Chairman Michaud, Ranking Member Miller, members of the Subcommittee, on behalf of Paralyzed Veterans of America (PVA) I would like to thank you for the opportunity to testify today on the proposed legislation that is meant to enhance the health care services available to veterans.  We appreciate the efforts of this Subcommittee to address the varying needs of the men and women who are currently serving in the War on Terror as well as those men and women who served during past conflicts.

Prohibition of Co-payments for Catastrophically Disabled Veterans

In accordance with the recommendations of The Independent Budget for FY 2009, PVA strongly supports the draft legislation that would prohibit the Department of Veterans Affairs (VA) from collecting certain co-payments from veterans who are catastrophically disabled.  This issue has the greatest impact on PVA members.  The current VA health care system allows veterans who have a non-service connected catastrophic disability, such as spinal cord injury, and who have incomes above means-tested levels to enroll in Priority Group 4.  Because of their designation as catastrophically disabled any PVA members not eligible for health care in Priority Group 1 can enroll in the system in Priority Group 4.  Congress granted these catastrophically disabled veterans this higher priority for health care enrollment because of the unique nature of their complex disabilities and in recognition of the specialized services that only the VA health care 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 non-service connected disabilities, who because of their incomes would otherwise be classified as Priority Group 7 or 8, can be enrolled in Priority Group 4 but are still subject to Priority Group 7 or 8 co-payments.  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.  Over 80 percent of our members use the VA for all or part of their care.  Because of the nature of their disabilities they require a host of pharmaceuticals, equipment, devices and supplies to function on a daily basis.  As stated in The Independent Budget for FY 2009:

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.  Any veteran determined by VA to be catastrophically disabled and placed in the priority group 4 should be afforded the same benefits as if rated as entitled to Aid & Attendance to eliminate medical/prescription co-pays and provide assistance with travel for that care. 

PVA looks forward to working with the Subcommittee to ensure that those veterans who are already struggling with the hardships associated with a catastrophic disability are relieved of this additional burden.  We believe that it is simply the right thing to do.

Counseling for Family Members of Veterans Receiving Non-Service Connected Treatment 

The proposed legislation would expand the authority of the VA to provide counseling for family members of veterans receiving non-service connected medical treatment.  Currently, the VA provides consultation, counseling and training to family members of veterans being treated by the VA for a service-connected disability when those services for the family members support the veteran’s treatment. 

Likewise, the VA is authorized to provide consultation, counseling and training for a veteran’s family, if the veteran has a non-service connected disability as long as the veteran is receiving hospital care and the services were initiated during the veteran’s hospitalization and if their continuation on an outpatient basis is essential to permit the discharge of the veteran from the hospital.  The proposed legislation would eliminate the criteria for hospital care and expand the authority of the VA to provide these essential services to family members. 

PVA supports this proposal.  We have, along with the co-authors of The Independent Budget, called for continued support for family services to benefit the spouses and dependents who are dealing with the struggles faced by the veteran.  However, it is imperative that adequate resources be devoted to these family support services if Congress chooses to expand this authority. 

 The “Veterans Nonprofit Research and Education Corporations Enhancement Act”

PVA 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 (NPCs).  This bill will allow the NPCs to fulfill their full potential in supporting VA research and education, which ultimately results in improved treatments and high quality care for veterans, while ensuring VA and congressional confidence in NPC management.

Since passage of P.L. 100-322 in 1988 (codified at 38 U.S.C. § 7361-7368), the NPCs have served as an effective “flexible funding mechanism for the conduct of approved research and education” performed at VA medical centers across the nation.  NPCs provide VA medical centers with the advantages of on-site administration of research by nonprofit organizations entirely dedicated to serving VA researchers and educators, but with the reassurance of VA oversight and regulation.  During 2007, 84 NPCs received nearly $230 million and expended funds on behalf of approximately 5,000 research and education programs, all of which are subject to VA approval and are conducted in accordance with VA requirements.

NPCs provide a full range of on-site research support services to VA investigators, including assistance preparing and submitting their research proposals; hiring lab technicians and study coordinators to work on projects; procuring supplies and equipment; monitoring the VA approvals; and a host of other services so the principal investigators can focus on their research and their veteran patients.

Beyond administering research projects and education activities, when funds permit, these nonprofits also support a variety of VA research infrastructure expenses.  For example, NPCs have renovated labs, purchased major pieces of equipment, staffed animal care facilities, funded recruitment of clinician-researchers, provided seed and bridge funding for investigators, and paid for training for compliance personnel.

Although the authors of the original statute were remarkably successful in crafting a unique authority for VA medical centers, differing interpretations of the wording and the intent of Congress, gaps in NPC authorities that curtail their ability to fully support VA research and education, and evolution of VA health care delivery systems have made revision of the statute increasingly necessary in recent years.  This legislation contains revisions that will resolve all of these and will allow the NPCs to better serve VA research and education programs while maintaining the high degree of oversight applied to these nonprofits. 

The legislation reinforces the idea of “multi-medical center research corporations” which provides for voluntary sharing of one NPC among two or more VA medical centers, while still preserving their fundamental nature as medical center-based organizations.  Moreover, accountability will be ensured by requiring that at a minimum, the medical center director from each facility must serve on the NPC board.  This authority will allow smaller NPCs to pool their administrative resources and to improve their ability to achieve the level of internal controls now required of nonprofit organizations.

The legislation also clarifies the legal status of the NPCs as private sector, tax exempt organizations, subject to VA oversight and regulation.  It also modernizes NPC funds acceptance and retention authorities as well as the ethics requirements applicable to officers, directors and employees and the qualifications for board membership.  Moreover, it clarifies and broadens the VA’s authority to guide expenditures.

We would urge the Subcommittee to reconsider one substantive change that the Subcommittee’s draft bill makes to its Senate companion, S. 2926.  That is, deletion of the provision that would authorize the NPCs to reimburse the VA Office of General Counsel for specialized legal services in regard to review and approval of certain research agreements.  While we would agree that the VA Office of General Counsel is obligated and funded to provide these services, the funds generated by these reimbursements would provide it with additional training and staffing resources to meet the high demand for these services which we understand may be obtained exclusively from VA attorneys.  We also understand that the foundations are in favor of making these reimbursements and that because in most cases the cost may be passed through to sponsors in the form of a legal review fee, there would be little or no impact on the funding available for the conduct of the research itself.  In our view, this reimbursement authority would be appropriate and PVA would concur with adding the necessary provisions to the Subcommittee’s discussion draft.

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 health care professionals.  We urge expeditious passage of this proposed bill so that veterans may benefit even more from the enhancements in operational capabilities and oversight that this bill provides.

Chairman Michaud and Ranking Member Miller, we appreciate the emphasis you have placed on providing for the needs of the men and women who have served and continue to serve in harm’s way.  We look forward to working with you to ensure that the best quality health care services are made available to them. 

Thank you again for the opportunity to testify.  I would be happy to answer any questions that you might have.