STATEMENT OF RICHARD B. FULLER NATIONAL LEGISLATIVE DIRECTOR PARALYZED VETERANS OF AMERICA BEFORE THE SUBCOMMITTEE ON HEALTH OF THE HOUSE COMMITTEE ON VETERANS’ AFFAIRS CONCERNING H.R. 2792, H.R. 1435, AND H.R. 1136 SEPTEMBER 6, 2001
Chairman Moran, Ranking Member Filner,
members of the Subcommittee, on behalf of
Paralyzed Veterans of America (PVA) I am pleased to present our
views on H.R. 2792, the “Disabled Veterans Service Dog and Health
Care Act of 2001,” H.R. 1435, the “Veterans’ Emergency Telephone
Service Act of 2001,” and H.R. 1136.
PVA would like to thank you, Mr. Chairman, for including many
of PVA’s legislative priorities as part of H.R. 2792. H.R.
2792, The “Disabled Veterans Service Dog and Health Care Improvement
Act of 2001” There are several provisions in H.R.
2792 that PVA supports, but there are several that we oppose at this
time. I will comment on
each of these provisions. Section
2: Authorization for
Secretary of Veterans Affairs to Provide Service Dogs for Disabled
Veterans The Department of Veterans Affairs (VA)
is currently authorized to provide guide dogs to blinded veterans with
service-connected disabilities only.
However, there are many veterans, both service-connected and
non-service connected, who suffer from certain disabilities who would
benefit a great deal from having guide dogs or service dogs.
These veterans include hearing-impaired veterans as well as
veterans who suffer from spinal cord injury or dysfunction or other
chronic impairments that severely limit mobility or function. The Journal of the American Medical
Association (JAMA) published a study in 1996 that assessed the value
of service dogs for people with ambulatory disabilities.
The study found “reports of paid and unpaid assistance
demonstrated dramatic economic benefits of service dogs.”
After one year, the study found a decrease of 68 percent in
paid assistance hours and a 64 percent decrease in unpaid assistance
hours. The JAMA study also detailed the many
tasks that service dogs can perform, such as “open and close doors,
turn switches on and off, pull a person up from a sitting position or
lying down position, assist a person in and out of baths and pools,
help pull on clothing, procure and pick up objects, pull wheelchairs,
and drag a person to safety in case of fire or other emergency.” PVA strongly supports Section 2 of H.R. 2792, that expands the authority of the Department of Veterans Affairs to provide guide dogs and service dogs to both service-connected and non-service connected veterans who are enrolled in the VA health care system. We believe service dogs and guide dogs are essential to creating a better quality of life for sight or hearing impaired veterans as well as those veterans who suffer from a spinal cord injury or dysfunction that substantially limits mobility or function. The dogs will give these severely disabled veterans a measure of self-confidence and independence that they would not otherwise have. We have concerns over the language, as introduced in the Senate, that would restrict service dogs to only those veterans in receipt of disability compensation. With health care eligibility reform we moved to a uniform benefits package for veterans enrolled for VA care. By limiting service and guide dogs to those veterans who are in receipt of disability compensation, we would again start down the path of a hodgepodge system of health care benefits, an approach repudiated only a few short years ago. The
advantages provided by service dogs, both in terms of economic
benefits and improvements in quality of life, should be made available
to all veterans who are in need of this wonderful service.
For over half-a-century, PVA has fought for the integration of
people with disabilities into the economic and social life of our
Nation. Providing service
dogs to veterans who need them would be a major step forward in the
ultimate realization of this goal.
As one participant, who has a spinal cord injury, stated in the
JAMA study, “with my [dog], I feel safe and capable, and I am no
longer afraid of the future. Everyone
needs someone to care for, and we care for each other with dignity.” Section
3: Maintenance of
Capacity for Specialized Treatment and Rehabilitative Needs of
Disabled Veterans Congress, in 1996, mandated that the Department of Veterans Affairs (VA) maintain its capacity to provide specialized services such as spinal cord injury or dysfunction (SCI/D). The VA, until last year, defied this simple statutory mandate. After much negotiation, the VA issued VHA Directive 2000-022 stipulating that all SCI centers return to mandated capacity levels by the end of the fiscal year. PVA believes that the only way to adequately, and accurately, determine capacity is to account for the number of beds and staff. Counting the number of patients treated, waiting times, outcomes, or resources are all interesting markers determining the extent of care provided, but we have found that counting staffed beds and dedicated staff assigned to SCI/D Centers are the only ways to truly measure capacity. This is the only way to ensure that the VA is living up to its statutory requirements, and upholding its own directive. PVA believes that Congress should address each of the VA’s specialized services, in terms of capacity, separately. This approach should be tailored to the distinct characteristics of each program, for elements that would address capacity for spinal cord injury/dysfunction care may well not adequately address the unique characteristics of mental health care, or blind rehabilitation. Unfortunately, Section 3 of H.R. 2792 does not go far enough. Although PVA appreciates the efforts to require VA to meet the capacity requirements mandated by law, we are concerned that this language will undercut the agreement and directive we have negotiated with the VA, and it will allow the VA to default to a lesser standard. Capacity should be determined by a true count of actual staffed beds, for acute and long-term care or residential beds, and specialized, professional health care staff dedicated to providing care at SCI centers. Any other method for accounting for capacity would only establish a standard based on wishes and good intentions that does not reflect the reality faced by SCI/D veterans seeking care. PVA
also believes that there must be some accountability in the capacity
reporting. Just having an
individual “monitoring” the reports or data is not enough.
The Veterans Integrated Service Network (VISN) directors must
be held accountable for ensuring that VAMC’s are meeting the
capacity requirement. We
propose that the maintenance of capacity of the specialized services
be included in the performance plans of the VISN directors. PVA supports the provision to extend
the capacity reporting requirement for another three years.
It provides a guide for enforcing the capacity requirement
mandated by law and directive. Section
4: Threshold for Veterans
Health Care Eligibility Means Test to Reflect Locality Cost-of-Living
Variations PVA has argued in favor of a change to the means test used by the VA to determine whether veterans will be placed in enrollment priority Category 5 or 7 for a long time. These category placements are important because veterans enrolled in lower categories, such as 6 or 7, whose incomes are above current means test levels are required to make co-payments for most of their care. Most importantly, veterans placed in Category 7 are at a greater risk of losing access to VA health care due to budgetary constraints. Congress, in establishing Category 5,
demonstrated its intention to provide health care to veterans with
lower incomes, thereby serving as a safety net.
Unfortunately, the current national “one-size-fits-all”
means test fails to take into account the higher costs of living faced
by certain veterans in different geographic locations. As the attached white paper discusses,
we have identified an established formula implemented by the
Department of Housing and Urban Development (HUD) to set income limits
for eligibility for low income housing benefits.
The HUD formula makes adjustments in means test eligibility
based on the cost-of-living experience in most every locality in the
United States. As with
the current VA system it also adjusts for the number of dependents in
the applicant household. PVA supports Section 4 which seeks to
adjust the national means test threshold by locality to reflect the
differences in geographic cost-of-living.
This adjusted means test would help veterans who have incomes
slightly higher than the existing threshold who have previously been
designated as Category 7 but will be reclassified as Category 5.
It is important to realize that the adjusted means test
threshold would benefit veterans located all over the county—North,
South, East, and West. The
new standard based on the Department of Housing and Urban Development
(HUD) Low Income Index established by the U.S. Housing Act of 1937
used to determine eligibility for low income housing assistance would
realistically and equitably reflect cost-of-living variations from one
locality to the next without going below the current means test
threshold. Section 5: Pilot Program for Coordination of Ambulatory Community Hospital Care PVA opposes Section 5 that would allow non-service connected veterans in under-served areas to go to private health care inpatient facilities using their private health insurance. The VA would pay for the co-payments associated with these health care visits. PVA is not opposed to contracting for medical services when there is a demonstrable lack of availability of certain services within the VA, but we do oppose efforts that would turn the VA into an insurer of health care rather than a provider of health care. Passage of this provision would not only represent a major departure from the usual delivery of VA health care services, but would provide disparate treatment of veterans depending on whether or not they have private insurance, undermine the VA’s ability to maintain its specialized services programs by eroding the VA’s patient and resource base, and endanger the well-being of veterans. PVA is concerned about the breakdown of the “hub-and-spoke” approach that the VA has used effectively in its health care system. The outpatient clinics (spokes) are supposed to feed patients into the nearest major VAMC (hub). However, under this program, patients would be sent from the outpatient clinic into the private sector. Once a veteran is sent into the private sector, the VA does not maintain any responsibility to provide follow-up care or treatment for that patient. Veteran patients would be lost to the system, as would any possible third-party payments. VA hospitals would see fewer patients. This would set a dangerous precedent that, if allowed to expand, could endanger the viability of a VA facility maintaining its full range of specialized inpatient services for all other veterans in the area as those resources go elsewhere. There
was concern in the past about funding this program from money
appropriated to the Veterans Health Administration hospitals.
In an attempt to overcome this problem, the bill proposes to
pay for the program with funds from the Medical Care Collection Fund.
Although this appears to release the pressure on hospitals to
take money from their own budgets, it does not because the hospitals
usually use money from the Collection Fund anyway because of the
annual shortfall in appropriations for health care in the VA.
With current inadequate health care appropriations, VA is
finding it difficult to care for existing enrolled veterans, let alone
subsidize an expansion of non-VA benefits and services. Section 6:
Pilot Program for Contract Hospitalization and Fee Basis
Ambulatory Care Currently, under 38 U.S.C. § 1703, the VA may, under certain circumstances, contract with non-VA health care facilities to furnish care for veterans if they live in an area where a VAMC is “geographically inaccessible” or because the VA is “not capable of furnishing the care or services required[.]” Under 38 U.S.C. § 1728, the VA has limited authority to reimburse veterans for health care received at non-VA facilities under certain special circumstances. Section 6, “Pilot Program for Contract Hospitalization and Fee Basis Ambulatory Care,” of H.R. 2792 would force veterans in four geographic areas to receive their health care under these two statutory sections from a managed care provider. We strongly oppose this section. People
with disabilities are most at risk under a managed care regime.
Forcing disabled veterans into a managed care plan would put
veterans at the mercy of the health care managers who would ration
their care. This could
negatively effect the quality of care that a disabled veteran is
receiving. A managed care
program would limit the veterans’ choice of health care provider.
Likewise, private managed care programs do not have
well-developed specialized services and direct access to specialists
required by people with severe disabilities.
There is no guarantee that the specialized services that the
disabled veterans need will be available in the private health system.
Severely disabled veterans would be forced to settle for low
quality specialized care or none at all. Section 7:
Recodification of Bereavement Counseling Authority and Certain
Other Health-Related Authorities PVA supports Section 7 of the bill.
For veterans who live at home, family members tend to be the
primary care givers, and provide as much to the health and well-being
of the veteran as a doctor or specialist.
For those family members who either provide care to a severely
disabled veteran or who suffer from their own severe illness or
disease, they deserve assistance from the VA. They should be entitled to any bereavement counseling or
support that they might need to improve their quality of life. Section 8:
Extension of Expiring Collections Authorities PVA supports the extension of collection authorities established by Section 8 of the bill. The VA already maintains the authority to collect per diem nursing home and hospital co-payments from certain veterans, and
to collect third-party payments for the treatment of non-service
connected disabilities of veterans with service-connected
disabilities. These
collections serve as additional income for the VA on top of money that
is appropriated by the government. H.R. 1435, The “Veterans’ Emergency
Telephone Service Act of 2001” As we have testified, we are unable to
support H.R. 1435, the “Veterans’ Emergency Telephone Service Act
of 2001.” As we stated
before the Subcommittee on Benefits on July 10, 2001, we believe that
the VA should operate any informational hotline that is created in
addition to the service it currently operates.
The VA has the expertise, and the mandate, to accurately answer
informational requests and to assist veterans with their benefits
claims. More can be done
to make the general public aware of this resource, and more can be
done to improve it, but granting money to an outside entity to create
a hotline without fixing the current hotline is inappropriate. H.R. 1136, A
Bill to Amend Title 38 U.S.C., to Require VA Pharmacies to Dispense
Medications to Veterans for Prescriptions Written by Private
Practitioners PVA does not support H.R. 1136, a bill
that requires VA pharmacies to dispense medications to veterans for
prescriptions written by private practitioners. The approximate $1
billion increase for health care slated for FY 2002 does not even
cover salary increases and inflation for the coming year. Moreover, it is estimated that next year the cost of
pharmaceuticals will be three times the rate of inflation. The VA does
not need to take on the role of the veterans’ drug store.
Now is not the time, when the VA does not have the resources
necessary to provide sick and disabled veterans the health care they
need, to further burden the VA with additional demands on these scarce
resources. Again, PVA appreciates the opportunity
to share our views on these important measures with this Subcommittee. It is clear that we need to work together to reach a common
ground on capacity requirements, the means test threshold, and
specialized care for severely disabled veterans.
The end result should be provisions that are equitable and fair
and that do not diminish the quality and quantity of health care our
veterans are receiving. This concludes my testimony, Mr.
Chairman. I would be
happy to answer any questions that you or any of the other members of
the committee might have. ATTACHMENT Proposal to Adjust
Veterans Health Care Eligibility Means Test to More Accurately Reflect
Locality Cost of Living Variations The
Paralyzed Veterans of America (PVA) is requesting legislation to
change the means test used by the Department of Veterans Affairs (VA)
to determine whether veterans will be placed in enrollment priority
Category 5 or 7 as set forth in 38 U.S.C. § 1722. Category placement
is important because veterans enrolled in lower categories (i.e., 6
and 7) whose incomes are above current means test levels are required
to make co-payments for much of their care. In
the “discretionary” Category 7, they could also be at greater risk
of disenrollment should the VA budget require it in the future. Justification In
creating Category 5, Congress demonstrated its desire to provide
health care to veterans who are unable to defray the cost of care. For this reason, Category 5 veterans do not pay co-payments
for health care received. Category
7 veterans do pay co-payments. In
addition, VA hospitals receive reimbursement for providing care to
Category 5 veterans. Hospitals
do not get reimbursed for Category 7 veterans.
Currently,
the VA uses a national means test income threshold of $23,688 for a
veteran with no dependents and $28,430 for a veteran with one
dependent. This universal
threshold applies regardless of the geographic cost-of-living
differences. A universal income threshold does not adequately address
many individual veterans’ inability to “defray the cost of care”
as required by 38 U.S.C. § 1722. Relevant
statutory Authority 38
U.S.C. § 1722 establishes the criteria by which a veteran is
determined to be unable to defray necessary expenses and establishes
the income thresholds to be used in making this determination. 38
U.S.C. § 1705 establishes the VA’s patient enrollment system. §
1705 (a) establishes the seven categories with which the VA
prioritizes the provision of care. § 1705 (a) (5) establishes the
fifth priority category as “ veterans not covered by paragraphs (1)
through (4)
who are unable to defray the expenses of necessary care as determined
under § 1722 (a) of this title”. § 1705 (a) (7) establishes
priority category seven as veterans described in § 1710 (a) (3) of
this title. 38
U.S.C. § 1710 (a) (3) authorizes the VA to treat veterans in priority
categories 6 and 7 on a “funds permitting” basis and at the
Secretary’s discretion. 42
U.S.C. § 1437a (b) (2) defines the term “low income families” as
“…families whose incomes do not exceed 80 per centime of the
median income for the area, as determined by the Secretary (of housing
and urban development) with adjustments for smaller and larger
families.” PROPOSAL The
most direct way to address this problem is to adjust the national
means test by locality to more accurately reflect the differences in
geographic cost-of-living. This
locality-adjusted means test would help veterans who have incomes
slightly higher than the existing threshold who have previously been
designated as Category 7. They would now fall below a newly-adjusted
means test threshold for their area and be classified Category 5. The
individual VA Healthcare networks, otherwise known as VISNs (Veterans
Integrated Service Networks), would no longer be able to collect
co-payments for the care provided to these veterans but would begin to
receive reimbursement for their care. PROPOSED
METHODOLOGY We
have identified the HUD Low Income Index as established through
Section 3 of the U.S. Housing Act of 1937, as amended in 1998, as a
viable index. The HUD index defines “low income” for families with
incomes that do not exceed 80 percent of the median family income for
the area in which they reside. The areas are broken down into a
variety of categories including Metropolitan Statistical Areas (MSAs),
Primary Metropolitan Statistical Areas (PMSAs) and counties. This
index has defined both geographic areas and cost of living within
these areas and should be relatively easy for the VA to implement. Using
the low-income methodology would mean that all veterans residing in a
defined locality would have a means test threshold that was adjusted
to reflect the cost-of-living determined by the HUD formula for that
particular defined area. This new threshold is more indicative of the
veteran’s ability to defray the cost of care. Furthermore, to insure
that no veterans are bumped from Category 5 into Category 7 when these
new thresholds are implemented, we propose to maintain the existing
$24,000 threshold, regardless of the number of dependents, nationwide
as the lowest figure for any means test variations even if the HUD
formula determines that the low-income rate for a particular area is
actually under $24,000. In other words, for any location where the
low-income index indicates that the new threshold should actually be
lower than $24,000, the means test figure will stay at $24,000,
regardless of the number of dependents in the veterans’ household.
This provision guarantees that no VISN will lose any Category 5
veterans and only stand to gain category 5’s from implementation of
this new means test system. The
following explanation of HUD’s methodology for determining the
median income and subsequent income amounts is taken from HUD’s own
briefing book: HUD METHODOLOGY
FOR ESTIMATING FY 2000 MEDIAN FAMILY
INCOMES (ECONOMIC AND
MARKET ANALYSIS DIVISION, OFFICE OF ECONOMIC
AFFAIRS, PD&R) FY 2000 HUD estimates of median family income are based on 1990 Census data estimates updated with a combination of local Bureau of Labor Statistics (BLS) data and Census Divisional data. Separate median family income estimates (MFIs) are calculated for all Metropolitan Statistical Areas (MSAs), Primary Metropolitan Statistical Areas (PMSAs), and non-metropolitan counties. The
income adjustment factors used to update the 1990 Census-based
estimates of MFIs are developed in several steps.
Average wage data from the Bureau of Labor Statistics (BLS)
were available for 1989 through the end of 1997 at a county level, and
were aggregated to the metropolitan area level for multi-county
metropolitan areas. Census
Divisional level median family and household income estimates were
available from the Current Population Report (CPR) March 1990-99
surveys, which measure incomes from mid-1989 through mid-1998.
These data were then used to update mid-1989 income estimates
from the 1990 Census to the middle of 1998.
The mid-1998 estimates were trended forward to mid-FY 2000
using a factor based on past P-60 Series trends.
The step-by-step normal procedures as well as the exception
procedures used are as follows: 1.
Estimate mid-1989 local median family incomes using 1990 Census
data. (Current HUD
Section 8 Fair Market Rent (FMR) program definitions are used to
define metropolitan areas, which are normally the same as Office of
Management and Budget metropolitan area definitions.) 2.
Calculate the BLS wage change factors for each Census Division
for the 1989-97 period as follows: Census
Division BLS Wages (1997) Census
Division BLS Employees (1997)
= 8-year BLS wage increase factor for Census
Division Census
Division BLS Wages (1989) Census
Division BLS Employees (1989) 3.
Calculate the change in median family and household incomes for
the nine Census Divisions for the 1989-1998 period using Census P-60
series data, as follows: Census
Division P-60 MFI (1998)
= 9-year increase factor for Census Census
Division P-60 MFI (1989)
Division P-60 Median Family Income 4.
Compare the BLS and P-60 series Census Divisional factors
calculated in steps 2 and 3 to provide a means of adjusting local BLS
wage factor changes so that they aggregate to the same change factor
as P-60 changes in family incomes plus contain an added year of CPS
trending. 9-year
increase factor for Census
Division P-60 MFI =
Ratio of Census Division P-60 8-year
increase factor for
MFI to ratio of Census Census
Division BLS Wages
Division BLS wage changes 5.
Calculate the 1989-98 increase factors for the individual
metropolitan areas and nonmetropolitan counties by applying the Census
Divisional index factors from step 4 to local BLS data. Local BLS
Wages (1997) Local BLS
Employees (1997) Ratio of Census 9-year income *
Division P-60
= adjustment MFI to Census
factor for Local BLS
Wages (1989)
Division BLS wages MSA or County Local BLS
Employees (1989)
= 1989 to
mid-
1998
MFI
Adj. factor 6.
Convert 1989-98 step 5 change factor to a 1989-2000 change
factor by applying an annual trending figure of 4.0 percent to
update the mid-1998 estimate to mid-1999, and applying a 3.0 percent
factor (3/4 of 4.0 percent) to the mid-1999 to April 1, 2000 period.
(Use of a trending factor is necessary because of lags in
Bureau of Labor Statistics and P-60 Series data availability; the 4.0
percent factor is based on national income change patterns in recent
years.) (Step 5 adj.
factor) * 1.04 * 1.03 = 1989 to mid-FY 2000 adjustment factor 7.
Calculate median family incomes for FY 2000 by multiplying the
step 1 Census estimate of median family income by the income
adjustment factor derived in Step 6. 1990 Census
Median Family Income * Step 6 factor = FY 2000 MFI EST. 8.
For American Housing Survey areas, compare the MFI estimates
from step 7 with median family income estimates based on post-1989
American Housing Survey (AHS) estimates of median family income
updated to 2000. Past analysis shows that there is 95 percent likelihood that
the true local median family income is within 6 percent of the
AHS-based estimate. For areas where an AHS-based estimate differs by
more than 6 percent from the Census-based estimate, local MFI
estimates are increased or decreased so that they are within 6 percent
of the AHS-based estimate. 9.
Compare the 2000 MFI estimate with the 1999 MFI estimate. If the 1999 estimate is higher set the 2000 estimate at the
1999 level. (This policy
is applied except when estimates are revised with decennial Census
data, and serves to minimize disruption in program activities due to
temporary decreases in income estimates.) In addition
to the above procedures, constraints are placed on annual changes in
the Census Divisional and BLS change factors based on past experience. These guidelines constrain increases for a small number of
areas with unusually high increases. VA’s ABILITY TO
COLLECT COPAYMENTS AND THIRD PARTY REIMBURSEMENT Applying
a regional adjustment to the means test would not affect VA’s
ability to charge third party health insurers for the cost of care
provided to a veteran because VA’s authority to collect insurance
payments is not tied to the means test.
However, the means test is used by VA to determine a
veteran’s obligation to pay co-payments for their care and adjusting
the means test would therefore affect VA’s ability to collect
co-payments. The
means test used by the Department of Veterans Affairs is set forth at
38 U.S.C. § 1722. While
this statutory provision sets forth the amount of the annual means
test threshold, and prescribes the methodology for calculating whether
a veteran’s income exceeds this threshold, it does not state the
purpose of the means test. Rather, the means test set forth in §1722 is referred to in
two distinct statutes that govern eligibility for care and the
obligation to pay a co-payment. The
means test threshold set forth in § 1722 is expressly referred to by
the statutory provision governing VA’s managed care system of
enrollment. See
38 U.S.C. § 1705(a)(5). Under
VA’s enrollment system, veterans are placed in one of seven priority
categories based on consideration of such factors as income, level of
disability, and percentage of service-connection.
See 38 U.S.C. §
1705. Each year, VA is
required to enroll only those categories of veterans that can be
treated within appropriated funding.
See 38 U.S.C. §§
1705, 1710(a)(4). Veterans
with income under the means test threshold are placed in priority
category 5, ensuring that those veterans determined to be unable to
defray the cost of their care will not be among the first cut from
care when appropriations are insufficient to provide care to all
veterans. Regionally
adjusting the means test will therefore elevate some veterans from
priority category 6 and 7 to priority category 5. The
means test threshold set forth in § 1722 is also referred to in the
statutory provisions governing the determination of a veteran’s
obligation to pay a co-payment. See 38 U.S.C. § 1710(a)(2)(G).
Under this statutory provision, veterans with income under the
annual means test threshold receive cost free care, while those with
income over the means test must pay co-payments for inpatient and
outpatient care. See
38 U.S.C. §§ 1710(a)(3), 1710(f).
Veterans with income over the means test must pay an inpatient
hospital co-payment of $768 per 90 days of care, plus a per diem
charge of $10 per day. See 38 U.S.C. § 1710(f). Veterans
with income over the means test must also pay an outpatient co-payment
of $50.80 per visit. See
38 U.S.C. § 1710(g). Regionally
adjusting the means test will therefore exempt some veterans from
these co-payment obligations if the means test is adjusted upward in
their region to an amount in excess of their current income. The
authority for VA to bill a veteran’s private health insurer is set
forth in 38 U.S.C. § 1729. This
statute neither references the provisions of § 1722 nor utilizes the
means test threshold to determine whether a veteran’s private health
insurer may be billed for the cost of care provided.
Rather, § 1729 broadly grants VA the authority to bill the
private health insurer of any nonservice-connected veteran, regardless
of priority category placement or income level, for the full cost of
care provided at a VA facility. See
38 U.S.C. § 1729(a)(2)(D)(ii). VA
is even permitted to bill third party health insurers for the full
cost of treatment provided for the nonservice-connected disabilities
of veterans with service-connected disabilities.
See 38 U.S.C. § 1729(a)(2)(E).
Since VA ’s authority to recover the cost of care from
private health insurers is not related to the means test threshold set
forth in § 1722, regionally adjusting the means test threshold will
have no impact on insurance billing. ESTIMATES OF
NUMBER OF VETERANS AFFECTED The
following chart estimates the number of veterans in certain MSAs that
would be moved form category 7 into category 5 through this proposal.
These numbers are based on data obtained form the VA. The MSAs listed
in the chart were chosen at random. Please note, that
while we are proposing that the bottom threshold be established at
$24,000, regardless of the number of dependents per family.
CONCLUSION Implementation
of the HUD low-income rates to augment VA's single means test standard
and methodology will create a system that realistically and equitably
reflects cost-of-living variations from one locality to the next,
reflecting a veteran’s ability to defray the cost of his health care
as per Congress’ original intent. Leaving the existing threshold as
a base level guards against harm for any veteran currently meeting
existing means test criteria. While VA’s health care networks will
lose the ability to collect co-payments from veterans formerly
enrolled in category 7 who would now be bumped into category 5, under
the original statutory intent governing the eligibility category
placement, where the ability to defray the cost of care is the
determining factor in placement in either category 5 or 7, these
veterans should never have been required to pay co-payments in the
first place. Furthermore, we believe that each VA health care system
will be able to recoup the loss of the moneys collected as co-payments
by “drawing down” reimbursement from VA central office for these
new category 5 patients. RICHARD B. FULLER Richard
B. Fuller is the National Legislative Director of the Paralyzed
Veterans of America, a non-profit veterans service organization
chartered by the United States Congress to represent the interests of
its members, veterans with spinal cord injury or dysfunction, and all
Americans with disabilities. PVA’s primary legislative focus centers
on issues supporting the Department of Veterans Affairs health care
system and the specialized services VA provides to PVA members.
He is responsible for coordinating the organization’s
legislative and oversight activities on all veterans’ benefits and
services, as well as oversight on all federal health systems –
Medicare and Medicaid – and research activities which benefit
veterans as well as all Americans with disabilities. Mr.
Fuller served for eight years on the professional staff of the
Committee on Veterans’ Affairs of the U.S. House of Representatives
with primary responsibilities in areas of veterans’ health and
education legislation. Since
1987, he has worked in the field of public policy and government
relations, specializing in health policy for a wide variety of health
advocacy, consumer health research and provider non-profit
organizations in Washington, D.C. Mr.
Fuller was Director of Public Affairs of the House Committee on
Veterans’ Affairs from 1979 to 1981.
He served on the professional staff of the Subcommittee on
Education, Training and Employment, and for the Subcommittee on
Hospitals and Health Care until 1987.
In 1987, he joined the national government relations staff of
PVA, serving first as Associate Legislative Director, and then as
National Legislative Director. In 1991, he joined a Washington D.C. health care consulting
firm representing the public policy and legislative interests of
several national medical and research societies, including: the
American Federation for Clinical Research; the American
Gastroenterological Association; the American Geriatrics Society; and
the National Association of Veterans Research and Education
Foundations. He returned
to PVA in 1993 to lead the organization’s outreach efforts on
national and state health-care reform. Mr.
Fuller graduated with a Bachelor of Arts degree from Duke University
in 1968. He served in the
United States Air Force from 1968 to 1972, stationed two and one-half
years in Vietnam and Southeast Asia as an aircrew Vietnamese linguist
with the Air Force Security Service. Information
Required by Rule XI 2(g)(4) of the House of Representatives Pursuant to Rule XI 2(g)(4) of the
House of Representatives, the following information is provided
regarding federal grants and contracts. Fiscal Year 2001 Court of Appeals for Veterans Claims,
administered by the Legal Services Corporation — National Veterans
Legal Services Program— $83,000
(estimated as of February 28, 2001). Fiscal Year 2000 General Services Administration
—Preparation and presentation of seminars regarding implementation
of the Americans With Disabilities Act , 42 U.S.C. §12101, and
requirements of the
Uniform Federal Accessibility Standards — $30,000. Federal Aviation Administration –
Accessibility consultation -- $12,500. Court of Appeals for Veterans Claims,
administered by the Legal Services Corporation — National Veterans
Legal Services Program— $200,000. Fiscal Year 1999 General Services Administration
—Preparation and presentation of seminars regarding implementation
of the Americans With Disabilities Act , 42 U.S.C. §12101, and
requirements of the
Uniform Federal Accessibility Standards — $30,000. Court of Appeals for Veterans Claims, administered by the Legal Services Corporation — National Veterans Legal Services Program— $240,000. Back to Witness List |
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