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Alethea Predeoux, Associate Director of Health Legislation, Paralyzed Veterans of America

Alethea Predeoux, Associate Director of Health Legislation, Paralyzed Veterans of America

Chairwoman Buerkle, Ranking Member Michaud, and members of the Subcommittee, Paralyzed Veterans of America (PVA) would like to thank you for the opportunity to present our views on the Federal Recovery Coordination Program (FRCP). 

For more than 65 years it has been PVA’s mission to help catastrophically disabled veterans and their families obtain health care and benefits from the Department of Veterans Affairs (VA), and to provide support during the rehabilitative process to ensure that all disabled veterans have the opportunity to build bright, productive futures.  It is for this reason that PVA strongly supports the FRCP, and appreciates the Subcommittee’s continued work on improving the transition from active duty to veteran status for severely injured, ill, or wounded veterans and servicemembers.

The FRCP was created as a joint program between VA and the Department of Defense (DoD) to provide severely injured, ill, or wounded servicemembers and veterans with individualized assistance obtaining health care and benefits, and managing rehabilitation and reintegration into civilian life.  Through the program, veterans and service members are assigned a Federal Recovery Coordinator (FRC) and create a Federal Individual Recovery Plan that consists of long-term goals for the veteran and his or her family members.  Such a plan motivates veterans to fight through the initial difficulties of adjusting to life after a catastrophic injury.

The purpose of today’s hearing is to again assess challenges of the FRCP and identify ways in which we can continue to improve this program to best meet the needs of veterans and servicemembers.  In the past year, the FRCP has made changes to enhance service delivery and expand its outreach; however, more work must be done in order to adequately meet the needs of veterans. 

When PVA provided the Subcommittee with a statement for the record for the hearing held on May 13, 2011, which examined the progress and challenges of the FRCP, we identified three areas in need of improvement:  continuity of care, care coordination, and program awareness.  Today, we still believe that these areas are critical to the success of the FRCP and are in direct alignment with the issues and recommendations outlined by the Government Accountability Office (GAO) in a March 2011 report entitled, “DOD and VA Health Care:  Federal Recovery Coordination Program Continues to Expand but Faces Significant Challenges ( GAO-11-250).”   In this report, GAO identified three primary challenges with implementation of the FRCP:  servicemember enrollment, hiring Federal Recovery Coordinators (FRCs), and care coordination.  GAO concluded the report with four main recommendations to help VA leadership address issues stemming from the main challenges facing the program.  Today, PVA will provide our position in support of the GAO recommendations, and our views on the current progress of the implementation of the FRCP.

 FRCP Enrollment

The first recommendation from the GAO report was to “ensure that referred service members and veterans who need FRC services are enrolled in the program by establishing adequate internal controls regarding the FRCs’ enrollment decisions.”    In particular, this recommendation identifies the need to require FRCs to record the factors they consider in making FRCP enrollment decisions, as well as the need to create an assessment tool to evaluate such decisions.  PVA believes that the use of such recording methods and assessment tools will help streamline the enrollment process, and ensure that veterans and their families are receiving help when it is requested.  Additionally, as it relates to veterans seeking assistance and looking to enroll in the FRCP, tracking enrollment decisions will provide FRCs with the opportunity to identify how a service member has learned about the FRCP.  Identifying referral sources will enable both VA and DoD to establish partnerships with other departments in and outside of their agencies to promote the FRCP and possibly reduce duplication of care-coordination efforts across VA and DoD programs.

PVA believes that service member enrollment is one of the most critical elements of the FRCP.  Service members must be informed of the FRCP and the variety of services available to them through the program.  However, making sure that veterans and servicemembers, as well as their families and caregivers, are aware of the FRCP has proven to be a continuous challenge.  While participation numbers are growing, FRCP leadership must work to keep information about the program circulating throughout the veteran and military communities.  This can best be accomplished as a joint effort that incorporates different offices and departments across both the VA and DoD.

To promote the FRCP, information posters and pamphlets should be made available to veterans and servicemembers when they visit different offices within VA and DoD.  The FRCP services should also be announced through social media tools such as Facebook and Twitter to inform veterans and servicemembers of this program.  Such educational literature would be useful not only for veterans and servicemembers, but for their families and caregivers as well.  Veterans and servicemembers participate in many VA programs, but it is often a loved one or caregiver who is helping manage and coordinate the various services of care and they can significantly benefit from the help of an FRC. 

Collaboration between FRCP staff and specialized services teams is another way to reach the targeted population that can benefit from FRCP services.   The referral criteria for the FRCP includes veterans and service members who have sustained a spinal cord injury, amputation, blindness or vision limitations, traumatic brain injury, post traumatic stress disorder, burns, and those considered at risk for psychosocial complications—all areas included in VA’s system of specialized services.  Therefore, it is only logical for the FRCP to work with these specialty teams to promote the program, and educate veterans entering VA specialized systems of care on the FRCP services and benefits.

With regard to VA health care, the Veterans Health Administration is currently undergoing a change in the way it delivers health care to veterans by utilizing patient aligned care teams (PACT).  PACT is designed to provide patient-centered care through a team-based approach that emphasizes care coordination across disciplines.  PVA encourages the FRCP leadership to work closely with the VA Office of Patient Centered Care and Cultural Transformation since FRCs serve as an information resource during the medical recovery process and the PACTs can make referrals when a veteran or servicemember appears to be in need of FRCP services.

Additionally, in support of care coordination, PVA hopes that FRCs will reach out to the service officers and advocates who represent various veteran service organizations and work with veterans in a similar capacity on a daily basis.  PVA has a network of National Service Offices within VA that provide services to paralyzed veterans, their families, and disabled veterans. These services range from bedside visits, to guidance in the VA claims process, and legal representation for appealing denied claims. 

In fact, we recently received multiple reports describing close working relationships between PVA’s Senior Benefits Advocates and FRCs.  Our Senior Benefit Advocates and the FRCs work together on a daily basis to assist veterans and their families.  National Service Officers can be a great resource to the FRC for referrals, information on VA benefits and programs, and getting the word out about the FRCP within the veteran community.

FRC Caseloads

The second recommendation from the GAO report encouraged “complete development of the FRCP’s workload assessment tool that will enable the program to assess the complexity of services needed by enrollees and the amount of time required to provide services to improve the management of FRCs’ caseloads.”  PVA believes that monitoring and managing the level of complexity and size of FRC caseloads is extremely important to adequately addressing the needs and concerns of veterans and servicesmembers enrolled in the FRCP.

No matter how well prepared and trained an FRC may be, he or she will not be able to effectively help veterans and servicemembers to their best ability if they are spread too thin and overwhelmed with an unreasonable caseload.  Conversely, an FRC managing a smaller caseload of enrollees with polytraumatic and severe injuries will need fewer cases to provide adequate attention and assistance to those veterans and servicemembers.  That said, a work load assessment tool is absolutely necessary to ensuring that FRCs are available to hear the concerns and needs of veterans and servicemembers  and provide appropriate assistance during the recovery and rehabilitation processes.     

As it is a goal of the FRCP to meet the individualized needs of veterans and service members, each case will be unique and require different levels of attention.  These factors must be taken into consideration if FRCs are expected to provide timely quality assistance that is truly helpful to servicemembers and their families.

Hiring FRCs

The third recommendation, to “clearly define and document the FRCP’s decision-making process for determining when and how many FRCs VA should hire to ensure that subsequent FRCP leadership can understand the methods currently used to make staffing decisions,”  is an area of serious concern for PVA.  Adequate staffing of the FRCP is essential for providing servicemembers with timely, quality care. 

PVA believes that in conjunction with the aforementioned FRC caseloads, the staffing of FRCs is another area of concern that must be assessed to determine if current staffing levels are adequate to meet veterans’ and servicemembers’ needs.  With such a limited number of FRCs, issues involving transportation and distance have the potential to hinder access to FRCP services for many veterans in rural areas, and thus, become threats to continuity of care.  Further, developing a decision-making tool to determine when and how many FRCs should be hired has the potential to increase the program retention. 

If FRC caseloads are manageable, and the FRCs believe that they can actually help veterans and servicemembers, it is likely that employee job-satisfaction will be high, and FRCs will continue performing their duties.  This will lead to adequate staffing of the program, which will allow for FRCs and enrollees to develop effective long-term relationships.  It is these relationships that can help veterans and servicemembers adjust to life after a severe or catastrophic injury.

Placement of FRCs

The final GAO recommendation calls for the FRCP to “develop and document a clear rationale for the placement of FRCs, which should include a systematic analysis of data, such as referral locations, to ensure that future FRC placement decisions are strategic in providing maximum benefit for the program’s population.”  PVA believes that all veterans and servicemembers who are injured, ill, or wounded have earned access to the FRCP.  We understand that as a new program, time is needed to create, implement, and assess the inner-workings of such a comprehensive initiative. 

As recommendations for improvement are provided to VA leadership, we strongly encourage both VA and DoD to utilize existing care-delivery models such as telehealth and teleconferencing, or electronic enrollee accessible programs like My HealtheVet to meet with and communicate with veterans and servicemembers in areas that do not have reasonable access to an FRC. 

Particularly, PVA encourages VA to develop an outreach strategy for veterans living in rural areas to make certain that they are aware of the FRCP and have access to an FRC if necessary.  Specifically, we ask that as the program expands, VA, DOD, and Congress consider placing FRCs in locations where veterans with disabilities are already seeking services such as VA spinal cord injury centers or amputation centers of care.  Developing a clear rationale for the placement of FRCs will help ensure that those who have paid a significant price in service to our country are not only aware of the resourceful programs available to them, but also have the opportunity to participate in them.   

In conclusion, PVA would like to thank the Committee for their continued Congressional oversight of this extremely important program and recommends that FRCP leadership periodically survey veterans and service members, and their families, to identify areas for improvement.  There are numerous lessons to be learned and an abundance of opportunities for development. 

PVA appreciates the emphasis this Subcommittee has placed on reviewing the care being provided to the most severely disabled veterans and service members.  Navigating through two of America’s largest bureaucracies is a daunting task, but it can be particularly overwhelming when doing so after incurring a catastrophic injury such as a spinal cord injury, amputation, or as a polytrauma patient.   Providing veterans with professional guidance and stability during this process gives them the resources to make informed decisions involving their health care and benefits and focus on their recovery and future endeavors.

PVA would like to once again thank this Subcommittee for the opportunity to testify today, and we look forward to working with you to continue to improve the Federal Recovery Coordination Program.  Thank you.

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 2011

Court of Appeals for Veterans Claims, administered by the Legal Services Corporation

— National Veterans Legal Services Program— $300,000 (estimated).

Fiscal Year 2010

Court of Appeals for Veterans Claims, administered by the Legal Services Corporation

—National Veterans Legal Services Program— $287,992.

Fiscal Year 2009

Court of Appeals for Veterans Claims, administered by the Legal Services Corporation

— National Veterans Legal Services Program— $296,687.