▶ 0:15:11Chair Moran: Who our nation's veterans. I represent a rural state and during my time as a member of the house of representatives, I represented a congressional district approximately the size of illinois. There is no va hospital included in that geographic territory and so I bring this perspective of long distance and long amounts of time for veterans to access care.
▶ 0:15:40Chair Moran: I have heard countless stories from veterans from kansas and across the country who live in faraway places from va facilities about those challenges. In the absence of ea's community care program, these veterans would not be able to use the va health care benefits they earned. Same can be said for veterans who face long wait times and those who require a service that the local va doesn't offer or veterans that have unique needs that are best served through community care.
▶ 0:16:08Chair Moran: The mission act was created so the va could more seamlessly care for those veterans, however, seven years after the mission's was signed into law, it is still not fully living up to its promise. I've heard from veterans nationwide who suffered as a result especially over the last year as va acted to discourage and restrict the use of community care under the mission act. Some of those veterans who suffered the most are those with mental health conditions and addiction.
▶ 0:16:37Chair Moran: This morning we will hear from veteran family members, we will hear from veterans and advocates about how they encountered pavers at the va which a limited access to potentially life-saving care and put their lives at risk. One of those veterans is eric golnick who will testify today about waiting more than a year to be connected to a counselor after asking the va for help in the midst of a personal crisis. Another one of those veterans is paige marg, whose husband charlie.
▶ 0:17:07Chair Moran: Page will testify about her and charlie repeated requests for inpatient care were denied by the va after charlie attempted suicide in a parking lot of a va clinic. Va leaders and advocates have repeatedly said suicide prevention is one of their top priorities.
▶ 0:17:25Chair Moran: If that is indeed true, stories like the one that eric and paige will share and the countless others that this committee has heard from, veterans and their loved ones should not be happy and cannot be allowed to continue. As chair of the committee, I'm committed to making certain that they do not.
▶ 0:17:43Chair Moran: That is why I'm introducing legislation today with chairman bost, my chairman in the senate to strengthen the mission act and give veterans and improve pathway to care in the va's direct care system and in the community. I hope this will be a bipartisan effort. The va health care system is an invaluable resource for veterans but it will only remain so if it stops feeling those who need them most.
▶ 0:18:10Chair Moran: With that, I yield to the ranking member, senator blumenthal, for his opening remarks.
▶ 0:18:14Sen. Blumenthal: Thank you, Mr. chairman. This cause must be bipartisan and immediate. There is no question about the need to speed, streamline, and safeguard access to community care and referrals to the kind of providers that are necessary to prevent the tragedies or near tragedies, such as your husband, charlie, suffered, Ms. marg.
▶ 0:18:46Sen. Blumenthal: I believe strongly that these two systems, private and va, must be complementary, not competitive. And overriding all of this debate is the need for more providers, more doctors, more nurses, more psychiatrists, and social workers who can provide the kind of care that our veterans need.
▶ 0:19:17Sen. Blumenthal: Obviously, the va should not be in competition with communities for the numbers of scarce providers, skilled professionals who are necessary to provide this care. But we are here on a morning when all of these programs are in severe and urgent jeopardy.
▶ 0:19:40Sen. Blumenthal: The trump administration has announced a legally that -- illegally that it will freeze funds for programs that are immensely important for veterans. This freeze on federal aid will hurt veterans by pausing funding for critical programs that millions of veterans and their families rely on.
▶ 0:20:02Sen. Blumenthal: We are talking about homeless veterans, funding for veterans nursing homes across the country, suicide prevention programs, many of the programs that we will be discussing today , and the efforts to streamline, speed, and safeguard access to community programs. A reimbursement for those providers who need it to make community care work. Frozen.
▶ 0:20:30Sen. Blumenthal: We are determined and discouraging that kind of community care right now in real time. I urge all the members of the committee, my colleagues to oppose this measure, to make their views known.
▶ 0:20:46Sen. Blumenthal: I call on veterans and their organizations across the country to make their views known because these funds must be freed immediately, or else veterans will be betrayed. There is nothing woke or marxist about wanting to end veteran suicide or wanting to deliver the benefit that they have earned and deserved.
▶ 0:21:16Sen. Blumenthal: I will put in the record later today a list of programs -- it will be probably two pages long, I have a tentative list here -- that will be adversely impacted by this freeze on funding. It is also, by the way, unsustainable legally. It violates the impoundment act. These funds have been lawfully appropriated under bills passed by the congress, signed by the president.
▶ 0:21:48Sen. Blumenthal: No member of the executive branch, including the president, has the lawful power to simply stop it. I am concerned also about the action to dismiss the inspector general.
▶ 0:22:07Sen. Blumenthal: I am going to be circulating a letter to my colleagues that would, in fact, protest to the president firing of the va inspector general, like missile, who has worked for many years under democratic and republican administrations, to call out fraud, waste, and abuse. He has done it in a nonpolitical way, aggressively and effectively.
▶ 0:22:36Sen. Blumenthal: The question for all of us is, why this measure of firing the inspector general of the va was done at this moment when in fact he has been the bulwark against waste, fraud, and abuse in the va, as have been expected generals across the executive branch.
▶ 0:22:56Sen. Blumenthal: I believe strongly that the private sector health care system and the va are complementary. One group to care should never come at the expense of the other. I feel that is what is happening today, the erosion of the va direct care is a real threat.
▶ 0:23:20Sen. Blumenthal: I say erosion because it could happen gradually, not all of a sudden, but if it happens, it may well be irreparable. I am hopeful that we will restore the inspector general, that we will make sure the funding for the va system and other programs will be unfrozen, and that we will work together in a bipartisan way to speed and
▶ 0:23:57Sen. Blumenthal: Assure the referral system under the kind of legislation the chairman has proposed. There was an effort last session, I supported it, to legislate in this area. I am hopeful that his measure is one that we can all support. I know that last session he offered the veterans health act. I assume this measure is similar to it.
▶ 0:24:26Sen. Blumenthal: Ranking member tester offered the making community care work for veterans act. I feel some combination of these measures is viable and achievable, and I'm hopeful that we can reach a bipartisan effort. Thank you, Mr. chairman.
▶ 0:24:41Chair Moran: Thank you, senator blumenthal. I would indicate a couple of things for all members. It's my understanding the department of veteran affairs leadership is meeting this morning to learn about this issue of impounding, withholding funding.
▶ 0:25:00Chair Moran: I would say that in both instances, both the inspector general and this issue, one of the things that we can do is get congressman collins confirmed and in a position to represent the department of affairs in these matters. That is apparently taking place this week. Now, I will call on our witness panel. Let me introduce them. Eric golnick, navy veteran, advocate for mental health and suicide prevention for veterans and first responders.
▶ 0:25:29Chair Moran: Paige marg, veteran's spouse with first-hand experience navigating the va health care system on behalf of her air force veteran husband charlie. Jim lorraine, president, chief executive officer of america's warrior partnership. Naomi mathis, assistant national legislative director for disabled american veterans. And john eaton, vice president for complex care for the wounded warrior project. Thank you all for being here this morning.
▶ 0:25:57Chair Moran: More importantly, thank you for all you do in care of veterans and your care and concern for your loved ones Mr. golnick, we will recognize you first. You are recognized for five minutes.
▶ 0:26:10Mr. Golnick: Chairman moran, recommend or limit thought, thank you for the opportunity to testify on the critical issue of improving access to care through the va's community care program. My name is eric golnick, and I am a U.S. navy veteran who has dedicated my life to supporting the health and well-being of veterans and first responders. The va is an essential resource for millions of veterans. Community care under the mission act is meant to complement, not replace, the va's services, ensuring veterans receive the right care at the right time.
▶ 0:26:43Mr. Golnick: I am going to begin by sharing a personal story to show you why this issue is so important to me. After leaving the military, I sought mental health care through the va. I was fortunate to see a psychiatrist relatively quickly but it took over a year to connect with a therapist. The lack of therapy meant I was only addressing part of the problem. This came to a head over the holidays a few years ago, a nd without the support of friends and fellow veterans, it may not be here today.
▶ 0:27:13Mr. Golnick: For someone with a mental health or substance use disorder, the window to intervene is often just days. For veterans, timely access to this care is a matter of life and death. My experience reflects the systemic barriers many veterans face in accessing timely care, and that is what inspired me to co-found forge health in 2016. We addressed urgent mental health and substance use needs for veterans and first responders, working closely with the va to help those who couldn't find adequate care.
▶ 0:27:42Mr. Golnick: This collaboration showcased the potential of how these relationships can work with the community but also highlighting the ongoing challenges. Some vamcs and visns fostered strong partnerships. However, inconsistent implementation across the system resulted in delays, highlighting the need for clear, standardized practices to ensure veterans receive timely and consistent care. While the mission act has expanded options for veterans, many don't know about these options.
▶ 0:28:10Mr. Golnick: Unclear eligibility requirements often lead to delays or denials, even for those that meet the access standards. One veteran, after being told he couldn't continue care with a clinician he had developed a strong therapeutic relationship with over the course of a year, told me 'I'm done. , I give up. Before this year, I was bounced between four clinicians in less than six months.' when transitioning from va to community care, many veterans face disruptions caused by poor communication and unclear processes.
▶ 0:28:43Mr. Golnick: For example, a marine veteran I worked with, struggling with post-traumatic stress, was referred to community care but waited months due to administrative delays. During that time, his condition worsened and he attempted suicide by a firearm. Some va employees hesitate to refer veterans to community care, fearing it could negatively impact their budgets. This can create barriers, forcing veterans to choose between systemic concerns and urgent care needs.
▶ 0:29:10Mr. Golnick: The mission act was designed to ensure timely, high-quality care, whether through the va or through community providers. Veterans, not funding structures, should remain the top priority in care decisions. To address these challenges, the va should enhance its efforts to educate veterans about their options under the mission act. Clear communication during va appointments, proactive outreach campaigns, and partnerships with vsos can ensure veterans are fully informed about their rights and choices.
▶ 0:29:37Mr. Golnick: The referral and approval process should be streamlined. Simplifying and automating these procedures can reduce delays, alleviate administrative burdens, and help veterans to access care more efficiently. This includes ensuring that community providers, tpas, visns and community providers is consistent, transparent, and structured.
▶ 0:30:06Mr. Golnick: For rural and underserved areas, it is critical to address gaps in services that the va might struggle to fill. Telehealth is also a powerful tool for bridging these gaps in rural or underserved areas, by providing immediate access to care. However, challenges such as limited broadband access can make this option unworkable.
▶ 0:30:28Mr. Golnick: It's also crucial for some veterans, especially when talking about mental health, to have the option to see an in person provider especially if you are processing trauma. Closing statement chairman moran, ranking member blumenthal, and members of the committee, the va has made progress in improving care for veterans, but significant challenges remain. By addressing these barriers and building on the foundation of the mission act, we can ensure all veterans receive the timely, high-quality care they deserve. It is our shared responsibility to ensure that no veteran is left behind.
▶ 0:30:58Mr. Golnick: By fostering collaboration and prioritizing veterans needs, we can fulfill our promise to those who have served. Every delay risks a veterans well-being and their life. One veteran told me "I shouldn't have to fight this hard to get help." thank you again for the opportunity to testify. I look forward to your questions and to working together to improve care for our nation's veterans.
▶ 0:31:16Chair Moran: Thank you for your testimony and your service. Ms. marg.
▶ 0:31:22Ms. Marg: Good morning, chairman moran, recommend blumenthal. Thank you for the invitation to speak at today's hearing. My name is paige marg, the wife of charles mark. I'm not here to talk about my husband in the past tense. Better?
▶ 0:31:48Ms. Marg: My name is paige marg, and I'm the wife of charles marg. I'm not here to talk about the life of my husband in the past tense but to tell you how charlie was saved. Countless times the va and community care program could have provided impactful mental health counseling, resources, and residential treatment but failed again and again. I met my husband 27 years ago. We have been married for 23 years.
▶ 0:32:15Ms. Marg: And this time I have seen my husband change dramatically from a pivotal deployment that he went on. In october of 2012, charlie deployed from germany to guantanamo bay, cuba for eight months. To this day, I'm not sure what happened on that deployment but whatever did happen permanently and profoundly changed my husband.
▶ 0:32:37Ms. Marg: In august of 2013 while still on active duty, charlie attempted suicide and was hospitalized at landstuhl regional medical center. It was that he disclose that he attempted suicide twice on deployment. His doctors told us he could not have ptsd because he was not deployed to a combat zone. He was diagnosed with major depressive disorder and anxiety and was medically retired in july 2015. We moved back to san antonio and charlie enrolled in the va heart of texas health care network.
▶ 0:33:07Ms. Marg: He was connected to a be a psychiatrist who only supported his mental health journey through medication. Counseling is not a part of these quarterly appointments. Charlie has repeatedly requested referrals from the psychiatrist and a cycle that includes the committee to care program failed to charlie again and again. He would wait six to eight weeks for the referral to be processed to see a community care provider.
▶ 0:33:29Ms. Marg: In each of the nine times that he went through this process, he has never been granted more than 12 visits with the counselor even when he needed more. In each cycle, he saw a different provider and he spent time re-telling his story and building rapport. In february 2023, charlie went to see his be a psychiatrist to request immediate mental health support as he was in crisis.
▶ 0:33:55Ms. Marg: We were told to go outside the va, to seek care, and we were given a list of local providers who except to try care. The earliest appointment we could find was 30 days out. On march 1, 20 23, my husband sat in his truck in the va clinic parking lot and attempted to overdose on his medication. I found him in his truck, drenched in sweat, crying and incoherent. He was transported to a local hospital.
▶ 0:34:23Ms. Marg: When he was released, he was of hurt again to the va communicate care system or counseling and received 12 visits before release from care again. His medication was adjusted multiple times over the next six months. Towards the end of his period, charlie went missing and was found by the police in the er waiting room at audie murphy va hospital. He was held on emergency detention order and admitted to the psychiatric ward for 36 hours.
▶ 0:34:51Ms. Marg: For several reasons, I asked for him to be sent to a residential program and was told that no option like that existed through the va. At his follow-up appointment, I explained the last few years of navigating fragmented community care counseling and that these 12-session appointment were not adequate support and that a longer-term solution was needed for him. I again requested that he needed to be put in a residential treatment program. A referral was submitted for residential treatment to the community care program.
▶ 0:35:22Ms. Marg: Charlie's psychiatrist called
▶ 0:35:23And Told Him The Rep. Roe: Was denied and suggested that he reach out to try care, wounded warrior project, or another veterans service organization to get the care covered. Wounded warrior project's complex care coronation program assigned a case manager and within three days paid for his flight to tucson, arizona, secured a bed for him at sierra tucson, and paid for six weeks a residential inpatient treatment.
▶ 0:35:51And Told Him The Rep. Roe: Sierra tucson is in the va's community care network and the va should have covered this expense. But failed to support charlie again. While he was there, all of his medications were changed and reset. He received intensive counseling, treatment for his nightmares, and was diagnosed with ptsd. Since he returned home, charlie has avoided the va for mental health support because he didn't want to go through the familiar cycle of fragmented care again. Instead he has sought outside support to local nonprofits.
▶ 0:36:22And Told Him The Rep. Roe: Charlie is currently attending counseling appointments through the local vet center in san antonio. Wounded warrior project saved his life by getting him connected to care that he desperately needed four years. Over and over again the va fell short on.
▶ 0:36:38And Told Him The Rep. Roe: It is heartbreaking to see your spouse become a shell of a person, to repeatedly ask for help, to maintain prescription compliancy for a decade and not miss appointments only to be discarded from the entity that should be providing treatment and care that he earned through his military service and sacrifice. The obtuse, heartless interactions with the va over and over are my veterans do not seek care. It is my veterans suffer in silence.
▶ 0:37:06And Told Him The Rep. Roe: How many veterans need to commit suicide for the va to prioritize long-term mental health care? How long do veterans need to wait for mental health care? How many veterans are getting lost and giving up on the community care system that do not have someone to advocate and fight for them? We need the va to be better. Thank you for the opportunity to share charlie's story.
▶ 0:37:29Chair Moran: Ms. mark, thank you for your must be difficult testimony but very compelling. And valuable to me and members of this committee. Mr. lorraine.
▶ 0:37:42Mr. Lorraine: Chairman moran, ranking member blumenthal, members of the committee, I'm honored to testify today regarding veteran access to health care specifically care in the community. The ability to make our own decisions is a foundational american freedom. I've always told my army serving son that a successful career should give him the choices throughout life. I remained in the military through retirement because I love service.
▶ 0:38:10Mr. Lorraine: But I also did it to ensure I had choices, especially managing my health care through tricare or the va, something my father, a world war ii veteran, never had the option. Awp believes veterans have a choice in managing the health care they were earned. Providing veterans with health care choice is where, when, and most importantly the continuity of care they seek is not only the right thing to do but also affordable and effective.
▶ 0:38:41Mr. Lorraine: Awp operates at a community level by building proactive relationships with veterans. Our mission is to partner with communities to holistically improve the quality of life of their veterans and families, thereby reducing veteran suicide. Community care is vital, a vital tool for veterans particularly those who do not trust the va and don't utilize the va facilities due to factors like distance, time, and continuity.
▶ 0:39:06Mr. Lorraine: While we recognize the va's crucial role in veteran care, awp always sides with the veteran. We have supported empowering veterans to make their own health care decisions and community care is one of the most popular and in demand options. The mission act and community care are enabled, and able veterans the opportunity to access outside va facilities as a result has been overwhelming.
▶ 0:39:32Mr. Lorraine: Community care helps veterans regain the trust in the system especially given that almost half of the 17.6 million veterans in the united states are unknown to the va. At awp, nearly 9000 veterans contacted us in 2024, over 4000 needing assistance. Most often related to health. These 4000 plus represented 6000 cases, issues. 392 related to mental health.
▶ 0:40:04Mr. Lorraine: Of those 392, 329 had suicidal ideation's within 30 days of contact. The most common theme we see is a struggle to access care. Even for veterans familiar with the system, navigating the va can be frustrating. Confusion come a long wait times, and canceled appointments erode trust in the system. Though it's popular, full implementation of the mission act has yet to be realized.
▶ 0:40:33Mr. Lorraine: In the past years, the va has continued to deny community care referrals, continue to expand va hospitals, continue to hire more employees, often competing with the private providers for talented medical professionals in the community. We must get this right. Mr. chairman, as you said during Mr.
▶ 0:40:53Mr. Lorraine: Collins confirmation, america's national security is dependent on an all volunteer military force, and the va that is successful in helping service members thrive as veterans is key to bolstering recruitment and keeping the nation safe. We agree 100%. And feel the va is not a social service department, it's a national security entity. Despite some opposition in clear data -- and it is clear, veterans are voting with their feet to seek care outside the va.
▶ 0:41:25Mr. Lorraine: The department should trust and empower veterans by allowing them to choose their care providers. After all, who knows what is best for the veteran, the government or the veteran? In my experience, both my wife who is a veteran, service-connected disabled veteran, and I have faced challenges accessing care in the va. After years of frustration, we seek care through tricare and medicare because it provides us with so many other choices.
▶ 0:41:56Mr. Lorraine: Community care is essential. Veterans should be able to choose their providers who meets their needs the best. Awp has put forward some recommendations for improving care. Codifying the active standards. Congress should codify the existing active standards for the community to ensure veterans have guaranteed access to timely health care. Eliminate the referrals for veteran substance abuse and tbi care. I add tbi care because it's essential. We need the services.
▶ 0:42:27Mr. Lorraine: It is often urgent as Ms. mark said. Referrals to latent need help. Further tbi assessment and care have been neglected because of their similarities to post-traumatic stress disorder symptoms. We must include tbi services when discussing mental health and substance abuse issues. We also need to educate veterans on community care options and allow veterans the preference for community care and allow veterans to utilize tricare select. If you is essential to improving veterans access to health care.
▶ 0:42:58Mr. Lorraine: We must continue to improve the system by empowering veterans, not restricting them. Together we can do better. Thank you.
▶ 0:43:04Chair Moran: Thank you, sir. Ms. mathis. Welcome.
▶ 0:43:09Ms. Mathis: Chairman moran, ranking member blumenthal, members of the committee, over the past decade due to increased demand for services, va's reliance on purchased medical care services has risen significantly. While the use of community care has grown, many veterans have encountered barriers to accessing that care.
▶ 0:43:32Ms. Mathis: Dav supported the va mission act which aim to improve veterans access to timely high quality veteran focused care, importantly, the support was based on maintaining a fundamental set of principles. Unfortunately, there are reports from some veterans indicating they have been denied eligibility and access to the veterans community care program.
▶ 0:43:53Ms. Mathis: The axis the axcess standards are clear and the va is responsible for educating its employees on the law and veterans rights to access community care when the va cannot provide needed care in a timely manner or due to distance from a va facility. In cases where it is determined to be in the best medical interest of the veteran.
▶ 0:44:17Ms. Mathis: We also continue to hear about delays and scheduling community care appointments once a referral has been made due to the lack of an interoperable health records system, va's troubles with transmitting patient records to community providers and integrating those records into the patient's vha electronic health record. Additionally, community providers report complications with transmitting health care information and test results back to va.
▶ 0:44:45Ms. Mathis: There are also complaints from veterans regarding billing issues associated with referrals to community care. Va must find an effective solution to ensure patient records are transferred in a timely manner and provide community care providers the tools and procedures for transferring records back to vha. Va should also require the return of patient records to vha before payments for services rendered are made.
▶ 0:45:14Ms. Mathis: Finally, vha must ensure veterans are not erroneously billed and burdened with resolving billing issues related to community referrals. A bipartisan issue and va's top clinical priority is suicide prevention. Yet it does not mandate community care providers to meet the same training and quality standards as va direct care providers.
▶ 0:45:37Ms. Mathis: Dav recommends va recommend -- amend its contract with these providers and require clinicians who treat veterans to be trained in military culture, suicide prevention, lethal mean safety counseling, and trauma informed care. Accessing mental health and substance abuse disorder care is essential in preventing veteran suicide, and we made recommendations in our testimony to ensure quality services are provided to veterans refer to the community.
▶ 0:46:07Ms. Mathis: Women veterans are also significant users of community care. They are referred to the community for all maternity care and often times for other basic gender specific or specialty reproductive health services. Although we want to see fixes to improve access to services in the community, we strongly believe that investing in va comprehensive veteran focused evidence-based care model is likely to produce better health outcomes for veteran patients and ensure quality of care.
▶ 0:46:41Ms. Mathis: It is essential to maintain va as the primary provider and coordinator of veterans health care. A bipartisan position supported by current and past va secretaries and under secretaries of health. A robust va health care system also provides vital research, essential clinical provider training, and emergency preparedness for veterans and the nation.
▶ 0:47:06Ms. Mathis: The failure to adequately fund, maintain, and expand va's direct care infrastructure and increased staffing levels to meet rising specialty care demand has led to unsustainable growth in community care threatening the long-term viability of the entire va health care system. Likewise, and improperly managed veterans community care program has resulted in some veterans receiving substandard care.
▶ 0:47:36Ms. Mathis: In closing, congress and va must work together to resolve existing issues impacting veterans health care, improvements need to be made expeditiously to ensure veteran patients receive quality, timely care. Most important is to maintain a veteran focus health care system for service disabled veterans who rely exclusively on vha for their health care needs.
▶ 0:48:03Ms. Mathis: Ensuring the va specialized care and services remain available is part of honoring the commitment to those who served. Mr. chairman, we look forward to working with you and the committee. This concludes my formal statement.
▶ 0:48:14Chair Moran: Ms. mathis, thank you for your testimony, for dav's presence before this committee. Thank you. Mr. eaton.
▶ 0:48:23Mr. Eaton: Thank you, chairman moran, ricky member blumenthal, distinguished committee members for the opportunity to speak. Since 2003, wounded warrior project have been working to transform the way america's injured post 9/11 veterans are empowered and fully engaged in their communities. Over the past 20 years, our programs and services have matured to a point where we can engage with each individual based on their unique needs.
▶ 0:48:49Mr. Eaton: Part of our process for helping the warriors is learning more about their journey to wounded warrior project. Some of these veterans have used va for mental health care, others have not. Using va is not a prerequisite to accessing our free programs and services nor is it a requirement to keep engaging with us. The majority of warriors we serve used va and nearly half report using va for mental health care. We also learned about what that care looks like for those who come seeking mental health care support from us.
▶ 0:49:17Mr. Eaton: For some, waits times are still an issue despite efforts to expedite access, many have reported wait times of several weeks to months before being provided with the mental health appointment. This is typically when a veteran or family reaches out to organizations like ours for help. We have relationships with direct care providers and can help triage veterans in the care sooner in many cases. While the va has its community care network for a similar purpose, we have learned some warriors still wait for care well beyond 20 days after we refer to a community provider.
▶ 0:49:49Mr. Eaton: For some of the same warriors and others, we hear frustration of provider turnover at the va. It can take time to develop trust and rapport with a counselor that is critical to effective care. When va mental health care providers leave the system, their patients are left to start over. This can be an agonizing process for some particularly those who struggle to tell their story.
▶ 0:50:09Mr. Eaton: Even as some veterans are refer to the community, an enduring relationship with a community based provider is not always possible as va workloads adjust an authorization for external care lapse after treatment. While these stories are not uncommon, the cot -- challenge we have seen first is accessing care through va's mental health, residential rehabilitation program, rrtp's.
▶ 0:50:32Mr. Eaton: These provide residential, rehabilitative, and clinical care to veterans with a wide range of symptoms, illness, or rehabilitative care needs. Do you get a clear, the va provides inpatient acute stabilization for veterans in crisis suffering from severe mental health -- illness. Rrtp's serve as a step down to that stabilization and a more intense treatment option for those that need substance abuse, ptsd care, and dual diagnosis treatment, for example in a residential setting.
▶ 0:51:02Mr. Eaton: Rrtps serve a small but high need population. Approximately 32,000 veterans received rrtp treatment at the va or in the community in 2023. By contrast, nearly 2 million veterans received individual or group mental health treatment in the va over that sign -- same period.
▶ 0:51:22Mr. Eaton: Despite the logical association between rrtp and health care, the axa standards memorialized in the code of federal regulations do not in practice extend to mental health or substance abuse disorder care provided in a residential setting. This becomes a problem even more pronounced when working directly with high risk warriors at the va or in the community. Stated most simply, we have encountered be a providers that have stopped making referrals to rrtp in the community even when there is no firm idea of when the care will be available in the va direct care system.
▶ 0:51:54Mr. Eaton: When this happens, we will pay -- pay for the faster connection to competent care paid for by donor dollars and with almost no opportunity to secure any reimbursement for the va. We are proud to step in at this point but we know we only see a small percentage of the veterans seeking this critical care. In totality, many veterans are not asks in care they need when they are ready to receive it.
▶ 0:52:16Mr. Eaton: Delays in finding appropriate care in a timely manner not only failed to capitalize on the veteran's desire to change their life circumstances but in some cases cause further damage to their mental and physical health, declines in their family and social relationships, and even involvement with the justice system. To mitigate the risk associated with unpredictable rrtp rrtp rrtp access and ensure consistent health throughout the enterprise, we believe the mission act axa standards must apply to the delivery of residential programs. We want and need the va to be successful in this.
▶ 0:52:47Mr. Eaton: Simply put, the va is our most critical partner in connecting veterans to the residential rehabilitative care they need. In closing, we think the committee and its distinguished members for the opportunity to share our perspective on va community care. We are eager to support your efforts and keep our promise to our nation's veterans. I look forward to your questions.
▶ 0:53:09Chair Moran: In so many instances as you do. Ms. marg, I want to highlight testimony between you and Mr. eaton. You indicated on numerous occasions the care that your husband needed was denied by the va and the suggestion was that you seek care through tricare or through a private organization. Not for profit.
▶ 0:53:37Ms. Marg: That's correct.
▶ 0:53:40Chair Moran: That is despite the fact that charlie had a 70% service-connected disability from the va.
▶ 0:53:48Ms. Marg: Correct. His reading has actually increased, so he is 70% but he is rated as iu, individual unemployability, so he is at 100% rate.
▶ 0:54:02Chair Moran: What was the reason the va made that recommendation that you seek care elsewhere? How did they explain that?
▶ 0:54:12Ms. Marg: At his follow-up visit after the second suicide attempt, the nurse practitioner told us that the va did not do long term mental health well. She turned around her computer screen and pulled up psychology today.com and told us to search and filter for which providers take tricare, to connect to a provider like that.
▶ 0:54:42Ms. Marg: The only explanation was they just don't do long term mental health well.
▶ 0:54:46Chair Moran: Is it true, Mr. eaton, the va could refer charlie to the same place that tricare would be paying for, under community care, the mission act?
▶ 0:55:02Mr. Eaton: Yes, sir, the location would be highlighted and would be eligible for referral.
▶ 0:55:10Chair Moran: That caught my attention, where you have helped find a place for Ms. marg's husband charlie is also eligible for the va to refer to community care. How do you explain that?
▶ 0:55:26Mr. Eaton: I think with a clear defined axa standards, the va is left to other alternatives to find that level of care. It goes back to education but also really clear, whenever a veteran is met with ambiguity in this critical time, you can imagine the barriers they have to accessing care. We need clear standards that are dispersed across the entire va that outline what veterans options are and what their rights are in this case.
▶ 0:55:56Ms. Marg: Can I add something to his statement? When my husband went to tucson, they have a program for veterans, the red white and blue program. My husband was their house with other veterans. Other veterans had the va paid for their care there. It really seems very hit or miss as to what the provider understands and knows what the process is, as to what kind of care they get connected with.
▶ 0:56:24Chair Moran: Really a partial answer to my follow-up question with you again. You know of other veterans, veteran families that have experienced similar circumstances? Are you just a one k circumstance?
▶ 0:56:41Ms. Marg: No, sir. There are other veteran families.
▶ 0:56:45Chair Moran: Mr. golnick, you were nodding your head.
▶ 0:56:49Mr. Golnick: Yes, senator. We saw this a lot at forge. The old saying, what you see at one the va, you see it another va. Like I mentioned in my testimony, visns, vamcs had a great education, others didn't. Unfortunately what happened with your husband, you are getting into those things. It is not necessarily something that is standardize across the system, so that is really the bigger issue.
▶ 0:57:18Chair Moran: Correct me if I'm wrong, my impression is the treatment at the va, if you remain there for the kind of treatment that you need for the circumstances that charlie and Mr. golnick both needed, is often opioid prescription, is that true?
▶ 0:57:39Mr. Golnick: Senator, in some cases. In some cases it is. A lot of can be severely and persistent mental illness that the va works with, pmi. But a lot of times that is the case.
▶ 0:57:54Chair Moran: I don't know if I made my question clear. There are programs that don't involve opioid treatment, but the va's tendency is to utilize opioids as a treatment. Is that true?
▶ 0:58:08Mr. Golnick: In a lot of cases, yes.
▶ 0:58:11Chair Moran: Maybe you already answered my question. Anybody want to add anything to what I asked? If not, we will go to the ranking member. >> the other point that is being missed, the ability to do care coordination at a national level to understand where resources are, wwp has figured it out, they have a great group of people that do complex care coordination. We work closely with them, but that is the absence.
▶ 0:58:40Chair Moran: There is care out there, it's just a matter of if you know about it, you know about it. But you have to know somebody. You need somebody who can navigate the system that way.
▶ 0:58:49Chair Moran: Senator blumenthal.
▶ 0:58:51Sen. Blumenthal: Thank you. What I hear is a common theme. Veterans should have choices. Care should be timely, and that should be high-quality. The most skilled professionals in the world ought to be available right away, especially in cases of mental health crisis, such as you experienced in your husband, Ms. marg. And the best laws in the world account -- demand accountability.
▶ 0:59:22Sen. Blumenthal: The va must be held accountable. One of the best means of holding it accountable is an effective inspector general. Would you agree, Mr. eaton?
▶ 0:59:30Mr. Eaton: Yes, sir.
▶ 0:59:33Sen. Blumenthal: Firing and inspector general sends a message on accountability, and it should be accountability not just for the va, but also for dollars spent on community care. Would you agree with that, Mr. eaton?
▶ 0:59:48Mr. Eaton: I believe so, yes, sir.
▶ 0:59:51Sen. Blumenthal: Right now, the inspector general is barred from that kind of accountability when dollars are spent in community care. And they are scarce dollars. We cannot afford to waste them.
▶ 1:00:09Sen. Blumenthal: Whatever we think about the va, at least there are means of tracking and record-keeping there that often is unavailable when dollars are spent on community care. We spend a lot of time talking about a facility wait times for example. That data is transparent. It can be recorded, tracked, acted upon, but that is not true in the private sector. Mr.
▶ 1:00:38Sen. Blumenthal: Eaton, would you agree that news to be accountability in both the private sector and the va?
▶ 1:00:43Mr. Eaton: I think when you consider access standards, what we have heard from veterans is even if they received a community care network referral, they could be waiting longer in the system, the 20 day mark. Certainly opportunity to identify how we can streamline care throughout the va's integrated system which includes the community care network.
▶ 1:01:06Sen. Blumenthal: That point is critical, the wait times for community care may actually be longer in some instances and we need to guarantee, again, the two systems have to be complement tree, not competitive, that veterans are not delayed in the care they receive. Care delayed can be care denied, as charlie's example shows so dramatically and graphically. I want to thank you, by the way, paige, for being here.
▶ 1:01:38Sen. Blumenthal: I know it is not an easy task. Thank you for telling us, being the voice of charlie's story. I want to talk about the hiring freeze. The hiring freeze was going to apparently deny position being filled in va facilities across the country. Doctors, nurses, attendants, technicians, people who provide direct care.
▶ 1:02:09Sen. Blumenthal: The administration may have walked back that hiring freeze, so far as va facilities are concerned. We are still unsure. Clearly, the hiring freeze still applies to essential core functions the va provides. And I'm going to ask you again, Mr. eaton, because your organization is so instrumental in providing care for charlie, and your organization, Ms. mathis, provide services for thousands of veterans across the country.
▶ 1:02:41Sen. Blumenthal: Isn't this hiring freeze having a detrimental effect on the va?
▶ 1:02:44Mr. Eaton: Thank you, senator, for the question. As our teams analyze the details of the freeze, looking at the exemptions, we note that critical roles like psychologist, therapist, licensed mental health counselors as of now are listed as exemptions. We will continue to work closely with warriors to hear their experience about the system so we can step in, if and when there is an area to support.
▶ 1:03:08Sen. Blumenthal: If there are insufficient exemptions, it will have a deleterious effect, you would agree?
▶ 1:03:15Mr. Eaton: Yes, capacity and timeliness for care is tied to capacity.
▶ 1:03:21Sen. Blumenthal: The freeze on funding affects vital programs. Just one example. Staff sergeant parker gordon fox suicide prevention program provides grants to communities to meet the needs of veterans. You are familiar with it, Mr. lorraine. Including easter seals in new london, wyndham counties in my state of connecticut.
▶ 1:03:49Sen. Blumenthal: That program is now frozen in terms of funding. That is a bad decision, would you agree?
▶ 1:03:57Mr. Lorraine: I think it freezes our ability. We connected 235 veterans a week through the fox grant. 235 veterans I cannot connect to.
▶ 1:04:08Sen. Blumenthal: Thank you. My time has expired. I have quite a few more questions. I hope the chairman will give us a second round.
▶ 1:04:15Chair Moran: Senator cassidy.
▶ 1:04:19Sen. Cassidy: Mr. golnick, maybe three years ago we had testimony that va was giving people ipads and allowing tele mental health and setting up satellite offices in the back of a walmart so it would be like you are going to the pharmacy but instead you sit back there and it would -- you are not going to a psychiatrist with a stigma but very discreet.
▶ 1:04:54Sen. Cassidy: I read each of your testimonies and I didn't see reference to that. I will start with you. What about this tele-mental health program, are you familiar with it?
▶ 1:05:04Mr. Golnick: Again, I think there are lots of good options out there. I am not anti-telehealth. I think veterans should have the opportunity to have the choice between seeing it in person provider versus a telemedicine care, if that is the only option available.
▶ 1:05:23Sen. Cassidy: I only mention that because the rural aspect of it, this is a way so someone doesn't have to drive one hour to getn, fighting traffic and maybe miss the appointment. I am a physician. By the way, Ms. marg, anybody else have experience with telehealth, is it effective? One issue here is the lack of providers.
▶ 1:05:48Sen. Cassidy: It been portrayed to us as a way that providers across the country would be able to provide services someplace else and therefore give some continuity of care and address that need.
▶ 1:06:01Ms. Mathis: We agreed telehealth is an excellent option. When it comes to license portability, there becomes an issue. For va it is not an issue. But if you are talking about --
▶ 1:06:16Sen. Cassidy: Specifically about the va.
▶ 1:06:19Ms. Mathis: Tele-mental health is a good option, complementary with in person.
▶ 1:06:25Sen. Cassidy: Is that being fully used, is it fully effective? A lot of what we have here is a shortage of providers, and therefore requiring long wait times and/or referral.
▶ 1:06:39Ms. Marg: My husband has utilized telehealth before and some of his referrals to community care. Personally for him, he would rather choose to see somebody in person given the opportunity, especially when he is talking about his mental health struggles.
▶ 1:06:55Sen. Cassidy: Next, again, on a physician. When there is so much churn, and that has been a feature of the discussions in mental health and the va for some time. It is telling me something is wrong. It could be that salaries are less. Why would you take the job in the first place? Or it could be that the administration is so frustrating that people just don't want to spend the rest of their life in this sort of situation.
▶ 1:07:24Sen. Cassidy: You are on the outside looking in perhaps but you may have special insights. Any ideas as to regard so why there is so much churn among providers?
▶ 1:07:34Mr. Golnick: In terms of them getting into the va?
▶ 1:07:38Sen. Cassidy: One of the things I read said that there was this constant provider turnover. When you're trying to get that report and six months you have somebody else. Six months later you have somebody else. We have seen previous statistics where there is a lot of hiring but a lot of departures. There is a pattern there, and it is disruptive of the patient-physician relationship.
▶ 1:08:05Sen. Cassidy: Do we have any insight as to what may be causing the churn?
▶ 1:08:13Mr. Lorraine: One of the things that we see, churn not just leaving the va but moving within the va as well. I mention continuity in my testimony. Continuity is critical. When we talk about telehealth, seeing a patient face to face as a provider myself, cannot be replaced -- it can be augmented and enhanced by telemedicine. But in terms of the churn, you are moving within an enormous va system.
▶ 1:08:44Mr. Lorraine: It is not just leaving the system, it is leaving the facility you are in.
▶ 1:08:47Sen. Cassidy: So they go from des moines, iowa to new orleans.
▶ 1:08:52Ms. Marg: Or move to -- Mr.
▶ 1:08:55Lorraine: Or move to another facility.
▶ 1:08:57Sen. Cassidy: Theoretically you have system to deal with that.
▶ 1:09:01Mr. Lorraine: You lose the continuity. It is a churn.
▶ 1:09:06Sen. Cassidy: Ok. Thank you all for your testimony. >> thank you, Mr. chairman. Thank you for being here today and for your service to our country. Whether by direct service or family of a service member. Testimonies date illustrates the ways that we are failing our veterans especially when it comes to veterans seeking mental health care.
▶ 1:09:32Sen. Cassidy: My personal experience, when I got back from the war, I tried to go right to my va and asked for services for ptsd. Was rejected because my paperwork had not caught up. Continue to try to get help as well as many others I served with, and actually avoided therapy for almost 12 years after that.
▶ 1:09:54Sen. Cassidy: Luckily, now in, have been, but a lot of us have missed opportunities to really put ourselves on the right path because of va bureaucracy back in the day. This was 2005, 2 thousand seven timeframe. This is very personal to me and even though I talked to my brothers in arms who are now also going through different levels of therapy and/or rehabilitation, so thank you for the testimony you are providing. This is obviously important.
▶ 1:10:26Sen. Cassidy: As well as also, getting somebody from the va to talk because they could have brought us a very good first-hand experience about what really effective contracting looks like, as well as asking the government accountability office about their assessment of the program last year. I think that would have been a very good perspective because we need to look at this holistically.
▶ 1:10:51Sen. Cassidy: For us veterans that you services, get ptsd services, we know the best way to deal with anything of this nature is holistically. Mr. golnick, thank you for sharing your experience seeking mental health care through the va and for the work you are doing with forge health. English is my second language. Sometimes I mess up things. Also have the experience of seeking care and dealing with the trauma of being told that you cannot get help. It is too common of a story among us veterans.
▶ 1:11:22Sen. Cassidy: It is our responsibility to ensure veterans have access to timely high quality health care. In your testimony, you said that, the men I was able to help catch in the first months of trauma were the ones that were able to recuperate and put on a good path. Those that we were not, it has been a long trial. You mentioned the collaboration between forge health and va community partnerships but also how these ongoing challenges.
▶ 1:11:49Sen. Cassidy: Can you speak more specifically about what you saw in terms of inconsistent implementations and what solutions would you recommend be implemented to address these issues in particular?
▶ 1:11:57Mr. Golnick: Thank you for the question, senator. Going back to what I mentioned previously, there are some visns , vamcs that are very collaborative and work well within the system, if there are delays, and there are some where they were basically told not to refer out no matter what the case was.
▶ 1:12:20Mr. Golnick: The standard of how we fix this in my personal opinion is to figure out a way to standardize those standards across the system, to wear, every visn, vamc has the same standards on how they will refer out, the number of people. I understand community care costs money. Again, senator, when you have a veteran and you don't catch them in time, and they end up going to the emergency room, it becomes way more expensive. So how do we go upstream to prevent that?
▶ 1:12:53Mr. Golnick: That standardize practice across the visns and vamcs is an important piece.
▶ 1:12:57Sen. Gallego: Some of it is sop's, no matter what unit of the military you were, you did sop's so you didn't have massive retraining.
▶ 1:13:08Mr. Golnick: Unfortunately, you saw it from the vamc, where the providers, the people referring out would say I'm trying to refer. I understand this veteran needs the care but the visn is telling us no.
▶ 1:13:24Sen. Gallego: Naomi, great organization. They actually help me get my va disability rating. Thank you so much. I wanted to follow-up up on that. Totally lost my train of thought. Currently any standards in place to make sure that community care providers are adequately trained to treat these kind of conditions?
▶ 1:13:48Sen. Gallego: Also have you seen any specific instances where the lack of veteran specific training, standards have negatively impacted the quality of veteran care, at these people, constituents of the dav, other organizations?
▶ 1:14:02Ms. Mathis: Thank you for the question, senator. Correct. There is a lack of training in community care. Currently, community care providers are only required to have opioid abuse treatment training. As far as compared to direct care.
▶ 1:14:25Ms. Mathis: There is a difference between what the direct care providers are required to have and the community care providers. This is why we believe that if you strengthen the va direct care, then you would have better health.
▶ 1:14:52Sen. Gallego: So, community care, only ends up getting treatment specifically for opioids but not for example trauma or deep trauma or things of that nature. There is probably a mismatch at that point where you say there's probably a better investment indirect care or hyping of community care and making them more accessible to traditional ptsd?
▶ 1:15:20Mrs. Mathis: Where they would understand military culture. You might have a veteran that presents before military care providers and they are missing cues where this patient may actually be suicidal. >> Ms. marg, I apologize what happened to your husband.
▶ 1:15:49Mrs. Mathis: I had a couple of friends go through the same situation. Terrible outcome. Some were arrested at the v.a. For not having an appointment and run off of the property. It is a terrible mess. How do you communicate with other service members or family who come to you and ask you about your husband's problem? What is that conversation like?
▶ 1:16:12Ms. Marg: I will tell them that any story that they've heard about the v.a. Is true. When I have heard other people's stories, when I first heard them I was surprised and shocked. This must be a one-off situation. My husband has been medically retired since 2015 and it seems like every step along the way it is just such a struggle.
▶ 1:16:44Ms. Marg: There have been many times when my husband has just felt that he has done, and I tell him that he is not, and we just keep fighting. Sometimes it takes going to an outside entity to get help, which I am incredibly hopeful that exists, but that is ridiculous.
▶ 1:17:11Ms. Marg: >> I heard you say in your opening statement, are we having problems getting information from the dod to the v.a.?
▶ 1:17:18Ms. Mathis: Yes, sir. >> and we spent billions of dollars doing that? Not millions, but billions? I wonder why we need a new ig. I wonder why we need to freeze the funds until we find out what is going on? It is absolutely embarrassing.
▶ 1:17:39Ms. Mathis: The biggest health care system in the world, the second largest budget in our country, and we can't figure out how to get information from one entity to the other. I have talked to people who said that they could do it, but we won't go to those people for some reason. We keep going to the same people. Any follow-up?
▶ 1:18:00Ms. Mathis: Senator, I think that that is something that v.a. Needs to really get a handle on, which is the records issue, the electronic health records system. I believe -- I probably misspoke. V.a., dod are probably easier to speak to each other, but when you talk about community care and v.a.
▶ 1:18:28Ms. Mathis: Is where you have the rub. Where you have the issue. Records are not coming back in from community care and they are not going out. Say, for a mammogram. If I go for a mammogram for three years in a row going to the same provider and then v.a. Sends me to another provider, the provider that is going to look at that radiograph needs to see the other images, not just the report.
▶ 1:19:01Ms. Mathis: And then the onus is on the veteran to transfer those records and images from one provider to the next or from the provider to v.a.. That is where they need to have an interoperable system that talks to each other.
▶ 1:19:20Sen. Tuberville: Just as bad with the v.a. Of information going back-and-forth and forth with disabled vet?
▶ 1:19:26Ms. Mathis: In dav?
▶ 1:19:30Sen. Tuberville: The same problem information-wise, the exchange of information from one entity to another?
▶ 1:19:37Ms. Mathis: From v.a.? From v.a. To dod they have actually worked on that with oracle. Really the issue is from community to entity.
▶ 1:19:59Sen. Tuberville: Thank you, Mr. chairman. >> thank you, Mr. chairman. I want to welcome our witnesses. Family members, caregivers, and thank you for standing by your husband. As far as dav, you hold my power of attorney as well. That says something. Mr. eaton -- yeah, both.
▶ 1:20:29Sen. Tuberville: Mr. eaton, I think I was the first female patient to receive one of the backpacks that the wounded warrior project handed out at walter reed. I was one of the first 10 handed out. It unfortunately had jockey shorts, socks, and a shaving kit, none of which I could use, but my husband thanks you for them.
▶ 1:20:56Sen. Tuberville: My children took my advice and readjusted, but certainly the wounded warrior project was there for me early on. I want to bring attention to what donald trump signed last night and what my colleague touched on briefly. All federal grant paused today. We are in a hearing room full of policymakers and citizens dedicated to the welfare of our nation's veterans.
▶ 1:21:24Sen. Tuberville: Let me tell you what it means for you and your loved ones who received care from the v.a. It will pause grants ranging from community-based suicide prevention efforts to rural veterans' telehealth access and transportation services come to the hiring and retention of nurses and veterans' homes, and so much more.
▶ 1:21:48Sen. Tuberville: It is sadly ironic that we are here today to discuss expanding access to care for veterans and the trump administration is actively preparing to restrict their access to care in a few hours time. What happens in the meantime to veterans who rely on these grants or suicide prevention resources? What happens to rural veterans who rely on transportation services? What happens to veterans who rely on these grants to live independently?
▶ 1:22:14Sen. Tuberville: This eo, which is illegal, creates chaos and threatens the stability of programs that in many cases offers lifelines to those people who sacrifice for their country. Congress has the power of the purse. Trump freeing loans that congress approved is unconstitutional and will hurt millions of people across this country.
▶ 1:22:36Sen. Tuberville: I hope that my republican colleagues and courts have the spine to stand up to trump in the face of this cruel and unconstitutional order that hurts everyday americans, including veterans.I could not agree more with the frustrations that have been described trying to access care through v.a. Within the v.a. Itself as well as through community care. I have both. I get care in the community because the v.a. Cannot provide me care with extremely advanced prosthetic devices I use.
▶ 1:23:07Sen. Tuberville: I should have the right, and I do have the right, to choose who provides me with that care. It is ironic. The v.a. Provides care for my left leg, but the community provides care for my right leg. It's important to me that they talk to each other, because otherwise it makes it very difficult to walk. Ms. mathis, you are touching on the communication piece that is important. When I went from dod to v.a.
▶ 1:23:35Sen. Tuberville: I was given a cd-rom. I had to wait 90 days to talk to v.a., at which point I saw a physician assistant who job it was to determine whether or not I was still an amputee. It was a waste of his time and my time. He wanted to be taking care of veterans and yet had to go through this rigmarole. They still lack a good transferring of information from the dod to the v.a..
▶ 1:24:05Sen. Tuberville: It is also compounded when you go to community care. I do think that we need to do much more to allow veterans to make their own decisions. Mr. golnick, I appreciate you bringing attention in your testimony about veterans being able to make the decisions. How should v.a. Ensure that veterans get the information they need to make decisions about their care, including receiving direct care at v.a.? V.a.
▶ 1:24:34Sen. Tuberville: Needs to be a medical center home. V.a. Is your medical center home. They say you are an iraq veteran, we will take care of your mental health but you may also have respiratory illnesses. You need to be informed. If you want to go to community to get care, that should be made seamless. Can you speak to that?
▶ 1:24:53Mr. Golnick: I think it is an education thing. On ground level, both of you have seen this before, the clinicians at the ground level at v.a. Want to do the right thing. They want to get veterans into care immediately. I think where it gets gunked up is when it gets to a different level. They're putting in the referral. In terms of educating their needs to be education of these are your options.
▶ 1:25:24Mr. Golnick: Here is what we can't provide. This is the process to do it. I think there needs to be an education on the ground level all the way up.
▶ 1:25:41Chair Moran: Senator blackburn. There is a vote at noon. We have less flexibility then we used to have in rolling the timeframe. I will try to keep everyone to their five minutes.
▶ 1:25:55Sen. Blackburn: I appreciate what senator tuberville said and senator duckworth alluded to this. It is very difficult for the veteran to get their records. I think one of the things we should look at is, who owns those records? It would be so much more helpful if the veteran himself controlled those records.
▶ 1:26:24Sen. Blackburn: If individually we owned our health care records, every one of us, and then that way you wouldn't have the problem you're talking about, Ms. mathis. The veteran would be in charge of their records and would be able to take it, whether they are in community care or try care -- tri care. We have seen an inordinate amount of waste in trying to build the electronic health records.
▶ 1:26:54Sen. Blackburn: Whether it is cerner, epic, oracle, they can't figure this out. In nashville, tennessee we have a lot of health I.t. Innovators to figure this out. One way to do it is let individuals, not the doctor, not the insurance company, not an agency, own their health care records.
▶ 1:27:16Sen. Blackburn: I find it sad that for many of our vets, tunnels to towers and wounded warrior are those that can help them get help because the v.a. Cannot figure out how to do their job. They are still working remote. They do not show up. It takes forever.
▶ 1:27:36Sen. Blackburn: That is why there are 956,000 claims in the queue, and over 120 days, and veterans cannot get a response from these people. I know a lot of it is because of the union that is at the v.a. That is stifling access to this care and benefits.
▶ 1:28:02Sen. Blackburn: I find it just something that should not be tolerated. It is frustrating to the veterans we are trying to serve. It's why community care is so vitally important. Mrs. marg, thank you for speaking to that. Mr.
▶ 1:28:25Sen. Blackburn: Golnick, thank you for your service and for what you are doing with forge in trying to solve a problem, because the v.a. Has thrown up barriers to health care. You are trying to get around that and improve access. I want you to give, like, 1, 2, 3 point. What could this committee require the v.a.
▶ 1:28:55Sen. Blackburn: To do to improve that access?
▶ 1:28:57Mr. Golnick: Just to be clear, I am the cofounder of forge. I stepped down from full time so I am representing myself. I will say that there are things -- and to your point, there are friction points preventing veterans from getting access to care. Especially when you're talking about mental health. With this committee can do is work with the v.a. To ensure that they are educating veterans. That the v.a. Is educating veterans on what their options are.
▶ 1:29:27Mr. Golnick: Number two, would be the administrative side of this. Ensure that the access standards are codified so that people within v.a. System know that if x then y. As simple as that. Then ensuring that there is oversight on certain v.a.'s in terms of that care, making sure that that care, the veteran is the true north star.
▶ 1:29:56Mr. Golnick: It is what their local budget is or anything else. Veterans should be the true north star of decisions.
▶ 1:30:03Sen. Blackburn: Putting the veteran at the center is why I have the v.a. Health care freedom act that would remove those obstacles and really put the criteria and the mission act for eligibility for community care, and give full choice to veterans in select regions.
▶ 1:30:26Sen. Blackburn: Let's roll this out as a pilot project and put it on the four -your path to fully implement it, so that a veteran can get what they need when they need it, where they need it, show their v.a. Card, and the v.a. Gets the bill, not the veteran. That would solve this and this enormous backlog that we have. Give the veteran the choice. Put them at the center of this. Thank you, Mr. chairman.
▶ 1:30:54Chair Moran: Senator king.
▶ 1:30:57Sen. King: In answer to senator tuberville's question, the beginning started with the no-bid contract about five years ago, six years ago, that was extended by the last administration. I still don't understand why we don't go to the market. I'm sorry that you mentioned epic. Epic is a successful medical records system that I observed in my system. Well, ok.
▶ 1:31:28Sen. King: In any case, it seems that in order to analyze the issue of the relationship between v.a. Direct care and community care we need more data. We know exactly the v.a. Wait times and all of those kinds of things. We don't have that kind of data in terms of the private sector. The private sector in maine, it is hard to get an appointment. Particularly with a specialist.
▶ 1:31:57Sen. King: I think in order to make policy care, Mr. chairman, we need some information. We need to have cost comparisons, we need to have time comparisons of wait times. Everyone is nodding. That won't show up in the record. Can someone say yes?
▶ 1:32:16Ms. Mathis: Yes, senator. I wholeheartedly agree. There is no data from the community back into v.a. There is no sort of accountability either when the records don't show up back to v.a. You have a provider, a primary care provider at v.a., that may have sent a patient to the community for specialized care.
▶ 1:32:43Ms. Mathis: The information when the patient comes back to v.a., the information isn't coming back and therefore that provider is not able to provide an accurate treatment plan for that patient.
▶ 1:32:52Sen. King: We don't have a handle on cost, quality, or time? Correct?
▶ 1:32:58Ms. Mathis: Correct, senator. When we are talking about the time of v.a.'s responsibility and backlogs, a staff freeze isn't going to help that problem. If there are fewer people to answer the phone, fewer people to process claims, that will only exacerbate the problem, not make it better.
▶ 1:33:21Ms. Mathis: I noticed the administration the other day appeared to walk back part of the hiring freeze with regard to direct care providers, but to leave a hiring freeze in effect that has fewer people responding, processing claims, those sorts of things, that is in effect a denial of benefits itself. Is it not, Mr. eaton? Mr. eaton yes. That is where we come in. Senator duckworth mentioned the backpack.
▶ 1:33:51Ms. Mathis: We received our start in 2003 providing backpacks to the first entered, ill, and wounded warriors coming back from iraq and afghanistan. We promise we will be there for their needs for a lifetime. We are doing that where there are changes in the system that we can be a constant to support them and remove barriers to increasing access to care.
▶ 1:34:12Sen. King: One other aspect with private sector is, there are huge shortages in the private sector. My major hospital, one of my major hospitals in maine is down something like 800 nurses. To say it is not a -- it is not to say it is not a -- it is not enough to say the community can take care of it when there are shortages of cna's, nurses, psychiatrists, psychologists.
▶ 1:34:45Sen. King: I think that we need to recognize that. That there is no simple answer to this. To me, the answer is better coordination, better data, and understanding the results that we want for our veterans. That is the goal, correct?
▶ 1:35:04Mr. Eaton: Yes, absolutely. Even the private sector, commercial payers aren't even collecting this data because it makes them look bad if the wait times are too long. It needs to be complementary.
▶ 1:35:17Sen. King: I just want to make sure we are comparing apples to apples when we decide policy, and we don't move towards a policy in the real world that doesn't necessarily improve things for the veteran. I am just concerned that we not hollow out the v.a. Capacity and say, look, the v.a. Is not doing very well when we have made it impossible for them to do it, to do the work that they have been charged to do.
▶ 1:35:49Sen. King: I appreciate you joining us here today and I look forward to continuing to work with you. I think that this is an issue that needs attention. Thank you, Mr. chairman.
▶ 1:35:57Chair Moran: The elizabeth dole act that we passed and became law requires significant data collection regarding community care. Maybe we will have some information and can make that analysis. I also point out that I have argued with the v.a. About when the wait time starts.they want to start when the appointment is made not when the veteran asks for the appointment.
▶ 1:36:20Sen. King: It ought to start with the call.
▶ 1:36:23Chair Moran: Yes. Thank you. Senator cramer.
▶ 1:36:27Sen. Cramer: Thank you for being here, for your testimony, and for your service. A couple of things come to mind. With regard to senator king's comments about the shortage of workforce, that is a real problem. It is a problem in health care, in manufacturing, in everything, but it's particularly challenging in health care. Which is why the staffing rule is so awful.
▶ 1:36:58Sen. Cramer: It literally, literally provides less opportunity, because it runs the risk of shutting down health care providers simply because they don't have a 24 hour per day, seven day a week are -- seven day a week rn. It isn't just quality of care, it is access, period.
▶ 1:37:24Sen. Cramer: I would also submit that I don't share some of my friends' view that it shouldn't be competitive. I think that the best way to improve care is competition. Whether it is competition against -- competition between the private and public sector, two private sector, or two public-sector agencies, little bit of competition. I agree I don't want to got the v.a. Direct care -- gut the v.a. Direct care.
▶ 1:37:56Sen. Cramer: I had a veteran who would drive 300 miles every day before he would see a local provider, particularly for counseling. All of that said, there are all kinds of barriers to community care. A lot of it is the bureaucracy itself. In north dakota where we have quite a cooperative va hospital in fargo, we hear many stories of roadblocks being put out to community care.
▶ 1:38:25Sen. Cramer: They check all of the boxes except for one, or they only check 99 out of the 100 boxes, therefore null. I agree with what senator blackburn said. If we put the choice in the hands of the veteran, the market will determine where they go. The type of care they get will determine where they go. How long the wait is will determine where they go. North dakota, we have one v.a.
▶ 1:38:56Sen. Cramer: Center and it is in fargo. Right on the red river, literally. It is on the shores of the red river which is the border to minnesota. If you are in williston, or dickinson, you might be 400 miles away from the va hospital. We have 37 critical access hospitals. Critical access care hospitals are there on purpose and has to do with access.
▶ 1:39:25Sen. Cramer: They are reimbursed by cms and their particular formula. By the way, I think it is just a handful of those in the same access as a critical access hospital. If training is required, I am for.
▶ 1:39:57Sen. Cramer: The critical access hospitals, they are barely hanging in there. Two or three or five more patients in the community might keep that hospital open. If it is 50 miles to the next hospital or 350 miles to the va hospital, that access, critical access hospital, might be the only provider that can save a veteran. I would like to make this automatic. No doubt smart people can figure out the records thing.
▶ 1:40:30Sen. Cramer: Maybe we will start with you. Am I somewhere in the ballpark of a possible solution in a very, very rural place?
▶ 1:40:42Mr. Lorraine: I have been to my not -- minot. I know how cruel it is. -- rooney rule it is.
▶ 1:40:53Sen. Cramer: That is one of the biggest cities.
▶ 1:40:56Mr. Lorraine: I want the staff nearby. We talk about mental health and substance abuse, but it is about access to health care. It is surgery. How many total are done in this location? We need to look at what is the best long-term outcome for a veteran in terms of getting their care. It might be the v.a. In their community.
▶ 1:41:21Mr. Lorraine: It might be the local hospital that the family can be present, the physical therapist, the staff is invested and it is all one.
▶ 1:41:30Sen. Cramer: I would rather have it easy than confusing and a likely denial of community care.
▶ 1:41:41Sen. Hassan: Thank you to all of our witnesses for being here today. Whether you have served or been an advocate for veterans or both, we appreciate your support for and commitment to our veterans and our nation. I appreciate that this hearing is focused on community care. It is important to providing care for our veterans come especially in new hampshire which doesn't have a full-service va hospital of its own.
▶ 1:42:11Sen. Hassan: It matters that we get this right and ensure that veterans who qualify for community care really get prompt access to it. Understanding a senator king has pointed out that access in the community care system is challenging for private citizens as well. Before I get to questions, want to take a moment to discuss what our ill legal and constitutional acts by this administration because of the way they affect the issues we are talking about today.
▶ 1:42:42Sen. Hassan: As senator duckworth referenced, last night the administration ordered a full halt on a lot of federal funds, including some states now locked out of medicaid funds. Community care in rural areas that senator cramer was talking about won't exist if rural hospitals don't exist. They are very dependent on medicaid. The administration appears to be halting that funding as it is halting critical funding today for veterans in rural areas that depend on it.
▶ 1:43:10Sen. Hassan: The administration took an illegal act when it decided to unilaterally try to fire inspector generals contrary to law. This is troubling for a lot of reasons, but for example the v.a. Inspector general's office released a report last fall on community care scheduling delays in the v.a. Health service.
▶ 1:43:36Sen. Hassan: The administration is unilaterally contrary to law decided to fire all of these inspector generals. The report that the inspector general did concluded that leaders had failed to focus on the patient, respond to staff concerns, and get to the root cause of concerns related to delayed scheduling of urgent consults.
▶ 1:43:58Sen. Hassan: This type of work of holding government accountable and making sure the system operates as efficiently as it can is at the heart of what independent senate-confirmed inspector general do. That is why I'm concerned by president trump's illegal firing of at least 17 inspectors general over the weekend, including the v.a. Inspector general who was confirmed to that decision with unanimous consent by the united states senate. The letter to these inspector general said that priorities were changing.
▶ 1:44:28Sen. Hassan: That is what the donald trump administration said. What greater priority is there than to ensure that taxpayer dollars are used well? It is in the interest of every american these public servants be able to investigate without political interference and stand up to powerful interests without fear of losing their jobs. We owe that to our country and especially to our veterans. I have time for a couple of questions. I want to start, Mr. eaton, with you.
▶ 1:44:58Sen. Hassan: In your testimony you discussed some of the obstacles that veterans encounter when seeking little health care, and in particular identified that more providers are needed regardless of whether they are in the community or in the v.a. System. Mr. eaton, can you speak to the need for veterans to have access to steady, high-quality mental health treatment, and how increasing the number of mental health providers could support that?
▶ 1:45:28Mr. Eaton: When you think about an effective care team, and we understand the first of all the personal journey that it takes to get to the first appointment, building the relationship, the report, -- the rapport, telling your story. As they are transitioning it leaves the veteran to navigate again on their own. As we have highlighted today, not only a veteran issue, but also civilians in general, mental health is a shortage area.
▶ 1:45:57Mr. Eaton: Looking at ways to incentivize providers to create environments where practicing medicine and mental health is a thriving environment. It is important as we hope to build assistance.
▶ 1:46:08Sen. Hassan: Community care provides a chance to receive timely quality care close to home for many veterans who don't live near v.a. Facilities. This is especially true for rural veterans and veterans in states like new hampshire who don't have a full-service va hospital. Could you please discuss the importance of ensuring timely access to local care for rural veterans and the role that community care plays in ensuring that veterans get the care that they need and deserve
▶ 1:46:39Ms. Mathis: Thank you for that question. As outlined in the mission act, it should be complementary, the two. We believe that access to community care is essential, especially in a rural community where you are fighting with the community to get specialized care. So, yes, absolutely access is critically important and really could be lifesaving.
▶ 1:47:07Sen. Hassan: Thank you, Mr. chair.
▶ 1:47:09Chair Moran: Mr. golnick, health care organizations get more frustrating and impersonal the bigger that they get. I think we all agree. The veterans health administration is the largest hospital system in the country. Why do you think the v.a. Is so bureaucratic, and what can congress do to change that culture?
▶ 1:47:31Mr. Golnick: That is a tough question. Every large health care system is frustrating. There are a lot of things that are structurally and place that I think are important things. Safety, especially talking about mental health. Accreditation. Clinicians should have a certain criteria. I don't think that it is on the clinical side that we are seeing the issues. I see the issues in the administrative.
▶ 1:48:01Mr. Golnick: The processes that are in place now between v.a. And community care, back and forth, what my colleague from dav has been talking about, I think that is where there could be good work done in codifying those access standards so that everybody in this bureaucracy -- I look at things as a naval officer. They said that the instructions are written in blood.
▶ 1:48:27Mr. Golnick: There needs to be a very clear line that shows, ok, if x then y. We don't see that a lot in these places because there is no standardization.
▶ 1:48:38Chair Moran: As a navy officer you understand culture. How can we change culture? What can members of congress do to force that culture to change?
▶ 1:48:49Mr. Golnick: I think the ability to ensure that the leadership at v.a. -- I've talked to some directors in my time where they said, you know, I give directives not orders. Right? Sometimes things are not just followed.
▶ 1:49:12Mr. Golnick: In order to change that culture I think really streamlining and codifying things in a more clear manner and having a sop and things in place will ensure that people are following the letter of those instructions.
▶ 1:49:24Chair Moran: Mr. lorraine, we hear about community care being too expensive. It accounts for 40% of veterans health care making up 25% of the v.a. Budget. That sounds like a good deal, isn't it? >> it is. I don't think we've given enough chance to community care to measure the long-term impact of local, meaningful, well-rounded health care.
▶ 1:49:48Chair Moran: The other thing if I can add to the question that you asked eric , in my opinion the veteran needs to be the center of the universe for the v.a., not the v.a. The center of the universe for the veteran. >> well put. The v.a. Added 120 thousand employees over the last decade. I support giving the v.a. The resources it needs to take care of our veterans. There are only so many doctors and nurses to hire. How can the department deliver health care with the personnel that it already has?
▶ 1:50:20Mr. Lorraine: There needs to be not managed health care but coordinated care. Someone needs to take responsibility for the veteran and connect them to private organizations like ww p, health care providers in the community care network, and the v.a. To look for the best opportunity. But to unify and coordinate the care for the best outcome. It doesn't just need to be in the v.a.
▶ 1:50:45Sen. Banks: We want vha care and community care to complement each other and not compete. What v.a. Policies need to change to make that happen?
▶ 1:50:59Mr. Eaton: We have had standard access throughout the board. We think vha as the largest integrated health network, direct care, but also these are cultivated networks created in partnership with third-party administrators that have been found to offer high-quality, veteran-centric care. Having the same standards care coordinated throughout the system, not thought about as two separate, would be a great first step.
▶ 1:51:25Sen. Banks: The v.a. Has 120 mental health rehab facilities. Veterans in crisis are waiting for three weeks to get placed. It takes the v.a. Three to five years to lease a new facility. Do you think that the v.a. Could open enough residential rehab facilities to fully meet the veterans' needs?
▶ 1:51:44Mr. Eaton: I think if we take a step back, that is why the community care network exists to complement the v.a. In areas where there is higher demand, gaps, and veteran needs are most sought. If we look at inputs from footprint from the v.a. And community care network, we will have all of the data points to make an informed decision.
▶ 1:52:05Chair Moran: Senator banks, thanks. We are not doing another round. If someone else walks through the door I am in trouble on time. Senator blumenthal has a couple of questions, I have a couple of questions, and we will wrap this up. A boat was expected at noon. We don't have the flexibility because we are attempting to enforce the votes only lasting 15 minutes. We used be able to do this differently, but we cannot.
▶ 1:52:36Sen. Blumenthal: I have a few questions answerable by yes or not. What I am hearing, as Mr. lorraine said so well, is that veterans should be the center of the universe, veteran's decisions should be informed so that the veteran's medical interests is put first.
▶ 1:53:00Sen. Blumenthal: An informed decision cannot be made by a veteran waste on -- by a veteran based on an ad that they see on television saying, get this drug. Anybody watching tv these days, you are deluged by ads depicting certain drugs as cure-all's. Veterans should be permitted to go into the community and say, give me this opioid. I assume that all of you would agree?
▶ 1:53:30Ms. Mathis: I would agree, senator.
▶ 1:53:33Sen. Blumenthal: I am taking the absence of disagreement as yes. Let me pose another question quickly. My fear, as I said at the beginning, is that there will be an erosion, a starving of the v.a., because of the attempt to shift care to the community without veterans having choices will mean less investment in the v.a. System.
▶ 1:54:04Sen. Blumenthal: In connecticut we are rebuilding our v.a. Facility in west haven. It will provide for new surgical suite, new parking, new care facilities -- particularly for women. That type of investment will make v.a. Care better than it is now. I assume all of you would agree that we need to make those capital investments in v.a.
▶ 1:54:27Sen. Blumenthal: Facilities across the country, and maybe build facilities in parts of kansas that right now don't have any. Would you agree?
▶ 1:54:40Mr. Lorraine: I disagree. I don't think we can build enough v.a. Facilities to meet the needs of every veteran in the united states. I think that there needs to me a merger between v.a. Facilities and not.
▶ 1:54:54Sen. Blumenthal: You are absolutely right. If I was unclear, I'm not saying that v.a. Facility should be billed for every veteran. We need some community care, no question, but the v.a. Facilities that exist now serving veterans in connecticut or kansas should be the gold standard. They ought to be top-flight. They ought to give veterans the best care possible. Would you agree?
▶ 1:55:19Mr. Lorraine: 100%.
▶ 1:55:21Sen. Blumenthal: Thank you. Let me conclude by saying, you know, this conversation seems a little bit surreal this morning, because I am hearing from -- I am getting emails from health care groups in connecticut whose funds have been frozen.
▶ 1:55:46Sen. Blumenthal: These are suicide prevention, addiction treatment, payrolls are halted, their budgets are in danger. We are talking about community care potentially decimated. There is chaos and confusion as a result of this freezing of funds.
▶ 1:56:06Sen. Blumenthal: In my prior life as attorney general in the state of connecticut I would be in court saying that this action is illegal, it is unconstitutional. Congress has the power of the purse. It is a seizure of that power, monarchical.
▶ 1:56:31Sen. Blumenthal: Putting aside the legalities, it is potentially devastating to health care for veterans. The fox suicide prevention program that was mentioned is just one of literally tens, maybe hundreds of programs that are in peril right now.
▶ 1:56:52Sen. Blumenthal: So, I call in my colleagues to join in protesting and once again I ask veterans to rise up and say, please, Mr. president, clarify that you aren't going to make veterans the victims of this illegal policy. The same point that I would make as to the firing of the inspectors general. Accountability for community care as well as veterans care.
▶ 1:57:24Sen. Blumenthal: Let's put veterans care first and foremost, including holding accountable the v.a. The v.a. Ought to have its feet to the fire, as michael missile has done as inspector general. He saved $40 billion, a rough estimate. There was a mention of the electronics record program.
▶ 1:57:53Sen. Blumenthal: There was a provision in the dole act that would have provided more accountability for the electronic records program. Apparently it was deleted at the last moment. I think that we can include it in whatever legislation we passed. I am fully in favor of making sure that standards and criteria are applied and that they eliminate wait times, whether at the v.a. Or community care. Mr. chairman, I appreciate your leadership.
▶ 1:58:23Sen. Blumenthal: I know you made reference to the importance of inspectors general when we had a hearing recently. I think that this cause can be bipartisan, and the hiring freeze, as Mr. eaton said so well, can be clarified so that it doesn't affect the v.a. And our veterans care.
▶ 1:58:41Chair Moran: Thank you, ranking member. There are five minutes left in the vote, but I still have questions. So, we are about done. Mr. eaton, Mr. lorraine, both the wounded warrior project and america's worrier partnership have seen trends indicating pressure from v.a. Administrators on v.a. Providers to not place referrals for care in the community.
▶ 1:59:14Chair Moran: Would one or both of you explain what you've seen?
▶ 1:59:17Mr. Eaton: What we are hearing from clinicians is that the pressure from an administrator perspective to minimize referrals out, and even a referral decision made at the administrative level versus clinical level. This means instead of going out into the community, a longer wait time within the v.a.. It could result in a different level of care than initially indicated.
▶ 1:59:43Mr. Eaton: Whether individual counseling could be shifted into a group setting, which is not aligned with what the veteran was looking for or what his clinician recommended for him or her.
▶ 1:59:53Chair Moran: Let me point out what I think is obvious. That can be contrary to what is in the best interest of the veteran patient. Who but the v.a., including their administrators, ought to be the most interested in the quality and timeliness of the care that a veteran or sleeves? I spoke about this and it bothers me because of my involvement in veterans issues first long as I've been in congress.
▶ 2:00:24Chair Moran: I sometimes can get individual cases altered, to fix a problem for a veteran, but it doesn't seem like when I do that it fixes the problem for the system, for every other veteran experiencing the same thing. I highlighted on the senate for the veteran in my hometown who was receiving cancer treatment. 60 treatments receiving them in the community at the authorization of the v.a. He had 59 treatments of the 60 that he needed. The v.a.
▶ 2:00:52Chair Moran: Called him back to the va hospital for the 60th treatment. The other example is the constant -- I have indicated so many times of what I think I know based on what I hear from veterans. Casework is part of that. The number of times that the chiropractic care has been recalled back out of the community.
▶ 2:01:19Chair Moran: You have a veteran who has been receiving chiropractic care with the same chiropractor for months and years, but the v.a. Says that that is no longer permissible. Community care won't cover your visit to a chiropractor. Come back to the v.a. Those decisions can't be deemed made on the best interest of the veteran. I was involved in the creation of the mission act.
▶ 2:01:46Chair Moran: One of the components by which a person can be referred to the community care is what is in the best interest of the veteran. We intentionally defined the best interest of the veteran to be determined by the veteran and his/her provider, not an administrator at the v.a. So it is made on the best health care interest of the veteran, not the caseload or financial interest of the v.a.
▶ 2:02:16Chair Moran: I'm all interested in seeing that the law is complied with. That is what I've spent so much time trying to convince in recent months the v.a. To utilize the mission act in the way that it was not only intended but in many instances actually written. We are trying to get the law to be the law with the v.a.
▶ 2:02:42Chair Moran: I appreciate the testimony that we heard today, and I think that there is a take away for me, and I hope others, that this is particularly important when it comes to mental health, suicidal ideation, all of the care for veterans matter. But there are certain things in which the timeliness and the consistency and the personal nature of the care determines the outcome and whether they are successful.
▶ 2:03:12Chair Moran: I take your testimony seriously with the renewed interest in trying to be a better advocate for not just community care or the mission act, but community care and the mission act as it may save a life and improve the quality of life for veterans who cannot get what they need within the v.a. I wanted to talk about residential treatment, but I don't have the time. It has captured my attention as well, what can the department of veterans do to provide longer term care for veterans?
▶ 2:03:44Chair Moran: I will conclude the hearing. It is concluded with an expression of gratitude for all of your presentations at your willingness to visit with us. It will try to be a committee who listens to those who tells us with the challenges are and respond appropriately. Each member of our committee has five legislative days with which to revise and extend their remarks, what we all said. I ask any senator who would like to submit a question to you to do so in a timely manner.
▶ 2:04:15Chair Moran: We would like for you to respond for the record following today's hearing in a timely manner as well. With that, this hearing is adjourned. [gavel falls]