November 8, 2016

Sgt. Shaft caricatureDear Sgt Shaft
There has been much talk about making life better for our nation’s veterans, especially as we approach Veterans Day.  Where does the VA stand in regard to these proposed changes?

Larry O.
Via the internet.

Dear Larry
I met with the VA Secretary recently and the following is a summary of his current priorities:

Appeals Modernization: In its FY 2017 Budget, VA set forward bold legislation to reform a disability claims appeals process that is failing Veterans. Within the limits of current law, VA is already pursuing changes in staffing and technology to improve the appeals process, but statutory structural changes are badly needed. The proposals put forward by VA in February established a framework for engagement with Congress, VSOs, and other stakeholders to work together to provide Veterans with the improved appeals process they deserve. We have convened initial informal discussions and believe that with a concerted effort, consensus on a foundation for a simplified appeals process that provides Veterans with a quality appeals decision within one year of their appeal can be achieved.

VA fully supports H.R. 5083 and S. 3328, the VA Appeals Modernization Act of 2016, which would provide much needed comprehensive reform for the VA appeals process with a new appeals framework that makes sense for Veterans, their advocates, VA and stakeholders.

Budget Flexibility VA’s FY 2017 Budget offered several straight forward proposals to improve budget planning and execution.  One such improvement would authorize VA to use the Veterans Choice Fund for all non-Department care.  In addition, the 2017 Budget proposes General Transfer Authority to provide flexibility to transfer funds among discretionary appropriations accounts to allow VA to respond to changing needs more readily and in a more business-like fashion.

Provider Agreements: On May 1, 2015, VA transmitted to Congress an Administration draft bill, the Department of Veterans Affairs Purchased Health Care Streamlining and Modernization Act.  S. 2179, the Veteran Care Agreements Rule Enhancement (Veteran CARE Act), introduced on October 8, 2015, fully incorporated the essential features of our proposal and also included useful technical refinements to our original language.

This bill with every passing day becomes more essential to clarify key legal issues regarding VA’s purchased care authorities outside of the Veterans Choice Program.  Failure to address the issue is already creating complications with extended care providers, and has placed other non-Veterans Choice care on insecure footing. We believe this basic clarification of VA authority is needed now.

The Senate Veterans’ Affairs Committee (SVAC) approved, as part of S. 425, the Veterans Homeless Programs, Caregiver Services, and Other Improvements Act of 2015, a greatly pared-down and time-limited version of this legislation, which only applies to extended care services and includes a sunset of the authority after two years. The House Veterans’ Affairs Committee (HVAC) approved, on February 25, a draft bill, the Department of Veterans Affairs Purchased Health Care Streamlining and Modernization Act. While analysis of the bill is ongoing, VA notes that the bill departs from the Administration proposal on some issues relating to requirements on providers, and that the bill would limit the new authority to 5 years. While we appreciate these efforts, we are eager to work with you to refine and improve these bills to ensure they will accomplish their objectives.

80-hour pay period: the 2016 Budget included a proposal to end an arbitrary 80-hour per Federal work period requirement that is simply not appropriate nor efficient for many medical professionals, and out of step with health care in the private sector. Enactment will both improve the efficiency of hospital operations and improve VA’s ability to recruit and retain critical professionals.  We appreciate SVAC’s inclusion of this provision in S. 425, the Veterans, Homeless Programs, Caregiver Services, and Other Improvements Act of 2015 as well as the introduction of H.R. 4150 in the House.

VISN & MCD Compensation: VA has requested special pay authority for VA Medical Center and Integrated Service Network Directors to help recruit and retain the best talent possible in hospital system management.

Partnership for Legal Services: Legal services remain a crucial but largely unmet need for homeless and at-risk Veterans. VA supports section 4 of S. 684, the Homeless Veterans Prevention Act, of 2015.  This section would authorize the Secretary to enter into partnerships with public or private entities to provide general legal services to Veterans who are homeless or at risk of homelessness.

VA as Choice primary payer: VA requests Congress to pass legislation that designates VA as the primary payer through the Choice program.  Paying non-VA providers is essential to getting Veterans the care they need and deserve.  Designating VA as the primary payer will ensure that non-VA providers are receiving prompt payment for medical services they provide to the Veteran.

Recording Obligations at Payment: VA chronically over-obligates more funds than are necessary for non-VA care due to the difficult in predicting whether Veterans will seek all of the care that is covered by their authorizations.  In accordance with the Recording Statute, 31 U.S.C. § 1501, and the Antideficiency Act, 31 U.S.C. § 1341(a)(1), VA is required to record an obligation covering the estimated amount of the non-VA care.  These amounts are highly unpredictable and this unpredictability has led to significant deobligations at the end of each fiscal year, resulting in large balances of expired prior year appropriations in the Medical Services account. VA seeks legislation that would allow VA to record obligations for Care in the Community on the date on which payment of a claim to a provider is approved rather than on the date that such care is authorized without regard to the Recording Statute and the Antideficiency Act.

Telehealth: There is pending legislation, S. 2170 that would help ensure that VA can utilize the fullest complement of telehealth capabilities in order to provide easier access to VA healthcare, especially in rural areas and across state lines.  As Telehealth opportunities become more readily available, more and more Veterans are using them.

Release of Certain Information for Sharing with Other Providers: Current law prevents VA from providing or sharing patient information relating to drug abuse, alcoholism or alcohol abuse, or infection with human immunodeficiency virus (HIV) or sickle cell anemia with public or private health care providers, including with Indian Health Service (HIS) health care providers, without the prior signed written consent of the patient, unless there is a bona fide medical emergency.  This restriction poses potential barriers to the coordination and quality of care provided to our patients by public or private care providers and actual barriers to providing health information to HIS for the treatment of shared patient populations.  This restriction is inconsistent with other health care practices and other Federal standards related to patient privacy. H.R. 5162, the Vet Connect Act, which VA supports and was part of our proposal in our Plan to Consolidate Programs of Department of Veterans Affairs to improve Access to Care in October 2015, would allow VA to provide non-VA health care providers with the necessary information needed for continued health care services for Veterans.



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