▶ 0:33:55come to order. The chair may declare a recess at any point. I'd like to welcome all the members and witnesses to today's Today, we'll discuss 12 bills designed to improve the lives of our nation's veterans and the systems they rely on for health care and health rellated matters. I'm looking forward to a very productive discussion on each of these bills, including the many that are focused on improving access to mental health care.
▶ 0:34:19And speaking of productive, I would just like to acknowledge that uh Ranking Member Brownley has uh decided to retire after this term. Uh I envy her, but I also want to say that uh she's been uh longer on the veterans uh uh health committee or the veterans affairs committee longer than I have, but this is my sixth year on the committee. Uh and her dedication to our veterans and her input has been invaluable. So, thank you so much, Ranking Member Brownley.
▶ 0:34:46Thank you. [applause] Thank you. Thank you. Thank you. Uh some of the bills that we'll discuss today is the recover act introduced by chairman Boston which would help fund programs targeted towards reducing attrition and mental health care. Many veterans in uh limited uh in areas with limited access to care still face barriers when sinking mental health services especially in rural and remote parts of the country. Provider shortages and capacity constraints for example are but some of those many obstacles.
▶ 0:35:16We know that in all of these rural areas or even uh urban areas uh that uh tele medicine is beneficial but still it can create uh problems and challenges if you don't have provider access. Uh the recover act would require the VA to carry out a three-year pilot program under which nonprofit outpatient medical health providers serving veterans who for reasons outlined in the bill may be more likely to discontinue care would be eligible for grant awards.
▶ 0:35:44This bill would use existing resources more effectively while working with providers to do more. Uh and as I said, uh tele medicine works well in this area, so it still is an option. I'm thankful to chairman Boston for his thoughtful legislation on this matter to bridge the gap in care.
▶ 0:36:00The Veterans Mental Health and Addiction Therapy Quality of Care Act, introduced by Representative Fallon, would require VA to commission an independent study examining quality, access, and outcomes for mental health and addiction treatment provided both inside and outside the VA. This bill would ensure that we continue to provide veterans with the best possible care to meet their needs. I'm proud to support it.
▶ 0:36:22The Beacon Act introduced by General Bergman would direct VA to support research and clinical trials focused on chronic mild traumatic brain injury or mild TBI. This would include non-farmaceutical and community-based rehabilitation approaches and independent research. Many veterans experience long-term and sometimes debilitating conditions because of MTBI. Despite the prevalence of these injuries, work remains in research, treatment options, and standard of cares.
▶ 0:36:50This bill would lay the groundwork for future decisions guided by evidence rather than assumptions. I thank General Bergman for making sure the VA delivers care that reflects the realities we're facing. I'd also like to thank Representatives McKenzie and Jackson for their work on legislation addressing brain injury and mental health issues affecting veterans. The Veterans Healthcare Desert uh Desert Reform Act of You can tell I I haven't had lunch yet. No, I'm kidding.
▶ 0:37:15The Veterans Health uh Desert Reform Act of 2025, a bill I introduced would direct VA to pilot partnerships with nonVA hospitals in area where care is lacking. This would allow veterans to receive care equivalent to community care. And I've seen this in my own district. Too many veterans living in rural areas across our nation face the challenge of living in a healthcare desert. An area without a VA facility of any type uh within a realistically accessible uh distance.
▶ 0:37:44In a health desert, basic care is difficult to maintain and even the most routine care presents a significant uh burden for veterans. My bill would fill geographic gaps in access. Again, uh recognizing the importance of tele medicine, ensuring that when VA facilities are not realistically accessible, veterans can still access care closer to home. This issue is a top priority for me and my bill is a common sense expansion of our veterans access to health care. I look forward to continuing this discussion and working on this matter.
▶ 0:38:15The Clarity on Carees Option Act introduced by Miss Kiggins would require VA to create and maintain a searchable directory of providers who accept the Civilian Health and Mental Program of the Department of Veterans Affairs, Champ VA. This would help ensure that beneficiaries make informed choices about their care. Often CHAMPV VA beneficiaries struggle struggle to identify which healthcare providers will accept their coverage. This leads to delays and confusion for families already navigating a complex system.
▶ 0:38:44As we heard in an earlier hearing, CHAMVA is an important health care program for dependents and survivors of our nation's veterans. I appreciate Miss Kigan's continued efforts to make uh that coverage more usable in practice for families. I also want to thank Miss King Hines for her diligence in ensuring that freely associated states veterans are not ignored. Her work on this matter is appreciated. This morning, we're also joined by several of our colleagues who will speak in support of their bills.
▶ 0:39:12We appreciate their dedication to serving our nation's veterans. In accordance with committee rules, I ask unanimous consent that the following members be permitted to participate in today's committee hearing. Representative Pat Fallon, Representative Ryan McKenzie, Representative Greg Lansman, and Representative Chris Delusio. Without objection, so ordered. I now yield to Yankee member Brownley for any opening remarks she may have.
▶ 0:39:37Uh thank you, Madam Chair, and uh thank you to our witnesses today for providing your testimony on the legislation we are considering. I'm excited that we are considering several of my Democratic colleagues bills on today's agenda. I know the sponsors of these bills will be on the first panel to speak about the importance of those bills.
▶ 0:39:58So, I will try to keep my remarks brief, but I appreciate my colleagues, Congressman Lansman and Congressman Conaway for introducing bills to build on VA's work to protect veterans from the risk of opio opioid overdose. I'm also glad we will consider Congressman Crow's legislation to further our understanding of ALS and the causes of veterans increased risk of the disease.
▶ 0:40:26Finally, I look forward to considering Congressman Delusio's bill to ensure veterans are not overly burdened by co-pays for participating uh in VA whole health services. However, I must express some serious concerns about several of the Republican sponsored bills on today's agenda. The Recovery Act, the Beacon Act, the Health Desert Reform Act, and the Datadriven Suicide Prevention Act share a common theme.
▶ 0:40:54They all siphon money from existing VA programs and redirect it to outside organizations and providers to do the very same things VA is already doing, but with fewer guard rails and fewer requirements to ensure quality of care.
▶ 0:41:13Taken together, these bills represent a concerted effort to circumvent VA's direct care program and research enterprise and create no strings attached handouts of VA funding to private companies. Not only is this wasteful and duplicative, but it will it could lead to a further fracturing of continuity of care for our veterans.
▶ 0:41:36Worse still, the grant programs that would be created by the Recovery Act and the Beacon Act lack meaningful mechanisms of oversight for VA to ensure that veterans are receiving the quality care and evidence-based standards of care through these grant programs. I'm on record acknowledging that there will always be a place for community care in geographic regions and in specialties where VA cannot directly provide needed care.
▶ 0:42:07However, there is a difference between participating in the community care network and creating competing and duplicative programs through which private providers can be paid to deliver care with minimal requirements for veteran cultural competency, care coordination, and communication with VA. All the while avoiding rigorous oversight of care outcomes.
▶ 0:42:33This is what will happen if the recovery act and the beacon act and the health desert reform act are allowed to become law. If private providers wish to provide care to veterans, they should ensure they can meet the VA community care network requirements and enroll in that instead.
▶ 0:42:52I don't believe we should be creating carveouts or grant programs that would allow private providers to avoid the requirements of the VA Mission Act and still financially benefit from VA funding.
▶ 0:43:07I would note that many organizations who have gone on the record supporting these bills already participate in VA's community care network and some are already receiving grants from VA's staff Sergeant Parker Gordon Fox suicide prevention grant program.
▶ 0:43:25It seems to me that creating new grant programs for which these organizations are uniquely eligible under the Recover Act and the Beacon Act does nothing but enable these organizations to double or triple dip and receive reimbursements for community care in addition to the new grant funding. That does not seem fiscally responsible to me.
▶ 0:43:49I will continue to oppose leg legislation that does does nothing to ensure veterans receive quality care and instead simply siphons money from VA straight into the pockets of private entities without any guard rails. I'm looking forward to hearing from our witnesses today and to some productive rounds of questions. With that, I yield back to your woman Miller.
▶ 0:44:21per bill to ensure we can move in a timely manner. Um, General Bergman, if you're not ready to go, I'm going to recognize Miss Kinghines. You're up unless you're not ready. And I'll go to Miss King Hind. Okay. Miss Kinghines, you're recognized for three minutes to speak on uh your uh discussion draft of your bill.
▶ 0:44:43Thank you, Chairwoman Miller Meeks, and thank you to the ranking member and to my colleagues for the opportunity to speak today. I'm proud to discuss my bill HR6652, a bill that is about honoring a commitment Congress made just two years ago through the KOFA act and ensuring that the Department of the Veterans Affair follows through on that promise. FAS citizens serve in the US military at among the highest rates per capita.
▶ 0:45:05However, the brave FAS citizens who have chosen to return home after their service face disproportionate challenges to receiving their full benefits, including access to medical care when residing in their Pacific islands. When the KOFA Act was enacted, it recognized a long-standing obligation to veterans and families from the freely associated states. The United States agreed to expand access to care and to ensure that those veterans won't no longer be left behind because of geography or administrative discretion.
▶ 0:45:33But despite that clear intent, implementation has remained stalled and too many veterans are still waiting for those commitments to translate into real reliable care. HR6652 is necessary because a promise alone is not enough. This bill makes clear that VA must fully deliver on what they agreed to under the KOFA act. It ensures that essential components of care and not treated as optional but as required parts of the services veterans receive. This bill does not require anything extraordinary.
▶ 0:46:00It ensures access to teleaalth mail order pharmacy services and makes beneficiary travel more accessible. This legislation provides clarity, consistency, and accountability so that veterans and their families can depend on the care they were promised rather than navigating uncertainty or delays. Our veterans upheld their end of the bargain through their service to this country. Congress acted through KFA and now it's time for VA to make good on that agreement. I look forward to working with my colleagues in the department of VA to ensure this promise is fully and finally kept.
▶ 0:46:29I yield my
▶ 0:46:31Thank you, Representative Kinghines. The chair now recognizes General Bergman for three minutes for any comments he may have on his bill. General Bergman yields. Uh the chair uh will now recognize offcom committee members to speak for three minutes on behalf of their legislation. The chair recognizes Representative Lansman for three minutes.
▶ 0:46:56Thank you, Madam Chair. Uh thank you to all the members uh ranking member uh for having me in today's legislative hearing and allowing uh me to talk about uh my bill HR 4590, the No Pain for Veterans Act. Uh I also want to thank our co-leads, Representatives Van Orton, Papis, Bergman, Su and Hamada for partnering with me on this important issue.
▶ 0:47:23Uh the opioid epidemic is a um it's a it's a disaster, right? You know, across the board, it has really hit our veterans and you all know that. This is a really frustrating situation because uh there are all these FDA pain treatments for veterans for everybody.
▶ 0:47:52And the VA won't provide those to veterans even though the FDA has approved them and they work. And veterans are asking for pain relief that won't ruin their lives. And the VA is saying, "No, no, no. It's going to require an act of Congress to update what we can provide to veterans.
▶ 0:48:14Um, as such, we're trying to get this bill onto the floor or or in, you know, um, uh, onto the, uh, the docket and and passed. There is a companion bill in the Senate. We can get this done.
▶ 0:48:28It will make a big difference for veterans uh who are asking for looking for nonopioid u you know based pain relief and you know the the statistics are staggering but you all know just how problematic uh you know this addiction can be and our veterans are going through all kinds of um you know dealing with all kinds issues
▶ 0:48:58that require some pain management. And again, this just would allow the VA to provide uh veterans with what Medicare folks and other folks in the private sector or with private insurance get uh which is a a a slew of nonopioid related or nonopioidbased pain relief. So hopefully we can get this on the on the floor on the docket. And I I appreciate your efforts in letting me speak here and encourage everyone to vote for it.
▶ 0:49:27encouraged their colleagues and and folks in the Senate to do the same so we can get this passed. Thank you. I yield
▶ 0:49:33The gentleman yields. The chair now recognizes Representative Fallon for three minutes to speak on his bill.
▶ 0:49:38Thank you, Madam Chair, uh for the opportunity to discuss our bill HR 2426, the Veterans Mental Health and Addiction Therapy Quality Care Act. This bill is an important step in ensuring that our veterans are receiving the best possible care across all treatment settings and to identify gaps uh or and for that matter best practices that could inform future policy. Today, approximately 18 veterans die of suicide daily. It's 18 too many. And this is not an abstract number.
▶ 0:50:08These are real men and women who served our nation. Not only they return home and they continue fighting battles and all too well or all too often unfortunately they fight those alone. This bill arises from a long-standing concern about how to best serve veterans mental health and addiction care needs particularly in light of the mixed delivery systems and persistent suicide and treatment access challenges.
▶ 0:50:32Over the last decade, Congress has worked in a bipartisan way to expand access to care, including through community care programs that allow veterans to seek treatment outside the VA. That effort was necessary and well-intentioned. However, access alone is not enough. Quality matters, and outcomes matter. Lives depend on it. HR 2426 addresses an important fundamental question.
▶ 0:50:57Are we truly delivering the highest quality mental health and addiction care to our veterans regardless of where that care is provided? What we still lack is an independent objective assessment of how mental health and addiction therapy delivered by VA providers compares with care delivered by nonVA providers. Competition is a good thing. This bill directs that such a study be undertaken by the Department of the VA and it will do two things primarily.
▶ 0:51:26One, assess the quality of care across a broad set of modalities including teleaalth, inpatient, outpatient, intensive, outpatient, and residential treatments. And secondly, perhaps most importantly, the department must make the findings of that report public. If the outcomes of this study show strengths, uh, we should of course build on them. And if they reveal gaps in community care, we should fix them because we we must fix them.
▶ 0:51:54And if it reveals exceptional care in any facet, we need to replicate that success everywhere. And here's the bottom line. Suicide rates are unacceptably high. Doing nothing is not acceptable. Our veterans and their families are being devastated by suicide. And we have the ability and the obligation to demand accountability and work towards improvements. I want to thank my colleagues on both sides of the aisle who have supported this legislation, specifically our Democratic co-lead, Representative Stanford Bishop.
▶ 0:52:21I'd also like to thank the veterans advocates who continue to rightfully push us to do better. This is not a partisan issue. It's a national responsibility. And I urge this esteemed subcommittee to give HR 2426 thoughtful consideration and swift action. Our veterans have already given us so much and given so much to this republic. We owe the we owe them the care that is worthy of that sacrifice. And thank you, Madam Chair. I yield back. Uh the gentleman yields.
▶ 0:52:51The chair now recognizes Representative Duzio for three minutes for any comments he may have on his bill.
▶ 0:52:56Thank you, Chairwoman Miller Meeks, Ranking Member Brownley. It's great to be back in back in front of the health subcommittee. Thank you for having me and considering my bill HR6848, the whole health for veterans act. Uh this bill will help more of my fellow veterans improve their health and well-being through access to the VA's whole health program. And I know the subcommittee members know that VA whole health, it's a comprehensive program. It helps veterans build a personal health plan that works for them as directed by their care team.
▶ 0:53:25It does things like teach uh veterans to treat their health proactively, provides resources and oversight for things like strength mobility training and is tailorade to help each veteran meet their own unique goals. When veterans are more actively involved in their own care, it improves healthcare outcomes and in turns can lower health care cost. Uh, I've seen this in action in VA Pittsburgh.
▶ 0:53:45I've heard from veterans who are part of this program and they talk about how it's saved them from surgery or other that could be much more costly and and invasive in their lives. So, I think it's something for us to build on. I think it's common sense that we can make this program available to all veterans. But, unfortunately, last October co-pays were introduced uh charging VHA priority groups 6 through eight veterans $15 per visit.
▶ 0:54:12And around that time, I heard from a constituent, a veteran, who loves this VA whole health program, uh, and the care he gets there, but talked about how he'd be unable to participate due to the cost now for the program. So, my bill addresses this to fix the problem by codifying an already existing prohibition on co-pays for priority groups one through five veterans and then caps the monthly co-ayments for other priority groups at $30 a month. Uh, veterans who want to improve their health and work with their care team, I think, should be able to do it without paying a fortune.
▶ 0:54:40VA healthcare ought to be the best in the world. As I understand it, VA has provided some feedback on the bill. I looked at it. I think there are issues that we can edit and incorporate, update on this bill and work through. So, I'm excited to work with the subcommittee. I invite uh support from both parties here, Madam Chair, and I yield back.
▶ 0:54:56The gentleman yields. The chair now recognizes Representative McKenzie to speak for three minutes on his bill.
▶ 0:55:02Thank you, Madam Chair. It's a pleasure to join the House Committee on Veterans Affairs. And before I again begin, I would like to extend my thanks to all of our veterans for their service to our country. Veteran suicide remains an urgent challenge facing our country. Despite years of effort, the overall rate has remained stubbornly high. And too often, we learn after the fact that many of the warning signs were missed.
▶ 0:55:27One of the most troubling realities is that more than half of our veterans who die by suicide were not engaged with VA healthcare in the years before their death. That tells you something important. That traditional episodic screening, often based on self-reporting, is not enough to identify risk early and consistently. That's why I'm introducing the data-driven suicide prevention and outreach act of 2025.
▶ 0:55:54The bill directs the VA to establish a time-limited competitive grant program to support the de development of predictive models that can identify risk factors before the crisis point. And they can do that by responsibly integrating benefits data, service records, and clinical information.
▶ 0:56:13By leveraging new technologies, we have the potential to revolutionize how we treat and monitor the crisis of veteran suicide, providing more opportunities for timely intervention that will ultimately save lives. Importantly, this bill does not replace clinicians, nor does it create a blackbox algorithm. Instead, it empowers decision makers and builds on the VA's knowledge of what works.
▶ 0:56:37Initiatives like the Reachvet program have shown that predictive analytics can help flag veterans at elevated risk and prompt earlier outreach and care engagement. What this legislation does differently is encourage innovation with guard rails. Grants are limited to organizations with demonstrated expertise in healthcare AI data security and clinical deployment. Models must be explainable, interoperable, and clinically actionable.
▶ 0:57:05They must comply with VA cyber security standards and any findings must be shared with the VA for systemwide evaluation. We also intentionally prioritize areas with elevated suicide risks and high crisis volumes uh with the suicide hotline. Also, we look at where there are long mental health weightlines and we can help prevent duplication of efforts or a missed uh opportunity to to intervene.
▶ 0:57:34Artificial in intelligence holds promise, but it's still new and carries real risks, which we want to recognize. And this measure, this bill takes a balanced and measured approach with a pilot program. stakeholders have emphasized that these predictive tools can be helpful and I've seen it in my local community where he health networks utilize AI running in the background and again it becomes a force multiplier where doctors can then go out and actually treat more of these situations uh that deserve their attention and
▶ 0:58:05and should be prioritized. So I would like to thank the chair uh for recognizing us and allowing me to be able to be with the committee today and appreciate the consideration of this important legislation. Thank you and I yield back.
▶ 0:58:17Thank you, Representative McKenzie. As is our practice, we'll forego a round of questioning for the members. For those off committee members, you may remain uh to ask questions uh later if you uh desire. Our first panel is already at the table. Um excuse me. The chair now recognizes General Bergman to speak for three minutes on his bill.
▶ 0:58:40Yeah. Thank you, uh Chairwoman. And there seemed to be a slight disconnect here when I walked in. I didn't think I was going to be speaking on this. So, we'll get our staffs together to make sure that uh that we uh we know when timing is right. But uh thanks for the opportunity. But this is a discussion uh draft of the what we have titled the beacon act and it's veterans TBI breakthrough exploration of adaptive care opportunities uh nationwide act.
▶ 0:59:09Uh the bill would direct the secretary of the VA to carry out programs awarding grants to eligible entities to study and conduct randomize control trials with respect to the neuro rehabilitation treatments for chronic mild traumatic brain injury. Additionally, grants would be available to design those uh treatments as well as measure the effectiveness of already funded treatments.
▶ 0:59:33Nonprofits, academic institutions, and healthc care providers with expertise in neural rehabilitative therapies would be eligible. And in the analysis of this, the randomized control trials measure the effectiveness of a new intervention or treatment and have been recognized as the gold standard for effectiveness research. The bill would dedicate resources to a prevalent issue like lost TBIs that occur each year as m or mild TBI or concussions.
▶ 1:00:02So this is not about as we hear so many times privatizing the VA. This is enabling the veterans administration uh through grant process to enable other uh scientific entities to do more breakthrough therapies that are going to uh not only help veterans but also others that that suffer from mild TBI. And with that I yield back.
▶ 1:00:24Uh thank you General Bergman. Um joining us today uh from the Department of Veterans uh affairs um are uh Dr. Mark uh Coner, VA's acting assistant under secretary for health uh for patient care services. He's accompanied by Dr. Lorente, VA's acting assistant under secretary for health for integrated veteran care. Dr. uh Koiger, you're now recognized for five minutes to present the department's testimony.
▶ 1:00:51Good afternoon, Chairwoman Miller Meeks, Ranking Member Brownley, and members of the subcommittee. Thank you for the opportunity to testify today on several bills that would impact VA health care programs and services. As a family practice physician, I understand the importance of comprehensive patient centered care and the trust that veterans place in us. My nearly 37 years in uniform have strengthened my commitment to delivering the highest quality care.
▶ 1:01:21I had the privilege of commanding the largest US military hospital in Iraq during 2009 to 2010. An experience that underscored the value of coordinated, timely care in saving lives.
▶ 1:01:36Today, as acting assistant under secretary for health for patient care services, I oversee 16 national program offices that support a wide range of clinical professions and care settings, including geriatrics, rehabilitation, and whole health. These experiences guide my work as we strive to strengthen VA health care for all who have served. I am joined by Dr. Maria Lorente, acting assistant under secretary for health for integrated veteran care.
▶ 1:02:07Before we begin, I would like to apologize for the delay in providing testimony to this committee. VA is working on process improvements internally as well as externally to make sure this is prevented in the future.
▶ 1:02:22While I will briefly highlight VA's position on several bills, my full written testimony provides detailed views on all 12 bills under Turning to the substance of the legislation, several of the bills on the agenda would require VA to establish new grant programs. VA has concerns with these bills as grants may not be the most appropriate means of providing the intended support.
▶ 1:02:51Grants are one way, but not the only way for providing financial assistance to non-governmental VA would welcome the opportunity to discuss these bills further with the committee to determine if a different structure might be more appropriate. First, regarding the recover act, VA strongly supports efforts to expand access to veteran centric evidence-based mental health.
▶ 1:03:17While we have concerns with certain provisions in the bill, we greatly value the committee's leadership in this issue and welcome the opportunity to work together on approaches that strengthen care coordination and deliver the greatest impact for veterans. Second, VA supports the Veterans Mental Health and Addiction Therapy Quality of Care Act, subject to amendments and the availability of appropriations.
▶ 1:03:42This bill is consistent with VA's current efforts to compare the quality of VA and nonVA mental health and addiction therapy care. Third, although VA appreciates the intent of the No Pain for Veterans Act, this bill would undermine VA's wellestablished evidence-based formulary process, which ensures medications are safe, effective, and economical.
▶ 1:04:08Fourth, regarding HR 59.99, VA supports expanding access to opioid antagonists subject to amendments and While Nlloxxone is already widely available at no cost to enrolled veterans, eliminating prescription requirements could increase risks of waste and fraud.
▶ 1:04:31Fifth, regarding the Veterans with ALS Reporting Act, VA supports the intent, but some provisions may duplicate existing efforts. We welcome the opportunity to collaborate on strategies that advance research and care without diverting resources from patients. Similarly, the Veterans Health Desert Reform Act underscores the importance of improving access for rural veterans, a goal VA strongly supports.
▶ 1:05:01However, the bill as written appears to create no new authority to further this goal. Finally, VA appreciates the committee's focus on innovative innovation through research and technology, including proposals related to traumatic brain injury and suicide prevention. These are critical areas where VA invests heavily. In closing, VA remains steadfast in its commitment to delivering world-class healthcare to veterans.
▶ 1:05:29We share the committee's goals of improving access, quality, and And we look forward to working with you to refine these proposals so they strengthen care without unintended consequences. We are happy to answer your any questions you may have. Thank you, Dr. Coner. As uh as is my uh usual practice, I'll reserve my time until after all members have had a chance to ask their questions.
▶ 1:05:57I now recognize ranking member Brownley for five minutes for any questions she may
▶ 1:06:01Thank you, Madam Chair. So, I I think I wanted to direct this question to uh Dr. Lorente. Um, as I cited in my opening comments and VA cited as well significant concerns with uh the recovery act, among other things, uh, your written testimony points out that grantees would be able to receive financial support from VA in the form of grant funds, still be able to bill the VA for services
▶ 1:06:32under the existing VA community care program, and also be able to bill veterans other health care insurance. So, I just I I can't see how this makes sense to me. We have three opportunities to perhaps triple dip uh with the VA. Um VA already has a community care network. Why is it important to adhere to the community care eligibility and authorization process that was established under the mission act?
▶ 1:07:01As you as you pointed out, the community care program does have a series of requirements to make sure that the providers who are delivering services to veterans have the needed credentials, have the privileges, and um offer the quality of care that we expect they will deliver. That is in fact one of the concerns that we do have with the bill as written.
▶ 1:07:25um it it doesn't really specify requirements and as written uh a community provider could potentially um get one of these grants and offer services through one of these grants that might not be eligible, might not meet the requirements under the community care program. It's why we really do welcome an opportunity to work with Congress to revise the the language um so that we can address some of these
▶ 1:07:52Thank you for that. And um to follow up um on another bill um VA already administers the Staff Sergeant Parker Gordon Fox uh suicide prevention grant program um which is intended to address the upstream factors that contribute to suicide risk such as housing and employment instability and lack of social support and engagement.
▶ 1:08:17We also have the compact act uh which allows VA to cover emergency treatment for veterans experiencing acute um suicidal crisises. Both the Fox Grant program and the compact act program serve veterans regardless of whether they are enrolled in or otherwise connected to VA healthcare. Given that, does VA think it needs the grant program that would be created under the recovery act or would it be duplicative?
▶ 1:08:46As um was described by Dr. Koiger, one of the questions that we have is whether a grant process or a grant program is the most effective mechanism to expand access to especially mental health and suicide prevention care for veterans. VA is always looking for opportunities to expand access to those types of services because we recognize that there are areas of the country where it may be more difficult to access those types of services.
▶ 1:09:17Again, we would really like to work with the committee first to determine what is the most effective mechanism to be able to conduct a pilot program um so that we can be coste effective and at the same time if there's an opportunity to expand services um we we we take that
▶ 1:09:37Thank you for that. And uh probably the last question that I have time for Dr. Koener. Um, is there any statutory or practical barrier to VA either through its existing research infrastructure or through its academic affiliates program being able to research, develop and implement novel or alternative treatments for TPI, TBI?
▶ 1:10:04Ma'am, I will have to take that question back to uh look in to make sure that uh there are no or are statutory requirements. I just don't have that information offhand, but I can get back to the committee.
▶ 1:10:19Okay. Um so, uh uh let's see. Um I I think I don't have time for this, so I will yield back. Uh, thank you. Thank you, Member Brownley. The chair now recognizes uh, Representative Hammeday for any questions he may have.
▶ 1:10:41Thank you, Chairwoman. President Trump has made veterans his priority again. He's expanded Community Care/bureaucratic red tape and put the veteran, not the bureaucracy, first, and I'm with him all the way. Now, the Veterans Access Act and My Caring Act are built on the same foundation. Veterans deserve seamless access to care, whether it's inside the VA or in the community. Dr.
▶ 1:11:03Koiger, can you explain to me step by step how are you how are you implementing the president's directive to ensure medical records actually follow the patient?
▶ 1:11:15So I am going to defer to my colleague uh Dr. Lorente.
▶ 1:11:22The medical records are really So when we refer veterans to community providers, we first have to provide them with some sort of consultation or referral. In some cases, that referral will include information about laboratories, um diagnostic imaging so that the community provider understands what is being asked um when when the veteran is referred.
▶ 1:11:50Similarly, once the community provider completes their evaluation, their treatment recommendations, they send those records back to the VA. At the present time, unfortunately, there are several different ways in which those records come to the VA.
▶ 1:12:08One of the things that we are in the process of doing through the request for proposals um that is currently um in solicitation that's been published is to be able to streamline those efforts where the TPAs um that received the award will create um essentially a portal where the medical records from the community providers will now be centralized in order to be able to streamline that process.
▶ 1:12:33Has this been attempted before? Uh to the best of my knowledge, no, but I'm happy to take that back and and get additional information.
▶ 1:12:43And how long until the RFP is selected?
▶ 1:12:46Um we're we're expecting to make the awards I believe in March. Um there's a 90-day review period and um I think the awards the solicitation closes um at the end of this month.
▶ 1:12:59And how long will it take to be
▶ 1:13:01It will take approximately a year. You know, that's the biggest concern that when I go back to my district is a lot of veterans, you know, they lose their medical records. The VA does a community care. So, I really encourage the department to really prioritize this because this is a constant theme I hear.
▶ 1:13:20But can you assure us after this is implemented, hopefully when you have the right RFP that you select, that the veteran isn't going to be waiting weeks for community providers records to actually reach the VA.
▶ 1:13:34You have my assurance that that is an absolute goal is that we're going to be receiving these records and then being able to upload them into the the veterans electronic health record. um because the specific mechanics are not currently in place. Unfortunately, that's about the extent of what I can say right now.
▶ 1:13:54And do you anticipate this actually cutting it the time significantly?
▶ 1:13:59Arizona has many rural communities that are miles from the nearest VA facility. President Trump understands that the veteran in rural Arizona matters just as much as the one here in Washington DC. Now, the Veterans Health Desert Reform Act we're considering today addresses this head-on. How is the VA proactively identifying these medical deserts right
▶ 1:14:23So, the uh the VA has uh certain processes in place that um uh within the office of rural health. Um so that office has been up and running for quite some time now.
▶ 1:14:41They have identified a lot of uh uh areas in u where veterans uh have to travel extended uh periods to get uh to healthcare and um they have uh again through the office of rural health we are engaging uh with those veterans on a regular basis.
▶ 1:15:06But do you wait for the veteran to bring this issue to you? Are you being proactive about it? Uh, no. The office is proactive in terms of outreach to veterans. I yield back.
▶ 1:15:20The gentleman yields. The chair now recognizes Dr. Conaway for five minutes for any questions he may have.
▶ 1:15:25Uh, thank you, Madam Chair. Uh, and thanks uh to ranking member Brownley for bringing us here today to discuss uh these uh important pieces of legislation. I want to discuss um a particular vulnerability that veterans have uh with respect uh to um their use of opioids.
▶ 1:15:44Many people in the service uh have chronic pain, service related injuries um and other trauma and uh and so people with chronic pain as I'm sure you're aware are um at higher risk of opioid uh reliance. uh some 289,000 vets are have used uh opioids in the short term and there are 162,000 veterans who are on long-term opioid loose use as of data in 2023.
▶ 1:16:15Thank you. Um and so uh would you describe um and the standard of care is uh that particularly for people on long-term opioid use that that um that nlloxxone be available as a preventative for uh death related to um um opioid use.
▶ 1:16:36So uh would you describe the current process by which a veteran uh who has VA benefits can receive Nlloxxone this standard of care treatment to prevent uh uh preventable opioid related deaths. So, uh, right now a veteran can walk up to a pharmacy and if they are high risk, um, they, uh, there are standing orders, uh, with the pharmacy.
▶ 1:17:04So, they can ask the pharmacist and the pharmacist uses those standing orders to, uh, uh, provide the veteran with the nlloxxone. And again the the nlloxxone is provided uh free of charge uh to uh veterans. Um we also distribute nlloxxone through uh through health fairs um and uh other means.
▶ 1:17:32Uh so u that's uh very good. So they can get the prescriptions uh without they can get their uh nlloxxone in the various forms without a prescription. Uh also I guess in pill form because it does have uses in helping people that have alcohol dependence as a problem and preventing or helping people to relieve themselves or get beyond alcohol dependence. So it's free access. It mirrors a lot.
▶ 1:17:58Uh you would say the VA system then is mirroring what many states have done in this area by providing u easier access to this
▶ 1:18:07Yes sir. chemotherrapeutic. Um, moving on, uh, discussing another piece of legislation, uh, on the list today. Uh, can you, um, I understand there's a current process through which providers and patients can submit former requests for new drugs to be included in the VA uh, national formulary. Can you briefly explain what process, what that process is, and how long it takes on average for requested drugs to be added to the formulary?
▶ 1:18:38So, um, veterans, of course, we have, uh, medications that are on the formulary and and that are not. Um, all FDA approved, uh, medications, veterans have access to all of them. So, if it is not on the formulary, a veteran can go to their provider, uh, ask the provider for a prescription, and generally within 96 hours will, uh, get the medicine.
▶ 1:19:05Now my understanding is that the um the DoD formulary and the um the triricare formulary has uh is broader than what is available to veterans um receiving VA care.
▶ 1:19:19And one of the pieces of legislation seeks to uh ensure that the veteran um who relies on VA care for their uh for their health care that that they have the same easy access uh to drugs that are already approved in other federal formularies. Your thoughts on
▶ 1:19:38So I am not aware of the specifics of what DoD has on their formulary. I would have to get back to you with uh
▶ 1:19:50Okay. Thank you. Um that ends my questions. Thank you both.
▶ 1:19:55The gentleman yols. The chair now recognizes Representative King Hines for five minutes for any questions you may
▶ 1:20:01Thank you, Madam Chairwoman. So, fun little fact. Um the northern Marana Islands is a part of the greater Micronesia and so the folks uh from the Kofa states, the Republic of the Marshall Islands, the Feder States of Federated States of Micronesia, Palao, you know, we're all Micronesians and one of the commitments that I made was that I was going to be their champion here in Congress because they don't have representation although they have served this country.
▶ 1:20:28Um so I thank you for the opportunity to have this conversation today regarding my bill. So, Dr. Koiger, you in your testimony, you referenced the unique legal consideration involved in extending VA benefits to veterans from uh the freely associated states.
▶ 1:20:46Um, you specifically mention that the department continues to support a phased implementation approach to ensure durable access to care and continuity of services particularly in geographically isolated and high-risk environments. So I guess I want to understand that statement a little bit more and I wanted a clarification on what specific legal what specific legal questions the VA is still working through.
▶ 1:21:13Ma'am, I'm going to defer to Dr. Lorente on that question.
▶ 1:21:18So to provide some examples, um let's talk about the the medications. There are certain medications that can be transported um based on Department of Transportation um regulations and laws and then there are others that are considered hazardous and cannot be transported or cannot be easily transported. Um there's certain medications that require um certain types of refrigeration.
▶ 1:21:43those would be logistically complicated to be able to um send via mail order to as you described very you know in some cases some fairly isolated areas over a broad geographic distance. Not saying that it's impossible to do some of these things um but we would need to be able to figure out how to do it. That's on our side.
▶ 1:22:06on the federate um the FAS side we would also need to understand what are their regulations what are their restrictions if they have any with respect to the use of medications are there some medications that they don't allow um and so that's just an example of the types of things that would have to be worked out in agreements similarly on the provider side so we have the authority for US providers to deliver services for example via via
▶ 1:22:36teleaalth, but those providers don't necessarily right now have licenses, if you will, to practice medicine in the federated states. It's it's a it's something that would have to be worked out in in the agreement. Um, these are just a couple of the examples of the the just the the types of logistical issues that would would need to be worked out.
▶ 1:23:01We welcome the opportunity um not only to work with Congress but to work with our inter agency partners um in in order to to see what we can do with respect to the options that would be available to deliver the services.
▶ 1:23:15So are are those regulatory changes that are required or are there specific laws which prohibits these agreements from being uh negotiated and and and how does that interplay with regards to what the commitments that we've made with with the KOFA agreement that was passed two years ago?
▶ 1:23:34I would respectfully request that you allow me to take that back for the record um because I I don't know the answer to your question.
▶ 1:23:41Okay. Well, thank you for that. Um my other question is um you know one of what one of the the issues that were raised with regards to uh this legislation is is is the cost right and what has been done basically to kind of more fully vet what that looks like.
▶ 1:24:02Um, and whenever cost comes up, it it kind of aggravates me because we didn't talk about costs when, you know, folks from the FAS signed up and served our country, right? And so, where are we at with that?
▶ 1:24:15Yes. So we have been working at trying to um examine and evaluate what some of the potential costs would be based on the types of services that would be offered, the types of medications that are likely to be needed. Um and then um the benny the beneficiary travel component to um try to come up with an estimate.
▶ 1:24:42The cost estimates also would necessarily um be a result of what the actual utilization turns out to be and that's not something that we know right at this point in time. It's something that we are working on to try to see if we wouldn't be able to obtain an estimate and a and a projection.
▶ 1:25:01All right. Thank you. I'm out of time. I yield back.
▶ 1:25:04Uh thank you very uh much representative King Hines. The chair now recognizes Representative Sherilis McCormack for five minutes for any questions you may
▶ 1:25:12Thank you so much and thank you for our witnesses who are here. Um I have so many questions. Florida's district is Florida has some of the top um numbers of our veterans who we serve and I hear a lot from them that one of the issues they have not just the distance and how long it takes them. I have some people who tell me it takes them a day to actually get to the VA. Um and so distance is a huge issue but also I hear from them that cultural competency is also when they have to go outside.
▶ 1:25:39So what are some of the safeguards that you have in place because we know our veterans are facing specific needs and they've had specific harms that are unique to their situations um especially when it's service related. So are there any safeguards in place to make sure that they're getting similar or uh care that the VA would give them?
▶ 1:26:01Um so when we talk about cultural competency um it's important to define the which culture we're talking about. Um in the VA of course we first and foremost start with veteran culture.
▶ 1:26:16Um because the needs the experiences and the health outcomes of veterans are quite different than what one typically would see in a civilian population. So there is a a strong component of um cultural competency with respect to the military culture, veteran health outcomes. Um the the pact recently mandated um toxic exposure training for every VA provider just as an example.
▶ 1:26:44Um so I think that there's very very strong training um for for the VA with respect to the veteran culture. Um there are those same types of trainings are afforded on um some external websites that the VA uses. Um the one that is most used by our community providers is called train. Um and there too we offer training to community on cultural competency for military culture and for veteran culture.
▶ 1:27:15Beyond that of course um one could think of um being a woman as a subtype of culture and being a woman veteran is also very very unique. Um it's one of the reasons why VA has established not only the women's health program and women's health clinics in our VA but also providers that um have specific training to be women's healthc care primary providers.
▶ 1:27:41So, I wanted to pause on that because that's getting to the root of the issue that we've been finding is that there's so much uniqueness when it comes to our veterans, not just from the military culture, but then when we're looking at individuals such as women, which are growing populations. And the concern really comes in because the training right now is voluntary. There's no real standardization when it comes to the community based care that they're receiving.
▶ 1:28:05You know, we submitted an amendment that would introduce that kind of standardization where anybody who's actually helping or servicing our veterans were trained the same way so they can recognize burn pits or they can recognize whatever they've gone through which would save our veterans a lot of time as they're trying to cipher what issues they have. So, do you have anything in place that would be mandatory or do you believe that any kind of mandatory standardization when it comes to community and care would actually be more advantageous to our veterans? Thank you.
▶ 1:28:34That's a that's a wonderful question. Um to the best of my knowledge, we do not have anything in place right now that is mandatory. Um it doesn't mean that there haven't been many conversations and discussions about that topic.
▶ 1:28:49I think that the biggest challenge is um if we started creating a whole host of mandatory requirements, would that then limit and/or restrict the availability of those community in other areas because I know there's continuing education for our health care professionals all the time. Um have we seen any burdens before because I don't see any other continuing um education when we actually look at priorities? Right.
▶ 1:29:15The priority is to make sure our veterans are taken care of and to make sure if our veterans are presenting any kind of issue that the VA can pick up that community care can pick it up just as fast and they're not going through a system for years where the VA could have found it. So, have you seen that before that the actual training has caused less
▶ 1:29:35Um, I I would have to take that back for the record in order to be able to um provide you with that answer.
▶ 1:29:42Thank you.
▶ 1:29:43I go back. The gentleoman yields. The chair now recognizes General Bergman for five minutes for any questions you may
▶ 1:29:50Thank you, Madam Chair. Uh Dr. Kaner, one of the biggest challenges with mild chronic uh TBI, traumatic brain injury, is that it can be hard to recognize and is often masked by other conditions. From the VA's perspective, what are the consequences of underdiagnosis or misdiagnosis for veterans?
▶ 1:30:13Yeah. Well, I certainly um the consequences of underdiagnosing or any medical uh uh problem uh is would have a negative impact on the veteran. And so whether it's mild TBI or any other medical condition, uh VA providers strive hard not to uh to underdiagnose or misdiagnose.
▶ 1:30:42Yeah. So, uh, you know, you're a medical professional. The idea, uh, I'm sure from your perspective is you want to get it right as best you can the first time.
▶ 1:30:52You know, that's I mean, that's, you know, the o oath you've, you know, sworn to to uphold and I thank you for that. So, uh, you know, on a different note here, but still along the same lines, Dr. uh Kaniger, many veterans struggling with mental health challenges never enter the VA system before engaging in self-destructive behaviors like suicide. They just don't they're not in the system. So, how do we, you know, calculate the numbers?
▶ 1:31:20As such, the true scope of need is likely far greater than existing data would would reflect. Reducing suicide risk requires meeting veterans where they are within their communities. The expectation, especially in districts like mine where it's rural and remote, I mean hours of drive from any kind of clinician.
▶ 1:31:42Um, this underscores the need for flexible, accessible care that engages veterans the moment they first seek help. if implemented, and I'm being specific here, how could the recover act, uh, sponsored, you know, introduced by Chairman Boss, change the way veterans experience mental health care at the moment they first raise their hand for help? Sir, I'm going to uh actually defer to Dr. Lorente.
▶ 1:32:13So we welcome the opportunity to be able to identify mechanisms in which to expand just the type of access that you described. Um, I think one of the um, advantages in the in the in the language as written is that the the providers would be encouraging veterans to enroll and engage with the VA to receive VA healthcare services in addition to any services offered in the community.
▶ 1:32:44However, we do have some significant concerns as written and would like to work with the committee to um, best address those concerns. Well, and I appreciate that. You know, the mission act became the choice act and then, you know, became community care, you know, all of those things that have morphed over time here over the last decade.
▶ 1:33:02And unfortunately still um we are in some ways uh as a committee struggling with dealing with the Veterans Administration to shape the environment for the the ability to first of all get the first step of diagnosing the issue which means contract contact with the veteran.
▶ 1:33:23So, I appreciate your willingness to take a look at different ways to make that initial contact because, you know, there's not a one-sizefits-all, especially in those rural and remote areas. With that, Madam Chair, I yield The gentleman yields. Uh, the chair now recognizes herself for five minutes for any questions she may have. Dr.
▶ 1:33:45Coninger, if the pilot in my health deserts bill proves effective, how could it reshape access to care for veterans living in healthcare day uh deserts nationwide and in fact worldwide?
▶ 1:34:00Ma'am, it's uh we are the VA is always in support of um trying to uh engage veterans in health deserts or you know in very rural areas.
▶ 1:34:13And again um the office of rural health has done a lot of work in those areas uh to um identify and and again define you know what a rural area is and then uh reach out to the vets who live in those rural areas and try and um get them first enrolled in the VA and then uh uh figure out how to best
▶ 1:34:44um work with them so that they can have access on a regular basis whether it be through things like ride sharing or uh teleaalth or uh services like that
▶ 1:34:59and uh Dr. Um just in response to uh a comment from my colleague uh about standardization uh and mandatory training for individuals whether they're within the VA providers whether they're in the VA system or in a community care system. Is it mandatory that an a veteran go to community care or is that something they request?
▶ 1:35:22Um so it's um first of all they have to meet the eligibility criteria for community care. Um and then secondly, we offer them the choice. They it's it's the veteran's preference. If they want to go to community care um and are eligible, then you know, we'll do everything that we can to facilitate. If they prefer to receive care from the VA, then we will honor their preference.
▶ 1:35:47Thank you. I just wanted to uh emphasize that point that it is it is voluntary in the choice of the veteran where they receive that care. Um Dr. Koiger. Um, why is it why is it important to explore care delivery models that leverage existing nonVA health systems in health
▶ 1:36:07I think um the what the VA wants to do is to make sure that it provides the absolute best care to veterans as possible. Um, and as Dr. Lorente just said, you know, um we need to consider all aspects of care, whether it's in the VA or outside of the VA, um and make sure that veterans have um access to the best care.
▶ 1:36:35Uh thank you. As a a veteran, married to a veteran, couldn't agree more. Uh so I'm I yield back on behalf of the subcommittee. I want to thank you all for your testimony and for joining us here today. You're now excused. And we'll wait for a moment for the second panel to come to the witness table.
▶ 1:37:29Can I grab you a water diet coke or anything? Good.
▶ 1:37:33I'll drink some water. I'll just drink
▶ 1:37:36how are you doing today?
▶ 1:37:37I'm doing well. How are you?
▶ 1:37:38I'm good.
▶ 1:37:39Today is Tuesday.
▶ 1:37:44I thought, but then like You said it.
▶ 1:39:05order. Uh I welcome everyone and thank them for their participation today. On our second panel, we have the honorable uh Charles Rudolph Paul, ambassador to the United States of the Embassy of the Republic of the Marshall Islands. Uh Mr. James Wley, chief executive offer officer for mission roll call. Uh Miss Elizabeth McCoy, associate director of government affairs, Wounded Warrior Project. Uh Miss K.
▶ 1:39:30uh Conwell Smith, deputy uh chief of military and veterans uh policy at the American Psychological Association. Uh, thank you once again for attending today. Ambassador Paul, you're now recognized for five minutes. Madame Chairwoman, ranking members, members of the subcommittee, thank you for the opportunity to testify on veterans healthcare issues
▶ 1:40:01affecting the Republic of the Marshall Islands and the other freely associated states. The Republic of the Marshall Island stands in one of the closest strategic relationship the United States maintain with any sovereign country. Under our Compact of Free Association enacted into law, we permit the United States to exercise a core element of our sovereignty, strategic denial. across the region spanning from Hawaii to Asia.
▶ 1:40:28We also host a critical US mil military installation that the joint chiefs of staff describe as the world's premier range for missile testing and space operations support. The United States also actively recruits in the Marshall Islands as if we were a US state or a territory. Our citizens enlist at some of the highest per per capita rates of any US jurisdiction.
▶ 1:40:56They serve honorably, deployed globally, and retire as US veterans. Yet today, many of these veterans are effectively unable to return home because they cannot access their health care they earned through their service. The issue was central during of the compact of free associations amendments act of 2024.
▶ 1:41:24Congress clearly intended that the veterans healthc care be made available in the freely associated states. That intent was reinforced in last year's continuing resolution and the national defense authorization act. However, despite clear statutory authority and treaty obligation, the Department of Veterans Affairs has not acted to implement this care on the ground.
▶ 1:41:52As a result, veterans must choose between remaining in the United States or returning home without access to VA The Republic of the Marshall Island strongly supports congressional action to resolve this gap and ensure the compact commitments are fulfilled. The issue is deeply personal at the highest levels of our government.
▶ 1:42:17The Minister of Foreign Affairs and Trade of the of the Republic of the Marshall Islands, the Honorable Kalani Kaneo, is himself a retired US Army veteran who honorably served 20 years, qualifying for full retirement. For more than a decade, he served as an Army recruiter and personally recruited approximately 200 marshal men and women to the United States Armed Forces.
▶ 1:42:45individuals who trusted the United States and answered its call to service. This issue is also personal to me. My younger brother medically retired from the United States Army after 13 years of service, including three combat tours in Iraq. He now lives in the Marshall Islands and cannot access the health care he would receive if he remained in the United States.
▶ 1:43:14My nephew is currently serving on active duty. He wants to return home after his service, but worries whether he'll be able to receive the care if he does. No veteran's decision to return home should depend on whether they can they can access basic medical care.
▶ 1:43:36Importantly, it is not a request for new Section 209A4 of the Compact Amendments explicitly directs the United States to enter into agreements to ensure the provisions of veteran services in the freely associated states. Congress has spoken clearly. The authority exists. The obligation is explicit.
▶ 1:44:04This is also a national security issue. Veterans living in the Marshall Islands strengthen local capacity, reinforce trust in the RMI US relationship, and serves as a stabilizing force in a strategically sensitive region. The Republic of the Marshall Island stand ready to work constructively with Congress, the Department of Veteran Affairs, and the administration to implement what the compact already promises.
▶ 1:44:35Our veterans honor their commitment to the United States. Implementing veterans health care in the freely associated states is not an expansion of benefits. It is the fulfillment of a solemn obligation. Thank you, and I look forward to your
▶ 1:44:51Thank you, Ambassador Paul. Mr. Wley, you're now recognized for five minutes for your testimony.
▶ 1:44:56Good afternoon, Chairwoman Miller Meeks, Ranking Member Bronley, and members of the Health Committee, distinguished guests. Thank you for the opportunity to testify today on behalf of Mission Roll Call and the veteran community. Our mission is straightforward. We collect data from veterans and we make sure that that information helps inform decisions made in Washington. We use polling and direct engagement to bring real unfiltered veteran perspectives to policy makers and the public.
▶ 1:45:25Amplifying this data on behalf of veterans and their families allows us to advocate for meaningful change that improves the lives of those who have served. The legislation under consideration today seeks to address and improve the lives of multiple generations of veterans, addressing traumatic brain injury, suicide prevention, access to care in remote and rural areas, mental health, opioid addiction, and more.
▶ 1:45:50Mission roll call survey data shows a strong need within the veteran community to address these issues in ways that place veterans first and delivers care when and how a veteran will benefit most. One area where this need is especially clear is suicide prevention and mental health care delivered outside of VA facilities. Emission Roll calls national suicide prevention polling.
▶ 1:46:14In July of 2025, nearly 80% of veterans told us that preventing suicide requires clinical treatment and community-based support working together, not in isolation. More than 90% said it is extremely or very important to include community- based organizations and prevention efforts. And an equally strong majority emphasized the importance of training, coordination, and accountability.
▶ 1:46:40The recovery act reflects those priorities by strengthening evidence-based mental health capacity in the community, ensuring providers are trained to understand veterans risks, and requiring outcome reporting so Congress and the VA can assess what is actually working to veterans. This is about a system that meets veterans where they are, especially when timely access to care can be the difference between stability and crisis.
▶ 1:47:07While suicide prevention only brings veterans into mental health systems, many of the underlying drivers of risk begin earlier and go untreated. Mission roll call survey data shows that over 95% of veterans say it's extremely or very important to have access to specialized TBI care, including care delivered outside the VA.
▶ 1:47:31Yet among veterans seeking care for TBI related symptoms, 73% report that assessing appropriate treatment is somewhat or very difficult. The Beacon Act responds directly to that gap by creating a structured evidence-based framework for evaluating innovative approaches for veterans and chronic with chronic TBI.
▶ 1:47:52Veterans are asking the VA to test confir pro promising therapies responsibly publishing results and expand access where evidence supports it. From the veterans perspective, the Beacon Act is about restoring function, reducing downstream mental health risk, and giving clinicians better tools to intervene before injuries compound into lifelong disability.
▶ 1:48:16In addition, mission roll call supports efforts to modernize veteran care by expanding evidence-based options while holding the system accountable for outcomes. The No Pain for Veterans Act moves VA toward broader use of effective nonopioid pain management therapies, while the Veterans Mental Health and Addiction Therapy Quality of Care Act ensures Congress and the VA have reliable independent data on how mental health and addiction care performs
▶ 1:48:46across VA and community programs. These measures reflect what veterans consistently ask for in our surveys. Care that is grounded in evidence, reduces risk, and is evaluated based on real world results.
▶ 1:49:02Mission Roll Call has always advocated that geography should not determine where a veteran re if a veteran receives timely care and supports legislation that addresses access gaps for veterans who live far from VA facilities or outside the continental United States. The Veterans Health Desert Reform Act and the US Vets of the Freely Associated States Act recognize this reality and seek to leverage community providers, teller health and mail order pharmacy service to close those gaps.
▶ 1:49:33We believe good policy starts with listening to the veteran community and ends with accountability. Veterans overwhelmingly seek better access to care in a manner that supports their life and family, rules that can be easily understood, and outcomes that can be measured and improved.
▶ 1:49:50The legislation before you reflects meaningful progress towards those goals, and we appreciate the subcommittee's continued focus on practical solutions that make the veteran and family central to the provision of care. Thank you, chairman.
▶ 1:50:06Uh, thank you, uh, Mr. Miss McCoy, you are now recognized for 5 minutes.
▶ 1:50:14Chairwoman Miller Meeks, Ranking Member Brownley, and members of the subcommittee. Thank you for the opportunity to testify. Today's agenda includes many bills that are aligned with Wounded Warrior Project's mission to honor and empower warriors, and I am pleased to speak on several that would have a heightened impact on the post 911 wounded, ill, and injured veterans that we serve.
▶ 1:50:37My remarks today focus on the link between mental health and brain health and why investment in brain health is essential. Military related traumatic brain injury, a signature wound of post 911 service, can significantly increase neurological conditions that influence physical and psychological functioning such as chronic pain, depression, and anxiety.
▶ 1:51:03To that end, a traumatic brain injury can both directly and indirectly elevate suicide risk. These realities underscore the need for continued investment and innovation. Scientific advancements have demonstrated that brain health must be treated as a long lifelong whole health priority both during and after military service just as we have learned with mental health.
▶ 1:51:30Yet much about brain function remains unknown, reinforcing the need for bold investment in research and advancement to improve outcomes. To address these challenges, we must move toward a strategic framework that integrates three pillars: prevention, treatment, and innovation. First, prevention and early identification of brain injuries are critical.
▶ 1:51:55Service members in training and combat can be exposed to blastover pressure and repetitive head impacts that accumulate over time. We encourage alignment of life cycle data and standards from the Department of War to the Department of Veterans Affairs, shared baselines, common measures, and longitudinal tracking so that no veteran falls through the cracks during their Legislation such as HR6444, the blast over pressure research
▶ 1:52:26and mitigation task force act strengthens blast exposure research and seeks to translate evidence into standardized screening and safeguards while assuring assessments migrate with the veteran from their time in uniform to civilian life. For these reasons, we are pleased to support this legislation. Second, personalized outcomedriven treatment is essential because brain injury manifests differently for every veteran.
▶ 1:52:54Precision approaches, tailored neuro rehabilitation, non-farmacologic therapies, and integrated mental health support offer pathways to measurable improvements in cognition, mood, and functioning. We support HR6993, the Beacon Act, which would seed innovation and clinical evaluation across nonprofits, academia, and community partners.
▶ 1:53:20We encourage streamlined funding so pilots add capacity rather than divert existing mental health resources. Third, proactive suicide prevention should take brain health into account. Predictive analytics can help clinicians identify veterans at higher risk and engage them earlier with safety planning, followup, and tailored treatment. But technology should not be used as a shortcut.
▶ 1:53:47Innovation should enhance proven strategies, not replace them. To that end, Wounded Warrior Project supports the discussion draft data-driven suicide prevention and outreach act of 2025. Veterans have earned care that is consistent. While public and private collaboration is essential to ensuring veterans receive the highest quality of care, VA should remain as the coordinator of programs and grant funding.
▶ 1:54:14Where shortages persist, especially in rural areas, we support piloting practical access solutions that meet veterans where they live, making sure data flows back to VA and measures outcomes. We are pleased to support the discussion draft Veterans Health Desert Reform Act of 2025.
▶ 1:54:35The legislation included in today's hearing moves beyond incremental fixes and strives towards a bold integrated vision for brain health that supports the service member to veteran life cycle. Wounded Warrior Project stands ready to partner with the subcommittee, VA, the Department of War, and community innovators to identify and prevent injury of the brain, create personalized outcomedriven treatment, and build proactive suicide prevention programs that take brain
▶ 1:55:05health into consideration. Thank you for your leadership, and for the opportunity to testify this afternoon.
▶ 1:55:11Thank you, Miss McCoy. Miss Conwell Smith, you're now recognized for five minutes for your testimony. Chairwoman Miller Meeks, Ranking Member Brownley, and distinguished members of the subcommittee. Thank you for the opportunity to testify. I am Conwell Smith, the deputy chief of for military and veterans policy for the American Psychological Association.
▶ 1:55:36APA is the nation's largest scientific and professional organization representing psychology with more than 190,000 members and affiliates. Today, more than 7,000 psychologists work in the VA, though that number has declined by nearly 300 since 2024. APA is proud of VA psychologyy's role in decades of mental health clinical and research advancements.
▶ 1:56:00My testimony focuses on ensuring that the legislation under consideration upholds the highest standards of veteran care regardless of where care is delivered. Several bills create new delivery models, programs, and access points operating outside the VA's direct care and community care program.
▶ 1:56:20APA is concerned that building parallel systems risk further fragmenting care, separating veterans from coordinated treatment teams, and weakening benefits of the VA's integrated care model. Two bills in particular, the Recover Act and the Draft Health Desert Reform Act, are well-intentioned efforts to expand access, but we fear risk unintentionally reducing the quality of veteran healthcare without stronger safeguards. APA recognizes the need to supplement BHA care.
▶ 1:56:48However, veterans should have the same expectations of quality and safety whether they are treated inside or outside the VA. To that end, our recommendations are as follows. Number one, APA strongly supports requiring key training for all community providers, including those providing care through separate VA funded grant programs. The Recover Act provides 60 million in grants to mental health facilities serving veterans, but does not require clinicians to meet the training standards expected of VA providers.
▶ 1:57:18Notably, suicide prevention training is not mandated. Even though the bill targets areas with high veteran suicide risk, veterans deserve clinicians who understand military culture, common service related conditions, and VA clinical expectations. Number two, APA leads with psychological science and emphatically recommends the use of treatments scientifically proven to be effective for the assessment and treatment of mental health disorders.
▶ 1:57:45The Recover Act does not require provider training and evidence-based practices, leaving a significant gap in provider readiness to treat conditions disproportionately impacting veterans such as post-traumatic stress, depression, sub, and substance use disorders. Additionally, the Beacon Act risks weakening long-standing VA leadership and traumatic brain injury research and treatment by creating a parallel research pathway outside existing rigorous VA processes.
▶ 1:58:12The VA's evidence-driven system has contributed to some of the most impactful TBI advances. Any new framework should reinforce, not bypass, that scientific rigor. Number three, APA supports requiring facility accreditation and strong quality assurance for any guarant for any grantee providing mental health services to veterans. The recover act does not require accreditation by the joint commission or the commission on accreditation of rehabilitation facilities diverging from accepted VA standards.
▶ 1:58:42Moreover, legislation should require standards for demonstrating improved clinical outcomes. Without outcome measure measures and enforcement, neither Congress nor the VA can assess impacts on veterans, positive or negative. Number four, effective mental health care relies on coordinated care supported by shared health records. Removing the VA as the coordinator of care and creating increased fragmentation of services could worsen continuity of care challenges that veterans already experience.
▶ 1:59:10APA recommends requiring all community providers to participate in timely medical record exchange with the VA. This ensures clinicians have the full health history needed to provide safe and consistent care. Number five, APA supports efforts to give veterans the information they need to make informed decisions about their care. We're encouraged by the creation of a publicly available directory for Champ VA healthcare providers as required in the Clarity on Care Options Act.
▶ 1:59:37We also support the intent of the Veterans Mental Health and Addiction Therapy Quality of Care Act. However, the bill falls short in enabling meaningful comparisons and quality assessments. It is an honor to represent the American Psychological Association and advocate for the essential work psychologists do for our veterans and military. And as the spouse of a disabled Army veteran who is with me here today and who receives his care through the Hampton VA Medical Center, ensuring highquality care across all settings is deeply personal to me.
▶ 2:00:06Distinguished members of the subcommittee, we know that each of you are earnest in your commitment to improve veteran healthcare access and quality. The VA remains a national leader and we stand ready to work with you on these legislative endeavors. Thank you. Thank you, Miss Conwell Smith, and thank uh to all of our witnesses for their thoughtful input. Ranking member Brownley, you're now recognized for five minutes for any questions you may have.
▶ 2:00:32Uh thank you, Madam Chair. Um thank you uh Miss Smith for your uh testimony. Um, Miss Smith, um, as written, the be the Beacon Act would be paid for by diverting funding, uh, from existing VA mental health care programs and from VA's National Center for PTSD. Can you expand on how diverting these funds will impact VA's ability to provide clinical care and continue to conduct research through programs?
▶ 2:01:03Thank you for that meaningful question. the VA's National Center for PTSD is is a recognized leader across all of our health care system. I think the concern is that sideststepping scientific rigor of the VA and the gains made in PTSD and TBI research could potentially cost much more than money. It could cost clinical advancements.
▶ 2:01:28And so I think working how figuring out how different entities work in tandem but maintaining very high level of standards and not defunding the VA is a critical approach.
▶ 2:01:40Uh thank thank you for that. Um and I you know I asked this question of the second panel but I was just I was curious to know if you are aware um of any statutory or practical barriers to VA either through its existing research uh infrastructure or academic affiliations programs.
▶ 2:02:00I am not.
▶ 2:02:01Thank you. So, um, I also noted in my opening statement that I have concerns about the weak oversight mechanisms, uh, of the grant program that would be created by the recovery act.
▶ 2:02:20Miss Smith, I'd like to get your take on whether the recovery recover act is robust enough from a clinical perspective and from your read of the bill, would it expand existing services or improve quality of care for
▶ 2:02:36I think as far as expanding services, my read of the bill is that it does not necessarily do so. It allows grantees to build the VA and other insurers and also receive a $ 1.5 million grant with no require to treat higher numbers of On the quality front, unlike VA the bill doesn't impose accreditation requirements, peer review processes, or evidence-based treatments, or training in those evidence-based treatments.
▶ 2:03:06And I believe that it requires one provider to be trained in cultural competency. And obviously APA feels very strongly that all providers of mental and behavioral health care should receive core competencies training.
▶ 2:03:20Thank you. And um are there any are there any requirements in the bill that would ensure grantees engage in care coordination of the VA returning medical records or making sure veterans receive follow-up care from VA? I don't believe that the bill mentions transmitting records to the VA. And of course, there's not a requirement to join the community care program where oversight exists.
▶ 2:03:47Um, you know, there was a recent GAO report that demonstrated that 33% of VA referrals to behavioral health um in the existing community care program were missing the initial visit records. So this is a very serious problem and I really appreciate that members of the committee were addressing um the importance of shared record exchange to quality of care.
▶ 2:04:08Thank you. And another question um if if is there any way that Congress would know whether the recover act grantees are following evidence-based practices in the provision of care uh for veterans. I I don't believe without a requirement. I don't believe that there would be an ability to know.
▶ 2:04:33I think oversight and accountability require um processes that that I am not familiar with with regard to this bill.
▶ 2:04:40And what kind of clinical outcomes would you expect to see reported following the provision of care by a recover act grantee versus similar care delivered by the VA? Well, we're encouraged that the bill does mention clinical outcomes, but it's a it's a vague word without again requirements and a building structure. Um, without evidence of grantee level effectiveness, how can Congress or the VA know what the positive and negative impacts are on veterans?
▶ 2:05:09So, um, we don't know that those care outcomes would be related to symptom improvement, for example. And I think we could look to the the congressional uh report on the Fox grants to demonstrate that if you don't have requirements and you don't have enforcement, there might be little there to to to be able to evaluate a program's
▶ 2:05:29Thank you for that. And um I will yield back, but I will just say that, you know, I certainly um respect the intentions of this bill, but I just feel like it needs more uh more accountability, more guard rails uh to ensure um evidence-based practices and quality of care. So, I yield back.
▶ 2:05:50Uh thank you, Ranking Member Brownley. The chair now recognizes Representative King Hines for five minutes for any questions you may have.
▶ 2:05:56Uh thank you, Madam Chair. First of all, Mr. Great to see you again. It was great meeting you the other day when we had the Beacon press conference.
▶ 2:06:04Yes, ma'am. Honorable Charles Yak, a lot of my questions are going to be focused on conversations about the RMI and and and my legislation that expands the not expands but actually upholds the current statutory requirements to extend VA benefits to uh our freely associated state citizens.
▶ 2:06:27And let's just start off by um having you describe what are the most unique challenges that our vets face in the freely associated states and how many of them are actually returning home.
▶ 2:06:41Well, thank you. Thank you very much, Congresswoman, for that. And um so some of the unique challenges that our vets are are experiencing living in the Marshall Islands um basically as outlined in my statement uh healthcare. I mean a lot of them did not identify if that they're veterans when they when they get healthcare because there's no benefit for them to doing so.
▶ 2:07:08Um and and also There are different types of um like healthcare needs that the islands are just not equipped to provide uh because we don't have wars or combat zones near anywhere around our islands. So there are certain things like um PTSD uh things of that nature.
▶ 2:07:36Um that that that um that we're seeing. So that's kind of what I wanted to get into in terms of the types of actual physical conditions whether it be PTSD or any type of uh visible injury. Right.
▶ 2:07:52Right. Yes. So like um uh visible injuries, things like you know lost limbs from from being um active duty. Uh but also mental a lot of mental issues um and mental health issues where um a lot of uh folks that you know commit um in the in veterans. Just a couple months ago, um, a veteran jumped off a
▶ 2:08:20uh, and there's really no treatment, uh, facility for we have one psychiatrist in the Marshall Islands for the whole So, the the veterans are not getting the um the care that they they deserve.
▶ 2:08:38So you heard the conversation that the the dialogue that I had with the VA in the previous panel and you know you you heard the challenges that they they race with regards to um the transportation of medication and whatnot right the shipping issue and the different statutes that um that are required to be I I think it'd be helpful for the panel to kind of hear um what your health care system sound what what
▶ 2:09:08it is actually what is there um because when you when you hear that description makes it seem as if you have zero healthc care facility and no no medication is currently being shipped in.
▶ 2:09:24I mean, in in your testimony, you pointed out that there's actual um Department of Defense presence there, which I assume, you know, there's regular goods and commodities that are being brought in through DoD and so can you just speak on that with the very little time that we
▶ 2:09:41Sure. Thank you so much. Yeah. So, um so we have dispensaries and hospitals that are being built by compact funds for over the past 35 years. So, we have doctors that are trained and and licensed from the United States in the Marshall Islands.
▶ 2:09:58And in fact, if I may speak to um about September 2024, we started engaging the uh to discuss um do environmental scans of what what it what the facilities are in the Marshall Islands. and and I believe about January, February 2025, we are this close to starting negotiating an agreement.
▶ 2:10:25So that was about less than six months going back and forth. We would hold monthly meetings with the VA and um and you know we were this close to executing an agreement that would resolve a lot of the issues that were brought up today. So um and I believe we can get there. Uh would you keep talking and try to come up with an agreement so we can provide the healthcare that is needed.
▶ 2:10:52Okay. Thank you for your time. I yield back the remainder of my time.
▶ 2:10:55Thank you.
▶ 2:10:56Thank you. The gentleoman yields back. The chair now recognizes uh Dr. Dexter for five minutes for any questions she may have.
▶ 2:11:03Thank you, Chair Meeks. And and thank you to our ranking member um for her service here. It's going to be very sad without you here on our subcommittee in a year we have you. Um so uh Miss Smith, thank you so much for coming and I very much appreciate that your statement reflects your organization's commitment to high quality um outcomes driven and accessible health care for our veterans.
▶ 2:11:28Um, as you said, uh, for our veterans, it's often best possible when veterans have access to clinicians and facilities that are accredited and fully trained and really culturally competent. Um, I also just want to shout out the outcome transparency and accountability that you referenced because it's really crucial. I'm a physician, was honored to practice in a VA.
▶ 2:11:53um it's crucial for making sure that what we think is science-based is actually driving better outcomes for our patients. So, thank you for calling that out. Last thing I wanted to highlight is your statement about medical record exchange. Um having provided care in a VA as well as as a community care provider, I cannot list how many times we led to redundant care or subjected people to recurrent um repeated unnecessary um treatments because we didn't realize they had already been given somewhere else.
▶ 2:12:22So, I want to um ask some questions related to the Health Desert Reform Act, which I will reiterate is very well-intentioned. We have to be able to provide community care to our veterans when they don't have access to a VA that can give timely care. That is absolutely, this is not a a political issue. This is a a priority issue that I think we all share here.
▶ 2:12:43Um, the section of the bill on oversight, I'll just note, is less than a page long, and it includes rather vague uh requirements that the VA secretary tracked track access, cost, quality, and veteran satisfaction for each hospital that enters into an agreement under the bill.
▶ 2:13:02Um, Miss Smith, do you have confidence that this requirement will be sufficient um to ensure the care delivered by those hospitals is of equivalent or superior quality to the care delivered by a VA As it is current currently written, I don't feel like there is the structure to give me that confidence. Um, am I encouraged that it could be? Certainly.
▶ 2:13:27Um but but I just think as it's written right now, no. I I would have to say no.
▶ 2:13:34And I share that that concern. Um and under this bill, there appears to be very few parameters placed on pilot program eligibility. It does not stipulate that for-profit or private equitybacked hospitals cannot take advantage of the program, nor does it require that a hospital be located in an area w with a demonstrated white weight time or drive time issue.
▶ 2:13:57Um, in your opinion, what risks does this pose in terms of possible exploitation, overutilization, or unnecessary duplication of services? APA has long been concerned that unfettered growth in the community realm without could have a negative impact on the integrated care system of the VA. Um, so we we do share that concern.
▶ 2:14:24Um, I I think there again I do think that there are structures even in the community care program that provide more oversight that could be applied in this
▶ 2:14:37And I just want to highlight an issue that I've raised in this committee that the VA budget unfortunately is a zero- sum game. If we take it from um VA facilities to provide this care, it it doesn't come back. And this bill includes no cap on the amount of funding that can be used to furnish care through the arrangements that it authorizes.
▶ 2:14:57So that means it's entirely possible that we could siphon large amounts of funding away from the VA where we know our veterans get the highest quality and best satisfaction. This has been documented. So and for uncertain quality and and it may or may not be necessary. Is is that your concern as well? It is our concern.
▶ 2:15:20Um, you know, we're down 300 psychologists over just this past year and we know that the demand for mental health treatment within the VA is skyrocketing. And so I think that, you know, using funds to also invest in the VA's ability to meet the demand by by staffing is a really important piece of the puzzle. So if money is going from one place to the other, how can we reinvest there as well?
▶ 2:15:46And with my last few seconds, I just want to underline that because I I have heard that even physicians who have long been practicing, at least in our Portland VA, that they cannot get their patients in for appointments because the staff who help coordinate or get them in for those appointments have been dismissed. So, it feels like right now we should be underlining the commitment to making sure VA veterans have access to the VA facilities that we have already funded. Thank you. And with that, I yield back. Thank you.
▶ 2:16:16The gentle lady yields. The chair now recognizes General Bergman for five minutes for any questions he may
▶ 2:16:22Thank you, Madam Chair. Mr. Whe, good to see you again.
▶ 2:16:28good to see you, sir.
▶ 2:16:29Just back a couple of days when we were out on the lawn or over, you know, uh, presenting on on what you all do and and you do it very well. Um,
▶ 2:16:37thank you. In talking with veterans in my district and across the country, it's clear that mild chronic TBI is far more common than is often recognized, frequently missed and undiagnosed. This prevalence seems to exceed what the VA's current clinical footprint alone would suggest. With only five poly trauma centers nationwide, the current system simply does not have the capacity to meet the full scope of need.
▶ 2:17:07The question, why is additional targeted funding necessary? And what kinds of community partners, nonprofits, or academic centers are best positioned to extend that care and innovation beyond the VA's walls. Thank you, sir, for that question. We listen to veterans.
▶ 2:17:29We take their opinions in an unbiased, unfiltered way and then we share it of course with all of you and with the media as well as our fellow veterans. It's clear when we speak to them that they want to be able to have the ability to get treatment early on in this process before it exaggerates, before it grows, before it affects their job, before it affects their family. It's a spiraling effect, right?
▶ 2:17:59When one thing goes bad, then the next, and then the next, and before we know it, we're on a slippery slope to a bad place. When um when we can get to this early and get treated and get the access to health care in a proper way, then we can mitigate that. We can slow it down. We can get them the the assets and the technology and the medication in some cases that they need.
▶ 2:18:24When I think about organizations that are doing great work here, I think about the Avalon Action Alliance which has a number of facilities and partners across the country uh that right now are is do are doing that uh God's work for helping veterans uh with TBI sometimes very mild sometimes very severe and they're doing it in a way that is very costly to them and not sustainable long term for them to do without getting support.
▶ 2:18:54I think it's important for us to realize that this is a national issue, just not a veteran issue. And that if we can't solve TBI for those that have served our country, then we're not going to be able to solve TBI for our citizens. Uh and so I think it's important to invest in this. I think it's important to make sure we have the assets to do that. We've been the best and brightest organizations to take a look at this. Obviously, we need guard rails, right?
▶ 2:19:24I mean, there has to be checks and balances to make sure that this is done in the right way. But I applaud the efforts of those on this committee and all of you for your work. I think everybody has the best intentions here. And we want the very best for our veterans and their families. And I say their families because if you have one veteran that has this problem, it affects his spouse. It affects the children. And when we think about it, there's 18 million veterans in our country. When you think about those dependents, you're now talking about 30 or 40 million Americans that this impacts.
▶ 2:19:55And right now, we're only having access through the VA to half of those veterans. So, this is a big problem. Thank you.
▶ 2:20:03Yeah. Thank you. And I noticed that admission roll called I took a photo of uh the backdrop. It said the key word takeaway is listening because in any conversation or any dialogue, at least one entity has to be listening. So, thank you for being a listener. Um, Miss McCoy, uh, if this research leads to clearer evidence of what works, how could that improve day-to-day care for veterans living with DBI?
▶ 2:20:31Thank you for that question, sir. Um, I would like to echo many of Mr. Why's points here that it really is our belief that innovation can come from anywhere. Um we are committed to efforts that reduce suicide risk among vet v veterans living with long-term effects of brain injury and that is a population that we serve regularly.
▶ 2:20:49Um I believe that um all of these efforts um collaboratively can be streamlined as you point under the fox grant and ultimately it's going to improve alignment, avoid duplication of care and really improve medical outcomes for veterans.
▶ 2:21:06Thank you. And I you know this is not a we talk about in weapon system fire and forget. What we're trying to do here is not a fire and forget. We just throw something out create the beacon. You know whatever it is we're trying to do the therapy. It's not a fire and forget. We got to keep working it because things are going to change. With that madam chair I yel back.
▶ 2:21:22Uh thank you general uh Bergman. The chair now recognizes Dr. Morrison for five minutes for any questions she may
▶ 2:21:29Thank you Madam Chair and ranking member Brownley. I reiterate uh Dr. Dster's comments. Thank you for your service and for your mentorship. You will be dearly missed. Um and thanks to each of the witnesses uh testifying before the committee today. Grateful for your presence. Uh in Minnesota, I represent Minnesota's third district and we are very proud of the Minneapolis VA. Uh it goes above and beyond for veterans in our state.
▶ 2:21:56And while certainly a testament to the leadership and community in Minnesota, this recognition is also a timely reminder of how critical health care workers are to the success of VA. Uh, intentionally tackling this burnout underscores how important investing in the VA workforce is and our ability to deliver on the promise that we made to our veterans.
▶ 2:22:19Having myself been one of the 70 plus percent of American doctors who has completed part of their medical training at a VA hospital, it also leads me to think about the unique challenges that veterans face when it comes to mental health, substance use disorder, and overdose risk.
▶ 2:22:35As our country struggles with the opioid crisis nationwide, my heart breaks for our veterans that research has repeatedly shown to be at higher risk of death from overdose, further complicated by chronic pain, service related injuries, or other service related trauma. A major part of what compelled me to serve in Congress was my firsthand experience as a doctor, seeing how difficult navigating our health care system can be.
▶ 2:22:59Helping veterans face unique challenges and elevated risk requires intentional work to break down those barriers. Now, as a member of this committee, I'm honored to have the opportunity to lead policies that will help uh meet veterans where they are. And that's why I'm proud to have joined with another experienced doctor, Congresswoman Conaway, to introduce HR599, the Veteran Opioid Emergency Treatment Act.
▶ 2:23:23This bill would reduce the barriers veterans face to accessing nlloxxone, a life-saving medication that can rapidly reverse an op an opioid overdose. Medication that would be life-saving in such critical moments should not be out of reach to veterans as a result of cost or difficulty scheduling appointments. I'm grateful for the bill's inclusion in today's hearing and I look forward to continuing to work with Dr. Conway and my colleagues as the bill moves through the committee.
▶ 2:23:48Miss Conway, could you elaborate on the importance of a consistent systemwide approach to ensuring timely access to nlloxxone? Why is this access and consistency of particular importance for veterans? Well, recogni thank you for the question. Recognizing the conditions that uh disproportionately impact veterans is part of how we approach treating them.
▶ 2:24:16And so we are recognizing that there is the there there is definitely a sensitivity to substance use disorder and we must do all that we can to to prevent unnecessary veteran Thank you. Um and in your testimony you highlight the importance of training an exceptional health care workforce.
▶ 2:24:36How does investing in VA providers protect the quality of care that veterans Well, you mentioned already in your comments about being part of the 70% who receive their training in the VA. Um, I have the pleasure of working with VA psychologists who are just tremendous public servants, but they also uh spend time training the next generation of mental health providers. And I think a lot of times it's lost that the VA is not only important to our veterans, which is first and foremost.
▶ 2:25:06It's important to each and every one of us because they really are training the healthcare workforce. Um, if I can add because you meant burnout. You mentioned burnout earlier. We're finding more and more psychologists clinical time is being taken up to, you know, their entire day is filled with clinical scheduling. Um, and it's not leaving the time for clinical for for training supervision.
▶ 2:25:30And that concerns us because I do think that there are training programs at certain VA facilities that are are dying on the vine only because they don't have the time and the people to foster the
▶ 2:25:43Thank you so much. And Madam Chair, I yield back.
▶ 2:25:47The general lady yields. The chair now recognizes Representative Kiggins for five minutes for any questions she may Thank you, Madame Chair, for just conducting the hearing today to talk about important pieces of legislation that will improve access to care for our veterans throughout the VA. Included in the hearing today is my legislation, the Clarity on Care Option Act. ChantVa is vital for caregivers and dependents of permanently disabled veterans.
▶ 2:26:14It ensures they can continue to support the veteran in their lives and still receive the healthcare services they require. To support our veteran caregivers in finding providers more easily, I introduced the clarity on care options act which directs the VA's community care network to create a public-f facing list of all providers who are in network for chant VA enroles.
▶ 2:26:34It's important for patients for providers, there's a lot of confusion and the more we talk about all the other great issues we talked about today from mental health care, how we're uh addressing addictions, co continuity of care issues, all the things we're working on. I need my my veterans out there to know to have kind of a directory so that they can find where the community care partners are. So that's just what my bill does is just establish this directory.
▶ 2:26:59We have so many and in and some of the great places our veterans live like Hampton Roads and uh just I think it would be a great addition to complimenting care. So I just had a couple questions first to Miss McCoy. What barriers do you see eligible families most common commonly facing when they're enrolling in Champ VA? what barriers do they face after having access to the program?
▶ 2:27:22Thank you so much for your question, Representative Kiggins. Um, surviving families and caregivers often face heightened mental health risks and require consistent and comprehensive support. Um, we are in support of this bill um and fully encourage efforts to expand information on how to access essential health care information. Um, we believe that a national registry provides a powerful tool for these beneficiaries to secure the care and support that they deserve.
▶ 2:27:51Great. Thank you. And are there specific populations such as surviving spouses, caregivers, or dependents with disabilities who face disproportionate challenges accessing Champa?
▶ 2:28:03Which would you which would you say or what are some of the more challenged
▶ 2:28:06Um, to my understanding, survivors and
▶ 2:28:10I would agree with that too. And and again for Miss McCoy, what are the most common reasons Champ VA claims are delayed or denied?
▶ 2:28:18Truthfully, I would have to come back to you on that answer.
▶ 2:28:21I think a lot of times our veterans probably access just either Google searching or, you know, look even hearing from friends and they make appointments and they're seen and then they find out after the fact that those were not not in the network, which is what this bill is hoping to prevent. And last question for Miss McCoy. What factors contribute to delays in enrollment and what steps could reduce those delays? at this point I would say perhaps the vision restructure, although yet it has not been implemented.
▶ 2:28:51We don't know what those changes will look like, but I'm hopeful that we'll see positive outcomes with the vision restructuring.
▶ 2:28:56Good. I hope so, too. And and again, I think just a directory and and really a I'd like to see an overhaul of even just logging on to the VA system sometimes, you know, as a veteran, married to a veteran and even daughter of veterans, that's I just for me personally, logging on that log on process can be simplified and even finding GI Bill, you know, health benefits, VA home loan, there's all the benefits that are there, but I just need my veterans to be able to to access and understand that.
▶ 2:29:23So hopefully this Champ VA piece will at least provide a little bit of clarity for our community care partners. And I have quick question then for for Miss Conwell Smith and welcome from I know you're you're from my hometown in my district. Uh so have you heard from psychologists that service Champ uh that are having trouble uh just servicing our benefici beneficiaries and what is the most common issue that psychologists are running into? I have not heard this directly, but we can certainly go back to our membership and gather more information about this.
▶ 2:29:53Um I I think that you you highlighted challenges of navigation of any veteran and their family and I think I think those of us that are in veterans families know those oh too well.
▶ 2:30:04Yes, very much so. And I know just psychologists are important care partners for us and there's a shortage of mental health care providers and we often speak of mental health but but thinking of the people who provide the the mental health. We need to do more of that and making sure that that the providers know too and the patients have a directory but but there's clarity kind of on both sides. So that's what we hope to accomplish with this bill. But thank you so much and I yield back.
▶ 2:30:27Uh the gentle lady yields. I now recognize myself uh for five minutes to ask questions. Um, and this is a question both for Mr. Wley and uh, Miss McCoy and then Miss Conwell Smith. And I realize that you're not clinicians per se, but uh, as I've listened to, uh, the testimony, the questions today and the bills before us, uh, I'm thinking about the blast injury, mild TBI.
▶ 2:30:53So, i.e., uh, a wave, shock wave, but not an actual concussion. uh and how difficult that is and we don't test for that. So would there be some validity to either an algorithm based test andor screening prior to uh discharge from the military for those individuals who during their training although they may not be in combat but during their training may have exposure
▶ 2:31:23to a blast neurot trauma and not a TBI or concussion in the typical diagnosed Thank you uh for that insight and question. Um we couldn't agree more. We have talked to a number of veterans either in our roundts or in our uh polling and find out that and find out um on a systemic basis that many times someone doesn't know they've had a TBI until a number of things have
▶ 2:31:53happened and by then you're kind of picking up the pieces versus getting
▶ 2:31:58Yeah. and and I realize the the brain activity and connections may be very different than what you see in a TBI, right? And so and I I don't have a lot of time because I want to ask other questions. So, Miss McCoy,
▶ 2:32:12thank you for your question. I think it directly leads into HR6444, which is this establishment of the task force, where we are able to begin to accumulate andor leverage currently collected data on the DoD side of the house and allow that full migration of information to accompany the service member as they move into veteran status. And again, to your point, um we know that blastover pressure has been kind of linked to cumulative neurological effects.
▶ 2:32:40um how those build in each veteran um and service member over time are so distinct that at this point you know we don't know what we don't know and so uh investment in research and innovation is just key and I think this task force um will be an important infrastructural step to that um goal.
▶ 2:32:58Thank you. And how could uh the pilot and some of these bills that we presented today are discussion bills so I appreciate all the input from all of our members and our witnesses. How could the pilot in the uh health deserts bill reduce travel burdens or delays for care and veterans? And I can assure you in Iowa uh especially northwest Iowa, but even in my district, uh veterans may have to travel 2 hours to go to a VA facility um clinic which has lesser services.
▶ 2:33:26And in many states, including Texas, a very populated state, that drive can be over that. So, if you're talking about a visit for coordinated care or whatever type of care you want, that could be a 5h hour uh travel time uh just back and forth without including the physician visit. So, Miss McCoy,
▶ 2:33:47uh thank you very much. Um I appreciate and agree with your point and um I think that this is filling a crucial need. I mean, you think about a veteran that's maybe going to a hospital where certain providers or certain care modalities are covered under the community care network and others may not. So, an initial appointment may be covered, but um a a scan or you know, some sort of MRI may not be covered. That fragmentation of care has to be incredibly frustrating.
▶ 2:34:15It's inefficient and ultimately it's a barrier to care. So, uh, a streamlined contractual agreement, um, can produce positive outcomes for veterans.
▶ 2:34:25Thank you. And, um, Miss Conwell Smith, and, uh, as a physician and a veteran, I appreciate, uh, your, uh, your focus on clinical outcomes. Do you consider, uh, it a favorable clinical outcome for 17% of veterans to still die by suicide? So, has the VA been successful? Is that a good clinical outcome measure? I would go back, thank you for the question.
▶ 2:34:54Um, I I would go back to the advances and progress within the VA when it comes to mental health treatment and effective treatments for mental health disorders, which I think are I think are have been extraordinary. We don't want one veteran suicide.
▶ 2:35:11Neither do we, but that certainly is a clinical outcome and we haven't moved that needle. And so I think looking at approaches uh that deliver care to veterans whether it's through tele medicine, community care, VA care and algorithm based care, new research. I think it's important all of us on this committee want to make sure that uh number one PTSD, veteran suicide uh that uh uh TBI veterans are getting the care that they need.
▶ 2:35:38And then lastly, and let me just say, Ambassador Paul, I don't have a question for you, but I just wanted to thank you for coming for testifying today and coming this long way to make sure veterans uh in your area in the Mariana's Islands and the uh FAST are uh that their needs are met as well, too. So, so thank I didn't want you to leave without my personal thank you. Uh so, thank the witnesses for being here today. Uh just in closing, I think we're looking at some bills, discussion drafts. I appreciate all of the input.
▶ 2:36:08Um, and then ranking member Brownley, do you have any closing remarks you would like to give?
▶ 2:36:13I don't think so, but I think, you know, there have been a lot of good bills here today and that uh, you know, certainly require serious consideration and I think we've had a good discussion on many of these bills and ways in which they can be improved upon um, so that we can move them forward. I yield.
▶ 2:36:33Uh, thank you, Ranking Member Brownley. On behalf of the subcommittee, I want to again thank all of our witnesses and members, including the VA who was on the first panel, uh Dr. Koiger and Dr. Lorente for uh being here today. I look forward to working with you uh to address the issues facing our veterans and also the suggestions uh that we've had from our witnesses and our members today. The complete written statements of today's witnesses will be entered into the hearing record.
▶ 2:36:59I ask unanimous consent that all members have five legislative days to revise and extend their remarks and include extraneous materials. Hearing no objection so ordered. Uh this hearing is now adjourned but please this room is being used immediately after this. So uh when the meeting's adjourned please exit the hearing room. Thank you.
▶ 2:37:19What's being used for?