Congress Approves Omnibus Spending Bill Prior to adjourning the 113 th Congress, the House and Senate approved H.R. 83, the Consolidated and Further Continuing Appropriations Act for FY 2015. The legislation is a massive omnibus spending bill that includes funding for the 11 major appropriations accounts, including the Department of Veterans Affairs (VA), through September 30, 2015. The lone exception is funding for the Department of Homeland Security. The bill includes funding levels that essentially match the recommendations for the VA included in the President s Budget Request in March 2014. PVA and the co-authors of The Independent Budget AMVETS, Disabled American Veterans, and Veterans of Foreign Wars believe that the bill still provides insufficient funds to properly meet demand placed on the VA health care system for both FY 2015 and FY 2016. However, the VA did receive approximately $5 billion to direct towards building internal capacity as a part of P.L. 113-146, the Veterans Access, Choice, and Accountability Act as well as approximately $10 billion for the purposes of purchasing care outside of the VA health care system as a result of the Choice program. The omnibus also includes a significant priority for PVA. It includes language that would authorize mandatory benefits in advance (fully one year prior to the start of a fiscal year). Currently, only VA health care funding is provided through advance appropriations. This new authorization would ensure that the payment of VA benefits, such as compensation and pension, DIC, and education benefits, are not jeopardized by political gridlock that could lead to another government shutdown (as occurred in October 2013). Health Subcommittee Conducts Legislative Hearing On November 19, 2014, PVA provided a statement for the record to the House Committee on Veterans Affairs, Subcommittee on Health on a number of bills currently pending before the Subcommittee. Legislation being considered included toxic exposure research, priority care for Medal of Honor recipients, suicide prevention programs, research for alternative therapies, and care for newborns. PVA supports much of the legislation, including H.R. 5475 The Newborn Care Improvement Act, a bill to authorize hospital stays for newborns of up to 14 days. Current law allows for a maximum stay of seven days. H.R. 5059, the Clay Hunt Suicide Prevention for American Veterans Act, requires a third-party review of mental
health and suicide-prevention programs administered by the Departments of Defense and Veterans Affairs at least on an annual basis. H.R. 4887, the Expanding Care for Veterans Act, would further research of complementary and alternative treatments for veterans and establish wellness programs at VA medical centers. H.R. 4720, the Medal of Honor Priority Care Act, would move Medal of Honor recipients from priority group three to group one for enrollment in the Department of Veteran Affairs health care system. PVA generally supports H.R. 4977, the Creating Options for Veterans Expedited Recovery (COVER) Act, a bill to establish a commission to examine VA s current mental health therapy model and potential benefits of incorporating complementary therapies. Therapies for the commission to evaluate range from outdoor sports therapy, to accelerated resolution therapy, to service dog therapy. These options fall outside VA s typical services. PVA has serious concerns regarding H.R. 5484, the Toxic Exposure Research Act of 2014. This legislation would require VA to select a VA Medical Center to be the National Center for research on the health conditions of descendants of individuals exposed to toxic substances while in the Armed Forces. It would also establish an Advisory Board for the National Center to determine links between exposure and health conditions for the purpose of adjudicating a claim for VA compensation and health care benefits. PVA agrees with the intent of this legislation for VA to further investigate possible health effects in offspring following parental exposure. However, PVA has serious concerns about the role of the advisory board and its proposed involvement in the adjudication process. The bill does not discuss the processes should the Advisory Board conflict with the findings of the IOM. In order to read PVA s full statement for the record, please go to www.pva.org. House VA Subcommittee Reviews the VA Family Caregiver Program On December 3, 2014, the House Committee on Veterans Affairs, Subcommittee on Health held an oversight hearing on VA s Family Caregiver Program. The hearing was prompted by a report by the Government Accountability Office (GAO) entitled, Actions Needed to Address Higher than Average Demand for the Family Caregiver Program (GAO-14-675). The report found that VA had egregiously underestimated the demand for the program and, as a result, caregiver services were extremely limited and delayed. Originally VHA estimated 4,000 caregivers would be approved by September 2014. By May 2014, over 15,600 caregivers were authorized to participate in the program more than nearly four times the original projection. The consequences that followed included severe staffing shortages, application backlogs, delayed medical assessments and home visits.
Additionally, the program has an ineffective and inefficient information technology (IT) system the Caregiver Application Tracker. Because it was designed to manage a small program it has myopic operating capabilities. Aggregate data must be assembled by hand, as the system is unable to assess its own workload. Program officials said they are looking to obtain a new IT system, but it is unclear how long that will take. With 500 approved caregivers being added to the program each month it is vital that these systemic issues be made functional as soon as possible. What the committee failed to properly examine was the expansion of eligibility for the program. The Family Caregiver Program is the only VA program that discriminates between veterans by dates of service. There is no justifiable reason why the Family Caregiver Program ought to be denied to a veteran who incurred a catastrophic injury prior to September 11, 2001. Because of the post-9/11 requirement and the exclusion of service-connected illnesses, the majority of PVA members are ineligible. The committee concluded the hearing by insisting that a cost-benefit analysis be conducted (by whom they did not say) before any further discussions of expanding eligibility could be had. In order to read PVA s full statement for the record regarding the Family Caregiver Program, please go to www.pva.org. Senate Committee Reviews VA Mental Health Programs On November 19, 2014, the Senate Committee on Veterans Affairs examined Mental Health and Suicide Among Veterans. A main concern voiced in the nearly four-hour hearing was the profound shortage of mental health professionals in VA and throughout most communities in America. There are exactly 1.2 mental health providers for every 1,000 veterans. Moreover, only one in seventeen medical students will pursue mental health as a career field. A recent RAND Corporation study found that only six percent of civilian mental health providers were culturally competent enough to effectively treat veterans. Of the civilian providers surveyed, sixty percent admitted they did not feel qualified to serve the veteran community. In light of this data, panelists voiced a possible consequence of the new Choice Program. Inadequate care from a community provider could provide little relief for a veteran, or worse, further exacerbate a mental health condition. Outgoing Sen. Begich (D-AK) urged the committee to proceed on this issue realistically, to recognize the provider shortages and invest in recruitment of students into the mental health field. In response to the Committee s lightly veiled accusation that VA has mishandled the $5 billion from VACAA (intended to fill staffing shortages), Dr. Harold Kudler, Chief
Consultant for VHA Mental Health Services responded, That money isn t earmarked for mental health. The nation as a whole is in a crisis. The Committee asked the panelists about how VA has been effective for veterans mental health in recent years. The responses were largely positive. The use rate of mental health care services has gone up. Yet there remain no effective programs that identify at-risk veterans when they transition from military service. Since 2007, the Veterans Crisis Hotline has made 39,000 rescues and 220,000 referrals. Kudler denied allegations that VA care has a systemic reliance on prescriptions or that VA is casually overmedicating veterans. They are looking to immediately integrate peer support groups into primary care settings in order to reduce stigma associated with treatment. To date, peer support has been one of the most effective mental health maintenance tools. Representatives from the Institute of Medicine (IOM) shared recent findings that suicides committed by female VA users have gone up 31 percent. Additionally, men, ages 50 and over, are the largest population of veterans that commit suicide. The popular perception that the experience of multiple tours makes a veteran more susceptible to suicide is not true. In fact, among OIF/OEF era veterans who have committed suicide less than half have been deployed. VA is currently trying to determine the causes of these statistical trends. Ms. Susan Selke testified on her experience dealing with veteran suicide. She is the mother of Clay Hunt, a deceased Marine Corps combat veteran for whom H.R. 5059, the Clay Hunt Suicide Prevention for American Veterans Act, is named. Ms. Valerie Pallotta, mother of Joshua Pallotta, a deceased Vermont National Guard combat veteran, shared her family s experiences. Her son committed suicide only a few weeks before the hearing. Chairman Bernie Sanders (I-VT) closed the hearing emphasizing the Committee s devotion to ensuring veterans received the mental health care they deserve. Additionally, the Committee will continue to make suicide prevention a top priority. U.S. Government Hires of People with Disabilities Reach 30-Year High The U.S. Office of Personnel Management (OPM) has released the Fiscal Year (FY) 2013 Employment of People with Disabilities in the Federal Executive Branch Report. Major findings include the fact that at no point in the past 33 years have people with disabilities been hired at a higher percentage than in FY 2013. People with targeted disabilities are also being hired at a higher percentage now than at any time in the past 18 years.
In FY 2013, total non-seasonal, full-time permanent employees with disabilities, including 30 percent or more disabled Veterans, increased from 219,975 in FY 2012 to 234,395, representing an increase from 11.89 percent to 12.80 percent. Full-time permanent new hires with disabilities totaled 16,024, representing an increase from 16.31 percent in FY 2012 to 18.18 percent. Of that last number, 38 percent or 6092 were veterans with disabilities rated at 30 percent or more. As a result, more people with disabilities are now in Federal service both in real terms and by percentage than at any time in the past 33 years. To read the full report - go to http://www.opm.gov/policy-data-oversight/diversity-andinclusion/reports/disability-report-fy2013.pdf HAVEN Act Included in National Defense Authorization Act A bill to expand accessible housing opportunities for veterans was included in the massive defense authorization bill recently passed by the House of Representatives. The Housing Assistance for Veterans Act or HAVEN Act, (Section 1079 of the larger NDAA) was introduced by Rep. Al Green (D-TX) and directs the Secretary of Housing and Urban Development (HUD) to establish a pilot program to award grants to nonprofit organizations that primarily serve veterans or low-income individuals. The measure requires such grants to be used to rehabilitate and modify the primary residence of disabled or low-income veterans (at a specified limited or no cost to such veterans) and requires a minimum of 50% matching funds by participating organizations. The defense bill is expected to be voted on by the Senate and sent to the President for his signature before Congress adjourns.