|
STATEMENT
OF JACQUELINE
GARRICK, ACSW, CSW, CTS
DEPUTY
DIRECTOR, HEALTH CARE NATIONAL VETERANS AFFAIRS AND REHABILITATION
COMMISSION THE
AMERICAN LEGION BEFORE
THE COMMITTEE
ON VETERANS’ AFFAIRS UNTIED
STATES HOUSE OF REPRESENTATIVES ON HEALTH
RELATED LEGISLATION SEPTEMBER
6, 2001
Mr.
Chairman and Members of the Committee: The
American Legion appreciates the opportunity to comment on these
important health care benefits that affect the nation’s veterans and
the Department of Veterans Affairs (VA).
The bills and draft legislation under consideration have been
reviewed by The American Legion and we offer the following comments
and recommendations. H.R.
2792-Disabled Veterans Service Dog and Health Care Improvement Act of
2001
Sec 2. Authorization for Secretary of VA to
provide Service Dogs for Disabled Veterans The American
Legion is aware of the vital services these animals offer in assisting
persons with disabilities. The
companionship and aide service dogs offer is well documented in the
private sector. This level of care goes a long way to improve the quality of
life for the disabled community.
Veterans should be no different.
VA should make every effort to assess and provide veterans
requesting service dogs with that option. Sec
3. Maintenance of Capacity for Specialized Treatment and
Rehabilitative Needs of Disabled Veterans
The
strength of the VA healthcare system is the experience it has in
handling the unique health care concerns of the service connected and
catastrophically ill veteran’s population.
Some maladies, such as spinal cord injury, blindness,
amputation, traumatic brain injury and mental illness, are more
prevalent in veterans than in the general population because of the
dangerous nature of military service.
The specialized treatment and rehabilitative needs of disabled
veterans is critical. The
American Legion does not believe that this legislation will ensure
that the maintenance of capacity for specialized treatment and
rehabilitative needs of disabled veterans will be protected.
VA has been measuring capacity using this formula since
eligibility reform passed, and each year The American Legion and her
sister veteran service organizations have testified on the lack of
capacity for the special emphasis programs.
This provision seems to be an attempt to circumvent the need
for VA to return to its previous level of capacity.
Therefore, The American Legion believes that VA should not be
allowed to reduce its capacity below the October 9, 1996 level. Sec
4. Threshold for Veterans Health Care Eligibility Means Test to
Reflect Locality Cost-Of-Living Variations
Subsection
(b) of section 1722, Title 38 United States Code, sets forth the
income threshold used for the determination of low-income families.
These thresholds are also used to determine the ability of
veterans to defray the cost of medical care.
Currently, the threshold is set at $17, 240 for a veteran with
no dependents and $20,688 for a veteran with one dependent, plus
$1,150 for each additional dependent. The
American Legion fully supports the proposed increases to $23,688 in
the case of a veteran with no dependents and to $28,429 for a veteran
with dependents. These
threshold increases are more in keeping with today’s cost of living. Sec
5. Pilot Program for Coordination of Ambulatory Community Hospital
Care
Access
and timeliness of VA health care are two monumental concerns The
American Legion consistently monitors and seeks to improve.
When The American Legion surveyed Legionnaires this past year,
it asked veterans to rate VA access by defining it as appointment
availability, travel distance and waiting times.
The average score for how veterans rated VA access was 78
percent. Although VA has
made significant progress in these areas, there is much room for
improvement. With the
dramatic shift in the last several years from inpatient to outpatient
care, both in VA and the private sector, a cost-effective means of
providing hospital care to veterans residing in under-served areas in
the country is fundamental. It
is well known that there are many veterans and their families who have
to drive several hours to receive hospital care in VA inpatient
facility. In
a nutshell, the proposed program would allow veterans to obtain
inpatient medical care at the local community hospital as opposed to a
VA inpatient facility two hours away.
The program would cover both service-connected and nonservice-connected
conditions. VA would pay
the costs for the hospital care and medical services to the community
hospitals. Also, VA may cover the costs for applicable plan deductibles
and coinsurance and the reasonable costs of inpatient care and medical
services not covered by any applicable healthcare plan of an enrolled
veteran. Eighty-five
percent of the participating veterans would be required to have some
type of healthcare plan. The
American Legion believes this should also include Medicare and the
dependents provision from the GI Bill of Health.
VA would coordinate all care being given to veterans in
non-Department hospitals to include the pre-approval of inpatient
admissions. In
the past, the American Legion has supported VA’s use of contracts to
expand access into rural communities where no VA care exists.
However, The American Legion through its National Field Service
site visit process has learned that in some cases contracts were
poorly written and resulted in additional expenses and lack of control
over the quality of patient care.
The American Legion passed resolution # 2, The
American Legion Policy on VA Contract Health Care Services, at the
National Executive Committee held October 18-19, 2000 in Indianapolis,
IN. This was done to
ensure that VA contracts were written to include pre-certification,
utilization review, concurrent screening, repatriation of patients,
and be negotiated by the Veterans Service Integrated Network (VISN)
office. In addition, the
community hospital must be accredited for the level of care it is
contracted to perform and must meet the same benchmarks for
performance by which a VA facility would be held accountable. Under
these circumstances, The American Legion would support the proposed
pilot program. Furthermore,
there is no clear delineation for psychiatric services under this
pilot and if VA could contract as outlined by The American Legion
resolution, then patients with psychiatric diagnoses should not be
discriminated against and should be offered the same type of access to
inpatient care. Sec
6. Pilot Program for Contract Hospitalization and Fee Basis Ambulatory
Care
The
American Legion recognizes the need to explore alternatives in the
management and delivery of care to our nation’s veterans.
Additionally, we realize that with the shift of care from
inpatient to outpatient, VA may need to rely increasingly on
contracted care and services.
With the rising cost of health care, delivering quality care,
with the added bonus of cost savings, is a challenge.
The pilot program suggested here would monitor the possible
success of that challenge over the next three years. Under
this program the Secretary would provide, through a managed care
coordinator contractor, contract hospitalization and fee basis for
veterans already receiving such care.
The managed care coordinator would be experienced and have a
network of credentialed providers already in place.
Veterans will be automatically enrolled for participation.
Each enrolled veteran would receive a pre-approved directory of
providers they could choose from to receive non-VA care or to use in
emergencies. The VA would
assign a primary care manager at each VA medical center who would
participate in the program. The
responsibilities of the primary care manager would include
coordination and case management of each enrolled veteran.
This manager would ensure that veterans receive appropriate
care and that the veteran is returned to the VA system for any needed
follow up care. The
contractor would provide a 24-hour a day, seven-day a week, help line
primarily for health care advice and referral information.
The contractor would also establish a service telephone line
that would provide veterans information on eligibility, enrollment,
and provider locations. The
American Legion views this provision with trepidation. VA oversight of
the contracting process has not been stellar, as previously noted in
this statement. The
American Legion believes each contract proposal should be evaluated
based on its enhancement of services and access to care for veterans
within their community and meet the VA benchmark to provide veterans
with care within thirty minutes or thirty miles from their home.
As outlined in American Legion resolution #2, contracted care
must comply with VA standards of quality and all contracts must
include pre-certification, utilization review, concurrent screening,
the ability to repatriate VA patients, and be negotiated by the
network office to meet specific needs of the geographic service area. The
American Legion is also concerned with the added burden placed upon
the nursing population with the assignment of a primary care manager
at each VA medical center. Case
managers are usually registered nurses and in previous hearings, it
has been documented that there is a critical nursing shortage within
VA. The addition of a new
category of employment may intensify the existing recruiting and
staffing problems. Finally,
The American Legion believes that the severing of long standing
relationships between the veterans and their VA care providers, if the
providers are not part of the managed care network, will ultimately
result in the dissatisfaction of the veteran.
This managed-care network is too reminiscent of the Department
of Defense’s Tricare system, which has left too many retirees and
their families frustrated, dissatisfied, and disconnected from their
healthcare providers. Sec 7.
Recodification of Bereavement Counseling Authority and Certain Other
Health-Related Authorities The
American Legion has long been a proponent of allowing veteran’s
dependents access to VA health care and includes this very concept in
its GI Bill of Health. The
expansion of services to bereaved spouses and families coping with
mental illness is a step in the right direction, but The American
Legion strongly urges congress to consider full implementation of the
GI Bill of Health component that deals with dependents access to VA
care. The
American Legion also recognizes the need for VA to be able to provide
humanitarian care in the event of emergencies and supports this
section. HR
1435 - Veterans’ Emergency Telephone Service Act of 2001
This
act would give the Secretary of Veterans Affairs the authority to
award a grant to a private, nonprofit entity for the purposes of
establishing a toll-free telephone number that veterans may call to
inquire about, and receive assistance on, any number of issues as they
relate to veterans’ benefits. The
VA currently has a toll-free number for veterans to call when they
need assistance on their benefits.
When called, this toll free number goes through an inclusive
litany of possible choices for benefits and medical care information.
Whatever selection the caller makes, general information on
that particular benefit is given along with suggestions to call the
nearest VA medical center or regional office for more detailed
information. The
caller may also choose to stay on the line to talk with a
representative. Given
the complex nature of veterans’ benefits and its administration, The
American Legion is skeptical that the establishment of such a service
by a private entity would not result in chaos, especially if there
were two different toll free numbers in operation.
H.R. 1435, as currently understood, would duplicate VA’s
current toll-free outreach service. It
is the opinion of The American Legion that it would be better to
expand and improve upon the VA’s current telephone information
system rather than trying to establish a new, expensive, and privately
owned operation. H.R.
1136 - Requires Department of Veterans Affairs Pharmacies to Dispense
Medications to Veterans for Prescriptions Written by Private
Practitioners. The
American Legion has carefully weighed both sides of this issue as
presented by VA leadership and in the July 24, 2001 testimony given by
the Honorable Richard Griffin, Inspector General (IG) before the
Senate Committee on Veterans Affairs.
VA leadership has expressed serious concerns over patient
safety and accountability if it were to act as a “drug store” and
simply fill prescriptions written by outside providers.
Currently,
if a veteran does have a prescription written by a private physician
and brings it to VA, the veteran is scheduled to see a VA provider who
re-evaluates the veteran, sometimes duplicating lab work or x-rays
done in the private sector before re-writing the prescription.
There is obviously a time-delay in this process and the
veteran, in the meantime, is going without a medication, which can
result in intensified symptoms, worsening of a condition, and result
in the need for hospitalization, longer courses of care or additional
medication. However,
when the IG testified, he did not support the concerns for quality or
safety VA leadership has purported.
The IG did not find evidence that filling outside prescriptions
would result in poorer quality of care as long as safety provisions
were in place. The
Department of Defense (DoD) does operate its formulary in this manner
and there have been no known documented cases whereby retirees
suffered because DoD filled a wrongly written prescription or there
was a drug interact. The
American Legion has received numerous e-mails, letters, and phone
calls about this process and veterans seem very much in favor of
having their non-VA provider prescriptions filled at a VA pharmacy.
In its recent VA Local User Evaluation (VALUE) survey, The
American Legion documented that 88 percent of veterans use VA because
of the prescription drug benefit.
In responding to the survey, many veterans offered comments on
expanding access to the VA formulary.
This is a tremendous issue for the entire veterans’ community
since the cost of pharmaceutical products is skyrocketing and acts as
barriers to getting them. Many
of these veterans who are trying to get VA to fill prescriptions are
Medicare eligible and do not have other prescription drug benefits. They are using their Medicare coverage in the private sector
to avoid the current VA $50.80 office visit co-payment, but then seek
VA services to fill the expensive prescriptions they could not
otherwise afford, not knowing that VA will make them see a provider.
The government ends up paying twice for these Medicare/VA users
since there is no coordination of care between these two systems.
Medicare subvention would go along way to alleviate this replication
of services and dual expenditure.
However,
in the absence of Medicare Subvention and since private provider
prescriptions are written for other categories of veterans, The
American Legion at this time feels there is enough evidence to support
expanding the VA pharmacy benefit to include outside prescriptions.
This mandate would have to be funded to take into account the
increase in workload this will generate for VA.
Mr. Chairman and Members of the Committee, that concludes this statement. The American Legion is available to answer any questions or concerns you may have. Back to Witness List |