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Robert L. Jesse, M.D., Ph.D.

Robert L. Jesse, M.D., Ph.D., Principal Deputy Under Secretary for Health Veterans Health Administration U.S. Department of Veterans Affairs

Good Morning Chairman Benishek, Ranking Member Brownley, and Members of the Subcommittee.  Thank you for inviting me here today to present our views on several bills that would affect Department of Veterans Affairs (VA) health programs and services.  Joining me today is Susan Blauert, Deputy Assistant General Counsel.
Because of the time afforded for preparation of views, we do not yet have cleared views on H.R. 241, H.R. 984, the draft bill “the Veterans Integrated Mental Health Care Act of 2013” and the draft bill “the Demanding Accountability for Veterans Act of 2013”.  
H.R. 288    Increase of Maximum Age for Children Eligible for Medical Care Under CHAMPVA Program.
The intent of H.R. 288 as expressed in its subtitle is to increase the maximum age for children eligible for medical care under the Civilian Health and Medical Program of the Department of Veterans Affairs (CHAMPVA).  However, VA believes the language in H.R. 288, as written, may not accomplish this intent because it does not address the definition of “child” in 38 U.S.C. § 101 which limits eligibility for children under CHAMPVA in 38 U.S.C. § 1781.  VA would be glad to provide technical assistance to the Subcommittee if it does intend to extend eligibility for coverage of children under CHAMPVA until they reach age 26.  VA believes that eligibility for coverage of children under CHAMPVA should be consistent with certain private sector coverage under the Affordable Care Act.  
Assuming the intent of H.R. 288 is to accord the eligibility for medical care under CHAMPVA to children until they reach the age of 26, VA supports it, contingent upon Congress providing additional funding to support the change in eligibility.  Should the bill carry out that intent, VA estimates costs of $51 million in FY 2014; $301 million over 5 years; and $750 million over 10 years.
H.R. 1284    Coverage Under Department of Veterans Affairs Beneficiary Travel Program of Travel in Connection with Certain Special Disabilities Rehabilitation.
H.R. 1284 would amend VA’s beneficiary travel statute to ensure beneficiary travel eligibility for Veterans with vision impairment, Veterans with spinal cord injury (SCI) or disorder, and Veterans with double or multiple amputations whose travel is in connection with care provided through a VA special disabilities rehabilitation program (including programs provided by spinal cord injury centers, blind rehabilitation centers, and prosthetics rehabilitation centers), but only when such care is provided on an in-patient basis or during a period in which VA provides the Veteran with temporary lodging at a VA facility to make the care more accessible.  VA would be required to report to the Committees on Veterans’ Affairs of the Senate and House of Representatives no later than 180 days after enactment on the beneficiary travel program as amended by this legislation, including the cost of the program, the number of Veterans served by the program, and any other matters the Secretary considers appropriate.  The amendments made by this legislation would take effect on the first day of the first fiscal year that begins after enactment.
VA supports the intent of broadening beneficiary travel eligibility for those Veterans who could most benefit from the program, contingent on provision of funding, but believes this legislation could be improved by changing its scope.  As written, the bill could be construed to apply for travel only in connection with care provided through VA’s special rehabilitation program centers and would apply only when such care is being provided to Veterans with specified medical conditions on an inpatient basis or when the Veteran must be lodged.  VA provides rehabilitation for many injuries and diseases, including for Veterans who are “Catastrophically Disabled,” at numerous specialized centers other than those noted in H.R. 1284, including programs for Closed and Traumatic Brain Injury (CBI+TBI), Post-traumatic Stress Disorder and other mental health issues, Parkinson’s Disease, Multiple Sclerosis, Epilepsy, War Related Injury, Military Sexual Trauma, Woman’s Programs, Pain Management, and various addiction programs.  In addition, many of these programs provide outpatient care to Veterans who might not require lodging but must travel significant distances on a daily basis who would not be eligible under this legislation.
Therefore, VA feels that the legislation as written would provide disparate travel eligibility to a limited group of Veterans.  However, VA does support the idea of travel for a larger group of “Catastrophically Disabled” Veterans (including Veterans who are blind or have SCI and amputees) and those with special needs who may not be otherwise eligible for VA travel benefits.  VA welcomes the opportunity to work with the Committee to craft appropriate language as well as ensure that resources are available to support any travel eligibility increase that might impact upon provision of VA health care.
VHA estimates costs for this provision as $2.4 million for FY 2014; $13.1 million over 5 years; and $29.8 million over 10 years.
Mr. Chairman, this concludes my statement.  Thank you for the opportunity to appear before you today.  I would be pleased to respond to questions you or the other Members may have.