Apr112013
Hearing Transcript on Legislative Hearing on Veterans Healthcare Legislation.
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LEGISLATIVE HEARING ON VETERANS HEALTHCARE LEGISLATION
HEARING BEFORE THE SUBCOMMITTEE ON HEALTH OF THE COMMITTEE ON VETERANS' AFFAIRS U.S. HOUSE OF REPRESENTATIVES ONE HUNDRED TENTH CONGRESS SECOND SESSION JUNE 26, 2008 SERIAL No. 110-95 Printed for the use of the Committee on Veterans' Affairs
U.S. GOVERNMENT PRINTING OFFICE For sale by the Superintendent of Documents, U.S. Government Printing Office
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CORRINE BROWN, Florida |
STEVE BUYER, Indiana, Ranking |
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Malcom A. Shorter, Staff Director SUBCOMMITTEE ON HEALTH
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. |
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C O N T E N T S
June 26, 2008
Legislative Hearing on Veterans Healthcare Legislation
OPENING STATEMENTS
Chairman Michael Michaud
Prepared statement of Chairman Michaud
Hon. Shelley Berkley
Prepared statement of Congresswoman Berkley
Hon. John T. Salazar, prepared statement of
WITNESSES
U.S. Department of Veterans Affairs, Gerald M. Cross, M.D., FAAFP, Principal Deputy Under Secretary for Health, Veterans Health Administration
Prepared statement of Dr. Cross
Paralyzed Veterans of America, Carl Blake, National Legislative Director
Prepared statement of Mr. Blake
Veterans of Foreign Wars of the United States, Christopher Needham, Senior Legislative Associate, National Legislative Service
Prepared statement of Mr. Needham
SUBMISSIONS FOR THE RECORD
American Legion, Joseph L. Wilson, Deputy Director, Veterans Affairs and Rehabilitation Commission, statement
American Veterans (AMVETS), Raymond C. Kelley, National Legislative Director, statement
Disabled American Veterans, Adrian M. Atizado, Assistant National Legislative Director, statement
Miller, Hon. Jeff, Ranking Republican Member, and a Representative in Congress from the State of Florida, statement
National Association of Veterans' Research and Education Foundations, Barbara F. West, Executive Director, statement
MATERIAL SUBMITTED FOR THE RECORD
Post-Hearing Request for Additional Views on H.R. 6366 and Draft Legislation:
Hon. Michael H. Michaud, Chairman, Subcommittee on Health, Committee on Veterans' Affairs, to Hon. James B. Peake, M.D., Secretary, U.S. Department of Veterans Affairs, requesting Administration views on H.R. 6366, and Discussion Draft relating to employment of psychologists by the Department of Veterans Affairs, letter dated July 2, 2008 [AS OF JANUARY 12, 2009, THE VA FAILED TO PROVIDE THE ADMINISTRATION VIEWS ON THE TWO BILLS.]
LEGISLATIVE HEARING ON VETERANS HEALTHCARE LEGISLATION
Thursday, June 26, 2008
U. S. House of Representatives,
Subcommittee on Health,
Committee on Veterans' Affairs,
Washington, DC.
The Subcommittee met, pursuant to notice, at 10:10 a.m., in Room 334, Cannon House Office Building, Hon. Michael Michaud [Chairman of the Subcommittee] presiding.
Present: Representatives Michaud, Berkley, and Salazar.
OPENING STATEMENT OF CHAIRMAN MICHAUD
Mr. MICHAUD. The hearing will now come to order. I apologize for the delay. With the July work period coming up, Members are in other Committees for markups.
But I would like to thank everyone for coming today. Today’s legislative hearing is an opportunity for the veterans service organizations (VSOs), the U.S. Department of Veterans Affairs (VA), and other interested parties to provide their views on and discuss draft legislation within the Subcommittee’s jurisdiction in a clear and orderly process.
I do not necessarily agree or disagree with the draft bills before us today, but I believe that this is an important part of the legislative process and encourage an open and frank discussion about the drafts before us today.
We have four drafts before us today. The first draft bill would expand VA's authority to provide mental health treatment for family members.
The second draft bill would prohibit the collection of co-payments from catastrophically disabled veterans.
The third draft would authorize nonprofit research and education corporations in the Department of Veterans Affairs.
And the fourth draft would establish seven consolidated patient accounting centers to facilitate third-party collection in the Department of Veterans Affairs.
I understand that the fourth draft I mentioned was not ready until yesterday, so I do not expect our witnesses to have prepared statements on this bill. We would, however, appreciate if the witnesses could provide their views on this bill for the record.
And I look forward to hearing the views of our witnesses on the draft legislation before us.
[The statement of Chairman Michaud appears in the Appendix.]
Without any further ado, why don't we start? We have two witnesses on our first panel, Carl Blake, who is the National Legislative Director of Paralyzed Veterans of America (PVA), and Christopher Needham, who is the Senior Legislative Associate for the Veterans of Foreign Wars of the United States (VFW).
So I want to thank both of you for coming here today and we will start with Mr. Blake.
STATEMENTS OF CARL BLAKE, NATIONAL LEGISLATIVE DIRECTOR, PARALYZED VETERANS OF AMERICA; AND CHRISTOPHER NEEDHAM, SENIOR LEGISLATIVE ASSOCIATE, NATIONAL LEGISLATIVE SERVICE, VETERANS OF FOREIGN WARS OF THE UNITED STATES
Mr. BLAKE. Thank you, Mr. Chairman.
On behalf of Paralyzed Veterans of America, I would like to thank you for the opportunity to testify today on the draft legislation.
As you mentioned, we will be happy to submit additional comments on the bill that came out last night.
In accordance with the recommendations of the Independent Budget for fiscal year 2009, PVA strongly supports the draft legislation that would prohibit the VA from collecting certain co-payments from veterans who are catastrophically disabled. This issue has the greatest impact on PVA members.
The current VA healthcare system allows veterans who have a nonservice-connected catastrophic disability, such as spinal cord injury, and who have incomes above median tested levels to enroll in Priority Group 4. Congress granted these catastrophically disabled veterans this higher priority for healthcare enrollment because of the unique nature of their complex disabilities and in recognition of the specialized services that only the VA healthcare system can provide.
However, being enrolled in Priority Group 4 does not necessarily exempt PVA members and other catastrophically-disabled veterans from the burden co-payments impose. Those PVA members with nonservice-connected disabilities ,who because of their incomes, would otherwise be classified a Priority Group 7 or 8 can be enrolled in Priority Group 4 but are still subject to the co-payments associated with 7s and 8s.
PVA members go to the VA because there is no other system in the country that provides the level and quality of spinal cord injury care offered by the VA. Because of the nature of their disability, they require a host of pharmaceuticals, equipment, devices, and supplies to function on a daily basis.
The hardship created by a catastrophic injury or disease is unique and devastating to the veteran and the family who may be responsible for his or her care. At a time when the veteran is in need of specialized assistance to regain some independence and quality of life, the financial burden of medical bills should be lifted.
PVA also strongly supports the "Veterans Nonprofit Research and Education Corporations Enhancement Act." The purpose of this legislation is to modernize and clarify the existing statutory authority for VA affiliated, nonprofit research and education corporations or NPCs.
This bill will allow the NPCs to fulfill their full potential in supporting VA research and education, which ultimately results in improved treatment and high-quality care for veterans while ensuring VA and Congressional competence in NPC management.
PVA has been a strong supporter of the NPCs since their inception, recognizing that they benefit veterans by increasing the resources available to support the VA research program and to educate VA healthcare professionals.
We urge expeditious passage of this bill so that veterans may benefit even more from the enhancements in operational capabilities and oversight that this bill provides.
Chairman Michaud, Ms. Berkley, again I would like to thank you for the opportunity to testify. I look forward to working with you and the Subcommittee to see that these bills get moved forward. And I would be happy to answer any questions that you might have.
Thank you.
[The statement of Mr. Blake appears in the Appendix.]
Mr. MICHAUD. Thank you, Mr. Blake.
Mr. Needham?
STATEMENT OF CHRISTOPHER NEEDHAM
Mr. NEEDHAM. Chairman Michaud, Members of the Subcommittee, thank you for the opportunity to testify today. The 2.3 million members of the Veterans of Foreign Wars appreciate the chance to comment on the important draft bills under consideration.
The first draft would exempt catastrophically disabled veterans in Priority 4 from having to pay co-payments for their healthcare. The VFW strongly supports this.
The voting delegates to our National Convention have approved Resolution Number 639, which calls for this exemption.
These veterans have a long list of specialized needs and VA is uniquely suited to care for them. With their ability to work impaired, they often lack other forms of health insurance as well as the financial means to pay for the intensive care they require.
The VA confers a special status on them by enhancing their enrollment to protect their eligibility for care, but VA fails to acknowledge this status when it comes to charging co-payments.
With special care co-payments at $50.00 per visit, it does not take too long before these men and women are suffering financial burdens of hundreds of dollars.
Approving this bill is the right thing to do as it eliminates an unfair financial penalty on a group of veterans who truly demonstrate need.
A second draft bill would expand family access to counseling services, closing a loophole in the law, which prevents many families, especially those of Operation Enduring Freedom/Operation Iraqi Freedom (OEF/OIF) veterans, from receiving care.
Under current law, which was written before the current conflicts began, VA is authorized to provide counseling and aid to families of veterans who lack a diagnosis of service connection only if the counseling begins while the veteran is hospitalized. The proposed changes of this bill would strike that requirement, freeing up VA to provide a broader range of services to more men and women and the families of those men and women.
These families might not have access to VA's counseling services because they are waiting months for VA to provide a claims rating decision for their loved one or perhaps the veteran has not yet filed for benefits despite suffering from some illness or condition.
The need for these expanded services is clear, but the prevalence of mental health issues among OEF/OIF veterans and the importance of a safe, stable family life for their recovery, these services are essential.
From marital counseling to assistance with helping their loved one deal with the sometimes difficult transition, the range of services VA can provide would be of great benefit to the families of any recently separated servicemember.
But it is also important because these stresses and strains affect not just the veteran, but the families as well. The pain and emotions involved can be difficult and studies have shown increasing numbers of servicemembers and their families are facing marital difficulties and divorce.
Expanding these services to more people would make a positive difference in the lives of our veterans and is the right thing to do for their families ,who in their own way make a valuable contribution to the war effort.
The third bill under consideration today involves VA's nonprofit research corporations. NPCs help VA conduct research and education and they assist with fund raising, especially from public and private services that VA otherwise would not have access to.
The changes proposed by this bill would ultimately make more funds available for critical research purposes while tightening up control and oversight of the program in accordance with the recent VA Inspector General report.
We believe that these changes would greatly benefit the VA's research programs and America's veterans and we are pleased to offer our support for it.
Mr. Chairman, this concludes my testimony, and I would be happy to answer any questions you or the Members of the Subcommittee may have.
[The statement of Mr. Needham appears in the Appendix.]
Mr. MICHAUD. Thank you both for your testimony.
Talking about looking at the mental health services bill, the repeated deployment of our veterans in OIF and OEF have created enormous strains on their families.
What types of services do you think family members need most? We will start with Mr. Needham.
Mr. NEEDHAM. Well, certainly as I said in the statement, divorce has become sort of an increasing problem. So marital counseling, sort of family counseling issues sort of dealing with the transition. How it affects the children as well.
For example, when you were speaking of repeated deployments, there was testimony earlier before the Committee that talked about how repeated deployments sort of increases, greatly increases the chance of post traumatic stress disorder (PTSD). And obviously PTSD is going to affect not just the veteran but that family.
So family and marital counseling are definitely one of the key things that needs to be done.
Mr. MICHAUD. Mr. Blake?
Mr. BLAKE. I would also suggest, Mr. Chairman, that some of the problems that the family members, spouses, and dependents or children face are not unlike some of the symptoms that many of the veterans have as it relates to PTSD or other mental health conditions.
Families certainly deal with depression because of the strains that the soldiers’ or the veterans' condition may place on the family and other types of symptoms that relate to that.
I think there has been a lot of discussion about—I hate to say suicidal tendencies, but, you know, suicidal thoughts among veterans, and I do not think that that would necessarily be unique to veterans. I think you also find that when the burden of these mental health issues are weighed on the family that probably similar symptoms occur within the family members as well.
I would also encourage the Subcommittee to look at, we have advocated for expanded caregiver assistance training for family members or even for nonfamily members who provide caregiver assistance to the most disabled veterans because we are finding that in many cases, particularly among the most severely-disabled veterans, their family becomes their caregiver.
And I think through some sort of caregiver assistance program, they may be reimbursed as a caregiver, that we could also benefit these families.
Mr. MICHAUD. And as you both know, PTSD and traumatic brain injury are the signature wounds of this war. Looking at the length of the war and what we are seeing, do you think the VA will need additional resources, funding, or personnel to execute this legislation and how much of an increase do you think they will need?
Mr. NEEDHAM. I am not sure I can quantify the increase, but I think that the specific place where, at least the VFW has seen a dramatic need for increase in personnel is at the Vet Centers, particularly with the expansion of this family bill.
If the number of family members who are going to receive care, and they primarily receive it through Vet Centers, is going to be increased, then personnel at the Vet Centers is going to increase as well.
What we have seen, at least so far, is that Vet Centers for the most part are managing sort of with current staff levels. Certainly there are some cases where, you know, there are problems, but we have not necessarily seen any sort of long-term waiting lines.
But as services continue to expand, whether, you know, expansion of their current obligations, but also sort of as more and more numbers of returning servicemembers and their families actually access the current benefits afforded to them, the staff members are going to need to increase there as well.
Mr. MICHAUD. Ms. Berkley, have any questions?
Ms. BERKLEY. Yes, I do. Thank you. Actually, I have a written statement and then questions, if that is okay.
Ms. BERKLEY. I know that Mr. Hare has been very concerned, as you know, and has been on the forefront of fighting for veterans' mental health needs and additional funding and access.
Since he is not here, if I could ask a question on his behalf, and I think I would like to address it to Mr. Needham, but you are both welcome to answer it.
In regards to OEF/OIF veterans who can receive care for up to five years, current law says that the VA may provide necessary family mental services.
What would your thoughts be on changing this language to shall instead of may?
Mr. NEEDHAM. That is certainly an interesting possibility. I do not think we would necessarily or obviously I do not think we would oppose it.
The catch is, I think, the current system, the way it is now, the current language can work with proper oversight. I mean, certainly, you know, VA, I think, by and large has done a pretty good job lately with mental healthcare issues. But as you are well aware, in some cases, we have had to sort of drag them kicking and screaming.
But as long as we have sort of proper oversight and continued oversight and continued leadership within VA to tackle these issues, I think finally now we realize the scope of the problems, then a change in the language might not be necessary.
Ms. BERKLEY. Okay. Thank you for your candid remark.
OPENING STATEMENT OF HON. SHELLEY BERKLEY
Ms. BERKLEY. I was absolutely delighted to learn a few weeks ago that the Senate passed S. 2162, the "Veterans Mental Health Improvement Act." I introduced a House companion to this bill.
This essential legislation increases research on post traumatic stress disorder and substance use disorders by establishing at least six National Centers of Excellence on PTSD and substance use disorders. The bill is designed to focus on how PTSD and substance use disorders affect each other.
These centers will offer comprehensive inpatient and residential treatment programs for our returning veterans diagnosed with PTSD and substance dependency.
This bill also contains a provision to provide for a review of all residential mental health facilities and to honor Justin Bailey. And I appreciate Mr. Michaud's help with that.
These provisions, which were also passed by the House in H.R. 5554, "The Justin Bailey Substance Use Disorders Treatment And Prevention Action," are vital to ensure that our veterans receive quality care at these residential mental health facilities and to make sure that what happened to Justin does not happen to anyone else.
And I can tell you in a conversation with Justin's father after the bill passed the House, there was not a dry eye in my office. He was so pleased and honored that his son's death may prevent the death of others. And that was very important to this family.
The Senate amended S. 2162 to include a number of provisions to make it a package bill. Some other initiatives in the Senate package include establishing Epilepsy Centers of Excellence, reimbursements for veterans receiving emergency treatment in non-VA facilities, homeless veterans' issues, as well as providing counseling for families of veterans for nonservice-connected issues.
This is a similar provision to one of the draft bills we are discussing today. I am hopeful that the House and the Senate will work together and get this important package to the President. And I, of course, needless to say, although this is a very supportive Committee and a wonderful Subcommittee Chairman, we are all going to support this, I am sure.
Soon it will be 4th of July and we will all be home. Every 4th of July, I go to our homeless veterans' shelter and help feed our homeless veterans and talk with them. So many of these homeless vets and mostly, at least in Las Vegas, Vietnam era veterans, so they are my contemporaries. While I was in college, they were in Vietnam. I am always amazed at how intelligent, how forthright, and how conversational they are. And I keep thinking if not for the grace of God go I.
And I am very happy that this Committee, and this Nation, appreciate the needs of the veterans coming home and that they are not, or at least intentionally, being treated the way our veterans coming home from Vietnam were treated. I think it created a lasting schism in this country and created unnecessary pain for thousands and thousands of young men that were in Vietnam through no choice of their own and came home badly damaged. And this Nation failed to recognize the damage emotionally, mentally. And I am hoping that we can make it up to our Vietnam vets by helping the veterans that are coming back now.
And thank you both for the extraordinary efforts that you have put forth to make sure that we are aware of the issues.
Thank you.
[The statement of Congresswoman Berkley appears in the Appendix.]
Mr. MICHAUD. Mr. Salazar?
Mr. SALAZAR. Well, thank you, Mr. Chairman.
I just briefly wanted to thank you for your work on veterans' issues, both of you.
I came in a little bit late. Did we discuss the bill that is actually introduced by Mr. Buyer to consolidate patient accounting centers?
Mr. BLAKE. Mr. Salazar, we did not actually get the bill until late last night, so we have not really had a chance to review it. But I think and Mr. Needham also said that we would be glad to submit some comments after we have a chance to review the bill.
Mr. SALAZAR. Okay. I just wanted your reaction to it. I do not know whether the bureaucracy is actually more simplified by doing this or if it becomes more cumbersome.
I would really appreciate it if you could review that and take a look at it and give us an answer. Thank you.
Thank you, Mr. Chairman.
Mr. MICHAUD. Thank you very much, Mr. Salazar.
I want to thank both of you once again for coming today. I look forward to your written comments on Mr. Buyer's draft proposal when it comes out. So, once again, thank you very much. I appreciate it.
I would like to now hear from the second panel, Dr. Cross, who is the Principal Deputy Under Secretary for Health, who is accompanied by Walter Hall, who is the Assistant General Counsel to the Department of Veterans Affairs, and Gary Baker, who is the Chief Business Officer for the Veterans Health Administration (VHA).
I want to welcome you three and look forward to hearing your comments. And without further ado, Dr. Cross.
STATEMENT OF GERALD M. CROSS, M.D., FAAFP, PRINCIPAL DEPUTY UNDER SECRETARY FOR HEALTH, VETERANS HEALTH ADMINISTRATION, U.S. DEPARTMENT OF VETERANS AFFAIRS; ACCOMPANIED BY WALTER A. HALL, ASSISTANT GENERAL COUNSEL; AND GARY M. BAKER, CHIEF BUSINESS OFFICER, VETERANS HEALTH ADMINISTRATION, U.S. DEPARTMENT OF VETERANS AFFAIRS
Dr. CROSS. Good morning, Mr. Chairman and Members of the Subcommittee, and thank you for inviting me here today to present the Administration views on several bills that would affect the Department of Veterans Affairs programs that provide healthcare benefits and services.
With me today are Walter Hall, Assistant General Counsel, and Gary Baker, Chief Business Officer of the VHA.
I am pleased to provide the Department's views on the draft bills under consideration.
Discussion draft one would amend current law to exempt catastrophically disabled, nonservice-connected veterans and zero percent service-connected veterans whose incomes place them in a co-payment required status for VA inpatient and outpatient care.
We recognize that the draft bill is intended to address any disproportionate financial burden that falls on these seriously ill and disabled veterans. Because their catastrophic disabilities are not service connected and because their incomes exceed VA's mean test for low-income veterans, they are not exempt from co-payment requirements.
We share the Subcommittee's concern that these severely-disabled veterans not be subject to any undue financial burden as a result of the co-payment obligations. However, we are still in the process of ascertaining these veterans' hospital and outpatient utilization rates and co-payments.
VA has not previously reported amounts and ranges of co-payments by enrollment category. Once we collect and analyze all the necessary data, we will come back to the Subcommittee with a recommendation as to the need for this legislation. And until then, we request that the Subcommittee refrain from taking action on this draft bill.
Discussion draft two would amend VA's authority to furnish counseling, training, and mental health services to immediate family members of veterans receiving VA treatment for a nonservice-connected disability.
Currently all enrolled veterans other than those receiving outpatient care for nonservice-connected disabilities are eligible for these family support services to the extent they are necessary to the veteran's treatment.
Veterans being treated for nonservice-connected disabilities are only eligible for these family support services when they are initiated during the veteran's hospitalization. The draft bill would make this group of veterans eligible for needed family support services similar to other veterans.
VA supports this bill. An enrolled veteran is eligible for any needed medical treatment regardless of whether the condition is service connected and consistent with this principle that family support services should be based on the medical needs, not on inpatient status or the service connection designation.
Importantly, these amendments could improve the treatment outcomes for the affected groups of veterans. We are still developing costs for this draft bill and we will submit them for the record as soon as possible.
Discussion draft three would update the law applicable to VA's nonprofit research and education corporations. VA affiliated nonprofit research corporations are important to VA's overall research program because they provide flexible funding mechanisms for the administration of non-VA funds for the conduct of VA approved research.
A provision of the discussion draft three would authorize a single corporation, nonprofit corporation to facilitate the conduct of research and education at more than one VA Medical Center.
It would also make it clear that corporations may reimburse a VA laboratory for the preliminary cost it incurs before a research project has officially been approved by the Secretary.
VA would also be authorized to reimburse corporations for costs incurred for the assignment of corporation employees to VA under "Intergovernmental Personnel Act of 1970."
Additionally, this draft bill would clarify that corporations may set fees for certain education and training programs they administer and retain those funds to offset program expenses.
We support the provision of the draft bill that would authorize the establishment of new multi-center, nonprofit research corporations and the consolidation of existing single-facility, nonprofit corporations into multi-facility ones. This offers the prospect of nonprofit corporation assistance in funding research projects to VA Medical Centers that are unable to support their own dedicated corporation.
This provision would also provide the system with the tools needed to consolidate or close nonprofit corporations that are too small to institute proper internal controls without the loss of the funding support for VA research and education programs that the corporation provides.
By requiring the Directors at all Medical Centers supported by a nonprofit corporation to sit on its Board of Directors, the provision provides this beneficial increased flexibility without sacrificing VA oversight.
With respect to the draft bill's remaining provisions, we ask the Subcommittee to defer further action on this draft bill in order to give the Department an opportunity to address underlying structural issues and to formulate policy related to the governance and finance of the VA affiliated nonprofit research corporations.
Specifically a Steering Committee, a Steering Committee has been chartered by the VHA Office of Research and Development to provide recommendations regarding governance, oversight, and finance issues related to the corporations by the end of the fiscal year.
We will be happy to provide you with a copy of the final report and recommendations.
Mr. Chairman, this concludes my prepared statement. I will be pleased to answer any questions.
[The statement of Dr. Cross appears in the Appendix.]
Mr. MICHAUD. Thank you very much, Dr. Cross.
Dealing with the co-payment issue, I know you are reviewing that as far as number of veterans in Priority group 4. When will the report be complete dealing with Priority Group 4 veterans?
Dr. CROSS. With the catastrophic provisions?
Mr. MICHAUD. Yes.
Dr. CROSS. Our analysis on that is trying to do a better job of understanding what the individual veterans are experiencing with this program. We have average figures and we have some figures that we are not quite comfortable with yet that are preliminary, that we are still refining.
I would really like to know what the spectrum of those costs are for veterans and what other sources of care and support that they have in terms of insurance and other assistance they receive based on higher income.
Until we get that information, which I hope we can get towards the end of next week, and we will provide that for you.
[As of January 12, 2009, the VA failed to provide the Administration views on the two bills.]
Mr. MICHAUD. Okay. Great. Looking at the mental health service for families, does the VA currently provide any of these counseling, training, or mental health services for family members outside of the Vet Centers?
Dr. CROSS. Yes, we do. These services are provided for the service-connected individuals and for the nonservice connected for inpatients where necessary in conjunction with the veteran's own treatment.
This is really directed at helping the family understand and deal with and respond to the veteran's needs and whatever the illness or injury that the veteran has sustained. And we are doing that now.
Mr. MICHAUD. Do you expect that the workload is going to increase and, if so, by how much and would you need additional staffing and resources to take care of the additional workload?
Dr. CROSS. I believe in our testimony we mentioned that we are still working on some of the data related to cost. But we think this is part of our mission to provide this.
And, furthermore, the rule that makes it necessary to start the process only if the person is an inpatient does not really respond to the current way that we do medical care.
So much more is being done for outpatients these days. Procedures that used to be done as inpatient are commonly done as outpatient circumstances. We need to move with the times and be able to provide that support for families without getting tangled up by that rule.
Mr. MICHAUD. And my only concern is with what is happening in Iraq and Afghanistan and what we are seeing. And I agree that family members is a big component of taking care of the veterans. If you open up access in rural areas to include the family members, which I think is extremely important, then that is going to add an additional burden on the VA.
And my concern is that I want to make sure that the VA has the staffing that it needs to take care of the men and women that need help. And when you look at the healthcare shortage, particularly in the mental health area, that could be problematic.
Dr. CROSS. Mr. Chairman, I think it is important that we clarify the limits on what this would really provide us. I will ask my associate, Mr. Hall.
Mr. HALL. Yes, sir. This authority would be limited to providing training and counseling necessary to permit the family to assist or aid the veteran in his treatment. It does not authorize the Department to independently care for the family members.
Mr. MICHAUD. But in that training and assistance, my concern is if you are going to do it, that you do it adequately and in a timely manner.
Will there be additional staffing needs for that? Doctor are you are saying you can do it within existing resources?
Dr. CROSS. We are doing much of it with existing resources already. Plus we have expanded our mental health staffing quite a bit. In fact, tremendously. But as I said in my statement, we still need to look at the resource and cost issues just a bit more.
Mr. MICHAUD. Okay. My last question is on the research provision. The Senate companion bill, S. 2926, has a provision that would authorize the nonprofit corporations to reimburse the VA Office of General Counsel for specialized legal services in regards to review and approval of certain research agreements.
Is this provision necessary and, if so, can you explain why that provision is necessary?
Dr. CROSS. I will defer to Mr. Hall for that.
Mr. HALL. Sir, we are currently providing those services to the research corporations. I think the research corporations are continuously increasing the amount of work they do, the number of agreements that they are entering into, and it is the responsibility of the Office of General Counsel to review those.
I think there is a concern with the attention they get and the speed with which we are able to address them. We are able to at this time to get to them all. I think there is always some concern that we could do them more quickly with more resources.
Mr. MICHAUD. Thank you.
Ms. Berkley?
Ms. BERKLEY. I just want to thank all of you for being here, and I have no additional questions.
Mr. MICHAUD. Mr. Salazar?
Okay. Once again, I want to thank you, Dr. Cross, and Mr. Baker and Mr. Hall for accompanying Dr. Cross, and for coming here this morning. We look forward to working with you as we move forward on these draft proposals.
Does the Counsel for the Minority side have any questions?
If there are no further questions, this hearing is adjourned. Thank you.
[Whereupon, at 10:46 a.m., the Subcommittee was adjourned.]
APPENDIX
Prepared Opening Statements:
Prepared statement of Hon. Michael H. Michaud, Chairman, Subcommittee on Health, and a Representative in Congress from the State of Maine
Prepared statement of Hon. Shelley Berkley, a Representative in Congress from the State of Nevada
Prepared statement of Hon. John T. Salazar, a Representative in Congress from the State of Colorado
Witness Prepared Statements:
Prepared statement of Carl Blake, National Legislative Director, Paralyzed Veterans of America
Prepared statement of Christopher Needham, Senior Legislative Associate, National Legislative Service, Veterans of Foreign Wars of the United States
Prepared statement of Gerald M. Cross, M.D., FAAFP, Principal Deputy Under Secretary for Health, Veterans Health Administration, U.S. Department of Veterans Affairs
Submissions for the Record:
Prepared statement of Joseph L. Wilson, Deputy Director, Veterans Affairs and Rehabilitation Commission, American Legion
Prepared statement of Raymond C. Kelley, National Legislative Director, American Veterans (AMVETS)
Prepared statement of Adrian M. Atizado, Assistant National Legislative Director, Disabled American Veterans
Prepared statement of Hon. Jeff Miller, Ranking Republican Member, and a Representative in Congress from the State of Florida
Prepared statement of Barbara F. West, Executive Director, National Association of Veterans' Research and Education Foundations
MATERIAL SUBMITTED FOR THE RECORD
Post-Hearing Request for Additional Views on H.R. 6366 and Draft Legislation:
Hon. Michael H. Michaud, Chairman, Subcommittee on Health, Committee on Veterans' Affairs, to Carl Blake, National Legislative Director, Paralyzed Veterans of America, requesting views on H.R. 6366, and Discussion Draft relating to employment of psychologists by the Department of Veterans Affairs, letter dated July 2, 2008, and PVA response letter dated July 8, 2008
Hon. Michael H. Michaud, Chairman, Subcommittee on Health, Committee on Veterans' Affairs, to Dennis Cullinan, National Legislative Director, Veterans of Foreign Wars (VFW), requesting views on H.R. 6366, and Discussion Draft relating to employment of psychologists by the Department of Veterans Affairs, letter dated July 2, 2008, and VFW response
Hon. Michael H. Michaud, Chairman, Subcommittee on Health, Committee on Veterans' Affairs, to Hon. James B. Peake, M.D., Secretary, U.S. Department of Veterans Affairs, requesting Administration views on H.R. 6366, and Discussion Draft relating to employment of psychologists by the Department of Veterans Affairs, letter dated July 2, 2008 [AS OF JANUARY 12, 2009, THE VA FAILED TO PROVIDE THE ADMINISTRATION VIEWS ON THE TWO BILLS.]
Hon. Michael H. Michaud, Chairman, Subcommittee on Health, Committee on Veterans' Affairs, to Raymond Kelley, Legislative Director, AMVETS, requesting views on H.R. 6366, and Discussion Draft relating to employment of psychologists by the Department of Veterans Affairs, letter dated July 2, 2008, and AMVETS response dated July 8, 2008
Hon. Michael H. Michaud, Chairman, Subcommittee on Health, Committee on Veterans' Affairs, to Joe Violante, Legislative Director, Disabled American Veterans (DAV), requesting views on H.R. 6366, and Discussion Draft relating to employment of psychologists by the Department of Veterans Affairs, letter dated July 2, 2008, and DAV response dated July 8, 2008
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