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STATEMENT
OF JOY J.
ILEM ASSISTANT
NATIONAL LEGISLATIVE DIRECTOR OF THE DISABLED
AMERICAN VETERANS BEFORE
THE
HOUSE
VETERANS’ AFFAIRS COMMITTEE SUBCOMMITTEE
ON HEALTH September 6, 2001 Mr. Chairman and
Members of the Subcommittee:
On behalf of the more than one million members of the Disabled
American Veterans (DAV) and its Auxiliary, we are pleased to express
our views on several pieces of legislation before the Subcommittee. Today’s
agenda includes H.R. 2792, the Disabled Veterans Service Dog and
Health Care Improvement Act of 2001, H.R. 1435, the Veterans’
Emergency Telephone Service Act of 2001, and H.R. 1136, a bill to
require Department of Veterans Affairs (VA) pharmacies to fill
prescriptions written by private practitioners. These several bills cover a range of issues important to
disabled veterans and their families.
We support many of the provisions, but for the reasons we state
below, we oppose or have concerns about a few. H.R.
2792¾DISABLED
VETERANS SERVICE DOG AND HEALTH CARE IMPROVEMENT ACT OF 2001
Section 2 of this bill would authorize VA to provide certain
hearing-impaired veterans and veterans with spinal cord injury or
dysfunction, in addition to blind veterans, with service dogs to
assist them.
Although DAV does not have a resolution on this issue, this
provision is beneficial and will assist all enrolled veterans with
certain severe disabilities. The
DAV is not opposed to the favorable consideration of this section of
the bill by the Subcommittee. Section
3 of the bill pertains to maintenance of capacity for specialized
treatment and rehabilitative needs of disabled veterans.
It proposes to amend the definition of capacity to include each
geographic service area of the VA, in relationship to the maintenance
of capacity in the Department for specialized treatment and
rehabilitative needs of disabled veterans.
It would require VA to measure capacity by the annual amount
expended for care (adjusted for inflation) in such dedicated programs.
Additionally, it would extend the annual Capacity Report
requirement through 2004. We suggest that section 3 of the bill further clarify the
obligation to maintain capacity and include a mandate for monitoring
capacity at the network level. The
VA noted in its draft annual Capacity Report for 2000 “[n]ationwide
capacity appears to be maintained or improved for workload measures in
seven out of eight special disability specialties….
For all disability programs except Substance Abuse, VHA can
document that it has maintained or improved its workload capacity for
its special disabilities programs….”
As we previously testified before this Subcommittee, we
disagree with these findings and assert that VA has not met capacity
in accordance with the spirit of Public Law 104-262, which mandated
that, [T]he
Secretary shall ensure that the Department maintains its capacity to
provide for the specialized treatment and rehabilitative needs of
disabled veterans (including veterans with spinal cord dysfunction,
blindness, amputations, and mental illness) within distinct programs
or facilities of the Department that are dedicated to the specialized
needs of disabled veterans in a manner that (A) affords those veterans
reasonable access to care and services for those specialized needs,
and (B) ensures that the overall capacity of the department to provide
such services is not reduced….
It was also
mandated that capacity would be maintained at levels reported in
fiscal year 1996. Interested parties argued that capacity measures should
be determined by the number of veterans treated and the dollars
expended for their care, and that capacity is only maintained if both
components are met. We
agree that both of these variables are necessary to accurately access
if capacity is being met. Including
both components would allow us to monitor whether the necessary
reinvestment of resources from institutional to outpatient-based care
is occurring in certain specialized programs.
Finally, we agree that these figures are only meaningful if a
reasonable adjustment for inflation is included.
Maintaining acceptable capacity levels in each network is key
to ensuring that veterans have timely access to specialized care in
the appropriate treatment venue.
It is essential that each network maintain capacity in its
medical centers and community-based outpatient clinics so that
veterans have access to the specialized programs they need.
We urge that additional requirements for measuring capacity be
added to ensure veterans have equal access to specialized programs
throughout the system. For
example, the Capacity Report should include specific information about
the types of programs available in each geographic service area, the
number of patients treated in each program, the number of inpatient
beds available, and the number of full-time employees that supports
these programs. Additionally,
there should be a means established by which network directors and
medical center directors can be held accountable for providing this
information and maintaining capacity levels of VA special disability
programs as mandated by law. Information
provided in the annual Capacity Report is essential for determining
the status of specialized programs within VHA.
Unfortunately, there is still valid criticism about the
reliability of the data contained in the report.
It is imperative that uniform data collection standards be
developed to ensure valid reliable data is generated for reporting
purposes. Information contained in the Capacity Report is necessary for
tracking the status of these important programs, and we agree there
should be an extension of the annual report requirement as proposed in
this section of the bill.
Section
4 of the bill would change the means test used by VA in determining
whether a veteran will be placed in enrollment priority Category 5 or
7. The current placement
eligibility threshold is set at about $24,000 nationwide.
This legislation attempts to level the playing field to adjust
the means test based on locality, thereby allowing veterans living in
high-cost areas to be classified as Category 5 if they fall below the
new threshold level.
DAV
does not have a resolution from our membership on this issue however,
its purpose appears beneficial. DAV
does not oppose the favorable consideration of this section of the
bill. Section 5 of
the bill would establish a pilot program designed to allow certain
veterans in under-served areas to seek inpatient services in private
sector hospitals utilizing their own health insurance, with VA
becoming a secondary payer of any other out-of-pocket expenses.
A similar measure was introduced last year with which we took
exception. Despite a few new revisions in this bill, our overall
objection to this concept still stands. This
measure would pay for the costs of general medical and surgical
inpatient care and services not covered by any applicable health-care
plan of the veteran. To be eligible, the veteran would have to be enrolled in VA
to receive medical care services, have received care within a 24 month
period proceeding application for enrollment in the pilot program, and
require care for a non-service connected condition if services are not
available from a VA facility. The
proposal contains language stating that VA would coordinate care by
providing case management. Additionally,
any expenditure of funds shall be made from amounts in the Medical
Care Collections Fund (MCCF). We are
deeply concerned that this initiative would shift medical services and
veteran patients from VA to the private sector.
It would encourage VA to refer patients, and the dollars used
to subsidize their care outside the system.
VA would lose third-party reimbursements that veterans bring to
help underwrite the provision of care for all veterans using the VA
health care facility. This
proposal sets a dangerous precedent that, if allowed to expand, could
endanger VA facilities’ ability to maintain their full range of
specialized inpatient services for all veterans.
It would erode VHA’s patient resource base, undermining
VHA’s ability to maintain its specialized services programs, and
endanger the well being of veteran patients. Additionally,
it would allow disparate treatment of veterans depending on whether or
not they have insurance, in essence creating a new eligibility
category for veterans’ health care based not on veteran’s need,
but solely on the veteran’s geographic location, and to a great
extent, the veteran’s own health insurance.
Finally, although the provision includes language for case
management, we believe the VA’s ability to coordinate care would be
limited at best. Clearly,
other initiatives should be considered to assist veterans who reside
in under-served areas. We are, however, opposed to any initiative that would turn VA
into an insurer rather than a provider of health care.
For the benefit of all, we feel the VA must use its resources
to maintain the base of its health care services, which are provided
through and by VA health care facilities and health care providers.
This traditional form of VA health care has served well to
offer an uninterrupted flow of services to veterans in need, and
ensure the quality of those services no matter where or when they are
provided. Section
6 of the bill would establish a managed care pilot program for
contract hospitalization and fee basis ambulatory care users.
All fee basis and contract hospitalization provided by the
Secretary in selected pilot locations would be furnished through a
managed care coordinator contractor.
Eligible veterans would be provided a directory to receive
non-VA care or to use in health emergencies in the case of contract
hospitalization. This
section provides that a primary care manager would be established in
each participating facility to ensure that veterans participating in
the program receive appropriate care, and that they would be brought
back into the VA system for followup care whenever possible and
appropriate.
Of great concern to the DAV is that managed care of VA fee
basis patients may create a barrier for these veterans in getting the
care they need. Managed
care programs frequently do not offer the kinds of specialized
services that disabled veterans may need.
Fee basis and contract care are provided to veterans when
needed services are unavailable at a VA health care facility or when
veterans would have to travel too far to a VA facility to receive the
care they need. Currently,
fee basis patients are able to choose the physician they want to see
for fee-based health care services.
As part of a managed care plan, the veteran would be required
to choose one of the participating clinicians or hospitals for care.
Many veterans participating in the fee basis program have long
established relationships with their health care providers and are
satisfied with the care they receive.
We do not see that this measure would assist veterans in
receiving timely, quality medical care to meet their health care
needs. Section
7 of the bill would authorize certain bereavement counseling and
counseling, training, and mental health services for immediate family
members of certain service and non-service connected veterans. Although
DAV does not have a resolution on these issues, this provision is
beneficial and will assist veterans’ family members in coping with
the loss of a loved one or in coping with a serious mental health
illness of a disabled veteran. The
DAV is not opposed to favorable consideration of this bill by the
Subcommittee. Section
8 of this measure would extend existing MCCF authority with respect to
third party collections and medication co-pays.
Congress authorized VA to collect co-payments for treatment of
nonservice-connected conditions as a temporary measure to achieve
savings for deficit reductions. Large
budget surpluses have been projected over the next decade, and, under
ordinary circumstances, veterans should not have to pay for benefits
accorded them by a grateful nation.
The delegates to our last National Convention in Miami Beach,
Florida, July 28-August 2, 2001, passed a resolution opposing any
legislation that would require the VA to increase or extend the
congressional authority for collection of co-payments. DAV
strongly opposes medication co-pays. H.R. 1435¾VETERANS’
EMERGENCY TELEPHONE SERVICE ACT OF 2001
This measure would authorize grants to establish a national toll-free hotline to provide information and assistance to veterans and their families, including crisis intervention counseling, general information regarding veterans’ benefits under title 38, United States Code, and information about provisions of emergency shelter and food, substance abuse rehabilitation, employment training and opportunities, and small business assistance programs. The provisions of this bill limit a grant to a period of not more than two years, with payment subject to annual approval by the Secretary and subject to the availability of appropriations. The proposed legislation would require a private, non-profit entity to contract with a carrier for use of a toll-free telephone line; employ trained and supervised personnel to answer incoming calls and provide counseling and referral service to callers on a 24-hour-a-day basis; assemble and maintain a current database of information; and publicize the hotline. The private, non-profit organization must demonstrate that it is a nationally recognized expert in the area of furnishing assistance to veterans and have a record of high quality service in furnishing such assistance, including the support from advocacy groups, such as veterans service organizations. As written, the DAV is opposed to H.R. 1435. As stated in our July 10, 2001 testimony before the Subcommittee on Benefits, this measure attempts to take away an intrinsic part of VA’s mission of service to veterans and their families. Since about 1993, the VA has had a toll-free number whereby veterans or other VA claimants could obtain information about benefits and health care services. VA counselors also have available to them information on benefits offered by other federal departments and agencies and the states. In March 2001, the DAV conducted a nationwide survey of VA’s national toll-free hotline. The supervisory NSOs in all of our offices were asked to call the VA toll-free number and track how many times they had to call before they got through and how long they had to wait to receive the requested service. They were instructed to request the “new” Agent Orange Help Line toll-free number, which had been published by the VA the week prior to our survey. The results of our survey were surprising and somewhat unexpected. In all but a few cases, our NSOs were able to access the help line on the first call. In one case, in Hartford, Connecticut, it took 14 tries before they were able to get through; however, very few NSOs received a busy signal when they called. For the most part, services were rendered in less than five minutes—this was total call time. In the vast majority of the calls, our NSOs received the correct toll-free Agent Orange Help Line phone number. In some cases, our NSOs were put on hold while the counselor obtained the phone number. In a few cases, our employees were referred to either the medical center or the Agent Orange registry. Overwhelmingly, we were informed that the counselors were polite and courteous. In some cases, the counselors offered to provide any additional assistance that might be needed on other matters.
The only complaint we received from a few of our supervisory
NSOs dealt with the automated, recorded message they had to listen to
before reaching a counselor. It
was their concern that older veterans might find it frustrating or
difficult to maneuver through the automated message.
However, it is difficult to imagine how a more effective system
might be devised to avoid this situation and still provide a complete
menu of available services. In conclusion, it would appear that the experience from our survey confirms that the current VA toll-free number is working. As with any service, it must be continually monitored, evaluated, and improved. If this Subcommittee believes that VA is not adequately meeting the needs of veterans or other VA claimants in providing needed information, then VA should be held accountable. If this Subcommittee also believes that 24-hour-a-day access to this information is necessary, then VA should be provided the resources to staff these toll-free telephone lines 24-hours a day.
The DAV does not believe that a private, non-profit
organization would be better able to handle this function.
Accordingly, we oppose this legislation.
This measure has been marked up by the Subcommittee on Benefits
and amended provisions were considered by the full Committee and
incorporated in H.R. 2540 as a pilot program for VA to expand its
current service hours. This
bill has passed the House and been referred to the Senate.
DAV supports the language of section 407 of H.R. 2540. H.R. 1136
This bill would require VA pharmacies to dispense medications
to veterans for prescriptions written by private practitioners.
This measure would be beneficial to a large segment of the
veteran population who do not currently receive their health care from
VA. We recognize that requiring this group of veterans to use the
VA system for all their health care needs just to receive prescription
medications would further burden the system, cause additional delays
in the delivery of health care services, and greatly increase the cost
of VA health care. Indeed,
VA is experiencing a large influx of veterans seeking care, apparently
to obtain medication through VA.
Perhaps this legislation would result in a net savings to VA.
However, we foresee that, if veterans were authorized to access
prescription drug benefits only, a significant number of veterans who
are not currently using the system would likely choose this option and
thereby cause a significant increase in overall pharmaceutical costs
to VA. Of
great concern to the DAV is that, if this measure were passed and not
appropriately funded to meet the presumed increased costs in
pharmaceuticals, it would be extremely detrimental to the VA health
care system and to currently enrolled veterans.
It would place significant stress on an already overburdened
system and cause a negative impact on veterans who depend on VA for
all their health care needs. Additionally,
we are concerned that if this mandate was not properly funded, VA may
again propose to increase co-pays for medications as a way to offset
rising pharmaceutical costs. CLOSING
The DAV sincerely appreciates the Subcommittee for holding this hearing and for its interest in improving benefits and services for our Nation’s veterans. The DAV deeply values the advocacy this Subcommittee has always demonstrated on behalf of America’s service-connected disabled veterans and their families. Thank you for the opportunity to present our views on these important measures. Back to Witness List |