November 15, 2009                                                         Volume 15, No. 11

 

President Signs Into Law Historic Advance Appropriation Legislation

 

On October 22, the President of the United States signed into law P.L. 111-81, the “Veterans Health Care Budget Reform and Transparency Act.”  This historic measure makes funding for the health-care programs administered by the Department of Veterans Affairs (VA) an advance appropriation guaranteeing sufficient, timely, and predictable funding. 

 

President Obama signaled his commitment to this needed reform during his campaign for the Presidency last fall.  He followed through on this commitment by again supporting it in his budget submission for the VA released last spring. 

 

For more than a decade, the Partnership for Veterans Health Care Budget Reform (the Partnership), made up of nine veterans’ service organizations, including Paralyzed Veterans of America, has advocated for reform in the VA health-care budget process.  Earlier this year, the Partnership made a concerted effort to affect real change in the budget process.  By working with the leadership of the House and Senate Committees on Veterans’ Affairs, the Military Construction and Veterans’ Affairs Appropriations Subcommittees, and key members of both parties, we were able to move advance appropriations legislation forward.  At the beginning of the year, Representative Bob Filner (D-CA), Chairman of the House Committee on Veterans’ Affairs, and Senator Daniel Akaka (D-HI), Chairman of the Senate Committee on Veterans’ Affairs, introduced the “Veterans Health Care Budget Reform and Transparency Act” (H.R. 1016/S. 423).  

 

Interestingly, the appropriations process this year served to validate the need for this critical reform.  As has become the normal process, the Military Construction and Veterans Affairs appropriations bill has yet to be completed even as the start of the new fiscal year passed on October 1, 2009.  While the House passed the bill in the summer, the Senate once again failed to live up to its responsibility to get the bill done in a timely manner.  This fact serves as a continuing reminder that, despite excellent funding levels provided over the last two years, the larger appropriations process is completely broken. 

 

As a result of these issues, Congress ultimately approved and the President signed into law P.L. 111-81, the “Veterans Health Care Budget Reform and Transparency Act.”  A review of recent budget cycles made it evident that even when there is strong support for providing sufficient funding for veterans medical care programs, the systemic flaws in the budget and appropriations processes continue to hamper access to and threaten the quality of the VA health-care system.  Now, with enactment of advance appropriations the VA can properly plan to meet the health-care needs of the men and women who have gallantly served this nation.   

 

Many members of the House and Senate deserve a great deal of credit for the passage of this important bill as well.  Specifically, we appreciate the efforts of House and Senate VA Committee Chairmen Bob Filner (D-CA) and Daniel Akaka (D-HI) and Senate VA Committee Ranking Member Richard Burr (R-NC) for steering these measures through their committees.  Also, our thanks go out to the Chairmen of the House and Senate Military Construction and Veterans’ Affairs Appropriations Subcommittees, Chet Edwards (D-TX) and Tim Johnson (R-IL).  The Chairmen of the Budget Committees, Senator Kent Conrad (D-ND) and Congressman John Spratt (D-SC) deserve credit for including this proposal in their Budget Resolutions earlier this year.  

 

Senator Akaka Takes Steps to Move Critical Veterans’ Legislation

 

Due to the fact that the Senate Committee on Veterans’ Affairs has been unable to move any of its major legislative measures to the Senate floor for consideration, Senator Daniel Akaka (D-HI), Chairman of the Senate VA Committee, has decided to merge the two major health care bills—S. 252, the “Veterans Health Care Authorization Act of 2009,” and S. 801, the “Caregiver and Veterans Health Services Act of 2009,” into a single bill.  As such, Senator Akaka has introduced S. 1963, the “Caregiver and Veterans Omnibus Health Services Act of 2009,” that combines the provisions of those two bills. 

 

This comprehensive legislation makes a number of positive changes to veterans’ health-care services and programs.  Specifically it would improve mental health programs, health-care services directed at women veterans, and personnel policies and procedures administered by the Department of Veterans Affairs (VA). 

 

Of particular importance to PVA are the sections of the legislation that would provide needed support to family caregivers of severely disabled veterans and that would eliminate co-payments that Priority Group 4 catastrophically disabled veterans are currently required to pay.  This has been a major legislative initiative for PVA for many years.  This legislation would eliminate the financial burden that many PVA non-service connected members face, in particular. 

 

This critical legislation has been stalled in the Senate because a hold has been placed on it.  Senators have the ability to place a hold on a bill prohibiting it from coming to the floor for consideration until his or her concerns are addressed.  More troublesome is the fact that holds are anonymous so the veterans’ service organizations cannot say for certain what senator is responsible for the hold.  However, PVA believes that Senator Tom Coburn (R-OK) has placed the hold on this legislation due to concerns he has raised about the cost of these bills, particularly the provisions associated with caregiver assistance. 

 

PVA Testifies on Inappropriate Billing by the VA

 

On October 15, PVA testified before the House Committee on Veterans’ Affairs, Subcommittee on Health, concerning inappropriate billing of veterans by the Department of Veterans Affairs (VA).  PVA testified that in recent years VA has seen significant increases in both medical care collections estimates, as well as the actual dollars collected, while PVA has received an increasing number of reports from veterans who are being inappropriately billed by the Veterans Health Administration (VHA) for their care.  Moreover, this is not a problem being experienced by just service-connected disabled veterans, but non-service connected disabled veterans as well.  The Independent Budget (IB) which is co-authored by PVA, AMVETS, Disabled American Veterans, and Veterans of Foreign Wars, has repeatedly focused attention on this issue.  Unfortunately, until now, little attention has been paid to the problem while medical care collections continue to grow at an alarming rate.

 

Inappropriate charges for VA medical services places unnecessary financial stress on individual veterans and their families.  These inaccurate charges are not easily remedied and their occurrence places the burden for correction directly on the veteran, their families or caregivers.  PVA testified that many veterans are not aware of these mistakes and simply submit full payment to VA when a billing statement arrives at their home.  In addition, service-connected veterans are faced with a scenario where they, or their insurance company, may be billed for treatment of a service-connected condition.  Meanwhile, non-service connected disabled veterans are usually billed multiple times for the same treatment episode or have difficulty getting their insurance companies to pay for treatment provided by the VA. 

 

PVA conducted an email survey, sending questionnaires to 4,000 PVA members.  Approximately nine percent of respondents claim to receive more than one bill for the same treatment episode, approximately 17 percent claim to be billed directly for treatment of a service-connected condition, and approximately 22 percent claim that their insurance company is being billed for treatment of a service-connected condition. 

 

While it is shameful that VHA takes advantage of veterans with service-connected conditions like this, it is equally disappointing that veterans who depend on the VA for their care but who are not rated for service-connected conditions are also being taken advantage of.  PVA recommended that the VA immediately change its regulations to discontinue this practice.  If the VA is unwilling to make the change, then PVA calls on Congress to fix this through legislation. 

 

Senate Committee on Veterans’ Affairs Holds Hearing on Pending Legislation

 

On October 21, the Senate Committee on Veterans’ Affairs held a hearing concerning pending legislation for veterans.  The hearing covered a large number of bills and discussion drafts of legislation.  PVA submitted a statement for the record outlining our views on the legislation being considered. 

 

PVA’s greatest interest was in S. 1753, the “Disabled Veterans Caregiver Housing Assistance Act of 2009.”  This legislation would increase assistance for disabled veterans who are temporarily residing in housing owned by a family member.  We expressed our views that this legislation is problematic to veterans in need of transitional housing who may have the intent of purchasing a home and using adaptive housing assistance at a later date.  The Temporary Residing Assistance (TRA) grant is subtracted from the overall maximum benefit of $60,000 from Specially Adapted Housing (SAH) grant.  For example: If a disabled veteran receives a TRA grant of $12,000, he/she would have only $48,000 available under the SAH grant, rather than $60,000, to adapt or build a permanent residence in the future.  This legislation is not conducive as a benefit to disabled veterans who have temporary and ultimately permanent adaptive housing needs.

 

GAO reported (GAO-09-637R) on June 15 to Members of Congress that VA has processed nine TRA grants since it’s creation on June 15, 2006 through a period ending February 28, 2009.  During the same period, VA processed 2,431 SAH and Special Home Adaptation (SHA) grants.  This is a substantial difference in the number of applications for each program.   

 

PVA recommended SAH and TRA become two separate grants due to having different objectives.  This would prevent TRA from being deducted from the maximum benefit of SAH and substantially increasing the favorability of the TRA grant for its applicants.  This would allow veterans to use TRA and still allow them to adapt their own residence in the future. 

 

PVA also expressed its strong support for S. 1429, the “Servicemembers Mental Health Care Commission Act.”  As the wars in Afghanistan and Iraq continue, more and more veterans of the War on Terrorism are in need of mental health care.  As the language of the legislation indicates, the rates of post traumatic stress disorder (PTSD) and depression are greatest among women veterans and members of the Reserves.  While the Armed Forces are working hard to help those who remain on active duty, veterans who have left the service face particular challenges as they leave the military support groups critical to coping with the horrors of war.

 

Establishing a commission to oversee monitoring and treatment of veterans with PTSD, traumatic brain injury and other mental health disorders caused by service and to study the long-term adverse consequences of these conditions is critical to determining treatments that may be most effective.  And, while PVA welcomes the requirement for annual reports to Congress, it will be unfortunate if this reporting remains simply an exercise and does not lead to Congressional action on recommendations.  Too often Congress has the information to make changes, but is unable to enact legislation that truly impacts those who need care.  As the wars in Afghanistan and Iraq continue, we ask that this legislation do more than just identify what we already believe, but be the first step in treating this serious effect of war.

 

 

Subcommittee on Economic Opportunity Holds Hearing on

Progress of Post-9/11 GI Bill

 

On October 15, the House Committee on Veterans’ Affairs, Subcommittee on Economic Opportunity held a follow-up oversight hearing on the implementation of the Post-9/11 GI Bill.  Chairwoman Stephanie Herseth Sandlin (D-SD) facilitated the hearing accompanied by Ranking Minority John Boozman (R-AR).

 

Only one witness was requested to testify on this important issue.  Keith M. Wilson, Director of the VA’s Office of Education Service in the Veterans Benefits Administration gave the update.  He appeared before the Subcommittee to update Congress on the VA’s actions taken to address the delays in payments to veterans starting school in September of this year.

 

On May 1, the VA started notifying veterans by mail that had previously applied for eligibility of their status. This certificate documented their eligibility to receive the GI Bill and for the total number of months they were eligible.  Over 210,000 veterans received these certificates of eligibility. The hearing disclosed that this process alone took over one hour of manual processing per application including examining the veterans DD 214, records from the Department of Defense, and VA databases.

 

Mr. Wilson explained to the Subcommittee that the current processing of the Post-9/11 GI Bill takes four separate manual processes using four separate IT systems that do not interface to each other.  This labor intensive process is the VA’s interim means of processing claims, while they develop the permanent IT process.  Starting in 2008 the VA’s IT department working with the Department of Defense, Space and Naval Warfare Systems Center Atlantic (SPAWAR), is developing the permanent processing system simultaneously while also processing claims manually. Their goal is to have the new system in place for the 2010 school year.

 

Several members of Congress have heard complaints from their constituents about not receiving the GI Bill payments on time.  Wilson told the Subcommittee that since May 1 his program has received over 937,000 claims for educational benefits and have processed 794,000 claims.  This processing action for educational programs increased by 180,000 over the same period last year.  He admitted that the implementation has had some unexpected delays which his department has worked day and night, sometimes six and seven days a week, to address. 

 

Mr. Wilson also explained that in previous testimony before the Senate Committee on Veterans’ Affairs the VA emphasized that it does not have a payment system, or the appropriate number of trained personnel to administer the program.  The VA stated that it would take a minimum of 24 months to deploy a new payment system.  Having less than 12 months to develop an interim system to enroll and disburse payments to veterans has been a challenge.

 

One common complaint from newly enrolled veterans was the timing of the benefit check paid to veterans. The VA has always issued payment at the end of each benefit month for that month.  The veterans check for classes completed in September would be paid on October 1.  Many veterans were expecting the check beginning in September.  Thus, they had rent and other expenses for September without funds to pay these obligations.

 

Chairwoman Herseth-Sandlin (D-SD) emphasized to the VA that there was not adequate information about the new program given to the veterans and the participating schools.  Wilson said that they were using the state approving agencies to inform the schools of the procedures of the new GI Bill.  “Apparently that was not enough outreach by the VA,” commented Herseth-Sandlin.  The Subcommittee expressed hope for continued and expanded outreach to veterans to encourage them to participate in this benefit.

 

House Passes Health Care Reform Measure

 

On November 7, in a rare Saturday session, the House of Representatives passed H.R. 3962, the “Affordable Health Care for America Act of 2009”, by a vote of 220–215.  The House bill will now go to the Senate where Senator Lindsey Graham (R-SC) said the House bill was “dead on arrival.”   Senator Harry Reid (D-NV), Senate majority leader, will lead the negotiations on combining the proposals from Senate Finance and Health Education Labor and Pensions Committees.

 

The provisions in the House bill that benefit people with disabilities include:

 

  • Major insurance market reforms such as the prohibition on pre-existing condition exclusions, guaranteed issue and renewal requirements, and elimination of annual and lifetime caps;
  • A two-year extension of the exceptions process to the Medicare therapy caps on physical, occupational, and speech and language therapies;
  • Requirements for the development of standards for accessible diagnostic and other medical equipment;
  • Inclusion of “disability” as a category for purposes of health disparities; 
  • Inclusion of “disability” as a subpopulation in the provisions regarding Comparative Effectiveness Research (CER);
  • The new Health Insurance Exchange’s essential benefits package includes rehabilitation and habilitation services, durable medical equipment, prosthetics, orthotics and related supplies, vision and hearing services, behavioral health treatment, and parity for mental health and substance abuse;

·        The Community Living Assistance Services and Supports (CLASS) Act, a new employment, premium-based, long term services insurance program to assist adults with severe disabilities to remain independent and a part of their communities, without having to “spend down” to become eligible for Medicaid;

·        A  “Sense of Congress” regarding the Community First Choice Option, which expresses support for allowing states to offer to Medicaid coverage of community-based attendant services and supports to people otherwise eligible for Medicaid institutional services;

  • Substantial federal subsidies and out-of-pocket limits to make coverage as affordable as possible;
  • Creates new mechanisms and payment methods to better coordinate care for people with disabilities and chronic conditions; and
  • Provision of wellness grants that prohibit the use of discriminatory incentives.

 

NCD Report on Health Care and Disability

 

The National Council on Disability recently released The Current State of Health Care for People with Disabilities, a study of disparities in health care and recommendations for the future.  Key findings of the report:

 

●        People with disabilities experience significant health disparities and barriers to health care, as compared with people who do not have disabilities.

●        People with disabilities frequently lack either health insurance or coverage for necessary services, such as specialty care, long-term services, prescription medications, durable medical equipment, and assistive technologies.

●        Most federally funded health disparities research does not recognize and include people with disabilities as a disparity population.

●        The absence of professional training on disability competency issues for health care practitioners is one of the most significant barriers preventing people with disabilities from receiving appropriate and effective health care.

●        The Americans with Disabilities Act (ADA) has had limited impact on how health care is delivered for people with disabilities. Significant architectural and programmatic accessibility barriers still remain, and health care providers continue to lack awareness about steps they are required to take to ensure that patients with disabilities have access to appropriate, culturally competent care.

The Report notes that people with disabilities tend to have poorer health and more secondary conditions than the general public.  Though they have a generally higher use of health care, they do not take advantage of preventive services.  The more significant the disability one has, the more difficulty accessing health care.  Further, inadequate transportation, limited personal assistance services, and patchwork financial assistance for people with low incomes compound the health problems and affect the overall health status of people with disabilities. 

The Report is available online at:  http://www.ncd.gov/.

 

GAO Report on Voting Accessibility

 

In September, the United States Government Accountability Office (GAO) released the report, Voters with Disabilities: Additional Monitoring of Polling Places Could Further Improve Accessibility, at the request of a number of U.S. senators. The GAO conducted a nationwide survey on Election Day 2008 to determine whether states had met the goals for voter access required by the Help America Vote Act (HAVA) of 2002. The report shows that strides have been made over the last few years, but in some areas of the country, barriers still remain for elderly and disabled individuals. For example, 46% of polling places surveyed in the report had voting systems technically considered “accessible,” but that could still pose problems for people in wheelchairs. To view the full report, go to the GAO home page or click on the link.  http://www.gao.gov/new.items/d09941.pdf

This report is the latest in a series examining the Department of Justice's efforts to ensure elderly and disabled voter accessibility. The next report, scheduled for release in November, will examine voting practices in long-term care facilities.

 

United We Ride Dialogue

 

PVA staff served as a catalyst in the two week long United We Ride online dialogue, November 2 - 13.  The dialogue was launched by the Federal Interagency Coordinating Council on Access and Mobility (CCAM) which includes 11 Federal departments working to increase the local coordination of Federal transportation funding resources.  The CCAM reached out to stakeholders across the country to learn what additional steps are necessary to continue increasing access to affordable and reliable transportation services for people with disabilities, older adults, and people with limited incomes.

 

The dialogue was open to any participant who had  ideas on improving accessible transportation.  Ideas were submitted and “tagged” with key words so that later participants could review ideas similar to their own.   After ten days, almost 3,000 people had visited the site and submitted over 200 ideas and 700 comments. 

At least four ideas were based on services to veterans.  Two commented on the lack of accessible vehicles at the VA; all mentioned the serious lack of transportation in rural areas.  One suggested that veterans transportation be expanded to more than medical appointments:  “Most [vets] are living on limited income only allowing for one vehicle per family. Isolation has been listed as one of the major causes of suicide in our veterans. With the majority returning to our rural communities we need to develop methodologies to address "essential life needs" rather than just medical needs.”  Another comment was to: “work with Veteran's Services so that their funding and programs can work with other Human Services Transportation -- so that individuals from a variety of programs including Veterans can share transportation, vehicles, etc. to travel to covered services. ”

Other issues receiving a lot of comments were the lack of options in rural area, insufficient participation by people with disabilities in transportation planning, ridesharing, volunteer drivers, and accessible taxis.  The site will remain available for viewing after 11/13:  www.uwrdialogue.org.