Dr. Upton. Senator, I know we have many bills on the docket
today. This is an area that I directly oversee and concur. And
I will just say, very briefly, that the CHAMPVA program, the
children that you are speaking of are children of
servicemembers who either are severely disabled from war or who
lost their parents, and they deserve to be treated equitably,
similar to the other health plans that are out there. And so we
are very supportive of this bill, in making that change, and I
appreciate you raising that.
Senator Brown. We will continue to work with you to make
sure that it is enacted and carried out. Thank you.
I was glad to see that Senator Murray's bill, Veterans
Family Health Services Act, that she was talking about when I
entered the room, is on the agenda. I am a co-sponsor, as many
are on this committee. It is beyond shameful we have not acted
to make this change, this benefit permanent. I urge my
committee colleagues to support this. This is a move forward,
so that wounded veterans receive comprehensive health care
benefits, including fertility treatments and counseling, to
enable them to have families. I just wanted to concur with
Senator Murray's very lucid comments.
I will end with one question for Dr. Smith, if I could. I
have worked on a bill to improve mental health connections for
transitioning servicemembers. It is not on today's agenda. My
job is to convince the Chairman and the Ranking Member that it
be. It is the Daniel Harvey and Adam Lambert Improving
Servicemember Transition to Reduce Veteran Suicide Act. It
would create a pilot program to counsel servicemembers about
mental health, the challenges they might face during transition
to civilian life and how that might affect their mental health,
and the services available to them at their local VA medical
facility, in the 90 days post transition.
A social worker or mental health professional from the
local VA would call the servicemember to set up an appointment.
We, I think, are increasingly conscious, as a society, as
members of the Senate, reflecting much of the time that society
we have simply not done what's needed to do for mental health
services throughout our government, throughout our society. No
excuses for not doing it at the VA.
So Dr. Smith, talk to me, if you would, for a moment, about
the value for veterans knowing that mental health programs are
available to them at their local, very trustworthy in their
minds, VA, and having that, shall we say, warm handoff back to
civilian life.
Dr. Smith. Thank you, Senator. We look forward to being
able to review that and provide technical assistant as that is
developed.
It is a critical time period. Transitions for any adult is
critical. It is a critical time for an individual who is
committed to serving in the military, and that may be the only
job, profession, role that they are familiar with, coming right
out of high school. So this is something new for them, and
there are a lot of stresses during that time.
So you bring up excellent points. It has to be a seamless
handoff, as much as we can be doing. The Hannon Act covers
this, with Section 101, and what we can be doing for services
in that first year. Solid Start is another addition to that.
All of these should be working together, in union, to address
the transition process, to make it as smooth as possible, as
seamless as possible, and to encourage our servicemembers to
make that transition.
Senator Brown. Thanks. Mr. Chairman, thank you.
Chairman Tester. Senator Tuberville.
SENATOR TOMMY TUBERVILLE
Senator Tuberville. Thank you, Mr. Chairman. I feel like I
am on the committee down here, on the end. You put me all of
the way at the end of that. It is good.
Thank you all for being here. Like many Americans over the
last year, Alabama's veterans took advantage of telehealth
services to meet their doctors. The total number of telehealth
visits for the VA-enrolled veterans in Alabama increased 886
percent in 2020, compared to 2019. I am an original co-sponsor
of S. 1863, Guaranteeing Healthcare Access to Personnel Who
Served Act, the GHAPs Act, which requires the Secretary of
Veterans Affairs to develop a strategic plan to ensure the
effectiveness of telehealth technologies.
Dr. Upton, given the astronomical increase in telehealth
appointments, what changes do you believe need to be made to
ensure quality of care for veterans who choose telehealth?
Dr. Upton. I appreciate that question, Senator, and
certainly telehealth has been one of the areas of the new
normal in health care that we are all adapting to, both
patients and providers, as a result of the pandemic, and VA has
been a leader in telehealth. It is something we believe very
strongly in.
And to address questioning that came up earlier about the
digital divide, I think ensuring that veterans have the
technology and the tools available to access telehealth is very
critical, and VA, under the leadership of my colleague, Dr.
Cox, does extensive work in quality monitoring and monitoring
of patient safety, and certainly we would be happy to work
together with you to share how we navigate that in the
telehealth space as well.
Senator Tuberville. Thank you. Anybody else want to comment
on telehealth?
Dr. Smith. I will just comment briefly, Senator, because I
was the one that helped pull some of that data for you. Just
looking at mental health, in 2019 there was about 2,000
encounters for a veteran having an appointment where they
choose, be it their home, a parking lot, the VFW, wherever. In
fiscal year 2020, the next year, there were over 11,000, a
substantial increase.
We need, in mental health, it is highly efficacious. We
know research supports it. But we have to do all we can to make
that process smooth. It is not always smooth, right. There are
IT difficulties. There are button difficulties. There are
connectivity challenges. Dr. Upton spoke to some of that. We
are committed to continuing to improve that process, because it
is a critical avenue within mental health to provide access to
care.
Senator Tuberville. Thank you. Does the VA intend to
include all the criteria listed in Section 201 of the GHAPs Act
as part of the strategic review?
Dr. Upton. Senator, our subject matter experts have
reviewed that, in the telehealth world, and they have some
technical comments that are outlined in our response to the
legislation, and we would be happy to work with you and your
staff to address that. I know you received it earlier today, so
you have our commitment to be a partner to address that as we
go forward.
Senator Tuberville. Thank you. Thank you, Mr. Chairman.
Chairman Tester. Thanks for being so efficient, Senator
Tuberville. I appreciate that. We are going to go to the next
panel. Doctor, Doctor, Doctor, Doctor, thank you all for being
here today, and we will move on to the second panel, which will
consist of veterans' advocates, and I will introduce them as
they are getting sat down.
First we have Ms. Joy Ilem, National Legislative Director
for Disabled American Veterans. Next we have Ms. Kathryn Monet,
Chief Executive Officer of the National Coalition for Homeless
Veterans. And last but not least we have Mr. Mario Marquez,
Director of the Veterans Affairs and Rehabilitation Division,
The American Legion.
Thank you all for being here. We appreciate your advocacy
and we appreciate your testimony. As with the previous panel,
know that your full written testimony will be a part of the
record. If you can keep your verbal comments to five minutes it
would be very appreciated. We still start with you, Joy.
PANEL II
----------
STATEMENT OF JOY ILEM
Ms. Ilem. Thank you, Mr. Chairman. DAV appreciates being
invited to provide our views on the bills that are under
consideration by the committee today. My written statement
details our position on all of the legislation on the agenda.
However, I will focus on my oral remarks on only eight of the
bills.
Reducing veteran suicide and ensuring access to quality
mental health care are key priorities for DAV. We know that
peer-to-peer programs are effective in getting at-risk veterans
the mental health services they need. Therefore, we support S.
544, which calls for an outreach and training initiative for
peer-supported wellness checks, to increase the number of
trained peers available to assist veterans in crisis.
DAV is also pleased to support S. 796, the Protecting Moms
Who Served Act, legislation that would increase support for
VA's maternity care coordination activities and improve
services for women veterans who are often at higher risk of
adverse birth and health outcomes.
Likewise, we offer support for S. 2102, the SERVICE Act.
This bill would revise the VA standards for mammography
screening for women veterans who served near burn pits and
ensure early access to these critical services that can save
veterans' lives.
DAV is also pleased to support S. 1280, the Veteran
Families Health Services Act. This legislation would improve
reproductive services and facilitate research for veterans with
genitourinary disabilities. It also adds access to fertility
services for enrolled veterans who are unable to conceive or
safely carry a pregnancy to term. Importantly, the bill would
correct existing inequities by allowing veterans access to this
benefit regardless of their marital status, gender identity, or
sexual orientation.
DAV also offers our support for S. 1467, the Cannabis
Research Act, which requires comprehensive research by VA into
the therapeutic benefits and risks of cannabis as a possible
treatment option for common conditions affecting service-
disabled veterans with chronic pain and PTSD.
DAV also supports S. 1319, which would require VA
facilities to disclose wait times, staffing levels, and
information about safety, quality of care, and health outcome
measures on the Department's Access to Care website. Public
availability of this data will enhance veterans' ability to
make more fully informed decisions about their care.
Mr. Chairman, a constant concern for seriously disabled
veterans as they age is what will happen when their spouse or
family caregiver is no longer able to provide a level of
support needed for them to remain in their home. With more than
half of the veteran population age 65 or older, a range of
effective, long-term care options is required. We are therefore
pleased to support S. 1965, the Planning for Aging Veterans
Act, which would require VA to develop a strategic, long-term
care plan for providing both institutional and non-
institutional care through home and community-based services.
DAV supports a number of provisions in S. 1863, the GHAPs
Act, including Sections 201 and 203, that would require VA to
study the efficacy of, and develop a strategic plan for the use
of telehealth services. Section 202 of the bill would require
GAO to assess VA's third-party transportation program for rural
veterans. As you know, DAV operates a large transportation
network program, providing hundreds of thousands of veterans
free rides to VA medical appointments each year. We recognize,
though, that there are still parts of the country that are
difficult to reach, and we agree that exploring additional
modes of transportation could improve veterans' access to care.
DAV is unable to support Section 101 of the bill, to codify
health care access standards promulgated by regulation in 2019.
Last November, VA reported to Congress that neither VA nor the
Community Care Networks were able to fully meet these access
standards. Since the MISSION Act already requires VA to provide
a report with recommendations for changes by next June, we
believe it would be premature to make these access standards
permanent now without sufficient evidence that doing so would
improve access and quality of care to enrolled veterans.
[The prepared statement of Ms. Ilem appears on page 80 of
the Appendix.]
Mr. Chairman, that completes my statement, and I am pleased
to answer any questions you or members may have. Thank you.
Chairman Tester. Thank you, Ms. Ilem. Kathryn, you may
proceed.
STATEMENT OF KATHRYN MONET
Ms. Monet. Chairman Tester, Ranking Member Moran, and
distinguished members of the committee, thank you for the
opportunity to join you today. Last week, NCHV presented
testimony before the HVAC Economic Opportunity Subcommittee on
veteran homelessness in the wake of COVID-19, and our testimony
touched on many things, most important among them that the need
for sufficient funding must be incorporated into non-emergency
appropriations and authorizations as we move away from COVID-
specific emergency funding for homeless veterans.
It is my pleasure to let you know, Chairman Tester, that
you will be awarded, NCHV's 2021 Policy Award in conjunction
with our annual conference that is currently ongoing this week.
We really appreciate everything that you did in terms of
introducing the GRACE Act, and your team has been wonderful to
work with, truly wonderful.
Chairman Tester. Kathryn, thank you but I have just got to
tell you, this is a joint effort, both sides of the aisle,
everybody on this committee, so thank you.
Ms. Monet. I hear you. Well, I will share comments on a
couple of bills. We do not oppose legislation that is not
included in our views, but we have abstained from offering
comments on legislation that is outside the scope of our
expertise.
We appreciate, Chairman Tester, your legislation, Building
Solutions for Veterans Experiencing homelessness. We appreciate
everything that Congress did to make it easier for current
grantees to take advantage of GPD capital grants to
decongregate their facilities, and we have requested future
rounds of capital grants in regular, non-emergency funding to
allow time for appropriate planning and construction. This will
allow our remaining congregate shelter providers opportunity to
reconfigure their facilities, and they all will benefit from
continued waivers of real property disposition and matching
requirements.
Certain restrictions in the most recent capital grant NFO
prevented certain grantees from making full use of this
opportunity, including the availability of sufficient per diem
funding to support 24/7 staffing operations and multiple sites,
particularly for providers who were not able to decongregate
their facility without adding to their physical footprint,
meaning that they would need an extra building and a whole
other set of staff. Grantees have found that current rates have
been insufficient to run these programs well before COVID-
related restrictions and the push to decongregate made that
even more complicated. We do request that the per diem rate be
maintained at 300 percent post-emergency, and we also ask that
you require VA to identify a way to decouple payments to GPD
operators from the state home per diem rate.
A key item to note here is that while the CDC has relaxed
masking guidelines for many activities and types of locations,
its guidelines for congregate shelter remain unchanged. They
continue to recommend decongregating, keeping isolation and
quarantine beds available, and continued social distancing,
even as much of the country goes back to normal operations. So
while certain bed models will continue to run deficits on a
regional basis, the bill's proposed 200 percent rate of per
diem is a first step toward funding providers for the level of
care that is expected and the level of care that veterans
deserve.
We support language in the bill that offers additional
technical assistance and training, as the amount provided for
those types of activities has not changed since programs have
started, and we also support the additional flexibilities for
transportation assistance.
We do anticipate that economic recovery will take time and
that payments made for rent in arrears could potentially move
veterans off of assistance before they have truly stabilized.
So to that end, reemployment and reintegration efforts will be
really critical through an expanded homelessness veteran
reintegration program.
While we support your expansion of the program, because
there are still a handful of states, including Kansas, who do
not have any HVRP grantees, the program has really outstanding
outcomes. Fifty-three percent of HVRP participants were placed
in a job paying more than $15 per hour, and the economic crisis
will continue to deepen when unemployment benefits sunset. We
hope that adequate funding for programs that prevent
homelessness and lift up veterans through quality employment
are a direct result of this legislation.
We do support the intent of S. 612, and we recommend some
technical changes to this legislation. We ask that you require
HUD and VA to jointly develop a mechanism for effectively
sharing and reporting data between HUD's HMIS systems and VA's
HOMES system. We further recommend that additional funding be
appropriated to VA's Health Care for Homeless Veterans Program
to enhance coordinated entry specialist support at each medical
center. Medical center catchment areas often overlay multiple
HUD continuums of care, meaning that some VA coordinator entry
specialists are responsible for maintaining partnerships with
multiple, multiple--many--COCs, and that is a challenge with
the staffing that they have got right now.
In closing, I do appreciate the opportunity to share views
with you today, and it is a privilege to work with all of you
to ensure that every veteran facing a housing crisis has access
to safe, decent, and affordable housing, paired with the
supportive services they need to remain stably housed. Thank
you.
[The prepared statement of Ms. Monet appears on page 101 of
the Appendix.]
Chairman Tester. Thanks, Ms. Monet. Mario, you are up.
STATEMENT OF MARIO A. MARQUEZ
Mr. Marquez. Thank you, Mr. Chairman. Good afternoon. Robin
Olson, a retired Navy chief petty officer, honorably served our
nation for 20 years. He has been diagnosed with the mental
health conditions of anxiety and depression. He is 100
permanent and totally disabled and does not qualify for VA's
service dog veterinary health benefit. After taking three years
of finding a nonprofit organization who was willing to take his
case, a subsequent 14-month application and interview process,
involving psychiatrists and psychologists, multiple meetings
with dogs, home visits and training for him and his dog, Robin
was finally paired with his service dog, Doc. This grueling
effort was accomplished at Robin's own personal expense.
Chairman Tester, Ranking Member Moran, and distinguished
members of the committee, on behalf of National Commander James
``Bill'' Oxford, representing almost 2 million dues-paying
members, it is my duty and honor to present the American
Legion's position on pending legislation being discussed here
today.
Currently, Robin's service dog, Doc, knows more than 100
purpose-driven commands. He helps Robin adjust to the real
world, in situations where Robin may otherwise be in danger to
himself or others. The value that Doc has provided Robin's
quality of life is immeasurable, a monetary price that Robin,
and his family, are willing to pay out of pocket again. But
they should not have to. No veteran should.
Robin's story is one example of the difficulties veterans
face while transitioning from service in the military,
difficulties that often lead to a feeling of helplessness or
incapacitation, and can result in suicidal behavior. The
pandemic exacerbated veteran suicide, and CDC statistics show
that reports of anxiety and depression have tripled, and in
some cases quadrupled, since 2019.
To combat this, the American Legion implemented Buddy Check
Weeks, where veterans call veterans to create a space, and open
and candid dialog with a veteran peer who has had similar
experiences, and potentially make them aware of resources at VA
or in the community.
S. 544 makes such suicide prevention efforts permanent by
directing VA to designate one week annually as Buddy Check
Week, for the purposes of encouraging outreach and peer
wellness checks by veterans to other veterans. This week will
be a VA-led but not VA-coordinated event. The success of Buddy
Check Week will be reliant on grassroots efforts by veterans
reaching out to veterans they served with, and letting them
know they are part of a community that cares about them. A VA-
led national Buddy Check Week will reach, support, and aid
significantly more veterans. Getting this bill signed into law
remains one of our top legislative priorities.
Shifting topics, and of urgent significance, is duly
honoring our Greatest Generation by awarding them VA health
care benefits while a fraction of the 16 million who fought and
served are still alive. VA regulations determine a veteran's
eligibility for health care benefits on factors related to
income, disability rating, and military service history. As a
result, World War II veterans are not exempted from means tests
required to enter VA health care system.
S. 1040 would fix this problem by extending automatic
eligibility to World War II veterans so those who currently do
not qualify for health care will have access to VA hospital
care, medical services, and nursing home care. We have done
this in the past for veterans of the Spanish-American War and
World War I, and it is time to do this for our Greatest
Generation. World War II veterans are dying by the day, and
there is no more time to wait. It is unacceptable that some of
our veterans from the Greatest Generation do not have access to
benefits they earned due to restrictions in eligibility for VA
health care. This legislation is vital for the welfare of our
World War II veterans, and we stand ready to assist Secretary
McDonough in doing what is best for America's veterans.
We thank Chairman Tester and Ranking Member Moran for their
incredible leadership and for always keeping veterans at the
core of their mission. It is my privilege to represent the
American Legion before this committee. I look forward to
answering any questions you may have. Thank you.
[The prepared statement of Mr. Marquez appears on page 107
of the Appendix.]
Chairman Tester. Thank you, Mr. Marquez. I appreciate your
testimony. I appreciate the testimony of all three of you.
Just for a real quick update, and I do not know if you are
going to be sticking around or not, Senator Tillis, but Senator
Moran and I myself have a conversation with the CBO at 4:30. If
you would be willing to chair the committee in our absence, I
would appreciate that.
Senator Tillis. Does that allow me to do a UC in the
absence of any other members?
Chairman Tester. You can do--well, Tuberville is here. He
will object to everything you do. And Maggie is here, but
Maggie is going to leave. Sorry.
I have a couple of questions, and I want to thank you all
for your testimony, and as I said in the opening, your
advocacy. This is for you, Ms. Monet.
After the pandemic-related flexibility ceases, the current
maximum grant per diem rate will drop from 300 percent to 115
percent. This is less than one-fifth of the current guarantee,
our operating within the 115 percent maximum. The bill that I
have is going to permanently that maximum of 200 percent. Ms.
Monet, what will be the impact on GPD recipients and the
veterans that they serve when the emergency declaration is over
and the maximum rate drops to 115 percent?
Ms. Monet. Well, I think the impacts will be dire on
veterans. I think one of the challenges that providers often
have is that the rate historically has not been enough to
provide the level of services that they need, so many of the
grantees spend a good chunk of time private fundraising,
finding other options to fill gaps, and that is time that could
be spent actually caring for veterans.
I do also think, to some degree, that we have been pushing,
and VA has also been pushing, facilities to decongregate, so to
space people out better, to improve facilities for veterans, to
give them the dignity that they need. Because I think one of
the things that is often unnoticed is that the homelessness
population is aging, so these are veterans who are in their
60s, 70s, in some places sleeping on cots or in bunk beds, and
that is certainly not something that I would want for my 70-
year-old grandfather, right?
And so we have been pushing for them to improve facilities
and offer higher quality care, but they cannot do that at 115
percent. It is impossible. So if they go to decongregate now
and they have got to have 24/7 staffing in two or three
buildings, you are now doubling your staff costs with less
funding. It just makes it very hard to provide that level of
care.
Chairman Tester. There are currently few, if any, options
for veterans with significant medical needs, especially elderly
veterans, to escape chronic homelessness. Traditional
transitioning housing facilities do not have the staff or the
authority to provide assistance with activities of daily
living, medication management, or medical crisis care. As such,
these veterans often find themselves bouncing between
facilities, ER waiting rooms, and the street.
The bill that I am sponsoring would allow transitional
housing facilities to hire the nursing staff necessary to
attend to the needs of these veterans and house them while they
wait for open spots in long-term care facilities. Ms. Monet,
can you explain how this provision would help connect these
veterans to options for permanent housing?
Ms. Monet. Well, I think one of the challenges that, you
know, we do not talk about a lot is that some veterans have
care needs that are too acute to remain in shelter but are not
acute enough to enter into long-term care. And when that
happens there is nowhere really for them to go. And so we do
hear from certain communities and certain providers where, you
know, they are struggling because their liaison will not let
them admit someone because they cannot provide the level of
care, but the local nursing home is not willing to take them,
so the person just ends up outside, back at square one, while
people try to find other solutions. And I do not think that is
something that anybody here supports.
Chairman Tester. Thank you. Senator Moran.
Senator Moran. Chairman, thank you. Thank you all three for
being with us this afternoon. In the past 15 months, in the
pandemic, there is a lot of light that has been brought to some
gaps in the American health care system, and VHA is no
exception to that. Persistent gaps in the VA health care system
continue to hamper our veterans in obtaining the care they
deserve, particularly in rural, highly rural, and medically
underserved parts of the country.
Mr. Marquez, we appreciated the strong support of The
American Legion for the Commander John Hannon Act, which was
signed into law last October. Building on that legislation, and
understanding your organization knows first-hand the importance
of peer support, can you speak how increased peer support can
help veterans find and stay on the road to recovery?
Mr. Marquez. Thank you, Senator. First, before I begin, on
behalf of The American Legion we would like to thank you for
your support recently when one of our posts in your state was
devastated by a flood, which caused the loss of over 300 flags
that you were able to replace, and that was detrimental to the
events that we had planned, and we were appreciative of your
efforts in that. So thank you very much.
The American Legion believes that peer support approach to
mental health and suicide prevention is instrumental to
anything that we do when it comes to our efforts and getting
after, hopefully one day, figuring out this devastating issue
of suicide. As a result, as you know, The American Legion has
led into our own efforts by conducting Buddy Check Week. We
believe that Buddy Check Week is a grassroots, boots-on-the-
ground, in-your-face, veterans getting after veterans.
Something I learned in the military, Senator, as a sergeant
major, it was devastating every time that I lost a marine while
I was on active duty, but it was even more difficult dealing
with the veteran that had already gotten out, and I just felt
helpless in trying to reach and assist them. And the efforts
that I believe we can achieve with peer-to-peer efforts at
getting after suicide prevention I believe will be instrumental
with the Buddy Check bill, and I hope that we can continue to
get this legislation through and passed and into action
immediately.
Senator Moran. Thank you for that answer. Mr. Marquez, what
are you hearing from your veteran members concerning current
access standards? What would be the advantage of codifying the
current standards, and what impact would a negative change to
the access standards have on veterans?
Mr. Marquez. Thank you, Senator. The American Legion
believes that access standards are crucial to the success of
the MISSION Act. If applied uniformly by VA and TPA networks,
which are currently not being done, we believe it would
facilitate access across the board in a fair standard.
Region 5, as you know, has a set of standards that we
believe our veterans, and our members believe are the standard,
but we also believe that is the minimum standard that we should
strive for and improve from that. Having said that, The
American Legion also believes that patient-centered access
standards should not be altered in any form that places any
more burden or reduce access on any veteran.
And finally, I do not foresee any scenario where adjusting
access standards to put a greater burden on the veteran, by
either expanding wait times or longer driving distances, would
be advisable. The access standards that I talk about now are
the bare minimum standards, and they should be codified as
such.
Senator Moran. Ms. Ilem, I appreciate the service DAV
provides, particularly to our rural and highly rural veterans
in regard to third-party transportation. Can you share with us,
the committee, how you feel Section 202 of the GHAPs Act would
assist Congress in filling those remaining gaps in rural
transportation services? You mentioned it in your testimony,
and I am not sure what--I want to just flesh out what you think
is there that would be helpful.
Ms. Ilem. I think just having a report and looking at the
full scope of what is available for veterans. I mean, we know
DAV's transportation network, very busy, and, you know, being
able to provide services across the country. But with the
pandemic and everything that happened, there are a lot of
changes that have occurred. We want to make sure that veterans
have access to the transportation they need to get to their
appointments. We do not want it to be a barrier to care. So
looking at all options is, I think, going to be really
critical. Where are those specific gaps and where are they in
the country, and what can be done to make other plans in those
areas?
Senator Moran. Thank you. Ms. Monet, you caught my
attention. Apparently the Chairman is not going to give me time
to ask a question, but the lack of Kansas participating in a
program regarding homelessness veterans has caught my
attention, and we will figure out what is going on. Thank you.
Chairman Tester. Thank you, Senator Moran. I will recognize
Senator Hassan and I will turn the gavel over to Senator
Tillis.
Senator Hassan. Well, thank you very much, Mr. Chairman and
Ranking Member Moran, again, for this hearing, and to the three
panelists, thank you, not only for your service but what you do
for our veterans.
I want to just ask two very brief questions, and then you
will see me dart out, so I apologize. But Mr. Marquez, you have
testified about the Buddy Check program and the bill, something
that Senator Ernst and I have sponsored. And I just wanted to
get you to elaborate a little bit more. Can you please speak to
how this Buddy Check Week initiative, how having a specific
week for this would help veterans and how we can support these
efforts through the VA, how we could reach more veterans?
Mr. Marquez. Yes, ma'am. First of all, I would like to
thank you for sponsoring this bill. Although it has not passed
yet, it is a great victory in our effort to get after suicide
and suicide prevention.
VA has a lot of great programs that they work on
continuously to get after suicide and suicide prevention, and
we applaud every one of their efforts. We think they are vital
and they are important. However, the Buddy Check bill is
complementary to everything that VA already does, and as I
alluded to earlier, and something that I would like to
emphasize, we like to talk about, unfortunately, that we were
able to count the number of suicides. But what we cannot count,
and something that I would love to be challenged with to count,
is the number of wins and lives we have saved. That is the
measure we need to achieve. How do we get after suicide
prevention is trying to measure the number of lives we saved by
engaging veterans in peer-to-peer efforts.
Senator Hassan. Right. And if we focus a week on it I think
it adds particular outreach and focus at a critical time. Thank
you to The Legion for leading on this.
Mr. Marquez. Yes, ma'am. Thank you.
Senator Hassan. And Ms. Ilem, I wanted to thank you for
your written testimony supporting the bipartisan legislation
that I am leading on the Solid Start Act. That would focus on
strengthening outreach to servicemembers in the first year
after they separate from the military, and it makes permanent
and bolsters Solid Start by prioritizing outreach to veterans
who accessed mental health resources prior to transitioning to
civilian life and ensuring that calls are tailored to the needs
of each veteran.
I have heard from New Hampshire veterans about the
importance of this type of outreach, including specifically
from women veterans who can face additional barriers to service
and to support. So how would servicemembers transitioning from
military to civilian life benefit from this tailored approach,
and specifically, how would women veterans benefit?
Ms. Ilem. Thank you for the question. I think it is a great
program, we agree, and we are pleased to support the bill. And
I think with regard to women veterans, again, you have put your
finger right on it, that sometimes there are some really
tailored needs for women veterans or women that are
experiencing certain barriers. So having that personal contact,
especially if there are mental health challenges, like you
said, someone that you know you can assist and maybe answer
some of their questions right up front for them, make sure they
know somebody is knowledgeable about what is helpful to them
and trying to really connect them with the programs and
services they need.
Senator Hassan. Thank you very much. Thank you, Senator
Tillis.
Senator Tillis. [Presiding.] Senator Hassan, before you go,
Senator Tuberville, I am going to let you ask questions next,
but I thank you for your comments on service dogs. One thing I
am going to ask the first panel to do is get back, and maybe as
a starting point, since we have done a lot of work here, is to
take a look at the bill that passed on the suspension calendar.
I am convinced we can make progress. Senator Tuberville?
Senator Tuberville. Thank you very much. Thanks for being
here today. Mr. Marquez and Ms. Ilem, in both The American
Legion and DAV testimony you note that your organizations
support legislation such as PAWS for Veterans Therapy Act,
because it allows for an alternative form of treatment for
veterans suffering from TBI and PTSD. I agree with allowing
alternative forms for treatment and I believe it is incumbent
upon us to make available every treatment option for veterans
available, suffering from any condition.
Today I introduced a bill that gives veterans suffering
from TBI and PTSD the right to hyperbaric oxygen therapy. Just
a question. Given your commitment to alternative, non-invasive
treatment options for TBI and PTSD, would you commit to
reviewing my legislation, which was out today, and work with my
staff on a way forward where you can support this bill? I would
appreciate that.
Mr. Marquez. Yes, sir, we can.
Senator Tuberville. Does anybody have any experience with
hyperbaric treatment, with any veterans?
Mr. Marquez. The American Legion does, Senator, but I would
have to go back and do a little bit of research, and we can
follow up with you and your staff as we do have some
resolutions that address this matter.
Senator Tuberville. Okay. Thank you.
Ms. Ilem. We are happy to work and review the legislation
and provide any feedback. You know, we have been hearing about
this for some time now, and again, I know some veterans have
indicated they benefit from it, and we want to make sure that
veterans have access to any treatments and services that may be
helpful to them.
Senator Tuberville. Anything we can do to help? You know,
we are having way too many suicides, and I have some experience
with some veterans that say it helps. And being a former
football coach, we had a lot of head injuries, and we used
that, and we made progress. It is something you cannot see, you
know, PTSD, you can't look at it, but we have got to find some
way to treat it. We just been through two wars and millions of
veterans coming back, and they all have problems, to some form.
Mr. Marquez. Senator, if I may, The American Legion, as you
may be aware, has a TBI, PTSD, and Suicide Prevention
committee. I can get this in front of my leadership and in
front of the committee and the commission, and we can do a
little bit more research and get you some information that I
think we will find to be valuable.
Senator Tuberville. Thank you.
Mr. Marquez. Yes sir.
Senator Tuberville. You probably heard my question earlier.
Any experience, any feedback on telehealth during the pandemic?
Ms. Ilem. We have heard from some DAV members that, you
know, they really liked it, I mean, for certain things. They
felt that they were being cared for throughout the pandemic.
They got their needs met, basic medications, that type of
thing. And we know that VA was open and available for seeing
veterans that needed to be seen in the facility. So I think
people appreciated it. It was new. It is a little bit
different. But I think for elderly veterans we need to make
sure, and that is why studying it would be important, about,
you know, if there is technology or a barrier for somebody who
is not used to doing something remotely, on their own, and do
they just forego care if they didn't know how to use the
computer or be able to do that. So that will be important to
look at and help outcomes.
Senator Tuberville. We had huge benefits in rural areas
from veterans. Ms. Monet, do you want to chime in on that?
Ms. Monet. Actually, I think telehealth was a really good-
news story for veterans experiencing homelessness. Some of the
provisions that you all enacted enabled VA to purchase
telehealth equipment for veterans experiencing homelessness,
and I believe that what we saw was that telehealth visits
really increased and really helped. HUD-VASH case managers
could case manage veterans remotely. And it was not a perfect
system but it really helped veterans get through the pandemic.
And so I do think we support further expansion of telehealth
and some of the authorities that are in Chairman Tester's bill,
to make permanent some of the things.
Senator Tuberville. Thank you. Through The American Legion
did you have any feedback on telehealth?
Mr. Marquez. We did. Recently I spoke to my commission
chairman and one of the things he reminded me of is although
telehealth has been a great convenience in many ways, as I said
in my opening remarks there is a little bit of a limitation
there. Some of it is connectivity, but also there is a matter
and a concern of privacy. Not all veterans have the privacy,
even if they have access to telehealth, whether it is at home
or in the office, or sexual assault we mentioned earlier, a
parking lot. A lot of times that may not be the right situation
for a veteran to then drive themselves if they are not in the
right mental state to properly finish whatever they just went
through.
And so the concerns with privacy, we are looking at it. It
is something we are researching in The American Legion, and we
would like to look into it further.
Senator Tuberville. Real quick, vaccines. How are we doing
with veterans, in your eyes?
Ms. Ilem. I think VA has done a great job in terms of
outreach and trying to make sure that all veterans know they
have access. At first there was a big clamoring and lots of
people coming in to get them, and I know VA is wanting to make
sure that every veteran who wants to get a vaccine is able to
get one.
Senator Tuberville. Ms. Monet?
Ms. Monet. I would agree. I think they are doing a lot
better at connecting with homeless shelters and permanent
supportive housing providers to do more mass vaccination
efforts, where that was really spotty and challenging at the
start of the pandemic.
Mr. Marquez. Senator, VA has done a great job in really
getting after vaccine hesitancy. Our organization, The American
Legion, does the same. We have published, on our websites,
every possible manner, down through the chain of command,
through the different posts. And as you may be aware, we also
recently had the Secretary down in Alabama, and our Executive
Director for Government Affairs was down with our National
Commander as well.
So we are putting it down at the grassroots level,
originating at the posts, and host any shot access that we can
get done, vaccine opportunities, and just offering it up. Even
if we do not get large numbers we are still continuing to see
people slowly getting back into a little bit of trust and
confidence with the vaccine. Because people want to get back to
normal life, and they know that they are probably hampering
that from happening in its totality.
Senator Tuberville. Thank you. Thanks for being here today.
Thank you.
Senator Tillis. Well, thank you all. Mr. Marquez, thank you
for your past and continued service to our nation and our
veterans.
Mr. Marquez. Thank you, Senator.
Senator Tillis. You did a great job in your opening
statement about Buddy Check Week. I am a co-sponsor. I think it
is very important. I was just at an event that was hosted by
the Independence Fund, called Operation Resiliency, where they
are bringing units back. This unit had served in Iraq in 2011,
bringing them together. And that connection, is something that
is very important, so thank you for your support of that bill.
You also mentioned, in your opening, before you started the
formal opening statement, the story of the journey of a veteran
at his own expense for getting a service dog. How is that
veteran doing now?
Mr. Marquez. He is doing great, Senator. The only thing is
that he is fighting for advocacy, so that other veterans do not
have to pay. And I realize there is a very strict and
regimented qualification process for that, and so in speaking
to him he asked me that we do what we can to pass legislation
to offer as many veterans. He is more concerned about other
veterans than he is himself, because his exact words, ``I could
afford this. My family could afford this. We would do this
again. But there are many veterans out there that they cannot
afford this.''
Senator Tillis. Well, it just so happens I have a personal
interest in this, and that is why my questions--I want to
really get to a good place. I think most people know, in my six
and a half years on the committee, I have maintained a very
positive relationship with the VA. I know they have a complex
task and I want to get through it.
Ms. Ilem, I know that the DAV expressed some concerns, I
think, with the Senate version of the bill. I have been
tracking very closely the compromise bill that passed on the
suspension calendar in the House. Have you had an opportunity
to take a look at that and take a position or express any
concerns on it?
Ms. Ilem. I have not seen specifically that, but in
comparing that to the Senate version, I mean, I think there
were some changes to the bill when I did compare what I had
availability to see, and I think, you know, there was certainly
an effort to try to address some of those things that
originally came up.
Our point is, I think, just as Mario has said, we want to
make sure that this is an equitable benefit that veterans are
going to have, that there is some standardized way to make sure
service dogs are available. And as you heard from the VA, it is
very limited ability to get a service dog. And while we are
appreciative of these types of initiatives, we just want to see
some standardized way, make sure there is an equity in this
benefit, and the veterans that really need it can get access to
a service dog.
Senator Tillis. Could I get your commitment to take a look
at--you know, in Washington, on our best day, it is hard to get
435 people to agree to something. And the fact that it passed
out of suspension calendar I think is an indication that
members who had similar but different bills were not out a
compromise, that in many respects, I believe, represent a
bridging of the gap between a couple of the bills that are in
the Senate.
So I would like for you to take a look at that, because in
good faith I would like to get with the VA and see if we can
get to a good place on the legislation, ideally what passed out
of the House. And I would appreciate the VA also providing us
feedback on where they think that bill may still fall short,
and work in good faith to resolve our difference. I would
appreciate that.
Ms. Monet, I appreciate your commitment to the homeless
vets. It is something else I have worked quite a bit on in
North Carolina. We just stood up a new Veterans Life Center,
which was, I think, going to be something that can be scaled
across the country. It is extraordinary.
You mentioned that the VA should maintain 300 percent GDP
rate post pandemic, and I know you probably understand the VA
has still not spent much of the supplemental funding, and will
not award GPD this year. So what should the VA be doing to
serve as many homeless vets as possible? New GDP awards? Other
ideas?
Ms. Monet. So in regards to what they have spent, I think
75 percent of what has been allocated to HPO has already been
spent. GDP is a little bit different because providers have to
spend the money and then go back and seek reimbursement. So I
do not know that I have any doubts that they will not spend
their money by the end of the fiscal year. I mean, I think VA
is probably in a better position to answer that question, but I
think what I heard from the program office last week is that
they will, in fact, spend all those funds.
I think that there are a lot of things that they can do in
other programs to enhance the way that they serve veterans, so
thinking about ways that they can increase HUD-VASH case
management staffing, thinking about ways that they can
coordinate better between programs, or that they can tie HVRP
programs more closely to SSVF and the shallow subsidies. There
is a lot that can be done, and that, I think, is in the works.
Senator Tillis. Thank you. I know a lot of my members, we
have several committees or subcommittees going on, so a lot of
my members were not able to make it. But this is one of the
great committees where we work together and try to produce a
good bipartisan outcome, under Chairman Tester's leadership.
I want to thank you all for participating today, both the
VA and the veteran service organizations. You have shared
valuable insight, but you know that a lot of the good stuff
happens when you come to our office and we work out differences
and get to a good place. I welcome you all to continue to come
to my office, and I am sure I speak for all my members, on
bills that you are not there yet, that we would like to get to.
So we will keep the record open for a week, and thank you
all for participating. The hearing is adjourned.
[Whereupon, at 4:47 p.m., the Committee was adjourned.]
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