Various Health Care Related Issues and Draft Legislation
March 25, 2010
ERIC A. HILLEMAN, DIRECTOR
NATIONAL LEGISLATIVE SERVICE
VETERANS OF FOREIGN WARS OF THE UNITED STATES
COMMITTEE ON VETERANS AFFAIRS
SUBCOMMITTEE ON HEALTH
UNITED STATES HOUSE OF REPRESENTATIVES
WITH RESPECT TO
VARIOUS HEALTH CARE RELATED ISSUES AND DRAFT LEGISLATION
WASHINGTON, D.C. March 25, 2010
MR. CHAIRMAN AND MEMBERS OF THE SUBCOMMITTEE:
On behalf of the 2.1 million men and women of the Veterans of Foreign Wars of the U.S. and our Auxiliaries, I want to thank you for the opportunity to testify at today’s legislative hearing. Before us is a wide range of health-care related bills, all of which would make improvements to the system that benefits America’s veterans.
Draft Bill for Continuing Education of VHA Staff
The VFW supports this bill, "to improve the continuing professional education reimbursement provided to health professionals employed by the Department of Veterans Affairs." Currently, only full-time board certified physicians and dentists are eligible for $1,000 annually for continuing professional education. This bill would increase the annual continuing education reimbursement from $1,000 to $1,600 annually, and bar any potential duplicate compensation from medical centers. Further, it would expand the eligible professions from physicians and dentists to also include podiatrists, chiropractors, optometrists, registered nurses, physician assistants, and expanded-function dental auxiliaries. We urge further expansion of this legislation to include education reimbursement for other health care professionals such as mental health.
The VA has built a reputation for being an innovator in research and a teaching institution. We are encouraged to see emphasis placed on continuing education for medical professionals. Ongoing education of VHA staff will help to keep VA a leader in providing high quality medical care and attract staff that are inclined toward constant improvement. 2
Draft Bill to Improve Performance Pay and Bargaining Rights
This draft legislation would further clarify performance pay awarded to physicians and dentists. Existing law does not specify that performance pay can only be awarded based on an individual performance. This has led to performance rewards ambiguity. The VFW supports this bill.
Draft Bill, Waving Requirements for Mental Health Counselors
The VFW opposes this legislation to allow the Secretary to wave licensure or certification requirements. The VA may be facing shortages of mental health professionals, but we believe making exceptions in lieu of valid state-issued certifications undermines the quality of care and the confidence that veterans have in speaking with VA mental health professionals. State licensure and certification, demonstrates that an individual meets the state requirements in the areas of prerequisite education, and knowledge, and is culpable under the law for malpractice or abuse of the unique trust placed in their position.
HR 84, the Veterans Timely Access to Health Care Act
The VFW supports the intent of the ―Veterans Timely Access to Health Care Act,‖ but we cannot support this bill. This legislation would require the VA Secretary to contract care for any veteran who would have to wait 30 days or more for primary care. The VFW has supported guaranteed access standards for VA Health Care for number of years – but we remained concerned about quality and cost of contract care.
The VFW shares the desire to see all veterans have timely access to high-quality VA health care, which has been and continues to be our highest legislative priority. We feel, however, that this legislation would create more problems than it would fix. We must be mindful of the unintended consequences of the legislation.
With the advent of advanced appropriations, VA now has the capacity to ensure that it can properly plan for and manage these dollars efficiently. Additionally, on-time funding should allow VA to recruit, hire and train doctors, nurses and other health care providers, ensuring that VA has sufficient staff to keep up with demand. Congress has made great strides in improving the funding stream for veterans’ health care – for which the VFW applauds your efforts – but a greater attention is needed to ensure those health care dollars are spent appropriately at each medical facility.
We strongly support the reporting requirements of HR 84. The reporting mechanisms on wait times would help gain more accurate insight into hard numbers, which are always more informative than anecdotal statistics. Better numbers would allow us to understand the problem as well as see which areas are having difficulties. 3
This bill addresses VA employee’s collective bargaining rights. Specifically, it repeals specified exceptions to rights of certain Department of Veterans Affairs (VA) employees to engage in collective bargaining. There by, allowing increased negotiation between VA employees and the VA Secretary on items such as professional conduct, competence and determination of employee compensation. It further requires a VA final decision with respect to the review of an adverse personnel action against an employee to be issued no later than 60 days after such action has been appealed. Subjects such decision to judicial review in the appropriate U.S. District Court or, if the decision is made by a labor arbitrator, in the U.S. Court of Appeals for the Federal Circuit. The VFW has no position on this legislation.
This bill would require the VA Secretary to seek outside contacts in the event a VA hospital is closed for greater than 180 days due to a national disaster. Currently, when VA hospitals are closed, veterans must travel long distances to other VA facilities, which may be impractical or impossible following a disaster. This bill would ensure that the VA secures alterative arrangements for local medical care, to include non-emergency care and inpatient medical care services as required.
The VFW supports this legislation. However, we feel 180 days is far too long for a veteran to wait for servicers. We urge the Veterans Affairs Committee to hold hearings evaluating the VA’s current disaster contracting provisions. Allowing a veteran to wait 180 days for medical care is unacceptable. Contracts to provide health care must be in place before a VA hospital shutters its doors due to natural disaster. The VFW believes plans need to be implemented immediately in the event of a disaster.
HR 2698, the Veterans and Survivors Behavioral Health Awareness Act
VFW is pleased to support this critical legislation to improve mental health care services for veterans and members of the Armed Forces and their survivors. This bill recognizes that many of today’s war wounds are invisible wounds – which often take months to appear, making the transition our service men and women face more difficult. We believe that this bill is a good first step in making positive changes for those suffering the invisible wounds of war.
Section 2 of the bill concerns Vet Centers. The VFW is a strong supporter of Vet Centers and their approach to providing mental health care to veterans. VA has done a good job expanding their reach, but they are victims of their own success. Many Vet Centers are struggling with difficult workloads as increasing numbers of veterans turn to them for the unique services they provide. Provisions provided in section 2 would give some relief by offering scholarship programs for individuals seeking education and training in health care specialties needed by the Vet Centers. Finding qualified mental health professionals is a challenge for VA, and the more incentives they can provide potential employees, the more likely that these men and women will turn to VA as their employer of choice.
Section 3 would require VA to help seek outside counseling services for veterans who are otherwise not authorized to receive care through VA. Many discharged OEF/OIF veterans who are beyond the five-year dead line of access to VA do not have access to counseling, so this is clearly the right thing to do. 4
Section 4 would allow VA to provide grants to nonprofit organizations that provide support for survivors of deceased servicemembers and veterans. Family members may not know where to go to seek help, and we believe that VA can help point them in the right direction.
HR 2699, the Armed Forces Behavioral Health Awareness Act
This legislation would offer OEF/OIF veterans counseling services at Vet Centers before they separate from the military. VFW supports all the provisions of this bill.
Section 2 expands mental health services and counseling to active duty forces and those in the Reserve Components. VFW believes this change is important for two reasons. First, military mental health services come with a stigma. That has been shown repeatedly to be the greatest impediment to men and women seeking care. By allowing servicemembers to seek care without fear of reprisal or reporting relieves an emotional burden that can and would otherwise have a serious impact on their career. The second reason is that the military does not have a sufficient number of mental health care providers. While this legislation does not absolve the military of their responsibility to properly care for these men and women while in service, it helps fill in the gaps in care that are often not there when our servicemembers need it.
Section 3 would require DOD to provide grants to nonprofit organizations that provide support for survivors of deceased servicemembers and veterans. This provision is similar to the provision offered in HR 2698. It allows DOD to expand its counseling base and go beyond the limited services provided by the military’s casualty assistance officers, which can help ease the burden on these families at a most difficult time in their lives.
Section 4 would require the Secretary of the Army to carry out a pilot program in three locations to improve PTSD awareness among members. The alarming rate of veterans and those on active duty suffering from mental stress has been well-documented. Providing an environment to study the neurophysiological and psychological effects associated with the stress and trauma of combat is critical to today’s armed forces. With repeated deployments affecting servicemembers and their families, this pilot program would begin to address some of the key factors in identifying and addressing PTSD, as well as helping those involved reintegrate back into civilian life.
HR 2879, the Rural Veterans Health Care Improvement Act of 2009
VFW supports this comprehensive bill aimed at improving care to veterans living in rural areas across the country. We applaud the provisions in the bill that would increase the travel reimbursement rate to 41.5 cents a mile when they travel to VA facilities for treatment, as well as language authorizing VA to establish a grant program to provide innovative transportation options to veterans in rural areas. The $50,000 grant to state veterans’ service agencies and veterans’ service organizations goes a long way towards helping rural veterans - oftentimes, getting to and from appointments is the largest hurdle to care.
The bill would also allow the VA Secretary to carry out demonstration projects to examine the feasibility and advisability of alternatives for expanding care to veterans in rural areas. The VA would establish partnerships with the Department of Health and Human Services, Centers for Medicare and Medicaid Services, Indian Health Services, and other programs to examine the best way to extend care 5
to these veterans. The VFW believes that VA should explore all avenues of telemedicine for care of veterans in rural areas.
It would increase care to OEF/ OIF veterans and their families by allowing VA to establish programs to provide peer outreach and support services. VA would be authorized to contract with community mental health centers and/or other qualified entities offering readjustment services in areas where those services are not adequately provided. Further, it would establish training goals with nonprofit mental health organizations by utilizing other veterans in providing peer outreach and peer support in their communities. Offering readjustment services and counseling where the servicemembers and families live is something the VFW believes is critical to the well being of our servicemembers and their families.
The Rural Health Care and Improvement Act would allow the VA Secretary to establish centers of excellence for rural health research, education and clinical activities. These centers would research the availability of health services in rural areas and develop specific models for furnishing those services to veterans in rural areas.
Section 7 of the bill – Indian Veterans Health Care Coordinators, would direct VA to employ an Indian health care coordinator at 10 VA medical centers that serve communities with large Indian populations. This provision is the same as language found in HR 4006, which we will comment on in that section of our testimony.
Lastly, HR 2879 would require the VA Secretary to submit an annual report to Congress on the implementation of the provisions of this bill and any amendments. VFW looks forward to the enactment of this bill to improve the quality and access to care for veterans in rural areas.
HR 3926, the Armed Forces Breast Cancer Research Act
The VFW strongly supports a joint study between VA and DOD into the occurrence of breast cancer among members of the Armed Forces. Breast cancer remains the second leading cause of death among women, and the rate of incidence for men have remain steady according to the American Cancer Society. This bill would for require VA and DOD to provide information on the number of servicemembers and veterans — male and female — who have been diagnosed with breast cancer, the treatment they have received and demographic information about their age and service. The report, which would be provided to Congress in 18 months, would also address whether Defense and VA officials see any service-related breast cancer risk or patterns. VFW encourages immediate passage of this bill and looks forward to reviewing the report to ensure those veterans affected receive the proper medical services they earned.
HR 4006, Rural, American Indian Veterans Health Care Improvement Act of 2009
VFW supports this bill which would improve care to American Indian veterans. H.R. 4006 would create an ―Indian Veterans Health Care Coordinator‖ for 10 VA medical centers that serve the greatest number of Indian veterans per capita. This coordinator would improve outreach to tribal communities, 6
coordinate the medical needs of Indian reservations, and expand the access and participation of VA in the Department of Veterans Affairs Tribal Veterans Representative program.
The bill would also require the VA and Department of the Interior to enter into a Memorandum of Understanding to ensure the electronic transfer of health records of Indian veterans between Indian Health Service (HIS) and VA facilities. VA would also be authorized to transfer to HIS any surplus medical and information technology equipment.
This bill would also require VA and the Department of Health and Human Services to report jointly to Congress on the advisability of the joint VHA-IHS establishment and operation of health clinics to serve eligible populations on Indian reservations.
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