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Submission For The Record of Veterans of Foreign Wars

MR. CHAIRMAN AND MEMBERS OF THE SUBCOMMITTEE:
On behalf of the men and women of the Veterans of Foreign Wars of the United States (VFW) and our Auxiliaries, I would like to thank you for the opportunity to offer testimony on today’s pending legislation.
H.R. 241, Veterans Timely Access to Health Care Act
This legislation would direct the Secretary of Veterans Affairs to ensure that all medical visits to Department of Veterans Affairs (VA) facilities are completed no more than 30 days after the veteran contacts VA to schedule an appointment.  Additionally, it would require that VA submit a detailed report to Congress on scheduled wait times no later than 60 days after the end of each quarter.  
The VFW understands that unacceptably long appointment wait times present a serious and ongoing problem, especially for new enrollees and those seeking specialty care, and agrees with the intent of this legislation to address that issue.  We are concerned, however, that its enactment would remove too much flexibility from the scheduling process.  Appointment wait times can be measured either from the date the veteran schedules the appointment or the date that the veteran desires the appointment to take place. The date of contact, or create date, could be several months in advance of the desired date, specifically when the veteran takes the opportunity to schedule a follow-up at the conclusion of his or her current appointment.  Many medical conditions require periodic visits with the veteran’s health care provider on a less than monthly basis. Legally mandating that all appointments must take place within 30 days of the create date could prevent VA from being able to offer long-term scheduling even when the veteran and the provider agree that it is appropriate.  A veteran desiring an appointment 60 days in the future would have until 30 days prior to the desired date to schedule.  This would greatly complicate the VA appointment reminder policy by necessitating reminders for when veterans should be making their appointments in addition to when those appointments occur.  For these reasons, we feel that eliminating the ability of VA to schedule appointments based on a distant desired date would inevitably lead to missed appointments, creating unnecessary cost to VA and diminished care for veterans.
The failure of VA scheduling staff to accurately establish veterans’ desired dates, however, has led to exceedingly long and inaccurately reported wait times in the past, as highlighted by the December, 2012 Government Accountability Office (GAO) report, Reliability of Reported Outpatient Medical Appointment Wait Times and Scheduling Oversight Need Improvement.  To correct this problem, GAO recommended that VA adopt a scheduling policy which more clearly defines the desired date or adopt new wait time measures that are not subject to interpretation.  In response, VA has adopted the use of the create date to determine the appointment wait times for all new enrollees. VA has further stated that it will move to a policy which no longer uses the desired date as determined by the scheduler, and instead begin using an “agreed upon date” which is determined jointly by the provider and the veteran to track appointment wait times for established enrollees.  The VFW will be closely monitoring these reforms and encourages Congressional oversight of their progress and effectiveness.
The VFW believes that, if executed properly, this new scheduling policy creates an accurate and reliable method of determining wait times and will increase veteran satisfaction while maintaining the current level of scheduling flexibility.  Consequently, we cannot support       H.R. 241 in its current form.  The VFW would, however, consider supporting similar legislation requiring VA to schedule all appointment requests no more than 30 days after the agreed upon date for established enrollees, and the create date for new enrollees and all those seeking referrals from their current providers to new providers or specialty care.
H.R. 288, CHAMPVA Children’s Protection Act of 2013
The VFW supports this legislation to extend the age limit for coverage of certain veterans’ dependents through the Civilian Health and Medical Program of the Department of Veterans Affairs (CHAMPVA) to the level set by the Patient Protection and Affordable Care Act (ACA).  
The ACA, passed in early 2010, allowed families with private health insurance coverage to keep their children on their plans until age 26.  TRICARE and CHAMPVA recipients were not included in that change.  Thanks to responsible leaders in Congress, TRICARE coverage has been guaranteed to this age group.  Unfortunately, CHAMPVA beneficiaries have not been afforded the same privileges.  This remains an outstanding issue that must be rectified.
The VFW urges, however, that this legislation be strengthened to explicitly provide coverage to all children of CHAMPVA beneficiaries under the age of 26, not just those who are enrolled full-time at an approved educational institution or are unable to do so because of disability.  Such a change would provide the standard of coverage offered under the ACA, as amended by the Health Care and Education Reconciliation Act of 2010, which offers coverage to all dependent children until age 26, regardless of educational status.  The VFW strongly believes that CHAMPVA, which was established in 1973 and has more than 378,000 unique beneficiaries comprised of dependents and survivors of certain veterans, should in no instance ever receive less than the national standard.  
H.R. 984, To direct the Secretary of Defense to establish a task force on urotrauma.
The VFW is pleased to offer our support for this legislation which would establish an interagency task force on genitourinary organ injuries (urotrauma) to advise on research and action needed to advance the care and treatment of urotrauma.
The American Urological Association has reported that urotrauma injuries account for 10 percent of battlefield injuries with a 350 percent increase in incidence for those serving in Afghanistan compared to those who served in Iraq.  Although less common than other physical injuries, the long-term emotional yet publicly invisible wounds from a genitourinary injury can mean loss of function and fertility for many service members.  The psychological outcome of these battlefield injuries for both men and women can be devastating.  
The VFW believes that this legislation will begin to address some of those needs by bringing together the Departments of Defense, Veterans Affairs, and Health and Human Services to study current incidence, morbidity and mortality rates, as well as the social and economic impact.  It would also task the agencies to evaluate public and private resources for the diagnosis, prevention, treatment and most importantly, research of these injuries.  Finally, it would focus on identifying programs and best practices among stakeholders to improve the coordination and management of urotrauma injuries.  
Better coordination and efficient use of resources both public and private will provide the key to improved care, treatment and management of those suffering from the residuals of these injuries.  We urge Congress to pass this bill quickly.
H.R. 1284, To amend title 38, United States Code, to provide for coverage under the beneficiary travel program of the Department of Veterans Affairs of certain disabled veterans for travel for certain special disabilities rehabilitation, and for other purposes.
The VFW supports this legislation which would extend beneficiary travel benefits to veterans with certain severe non-service connected disabilities who travel to receive care provided through a VA special disabilities rehabilitation program.  Veterans who are catastrophically disabled due to spinal cord injuries, visual impairments, and multiple amputations often require in-patient care in order to achieve full rehabilitation.  Not all VA facilities, however, offer the specialized programs of care needed to properly treat these severe disabilities, and many veterans are forced to travel great distances to receive the care they need.  Those not eligible for travel reimbursement must do so at great personal cost and, as a result, may be forced to forego essential primary or preventative care for financial reasons.  This legislation would alleviate that hardship for this small but vulnerable population of veterans.
Draft Bill, Veterans Integrated Mental Health Care Act of 2013
The VFW does not support this legislation which would require VA to furnish non-VA mental health care to any eligible veteran who elects to receive such care at a non-VA facility that is able to meet certain care-coordination standards.  The VFW strongly believes that veterans deserve access to timely and high quality mental health care that is fully integrated and responsive to their needs.  However, VA must remain firmly in control of health care delivery.  VA is currently moving forward with a major national initiative to revolutionize fee basis care, the Patient Centered Community Care (PCCC) program, which would establish contracts to provide a number of managed care services at non-VA facilities based upon individual need, including mental health services.  The VFW believes that mandating new contracting requirements when VA is on the cusp of awarding PCCC contracts could create confusion within VA, halting or disrupting the progress of PCCC reform.
Draft Bill, Demanding Accountability for Veterans Act of 2013
The VFW cannot support this legislation in its current form, which dictates specific disciplinary actions on any responsible manager following a failure by VA to properly respond to the recommendations of a covered report of the Inspector General (IG), as determined by IG.  We understand and agree with its intent, but are concerned with the precedent set by placing IG in a personnel management role. Managers must be held responsible for failing to properly perform their duties, but VA must maintain direct control over the accountability of its employees.
Mr. Chairman, this concludes my testimony.