[House Hearing, 118 Congress]
[From the U.S. Government Publishing Office]
LEGISLATIVE HEARING
=======================================================================
HEARING
before the
SUBCOMMITTEE ON HEALTH
of the
COMMITTEE ON VETERANS' AFFAIRS
U.S. HOUSE OF REPRESENTATIVES
ONE HUNDRED EIGHTEENTH CONGRESS
SECOND SESSION
__________
WEDNESDAY, SEPTEMBER 11, 2024
__________
Serial No. 118-79
__________
Printed for the use of the Committee on Veterans' Affairs
[GRAPHIC NOT AVAILABLE IN TIFF FORMAT]
Available via http://govinfo.gov
______
U.S. GOVERNMENT PUBLISHING OFFICE
57-073 WASHINGTON : 2026
COMMITTEE ON VETERANS' AFFAIRS
MIKE BOST, Illinois, Chairman
AUMUA AMATA COLEMAN RADEWAGEN, MARK TAKANO, California, Ranking
American Samoa, Vice-Chairwoman Member
JACK BERGMAN, Michigan JULIA BROWNLEY, California
NANCY MACE, South Carolina MIKE LEVIN, California
MATTHEW M. ROSENDALE, SR., Montana CHRIS PAPPAS, New Hampshire
MARIANNETTE MILLER-MEEKS, Iowa FRANK J. MRVAN, Indiana
GREGORY F. MURPHY, North Carolina SHEILA CHERFILUS-MCCORMICK,
C. SCOTT FRANKLIN, Florida Florida
DERRICK VAN ORDEN, Wisconsin CHRISTOPHER R. DELUZIO,
MORGAN LUTTRELL, Texas Pennsylvania
JUAN CISCOMANI, Arizona MORGAN MCGARVEY, Kentucky
ELIJAH CRANE, Arizona DELIA C. RAMIREZ, Illinois
KEITH SELF, Texas GREG LANDSMAN, Ohio
JENNIFER A. KIGGANS, Virginia NIKKI BUDZINSKI, Illinois
Jon Clark, Staff Director
Matt Reel, Democratic Staff Director
SUBCOMMITTEE ON HEALTH
MARIANNETTE MILLER-MEEKS, Iowa, Chairwoman
AUMUA AMATA COLEMAN RADEWAGEN, JULIA BROWNLEY, California,
American Samoa Ranking Member
JACK BERGMAN, Michigan MIKE LEVIN, California
GREGORY F. MURPHY, North Carolina CHRISTOPHER R. DELUZIO,
DERRICK VAN ORDEN, Wisconsin Pennsylvania
MORGAN LUTTRELL, Texas GREG LANDSMAN, Ohio
JENNIFER A. KIGGANS, Virginia NIKKI BUDZINSKI, Illinois
Pursuant to clause 2(e)(4) of Rule XI of the Rules of the House, public
hearing records of the Committee on Veterans' Affairs are also
published in electronic form. The printed hearing record remains the
official version. Because electronic submissions are used to prepare
both printed and electronic versions of the hearing record, the process
of converting between various electronic formats may introduce
unintentional errors or omissions. Such occurrences are inherent in the
current publication process and should diminish as the process is
further refined.
C O N T E N T S
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WEDNESDAY, SEPTEMBER 11, 2024
Page
OPENING STATEMENTS
The Honorable Mariannette Miller-Meeks, Chairwoman............... 1
The Honorable Sheila Cherfilus-McCormick, Acting Ranking Member.. 2
SPEAKING FROM THE DAIS
The Honorable Morgan Luttrell, U.S. House of Representatives,
(TX-08)........................................................ 3
The Honorable Scott Franklin, U.S. House of Representatives, (FL-
18)............................................................ 4
The Honorable Gabriel Vasquez, U.S. House of Representatives,
(NM-02)........................................................ 5
The Honorable Keith Self, U.S. House of Representatives, (TX-03). 6
The Honorable Marie Gluesenkamp Perez, U.S. House of
Representatives, (WA-03)....................................... 7
The Honorable Steve Womack, U.S. House of Representatives, (AR-
03)............................................................ 8
The Honorable Jill Tokuda, U.S. House of Representatives, (HI-02) 9
The Honorable Lori Chavez-DeRemer, U.S. House of Representatives,
(OR-05)........................................................ 10
WITNESSES
Panel I
Dr. Carolyn Clancy, Assistant Undersecretary for Health,
Discovery, Education, and Affiliate Networks, Veterans Health
Administration, U.S. Department of Veterans Affairs............ 12
Accompanied by:
Dr. Matthew Miller, Executive Director, Office of Suicide
Prevention, Veterans Health Administration, U.S.
Department of Veterans Affairs
Dr. Ajit Pai, Executive Director, Office of Rehabilitation
and Prosthetic Services, Veterans Health Administration,
U.S. Department of Veterans Affairs
Dr. Ryan Heiman, Acting Director, Member Services, Veterans
Health Administration, U.S. Department of Veterans
Affairs
Panel II
Mr. Brian Dempsey, Director of Government Relations, Wounded
Warrior Project................................................ 20
Ms. Missy Meyer, Director of Community Integration, America's
Warrior Partnership............................................ 22
Mr. Clark Pennington, Chief Operating Officer, The Independence
Fund........................................................... 24
Mr. Jon Retzer, Deputy National Legislative Director, Disabled
American Veterans.............................................. 26
APPENDIX
Prepared Statements Of Witnesses
Dr. Carolyn Clancy Prepared Statement............................ 35
Mr. Brian Dempsey Prepared Statement............................. 59
Ms. Missy Meyer Prepared Statement............................... 72
Mr. Clark Pennington Prepared Statement.......................... 74
Mr. Jon Retzer Prepared Statement................................ 77
Statements For The Record
U.S. Office of Government Ethics Prepared Statement.............. 83
American Federation of Government Employees, AFL-CIO Prepared
Statement...................................................... 85
American Psychological Association, Association of VA
Psychologist Leaders, Association of VA Social Workers,
National Association of Veterans Affairs Physicians and
Dentists, Nurses Organization of Veterans Affairs, Veterans
Healthcare Policy Institute Prepared Statement................. 87
The Honorable Jason Crow, U.S. House of Representatives, (CO-06)
Prepared Statement............................................. 95
National Association of State Veterans Homes Prepared Statement.. 96
LEGISLATIVE HEARING
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WEDNESDAY, SEPTEMBER 11, 2024
Subcommittee on Health,
Committee on Veterans' Affairs,
U.S. House of Representatives,
Washington, DC.
The subcommittee met, pursuant to notice, at 10 a.m., in
room 360, Cannon House Office Building, Hon. Mariannette
Miller-Meek [chairwoman of the subcommittee] presiding.
Present: Representatives Miller-Meek, Radewagen, Bergman,
Murphy, Van Orden, Luttrell, Kiggans, Brownley, Levin,
Budzinski, and Landsman.
OPENING STATEMENT OF MARIANNETTE MILLER-MEEKS, CHAIRWOMAN
Ms. Miller-Meeks. I agree with yesterday's hearing that
members need to be given a map and a watch to be on time to
hearings. That includes both sides of the aisle. It is not
directed to one or the other.
We welcome all members of the subcommittee and our
witnesses. We look forward to a very productive session today
on some impactful veterans legislation.
Before we begin, however, I would like to take a moment to
remember the nearly 3,000 American lives that were lost 23
years ago today. Please join me in a moment of silence for the
9/11 victims and their families. Thank you.
Today, we will be discussing 16 bills. Each bill would
attempt to improve the delivery of healthcare to the men and
women who have served. These bills include creative solutions
that would seek to address difficult problems, including a
pilot program to fill vacant shifts, reforms to ensure that the
U.S. Department of Veterans Affairs (VA) has the authority to
prescribe medicine, and a study which looks at the mental
health crisis that affects our veteran community.
I would now like to take a moment to discuss my bills, H.R.
9438, the No Wrong Door for Veterans Act and H.R. 9478,
Veterans Sports Act. H.R. 9438 would seek to reauthorize an
incredibly important VA mental health program, the Staff
Sergeant Parker Gordon Fox Suicide Prevention Grant Program.
The Fox Grant Program is a successful grant program that
enables the VA to provide grant funding to community-based
organizations to help organizations in communities where
veterans live expand the reach of their mental health efforts.
My bill would reauthorize the Fox Grant Program for an
additional 3 years until 2028. It would also make changes to
the administration of the program including improvements to
coordination of care between VA providers and grantees and the
standardization of the veteran intake process.
This program is another avenue for veterans to receive
brain health support. There should be no wrong door when it
comes to seeking brain health, and I am proud to have
introduced this bill to continue and improve this amazing
program.
My second bill is H.R. 9478, the Veterans Sports Act. This
legislation would provide access to adaptive limbs for amputee
veterans by ensuring that they are able to have the highest
quality of life that we can provide them.
This bill would amend existing law to ensure the
availability of adaptive sports and recreation prostheses limbs
by recognizing them as medically necessary for veterans living
with limb loss.
I think it is critical that we ensure that disabled
veterans have the equipment and tools they need to live active
lifestyles as they please in order to allow them to live the
fullest and make them whole.
I am proud to introduce these bills and look forward to
discussing the many others on our agenda.
I want to again thank our witnesses for being here today
and those organizations that submitted statements for the
record. It is a privilege to collaborate on crafting impactful
legislation for our veterans and to address some critical
issues facing them.
I now yield to Representative Cherfilus-McCormick for her
opening remarks.
OPENING STATEMENT OF SHEILA CHERFILUS-MCCORMICK, ACTING RANKING
MEMBER
Ms. Cherfilus-McCormick. Thank you, Chairwoman Miller-
Meeks.
Thank you to our witnesses for being here today to discuss
these bills. I am sitting in for Ranking Member Brownley who,
unfortunately, could not be here today. I know she is
disappointed to not be here, especially not to be able to speak
about her bill, the Have You Served Act, which is on the agenda
for today.
I will take the opportunity to recognize her for her work
on this issue. So often just asking the question have you
served could make a huge difference in recognizing and
supporting veterans.
Helping service providers learn how to appropriately talk
about veteran status and where to connect them to resources
will change lives. Representative Brownley's bill will create
grants to establish ask the question campaign training
programs, establish key matrices for the training and improving
outreach about the efforts. I want to thank her for leading
this effort.
We will also consider several other bills today sponsored
by my Democratic colleagues which will increase access to VA
healthcare, especially for rural veterans. This includes the
Rural Veterans Transportation to Care Act, which will expand
the VA's very popular highly rural transportation grant program
and expand the program to serve veterans in rural in addition
to highly rural communities.
It also includes the New Mexico Rural Veterans' Healthcare
Access Act, which would adjust Veterans Integrated Service
Network (VISN) lines to ensure veterans in New Mexico can
easily receive travel reimbursement when accessing care at the
nearest VA medical facility to them.
I am also glad we are considering the Veterans Sentinel Act
legislation to address suicides that occur on VA campuses.
While these events are rare, they are tragic and devastating
for VA and to all of the veterans' community.
Representative Crow's bill would create a task force to
identify root causes for these events and analyze ways to stop
further events from happening.
Finally, we will consider a bill to give co-pay parity to
veterans that identify as Native Hawaiians and strengthen VA
coordination with the Native Hawaiians' health care system.
However, I am disheartened to see so many bills from my
Republican counterparts on the agenda that focus on diverting
more care out of VA. We know that VA provides the best care and
that more often than not veterans want to receive their care
from the VA.
Some of these bills, like the Veterans Mental Health Access
Act and the No Wrong Door for Veterans Act, propose to send
more money to outside entities creating grant funding giveaways
with no or very few strings attached.
These bills lack vital matrices to monitor the performance
of grantees and ensure these programs are meeting their
intended purposes.
I look forward to hearing from our VA witnesses about the
department's view on all these bills on today's agenda and how
we can work together to ensure VA can serve veterans to the
best of their ability.
I am also looking forward to hearing from our Veterans
Service Organization (VSO) partners about what these bills
would mean for their members.
With that, Madam Chairwoman, I yield back.
Ms. Miller-Meeks. Thank you, Representative Cherfilus-
McCormick.
We have a full agenda today so I will be holding everyone
to 3 minutes per bill to get through in a timely manner.
This morning we are joined by several of our colleagues who
will testify on their bills. We are appreciative of their work
in serving our Nation's veterans.
With that, I ask unanimous consent that all non-committee
members be waived on to speak on their bills from the dais.
Hearing no objections, we will move forward.
I now recognize Representative Luttrell. You are now
recognized for 3 minutes.
STATEMENT OF MORGAN LUTTRELL
Mr. Luttrell. Thank you, Madam Chairwoman. The Service Dogs
Assisting Veterans Act, or the SAVES Act, would require the
secretary to establish a 5-year pilot program that would award
competitive grants to nonprofit organizations providing service
dogs to the eligible veterans.
This bill would ensure that veterans receiving service dogs
through these grants are not charged fees and are provided with
a veterinarian insurance policy for their service dogs. The
bill would also establish a process for granting service dogs
to veterans with mental health conditions and would authorize
the secretary to allocate up to $10 million annually for the
program.
This builds upon previous legislation, the Puppies
Assisting Wounded Service Members, or PAWS, for Veterans
Therapy Act, Public Law 117-37, which expanded efforts to
support veterans with Post-Traumatic Stress Disorder (PTSD) and
other service-related injuries with service dogs.
The VA refers veterans to nonprofit organizations to
receive these service dogs, but the process can often be
lengthy and with veterans waiting up to 1 to 3 years, and the
availability of the of the dogs is extremely limited.
The SAVES Act aims to address these limitations and wait
times by expanding the avenues that veterans can receive
service dogs from VA to nonprofit organizations. Generally,
nonprofit organizations are expected to provide these service
dogs quicker than VA due to there being less bureaucracy.
This legislation also looks at addressing the needs of our
veterans. Amid that is why it expands the scope of the
disabilities covered for the veterans who qualify for service
dogs and will allow veterans who suffer from blindness, visual,
or mobility impairments, seizures, post-traumatic stress
disorder, and traumatic brain injuries to qualify as well.
Veterans face a wide range of issues and there is never a
one-size-fits-all approach. I am pleased to introduce this
piece of legislation or this bill and it is bipartisan. It does
have bipartisan support. Thank you.
Ms. Miller-Meeks. Thank you, Representative Luttrell.
Typically, we would go to the Democrat. The Democrat up to
speak next is not here so we are going to go to Representative
Franklin. Representative Franklin, I now recognize you for 3
minutes.
STATEMENT OF SCOTT FRANKLIN
Mr. Franklin. Thank you, Madam Chairman. This is a solemn
morning, as you noted, as we recognize the 23d anniversary of
the attacks on 9/11. That evil act of cowardice sent many of
our sons and daughters to foreign soil to defend our Nation.
Two decades now and trillions of dollars spent, an entire
generation at this point of our young men and women who
answered the call to join our armed forces to defend our great
Nation, many of them have now joined the ranks of veterans who
served in previous eras.
It is the duty of this panel, our primary duty I would
argue, to ensure that these brave Americans receive the best
care and the benefits they have earned.
Despite the sacrifices our veterans and their families have
made, reports indicate they are being cutoff from certain
services the VA is obligated to provide them.
Recently, the VA has been pushing more veterans back into
VA facilities from community care providers without
consideration of continuity of care when deciding in a
veteran's best medical interest. This abruptly cuts off
veterans from longtime treatment plans and providers they
trust.
It is difficult for veterans to build rapport with a
provider or a counselor and then be forced to find a new one,
creating gaps in care. These gaps can negatively impact all
aspects of life for veterans and their families.
It is unconscionable this would be allowed to even happen
and that this committee would do so. It is something we must
stop.
I am concerned by the comments by members of the committee
that appear to be in direct opposition to community care. The
same comments advocate shrinking the funding and size of the
program.
The rationale often centers around the VA's recent efforts
to increase convenience with new clinics and improve care by
recruiting new specialists. I applaud those efforts, including
the opening of a fantastic new clinic in my hometown of
Lakeland, Florida.
I consider those efforts to be table stakes. The VA can
always be striving to improve. Excellent care at VA facilities
and providing flexibility to veterans are not opposing
missions. VA must continue to improve care and expand
convenience for our veterans. They deserve nothing less.
I believe, and I know many of my colleagues here agree,
veterans should be able to choose the care that works best for
them, whether that is inside the VA or out, especially for
those who are already using community care.
My bill, the Ensuring Continuity in Veterans Health Act,
protects veterans who have chosen to utilize community care. It
will also provide clarity for veterans concerned that they will
lose their provider.
Specifically, this requires the VA to consider continuity
of care in determining best medical interest of a veteran. This
will provide disruption in care for veterans already receiving
services from community care providers. Most importantly, it
will allow veterans to continue choosing the most convenient
care for them.
I would like to thank the chairman for supporting this
legislation, and I look forward to working with the committee
to mark up this bill in the coming days. I urge we take it to
the House floor for a vote.
Thank you, Madam Chair, I yield back.
Ms. Miller-Meeks. Thank you, Representative Franklin.
I now recognize Representative Vasquez for 3 minutes.
STATEMENT OF GABRIEL VASQUEZ
Mr. Vasquez. Thank you, Chairwoman Miller-Meeks and Ranking
Member Brownley, for allowing me to testify today in support of
my bill, the New Mexico Rural Veterans Healthcare Access Act.
Traveling across my district can take up to 9 hours from
Jal, New Mexico to Zuni Pueblo. That means that nearly 50,000
veterans who call New Mexico's Second District home have more
difficulty accessing critical resources, including VA
healthcare, which is largely contained in two Veteran
Integrated Service Networks.
However, in southern New Mexico, the lines do not work and
veterans suffer. This problem has been occurring for over a
decade. In fact, I started this fight as a staffer before I
became a Member of Congress.
The current lines force veterans in Otero and Edi Counties
to travel more than 4 hours to Albuquerque instead of nearby El
Paso less than an hour away for healthcare. Traveling long
distances for basic care referrals and other appointments
creates an incredible hardship for those who served our
country.
It is not just long distances. It is the dignity of care
and extended waiting times. The VA will only provide a mileage
reimbursement to veterans who seek service within their VISN
lines.
A veteran in Carlsbad is faced with an unjust choice. Get
reimbursed for a 9-hour trip to their designated VA hospital in
Albuquerque or bear the cost themselves for a 4-hour trip to El
Paso.
Our veterans opt for the closest VA but are not receiving
any mileage reimbursement for going outside their VISN lines,
defeating the purpose of this system.
I recently met with both the directors of the Albuquerque
and El Paso VA healthcare systems and brought the ranking
member of the Veterans Affair Committee to listen directly to
veterans about the hardships that they face. Everybody in the
room agreed that the line should be changed.
As legislators, we cannot leave our rural veterans behind.
The Veteran Integrated Service Networks were created to make
sure veterans are organized into a system where they have
access to what they need, but for the rural veterans in my
district in southern New Mexico that benefit simply does not
exist.
My bill, the New Mexico Rural Veteran Healthcare Access
Act, would move Edi and Otero Counties in my district into
Veteran Integrated Service Line 18. This change would give
these veterans closer access to specialty care and mileage
reimbursement for the VA hospital trips that they are already
making.
To the veterans of New Mexico's Second congressional
District, know that I am here fighting for you. Whether you are
in Edi or Otero County, Dona Ana or Bernalillo, you all deserve
equal access to the benefits that you deserve.
I urge support for my legislation in this committee, and I
yield back. Thank you, Mrs. Chairwoman.
Ms. Miller-Meeks. Thank you, Representative Vasquez.
I now recognize Representative Self for 3 minutes.
STATEMENT OF KEITH SELF
Mr. Self. Thank you, Chairwoman Miller-Meeks. I am honored
to introduce H.R. 9485, the Enhancing Faith-Based Support for
Veterans Act of 2024. This important legislation addresses a
crucial gap in the spiritual care provided to our veterans.
Under this bill, VA chaplains would be required to offer
veterans the option to order their name and contact information
to be shared with non-VA religious or faith-based organizations
of their choice. In other words, this option is at the sole
discretion of the veteran.
This step will ensure that veterans have access to the
spiritual care they need and want, regardless of their faith.
This issue was brought to our attention by a dedicated Army
veteran who also serves as a Catholic Eucharistic Minister in
the Dallas Diocese. He learned of the problem through a
parishioner who had been bringing Catholic communion to the Sam
Rayburn Memorial Veterans Center and Bonham VA Clinic for many
years.
However, 2 years ago, they were informed that due to a
change in policy access to VA patients had been revoked. H.R.
9485 aims to fix these issues by allowing veterans to complete
a privacy release form, similar to what all of our constituents
have to fill out before opening casework.
This will enable the VA to connect them with chaplains or
religious leaders who can offer the specific spiritual support
they need and want. By passing this bill no veteran would be
denied the spiritual care they require due to bureaucratic red
tape.
I am grateful to my constituent who brought this issue to
light, and I look forward to working with my colleagues to
advance this bill through Congress. I yield back.
Ms. Miller-Meeks. Thank you, Representative Self.
I now recognize Representative Gluesenkamp Perez for 3
minutes.
STATEMENT OF MARIE GLUESENKAMP PEREZ
Ms. Gluesenkamp Perez. Thank you to the chairwoman and
ranking member for the opportunity to testify today about my
bill, Rural Veterans Transportation to Care Act.
Almost exactly 1 year ago today I heard from one of my
counties in my district that they had just received notice from
the VA that they were no longer eligible for the VA highly
rural transportation grant program.
The county had been operating a van for the purposes of
transporting veterans to the Department of Veterans Affairs
facilities to receive medical care free of charge since 2014.
Over the years, this service has proven essential to
veterans seeking essential care to things like chemotherapy and
critical surgeries and treatment for heart conditions.
In 2022 alone, the van made approximately 300 trips and
transported between 40 and 60 veterans. However, due to the
definition of eligibility for these grants as set in statute,
as fewer than seven residents per square mile Skamania County
learned that due to new Census data and migration changes that
happened during the pandemic, that our rural county was no
longer considered rural enough.
Now we are at 7.15 residents per square mile. With just 1
week's notice we lost transportation funding.
I sent a letter to the Secretary of Veterans Affairs
McDonough in October urging the VA to fill transportation gaps
for rural veterans and work with Congress to redefine highly
rural.
In a reply earlier this year the department expressed
support for the provision outlined in Rural Transportation to
Care Act. The bipartisan bill would improve how VA measures
rurality, helping more veterans living in rural areas get
transportation to VA or VA-authorized healthcare facilities.
The bill would also expand eligibility to both rural and
highly rural counties, as well as tribal organizations.
Last, the legislation would increase the maximum funding
amount so transportation services could keep pace with
inflation.
It is our responsibility to our Nation's heroes to ensure
that our Nation's heroes are well supported after returning
from home and can access the benefits they have earned and
deserve. Just last week, I was visiting with veterans in
Pacific County about how vital these kinds of transportation
services are, and they are literally life or death.
People who have been waiting for appointments for 18 months
can lose an appointment if they are just 10 minutes late or 15
minutes late to their appointment, setting them back 10 months
to care.
Access to professional, reliable transportation is critical
to deliver lifesaving care to our veterans. As veterans across
my district and the country face dramatic reductions in
lifesaving services, it is our duty to make sure they are not
left behind.
This bipartisan bill will not only restore critical
healthcare transportation services for Skamania County veterans
but will also newly expanded eligibility to make sure more
veterans in rural areas around the country have a safe and
reliable way to get to their appointments and receive the care
they deserve.
I thank you again for the opportunity to testify on this
bill and I look forward to continuing to work on getting this
across the finish line.
Ms. Miller-Meeks. Thank you very much, Ms. Gluesenkamp
Perez.
The chair now recognizes Representative Womack for 3
minutes.
STATEMENT OF STEVE WOMACK
Mr. Womack. I thank the Chairwoman Miller-Meeks and Ranking
Member Brownley, and distinguished members of the subcommittee.
I want to thank you for considering my bill, H.R. 9324, the
Protecting Veteran Access to Telemedicine Services Act of 2024.
I would also like to express my sincere gratitude for
allowing me to speak in support of this legislation today. This
bill seeks to ensure that our Nation's veterans, whether they
reside in bustling urban centers or in the most remote areas of
our country, have uninterrupted access to the healthcare
services they need and deserve.
As you are aware, the Ryan Hate Online Pharmacy Consumer
Protection Act was enacted in 2008 to regulate the prescription
of controlled substances via telemedicine in response to the
rise in online pharmacies and the potential for misuse.
This law plays an important role safeguarding public
health, but also has not been updated to reflect the
differences between 2024 compared to 2008 and does not
acknowledge the difference between VA and general civilian
online pharmacies.
During the COVID-19 pandemic, requirements under the Ryan
Hate Act for a patient to meet with a practitioner in person
for the prescription of a controlled substance were temporarily
waived.
The Drug Enforcement Administration (DEA) and U.S.
Department of Health and Human Services (HHS) announced the
temporary extension of these flexibilities, but that extension
expires at the end of this year. My bill, the Protecting
Veteran Access to Telemedicine Services Act of 2024, would
permanently extend this exemption to allow healthcare
professionals employed by the VA to prescribe medically
necessary controlled substances to veterans via telemedicine
under certain conditions.
This exemption has been a lifeline for our Nation's
veterans and without a permanent exemption, many veterans could
see their access to vital healthcare services severely
restricted.
For our veterans in urban areas, the expiration of this
exemption would mean longer wait times for in-person
appointments, further straining an already burdened VA
healthcare system.
The situation is even more critical for veterans in rural
areas. These veterans face unique challenges, including
geographical isolation and limited access to healthcare
providers. The Ryan Hate Act exemption has enabled them to
receive care from VA providers and specialists who may be
hundreds of miles away without the need for costly and time-
consuming travel.
The continuation of this exemption is not just a matter of
convenience. It is a matter of necessity. It ensures that
veterans in every corner of this country have equal access to
the care they so desperately need and they deserve.
It is an honor to speak in support of my legislation today.
I urge my colleagues on this subcommittee to support the bill
and to act swiftly in passing this legislation.
Our Nation's veterans have sacrificed so much for our
freedom. It is our duty to ensure they receive the care they
have earned in a manner that meets their needs in today's
world.
With that, Madam Chairwoman, I yield back my time.
Ms. Miller-Meeks. Thank you very much, Representative
Womack.
The chair now recognizes Representative Tokuda for 3
minutes.
STATEMENT OF JILL TOKUDA
Ms. Tokuda. Thank you, Chairwoman Miller-Meeks,
Representative Cherfilus-McCormick, and distinguished members
of the Health Subcommittee, thank you for including my bill,
H.R. 8562, the Parity for Native Hawaiian Veterans Act, in
today's legislative hearing and for the opportunity to speak in
support of this important bill.
In the United States there are approximately 614,600 Native
Hawaiian veterans, including nearly 275,000 in my home State of
Hawaii. According to a May 2022 report by the Veterans Health
Administration (VHA), Native Hawaiian and other Pacific
Islander veterans aged 45 and older experienced significantly
less access to checkups and routine care than their white
counterparts.
The report concluded that ``work is needed to improve the
veteran experience of care among
[Native Hawaiian and other Pacific Islander] veterans'' and
better information could be ``helpful in understanding and
addressing their disparities.''
They served and sacrificed the same as their fellow
veterans, yet our country is failing to meet our obligations to
them. More must be done to eliminate needless barriers to care
for our Native Hawaiian veterans.
That is why I have introduced the Parity for Native
Hawaiian Veterans Act to ensure Native Hawaiian veterans can
access health care services in a similar manner as their
American Indian and Alaska Native counterparts.
To fulfill the Federal Government's trust responsibility to
the Native Hawaiian community it is vital that Native Hawaiian
veterans be treated the same as other Native American veterans
and explicitly included in Federal programs and policies
supporting other Native veteran populations.
Currently, the Indian Health Service (IHS), Tribal health
programs, and IHS-funded urban Indian organizations can seek
direct reimbursement from the VA for services rendered to
eligible American Indian and Alaska Native veterans.
The Parity for Native Hawaiian Veterans Act would codify
the same reimbursement relationship between VA and the Native
Hawaiian health care systems that have been authorized by
Congress to provide comprehensive health promotion and disease
prevention services, as well as primary health services to our
Native Hawaiians.
With more locations near to where Hawaiians live, this is
about meeting our veterans where they are at and greatly
increasing their access to care.
My bill does three things. It updates the definition of
Native Hawaiian in statutes governing veterans' care and
benefits. It eliminates co-pays for qualified Native Hawaiian
veterans. It allows the VA to directly reimburse the Native
Hawaiian health care systems for care provided to Native
Hawaiian veterans.
This bill was developed in consultation with Papa Ola
Lokahi, which has been authorized by Congress to coordinate and
assist healthcare programs and services provided to Native
Hawaiians. The bill also incorporates technical assistance from
VA and past work by the Office of Hawaiian Affairs.
Ultimately, the Parity for Native Hawaiian Veterans Act is
about improving healthcare access and affordability for Native
Hawaiian veterans and ensuring all veterans are provided the
care they need and are entitled to as a result of their service
to our country.
I look forward to working with members of this committee
and Senator Hirono, who has introduced identical legislation in
the Senate, to advance this measure forward in Congress. Mahalo
and I yield back.
Ms. Miller-Meeks. Thank you very much, Representative
Tokuda.
The chair now recognizes Representative Chavez-DeRemer for
3 minutes.
STATEMENT OF LORI CHAVEZ-DEREMER
Ms. Chavez-DeRemer. Chairwoman Miller-Meeks and Vice Chair
Cherfilus-McCormick, thank you for inviting me today to speak
on behalf of my legislation, the VA Geriatrics and Gerontology
Advisory Committee Expansion Act.
This bill is simple. It would include a representative of
the National Association of State Veterans Homes (NASVH) on the
Department of Veterans Affairs Geriatrics and Gerontology
Advisory Committee.
NASVH has been great partners and supporters of this
legislation. Their goal as an all-volunteer organization is to
promote and enhance the quality of care and life for veterans
and families in their network of homes through education,
networking, and advocacy.
There are 169 VA-recognized State Veterans Homes across the
Nation, including two in Oregon, one in The Dalles, and one in
my district in Lebanon, Oregon.
The Geriatrics and Gerontology Advisory Committee was
authorized in 1991. Its primary role is to advise the VA on
geriatric research education and assess the demand for long-
term veteran care and the VA's ability to provide for its plan
to meet these geriatric services.
A representative from NASVH having full representation on
the committee would be able to bring new, unique, and tested
clinical expertise to strengthen this mission. With over 8
million living veterans who are aged 65 and older, many still
from our greatest generation, there is an everlasting need to
strengthen and expand long-term care options for our veterans.
The amount of nursing home care offered by the VA is
currently not meeting the overall number of eligible veterans.
NASVH will be able to offer nursing home care, experience
combined with the ability to stretch adequate resources and
serve as many veterans as possible, including expanding care to
veterans who can be serviced in their own communities and
homes.
With a nationwide network, NASVH has the capabilities to
understand the changing demographics, needs, and preferences of
veterans in all areas of the country. I believe State Veterans
Homes have the full capability to advise the VA on the long
care options, and I also believe the VA must also make a long-
term commitment the State Veterans Homes.
I have appreciated the ongoing support of Chairman Bost and
the committee here today and thank them for their steadfast
support and leadership in aiding our Nation's veterans.
They were kind enough to visit my district back in June to
tour the Portland VA Medical Center and also help me hosting a
listening session in Bend, Oregon, where we heard directly from
local veteran constituents on the issues they face in receiving
the care they deserve.
One of the main issues we discussed was long-term and
community care for the aging veterans. Further, I echoed those
concerns of Oregonian veterans in writing to Secretary
McDonough asking the department to respond to a series of
questions that were raised during that listening session by
July 31. We have yet to receive that response from the VA.
I urge Secretary McDonough to respond to these questions
quickly because they are questions not coming from me. They are
questions from our veterans, the very ones he was appointed to
and confirmed to serve.
Again, I want to thank my colleagues on both sides of the
dais for their consideration of this legislation, and I urge
their support. Passing the VA Geriatrics and Gerontology
Advisory Committee Expansion Act will be a clear win for the
States Veterans Homes, network, and for our Nation's aging
veterans.
With that, Madam Chair, I yield back.
Ms. Miller-Meeks. Thank you very much, Representative
Chavez-DeRemer.
As is our practice, we will forgo a round of questioning
for those members waiving on to present their bills. They have
excused themselves or they may now be excused.
I now invite our first panel to the table. Joining us today
from the Department of Veterans Affairs is Dr. Carolyn Clancy,
assistant under secretary for Health, Discovery, Education, and
Affiliate Networks, Veterans Health Administration.
She is accompanied by Dr. Matthew Miller, executive
director, Office of Suicide Prevention, Veterans Health
Administration, Dr. Ajit Pai, executive director, Office of
Rehabilitation and Prosthetic Services, Veterans Health
Administration, and Mr. Ryan Heiman, acting director, Member
Services, Veterans Health Administration.
Dr. Clancy, you are now recognized for 5 minutes to present
the department's testimony.
STATEMENT OF CAROLYN CLANCY
Dr. Clancy. Well, good morning, Chairwoman Miller-Meeks and
acting Ranking Member Cherfilus-McCormick, and members of the
subcommittee. Thank you for the invitation to present our views
on several bills that would affect VA programs and services.
I am not sure if we have name tags so we will just point
out Dr. Matthew Miller, Dr. Ajit Pai, and Mr. Ryan Heiman, who
are with me here today.
Today's date, as noted by you earlier, Madam Chair, holds
profound significance in our Nation's history and for VA.
Twenty-three years ago our Nation was under attack, and in the
aftermath many brave Americans honorably answered the call to
serve, creating a new generation veterans, each with unique
challenges and healthcare needs for nearly 2 decades of
conflict.
Our solemn duty is to ensure that all veterans receive the
exceptional care and respect they deserve. The sacrifices and
those of their families underpin our unwavering commitment to
VA's noble mission.
While we are prepared to discuss all proposed legislation,
I will highlight a few bills in these opening remarks. The No
Wrong Door for Veterans Act proposes changes to VA's Staff
Sergeant Parker Gordon Fox Suicide Prevention Grant Program.
Key provisions extend this program's duration, modify the
definition of emergency treatment, and require baseline mental
health screening for grantees using the Columbia-Suicide
Severity Rating Scale, also known as the C-SSRS. The bill also
requires annual briefings between grantees and VA Medical
Center personnel.
We support the bill's intent but have concerns. We are
opposed to codifying C-SSRS use as this could prevent adapting
more effective future tools.
Additionally, we recommend extending the pilot to allow the
program to run a full 8-year period and also recommend
increasing authorized appropriations to reflect the extended
program duration and allow nationwide scaling.
Our teams are prepared to collaborate with your offices to
incorporate these recommendations and others noted in the
written statement.
Next, H.R. 6291, Have You Served Act, provides a grant
program encouraging human services professionals. State and
local governments. and community providers to inquire about
military service.
This bill would authorize VA to make up to 25 grants
annually not exceeding $200,000, each to eligible entities for
developing or expanding ask the question campaigns. These
campaigns are crucial to identifying and supporting veterans in
various community settings.
We support the bill's intent but recommend technical and
clarifying edits for successful implementation, including
expanding the scope of eligibility and supported services and
other amendments would just be needed to provide VA with some
flexibility in program administration.
With respect to H.R. 6330, the Veterans' Sentinel Act,
Section 2(a) would require VA to establish a pilot program for
a working group to collect and analyze data regarding on-campus
suicides and attempted suicides.
We support this section but recommend technical edits to
ensure optimal use of resources for preventing veteran suicide.
We recommend that Congress avoid legislating a specific
methodology or evaluation approach, allowing VA the flexibility
to determine the best strategies and apply innovative solutions
to address this critical issue. As written, we anticipate
significant implementation costs.
Section 2(b) would require VA to annually evaluate
statistical trends of suicides and attempted suicides by
veterans that occur on VA property and determine
recommendations for prevention, and we support this section,
recognizing the need for timely and useful surveillance efforts
to end veteran suicides.
We defer to the Comptroller General regarding Section 2(c).
Finally, we appreciate the committee's interest in two
bills resembling legislative proposals in fiscal years 2024 and
2025 Presidential budgets, H.R. 7504 and H.R. 9324, which would
both make important progress in reducing barriers
disproportionately affecting rural and otherwise underserved
veterans.
We support both bills, however, several technical and
clarifying edits technically are needed to fully address the
intended problems.
Thank you for your ongoing support of programs supporting
our Nation's veterans. Your dedication has improved the lives
of those who have served our country, and we look forward to
working together with you to develop innovative solutions and
develop emerging challenges to meet veterans' evolving needs.
Your partnership is absolutely invaluable.
Madam Chair, Ranking Member, this concludes my statement
and we are happy to answer questions.
[The Prepared Statement Of Carolyn Clancy Appears In The
Appendix]
Ms. Miller-Meeks. Thank you very much, Dr. Clancy.
Typically I will reserve my questions until the end so that
other members can go prior to me, so Representative Cherfilus-
McCormick, I now recognize you for 5 minutes.
Ms. Cherfilus-McCormick. Thank you, Madam Chair.
Dr. Clancy, in your testimony you suggest that
Representative Brownley's bill be modified to provide greater
clarity in terms of how the grant program would be administered
to include the application process, the award of grants, and
requirements for applications.
Could you elaborate on this? What kind of requirements for
applicants would be most helpful to ensure grants are awarded
to appropriate entities?
Dr. Miller. Thank you for the question. As we have
indicated, we fully support the spirit and the intention of the
Have You Served as to the question of legislation.
This is in direct reinforcement of Governor's Challenge
goal number one, which is to better identify veteran service
members, family members in the community, and in turn, connect
them to care.
I think the increased clarity that is requested around the
application process, applicant requirements, awarding of
grants, and use of grant funds can relatively easily and in a
straightforward manner be worked through within the markup
process. Our team stands by ready to offer suggestions therein.
Ms. Cherfilus-McCormick. Thank you.
My next question is for Dr. Clancy, but I guess you are
directed to who can best answer it. As written, Representative
Brownley's Have You Served Act is pretty deferential to the
secretary on the topic of what VA resource grantees should
connect veterans to.
In your written testimony, you recommend that the bill be
amended to be more specific about the array of VA services and
benefits to which grantees should connect with veterans. Can
you expand on how you believe those services should be
identified and why more prescriptive language would be helpful
to VA in ensuring veterans can be connected with those
programs?
Dr. Clancy. Great questions, thank you. Also for Dr.
Miller.
Dr. Miller. I think that that is our--I think it is a
really good question. It is always a fine line between writing
this in a way that is broad versus overly prescriptive to find
the right balance and mix.
I think the right subject matter expertise teams between
the Veteran Experience Office and our Partnerships Office would
happily sit down and talk about the specifics to strike that
balance in a way that most fully supports the spirit and the
intention of this bill.
Ms. Cherfilus-McCormick. Thank you. I think this question
is going to be for you also, Dr. Miller. I appreciate the VA's
testimony on the Have You Served Act and the recommendation
that the scope of eligible entities that can apply for these
grants to be expanded.
Can you speak to some of the work that the community
partnership in the VA, in the Vet Resource Community Network
and the VHA National Center for Healthcare Advancement and
Partnership that this bill might be able to help and support it
becoming law?
Dr. Miller. This bill as it is currently written speaks
very directly and I must say, from my perspective, I appreciate
it as such to the efforts being conducted through the
Governor's Challenge. It highlights efforts that eight states
and one U.S. territory are currently engaged in with ask the
question and seeks to expand those efforts.
In the spirit of expansion, it also looks at and offers to
look at other partnerships, such as those that are engaged and
structured through the Veterans Experience Office (VEO) and
through the National Center for Healthcare Advancement and
Partnerships (HAP). It is opening the door to other
partnerships beyond Governor's Challenge and drawing them in.
Ms. Cherfilus-McCormick. Well, I have a quick question. I
wanted to shift toward Veterans Sentinel Act. Dr. Miller. I was
glad to learn from your testimony that VA established an
interagency workgroup to address the U.S. Government
Accountability Office's (GAO) recommendations regarding on-
campus suicides.
Can you share what the VA's existing interagency workgroup
has done to improve VA's response to on-campus suicide,
particularly in improving processes?
How long does VA intend to continue convening the working
group and would codify the working group help ensure this work
continues?
Dr. Miller. Three improvements stand out to me to offer to
you in response to your question. Improvement number one from
the interagency workgroup is we have improved the process of
the informational briefing system such that we have
standardized the process across VHA, Veterans Benefits
Administration (VBA), and National Cemetery Administration
(NCA) so that standardized information is included.
Number two, we have included in the process very specific
checkpoints for asking was an Root Cause Analysis (RCA)
conducted? Was a peer review conducted? Creating hard stops
with those questions.
Three, we have addressed direct needs that have been
identified, parking lot signs being one. We in Fiscal Year 2023
provided parking lot signs to 100 percent of VA facilities. In
Fiscal Year 2024 we are offering 7,000 additional parking lot
signs with the Veterans Crisis Line (VCL) number and 988
updates.
Ms. Cherfilus-McCormick. Thank you. I yield back.
Ms. Miller-Meeks. Thank you very much.
The chair now recognizes herself for 5 minutes. Dr. Clancy,
the VA's testimony request for moving the statutory cap on Fox
Grant amounts, VA has not properly managed grant funds within
the first 2 years of the program, given that some organizations
are receiving the full grant the amount and serving less than
20 veterans a year.
How do you justify removing the cap when the VA is not
properly overseeing these funds?
Dr. Miller. I am happy to take that question, ma'am. As the
program that administers the Staff Sergeant Gordon Parker Fox
Grant Program, I appreciate your question. I thank you for it.
The request to adjust the cap is in response to adjustments
to something we all have been talking about, inflation so that
the awards as it continues are reinforcing of current costs and
adjust to current costs.
I think panel two members noted the advantage of this as
well within their written statements.
Ms. Miller-Meeks. Thank you.
Dr. Clancy, given the significant, and I realize that you
may refer this, given the significant physical and mental
health benefits of adaptive prostheses and terminal devices for
sports and recreational activities, why does the VA not support
including these devices in the definition of medical services
under Title 38?
Dr. Clancy. This is Dr. Pai, who is the expert here.
Thanks.
Dr. Pai. Good morning, Chairman. We already include that
definition of adaptive sports devices in our regulations and
our clinicians are prescribing them.
Ms. Miller-Meeks. You said you include a definition but
does that definition mean that they are--it does not mean that
they are medically necessary?
Dr. Pai. Correct. With adaptive sports and let me say that
we really appreciate the intent and the spirit of this
legislation. These devices are highly complex, right? An
individual with an amputation has to go through weeks, months,
sometimes years of rehabilitation and their medical
comorbidities can impact their ability to utilize that device.
You know, we just have had the Paris Paralympics and we are
really proud of our 13 veterans that we support over there.
What we see is that the rehabilitation for this type of journey
can take even longer than just that initial phase.
We really want to make sure that a veteran has consistent
and constant participation in that activity so that they can
really benefit with lifelong care.
Ms. Miller-Meeks. I just want to make sure I understand
this correctly. You support the current regulatory framework.
You are not opposed to these devices being utilized. Is the
problem with codifying these provisions into law problematic
because you are afraid veterans will not get the rehabilitative
services that they need?
Dr. Pai. No, ma'am. We just feel that the legislation is
redundant because we are already doing that. We understand that
there are veterans out there that are having challenges, and we
really want to make sure that we are hearing from those
veterans, from those districts, from yourself and other
Congress persons to make sure that we are caring for those
veterans.
I understand that there is a question of will one clinician
prescribe something that another clinician may not prescribe?
We are really putting in efforts to educate our clinicians.
Ms. Miller-Meeks. Right, thank you, which is why we need to
have it codified into law. Thank you for that.
I had another question in regards to the Have You Served
Act, Dr. Clancy. Rather than setting up a new program, why
cannot grants be utilized for those entities that are already
doing this?
In Iowa we have veteran service organizations in every
single county. Why could not these grants go to them or why
could not these grants go to our, you know, our great veteran
service organizations, such as the Legion, Disabled American
Veterans (DAV), Wounded Warrior Project, Purple Heart, Veterans
of Foreign Wars of the United States (VFW).
There are too many. If I left you I do apologize.
Why not give the grants to existing organizations who
already work with veterans and are adept at that?
Dr. Clancy. I think the short answer is we could certainly
do that and happy to work with your staff on that. At the same
time, we would also like to recognize that there are places
that are beyond the reach even of those phenomenal
organizations and not preclude their contributions as well.
Ms. Miller-Meeks. Oh, interesting. The smallest town in
Iowa of 200 people has a VSO but thank you so much for that.
I am seeing no other members. I think this round of
questioning is over. Our second round of questions, do you have
a second round of questions?
Ms. Cherfilus-McCormick. Yes.
Ms. Miller-Meeks. The chair now recognizes Representative
Cherfilus-McCormick.
Ms. Cherfilus-McCormick. Thank you.
I appreciate your testimony points. I appreciate that your
testimony points out that while on-campus deaths by suicide are
tragic, they are relatively rare among all suicide deaths.
However, we have no way of knowing how many veteran deaths
by suicide may be occurring at community care facilities or
their root causes.
Would VA be able to apply the same investigation method in
this bill, which is the Veterans Sentinel Act, to suicide
deaths that occur at community care facilities if we were to
amend the bill to include that?
Dr. Miller. Happy to answer that question. There have been
20 on-campus suicides to the present day this fiscal year.
Adding information from non-VA sites applicable to veterans, I
think, would be value added to our awareness and surveillance
process.
We would be very happy to take a look at what would be
needed to engage that process with our community partners, yes.
Ms. Cherfilus-McCormick. Thank you. I want to also talk
briefly about the New Mexico Rural Veterans' Healthcare Access
Act.
Dr. Clancy, in your testimony regarding the New Mexico
Rural Veterans Healthcare Access Act, you mentioned that VA is
taking action to address this issue. However, there are
veterans currently electing to receive their care on the El
Paso VA healthcare system because it is closer to them.
However, in VA's eyes they live within the catchment area
of the Albuquerque VA and are therefore officially assigned to
that facility and only receiving travel reimbursement when they
travel to that facility.
What actions, if any, can the VA take right now to address
this without requiring VISN lines to be redrawn to ensure that
veterans who are already doing this are able to get their
transportation reimbursed?
Dr. Clancy. Great question. Mr. Heiman.
Dr. Heiman. Sure. Thank you, Ranking Member Cherfilus-
McCormick and also thank you to Representative Vasquez for his
testimony earlier.
We agree with the interest of examining the particular
lines. That is something that we do not feel we need a law to
actually accommodate, and as such, we are currently looking
into everything from referral patterns to transportation
reimbursement, as you mentioned and as Representative Vasquez
mentioned.
We are committed to this and we intend to brief the
committee as well as local delegations of these efforts in and
around the end of the calendar year.
Ms. Cherfilus-McCormick. Does VA have any plans to adjust
the VISN boundaries to account for these veterans? If so, what
is keeping the VA from doing this as expeditiously as possible?
Dr. Heiman. Thank you for the question. We are actively
looking into what those boundaries could be, and I think
certainly redistricting or reapplying the VISN structure and
boundaries is something that is within our control and
something that we are actively working at between VISN 22 and
VISN 17.
Ms. Cherfilus-McCormick. Dr. Clancy, I understand that your
testimony that the SAVES Act, which would create a 5-year pilot
grant program for nonprofit organizations to provide service
dogs to veterans, would likely require new staff in a dedicated
office.
Do you have an idea of how many additional staffs would be
needed to administer this program and within which program
office with VHA would you house this program?
Dr. Clancy. I will need to take that for the record,
Congresswoman. I do not think it would be an enormous lift in
terms of the number of staff, and I am guessing it would
probably come under prosthetics but I do not want to speak for
my colleague here. We will get back to you on that. He was
about to say no.
Ms. Cherfilus-McCormick. Dr. Miller, can you explain more
about why VA is concerned about the No Wrong Door Act codifying
the Columbia-Suicide Severity Rate Scale as the only tool Fox
Grant recipients may use to complete baseline mental health
screenings?
What is the current practice? What are some other possible
tools that could be used, and how would limiting the program to
Columbia-Suicide Severity Rating Scale affect grantees and
outcomes?
Dr. Miller. Thank you for the question and let me be clear
that the Suicide Prevention Program Office supports the
Columbia as a scale from a validity and reliability perspective
and sees the value of its role.
I think our concern can best be summarized in terms of
codifying it as the tool to use. If a more effective tool
arises in the next 2 to 3 years we want to be able to flexibly
adjust to that and our current bylaws allow for that rather
than an act of Congress, literally, to adjust from the Columbia
to a different measure.
Ms. Cherfilus-McCormick. Thank you very much.
I yield back.
Ms. Miller-Meeks. Thank you very much, Representative
Cherfilus-McCormick.
The chair now recognizes Ranking Member Takano for 5
minutes if he has questions.
Mr. Takano. Thank you, Chair Miller-Meeks.
Dr. Miller, we received VA's interim report on the Fox
Grant Program that included some limited data on the
effectiveness of the program so far, and we appreciate that VA
anticipates having additional data in its final report and
believe these data will help Congress and VA evaluate whether
the program is working as intended.
Do you believe that limiting grantees to the Columbia-
Suicide Severity Rating Scale would impair the level of data
that grantees can collect and therefore limit our ability to
assess the effectiveness of the program if we reauthorize it?
Dr. Miller. Thank you for your question, sir, good to see
you. Yes. We do believe that limiting to the Columbia would
impact the reliability and the validity of outcome evaluation
of the Fox Program.
With that said, we do not necessarily read in the
legislation that outcome data is restricted to the Columbia
necessarily as there are other measures and broader measures of
well-being, mental health, financial status that will also be
included in the outcome measures as part of the Fox Grant
Program.
Mr. Takano. Okay. Well, I want to, kind of, switch gears
here and talk about H.R. 9426 to carry out a pilot program
under the secretary under which the secretary may fill vacant
shifts at medical facilities of the Department of Veterans
Affairs with non-departmental healthcare providers.
While I appreciate my majority counterpart's intent in
putting forth a bill that would allow VA to use contractors to
cover vacant shifts at VA medical facilities, I share VA's
concern that key aspects of the bill are not clearly defined
and the implementation would be difficult.
However, knowing that staffing shortages are often a
concern for medical centers, I am glad to hear that our VISNs
are already offering clinical resource hubs to ensure staffing
needs are met in times of vacancies.
Can you expand on how that is activated and if it has so
far been sufficient to address shortages?
Dr. Clancy. I will give you a couple of examples. The
notion is if a veteran, for example, is seen at Detroit and by
a primary care clinician who then believes that that clinician
needs a specialist but that specialist is not available or they
do not have the capacity to see that veteran in a timely way at
that facility, through this clinical resource hub they can
identify another facility in the network where the veteran
could get that care.
This has worked extremely well, as I understand it, in VISN
23, you know, which is Minnesota, Iowa, South Dakota, and North
Dakota. It has allowed them to bring much more of the
cardiology care back into VA.
Obviously, in areas in all of those states where there are
not cardiologists everywhere. It also works very well on a
number of other networks, but that is the intent of it.
In other words, the VISN is more than just a silent
overseer, if you will, of multiple freestanding facilities but
really is leveraging their capability as a system within a
system, if that makes sense?
Mr. Takano. Dr. Clancy, are these, in this example you
gave, would the cardiologist, would that be a VA doctor or
maybe potentially a contract doctor?
Dr. Clancy. A VA doctor.
Mr. Takano. Okay. That is through, so it is called a
clinical resource hub?
Dr. Clancy. Yes.
Mr. Takano. How does VA currently decide how and when to
activate contracts with temporary help service firms?
Dr. Clancy. We have put together a new contract, I think a
year and a half ago, the interim critical staffing program
where we can hire a whole array of medical, nursing, and other
healthcare specialties as needed.
That would be activated by individual facilities. It can
also activate administrative and managerial support as needed
as well.
Mr. Takano. To what extent are these already in use?
Dr. Clancy. I would have to take that for the record and
get back to you, sir, because it became live shortly before we
realized that we needed to be more strategic with hiring and so
forth.
Mr. Takano. Madam Chair, I have a couple more just odd
questions or do you want to just, kind of, stop now for now?
Okay. All right. All right that is fine. I will yield back.
Mr. Takano. Thank you very much, Ranking Member Takano.
On behalf of the subcommittee, seeing that no other members
are here, I wanted to thank all of you for your testimony and
for joining us here today. You are now excused, and we will
wait for a moment as the second panel comes to the witness
table.
Dr. Clancy. Madam Chair, I had one quick question.
Representative Tokuda from Hawaii made a point today which
clarified an issue for us which may require a correction or
addendum to the written statement. Is that feasible?
Ms. Miller-Meeks. I think that you can submit that for the
record.
Dr. Clancy. Perfect, thank you.
Ms. Miller-Meeks. Welcome, everyone, and thank you for your
participation today. On our second panel we have Mr. Brian
Dempsey, director of Government Relations for the Wounded
Warrior Project, Ms. Missy Meyer director of Community
Integration at America's Warrior Partnership (AWP), Mr. Clark
Pennington, chief operating officer at the Independence Fund,
and Mr. Jon Retzer, deputy national legislative director for
health at Disabled American Veterans.
Mr. Dempsey, you are now recognized for 5 minutes.
STATEMENT OF BRIAN DEMPSEY
Mr. Dempsey. Thank you. Chairwoman Miller-Meeks, Ranking
Member Takano, and distinguished health subcommittee members,
thank you for inviting Wounded Warrior Project to testify at
this morning's hearing to discuss legislation intended to
improve VA's ability to provide better access to care and
ensure better health outcomes for our Nation's veterans.
Honoring and empowering wounded warriors has been at the
heart of our mission since 2003. Meeting the needs of those who
volunteered to serve our Nation and protect the freedoms we
enjoy as Americans is not only a solemn obligation but a
national priority.
Our written statement reflects our views on several of the
bills before you, but for today's hearing on the anniversary of
the September 11th attacks that led to our founding, I am going
to focus on legislation that we believe will be most impactful
on the lives of the post-911 wounded, ill, and injured warriors
that we serve.
First, we support H.R. 9438, the No Wrong Door Act, which
would reauthorize the Staff Sergeant Parker Gordon Fox Suicide
Prevention Grant Program through 2027 and extend an important
tool for VA to provide upstream suicide prevention services in
communities around the country.
We remain hopeful that the Fox Grant Program becomes a
permanent fixture in VA's public health strategy, however, we
believe that attention should be given to how service
eligibility determinations are made and how clinical care can
be responsibly provided before the program is made permanent.
To that end, we support adoption of the Columbia protocol
for baseline mental health screenings, which were used at
Wounded Warrior Project for the same purpose.
Second, we support H.R. 9427, legislation that would allow
VA to provide grants to nonprofit organizations to provide
outpatient mental health treatment services to veterans. While
we appreciate the need to keep VA as a coordinator of
unfragmented clinical care, we believe that embracing grants to
direct care programs is a commitment most consistent with
putting the needs of the veteran first, particularly when
skepticism toward VA in the veteran community is an unfortunate
reality for some.
We believe this legislation can be thoughtfully
incorporated into the No Wrong Door Act so that grants are
carefully coordinated with other community-based efforts to
help serve an overarching intent to connect veterans to the
care and support they need now, but also foster a healthier
awareness of and trust in the VA services that are available.
Third, we support draft legislation to include a
representative of the National Association of State Veterans
Homes on the Geriatrics and Gerontology Advisory Committee of
the Department of Veterans Affairs.
VA's long-term support services reached just over a half a
million veterans last year and 30 percent were under the age of
65.
While we do not have figures to definitively state how many
of these younger veterans served after 9/11, one of Wounded
Warrior Project's most significant programs, the independence
program, supports warriors with moderate and severe traumatic
brain injury symptoms or other debilitating injuries or
illnesses for whom independent living may be far from assured
in both the near and long term.
We need to plan for their futures and the present needs of
aging veterans is more important than ever. We need to ensure
that critical stakeholders in VA's long-term support service
portfolio have a voice in that planning.
Shifting attention to veterans whose injuries may be more
evident, we are proud to support H.R. 9478, the Veterans
Supporting Prosthetics Opportunities and Recreational Therapy
Act. This bill would raise adaptive prostheses and terminal
devices for sports and other recreational activities to the
same level as wheelchairs, artificial limbs, and special
clothing as far as how VA is prepared to assist veterans on
their path to a new normal.
Under current law, VA will not provide adaptive recreation
equipment to a veteran unless it is part of a medical or
rehabilitative treatment plan. This legislation would
effectively remove this barrier between the veteran and the
support they may need to pursue activities like biking,
swimming, or weightlifting that can be every bit as beneficial
to mobility and mental well-being as clinical or guided
rehabilitative care.
We are proud to support this legislation because we have
seen firsthand the positive and life-changing effects of
adaptive equipment on a veteran's quality of life and mental
health.
Last, I would also highlight the needs of post-911 veterans
with traumatic brain injury as a basis for our support for H.R.
7504, the Rural Veterans Transportation to Care Act. Traumatic
brain injuries and related neurocognitive impairment can
challenge, if not totally eliminate, a veteran's ability to
travel to and from VA medical appointments. Some may rely on
caregivers but extensive commutes can add to the stress of
caring for a loved one.
Others may rely on public transportation, which can be very
tedious and time consuming, if it is even available in the
rural areas where they live. The Rural Veterans Transportation
to Care Act would expand access to VA's highly rural
transportation grants to veterans residing in rural areas.
This VA grant-based program currently only helps veterans
in highly rural areas travel to VA or VA-authorized health care
facilities, but there are clearly many more who could benefit
from this critical service.
Ladies and gentlemen, it is my distinct honor to be here to
represent our Nation's wounded warriors and their families.
Thank you for letting us do our part to keep the promise.
This concludes my testimony and I look forward to your
questions. Thank you.
[The Prepared Statement Of Brian Dempsey Appears In The
Appendix]
Ms. Miller-Meeks. Thank you, Mr. Dempsey.
Ms. Meyer, you are now recognized for 5 minutes.
STATEMENT OF MISSY MEYER
Ms. Meyer. Chairwoman Miller-Meeks, Ranking Member Takano
thank you so much for the privilege of being here today to
testify. There are two bills that I would like to discuss
today.
First, America's Warrior Partnership is in support of H.R.
9427 introduced by Chairman Bost to carry out the pilot program
to provide grants to outpatient mental health facilities. The
more our Nation can expand access to mental health care for
veterans the better, but it must be done with a holistic
approach.
Every veteran is unique. Offering counseling is wonderful.
Additional choices such as outpatient facilities for mental
health, access to traumatic brain injury treatments, since it
is often concurrent with mental health crisis, and post-
traumatic growth training can expand the resources that are
available.
The main focus of my testimony today is going to be on the
No Wrong Door for Veterans Act. AWP is focused on outreach to
all veterans and as we told the committee last year, the
original idea of the SSG Fox Grant had a singular goal, find
veterans in the community that need help and help them.
To reach that goal, Congress needs to implement reforms
that specifically bring back outreach as the singular focus,
streamline the intake into the VA for eligible Fox
participants, and hold organizations accountable.
We are thankful for the committee's hard work on this
program, and we offer a few observations and suggestions. As
one of 80 grantees we have done a significant amount of
outreach since Fox inception.
Currently we have screened 1,917 warriors for the risk of
suicide using the Columbia-Suicide Severity Rating Scale, or
the C-SSRS. 370 of those warriors discussed and disclosed some
level of suicide risk or a previous attempt. That is 19
percent.
Ninety-four percent of the warriors that have turned to AWP
with their thoughts and trusted us with the risk of suicide,
were not seeking assistance for a mental health-related issue.
The SSG Fox Program is working. Relationships are being built
and connections to resources are made.
The Fox Grant is a success story and asking the question
works. AWP, the VA, and Congress have all played an integral
part in saving the lives of these warriors, but there is more
to do.
First, we are thankful for the inclusion of language that
directs briefings for VA employees in regard to the SSG Fox
Program and ensuring a bi-direction, solid, working
relationship with local VA staff is essential.
It is more important than ever that we have education for
frontline staff at the VAs to understand this program and its
purpose.
While the legislation mandates the C-SSRS as the only
required screening protocol, AWP recommends also adding
language that would make the additional baseline assessments
discussed earlier as optional.
Rarely do veterans in our program complete all five of the
additional baseline assessments and very rarely do they
complete them twice as required. The assessments have been
described as both triggering and redundant by both our staff
and the warriors that they are being administered to.
Third, the emergent care section is very helpful. AWP
recommends adding a section that clearly lays out expectations
for the program and identifies boundaries for both the VA and
the grantees.
The SSG Fox Grant Program is about outreach, however, the
line has become muddied and expectations can be unclear. To fix
this it would be helpful to add a section that requires a
specific program on-ramp for veterans identified as eligible
and in need of VA care.
The process does not need to be complex. It does not need
to be burdensome. It can be done through the 988 crisis line.
It can be done through local Veterans Affairs Medical Centers
(VAMC) with expedited care or even a dedicated line for
grantees to call when we have an eligible participant.
The key here is expedited. If we are going to ask the
question we need to have a plan for the answer.
Fourth is accountability. The Fox Grant Program is working
and to keep the program successful Congress and the VA must
hold organizations accountable with verifiable metrics.
AWP recommends adding a section requiring the VA to develop
accountability metrics in regard to outreach, screenings,
eligible participants identified in the course of the program,
referrals, et cetera and then require regular reports back to
Congress.
While accountability and metrics are vital, the data
collection tool implemented by the VA at the end of 2023 has
had the opposite of its intended effect. The Fox Grant
Program's assessments are meant to be anonymous but currently
the tool requires a Social Security number and a date of birth
to enter any data into the tool.
This has caused AWP to go from reporting nearly 100 percent
of our data to less than 5 percent. AWP has suggested returning
to the original anonymous participant identification numbers
instead of requiring our warriors to provide personal health
information to be in the program.
Finally, the only limitation AWP has on being more
successful is funding. If the ceiling on grants was doubled
tomorrow so would our outreach efforts. For these suggestions,
please see our written statement that we have submitted.
Thank you for the opportunity to testify, and I look
forward to any questions you may have.
[The Prepared Statement Of Missy Meyer Appears In The
Appendix]
Ms. Miller-Meeks. Thank you, Ms. Meyer.
The chair now recognizes Mr. Pennington for 5 minutes.
STATEMENT OF CLARK PENNINGTON
Mr. Pennington. Chairwoman Miller-Meeks, Ranking Member
Takano, and distinguished members of the subcommittee, on
behalf of Sarah Verardo, Chief Executive Office (CEO) of the
Independence Fund, thank you for the opportunity to testify
before you today.
The Independence Fund was founded in the halls of Walter
Reed to serve catastrophically wounded veterans, their
caregivers, and their families. While the Independence Fund
submitted written testimony on most of the bills before the
subcommittee, I will limit my remarks to two pieces of
legislation that impact our constituency the most.
In 2017, VA promulgated a regulation entitled,
``Prosthetics and Rehabilitative Items and Services'' under 38
CFR, Part 17 that specifies when adaptive creative recreation
equipment within prosthetics may be approved.
The regulation cites, ``An item that is designed to
compensate for or that may by design compensate for loss of
physical, sensory, or cognitive function and is necessary for a
veteran to actively and regularly participate in a sport,
recreation, or leisure activity to achieve the veteran's
rehabilitative goals.''
This definition appears to cover items like a running
blade, climbing blade, a swimming or diving prosthetic, among
others. However, the regulation potentially limits VA's
approval at a local level of such an item for a veteran unless
it is part of a medically necessary rehabilitation plan to meet
a medical goal and not for a long-term life or health plan and
a routine solitary or group activity for what VA states is only
for personal enjoyment.
The wording of that regulation has the potential to bias VA
practitioners and VA employees in the prosthetics approval
chain from allowing these devices to be approved, ordered,
manufactured, or provided to veterans who seek to remain active
throughout their lives beyond the rehabilitation phase.
The very nature of this regulation appears to be at odds
with VA's often invoked philosophy around whole health of the
veteran and the VA's implied mission to help veterans heal and
incrementally or ultimately achieve some degree of self-
actualization and self worth despite their medical history.
The idea of using whole health approach to medicine is an
important aspect of improving mental health and reducing
suicide. Because of the disparity between VA's whole health
philosophy and the regulation it imposes, limiting when
veterans can obtain adaptive prosthetics, the Independence Fund
is pleased to support Chairwoman Miller-Meeks' legislation that
will amend Section 1702, Subparagraph 6 to specifically include
adaptive prosthesis and terminal devices for sports and other
recreational activities to the list of medical services VA must
provide.
This legislation will ensure veterans seeking to enjoy and
benefit from physical and psychological aspects of recreational
activities will now be guaranteed access to the prosthetics
they need to thrive. The Independence Fund encourages the
committee to quickly pass this legislation.
Suicide prevention is one of VA's stated healthcare
priorities. In 2020, Congress passed into law Commander John
Scott Hannon Veteran Mental Health Care Improvement Act.
Included in that act is the staff Sergeant Parker Gordon Fox
Suicide Prevention Grant, which provides grant recipients the
means and authority to evaluate suicidality through a mental
health assessment.
In the case the veteran is deemed to need access to
immediate higher level mental health care due to acute suicidal
crisis, the statute requires the secretary to furnish that
care. What is missing from the statute is the time requirement
in which that care must be placed.
Along with reauthorizing the grant program, the No Wrong
Door for Veteran Act mandates that if the secretary cannot
provide the emergent care within 72 hours, the veteran will be
deemed eligible for emergent suicide care under Paragraph 1720J
of Title 38.
This is a much-needed provision. Veterans who are in acute
crisis do not have days or weeks to be placed in a care setting
that can address the crisis. This legislation will ensure that
every care option is used so veterans are not left on their own
while they are in the greatest period of need.
The Independence Fund fully supports the enactment of this
legislation. This concludes my testimony and I am happy to
answer questions.
[The Prepared Statement Of Clark Pennington Appears In The
Appendix]
Ms. Miller-Meeks. Thank you, Mr. Pennington.
Mr. Retzer, you are now recognized for 5 minutes.
STATEMENT OF JON RETZER
Mr. Retzer. Chairwoman Miller-Meeks, Ranking Member Takano
and Member Bergman, thank you for inviting DAV to offer our
views on the veterans' healthcare bills being considered by the
subcommittee today.
Many veterans do not recognize their veteran status and are
not receiving care and benefits through the Veterans Health and
Benefits Administration and community services.
By asking have you served healthcare providers and
community partners can identify veterans who might otherwise go
unnoticed and ensure they receive tailored healthcare, access
to benefits, and community services. For this reason, DAV is
pleased to support H.R. 6291, Have You Served.
Data is essential for preventing veteran suicide by
identifying at-risk individuals, tailoring their interventions,
and monitoring trends. Leveraging data enables VA to comprehend
veteran suicide complexities, devise effective prevention
strategies, and ultimately save lives.
Therefore, DAV supports H.R. 6330, the Veteran Sentinel
Act, but recommends expanding its scope to also include
collecting suicide data for veterans using the veterans
community care program.
2.7 million rural and highly rural veterans confront unique
obstacles in accessing VA's top-notch healthcare services. DAV
supports H.R. 7504, the Rural Veterans Transportation to Care
Act that would modify the existing transportation grant program
to improve access to healthcare for rural veterans.
H.R. 9324, the Protecting Veteran Access to Telemedicine
Service Act, would enhance telehealth care accessibility for
veterans in remote or underserved areas by eliminating the in-
person visit, a requirement for prescribing certain controlled
medications.
DAV supports this bill as it would guarantee continuous
medication access for veterans, regardless of their ability to
physically go to a VA facility.
H.R. 9427 would direct the VA to carry out a pilot grant
program for non-VA outpatient mental health facilities to
ensure the delivery of culturally competent, evidence-based
mental health care for veterans.
Rather than creating a parallel system with little
oversight and potential lower standards of care, we recommend
increasing the number of VA mental health clinicians to reduce
the wait times for mental health care in VA and veteran
community care program settings.
The recent VA Red Team report emphasized the need to expand
the use of VA direct healthcare and balance the use of
community healthcare services to prevent the erosion of the VA
healthcare system.
Madam Chair, H.R. 9438, and No Wrong Door for Veterans Act,
would amend and reauthorize the VA Staff Sergeant Parker Gordon
Fox Suicide Prevention Grant Program. DAV has no concerns about
the provision to reauthorize the Fox Grant Program for an
additional 3 years.
However, the bill would also establish a new access
standard mandating a 72-hour deadline for the VA to provide
services after a veteran is referred to non-suicidal mental or
behavioral health follow-up care.
Although we prioritize timely access to mental health
services for veterans, this provision may risk disconnecting
them from VA and other necessary support services. For these
reasons we do not support this provision of the bill.
DAV supports H.R. 9478 to include adaptive prosthesis and
terminal devices for sports and other recreational activities
in VA's medical service package. These devices will help to
promote physical activity and overall well-being among
veterans, allowing them to engage in sports and recreational
activities that they need and enjoy.
DAV supports the Safeguarding VA's Healthcare Workforce Act
which would allow VA to bring in outside healthcare providers
when they need to fill vacant shifts, ensuring enrolled
veterans have timely access to care.
However, we highly recommend VA prioritize its efforts to
maintain proper hiring and retention practices, strengthen
internal staffing levels, and remain the primary provider and
coordinator of care while effectively utilizing community care
networks.
Finally, DAV supports the Service Dogs Assisting Veterans,
SAVES, Act that would establish a pilot program to award grants
to nonprofit organizations to assist in providing service dogs
to eligible veterans.
This bill would also ensure prescribed service dogs are
provided at no cost, that there is reimbursement for any
required follow-up training, and as well as coverage of
veterinary benefits for the life of the service dog.
Chairwoman Miller-Meeks, this concludes my testimony and I
am pleased to answer questions you or members of the committee
may have.
[The Prepared Statement Of Jon Retzer Appears In The
Appendix]
Ms. Miller-Meeks. Thank you very much.
Thanks to all of you for your thoughtful comments.
I now recognize general Bergman for 5 minutes.
Mr. Bergman. Thank you, Madam Chair.
Thanks to all of you for being here today and your
thoughtful, articulate, and timely testimony, not only timely
in the subject at hand, but maintaining yourself within the
standards of time. You know, you did not waste any time. You
got right to the point.
I would like to focus on two important bills that will help
improve veterans' access to mental health care and suicide
prevention programs. First, the No Wrong Door for Veterans Act,
which I joined Chairwoman Miller-Meeks in introducing last
month. Despite spending more and more money each year on VA
suicide prevention programs, more and more veterans continue to
take their lives every day.
There is a--it leaves a hole not only, I think, I know in
the family's heart, but it leaves a hole in those of us, and
you included, trying to do the right thing for the right
reasons for our veterans. It takes a little bit out of you
every day knowing that we are still dealing with this.
The Fox Grant Program, which I helped to champion during
the 116th Congress, complements VA's existing suicide
prevention efforts by targeting veterans outside of the VA
system and ensuring that those in need are able to receive
evidence-based care.
The No Wrong Door for Veterans Act will reauthorize and
improve the Fox Grant Program so that more veterans can
continue to receive the suicide prevention that they need,
prevention and care that is, not just prevention.
Second, I would like to highlight Chairman Bost's Veterans
Mental Health Access Act which would create a pilot program to
increase veterans' access to behavioral health care in the
community. Both of these bills would make real changes to
address the veteran mental health and suicide epidemic while
protecting and complementing the important work of the VA.
Now for questions. Ms. Meyer, could you speak to the
bureaucratic barriers at VA that might prevent a veteran from
receiving mental health or suicide prevention care?
Ms. Meyer. Thank you for the question. The barriers tend to
be twofold, one of them being the requirements of the program
to be enrolled, participating in the lengthy and sometimes,
well, most of the time redundant baseline mental health
screenings.
We may have a veteran that is qualified based on the C-
SSRS, however, they do not want to participate in four or five
other baseline assessments, so they are now ineligible so they
would not be then enrolled in the Fox Grant Program. AWP will
still refer them to the VA.
Mr. Bergman. Okay. Do you think that the bills like
Chairman Bost's Veterans Mental Health Access Act will give
more options to veterans who need mental health care?
Ms. Meyer. We hope so.
Mr. Bergman. Okay.
Mr. Pennington, how has the Fox Grant Program improved
veteran access to suicide prevention care?
Mr. Pennington. Well, I would say that the Fox Grant is
obviously an opportunity for organizations to capitalize on
that funding to move their programs forward.
At the Independence Fund we do not typically take part in
that in our suicide prevention. Our operation resiliency
program is a program that is funded through 100 percent
donations.
The Fox Grant is enabling us to also reach out to
organizations like law enforcement and using that opportunity
to educate law enforcement, who is typically our first
responders onsite with somebody who is in crisis. That is a
huge opportunity for us under the Fox Grant.
Mr. Bergman. Okay. I am going to interpret, but what you
said is that the reforms to the Fox Grant Program included in
H.R. 9438 will actually improve in broad-based, you know, more
broad basing of these efforts and hopefully targeted to
appropriate and much in need veterans.
Mr. Pennington. Yes, sir.
Mr. Bergman. Okay.
Well, then with that, Madam Chair, I know there was a
couple of hearings ago I went over my time so I am going to
yield back 35 seconds.
Ms. Miller-Meeks. Thank you very much, General Bergman.
I now recognize myself for 5 minutes. Mr. Dempsey, can you
elaborate on the benefits of requiring the baseline screening
to be conducted using the Columbia protocol in terms of
streamlining intake and standardizing data collection as
specified in the reauthorization of the Fox Grant Program?
Mr. Dempsey. Of course. Thank you, Madam Chair. Our
perspective on that bill in using the Columbia protocol is very
much rooted in our own personal experience at Wounded Warrior
Project where our largest programming investment has been in
the delivery of mental health support and related care.
We recently established a triage team to help assign
veterans to several programs within a continuum of support. The
Columbia protocol has allowed us to quickly and effectively
screen veterans for their risk of suicide and help assign them
to the appropriate level of care.
I think it is the efficiency that you can move through and
screen that has been the most beneficial aspect of us, but I
would be happy to follow up with colleagues of mine who work
with warriors directly and then we can, perhaps, provide some
more insight on just how effective that has been for our
organization. Thank you.
Ms. Miller-Meeks. Thank you.
Ms. Meyer, as you know, many VA medical facilities are not
aware of the Fox Grant Program. Can you tell me why you think
the quarterly briefings in this bill would build partnerships
between the community and the VA, as well as increase care
coordination and ultimately provide better care to our
veterans?
Ms. Meyer. Yes, ma'am. Thank you for your question. I think
that the quarterly briefings would be successful. When you
become a grantee you are required to reach out to all the
suicide prevention coordinators within your community and so we
have done that.
Then the gap so far has been that then the frontline staff
answering the phone has no idea when I call and say, hi, I am a
Fox Grantee and I am a Fox participant. They do not even know
what that is.
Making sure that they understand, knowing who we are when
we make the phone call, knowing why we are calling to serve
that veteran immediately would just, I think it could change
the intake process completely.
Ms. Miller-Meeks. Thank you.
Mr. Retzer, the H.R. 9324, Protecting Veteran Access to
Telemedicine Services Act of 2024, how do you believe this bill
would better serve rural veterans who may not have a VA
provider within a reasonable driving distance?
Mr. Retzer. Thank you for that question, very good
question. We look at this situation as our veterans that are in
challenges with barriers for geographical location or even
climate, they may not be able to make their way VA all the
time.
That brings a risk when there is a deadline to get their
medications on time. Many other medications that they are
taking actually are much needed for lifesaving purposes and
actually have some risky side effects if they do not have that
continuity of care from their medication. That is one of the
things that we see in the advancement in the use of
telemedicine to be able to facilitate that gap and barrier.
Ms. Miller-Meeks. Thank you very much.
Mr. Pennington, in regards to H.R. 9478, the Veterans
Sports Act, you have noted concerns about VA's policy of not
providing adaptive recreation equipment such as adaptive
prostheses or terminal devices when the equipment is intended
solely for recreation.
How many veterans have you heard from who were denied such
equipment due to this policy and could you provide any specific
examples of veterans who are affected by this limitation and
the impact it had on their physical, and even more importantly,
their mental or emotional well-being?
Mr. Pennington. Yes, ma'am, thank you. In reference to
that, I mean, you can look back to a survey that we conducted
in 2021 where we reached out to a significant population within
our constituency that is seeing a significant reduction in the
opportunity for recreational prosthetics.
I can bring two examples to you right now that we are
currently working with the VA on that has specifically
requested swimming blades, specifically requested opportunities
to continue recreational opportunities and activities that they
did prior to their injury that they no longer can do because of
their injury and therefore is impacting their mental health.
Because of some of the restrictions in not just the fitting
of a prosthetic to the individual initially, then the
opportunity to have access to recreational prosthesis is not a
significant mental health barrier for them.
We saw a significant decline in both of these that we have
access to and that we presented to the committee before in the
past that we really believe that this opportunity improves
their mental health.
I did hear from the VA during their testimony here today
that they believe this is already part of their process. I
would say that the information coming from that level down to
the practitioners inside of those VISNs is not happening
because they are being denied access to these recreational
prosthetics that ultimately go to mental health improvement.
Ms. Miller-Meeks. Thank you very much.
As a doctor and veteran I can certainly testify to the need
for making people whole, similar to what their lives were
before their injuries.
Seeing that no other members are here, I would recognize
the ranking member for closing remarks but he is not here.
On behalf of the subcommittee I want to thank you all, all
of the witnesses for being here today. I look forward to
working with you and with the VA to address some of the issues
facing our veterans and some of the points brought up today in
testimony.
The complete written statements of today's witnesses will
be entered into the hearing record. I ask unanimous consent
that all members have 5 legislative days to revise and extend
their remarks and include extraneous material. Hearing no
objection, so ordered.
I want to thank the members and witnesses for their
participation today. This hearing is now adjourned.
[Whereupon, at 11:30 a.m., the subcommittee was adjourned.]
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A P P E N D I X
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Prepared Statements of Witnesses
----------
Prepared Statement of Carolyn Clancy
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Prepared Statement of Brian Dempsey
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Prepared Statement of Missy Meyer
Chairwoman Miller-Meeks, Ranking Member Brownley, and other
honorable members of the Subcommittee
Thank you for the honor to testify before the House Veterans
Affairs Subcommittee on Health. There are many bills up for discussion
today, but my testimony will primarily focus on one: The No Wrong Door
for Veterans Act, which reauthorizes the SSG Parker Gordon Fox Suicide
Prevention Grant Program.
However, before I discuss the bill, I wanted to mention America's
Warrior Partnership's support for another bill being discussed today,
H.R. 9427, introduced by Chairman Bost, to carry out a pilot program to
provide grants to outpatient mental health facilities for the provision
of culturally competent, evidence-based mental health care for
veterans.
At AWP, one of the most common requests for health care services is
related to mental health. The more our Nation can expand access to
mental health care for veterans, the better. But it must be done with a
holistic approach. Counseling is a great tool, but every veteran is
unique. Offering additional choices, such as outpatient facilities for
mental health, access to Traumatic Brain Injury (TBI) treatment (since
it is often concurrent with mental health crisis), and Post-Traumatic
Growth (PTG) training (both pre-and post-crisis) can expand the
resources available.
That being said, AWP is focused on outreach to all veterans. Since
I was last before the Subcommittee to discuss the SSG Fox Grant last
December, much has changed and much has been accomplished. AWP is one
of the most successful recipients of funding from the SSG Parker Gordon
Fox Suicide Prevention Grant Program (aka SSG Fox Grant).
As we told the Committee last year, the original idea of the SSG
Fox Grant had a singular goal: find veterans in the community that are
in need and help them.
However, as the program was implemented by the VA and put into
practice by organizations across the country, part of this goal has
been diluted and lost. To reach that goal, Congress needs to implement
reforms that specifically bring back outreach as the singular focus,
streamline the intake into the VA for eligible Fox veterans, and hold
organizations accountable.
We are very thankful for all your hard work on this program,
Chairwoman Miller-Meeks, Ranking Member Brownley. The introduced
legislation, H.R. 9438, to reauthorize the SSG Fox Grant, is a terrific
start, and AWP is grateful for your efforts to continue this successful
program. To help improve the SSG Fox Grant program, we offer a few
observations and suggestions:
Program Overview
As one of 80 SSG Fox Grant recipients, we have done a significant
amount of outreach with the program since its inception. From October
2023 to July 2024, AWP produced results:
-1,818 warriors screened for suicidal ideation using the
Columbia-Suicide Severity Rating Scale
-13 percent disclosed some level (low, moderate, high) of
suicide risk (235)
This rate of outreach, screening, and eligibility is consistent
with past years.
The SSG Fox Grant Program is working. Veterans who are both inside
and outside the VA and VSO system and in need of assistance are being
identified.
Relationships are being built and connections with resources made.
Since Fox Grant Inception, 370 veterans have trusted AWP with their
thoughts of suicide while only 6 percent of those warriors were seeking
assistance for a mental health related issue to begin with. This is a
success story and asking ``the question'' works. AWP, the VA, and
Congress have all played an integral part in saving these veterans, but
there is more that can be done.
Coordination:
AWP is thankful for the inclusion of language that directs
briefings for VA employees about the SSG Fox Grant program. It's
important for organizations in the community and the VA to all
coordinate together. It is our hope that grant recipients will be
invited to these briefings and work together to improve communication
and ``warm hand-offs'' of individual cases as they arise. Previously,
many VA staff members had no idea what the Fox Grant is or why grantees
were calling asking for assistance with a ``Fox Participant.'' Ensuring
a bi-direction, solid working relationship with local Suicide
Prevention Coordinators and VA staff is essential, as is more education
to frontline staff on the SSG Fox Grant. Accordingly, as an advocate
for veterans who trust us, it is essential for the VA to communicate
back to grantees their plan and status of that veteran.
Screening Questionnaires:
Next, AWP is very grateful for the inclusion of language in H.R.
9438 that eliminates some of the redundancies and bureaucracy of the
screening questions. As AWP mentioned in previous testimony in December
2023, rarely did veterans make it through all the questionnaires, and
the Columbia Protocol (C-SSRS) has proven to be the most inclusive and
comprehensive set of questions needed to ensure those at risk are
identified quickly and easily.
While the legislation mandates C-SSRS as the only required
screening protocol, AWP recommends adding language that would make the
five follow-on assessments optional. Rarely do veterans make it through
all five of the VA-mandated assessment questionnaires, and it has
become burdensome on staff as well. Instead, the focus should be on
ensuring the veterans have access to resources and not focusing on
answering redundant questions.
Crisis Intervention:
In H.R. 9438, the section on ``Emergent Suicide Care'' is a strong
addition. In many instances, AWP has used the 988-emergency crisis line
to help veterans identified through Fox Grant outreach. This language
helps codify support and resources available to those who are unable to
obtain services in the crucial 72-hr window after first contact.
Clearly Defined Pathway for Eligible Individuals:
The addition of the Emergent Care section in H.R. 9438 is very
helpful. However, AWP recommends adding a section that clearly lays out
the expectations for the program itself and identifies boundaries for
the VA and organizations. While AWP does all it can to provide
connections to referrals and resources, AWP is not a direct service
provider. It is clearly outlined in the scope of the grant proposal.
However, the line has become muddied and expectations are often
unclear.
To fix this, it would be helpful to add a section that requires a
specific program ``on-ramp'' for veterans identified by grant
recipients that need VA care. The process does not need to be complex
or burdensome. Since grant recipients have already asked the required
questions and processed the information, passing along the information
to the VA without burdening the veterans themselves again with tiring,
frustrating, redundant questions (which sometimes involve discussing
traumatic experiences) would dramatically increase the success rate of
the program as well as assist the veteran more efficiently.
This can be done in several ways. For example, requiring that after
grantees go through the required screening procedures, eligible
veterans must be connected with the 988-crisis line or their local VAMC
for expedited care when necessary. In addition, Congress could also
mandate that the VA create a dedicated phone line for intakes from
grantees that would offer expedited care.
Accountability:
The SSG Parker Gordon Fox Suicide Prevention Grant Program is
working. To keep the program successful, we need to ensure all
organizations that are receiving grants in the program are held to
account. The $750,000 grants come from the trust Congress and the
American taxpayers have in our organizations, and AWP holds that trust
in the highest regard. Accordingly, AWP holds itself to account
regularly with audits and reviews, and we work hard to ensure these
funds are maximized efficiently to find veterans in the community and
serve them.
At AWP, we hope all other grantees are holding themselves
accountable with the same high standards. However, Congress and the VA
must also hold organizations accountable with verifiable metrics. AWP
recommends adding a section requiring the VA develop accountability
metrics that report outreach, referrals, etc--and then require regular
reports to Congress. It is the only way to find if some organizations
are not fulfilling their responsibility under the program.
For the metrics themselves, it's hard to identify specific keys to
success. However, AWP believes the best way to look at program success
is to measure the number of screened individuals and the number of
eligible veterans, in addition to outreach completed to document
efforts toward identifying those in need.
While accountability and metrics are vital, the Data Collection
Tool (DCT) implemented by the VA at the end of 2023 has had the
opposite of its intended effect. While developed to streamline data
submission previously completed in thousands of pdf documents, the
result has been a standstill in reporting for many grantees. The SSG
Fox Grant Program assessments are meant to be anonymous. The DCT now
requires a participant's Date of Birth and Social Security Number to
enter any data shared in the DCT. AWP has gone from reporting nearly
all data to less than 5 percent. Previously, the program was hindered
by the redundancy of assessments and lack of incentive to complete them
multiple times. Now that is compounded by the obvious lack of anonymity
that comes with providing your PHI to the VA for an ``anonymous
program.'' AWP hoped the DCT would save both AWP staff and clients from
repetitive and exhausting data reporting, but unfortunately it has only
diminished any data collection the VA hoped to gain through this grant.
In February 2024, the VA asked for suggestions on how to remedy
this issue. AWP has suggested returning to participant identification
numbers that were previously used to report data (created and tracked
only by the reporting agency) rather than PHI of participants. This
issue remains despite repeated acknowledgements by VA staff that data
is not being adequately captured with the DCT as it is.
Grantee Funding:
For AWP, the only limitation in being more successful with the
program is funding. If the ceiling on the grants was doubled overnight,
so would AWP's outreach efforts.
Accordingly, while $750,000 has been the limit on SSG Fox Grants to
date, there are organizations, like AWP, who have successfully utilized
the grant and could do more with more. While not for all organizations,
raising the ceiling could be beneficial if done correctly. Again, it
would require metrics and reporting.
Members of the Subcommittee, thank you again for the opportunity to
testify today. We look forward to our continued work together and would
like to thank each of you for all your hard work and dedication to
those who served in our Nation's armed forces.
Prepared Statement of Clark Pennington
The Independence Fund was established in 2007 to empower our
Nation's catastrophically wounded, injured, or ill Veterans, by helping
them cope with and overcome the physical, mental, and emotional wounds
sustained in service. The Fund is dedicated to improving the lives of
Veterans and their families through a range of programs including
Mobility, Caregiver Support, Advocacy, Casework, Operation RESILIENCE,
Independence@Home, and other Family oriented initiatives, The
Independence Fund strives to bridge the gaps in care across all these
areas and offers comprehensive support to Veterans and their families
in need by working with the Department of Veterans Affairs, Department
of Defense Health Agency, State level agencies, non-profit entities,
and private mental health professionals.
The Independence Fund is honored to present its views on the
legislation that impacts catastrophically disabled veterans and their
caregivers.
Draft Legislation to amend title 38, United States Code, to include a
representative of the National Association of State Veterans Homes to
the Geriatrics and Gerontology Advisory Committee of the Department of
Veterans Affairs.
This bill amends section 7315(a) of title 38, USC, requiring the
Under Secretary of Health to consult with the President of the National
Association of State Veterans Homes (NASVA) when selecting members for
appointment to the Geriatrics and Gerontology Advisory Committee. This
legislation will also require that the Committee include one
representative who holds a professional license in nursing home
administration and is a member of the National Association of State
Veterans Homes.
The Independence Fund supports this legislation. No other
association is more qualified at understanding the needs of aging
veterans than members of NASVH, and as such, their participation will
be an invaluable in advising the Under Secretary of Health and
assessing the capabilities and needs of VA's obligation to care for our
aging veteran population.
Draft Legislation to direct the Secretary of Veterans Affairs to carry
out a pilot program to provide grants to outpatient mental health
facilities for the provision of culturally competent, evidence-based
mental health care for veterans, and for other purposes.
The Independence Fund holds no position on this legislation.
Draft Legislation to amend title 38, United States Code, to require
that non-citizen appointees to positions in the Veterans Health
Administration are subjected to background investigations prior to
employment.
The Independence Fund holds no position on this legislation.
Draft legislation to amend title 38, United States Code, to permit the
voluntary transmission of patient contact information to certain
religious or faith-based organizations by chaplains employed by the
Department of Veterans Affairs, and other purposes.
The Independence Fund holds no position on this legislation.
H.R. 9438, a bill to amend and reauthorize the Staff Sergeant Parker
Gordon Fox Suicide Prevention Grant Program of the Department of
Veterans Affairs.
This legislation includes four main provisions. First, the bill
limits the amount of the grant that can be used on food and non-
alcoholic drinks. This is a commonsense amendment that ensures grant
recipients are using the bulk of the funding to provide services.
Second, the bill requires quarterly updates to VA personnel on grant
recipients that are within 100 miles of the VAMC to better educate and
coordinate available services the grant recipients provide. Third, this
bill requires VA to refer a veteran who needs emergent suicide care to
the community if VA cannot provide that care within 72 hours. Last,
this legislation will extend the program until September 30, 2027.
Veterans who are in crisis cannot wait for care. The Independence Fund
fully supports this legislation.
H.R. 9324, a bill that amends title 38, United States Code, to
authorize certain health care professionals employed by the Department
of Veterans Affairs to deliver, distribute, or dispense to veterans
certain controlled medications via telemedicine under certain
conditions, and of other purposes.
The Independence Fund supports this legislation. VA is a leader in
the use of telemedicine, working to improve access to care regardless
of where veterans live or their preferred mode of receiving care should
continue to be a priority. A gap in current law, that has been
temporarily lifted in response to COVID-19 and is set to expire on
December 31, 2024, prevents VA providers from prescribing controlled
substances without an in-person medical examination. This legislation
will make this authority permanent to VA providers, allowing for
increased access and functionality to VA's robust telehealth
capabilities.
Draft legislation that directs the Secretary of Veterans Affairs to
carry out a pilot program under which the Secretary may fill vacant
shifts at medical facilities of the Department of Veterans Affairs with
non-Department health care providers.
The VA currently is under a 5-year, indefinite delivery/indefinite
quantity contract with the medical staffing company, Aptive, to provide
staffing services for all levels of clinical care and administrative
support. If this contract is insufficient to fulfil VA's needs, The
Independence Fund recommends modifying the current contract.
H.R. 9478, a bill to amend title 38, United States Code, to include
adaptive prostheses and terminal devices for sports and other
recreational activities in the medical services furnished to eligible
veterans by the Secretary of Veterans Affairs.
The Independence Fund fully supports this much needed amendment to
law. VA currently applies a 2017 regulation ``Prosthetic and
Rehabilitative Items and Services, 38 CFR Part 17 that specifies when
``adaptive recreation equipment'' within prosthetics may be approved,
allowing for ``an item that is designed to compensate for, or that, by
design compensates for, loss of physical, sensory, or cognitive
function and is necessary for a veteran to actively and regularly
participate in a sport, recreation, or leisure activity to achieve the
veteran's rehabilitative goals.'' This language limits approval of
these adaptive and recreational prosthetics when they are specifically
part of a medical goal, and not for long term life and health goals
that are described as ``for personal enjoyment.'' This regulation
ignores VA's philosophy of ``whole health.'' Veterans who have lost a
limb and what to begin, return to, or maintain an activity that keeps
them active improve social engagement and psychological and physical
health and should not have to be subject to specific medical goals.
Draft legislation to require the Secretary of Veterans Affairs to award
grants to nonprofit organizations to assist such organizations in
carrying out programs to provide service dogs to eligible veterans, and
for other purposes.
Research studies have found that veterans who have PTSD see a 66
percent reduction in symptoms within 3 months of being paired with a
service dog. This research found that the presence of the service dog
lowers anxiety and depression, improves social functioning and
relationship health, and interrupts panic attacks. Unfortunately, the
capability of organizations to train and provide service dogs does not
meet the demand. This legislation will provide grants to nonprofit
organizations to increase the number of dogs that can be trained to be
service animals. This is a small investment to increase access to a
clinically proven method of improving veterans' mental health. The
Independence Fund is proud to support this legislation.
H.R. 9146, a bill to amend title 38, United States Code, to require the
consideration of continuity of health care in determining best medical
interest under the Veterans Community Care Program, and for other
purposes.
This legislation amends Section 1703(d)(2) of title 38 to include
continuity of care as a consideration for referral to community care.
1703 (a)(2)(B) requires the Secretary of Veterans Affairs to ``ensure
continuity of care and services'' when coordinating non-VA hospital
care. However, under subparagraph (d) ``Conditions Under Which Care Is
Required To Be Furnished Through Non-Department Providers'' there is no
mention of continuity of care as a factor for consideration in
determining the bast medical interest for when and where a veteran
receives care. This legislation includes continuity of care in the list
of considerations a provider can use to ensure veterans get non-
disrupted care. The Independence Fund suggests that the bill be amended
to include guidelines that will prevent CCN providers from requesting
additional authorization of care without that care being approved by
the PCP or the VA provider who initially authorized the care.
Draft legislation to amend title 38, United States Code, to make
improvements relating to conflicts of interest for certain Department
of Veterans Affairs employees, and for other purposes.
The Independence Fund does not hold a position on this legislation.
H.R. 9301, a bill to direct the Secretary of Veterans Affairs to
include two counties in New Mexico in a certain Veteran Integrated
Service Network.
The Independence Fund does not hold a position on this legislation.
H.R. 6291, the ``Have You Served Act''
Many State and local governments and community organizations
provide benefits and services to military veterans and their families,
but all too often veterans are unaware of the benefits. This grant
program provides funds to human resource offices in these agencies and
organizations to train frontline employees on how to ask about military
service as well as build campaigns to proactively inform the veteran
community of the programs and services that are unique to that
community. The Independence Fund fully supports this legislation.
H.R. 6330, the ``Veterans' Sentinel Act''
Every effort must be taken to understand and mitigate the
circumstances that lead to suicide. It is particularly disturbing when
a veteran dies by suicide on a VA campus. This should signal to VA and
advocates alike that the system designed to provide mental health care
is inadequate. The Veterans' Sentinel Act call on the Secretary to
establish a pilot that would form a working group to collect and
analyze data regarding on-campus attempted and completed death by
suicide. Importantly, this legislation requires the working group,
through the Secretary, to send a report to the House and Senate
Committees on Veterans Affairs that outlines any recommendations that
can lead to the reduction of suicide attempts on VA campuses. The
Independence Fund fully supports this legislation.
H.R. 7504, the ``Rural Veterans Transportation to Care Act''
H.R. 7504, the ``Rural Veterans Transportation to Care Act'' amends
current law, allowing transportation grants to include rural regions,
which account for 2.7 million enrolled veterans. By expanding access to
this population, veterans will have easier access to VA's direct care
services. Additionally, this bill will increase the grant amount to
modify vehicles to comply with ADA requirements. Both of these
provisions are necessary to care for veterans who are catastrophically
disabled.
H.R. 8562, the ``Parity for Native Hawaiian Veterans Act of 2024''
The Independence Fund holds no position on this legislation.
Prepared Statement of Jon Retzer
Chairwoman Miller-Meeks, Ranking Member Brownley and Members of the
Subcommittee:
Thank you for inviting DAV (Disabled American Veterans) to testify
at today's legislative hearing of the Subcommittee on Health. DAV, a
congressionally chartered non-profit veterans service organization
(VSO), is comprised of nearly one million wartime service-disabled
veterans. Its single purpose is to empower veterans to lead high-
quality lives with respect and dignity. DAV is pleased to offer our
views on the bills under consideration today by the Subcommittee.
H.R. 6291, the Have You Served Act
H.R. 6291, the Have you Served Act, would require the Department of
Veterans Affairs (VA) to provide grants to eligible organizations for
the purpose of conducting ``Ask the Question Campaigns'' encouraging
human services professionals, State and local governments and community
providers to ask whether someone has served in the military. By
promoting the question ``have you served?'', the bill seeks to raise
awareness about veteran status among health care providers, social
service agencies, and the general public. Improved identification of
veterans can lead to better access to VA benefits and services and
addressing unmet needs within the veteran community.
While DAV does not have a specific resolution on this matter, the
bill could potentially get veterans who are unaware of their veteran
status access to earned benefits and health care services. For these
reasons DAV supports H.R. 6291, in accordance with our Statement of
Policy, which calls for enhanced outreach to ensure that all disabled
veterans receive the benefits they have earned through their military
service.
H.R. 6330, the Veterans Sentinel Act
H.R. 6330, the Veterans Sentinel Act, would address the issue of
veteran suicides on VA property by implementing a pilot program within
the VA.
This bill would require the VA to set up a working group within the
Office of Mental Health and Suicide Prevention for the purpose of
gathering and analyzing data on veteran suicides and attempted suicides
that occur on VA property. The working group would unify disparate
sources of data related to on-campus suicides to improve the accuracy
and comprehensiveness of the information collected. Furthermore, the VA
would analyze the statistical trends of suicides and attempted suicides
at VA facilities annually and be required to report on policies,
staffing and resource levels and suggest preventive actions for these
incidents.
DAV supports H.R. 6330, the Veterans Sentinel Act, in accordance
with DAV Resolution No. 224, which supports program improvement and
enhanced resources for VA mental health programs and suicide prevention
efforts. We do however, suggest the bill be amended across all veteran
care settings to include gathering information on suicide attempts and
deaths within the Veterans Community Care Program (VCCP) as well. This
expanded study should encompass onsite VCCP suicides and any suicides
occurring within 24 hours of Community Care Network (CCN) contact. This
timeframe aligns with the VA's current practice for root cause
analyses, a standard not yet adopted by the VCCP.
H.R. 7504, the Rural Veterans Transportation to Care Act
The goal of H.R. 7504, the Rural Veterans Transportation to Care
Act, is to improve veterans transportation options to VA medical
facilities for veterans living in rural areas.
Veterans living in rural areas can face challenges that lead to
disparities in access and quality of health care compared with their
urban counterparts. This bipartisan bill would expand eligibility to
the VA's Highly Rural Transportation Grant Program, which provides
grant funding for veteran service organizations and State veterans
service agencies to provide veterans transportation in eligible
counties by increasing the maximum amount of funding granted to
purchase an ADA-compliant vehicle.
The bill would also modify the existing grant program to include
both rural and highly rural counties, by redefining ``rural'' and
``highly rural'' using Rural-Urban Commuting Area (RUCA) designations
to better account for population density, urbanization, and commuting
patterns.
Our nation's 2.4 million veterans living in rural areas often face
unique difficulties accessing VA health care that those living in urban
and suburban areas do not. Chief among them is transportation to VA
medical facilities. The nearly 300,000 veterans living in areas
considered highly rural face even greater obstacles and deserve
increased attention to assistance in accessing VA's high-quality health
care.
DAV is proud to support H.R. 7504, the Rural Veterans
Transportation to Care Act, in accordance with DAV Resolution No. 42,
which calls for ensuring sufficient access to care to meet the health
needs of veterans residing in rural or remote areas. This bill would
help the VA provide more rural veterans better access to health care
and help ensure our Nation keeps its promises to America's veterans.
H.R. 8562, the Parity for Native Hawaiian Veterans Act of 2024
H.R. 8562, the Parity for Native Hawaiian Veterans Act of 2024,
would amend title 38, United States Code, and make modifications to the
program for direct housing loans and medical care services from the
Department of Veterans Affairs for Native Hawaiians.
The bill would modify the definition of Native Hawaiian veterans
and aims to improve access to medical care for Native Hawaiian veterans
by eliminating copays for services received through the VA, and
enabling the Native Hawaiian Health Care System to seek direct
reimbursement for certain costs from the VA.
DAV has no resolution on this issue and takes no position on the
bill.
H.R. 9146, the Ensuring Continuity in Veterans Health Act
H.R. 9146, the Ensuring Continuity in Veterans Health Act, would
ensure that continuity of health care is considered when determining
the best medical interest under the Veterans Community Care Program
(VCCP).
The proposed legislation would amend title 38, United States Code,
to ensure that continuity of health care is a factor considered in
determining the best medical interest for veterans using the VCCP. This
would be achieved by adding a new subparagraph to Section 1703(d)(2) of
title 38, which explicitly includes continuity of care as a
consideration. The amendment does not specify the definition of
continuity of care or its requirements. The focus is solely on
expanding the criteria used by a provider to evaluate the best medical
interests of a veteran within the existing framework of the VCCP when
VA services are not readily available.
It appears the bill aims to ensure that veterans are able to
maintain consistent relationships with their health care providers and/
or complete an episode of care when referred to care in the community.
We agree it is important that VA maintain quality and consistency of
health care services provided to veterans and believe VA already has
the authority to consider continuity of care as a factor under the
existing statute. At the same time, it is important to point out that
numerous research studies have shown that care provided by the VA
direct care system is of comparable and often superior quality to that
provided by private sector providers and may have other advantages from
coordination and continuity of care perspectives.
H.R. 9301, New Mexico Rural Veteran Health Care Access Act
H.R. 9301, the New Mexico Rural Veteran Health Care Access Act,
would add two new counties in New Mexico as part of the VA's Veterans
Integrated Service Network (VISN) 17. The new areas to be included in
the VISN would be Eddy and Otero counties.
Currently, Eddy and Otero counties are part of VISN 22, which
covers most of the State of New Mexico. VISN 17 covers all of Texas and
small portion of eastern and southeastern New Mexico. This legislation
would bring together the final two counties in the southeastern portion
of New Mexico and include them in VISN 17.
DAV does not have a resolution specific to VA's VISN system;
however, we do not have an objection to the bill's intent to address
regional disparities in access to veterans' health services.
H.R. 9324, Protecting Veteran Access to Telemedicine Services Act
This bill aims to permanently extend a pandemic-related exemption
that allows VA health care professionals to deliver, distribute, and
dispense medically necessary controlled substances to veterans via
telemedicine, even if they have not conducted the in-person medical
examination.
By removing the requirement for an in-person visit, the bill aims
to make health care more accessible for veterans who reside in remote
or underserved areas. Last, this bill would ensure that veterans can
continue to receive their medications without interruption, even if
they cannot physically visit a VA facility.
DAV supports H.R. 9324, in accordance with DAV Resolution No. 42,
which supports the right of rural veterans to be served by the VA to
the maximum extent practicable and calls for the VA to overcome
barriers to care for rural veterans by continuing to improve access to
telehealth care initiatives.
H.R. 9427, to direct the VA Secretary to carry out a pilot program to
provide grants to outpatient mental health facilities for the provision
of culturally competent, evidence-based mental health care for veterans
H.R. 9427 would direct the Secretary of Veterans Affairs to carry
out a pilot program to provide grants to non-VA outpatient mental
health facilities to ensure the delivery of culturally competent,
evidence-based mental health care for veterans.
This bill recognizes the importance and expertise VA provides in
the delivery of specialized mental health services to veterans. In
doing so, it highlights the need to ensure high-quality, evidence-based
care when a veteran is referred to the community for services.
Although DAV Resolution 224 calls to support program improvement
and enhanced resources for VA mental health programs and suicide
prevention to address the mental health needs of veterans and ensure
they receive high-quality, accessible care, we have concerns with this
bill. Specifically, that it could potentially weaken the VA's
integrated health care system, which conflicts with DAV Resolution 403,
calling for strengthening and protecting the VA health care system.
Veterans in need of mental health care are eligible for care via
the Veterans Community Care Program (VCCP) if the VA cannot provide it
within 20 days or 30 minutes of drive time. This bill would create a
system parallel to the existing VCCP and introduces a new structure
with competing eligibility rules. For veterans receiving care through
the MISSION Act, VA serves as the authorizer of community care when a
veteran is eligible. For veterans receiving care through the grant,
VA's role in authorizing community care would be bypassed, which
eliminates VA as the default provider of care when available in a
timely and convenient manner. Under this bill, even when VA services
are readily available, a veteran would be entitled to obtain outside
care.
This approach sets a precedent that could extend beyond mental
health care, potentially leading to a system that is the exact opposite
of what MISSION intended, i.e., to rely on community resources to
supplement and not supplant VA care.
The recent VA Red Team Report strongly advised for VA to expand
direct-delivered care and reduce community-delivered health care to
prevent the VA system's collapse. This bill would potentially move in
the opposite direction.
If the goal is to reduce wait times for mental health care access
in VA and VCCP settings, the most effective solution would be to
increase the number of VA mental health clinicians rather than create a
parallel system with little oversight and potentially lower standards
of care. Medical facilities that are not currently participating in the
VCCP who wish to furnish mental health care to veterans should be
actively invited to join the VCCP.
H.R. 9438, No Wrong Door for Veterans Act
H.R. 9438, the No Wrong Door for Veterans Act, would amend and
reauthorize the VA Staff Sergeant Parker Gordon Fox Suicide Prevention
Grant Program (SSG PGFSP), which supports nonprofit community
organizations and government agencies working to serve veterans at risk
of suicide. This grant program utilizes a public health approach and
combines clinical and community-based interventions with a goal of
preventing suicide for veterans inside and outside of the VA health
care system.
The Fox Grant Program allowed VA to implement a comprehensive
mental health screening for grantees to measure the effectiveness of
services. In order to combat veteran suicide and assess program
outcomes, it is vital to examine data on specific interventions.
The March 2024 congressionally mandated report, An Interim Report
on the Provision of Grants through the Staff Sergeant Parker Gordon Fox
Suicide Prevention Grant Program (SSG Fox SPGP), noted under
``Measurement Outcomes'' that grantees spent much of the first year,
since January 2023, building and staffing their programs before
starting to provide services and screening potential eligible
individuals.
Although limited, the data collected from SSG Fox SFGP grantees was
considered to be beneficial for reporting, program management, and
evaluation. VA indicated it is using the initial year's program data to
assess the suitability of benchmarks for future performance standards.
Over time, VA predicts an increase in available data and the potential
for more program graduates. The final report will better assess the
effectiveness, capacity, and the feasibility of expanding grant
provisions.
The No Wrong Door for Veterans Act would appear to limit VA in its
ability to measure Fox Grant recipients who currently evaluate
participants using both pre and post measurements across relevant
metrics. Data collection and assessment will help VA make better
decisions regarding program effectiveness and the needs for future
resource allocation and we believe it is critical to maintain a robust
set of metrics and evaluation tools, particularly during the early
phase of this program.
The No Wrong Door bill would also implement new access standards
that enforce a 72-hour deadline for the VA to deliver services after a
veteran is referred for follow-up care for non-suicidal, non-emergency
mental or behavioral health. This provision dramatically shortens the
timeliness standard for VA mental health care for Fox Grantee veterans
from the current 20-day standard to a mere 72 hours. If the VA fails to
meet this timeline, the veteran would automatically become eligible for
non-VA care, even outside of the Veterans Community Care Program, in
line with the COMPACT Act standard, which ensures that mental health
care is available anywhere for veterans who are in mental health crisis
and at imminent risk for suicide. We are concerned that this
unrealistic and unworkable new standard could undermine VA's efforts to
provide coordinated mental health care to veterans.
This provision has the potential to negatively affect the VA health
care system and the veterans it serves.
Draft bill to include a representative of the National Association of
State Veterans Homes on the VA Geriatrics and Gerontology Advisory
Committee
This draft legislation would require the VA to include a
representative from the National Association of State Veterans Homes,
who holds a professional license in nursing home administration, on its
Geriatrics and Gerontology Advisory Committee (GGAC).
The VA's GGAC was created in 1980 to address challenges VA faced
related to caring for a large influx of aging World War II veterans.
One of the committee's main duties is to assess the capabilities of
VA's health care facilities to respond with effective and appropriate
care and services to address the medical, psychological, and social
needs of older/aging veterans.
DAV has no specific resolution that addresses who should be
appointed as a member of the VA's GGAC; however, the experience and
expertise of a representative from the National Association of State
Veterans Homes could be beneficial to the Committee's work and we have
no objection to this draft bill moving forward.
Draft bill to require that non-citizen appointees to positions in the
Veterans Health Administration are subjected to background
investigations prior to employment
This draft legislation would require that non-citizen appointees
undergo a background investigation prior to their employment with the
VA. Currently, a non-citizen appointee may be hired by VA on a
temporary basis under title 38, United State Code.
While DAV has no resolution that addresses VA hiring practices for
non-citizen appointees, according to VA, these appointees are subject
to background investigations. Furthermore, as part of VA's Personnel
Security and Suitability Program, all employees, including non-
citizens, are required to meet the necessary security and suitability
standards before being hired by VA.
Draft bill, the Enhancing Faith-Based Support for Veterans Act
This draft legislation would allow a VA chaplain to send a
veteran's contact information to a non-VA religious or faith-based
organization. Once the VA chaplain has completed a spiritual
assessment, the veteran must approve/elect to have their contact
information shared with a non-VA religious or faith-based organization.
The spiritual assessment includes the medical treatment plan of the
veteran as well as their personal spiritual information.
While DAV has no resolution that addresses this matter, we have no
objection to ensure that veterans have access to a wide range of
supportive services, including those offered by faith-based
organizations.
Draft bill, Safeguarding VA's Healthcare Workforce Act
This draft bill would establish a 3-year pilot program that allows
the VA to fill vacant shifts at its medical facilities with non-
Department health care providers once the number of vacant shifts
reaches a minimum threshold, predetermined by the Secretary.
This initiative could help address staffing shortages and ensure
that veterans receive timely and quality care. By leveraging non-
Department health care providers, this program could improve veterans'
access to care, especially in underserved areas.
That said, it is important that VA continue to work diligently to
ensure appropriate hiring and retention practices are exercised and
that internal VA staffing levels continue to be strengthened.
DAV supports this draft bill in accordance with DAV Resolution No.
403, which calls for VA to provide timely and convenient access to care
for enrolled veterans, and for VA to remain the primary provider and
the coordinator of care, while continuing to optimize the use of
community care networks to fill in gaps, particularly in rural and
remote areas.
Draft bill, to include adaptive prostheses and terminal devices for
sports and other recreational activities in the medical services
furnished to eligible veterans by the Secretary of Veterans Affairs
This draft bill would include adaptive prostheses and terminal
devices for sports and other recreational activities in the medical
services furnished to eligible veterans by the Secretary of Veterans
Affairs. A terminal prosthetic device is one that works by means of
cables to create voluntary opening and closing for managing a grip.
Amending current medical-services law would be a significant step
in enhancing the quality of life for many veterans. The proposed
amendment would ensure that veterans have access to adaptive prostheses
specifically designed for sports and recreational activities. This can
include specialized limbs for running, swimming, cycling, and other
activities. By providing these adaptive devices, the amendment aims to
promote physical activity and overall well-being among ill and injured
veterans, helping them to engage in sports and recreational activities
that they enjoy and need to maintain their fitness and independence.
The amendment would establish guidelines for veterans to be
eligible for these devices, guaranteeing access through the VA for
those in need. VA would not only provide such devices, but also offer
training and support to help veterans effectively use their new
prostheses. Furthermore, the amendment could stimulate the exploration
and creation of new adaptive technologies, guaranteeing veterans have
access to state-of-the-art prosthetic and adaptive devices.
DAV supports this draft bill in accordance with DAV Resolution No.
429, which supports sufficient funding for VA prosthetics and sensory
aids service and timely delivery of prosthetic items, promoting
physical activity and overall well-being among veterans, helping them
to engage in sports and recreational activities that they enjoy.
Draft bill, Service Dogs Assisting Veterans Act (SAVES Act)
The SAVES Act would establish a 5-year pilot program to require the
Secretary of Veterans Affairs to award grants to nonprofit
organizations, accredited by Assistance Dogs International or the
International Guide Dog Federation, to assist in providing service dogs
to eligible veterans. The bill would also provide for the training of
the dogs to assist veterans with various mental health and physical
conditions. This bill would also provide each veteran who receives a
dog through the grant program a commercially available veterinary
insurance policy for the service dog.
DAV supports this draft bill in accordance with DAV Resolution No.
590, which supports a consistent benefit for service dogs, to include
that any veteran for whom a service dog is prescribed receives the dog
at no cost; there is reimbursement for any follow-up training deemed
appropriate; and a veterinary benefit provided for the life of that
service dog.
Draft bill to make improvements relating to conflicts of interest for
certain Department of Veterans Affairs employees
This draft bill seeks to make improvements relating to conflicts of
interest for certain VA employees.
Currently, title 18, United States Code, Sec. 208 addresses
conflicts of interest for Federal employees, including those at the VA.
This law prohibits Federal employees from participating personally and
substantially in any government matter that could affect their own
financial interests or those of their family members, business
partners, or organizations they are affiliated with. This law ensures
that Federal employees, including VA researchers, maintain the highest
standards of integrity and avoid any actions that could compromise
their objectivity.
In the past, researchers could freely discuss the science with both
VA and their academic affiliate without conflict, except for the
funding and research agreement. Recognizing their erroneous historical
interpretation and the potential legal risks, the VA Office of General
Counsel (OGC) concluded that science, funding, and research agreements
are all crucial aspects of the matter. Due to this OGC decision,
employees working on the matter or research topic must secure a waiver
prior to proceeding.
Initially planned for March, the policy's enforcement was deferred
by VA until at least September 30, 2024. The absence of a policy for
pursuing waivers at VA significantly impacts thousands of researchers
by substantially delaying approval of research projects, as they
require approval from both OGC and local VAMCs.
Although DAV does not have a resolution specifically addressing
conflict of interest matters for Federal/VA employees, research is a
critical part of VA's mission of serving our Nation's ill and injured
veterans. For these reasons, we suggest that measures taken to address
this issue should focus on maintaining quality researchers and
employees. VA must ensure that their work can continue without undue
administrative burdens.
This concludes my testimony on behalf of DAV. I am pleased to
answer questions you or members of the Subcommittee may have.
Statements for the Record
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Prepared Statement of U.S. Office of Government Ethics
The U.S. Office of Government Ethics (OGE) is pleased to provide
its views on proposed legislation to amend title 38, U.S. Code, to
provide exceptions to the criminal conflict of interest laws, 18 U.S.C.
Sec. Sec. 203, 205, and 208, for employees of the Department of
Veterans Affairs (VA) who concurrently hold outside positions with
certain outside employers. OGE has not reviewed and takes no position
on other pending legislation being considered at this hearing.
OGE appreciates VA's and the Subcommittee's ongoing work to address
the complex balance between recruitment and retention of qualified VA
medical personnel and the need to protect government processes from
abuse and conflicts of interest. OGE is concerned, however, that the
draft legislation does not effectively balance these competing
equities. As written, the draft legislation would disturb the carefully
balanced conflict of interest program that has existed for the past 60
years by providing overly broad exemptive relief, reducing oversight
and transparency in the process of waiving the conflict of interest
laws, and creating inconsistent treatment between dually appointed VA
scientists and other scientists. More importantly, OGE believes that
the existing legal framework is flexible enough to provide exemptive
relief in many cases in which there is a legitimately low risk of an
actual conflict of interest.
I. Current Law and Effect of Proposed Legislation
Congress enacted 18 U.S.C. Sec. Sec. 203, 205, and 208 as part of
omnibus legislation updating the Federal bribery, conflict of interest,
and graft laws in 1962.\1\ These laws were promulgated carefully, with
the goals of not only strengthening limitations on conflicts but also
ensuring that the government could access qualified experts from
outside government, particularly scientists.\2\
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\1\ Modern Bribery, Graft and Conflict of Interest Law, P.L. 87-
849, 76 Stat. 1119 (1962). Additional conflict of interest laws are
found in chapter 11, title 18, of the United States Code. Employees of
the executive branch are also covered by comprehensive standards of
conduct found in 5 C.F.R. part 2635.
\2\ H. Rep. 748, 87th Cong., 1st Sess. 4 (1961); S. Rep. No. 2213,
87th Cong., 2d Sess. (1962).
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Section 208 provides that an employee may not participate in any
particular matter in which, to the employee's knowledge, the employee,
a spouse, minor child, general partner, or any ``organization in which
[the employee] is serving as officer, director, trustee, general
partner or employee, or any person or organization with whom [the
employee] is negotiating or has any arrangement concerning prospective
employment'' has a financial interest.\3\ While the prohibition is
broad, it provides several authorities that allow OGE or an agency to
waive insubstantial conflicts of interest. These authorities include
personalized waivers\4\ and regulatory exemptions.\5\ The draft
legislation would change this framework by creating two special
exemptions at 38 U.S.C. Sec. Sec. 7302(f)(1) and 7303(e)(1) that would
allow dually appointed VA employees to participate in health profession
education and research particular matters affecting the financial
interests of their outside employers--so long as they do not make a
final, binding determination related to that matter--notwithstanding 18
U.S.C. Sec. 208(a).
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\3\ 18 U.S.C. Sec. 208(a). For OGE regulations interpreting and
providing guidance on Sec. 208, see 5 C.F.R. pt. 2640.
\4\ 18 U.S.C. Sec. 208(b)(1). Agencies must confer with OGE prior
to issuance of an individualized waiver whenever practicable, provide
OGE with a copy of each executed waiver, and make each executed waiver
available to the public upon request. OGE is committed to reviewing
waivers as fast as possible while meeting its responsibility to
objectively review the facts of each case to ensure the statutory
standard is met.
\5\ 18 U.S.C. Sec. 208(b)(2).
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Section 205 provides that an employee may not represent an outside
party before the Federal Government in relation to any particular
matter in which the United States has a direct and substantial
interest.\6\ Section 203 provides that an employee may not receive any
compensation for representational services provided by themselves or
another person in any particular matter in which the United States has
a direct and substantial interest.\7\ Although these two laws apply to
all government employees, there are several exemptions, including
exemptions for intermittent and temporary appointees.\8\ These
exemptions balance the need for specialized expertise from outside the
government with the need to prevent these employees from using their
positions to unfairly advantage their outside employer. The draft
legislation would change this framework by creating two special
exemptions at 38 U.S.C. Sec. Sec. 7302(f)(2) and 7303(e)(2), allowing
dually appointed VA employees to lobby the government on behalf of
their outside employers on health profession education and research
matters, as well as receive compensation for those communications,
notwithstanding 18 U.S.C. Sec. Sec. 203 and 205.
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\6\ 18 U.S.C. Sec. 205(a)(2).
\7\ 18 U.S.C. Sec. 203(a).
\8\ 18 U.S.C. Sec. Sec. 203(c), (e); 18 U.S.C. Sec. Sec. 205(c),
(f).
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II. Concerns Regarding Proposed Legislation
OGE is concerned that the draft legislative exemptions to 18 U.S.C.
Sec. Sec. 203, 205, and 208 are overbroad and lack the necessary
protections against substantial conflicts of interest found in current
law. Unlike current exemptions to 18 U.S.C. Sec. 208, which are only
available when a conflict of interest is insubstantial, remote, or
inconsequential,\9\ the proposed legislation would allow an employee to
participate in any health profession education or research particular
matter regardless of how substantial the potential financial gain to
their home institution--potentially including multi-million-dollar
contracts, grants, cooperative agreements, and other financial
assistance arrangements. In addition, by enacting exemptions to 18
U.S.C. Sec. Sec. 203 and 205, dually appointed VA employees would be
free to both lobby for benefits on behalf of their outside employer and
participate in the decision to grant those same benefits in their
official role, so long as they were not the final signatory. Without
necessary safeguards, dually appointed VA researchers could be placed
in the position of making decisions not because it is the right thing
to do, but because it advantages their home institution.
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\9\ See 18 U.S.C. Sec. 208(b)(1)-(2).
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OGE is also concerned that the draft legislation would remove
important checks and balances that ensure that waivers and exemptions
are done in an accountable and transparent way. For example, agencies
are currently required to consult with OGE prior to issuing individual
waivers when practicable and must make those waivers public upon
request.\10\ Likewise, OGE provides centralized review and issuance of
regulatory exemptions to 18 U.S.C. Sec. 208.\11\ OGE's involvement
ensures that those waivers and exemptions are consistent with the
statutory criteria and that these authorities are not subject to abuse.
The proposed legislation does not contain similar checks and balances
as the existing conflicts of interest statutes.
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\10\ 18 U.S.C. Sec. 208(d)(1).
\11\ 18 U.S.C. Sec. 208(b)(2).
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OGE is likewise concerned that the draft legislation would treat
dually appointed VA researchers differently than other VA employees and
other scientists and medical professionals that work for other
agencies.\12\ Avoiding inconsistent treatment and a proliferation of
``nonuniform ad hoc exemptions'' was one of the principal reasons
Congress established a single, uniform set of conflict of interest
rules.\13\
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\12\ Congress recently enacted a limited exemption to 18 U.S.C.
Sec. 209 for dually appointed VA researchers. See Consolidated
Appropriations Act, 2023, P.L. 117-328, Sec. 182, 136 Stat. 5436
(2023) (codified at 38 U.S.C. Sec. 7382(b)). While that provision has
no effect on the views in this statement, OGE notes that there are more
safeguards that apply to that provision than are found in this draft
legislation, including a requirement that the Secretary authorize use
of the exemption in writing.
\13\ H. Rep. No. 748 at 14.
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Finally, OGE believes that the legislation may be unnecessary. In
instances in which a conflict of interest arising from a health
professional education or research particular matter is insubstantial,
remote, or inconsequential, the VA can issue an individualized waiver
or may be able to work with OGE to promulgate an appropriately scoped
regulatory exemption. Likewise, dually appointed VA employees serving
only intermittently with the government may be able to rely on a pre-
existing exemption or receive an individualized waiver of 18 U.S.C.
Sec. Sec. 203 and 205 to communicate on a grant or contract with the
United States if the VA Secretary has determined it is in the public
interest.
OGE thanks the Subcommittee for the opportunity to present views
related to this draft legislation. OGE stands ready to work with the
Subcommittee and with VA to identify and implement procedures that
ensure the VA can continue to retain qualified VA researchers, while
also limiting the influence of conflicts of interest in the research
and education process. We believe that an approach is possible that
will appropriately balance the needs to secure qualified medical
professionals while protecting Government processes from abuse and
conflicts of interest.
Please do not hesitate to contact us if we may be of additional
assistance.
Prepared Statement of American Federation of Government Employees, AFL-
CIO
Chairwoman Miller-Meeks, Ranking Member Brownley, and Members of
the Subcommittee:
The American Federation of Government Employees, AFL-CIO (AFGE) and
its National Veterans Affairs Council (NVAC) appreciate the opportunity
to submit a statement for the record for the September 11 House
Veterans' Affairs Health subcommittee legislative hearing. AFGE
represents more than 750,000 Federal and District of Columbia
government employees, 304,000 of whom are Department of Veterans
Affairs (VA) employees. AFGE's positions on several of the bills being
considered are below:
H.R. 9146, Ensuring Continuity in Veterans Health Act (Rep. Franklin)
H.R. 9146 requires the Secretary to include ``continuity of care''
as one of the criteria used to determine when private care would be in
the best medical interest (BMI) of a veteran. We oppose this provision
because it will make it harder for VA to bring veterans back to VA from
private care in instances when private care is no longer in the best
interest of the veteran by requiring that continuity of care in the
community be considered as a criterion in determining medical best
interest. This would hamper VA's efforts to reverse excessive
privatization by bringing back more veterans to direct care after
receiving private for-profit care. VA already has flexibility under the
current statute to consider continuity of care if it is in the best
interest of the veteran. But adding it as a required criterion in
determining best interest would limit VA's ability to decide that
transferring a veteran back to the VA from private care is truly in the
best interest of that veteran. This would particularly impact the VA's
ability to rein in costly private care following emergency care by
transferring veterans to VA hospitals after a veteran has been
stabilized. In a recent Hospital Consumer Assessment of Healthcare
Providers and Systems (HCAHPS) survey conducted by the Centers for
Medicare & Medicaid Services, nearly 80 percent of VA medical
facilities received a four or five-star rating compared to only 40
percent of non--VA hospitals. This only adds to an already large body
of evidence that VA provides higher quality care to veterans than
private providers. It therefore is neither in the best interest of the
veteran nor the taxpayer to legislate keeping veterans out of VA where
they receive high-quality care specifically targeted to their needs at
lower cost than private for-profit care.
H.R. 6330, the Veterans Sentinel Act
H.R. 6330 establishes an Office of Mental Health and Suicide
Prevention, a pilot program under which the Secretary establishes a
working group to collect and analyze data regarding on-campus suicides
and on-campus attempted suicides. AFGE supports efforts to improve
suicide prevention by collecting data on direct care suicides and
conducting root cause analysis. However, the bill should be amended to
include parallel data collection and analysis for suicides that happen
when veterans are served at non-VA facilities.
Pilot program to fill vacancies with non-departmental staff
This bill creates a pilot program under which the Secretary would
contract out to fill vacancies at a medical facility with non-
department health care providers. This would create a new program that
fills vacancies with non-department health care workers in addition to
the Integrated Critical Staffing Program (ICSP) for temporary
contractors, which the VA already has in place. The ICSP has already
created a troubling precedent for outsourcing hiring at the expense of
permanent staff. In recent months, VA directed medical centers to
remain FTE-neutral, a policy it applied to permanent workers but not to
contractors. VA has admitted that it needs an additional 5,000 FTE in
Fiscal Year 2025 to meet its direct care needs. If VA continues rely on
this privatization accounting scheme to hire contractors to meet these
needs and not permanent workers, contract workers will effectively
crowd out funding for permanent FTE. Rather than further expanding
costly temporary staffing, the VA should pass a comprehensive
recruitment and retention bill that addresses problematic hiring and
compensation policies.
Veterans' Mental Health Access Act (Chairman Bost)
The Veterans' Mental Health Access Act would create a pilot for a
new program to create non-VA outpatient mental health. This program
would provide grants to nonprofit organizations that have operated at
least one outpatient mental health facility in the United States for a
continuous period of at least 3 years. AFGE opposes creating a parallel
private mental health program that supplants VA's direct care system
rather than supplement it when veterans cannot reasonably access VA
care. Veterans are already eligible for private care if the VA cannot
provide it within 20 days or 30 minutes of drive time. VA, however,
must authorize this care. This bill would undermine the direct care
system by creating a parallel private program that veterans would
access without VA authorization. This would erode the integrity of the
VA's integrated delivery system which depends on VA to coordinate
veterans' care. Finally, the bill does not include quality or licensing
standards for these providers. Rather than create a private, standard-
free program for mental health outpatient treatment, Congress should
invest in direct care mental health by funding additional VA mental
health providers.
H.R. 9438, the No Wrong Door for Veterans Act,
H.R. 9438 would amend and reauthorize the VA Staff Sergeant Parker
Gordon Fox Suicide Prevention Grant Program which supports nonprofit
community organizations and government agencies that identify at-risk
veterans and provide an array of suicide prevention interventions such
as suicide risk education and peer support services. The focus of the
program is on supplementing VA's clinical program with community-based
prevention programs.
H.R. 9438 introduces a new 72-hour deadline for the VA to provide
services after a veteran is referred for follow-up care. If the VA
can't meet this deadline, the veteran becomes eligible for private
care. This drastically reduces the wait time for VA mental health care
from the current 20 days (under the MISSION Act) to just 3 days. This
new standard is impossible for the VA to consistently meet. We have
opposed other provisions like this. Again, Congress should instead fund
additional VA mental health providers.
AFGE looks forward to working with members of the health
subcommittee to advance legislation that strengthens the VA workforce
to improve veteran care.
Prepared Statement of American Psychological Association, Association
of VA Psychologist Leaders, Association of VA Social Workers, National
Association of Veterans Affairs Physicians and Dentists, Nurses
Organization of Veterans Affairs, Veterans Healthcare Policy Institute
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Prepared Statement of Jason Crow
[GRAPHIC NOT AVAILABLE IN TIFF FORMAT]
Prepared Statement of National Association of State Veterans Homes
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
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