Senate Veterans’ Affairs Committee Hearing
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Testimony by
Good Morning Chairman Sanders, Ranking Member Burr, and Members of the Committee. Thank you for inviting us here today to present our views on several bills that would affect
VA is still in the process of formulating views on the following bills for which VA received notice or drafts on
Additional bills provided to VA during October for which views will be provided for the record are: draft bills entitled the "Enhanced Dental Care for Veterans Act," the "Improved Compensation for Hearing Act," the "SCRA Enhancement and Improvement Act," the "Ensuring Safe Shelter for Homeless Veterans Act; the "Servicemember Housing Protection Act,"; the "Support for Joint Federal Facilities Act, " a bill to re-designate the name of a
S. 1148 - Veterans Benefits Claims Faster Filing Act
Section 2(a) of S. 1148, the "Veterans Benefits Claims Faster Filing Act," would require VA to post in a conspicuous place in each regional office and claims intake facility and on VA's internet website information concerning the average processing times for claims based on various formats in which a claim can be submitted, and information concerning the percentage of claims for which benefits are awarded, categorized by whether the claimant was represented by a
VA understands and appreciates the importance of transparency and the need to keep Veterans,
VA does not support this bill, for several reasons. The bill would create a significant administrative burden that would effectively delay the processing of disability compensation claims. The requirement that VA provide certain information to each claimant potentially would require VA to revise a number of forms and would implicate the requirements of the Paperwork Reduction Act, requiring two periods of public notice prior to changing the form. VA currently provides notice on FDC forms stating that the FDC program is the fastest way to receive a decision on a claim. Soon, VA will be revising the notice to inform claimants of the potential entitlement to an extra year of benefit payments for original FDC claims.
VA has concerns about the complexity of data that would be required based on the bill. Some of the metrics outlined in the bill are not currently available in VA systems. For example, VA generally does not routinely track grant rates for particular types of claims or whether claims are submitted in standard or non-standard paper form. Similarly, the term "for which benefits are awarded," as used in section 2(c) of this bill, is ambiguous. Awards of service connection for a disability evaluated at zero percent do not result in payment. Disability compensation claims can involve a single disability contention or multiple contentions, and several claims from the same individual may simultaneously await resolution. It is unclear whether VA would be required to report awards per claimant, per claim, or per individual contentions within each claim.
The complex data that would be provided under the bill could easily mislead or confuse claimants rather than help them understand what they should do to support their claims. Providing this type of information could be seen as directing claimants to file, or not file, certain types of claims or to elect a particular type of representative. However, the data provided may not be the best indicator of the most appropriate course of action for the particular claimant. Also, reporting the percentages of claims with a power of attorney naming a VSO may be misleading, as Veterans with authorized VSOs often file claims without the direct involvement of their designated VSOs. Furthermore, most powers of attorney used to authorize claim representatives are not "durable."
VA also notes that H.R. 1148 does not specify which VA benefit(s) would be impacted by this bill. Although VA believes the bill is likely intended to apply to claims for service-connected disability compensation, the bill does not explicitly state this and would therefore apply to all benefits. Further, although the bill would require VA to notify each claimant of the availability of an extra year of benefit payments if a person files a FDC, section 506 of Public Law 112 154, which authorizes a one-year retroactive payment for persons who file FDCs, applies only to original (i.e., initial) claims by Veterans for disability compensation. Providing notice of the retroactivity provision to persons claiming other benefits, or to Veterans attempting to reopen disability compensation claims or to claim increased compensation, may be confusing and misleading. In addition, the FDC retroactivity provision has a sunset date, while the bill would require in perpetuity notice of the availability of the benefits.
VA estimates that there would be no benefit costs associated with enactment of S. 1148. VA estimates the general operating expenses (GOE) for section 2 of S. 1148 would be
S. 1155 - Rural Veterans Mental Health Care Improvement Act
Section 2 of S. 1155 would amend section 117(c) of title 38, United States Code, to add accounts providing funds for information technology, including subaccounts of the medical services, medical support and compliance, and medical facilities accounts, to the list of accounts in section 117 that receive advance appropriations.
We appreciate how Congressional support for VA advance appropriations for our medical care accounts has enabled a multi-year approach to medical budget planning and ensured continued medical services for Veterans. The advance medical care appropriation was designed to ensure continuity of critical medical operations in the face of fiscal uncertainty.
A proposal to expand VA advance appropriations to other accounts needs to take into consideration the advantages and disadvantages of such an approach not only for VA, but potentially other programs and agencies. We cannot therefore offer a position on section 2 of S. 1155 at this time. We very much appreciate the concern for Veterans services reflected in the proposal, and look forward to working with the Committee on how to best maintain the provision of VA benefits and services in light of fiscal uncertainties.
We are finalizing our views and costs on sections 3-5 of S. 1155. We will forward the views as soon as they are available.
S. 1165 - Access to Appropriate Immunizations for Veterans Act of 2013
S. 1165 would amend section 1701of title 38, U.S.C., to include certain adult immunizations as part of the preventive services detailed in subsection 9 of the statute. The bill would also amend section 1706 of title 38, U.S.C., to require VA to develop quality measures and metrics to ensure that Veterans receiving medical services also receive the immunizations.
VA strongly supports preventive care measures, including making a wide range of immunizations available at VA medical facilities. However, because we believe VA is already satisfying the purpose of this bill, we do not support this legislation. Under current policy, VA already provides preventive immunizations at no cost to the Veteran. In addition, VHA is represented as an ex-officio member of the
The delivery of preventive care including vaccinations has been well established in the VHA Performance Measurement system for more than 10 years with targets that are appropriate for the type of preventive service or vaccine. VA updates the performance measures to reflect changes in medical practice over time. Adding the additional legislative process of regulations to the development of targets would be burdensome and lengthy. Moreover, the legislative process does not allow for nimble changes as new research or medical findings surrounding a vaccine come to light. Because the clinical indications and population size for vaccines vary by vaccine, blanket performance monitoring of all vaccines can be cost prohibitive and may not have a substantial positive clinical impact.
S. 1211 - Regarding the use of the phrases "GI Bill" and "Post 9/11 GI Bill"
S. 1211 would amend chapter 36 of title 38, United States Code, to add a new section 3697B, which would prohibit, except with the written permission of the Secretary, the use of the words and phrases "GI Bill" or "Post-9/11 GI Bill" in connection with any promotion, goods, services, or commercial activity in a manner that reasonably and falsely suggests that such use is approved, endorsed, or authorized by VA or any component thereof. A determination that the use of one or more words or phrases covered by section 3697B does not violate that section could not be based solely on the ground that such use includes a disclaimer of affiliation with VA or any VA component. S. 1211 would authorize the Attorney General of
VA supports this bill. VA has already taken action to prevent the misuse and misrepresentation of the phrase "GI Bill." The phrase "GI Bill" is a trademark owned by VA and registered with the U.S. Patent and Trademark Office as of
VA estimates there would be no costs to VA associated with implementing this bill because, according to the bill text, the Attorney General's office would be responsible for enforcing the prohibition. If VA was notified of, or became aware of, prohibited use of the phrases "GI Bill" or "Post-9/11 GI Bill", VA would refer the incident to the
S. 1216 - Improving Job Opportunities for Veterans Act of 2013
Section 2 of S. 1216, the "Improving Job Opportunities for Veterans Act of 2013," would reduce, during the 4-year period beginning on the date that is one year after the date of enactment, the amount of wages paid the eligible Veteran or person in an OJT program not later than the last full month of that training period from 85 percent to 75 percent of the wages paid for the job for which such individual is being trained
Section 3 of the draft bill would require VA, beginning 1 year after the date of enactment, to enter into agreements with other Federal departments and agencies to operate their own OJT programs under section 3677 of title 38, United States Code, to train eligible Veterans or persons in skills necessary to obtain employment by those entities. Finally, section 4 of the draft bill would extend from
VA does not object to the provision in section 2 that would temporarily reduce the wage requirement from 85 percent to 75 percent, subject to
VA will provide views and a cost estimate for section 4 of the bill for the record at a later date.
S. 1262 - Veterans Conservation Corps Act of 2013
Section 2(a) of S. 1262 would require the Secretary of
Section 2(b) of the bill would require as part of the Veterans conservation corps that the Secretaries of
Section 2(c)(1) of the bill would require as part of the Veterans conservation corps that the Secretary of Homeland Security award grants under section 34 of the Federal Fire Prevention and Control Act of 1974 to hire Veterans as firefighters. Section 2(c)(2) of the bill would require the Attorney General to award grants under part Q of title I of the Omnibus Crime Control and Safe Streets Act of 1968 to hire Veterans as law enforcement officers. Section 2(c)(3) would require the Secretary of Homeland Security to provide funds to increase participation by Veterans in the
Section 2(d) of the bill would authorize the Secretary of
Section 2(e) of the bill would require the Secretary of
S. 1262 includes similar concepts to the Administration's
S. 1281 - Veterans and Servicemembers Employment Rights and Housing Act of 2013
S. 1281, the "Veterans and Servicemembers Employment Rights and Housing Act of 2013," would prohibit discrimination in employment and housing on the basis of military service. Section 2 of S. 1281, which would prohibit employment-related discrimination on the basis of military service, would affect programs or laws administered by the
S. 1295 - Regarding notice to Veterans filing electronic claims for benefits of the availability of services from Veteran Services Organizations
S. 1295 would add to title 38, United States Code, a new section 5103B, which would require, "[t]o the degree practicable," VA to notify claimants, when they electronically file applications for VA benefits, that relevant services may be available from VSOs. S. 1295 would also require VA to provide claimants a list of VSOs and applicable contact information.
VA appreciates the intent of S. 1295, but does not support the bill because VA has been able to carry out its purpose under current law. VA already notifies claimants who file claims electronically that VSO representation is available. In addition, VA already provides claimants easy access to information about claim representation from VA-accredited VSO representatives, claims agents, and attorneys. For example, the electronic benefits website (http://www.ebenefits.va.gov/) provides a link to a directory of all VA-recognized VSOs with their contact information. This directory is searchable and allows a claimant to search for VA-accredited VSO representatives, claims agents, and attorneys by location. Although VA views the bill as unnecessary, VA supports the intent of the bill and will continue to ensure that notice of available representation is clearly indicated on its electronic application portal, eBenefits.
VA estimates that there would be no benefit costs or GOE costs associated with enactment of this bill.
S. 1361 - World War II Merchant Mariner Service Act
S. 1361, the "World War II Merchant Mariner Service Act," would direct the Secretary of DHS to accept certain types of evidence for verifying that an individual performed honorable service as a coastwise merchant seaman during the period beginning on
DHS is responsible for verifying that an individual served in the American Merchant Marine in oceangoing service during the specified period. A finding in section 2 of S. 1361 identifies the types of documentation DHS currently accepts to establish such qualifying merchant-seaman service. Section 3 of S. 1361 would direct DHS to accept certain alternative types of evidence as sufficient to establish qualifying merchant-seaman service for purposes of certain Veterans' benefits and other purposes. In the absence of a
VA supports measures to ensure that individuals who have qualifying service can establish eligibility for the benefits they have earned. However, because DHS, rather than VA, is responsible for the service verifications to which this bill pertains, VA defers to the views of DHS regarding section 3 of this bill.
VA's
VA cannot determine whether this bill would lead to any increase in the provision of burial benefits to merchant mariners and their survivors. Therefore, VA cannot provide a cost estimate.
S. 1399 - Amending the Servicemembers Civil Relief Act
S. 1399 would extend the interest rate limitation on debts incurred before military service to debts incurred during military service to consolidate or refinance student loans incurred before military service. This bill would affect issues relating to current members of the uniformed services and consequently is of primary concern to DoD. The bill further relates to matters of the
S. 1411 - Rural Veterans Health Care Improvement Act of 2013
S. 1411, Rural Veterans Health Care Improvement Act of 2013 (the "Act"), would direct the Department to apply specified consultation, information, and transmittal requirements when issuing VHA's planned update of the 2010-2014 Strategic Plan of the
* Goals and objectives for the recruitment and retention of health care personnel in rural areas;
* Goals and objectives for ensuring timeliness and improving quality in the delivery of health care services in rural areas through contract and fee-basis providers;
* Goals and objectives for the implementation, expansion, and enhanced use of telemedicine services in rural areas, including through coordination with other appropriate offices of the Department;
* Goals and objectives for ensuring the full and effective use of mobile outpatient clinics for the provision of health care services in rural areas, including goals and objectives for the use of such clinics on a fully mobile basis and for encouraging health care providers who provide services through such clinics to do so in rural areas;
* Procedures for soliciting from each VA facility that serves a rural area the following information: the clinical capacity of facility; the procedures of such facility in the event of a medical, surgical, or mental health emergency outside the scope of the clinical capacity of such facility; the procedures and mechanisms of such facility for the provision and coordination of health care for women veterans, including procedures and mechanisms for coordination with local hospitals and health care facilities, the oversight of primary care and fee-basis care, and the management of specialty care;
* Goals and objectives for the modification of the funding allocation mechanisms of the ORH to ensure that the Office distributes funds to components of the Department to best achieve the goals and objectives of the Office and in a timely manner;
* Goals and objectives for the coordination of, and sharing of resources with respect to, the provision of health care services to veterans in rural areas between the VA, DoD, the
* Specific milestones for the achievement of the goals and objectives developed for the update; and
* Procedures for ensuring the effective implementation of the update.
Finally, S. 1411 would require the Secretary to transmit the first update (or successor plan) to
VA believes the bill is duplicative of both past and continuing Departmental efforts and thus does not support S. 1411. Specifically, ORH produced a 5-year strategic plan for FY 2010-2014 to ensure that ORH programs and initiatives meet the health care needs of rural Veterans. That plan was refreshed in FY 2011 to better align ORH resources with identified health care needs, especially in light of new technologies and delivery systems for rural Veterans.
Further, ORH is currently developing a new strategic plan for FY 2015-2019 to better align our goals with those outlined in the FY 2013-2018 VHA strategic plan to better serve the future health care needs of rural Veterans given the changing landscape of health care delivery and access and the stronger emphasis on prevention and community wellness. Goals of the FY 2015-2019 ORH strategic plan include strategic dissemination and integration within and outside VA of best practices in rural health care delivery to increase access and quality; strengthening of the rural health infrastructure through partnerships and collaborations with other Federal and community entities; enhancing rural provider capacity through increased student clinical training opportunities in rural areas and increased rural provider training opportunities; and enhancing rural telehealth capabilities. ORH will also continue to evaluate its on-going programs, including the pilot and demonstration projects that ORH currently funds across the VA health care system, in order to assess their effectiveness in delivering quality care to rural Veterans and improving those individuals' access to care.
The FY 2015-2019 ORH strategic plan will be re-evaluated annually to determine if additional initiatives or actions are needed. During FY 2019, ORH will draft a new strategic plan based on its evaluation of the success of past projects undertaken to date and updated assessments of the health care needs of Veterans residing in rural areas.
S. 1434 - To designate the
S. 1434 would designate the
S. 1471 - Alicia Dawn Koehl Respect for National Cemeteries Act
Section 2 of S. 1471, the "Alicia Dawn Koehl Respect for National Cemeteries Act," would authorize the Secretary of
If the appropriate Federal official finds, based on a showing of clear and convincing evidence and after an opportunity for a hearing in a manner prescribed by the appropriate Federal official, that the person committed a Federal capital crime or a State capital crime but was not convicted of such crime by reason of not being available for trial due to death or flight to avoid prosecution, section 2 would require the official to notify appropriate survivors and provide an opportunity to appeal the decision to disinter the remains or remove the memorial headstone or marker.
Regarding VA, when a decision to disinter remains or remove a memorial headstone or marker becomes final by either failure to appeal the decision or by a decision of the
Section 3 of the bill would require the Secretary of
Section 2 of S. 1471 would not authorize VA to reconsider a decision if an individual was convicted of a Federal or State capital crime or convicted of a Tier III sex-offense and VA had not received prior written notice of the conviction. VA would support closing this gap and will be glad to work with the Committee to provide technical assistance to effect broadening the scope of the legislation. Regarding the portions of section 2 which apply to the
VA has another technical concern regarding the bill language in proposed section 2411(d)(4)(B) that states, "A notice of disagreement filed with the Secretary under subparagraph (A) shall be treated as a notice of disagreement filed with BVA under chapter 71 of this title, and shall be decided by the BVA in accordance with the provisions of that chapter." The language is problematic because notices of disagreement are not filed "with the Board" under chapter 71. Under section 7105(b)(1) of title 38, United States Code, notices of disagreement are filed "with the activity that entered the determination with which disagreement is expressed." Thus, the language "with the
VA will provide a cost estimate for S. 1471 for the record at a later date.
S. 1547 - Veterans Dialysis Pilot Program Review Act of 2013
If enacted, S. 1547 would prohibit VA from expanding VA's dialysis pilot program to facilities other than the four participating outpatient facilities until after VA has implemented the pilot program at each facility for at least 2 years, VA has provided for an independent analysis of the pilot program at each facility, and a report to
This bill would have the effect of prohibiting VA from activating any additional free-standing dialysis centers until at least
An independent review of two of the pilot facilities (
S. 1558 - A bill to require the Secretary of
S. 1558, the "Veterans Outreach Enhancement Act of 2013," would require VA to establish a five-year program for the purpose of increasing Veterans' use of the range of Federal, State, and local programs that provide compensation or other benefits, as well as increasing Veterans' awareness of such programs and their eligibility. VA would have authority to enter into agreements with Federal and State agencies to further the purposes of the program. VA also would have authority to enter into agreements with certain named regional authorities and commissions to provide technical assistance, award grants, enter into contracts, or otherwise provide amounts to persons or entities for projects that accomplish specifically enumerated purposes. The bill also would require within 4 years a comprehensive report to
VA appreciates and shares the Committee's interest in expanding outreach activities through collaborative agreements and partnerships and is very supportive of the concept and purpose of this legislation. As detailed below, VA currently has a number of agreements and programs with similar aims as this bill.Unless
Section 2(d)(1) of S. 1558 would allow VA to "enter into agreements with other Federal and State agencies to carry out projects under the jurisdiction of such agencies to further the purpose" of the bill. VA is continually seeking to improve our collaboration and coordination with State, local, and tribal agencies to increase awareness and access to VA benefits and services. VA has existing agreements regarding outreach to Veterans with DoD, DOL, the
Section 2(d)(2) of the bill would provide VA authority to "enter into agreements with" specifically enumerated "applicable authorities and commissions" in order "to provide technical assistance, award grants, enter into contracts, or otherwise provide amounts to persons or entities for projects and activities that" pursue specifically enumerated goals. VA certainly encourages expanded authority to further the goals of the bill. However, the language in section 2(d)(2) is ambiguous with regard to the nature and scope of the authority, and how such authority differs from the authority provided for under section 2(d)(1), apart from the entities to which each section refers. We are concerned that the authorizing language may not be specific enough to provide sufficient guidance for the creation of a grant program.
Moreover, section 2(d)(2)(D) is focused on education and outreach related to the Uniformed Services Employment and Reemployment Rights Act (USERRA), a law that falls under the jurisdiction of the
Section 2(d)(3) specifically enumerates the "applicable authorities and commissions" discussed in section 2(d)(2). VA believes the funding authority should also encompass local and tribal governments. Many local and tribal governments have established Veterans agencies with which VA currently partners to conduct outreach. The ability to provide direct assistance to those governments could be a more efficient use of funds in some situations.
Section 2(e) would provide VA the authority to provide, or contract with public and private organizations to provide, information, advice, and technical assistance to nonprofit organizations. VA supports the authority provided in this subsection, but recommends expanding this authority to provide technical assistance to other entities as well. Circumstances vary by jurisdiction. We believe States may be in a better position in some instances to meet the goals of this section. Expanding the scope of this provision to encompass States would allow VA a wider range of options.
With regard to the comprehensive report on the outreach activities of VA that would be required under section 2(f), VA is already required to provide a biennial report on all VA outreach activities under section 402 of Public Law 109-233. All outreach activities associated with this legislation would be included in the outreach reports to be provided to
VA has a strong interest in ensuring that Veterans know of the benefits they have earned--the role of outreach is critical throughout the myriad missions of VHA, VBA, and NCA. We would be glad to meet with the Committee to discuss ongoing outreach efforts and the ideas represented in this bill. VA will provide its cost estimate for this bill at a later time.
S. ___ (Draft Bill)- Veterans Health Care Eligibility Expansion and Enhancement Act of 2013
The draft bill would expand eligibility for VA health care. While VA understands the intent behind expanding eligibility and enhancing services for Veterans. However, before providing definitive views, VA must carefully consider the implications of each provision of this bill, including the cost for such expansion and the impact upon existing eligible populations. VA received the text of this bill on
Section 2 of the bill would amend 38
Section 3 of the bill would add a new subsection to 38 U.S.C. 1705 which would require the Secretary to provide for the enrollment of certain veterans who are unable to enroll in the VA health care system as of the date of the enactment of the bill and who do not have access to health insurance except through a health exchange established pursuant to section 1311 of the Affordable Care Act. Section 3 would require VA to work with HHS and the
Section 3 of the bill presents many potential complications and uncertain effects on VA's enrollment system, as well as issues that will require detailed consultation with HHS and the
Section 4 of the bill would expand the combat eligibility provision in 38 U.S.C. 1710(e)(1)(D) for Veterans discharged after
Section 6 of the bill would require VA and the Secretary of
From our preliminary review to date, VA has particular concerns with Sections 6, 7 and 8 of this bill, and needs additional time to fully study the impact on existing business infrastructure, billing systems, and net Federal costs. In regards to section 6, VA needs additional time to fully understand the impact of obtaining
Mr. Chairman, as noted above, we are working diligently to provide fuller analysis and notes on anticipated costs shortly after this hearing. As you know, we have had the opportunity to discuss the critical subject of access to health care for Veterans with you and Committee staff prior to receiving the text of this bill. We look forward to continuing those discussions.
S. ___ - (Draft Bill) Regarding the
The draft bill would update the
VA supports the intent of this draft bill to change the mortality basis of the S-DVI program, provided
The draft bill would base S-DVI premiums on the 2001 CSO Mortality Table, which is the current mortality standard in the commercial insurance industry. This would result in significantly lower premium costs for service-connected disabled Veterans. As a result, VA could see a greater number of such Veterans applying for S-DVI coverage, thereby enhancing financial security for them and their families. Further, because this draft bill would also reduce premiums for current policyholders, it would allow both new and current policyholders who are paying premiums to use funds they currently expend on their S-DVI premiums for other purposes. Approximately 60 percent of current policyholders have their premiums waived because they have been determined to be "totally disabled." A comparison conducted by VA of current premium rates with those that would be charged shows that premiums would be dramatically reduced for some individuals, and all policyholders would see their premiums significantly reduced.
VA recommends that the bill be amended to also change the interest rate basis from 2.25 percent to 3 percent. Current economic indicators suggest that 3 percent more accurately reflects a realistic long-term interest rate for this program. Changing the basis to 3 percent would further lower the premium rates for S-DVI policyholders.
VA will provide a cost estimate for the record at a later time.
Read this original document at: http://www.veterans.senate.gov/hearings.cfm?action=release.display&release_id=0be0a004-5439-4c8b-be08-29dcfa4954c3
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Senate Veterans’ Affairs Committee Hearing
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