Senate Veterans’ Affairs Committee Hearing
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Thank you for inviting the DAV (
S. 875, the
Draft Bill, to require the Secretary of
These measures seek to strengthen
Timely disease surveillance, identifying disease outbreaks, and recognizing disease trends in a community is critical to preventing infectious disease morbidity and mortality. Incomplete reporting, lack of consistent national standards, and a lack of timely reporting have created significant barriers to appropriate and effective disease-specific control measures since delays between the onset of illness and receipt of disease notification can allow for additional transmission to occur and additional people to become ill, thereby facilitating further spread of infection.
DAV believes the intent of these bills is laudable; lacking a national standard however, we urge the Committee ensure VA,
S. 1148, the Veterans Benefits Claims Faster Filing Act
S. 1148 would direct the Secretary of
This legislation would make available to all current and potential veteran claimants information regarding the success or allowance rate of claims in each
The type of information this legislation is seeking to publicize to every claimant is the average processing time of claims and the percentage of allowed or granted claims for those with representation versus those without representation. Additionally, S. 1148 will require the information to be broken down into the percentage of claims that were FDC submitted electronically versus paper as compared to those who do not file their claims through the FDC program in electronic, standard paper or non-standard paper form.
DAV supports the principle of S. 1148, which is to bring better awareness and information to a claimant prior to filing a claim for benefits in the same manner as its companion bill, H.R. 1809, which was passed by the House. Both S. 1148 and H.R. 1809 are directed at providing more in-depth information to a claimant about representation in keeping with the primary goal of encouraging claimants to submit their claims for benefits through the FDC program.
DAV agrees with encouraging claimants to submit their claims through the FDC process, as is a standard practice for DAV. Nonetheless, DAV believes, in order to fully reach the goal of this legislation and, more importantly, to benefit the claimant in the best way possible, the posted information should provide a breakdown of the number of claims represented and the allowance rate for each VSO and for representatives other than VSOs. Otherwise, this information may not allow an individual to make an informed decision about representation. Moreover, when publishing this type of information, it should include the fact that DAV and other VSOs provide representation to virtually any claimant in the process, with the exception of frivolous or fraudulent claims. Conversely, others providing representation, including attorneys, tend to be much more selective in their representation; often choosing to represent only claims wherein the predicted outcome is favorable to the claimant. DAV believes this should also be made clear to a claimant in the published information.
While we do not have a specific resolution to support this matter, DAV does support the intent of S. 1148, which will require VA to make this information available to claimants; however, we are concerned about the possibility that this legislation, if enacted, may burden the VA at a time when their primary focus is directed at reducing the backlog of disability claims and transforming the claims process.
S. 1155, the Rural Veterans Mental Health Care Improvement Act
S. 1155, if enacted, would achieve four basic purposes. First, it would amend current law governing advance appropriations in VA health care by adding appropriations accounts and sub-accounts that provide funding for information technology (IT). Second, it would add two professional fields (marriage and family therapists, and mental health counselors) to existing career health fields that are participating in VA's academic health education programs, and would require the VA Secretary to apportion funding, from funds available, to these new professions. Third, the bill would require amendments to current authority for readjustment counseling and mental health counseling for family members of certain veterans; and, fourth, the bill would require VA to submit a report to
Based on DAV Resolution No. 180, DAV strongly supports
DAV has not received a specific resolution from our membership addressing the need to add the two new career fields of marriage and family therapists and mental health counselors to VA's academic responsibilities. VA already possesses authority to employ such providers, either in direct health care or in Readjustment Counseling Vet Centers. Absent a showing of shortage of available practitioners in these professions, mandating their inclusion within VA's responsibility in conducting its health care training programs may be ill advised. We defer to VA on balancing its academic programs across health professionals career fields and suggest the same to the bill's sponsor.
On the strength of resolutions from our membership we strongly support the existing VA family caregiver support program and VA's independent Vet Center readjustment counseling program; therefore, we support these provisions in this bill that would clarify and expand these efforts.
We have no objection to the report on telemedicine that the bill would require.
S. 1165, the Access to Appropriate Immunizations for Veterans Act of 2013
This measure would require the Secretary of
DAV Resolution No. 036 calls on VA to maintain a comprehensive, high-quality, and fully funded health care system for the nation's sick and disabled veterans, specifically including preventative health services. Preventative health services are an important component of the maintenance of general health, especially in elderly and disabled populations with compromised immune systems. If carried out sufficiently, the intent of this bill could also contribute to significant cost avoidance in health care by reducing the spread of infectious diseases and obviating the need for health interventions in acute illnesses of those without such immunizations.
While DAV is pleased to support this bill, we urge the Committee to work with VA to address concerns the Department has raised with similar legislation. Those concerns included requiring that the quality metric, including targets for compliance, be established via notice and comment rulemaking would limit VA's ability to respond quickly to new research or medical findings regarding a vaccine. Moreover, because the clinical indications and population size for vaccines vary by vaccine, blanket monitoring of performance of all vaccines could be cost prohibitive and may not have a substantial positive clinical impact at the patient level.
S. 1211, to prohibit the use of the phrases GI Bill and Post-9/11 GI Bill to give a false impression of approval or endorsement by the VA
S. 1211 would amend title 38, United States Code, to prohibit the use of the phrases GI Bill and Post-9/11 GI Bill to give a false impression of approval or endorsement by the VA.
DAV does not have a resolution on this issue and takes no official position.
S. 1216, the Improving Job Opportunities for Veterans Act of 2013
S. 1216 would improve and increase the availability of on-job training and apprenticeship programs carried out by the Secretary of
In accordance with DAV Resolution No. 001, DAV supports this legislation.
S. 1262, the Veterans Conservation Corps Act of 2013
S. 1262 would require the Secretary of
DAV does not have a resolution on this issue and takes no official position on this legislation.
S. 1281, the Veterans and Servicemembers Employment Rights and Housing Act of 2013
S. 1281 would prohibit employment practices that discriminate based on an individual's military service and amends the Fair Housing Act and the Civil Rights Act of 1968 to prohibit housing discrimination against members of the uniformed services.
DAV does not have a resolution on this issue and takes no official position on this bill.
S. 1295, to require the Secretary of
S. 1295 would amend title 38, United States Code, to require the Secretary of
While DAV does not have a specific resolution on this issue we support the intent of the legislation to make claimants fully aware of the vast, free services and assistance that are available from veterans service organizations. Navigating the VA system and the plethora of benefits available can be very complicated and paralyzing to any claimant and we appreciate the goal of S. 1295 to help ease this burden.
S. 1296, the Servicemember's Electronic Health Records Act of 2013
This measure would amend Section 1635 "Wounded Warrior" and veterans provisions in the fiscal year 2008 National Defense Authorization Act (NDAA), to create a specific timeline and deadlines for a joint electronic health record to be implemented. This timeline would require, among other things, the
The bill also would require the agencies to consider storage of patient data in a secure, remote, network-accessible computer storage system or a cloud storage system. This type of storage system would allow service members and veterans to upload their own information and allow their providers to have the ability to see the records at any time. The cloud storage system would increase interoperability and allow the patient to more easily share their information with their medical provider.
The development of an integrated DOD-VA electronic health record (EHR) has been beset with problems for years. Efforts to create a joint
The plan also assumes that in the summer of 2013, both Departments were to have launched pilot programs on the common interface at seven joint rehabilitation centers nationwide, initially, and eventually to nine sites, overall. All of the facilities were scheduled to exchange data that is computable and interoperable by the end of July.
Criticism of this decision resulted in an amendment to the House passed 2014 NDAA to increase oversight of the integrated electronic health record (iEHR). Notably, Section 734 of the National Defense Authorization Act of 2014 would require
We note that despite strong and consistent Congressional mandates and oversight over those years, efforts by both Departments remain fragmented and have proceeded at a glacial pace. As part of The Independent Budget, DAV remains firm that the
DAV believes the intent of S. 1296 is laudable; however, we ask the Committee ensure the measure is consistent with the pertinent provisions in the 2014 NDAA awaiting consideration by the
S. 1361, the World War II Merchant Mariner Service Act
S. 1361 would direct the Secretary of Homeland Security to accept additional documentation when considering the application for veteran status of an individual who performed service as a coastwise merchant seaman during
DAV does not have a resolution on this issue and takes no position on S. 1361.
S. 1399, to extend the interest rate limitation on debt entered into during military service to debt incurred during military service to consolidate or refinance students loans incurred before military service
S. 1399 would amend the Servicemembers Civil Relief Act to extend the interest rate limitation on debt entered into during military service to debt incurred during military service to consolidate or refinance students loans incurred before military service.
DAV does not have a resolution on this issue and takes no official position on this legislation.
S. 1411, the Rural Veterans Health Care Improvement Act of 2013
S. 1411 would require the
S. 1434, to rename the
S. 1434 would designate the
As a local issue, DAV does not have a national position on the matter.
S. 1471, the Alicia Dawn Koehl Respect for National Cemeteries Act
S. 1471 would authorize the Secretary of
DAV does not have a resolution on this issue and takes no official position on this bill.
S. 1540, to remove a legal obstacle that effectively prevents state veterans homes from applying for federal grants to support homeless veterans programs
S. 1540 was introduced in order remove a legal obstacle that effectively prevents state veterans homes from applying for federal grants to support a homeless veterans program.
State veterans homes are a partnership between the federal government and the States, with the federal government providing construction grants that may cover up to 65 percent of the cost to build and maintain the homes, and states providing the balance. In addition, the federal government pays a per diem covering approximately one-third of the cost to care for qualified veterans under three authorized programs: nursing home care, domiciliary care and adult day health care.
Currently, some state veterans homes have underutilized bed capacity in their domiciliary program, a portion of which could be repurposed for homeless veterans programs. A few state homes that are well positioned to provide and coordinate the multitude of health care and supportive services required by homeless veterans have expressed an interest in applying for grants operate such a program. However under current law, state homes are authorized to use their federal support only for the three aforementioned programs and if a state home were to operate a homeless veterans program, the federal government could seek to recapture construction grant funding provided over the prior twenty years. Since no state home could afford to pay that high a financial penalty, this provision effectively prevents them from using excess capacity for operating a homeless veterans program.
S. 1540 seeks to resolve this problem by amending the recapture provisions of title 38, United States Code, section 8136, with an exemption for state homes that receive a contract or grant from VA for residential care programs, including homeless veterans programs. The change would remove the financial obstacle preventing some state homes from applying for federal grants to support homeless veterans, such as through VA's Health Care for Homeless Veterans program, but the decision to award the grant (or contract) would remain solely with VA as the grantor. It would be up to VA to determine whether the state home had sufficient excess capacity and was capable of operating a successful homeless veterans program.
By allowing state homes with excess bed capacity in their domiciliary programs to repurpose a portion of that existing space to support homeless veterans, this legislation would allow some additional options for homeless veterans in a cost-effective manner.
In line with DAV Resolution No. 165, which calls for sustained sufficient funding to improve services for homeless veterans, DAV supports the intent of this legislation; however, we urge the Committee ensure the legislation allows for the recapture of the portion of grants to state homes if so provided for the costs of construction, renovation, or acquisition of a building for use as service centers or transitional housing for homeless veterans under VA's Homeless Providers Grant and Per Diem Program.
S. 1547, the Veterans Dialysis Pilot Program Review Act of 2013
VA estimates show that in FY 2011, approximately 35,000 veterans enrolled in the VA health care system were diagnosed with end-stage renal disease (ESRD) reflecting a higher prevalence in the VA population than in the general U.S. population. Initiated based on the rapidly rising cost of VA paid hemodialysis treatment in non-VA facilities and the high rates of morbidity and mortality of veteran patients with ESRD, several VA studies of this veteran patient population and paid for or directly provided dialysis therapy have been conducted.
The
This measure would limit the expansion of VA's dialysis pilot program beyond current locations, require an independent analysis of the pilot, and to submit a report to
While
Certainly, ESRD patients are one of the most resource-intensive patient populations in the VA health care system. However, the burden of hemodialysis is extreme to veteran patients. It is a life-altering event that has implications for the veteran's health, lifestyle, and livelihood. Veterans diagnosed with ESRD are often prescribed and must receive dialysis treatments. These treatments are time intensive for veterans and typically require three outpatient treatments per week that each last about 4 hours for the rest of their lives unless they receive a kidney transplant.
As one of The Independent Budget veterans service organizations (IBVSOs), coordinating care among the veteran, dialysis clinic, VA nephrologists, and VA facilities and physicians is essential to improving clinical outcomes and reducing the total costs of care. The benefits of an integrated, collaborative approach for this population have been proven in several
We understand that some community dialysis providers are piloting the integrated care management concept among their veteran population. The IBVSOs believe that VA should provide integrated care management in this pilot program that can test and demonstrate the value of such an approach to VA and the veterans it serves.
S. 1556, to modify authorities relating to the collective bargaining of employees in the VHA
S. 1556 would amend title 38, United States Code, to modify authorities relating to the collective bargaining of employees in the
This bill would restore some bargaining rights for clinical care employees of the VHA that were eroded by the former Administration and through subsequent federal court decisions. The bill would strike subsections (b), (c) and (d) of section 7422 of title 38, United States Code. Enactment of the bill would have the effect of authorizing employee representatives of recognized bargaining units to negotiate with VHA management over matters of employee compensation and conditions of employment other than their rates of basic pay. This feature is an important one in that locality pay elements and performance pay increments are subject only to VA's internal policy-making determinations. Recognized VA employee representatives have been subjectively excluded from participating in these decisions based on VA's interpretation that section 7422 broadly blocks any negotiation due to its potential negative impact on the quality of care of veterans.
We believe labor organizations that represent employees in recognized bargaining units within the VA health care system, including in its professional units, have an innate right to information and reasonable participation that result in making the VA health care system a workplace of choice, and in particular, to fully represent VA employees on issues impacting their conditions of employment.
We believe this bill, which would rescind VA's ability to refuse to bargain on matters of employment conditions and elements of compensation other than rates of basic pay embedded in law, is an appropriate remedy to address part of the bargaining problem in the VA's professional ranks. We understand recently VA has given federal labor organizations some indication of additional flexibility in negotiating labor-management issues such as some features of supplemental compensation, and we are hopeful that this change signals a new trend in these key relationships that directly affect sick and disabled veterans.
While DAV has not received a specific resolution from our membership related to the issues contained in this bill, we would not object to its enactment, while continuing to hope that VA and federal labor organizations can find a sustained basis for compromise.
S. 1558, to carry out a program of outreach for veterans to increase their access and use of Federal, State, and local programs providing compensation for service in the Armed Forces
S. 1558 would require the Secretary of
Although DAV does not have a resolution on this particular matter, we currently provide such outreach to veterans and, therefore, we would not oppose passage of this legislation. The intent of this bill is to make veterans aware of the services and benefits from the VA that they have earned, which will increase the use of VA benefits and services. While we certainly agree and support the increased awareness, this will undoubtedly lead to increased demands placed upon the VA.
If the enhanced outreach is successful and the demand too great, then this endeavor would cause a negative impact on VA and the veterans it serves.
S. 1559, the Benefits Fairness for Filipino Veterans Act of 2013
S. 1559 would amend title 38, United States Code, to modify the method of determining whether Filipino veterans are
DAV does not have a resolution on this issue and takes no position on S. 1559.
S. 1573, the Military Family Relief Act
S. 1573 would amend section 1318 of title 38, United States Code, to provide for the payment of temporary compensation to a surviving spouse of a veteran upon the death of the veteran. Essentially this legislation is aimed at providing temporary death benefits to a surviving spouse for six months, without regard to whether that individual has submitted a claim for such compensation if, at the time of the veteran's death the veteran was in receipt or entitled to receive compensation for a service-connected disability continuously rated as total for not less than one year immediately preceding the veteran's death.
Specifically, if enacted, S. 1573 would allow a surviving spouse to receive payment of survivors benefits temporarily, for six months, with no lapse in time from the discontinuance of disability compensation upon the veteran's death. Given the current backlog of pending claims within the
Under section 1318 of title 38, United States Code, certain surviving spouses may be entitled to DIC if at the time of the veteran's death, the veteran was continuously rated totally disabled for a period of five years within discharge or release from active duty; the veteran was continuously rated totally disabled for a period of 10 years or more; or the veteran was contiuously rated totally disabled for a period of one year if the veteran was a former prisoner of war.
Generally, claims submitted for DIC that meet any of the aforementioned eligibility criteria can be processed by VBA very quickly because little to no development is required. However, because of the dire backlog of claims within VBA, qualified surviving spouses are left to languish for unacceptably long periods of time with no income. Even if the surviving spouse were to file a qualifying claim for DIC pursuant to Section 1318 of title 38, United States Code, under the more expedient FDC process, a lapse in payment and loss of vital income would still exist. S. 1573 is directed specifically at bridging the gap of benefits between the veteran's death and the time DIC is awarded. While this measure would provide DIC only temporarily for six months, it would ease the burden the veteran's death and immediate loss of vital income while VBA finally processes the claim.
In accordance with DAV Resolution No. 001, DAV supports enactment of S. 1573.
Draft Bill, to update the
This bill would amend title 38, United States Code, to update the
It is strongly supported by our organization and has been adopted for decades as a formal resolution by DAV delegates. Also, the IBVSOs have encouraged
DAV strongly encourages this Committee to work with your colleagues and with the
Draft Bill to provide replacement automobiles for certain disabled veterans and members of the Armed Forces
This bill would amend title 38, United States Code, to provide replacement automobiles for certain disabled veterans and members of the Armed Forces. This measure, if enacted, would amend section 3903 allowing qualified disabled veterans the opportunity to utilize this vital program up to three times, rather than the currently allowed one time, and increase the current amount from
Not only has the issue of increasing the amount of the automobile grant benefit been a long-standing issue for DAV, other veterans service organizations (VSOs) have also sought to have the amount of this vital benefit increased. DAV, joined with the other IBVSOs, have urged
For example, the VA provides financial assistance in the form of grants to eligible veterans toward the purchase of a new or used automobile to accommodate a veteran or service member with certain disabilities that resulted from a disabling condition incurred or aggravated during active military service. In
Additionally, last year the
As such, in accordance with DAV resolution No. 170, DAV supports enactment of this draft legislation as it will expand the vital automobile grant benefit by allowing multiple uses while increasing the current amount from
Draft Bill, the Veterans Health Care Eligibility Expansion Act of 2013
Section 2 of this measure would amend title 38, United States Code, section 1710 authorizing VA to provide health care to all veterans not currently enrolled in the VA health care system provided they meet other statutory requirements, including section 5303, availability of appropriations, agreeing to pay copayments, etc.
In amending section 1710 however, this new authority would require VA provide nursing home care to veterans described under the new paragraph (3) of subsection (a) while giving VA the discretion to provide nursing home care to veterans described under paragraph (2) of subsection (a).
(2) The Secretary (subject to paragraph (4)) shall furnish hospital care and medical services, and may furnish nursing home care, which the Secretary determines to be needed to any veteran-
(3) In the case of a veteran who is not described in paragraphs (1) and (2), the Secretary shall subject to the provisions of subsections (f) and (g), furnish hospital care, medical services, and nursing home care which the Secretary determines to be needed. [Emphasis added]
DAV National Resolution No. 186 supports top priority access for service-connected veterans within the VA health care system.
For purposes of equity, we recommend language amending paragraph (2) to state that the Secretary shall furnish hospital care, medical services, and nursing home care that the Secretary determines to be needed to any veteran under subparagraphs A through G.
Section 3 would amend title 38, United States Code, section 1705 requiring VA allow for the enrollment by
DAV has no resolution to support this section and would not object to its favorable consideration as long as sufficient resources are in place at the time this enrollment takes effect.
Section 4 seeks to extend the eligibility for enrollment in the VA health care system from 5 to 10 years following discharge for a combat veteran discharged after
DAV has no specific resolution but the provision appears beneficial, thus we would not oppose favorable consideration of this section.
Section 5 intends to relocate section 1710(a)(4), which this measure proposes to eliminate, and by adding a new subsection (c) in section 1707.
DAV has no resolution and would not object to its favorable consideration. However, we note the requirements of VA in providing required nursing home care under section 1710A is due to expire
Section 6 would insert a new section (1729B) in title 38 to establish the "Medicare VA reimbursement program" for the purposes of recovering from the
DAV has no resolution on this section and takes no formal position. However, notwithstanding the "Sense of
History has also shown that VA does not have a good record of meeting projected amounts to be collected from reimbursements and must then operate a health care system with less funds than needed to meet the demand for care and services.
Draft Bill, the Enhanced Dental Care for Veterans Act of 2013
This measure would authorize VA to establish a three-year pilot program in at least 16 locations to assess the feasibility and advisability of furnishing dental care to veterans enrolled in the VA health care system who are not eligible under current authorities for VA dental care. In addition, this bill would extend for an additional two years the VA Dental Insurance Program (VADIP) for veterans and survivors and dependents of veterans mandated under Section 510 of Public Law 111-163.
The legislation also requires VA to establish a mechanism to add any dental care treatment information provided by private providers under VADIP in VA's Computerized Patient Record System (CPRS). Until recently, the discretionary nature of receiving any treatment information from a non-VA provider and electronically associating it with a veteran treatment file in CPRS has traditionally not been successful particularly if there is no requirement that submission of such records to VA was a condition to receive payment from the Department or that it is required by VA policy to include such records in CPRS. While we are supportive of the intent in Section 5, we believe there will be limited success without an incentive or disincentive for the transmission or receiving end of such information.
DAV is pleased to support this measure based on DAV Resolution No. 072, supporting legislation to amend title 38, United States Code, section 1712, to provide outpatient dental care to all enrolled veterans. However, DAV opposes subsection (g), the copayment provision under the VA provided dental care pilot program in accordance with our Resolution No. 194, calling for the elimination or reduction of VA health care out-of-pocket costs for service-connected disabled veterans.
Draft Bill: Mental Health Support for Veterans Families and Caregivers Act of 2013
The Mental Health Support for Veterans Families and Caregivers Act of 2013 would require the Secretary of
The bill would mandate VA to establish the education program in at least 10
In order to facilitate the program, the Secretary is required to enter into contracts with nonprofit entities with experience in mental health education and outreach to include work with children, teenagers and young adults. These groups must use high quality, relevant and age-appropriate information in their educational materials and coursework. The nonprofit entities must work with agencies, departments, nonprofit mental health organizations, early childhood educators and mental health providers to develop the educational programming, materials and coursework. The Secretary would give priority entering into contracts with entities that also use Internet technology for delivery of course content in order to expand the availability of support services, especially in rural areas.
The education component of the program would consist of at least 10 weeks of general education on different mental health disorders with information on understanding experiences of persons suffering from the disorders; techniques for handling crisis situations and administering mental health first aid; techniques for managing stress affiliated with living with a person with a mental health disorder; information on additional services available for family members and caregivers through VA or community organizations as well as mental health providers.
The instructors of the education program must be proficient in the course of education and able to prove their level of proficiency to the Secretary. Two years after the program has begun, those who have successfully completed the course of education as well as any additional training that may be required, may act as an instructor in the education course. The Secretary will select mental health care providers to monitor the instruction of the education program along with primary care providers. The mental health providers will monitor instructors by meeting with them quarterly, and at a minimum of twice a year will submit a report on the progress of the instruction provided in the education program to the Secretary.
The peer support program will be conducted at the same locations the Secretary chooses for the education program and will consist of group meetings at least twice each calendar quarter between a peer support coordinator, family members and caregivers of eligible veterans on matters related to coping with mental health disorders in veterans. The medical facility director of each participating facility shall select an individual who has completed a course of education and maintains proficiency to serve as a peer support coordinator. A mental health care provider selected by the Secretary would be required to mentor each peer support coordinator and will meet with them quarterly to monitor progress of the program, and at a minimum of twice a year will submit a report on the progress of the peer support program to the Secretary.
The measure would also require the Secretary to conduct a comprehensive and statistically significant survey of individuals who have participated in the education and peer support programs to include their level of satisfaction, perceived effectiveness and applicability of the programs. This information is to be included in a mandated annual report due no later than one year after the start of the education program, and no later than
The final report would be due to the Committees on Veterans' Affairs of the
In accordance with DAV Resolution No. 166, DAV is pleased to support the Mental Health Support for Veterans Families and Caregivers Act of 2013. DAV Resolution 166 calls on the Secretary of
VA treats a large patient population of veterans suffering from chronic effects of PTSD, depression and other serious mental illnesses. Many of these veterans suffer marriage and relationship breakdown, under-employment or loss of employment, financial hardship, social alienation and even homelessness. When a veteran experiences emotional distress and or mental decompensation, the consequences of that behavioral health event often fall directly on the veteran's family members and caregivers. Experts argue that support of family members and caregivers is often vital to a veteran's gaining and maintaining emotional stability and eventual recovery from mental illness.
Currently, title 38, United States Code, subsection 1712A(b)2 authorizes the
Additionally, title 38, United States Code, section 1782 authorizes a program of counseling, training, and mental health services, including psychological support, for immediate family members of disabled veterans who need care for service-connected disabilities; who have service-connected disabilities rated at 50 percent or more disabling; who were discharged or retired from the armed forces for injuries or illnesses incurred in line of duty; who are
This measure would expand education, training and psychological support, for family members and caregivers of enrolled veterans with mental health disorders.
Draft Bill, the Medical Foster Home Act of 2013
This bill would authorize the Secretary of
VA inspects and approves
VA ensures the caregiver is both well trained to deliver VA's planned care for the veteran and is on duty 24 hours a day, 7 days a week. While living in a Medical Foster Home, veteran residents are enrolled in the VA Home Based Primary Care program and care is provided by an interdisciplinary team that offers a broad array of supportive services.
DAV is pleased with VA's innovation by offering medical foster homes as part of its long-term care program. While patient participation in this program is voluntary, it yields exceedingly high satisfaction among veteran residents. In addition, because of its low cost, many VA facilities perceive this program as a cost-effective alternative to nursing home placement and it is gaining popularity based on the expansion of this program over the last several years.
However, based on DAV Resolution No. 198, supporting legislation to expand the comprehensive program of long-term services and supports (LTSS) for service-connected disabled veterans, and as part of the IB, DAV is greatly concerned that veterans living in medical foster homes are required to use personal funds, include VA disability compensation, as payment.
Because this program operates under VA's community residential care authority, veterans in medical foster home programs have to pay for their care, which range from about
We thank the Chairman for introducing this measure, which would give VA the authority to pay for those costs service-connected veterans must currently pay out-of-pocket to reside in a VA approved medical foster home.
DAV is pleased to support the intent of this bill; however, because current statutory authority prohibits VA from meeting is mandatory obligations in providing long-term services and supports to service-connected disabled veterans, we believe the intent of this legislation should be codified.
Draft Bill, the SCRA Enhancement and Improvement Act of 2013
The SCRA Enhancement and Improvement Act of 2013 would amend the Servicemembers Civil Relief Act to extend the interest rate limitation on debt entered into during military service to debt incurred during military service to consolidate or refinance students loans incurred before military service.
DAV does not have a resolution on this issue and takes no official position, but would not oppose enactment of such legislation.
Draft Bill, the Improved Compensation for Hearing Loss Act of 2013
The Improved Compensation for Hearing Loss Act of 2013 would require the Secretary of
Specifically, if enacted, this proposed legislation would allow the Secretary one year from the date of such enactment to report to
This measure requires the Secretary's report to include an evaluation as to the number of veterans who had a military occupational specialty (MOS) not included in the Duty Military Occupational Specialty Noise Exposure Listing (MOS List) that are precluded from receiving hearing loss benefits from VA. This measure also requires the Secretary to report the number of veterans who had an MOS listed on the MOS List that were granted and denied benefits for hearing loss; and of those veterans with an MOS not listed on the MOS List, the number that were granted and denied entitlement to hearing loss benefits, as well as the number of those denied that were successfully granted on appeal.
While this proposed legislation is one of reporting requirement in nature, of particular interest to DAV is the requirement for the Secretary to provide an explanation of the rationale for the practice of not issuing a compensable rating for hearing loss that is severe enough to necessitate the use of hearing aids. This particular provision in the proposed legislation is directly in line with a long-standing DAV resolution, as well as in consensus with the other Independent Budget VSOs, as it has been recognized that certain veterans may suffer from hearing loss to the degree of requiring a prescribed hearing aid, but are not able to receive compensation.
In fact, the VA Schedule for Rating Disabilities (VASRD) contained in title 38, Code of Federal Regulations, part 4 does not provide a compensable rating for hearing loss at certain levels severe enough to require the use of hearing aids. The minimum disability rating for any hearing loss severe enough to require use of a hearing aid should be 10 percent, and the VASRD should be amended accordingly.
A disability severe enough to require use of a prosthetic device should be compensable. Beyond the functional impairment and the disadvantages of artificial hearing restoration, hearing aids negatively affect the wearer's physical appearance, similar to scars or deformities that result in cosmetic defects. Also, it is a general principle of VA disability compensation that ratings are not offset by the function artificially restored by a prosthetic device.
For example, a veteran receives full compensation for amputation of a lower extremity although he or she may be able to ambulate with a prosthetic limb. Additionally, a review of title 38, Code of Federal Regulations, Part 4 [VASRD] shows that all disabilities for which treatment warrants an appliance, device, implant, or prosthetic, other than hearing loss with hearing aids, receive a compensable rating.
Assigning a compensable rating for medically prescribed hearing aids would be consistent with minimum ratings provided throughout the VASRD. Such a change would be equitable and fair.
While DAV appreciates the proposed legislation requiring the Secretary to provide an explanation, we believe this provision would merely allow VA the opportunity to prolong this inequitable issue. In accordance with DAV Resolution No. 111, DAV recommends this provision of the proposed legislation be changed from requiring the Secretary to provide an explanation to that of amending the VASRD to provide a minimum 10 percent disability rating for any service-related hearing loss medically requiring a hearing aid.
Although we do not have a resolution to support the other reporting requirements of this proposed legislation, DAV is not opposed enactment of those provisions, provided they do not overburden VA at a time where transformation of the claims process and reducing the backlog of pending disability claims is paramount.
Draft Bill the
The
Section 3 of the bill would require the VA Secretary, no later than 540 days after enactment of the Act, to develop and implement a screening mechanism to be used when veterans seek health care services from VA to identify if the veteran has been a victim of domestic abuse. The purpose of this provision is to improve treatment of the veteran and assess prevalence of domestic abuse in the veteran population. Domestic abuse, in part, is defined as behavior that constitutes a pattern of physical or emotional abuse, economic control or interference with personal liberty, or a violation of federal or state law involving the attempted, threatened, or actual use of force or violence against the person, in addition to a violation of a protective order. In order to qualify as domestic abuse, the behavior is committed by a current or former spouse or domestic partner, or a person that shares a child with the individual, is a current or former intimate partner that shares or has shared a common residence or is a caregiver of the individual as defined in section 1720G(d) of title 38, United States Code, or in any other type of relationship with the individual that the Secretary may specify for this purpose.
Section 4 of the legislation would require the VA Secretary, within a year after enactment of the Act, to submit a report to the Committees on Veterans' Affairs of the
Additionally, within a year after enactment of this Act and annually thereafter for five years, the VA-DOD Joint Executive Committee would be required to submit a report on MST and domestic abuse that details the processes and procedures utilized by VA and
The continued prevalence of sexual assault in the military is alarming and often results in lingering physical, emotional or chronic psychological symptoms in assault survivors.
For these reasons, DAV is pleased to support the
DAV also suggests the Committee consider adding a provision in the bill related to MST care and beneficiary travel reimbursement. As a result of VA clinical determinations, some veterans are referred to VA medical facilities other than their local facilities or closest Veterans Integrated Service Network to receive the specialized MST care they need. The VA Office Inspector General (IG) conducted a healthcare inspection of inpatient and residential programs for female veterans with mental health conditions related to MST. The IG found that obtaining authorization for travel funding was frequently cited as a problem for patients and staff.
According to the IG, the VA's current policy in beneficiary travel indicates that only selected categories of veterans are eligible for travel benefits and payment is only authorized to the closest facility providing comparable service. The IG points out that this Directive is not aligned with the MST policy that states that patients with MST should be referred to programs that are clinically indicated regardless of geographic location. If a VA clinician determines an MST survivor needs specialized care from a VA MST inpatient facility, VA's beneficiary travel policy may serve to obstruct access to that unique resource, or force an MST survivor to self-pay all travel costs in order to gain access to these specialized services. For these reasons, DAV supports legislation to change beneficiary travel policies to meet the specialized clinical needs of veterans receiving MST-related treatment in accordance with DAV Resolution 125.
Draft Bill, to expand and facilitate compensation of veterans for illnesses associated with exposure to toxic substance during service on active duty in the Armed Forces
This bill would amend title 38, United States Code, to expand and facilitate compensation of veterans for illnesses associated with exposure to toxic substance during service on active duty in the Armed Forces. Although DAV has two resolutions on providing health care and benefits for veterans exposed to toxic substances while on active duty, we have not had sufficient time to review this bill thoroughly. We ask the Committee to allow DAV to submit supplemental comments on this legislation for the record, after we have had time to fully analyze this draft legislation.
Draft Bill, to provide a limited exception to the 24-month requirement in order for veterans enrolled in the VA health care system to be eligible for payments or reimbursement for non-VA emergency treatment
This bill proposes a limited exception to the 24-month requirement in order for veterans enrolled in the VA health care system to be eligible for payment or reimbursement for non-VA emergency treatment under title 38, United States Code, section 1725.
DAV Resolution No. 212 supports legislation to amend title 38, United States Code, to eliminate the provision that requires enrolled veterans to have received care from VA within the 24-month period prior to date of the emergency care. DAV believes a health care benefit package is incomplete without a provision for emergency care. Accordingly, the 24-month requirement under [Sec.] 1725 discriminates against otherwise healthy veterans who need not seek care at least once every 24 months, yet is required to make an otherwise unnecessary medical appointment in order to be eligible for payment or reimbursement for non-VA emergency treatment.
While DAV supports the concept of the legislation, which is to address the restrictive nature of the 24-month requirement included in [Sec.]1725(b)(2)(B). We are concerned with the measures approach, which further fragments an already poorly constructed eligibility criterion, by providing relief to only "new veteran patients" with the "safety net" of non-VA emergency coverage.
Notably, "established patients" represent approximately 90 percent of VHA's total outpatient appointments. Currently, the VHA defined "established patients" as those who have received care from a qualifying provider in a specific clinic in the previous 2 years; "new patients" represent all others.
VA examines wait times for completed appointments with the ultimate goal of delivering high quality service at the time wanted and needed by each veteran. In 2014, VA will measure wait times for primary care, specialty care, and mental health appointments for new and established patients. In 2013, VA updated the methodologies to measure wait times for "new" and "established patient" appointments to improve reliability and consistency. Appointments for "new patients" will use the create date, defined as when the appointment was made and automatically captured by the scheduling system. Appointments for "established patients" will use the desired date, defined as the agreed upon date determined together by provider and patient. Desired date is measured prospectively to better represent patient satisfaction. Therefore, no targets are set in 2013 and 2014 so that baseline performance can be established.
We also note the ill-defined legislative text "a waiting period imposed by the Department" pertaining to wait times associated with a newly enrolled veteran's initial appointment at a VA medical facility is especially problematic. In determining "a waiting period," this Committee is aware of continuing reliability issues of VA reported outpatient medical appointment wait times and the need for improving appointment scheduling oversight.
Draft Bill, to require entities that receive per diem payments through VA, for the provision of services to homeless veterans, to submit an annual certification to the Secretary of
This draft bill would amend title 38, United States Code, to require entities that receive per diem payments through VA, for the provision of services to homeless veterans, to submit an annual certification to the Secretary of
The certification would include compliance with requirements outlined in the recently published version of the Life Safety Code or such other comparable fire and safety requirements as the Secretary may specify. Additionally, all licensing requirements regarding the condition of the structure and the operation of supportive housing or service center, including fire and safety requirements, must be provided.
DAV previously testified on a similar bill, H.R. 2065, introduced in the 113th
For entities that receive per diem payments during the year in which the legislation is enacted, the recipient must submit all certifications required to the Secretary no later than two years after the date of enactment, or additional per diem payments will be halted until certification is received. Both the
While DAV agrees with the intent of the measure to provide safe shelters for our homeless veterans, we urge the
Draft Bill, to rename the
This bill would redesignate the
This is a local issue. DAV does not have a national position on the matter.
Draft Bill, the Servicemember Housing Protection Act of 2013
This bill would amend the Servicemembers Civil Relief Act to enhance the protections accorded to service members and their spouses with respect to mortgages.
DAV does not have a resolution on this issue and takes no official position, but would not oppose enactment of such legislation.
Draft Bill, the Support of Joint Federal Facilities Act of 2013
This measure would provide VA the authority to enter into agreements with the
DAV has no resolution on sharing medical facilities with HHS; however, National Resolution No. 188 calls on
Although
Like the original authorization provided to VA and
Mr. Chairman, this concludes my testimony and I would be happy to answer any questions from you or members of the committee.
Read this original document at: http://www.veterans.senate.gov/hearings.cfm?action=release.display&release_id=dba2808c-a899-4c22-b71d-3fdb8497d38a
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Senate Veterans’ Affairs Committee Hearing
Senate Veterans’ Affairs Committee Hearing
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