VA Inspector General Testifies before House Veterans Affairs Committee

On July 14, 2014, Linda Halliday, Assistant Inspector General for Audits and Evaluations in the Veterans Affairs Office of the Inspector General (OIG), testified before the House Veterans Affairs Committee on the progress the VA has made with some changes they’ve supposed to have been putting into effect over the past few years.

Despite the fact that the problems at the VA have been under scrutiny for years and that the VA has committed numerous times to implementing the many recommendations made, the OIG inspections continue to find that, while some improvements have been made, the VA is still not fully living up to those commitments.

Since March 2013, the VA has been attempting to improve their VA Disability Claims process and decrease the backlog by putting in place initiatives and procedures with a goal of achieving an accuracy rate of 98% within 125 days by 2015. The OIG, however, continues to find a significant amount of errors in accuracy during their inspections of VA Regional Offices. Looking at just TBI cases, the OIG recently found that processing errors continue to occur in 27% of these cases. That’s still a long way off from their 2% goal.

Similarly, the OIG reported in January 2011 that the VA was paying out way too much money to about 27,500 veterans. These cases in particular dealt with veterans who had been temporarily assigned a 100% VA Disability Rating. When assigning these ratings, the VA is required to have the condition re-evaluated regularly so that they can then assign a permanent rating once the condition has stabilized. In 2011, 27,500 of the 181,000 cases had not been re-evaluated in far too long and not given permanent ratings, resulting in a massive amount of overpayments.

To fix the issue, the OIG made 7 recommendations to help the VA properly process these claims. The OIG now reports that only 6 of these recommendations have been properly put into place, resulting in over $400,000 in overpayments this year alone. The failure to implement that 7^th recommendation has raised questions about the VA’s commitment to reduce these improper payments.

The OIG continues to conduct inspections and make recommendations for fixing the problems they uncover. Hopefully the new leadership at the VA will take those recommendations and actually put them to use making the necessary changes that have been far too long in coming. 

Some Good News From The VA!

There have been a few good things happening at the VA that you should be aware of.

First, the new VA Secretary, Robert McDonald, has instructed all VA facilities nationwide to hold at least one town hall meeting between now and the end of September. At each of these meetings, the veterans will be invited to share thoughts and give feedback to the VA about the changes that they are planning. This is a GREAT opportunity to really let your voice be heard!

“Caring for Veterans is a calling, and our first commitment is to provide Veterans and their families the timely, quality care and benefits they have earned and deserve through their service to our Nation,” said Secretary McDonald. “As we seek continual improvement and to rebuild trust among Veterans, it is critical that we continue to listen and learn directly from those who use our system.”

All veterans and families, Veterans Service Organizations, and community organizations and partners are invited to attend these meetings. Check with your local VA facility to find out when and where a town hall meeting is scheduled for your area.

Second, on August 13^th, the VA announced that it is expanding its Patient-Centered Community Care (PC3) program. The VA uses PC3 to purchase non-VA care when it can’t provide a specific treatment (for example, when surgery or hospital care is needed and the only VA facility close by is an outpatient clinic) or when it would be better for the veteran to receive treatment closer to home (such as when transportation is difficult for a Disabled American Veteran). The VA can also use PC3 to help reduce wait times.

The PC3 program already allows eligible veterans to receive non-VA care in several areas, such as Mental Health, some Emergency care, and both inpatient and outpatient Specialty Care (things like cardiology or neurosurgery). Now they are adding Primary Care, which includes Family Practice, Internal Medicine, and Ob/Gyn—providing veterans with even more options for receiving care.

It’s good to see that the VA is actively taking steps to help meet our veterans’ needs.

Military Sexual Trauma Awareness Grows—Changes Coming?

Military Sexual Trauma (MST) is defined as the sexual assault or repeated sexual harassment of an individual while serving in the military. A variety of conditions, including mental disorders, have been linked to Military Sexual Trauma. Some of these conditions develop immediately, but some show up years after the trauma occurs. 

It is estimated that 86% of Military Sexual Trauma cases go unreported due to the fear of negative repercussions like ridicule, pity, isolation, and prejudice. However, growing awareness of the problem is making it easier and less stressful for victims to get help.

Contrary to what you might hear, VA disability benefits can be given to individuals who have experienced Military Sexual Trauma (see our blog on Military Sexual Trauma for more details). 

Additionally, treatment for conditions related to Military Sexual Trauma is available through the VA, and the requirements to qualify to receive it are much less strict than they are for all other conditions.

Currently, all conditions must be clearly documented by a physician while the individual is in the military for the VA to give medical care for it. Military Sexual Trauma, however, does not have to be. While it is best if the incident was officially reported at the time it happened, the VA looks for other indicators or “markers” to establish whether a condition was caused by Military Sexual Trauma. Such indicators include:

• Records from police reports, hospitals, doctors, or rape crisis centers
• Tests for pregnancy or STDs
• New incidences of substance abuse
• Onset of depression or panic attacks
• Sudden or unexplained changes in social behavior or job performance
• Request for a change in military assignment

The following are additional exceptions that allow victims of Military Sexual Trauma to receive the treatment they need. 

• Veterans who are not eligible for other VA services may be eligible, perhaps even those with dishonorable discharges (this is decided on a case-by-case basis). 
• The incident(s) do not have to have been reported.
• There are no standard eligibility requirements for treatment, such as income, length of service, etc.
• The condition for which a victim of Military Sexual Trauma needs care does not have to be service-connected in order for them to receive treatment.  

The VA health care reform bills passed by the House and Senate that we reported on last week may offer additional relief to those suffering from Military Sexual Trauma-related conditions. The Senate bill includes changes that would expand eligibility for Military Sexual Trauma counseling and treatment to Reservists on inactive duty training (authorized training by a Reservist not on active duty). The Senate bill also calls for the transition of all Military Sexual Trauma treatment from the DoD to the VA. The veteran would still receive any DoD medical care that he qualifies for, but the treatment for his Military Sexual Trauma would be taken over by the VA. 

Right now the Senate and the House have formed a joint committee to work out a compromise bill that, if passed by both chambers, will go to the president to be signed into law. We’ll keep you posted on the final changes to Military Sexual Trauma treatments once the bill is officially signed into law

The New Veteran’s Choice Cards

It’s official! President Obama signed the Veterans Access, Choice and Accountability Act that we discussed in detail last week into law this past Thursday, August 7, at a ceremony at Fort Belvoir, Virginia.

The law provides funding for measures intended to decrease wait times at VA facilities, including Veteran’s Choice Cards, which will enable veterans who have waited more than 30 days for an appointment or who live more than 40 miles from a VA medical facility to receive care from civilian providers.

This provision of the law is likely to be the first to go into effect, but before you get too excited, remember that this card will not be an unlimited credit card to be used whenever and wherever you want. The Veteran’s Choice Card comes with plenty of restrictions. 

First, the funding for this program is considered emergency funding which the VA can use on an ‘as needed’ basis to purchase health care from providers outside the VA network if the veteran faces a long wait time for VA care. The VA gets to decide on a case-by-case basis if this is ‘needed.’

Second, you must have been enrolled in the VA system by August 1 of this year to be eligible to receive a card.  If you enroll after that date, you must have been on active duty in a combat theater sometime within the last 5 years.  

Third, the card will be used less like a credit card and more like an insurance identity card to allow non-VA providers to check a veteran’s eligibility to receive care that a VA care coordinator has pre-approved and pre-arranged. Essentially this means that you will have to have a referral to receive non-VA care, and that the VA will arrange this care for you.

Fourth, you may or may not get to choose your non-VA care provider.  These providers are limited to DoD facilities, Community Health Care facilities, Indian Health Care facilities, and private providers who accept Medicare. All of these providers have the right to refuse to accept the card just as they can choose to refuse Medicare, mostly because of the long waits for reimbursement.  

Even with these restrictions on the use of the Veteran’s Choice Cards, the good news is that changes ARE finally coming to the VA! For full details about the rest of the changes that will be enacted with this law, see our news article from last week.

Busy Week in Congress for Veterans Health Care

On Tuesday, July 29, 2014, the Senate confirmed Robert McDonald as the new Secretary of Veterans Affairs. Sloan Gibson, who had been Acting Secretary, will serve as the Deputy Secretary. 

The Veterans Access, Choice and Accountability Act of 2014 has passed both chambers of Congress and is on the President’s desk waiting to be signed into law.  While they didn’t meet the hoped-for deadlines we mentioned in our news article from June 16, 2014, Congress still acted with uncharacteristic speed in passing this legislation to help our disabled American veterans.  

So, now that this is law (I’d be surprised if the President doesn’t sign it…), the high points of what’s going to happen include (1) funding will be increased to hire more primary and specialty care providers, as well as additional clinical and support staff, and (2) emergency funds will be authorized for leasing new VA facilities, both of which should make it easier for veterans to receive care in a timely manner, and hopefully not travel as far.

 Additionally, the bill will provide expanded access to care through the Veterans Choice Card, which will allow veterans who have waited more than 30 days for an appointment or who live more than 40 miles from a VA facility to seek care at a private medical facility, a DoD facility, a community health center, or an Indian Health Center.   

The bill will not only improve the delivery of care and treatment for Military Sexual Trauma for veterans, but also authorizes the VA to provide this care for active duty military as well as National Guard and Reserves on active duty.

The cost of all this is nearly $17 billion: $10 billion to cover the costs of veterans’ receiving health care outside the VA system, $5 billion to increase staffing and the ability to provide care in VA facilities, and $2 billion to cover additional leases and other programs. These costs will be offset by an estimated $5 billion in savings from other VA programs, bringing the total down to about $12 billion.

While this is a fairly hefty price tag, it is far less than originally estimated, and will help to ensure that our veterans receive the health care they deserve.  As Senator Bernie Sanders, Chairman of the Senate Veterans Affairs committee, said:  “Planes and tanks and guns are a cost of war.  So is taking care of the men and women who use those weapons and fight our battles.”