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Witness Testimony of Kimo S. Hollingsworth, American Veterans (AMVETS), National Legislative Director

Mr. Chairman and Members of the Subcommittee:

I am pleased to offer testimony on behalf of American Veterans (AMVETS) regarding pending health legislation before this Subcommittee.  AMVETS appreciates the Subcommittee’s work to ensure the Department of Veterans Affairs can fulfill its obligation to provide health care and other health related services to veterans. 

Mr. Chairman, some of the issues relevant to today’s hearing are extremely important to returning veterans from Operations Iraqi Freedom and Enduring Freedom.  Specifically, suicide prevention, mental health funding, and access to health care in rural or underserved areas.  These issues were identified and highlighted at the AMVETS sponsored “National Symposium for the Needs of Young Veterans” in
Chicago, Illinois
last year.  More than 500 veterans, active duty and National Guard and reserve personnel, family members and others who care for veterans examined the growing needs of our returning veterans.  With regards to today’s legislative agenda, AMVETS would like to offer the following observations.

H.R. 1448 would establish a Hospital Quality Report Card Initiative in order to report on health care quality in the Department of Veterans Affairs Hospitals.  The Government Performance and Results Act, Public Law 103-62, requires that agencies develop measurable performance goals and report results against these goals.  In the President’s Fiscal Year 2008 budget request, VA focuses on the Secretary of Veterans Affairs priority of providing timely and accessible health care that sets a national standard of excellence for the health care industry.   VA generally tracks the timeliness of care in two broad areas – primary and specialty clinic appointments.  Over the next year, the percent of appointments scheduled within 30 days of the desired date is expected to reach 96 percent for primary care appointments and 95 percent for specialty care appointments.

In July 2005, the VA Office of Inspector General (OIG) reported that VHA’s scheduling procedures needed to be improved and issued eight recommendations.  As of September 2006, five of the eight recommendations for improvement remained open and AMVETS encourages the Department to implement the remaining recommendations.  The Department has tracked and monitored the quality of care at VA facilities since the early 1970s through comprehensive quality management (QM) programs.  Furthermore, Public Laws 99-166 and 100-322 require the VA OIG to oversee VA QM programs at every level and a large part of the VA Office of Inspector General Combined Assessment Program (CAP) reviews focus on quality, safety and timeliness of VA health care.  Mr. Chairman, AMVETS supports efforts to improve VA health care and supports the intent of H.R. 1448.  However, we believe this legislation would mandate a duplicative effort as many of the items to be reported in a report card are already reviewed and reported through the VA QM and CAP programs.

H.R. 1853 would direct the Secretary to ensure the Department of Veterans Affairs police officers receive training to interact with visitors and patients at medical facilities who are suffering from mental illness.  VA police officers already receive some degree of training in interacting with individuals with potential mental illnesses and mandating this training will codify an existing practice.  AMVETS supports the intent of the bill.

H.R. 1925 would direct the Secretary of Veterans Affairs to establish a separate Veterans Integrated Service Network (VISN) for the Gulf Coast Region of the

.  Mr. Chairman, Public Law 104-204 directed VA to implement a more equitable resource allocation system that was to reflect, to the maximum extent possible, the Veterans Integrated Services Network developed by the Department to account for forecasts in expected workload and to ensure fairness to facilities that provide cost-efficient health care; and … ways to improve the allocation of resources so as to promote efficient use of resources and provisions of quality health care…  Obviously the Veterans Equitable Resource Allocation (VERA) model is designed to bring consistency, fairness and stability to the VA funding process.  This in turn is dependent upon the VISN model.

The Capital Asset Realignment for Enhanced Services (CARES) was supposed to be a system-wide process to prepare the VA for meeting the current and future health care needs of veterans. CARES addressed the appropriate clinical role of small facilities, vacant space, the potential for enhanced use leases and the consolidation of services and campuses.  To date, it is the most comprehensive analysis of VA’s health care infrastructure conducted.  The CARES made some very specific recommendations with regards to health care infrastructure, to include areas of the Florida Panhandle and the

Gulf
Coast

.

Overall, AMVETS supported the CARES process and we believe Congress should consider the CARES recommendations in deliberations about VA infrastructure to include deliberations about the current VISN model.  AMVETS would like to note that VA adopted the VISN model in 1995.  Considerable time has elapsed since implementation of the VISN model and there clearly have been demographic changes within the general population that would most likely include changes to the veteran population.

H.R. 2005 would seek to improve health care for veterans living in rural areas, to include providing an increase in the travel reimbursement and establishing centers of excellence for rural health research, education and clinical activities.  AMVETS continues to support an increase to the travel reimbursement rate for our veterans.  The VA beneficiary travel program was intended by Congress to assist veterans when trying to access VA health care.  The mileage reimbursement rate is currently fixed at 11 cents per mile; however, current law limits the actual reimbursement with a $3.00 per trip deductible capped at $18.00 per month.  The Secretary of Veterans Affairs has the authority to make rate changes to these rates, but changes have not been adopted in more than 30 years.  Obviously the price of owning and operating a vehicle has risen dramatically during this time period.  AMVETS believes it is now time for Congress to act by mandating a realistic reimbursement rate for the VA beneficiary travel program.

Regarding the delivery of rural health care, an important issue brought forth at the “National Symposium for the Needs of Young Veterans”, Sections 212 and 213 of Public Law 109-461 are specifically targeted at advancing the health care needs of veterans in rural areas.  VA is mandated to establish an Office of Rural Health within the Veterans Health Administration (VHA).  The office is charged with improving VA health care for veterans living in rural and remote areas.  Among other provisions, the law requires an extensive assessment of the existing VA fee-basis system of private health care, and eventual development of a VA plan to improve access and quality of care for enrolled veterans who live in rural areas.  AMVETS would encourage Congress to fully fund the Office of Rural Health and allow VA to conduct the mandated assessment.

H.R. 2172 would require VA orthotic-prosthetic laboratories, clinics and prosthesists to be certified by either the American Board for Certification in Orthotics and Prosthetics or the Board of Orthotics and Prosthetic Certification.  Mr. Chairman, the VA already receives certification from these agencies and we support the certification process.  AMVETS does have concern with the section of the bill that would require the VA to enter into contracts for service and repair of prosthetic devices with non-department entities.  This provision would create a “sole-source” contract, and AMVETS would oppose this provision.

H.R. 2173 would authorize additional funding to allow VA to enter into contracts with local or community health centers.  Mr. Chairman, as we are all aware, there is a large number of National Guard and reserve units that have deployed or will be deployed into a theater of combat operations.  Many of these units and personnel are from areas of the country that do not have VA health care or VA health care services readily available.  AMVETS continues to support the Secretary of Veterans Affairs in his authority to contract out for medical and health care services when/where applicable and also supports additional funding for these services.

H.R. 2192 would establish an Ombudsman within the Department of Veterans Affairs to act as a liaison for veterans and their families with respect to the receipt of health care and benefits administration.  The VA has a long history of special efforts to bring information on VA benefits and services to active duty military personnel.  These efforts include counseling about VA benefits through the Transition Assistance Program (TAP), a nationally coordinated federal effort to assist military men and women to ease the transition to civilian life through employment and job training assistance. A second component of the program, the Disabled Transition Assistance Program (DTAP), helps separating servicemembers with disabilities.

VA also has launched special efforts to provide a "seamless transition" for those returning from service in Operations Iraqi Freedom and Enduring Freedom.  Internal coordination was improved and efforts currently focus on reducing red tape and streamlining access to all VA benefits. Each VA medical facility and benefits regional office has identified a point of contact to coordinate activities locally to help meet the needs of these returning combat servicemembers and veterans. In addition, VA increased the staffing of benefits counselors at key military hospitals where severely wounded service members from and are frequently sent.  AMVETS does not oppose legislation to establish an Ombudsman within the VA.

H.R. 2219 would direct the Secretary to award a grant to a private, nonprofit entity to establish, publicize and operate a national toll-free suicide prevention telephone hotline targeted to and staffed by veterans of the Armed Forces.  Mr. Chairman, the Department of Veterans Affairs Office of Inspector General recently reported that veterans returning from and

are at increased risk of suicide because Veterans Administration health clinics do not have 24-hour mental health care available.  Many facilities lack 24-hour staff, adequate screening for mental problems, or personnel who were properly trained.

The report also concluded that VA clinics and military hospitals must improve their sharing of health information, particularly for patients who might return to active-duty status and that VA should loosen criteria for inpatient PTSD care. Currently only veterans with "sustained sobriety" get treatment.  It is AVMETS’ understanding that the VA Undersecretary for Health, concurs with findings and recommendations, and that VA has recently installed suicide prevention coordinators in each medical center to better develop prevention strategies.  AMVETS supports the Undersecretary in this endeavor; however, AMVETS would oppose efforts by Congress to mandate the Secretary of VA to enter into contracts with a private entity for these services and believes that the Secretary must continue to have flexibility in how he implements these services.

H.R. 2378 would establish a financial assistance program to facilitate the provision of supportive services for very low-income veteran families in permanent housing.  We continue to urge Congress to provide resources and oversight on homeless veterans programs and veterans who may be at risk.  With regards to the establishment of a financial assistance program for very low-income veterans, AVMETS would urge Congress to provide veterans priority assistance through the Department of Health and Human Services as opposed to creating a new program within the Department of Veterans Affairs.

Mr. Chairman, this concludes my testimony.