▶ 0:00:00good afternoon this oversight hearing for the subcommittee on health will now come to order before I begin my remarks I would like to highlight some numbers first 20.9 billion that's the amount the veterans Health Administration received in 2001 at the onset of the global war on terror in that same year an estimated 16 to 17 veterans took their own lives every single day second 12 121 billion that's the amount the VHA received in 2024 after nearly two decades
▶ 0:00:30of War an entire generation of veterans now relying on the system built to care for them 17 that's the number of veterans our nation loses to suicide every single day in 2024 that number could be higher as the VA does not include veterans who lose their lives to overdoses in its official suicide statistics the numbers tell a clear story va's problem is not a lack of resources va's problem is not a lack of funding
▶ 0:01:00va's problem is not a lack of Staffing va's problem is not that Congress has failed to provide what it needs to care for those who have served since the beginning of the global war on terror va's budget has increased an incredible 479 per.
▶ 0:01:17yet the number of veterans we lose every day has remained approximately the same and these are just the suicides that we know about are that the VA counts some seem to believe that the solution is straightforward continue to invest in VA Staffing expand Services grow the system but the numbers do not lie if money alone could solve this problem it would have been solved long ago no the VA does not have a resource problem it has an access and a process problem it's a blatant failure of
▶ 0:01:47the VA to adapt to the needs of the very uh people it was created to serve va's current processes are not designed to provide veterans care when and where they need it instead veterans are left navigating delays bureaucratic red tape and systemic inefficiencies that create barriers rather than breaking them down well I believe that Congress and the VA has taken some necessary steps to increase access it's not enough we continue to hear from veterans who are turned
▶ 0:02:17away from the life-saving care that they need some are denied Residential Treatment because they have not previously sought V care as if a veteran in crisis should have predicted their need for help years in advance others are told they cannot access Community Care unless a VA facility fails to meet a 20-day threshold forcing them to wait even when immediate alternative options exist and some are simply lost in the system bounced from program to program expected to navigate
▶ 0:02:47a maze of bureaucracy while struggling with the very mental health conditions that make the process overwhelming in one particular case a veteran suffering from severe alcohol withdrawal who was seeking admission into a residential Rehabilitation treatment program in the community was outright denied because the VA stated they had a bed available 100 miles away had the leadership at that Community facility not stepped up the VA would have effectively force that veteran into
▶ 0:03:18homelessness that's why I support chairman Bost veterans access act which takes long overdue steps towards fixing these issues the veterans access act recognizes that the goal should be to protect veterans not VA bureaucracy and it cuts through va's arbitrary restrictions by allowing more veterans to seek the care they desperately need in the community when the VA cannot provide it VA claims that there is no wrong door for veterans seeking care yet we continue to hear about doors locked doors
▶ 0:03:48hidden and doors that simply do not exist it's time we stop making excuses and start making changes real changes that put veterans first today we will hear from firsthand from those who can speak to these process failures and those who can help us fix them the cost of inaction is too high thank you all for being here I look forward to today's discussion with that I yell to ranking member brownley for any opening remarks she may have thank you madam chair
▶ 0:04:18I'd like to First say that we cannot have a hearing discussing veterans access to Mental Health Care without also acknowledging the very real impacts that the Trump administration's chaotic and halfhazard actions are causing both to va's mental health Workforce and to the mental health of many veterans who rely on VA for their health care their support system and their livelihoods veterans are scared scared that their VA mental health providers
▶ 0:04:48who are being forced to report to work in person at facilities that don't have room for them will decide that providing care in an environment that doesn't ensure veteran privacy isn't worth it and will resign from the VA they are scared that the very support staff who make it possible for VA providers to focus on care and putting veterans first will be fired leaving clinicians less able to focus on their care and they're scared
▶ 0:05:18that the outside research and agencies that help improve VA care will be shut down weakening va's ability to provide worldclass care un unexpected VA Staffing shortages are already affecting veterans in my district just last Thursday I held a Roundtable for veterans to share the impacts they're experiencing related to Workforce cuts at VA in a very concerning way I heard that at a local vet
▶ 0:05:49center that serves many of the veterans in my district there is only one provider left to offer care typically vet centers employ at least four of five providers because of this severe Staffing shortage and va's failure to fill these critical vacancies the vet center now can only offer group therapy which is not clinically appropriate for every veteran Workforce shortages and cuts
▶ 0:06:19at VA should not be what determines how and where veterans receive care if the Trump Administration moves forward with its plan to further cut its Workforce by up to 83,000 employees I fear this problem will only get worse and Veterans have Choice than ever before the this context leads me to today's hearing topic the Doge cuts and the Trump administration's Workforce
▶ 0:06:49actions are already directly impacting the programs we're discussing today my staff has heard of at least one researcher who was fired from va's Center for substance addiction treatment and education the center responsible for developing best clinical practices for substance use disorders the Trump Administration has also taken aim at the Department of Health and Human Services Substance Abuse and Mental Health Services Administration
▶ 0:07:20or samama with cuts of up to 50% of the workforce expect expected samama oversees 9A 88 the National Suicide and crisis line which routes calls directly to the Veterans Crisis Line through 988 press one and although samsa's programs do not directly serve veterans cutting its Workforce will undoubtedly have Ripple effects across any provider of substance use disorder treatment
▶ 0:07:50I agree with my colleagues across the aisle that we must ensure that any veteran who is ready to seek assistance can get that treatment but but I don't agree that the answer is to cut existing Workforce at VA cut other essential services in research and just throw the doors open to community providers because VA has not developed a fee schedule for residential Rehabilitation treatment programs Community Pro providers who treat veterans can effectively
▶ 0:08:21set their own rates and VA will reimburse them at rates far higher than the industry norms these providers have a vested financial interest in treating veterans a population that they admit in their own statements that they have not been able to access because so many already received Care at VA worse still there is a serious lack of oversight over Community providers there's no guarantee that veterans
▶ 0:08:51receiving care in the community will get better more timely access to care and we don't know if they do because VA doesn't track that when veterans do access Care at residential treatment facilities in the community we have no way of knowing the level of treatment or support they are getting we don't know if veterans are receiving care from providers who understand what it means to be a veteran and can establish a rapport with their patients we don't know if they
▶ 0:09:21are being referred back to VA care in a timely manner as VA is the is in the best position to coordinate their overall care beyond treatment for their substance use disorder which is often just one aspect of their overall health care needs unfortunately because VA has not developed a fee schedule for residential rehabilit Rehabilitation treatment there's also no way to ensure that VA is not overpaying for these services
▶ 0:09:52in fact we've heard of some Community Residential Treatment Centers charging VA up to6 ,000 a day for one Veteran's care it simply will not be sustainable for VA to continue paying for these services at these rates I have said before we must find a balance between Community Care and VA direct care in my opinion we have not found that balance when it comes to residential Rehabilitation
▶ 0:10:22treatment facilities and I look forward to hearing from our VA Witnesses on how we can work together to get get closer to that balance I thank our Witnesses for being here today and with that I will yield back thank you rank member brownley I would now like to introduce the panel one Witnesses testifying before us today we have Miss Missy Jarrett mother of Navy veteran Landen hanom holcom excuse me Mr Michael Urban Army veteran and licensed clinical social worker and Dr shanar yamach
▶ 0:10:52chili CEO of River Region Psychiatry Miss Jarrett you're now recognized for 5 minutes to deliver your Lord Mak and ranking member brownley and all of the members attending today I have Landon sitting right beside me right here and if you'll notice that infectious smile that I'm about to mention if soldiers are going to die it needs to be
▶ 0:11:23at the attempt of an enemy not a lack of effort and unorganized Antics by the VA the VA is killing our soldiers my son Landon who served as an air traffic controller Navy veteran NAS Jacksonville seven years ago was struggling to find mental help in a system that completely failed him like many veterans he reached out to the VA
▶ 0:11:53for help and support his first consultation with a provider was on December 4th 2023 however the VA did not provide a follow-up visit until April 10th 2024 Landon had scheduled events between this time frame However unfortunately the VA cancelled multiple visits Deni denying him the chance to see a provider who specialized
▶ 0:12:23in medicine management Landon tried and tried to keep his head up that the VA would follow through he was experiencing anxiety insomnia restlessness and mood swings Landon knew that he needed a mood stabilizer Mom I'm struggling after four unsuccessful months he began to unravel with all of the cancelled appointments he became hopeless in the system he was very emotional
▶ 0:12:54on April 10th he visited the Savannah VA mental health Team who determined that he wasn't under distress how do you determine mental health when symptoms are invisible Landon said the visit was a checklist and he explained that he had been asking for his psychiatrist medicine management he was hoping for a better outcome and knew that this meant another
▶ 0:13:24delay in getting the help he critically needed those that smil the brightest might be fighting a war within Landon was fighting he came by to see me after this visit at this point family and friends became involved in searching for psychiatrist and to no avail we took it upon ourselves to call psychiatrists in the savannah bluon and Hilton Head South Carolina areas
▶ 0:13:55they did not accept military Insurance take new patients or charge $300 an hour more stress Landon made numerous calls himself hey Mom I was
▶ 0:14:25calling you back I was on my SC right left the gym I tried to call how I've also been on it off the phone Therapy Group shink um Savannah and the people over here at coal ire so been a lot of phone calls this morning um I'm going to get a workout in call me back when you want to all right this that call that voice mail was the Monday before
▶ 0:14:55he died on April 19th he received a call from the Charleston VA for Zoom appointment scheduled for May 3rd he did not make that appointment and passed away on May 2nd the unthinkable happened Landon was found in the restroom of a restaurant on Hilton Head Island he had fentol in his system to numb his pain he thought he was taking oxies
▶ 0:15:25Lon did not plan to leave us he was not suicidal the hopelessness of cancelled appointments feeling abandoned and not taken seriously and the emotional spiraling ended his life Landon was buried at the Buford National Cemetery in South Carolina with US Naval honors on May 13th he leaves behind two beautiful
▶ 0:15:55teenagers a loving family and many loving friends he was a true patriot who loved his country help just didn't come soon enough mental health is real it can't wait all Landon asked for was a mental health appointment for medicine management he raised his hand over and over and over again in memory of my 39-year-old son who could light up the room with his infectious smile
▶ 0:16:26let his voice I'm sorry be heard from heaven above and on behalf of the veterans who struggle every day let's be reminded to never leave a soldier Behind these are our children this is why I'm here today how many more testimonies is it going to take for change how
▶ 0:16:56many may God bless our m militar serving all over the world and may God bless our veterans and all our military families thank you very much Miss Jared Mr Urban You're Now recognized for five minutes to present your testimony good afternoon members of the committee I'm honored to share my personal story and experiences with the Department of Veterans Affairs medical system in 200 2003 after serving four years as a power Trooper in the 82nd Airborne
▶ 0:17:27I was medically discharged following an accident during a jump the subsequent 13 surgeries led to a regimen of heavy heavy opioid use a path all too familiar to many veterans in 2004 I began receiving Care at the Philadelphia VA Medical Center in my journey I've experienced firsthand the challenges of accessing care within the VA system when I sought help in 2004 I Wast I faced a wait time of two to three months for a bed I've had multiple
▶ 0:17:57stays in VRT PS where I witness practices that now as a clinician I know not to be best practices in 2014 I had the opportunity to receive treatment outside the VA system which provided a transformative experience since December 2 2014 I have maintained sobriety and achieved numerous personal and Milestones all attributed to the quality of care I reive Community providers are required
▶ 0:18:27to operate following a Sam a standard of care which is much higher than that of va a standard which I encourage VA to adopt oig has applied and referenced this standard during investigations into the deaths of veterans related to the lack of alcohol detoxification standards in 2021 2022 2023 and 2024 how many years are yet better how many more veterans must die before VA follows a standard
▶ 0:18:58in 2020 during the pandemic I developed a program for veterans affected by lockdowns treating approximately 200 veterans from vis4 in under 6 months this experience highlighted the potential for collaboration between VA and Community providers but also revealed inconsistent practices across different VA facilities 2021 I joined a national provider to develop veteran programming at 18 facilities expanding my presence from local to National
▶ 0:19:29this afforded me a unique glimpse of the entire VA system over the past four years I have visited over 75 VC's numerous seab boox and vet centers I had the privilege to address VA service gaps not only at our 18 facilities but by opening facilities in Alaska Denver virtual services for Rural veterans and develop an eating disorder program specifically for veterans through my extensive interactions with veterans veteran Advocates and
▶ 0:19:59VA employees across the country I have consistently encountered growing challenges in accessing community care for mental health we have observed a decline in veterans ability to receive this essential care and this problem is not confined to a specific region I have witnessed it in VA medical centers from Florida to Alaska unfortunately the situation has deteriorated since last March at Brockton VA I worked with a veteran who has denied entry into art RTP due
▶ 0:20:29to past Behavior he then requested community care but was denied without reason at Hines a veteran was told DriveTime standards do not apply to his rrtp needs in Houston Veterans were restricted to facilities only approved by the chief limiting their choices in Denver veterans are all forced to travel out of state for VA care when it is available locally in the community in Portland VA social workers confirmed we don't use community care referring
▶ 0:20:59veterans to Medicaid accepting providers instead in Philadelphia Veterans were denied Community Care due to the chief who told me I can't send veterans to the community as it won't allow me to justify my budget next year the issues faced by veterans and accessing Community Care are Sy systemic widespread these challenges include Vaas often fail to provide written explanations for denying Community Care the interpretation of access standards obtaining
▶ 0:21:29a consult and referral for substance use in mental health has become complex and time consuming requests for services for veterans hospitalized in the community are not processed promptly leading to prolonged delays and discharge without necessary care and five ignoring the best medical interest standard administrators often prioritize VA interest over decisions made by the veteran and provider I have personally witnessed the struggles of homeless and addicted veterans in almost every state
▶ 0:22:00many of them prefer not to seek Care at the VA due to the barriers they face instead opting for Medicaid or Community Resources this raises a question why should veterans who are entitled to VA Services rely on Medicaid when VA is specifically funded to support them VA has a tagline choose VA well I must tell you it's not much of a choice when VA employees are the one making the choice during the pandemic we demonstrated the community and VA can affect effectively collaborate to address challenges
▶ 0:22:30faced by veterans by working together we can better tackle these issues and provide more comprehensive support it has become an us first them mentality and the ones who suffer are my fellow veterans instead of creating barriers VA should focus on removing them particularly for those seeking mental health treatment each year VA releases statistics on veteran suicide which remains almost unchanged despite va's significant investments in initiatives like increased Outreach while Outreach
▶ 0:23:00is crucial it is insufficient when a veteran in crisis is met with very limited options such as being placed on acute psych ward or the police being confined in such a setting can feel punitive rather than supportive for those seeking help it is time for us to prioritize improving access to care and the appropriate levels of care from the moment a veteran request it rather than subjecting them to a bureaucratic nightmare or worse a literal one by doing so we can ensure that veterans receive timely
▶ 0:23:30and effective support when they need it most whether it be at VA or in the community we need timely access to care and we only get there by together thank you Mr Urban Dr yalamanchali you're now recognized for five minutes to present your testimony you and good afternoon chairman Jan Miller Meeks ranking member brown Le and members of the subcommittee thank you for the opportunity to testify today I'm honored and privileged V to be here and serve our country
▶ 0:24:01I'm here to be a resource to our country and our veterans and the VA my name is Dr Yan CH though many know me as Dr Chile and I'm a board certified psychiatrist with over 20 years of experience I currently serve as a founder and medical director of River Region Psychiatry associate soon to be ally Psychiatry a multi-state behavioral health Enterprise our mission is simple to improve access to high quality manal health care for those who need it most close to where they live Live While reducing costs and increasing efficiency
▶ 0:24:32our practice route started in and we continue to provide care in rural communities as our future name suggests we want to be an ally to everyone that help after beginning my psychiatric career in the VA hospitals of Montgomery and Tuskegee in 2005 I became increasingly frustrated with inefficiencies that prevented veterans from getting timely care I later moved to Community Mental Health Centers where I worked to improve operations however I quickly saw how widespread mismanagement
▶ 0:25:03systemic inefficiencies and fragmented care delivery were contributing to the rising costs and poor outcomes not only for patients but for the healthcare system as a whole today I stand before you to offer a proven scalable solution that has already improved Mental Health Access for thousands of patients and one that has the potential to save our nation I believe at least a billion dollars annually in healthcare costs at RP and Alli Psychiatry we have built a care model that delivers patient centered technology-driven
▶ 0:25:33care across both inpatient and outpatient settings in 2024 alone our 68 Physicians and 157 advanced practice providers served over 15,000 our patients and completed over 400,000 patient visits our inpatient services are located in hospitals jails Residential Treatment Centers ensuring car is accessible across a variety of environments with this expansive footprint our deliver our model deliver SC at approximately 25%
▶ 0:26:03lower per patient cost than the traditional V or Hospital Systems moreover we consistently outperform National benchmarks achieving a 20% increase in emergency department throughput 25 25% reduction in in patient l of stay and 15% reduction in avoidable readmissions for behavioral health patients our providers average 1,000 more patient encounters a year more than full time employees at the VA who often see 8 to 10 patients a day on a 4 day work week
▶ 0:26:33with our care model 100 RPA providers working in the VA system could enable 100,000 more patient visits annually while reducing costs up to 20 to 30% which is what we have seen in our current Partnerships there are real challenges in access to care at the VA despite the best intentions of both providers and administrators a 2023 GAO report found that veterans often wait 30 days or more for routine Mental Health appointments even longer in rural areas where sometimes
▶ 0:27:04weight times exceed 60 days Community Care Network meant to expand access but it often fails to meet the needs of veterans with chronic mental health conditions providing only episodic care with limited continuity many of these issues are due in part to Staffing shortages for example uh the vaig report um reported that over 61 facilities had severe psychology shortages and 47 facilities had severe psychiatric shortages in 2023
▶ 0:27:34this means that the providers that are there often cannot handle the current case loads patients are't seen in a timely manner and provider suffer burnout delayed care as we here can lead to worsening mental health conditions High rates of hospitalizations and increased emergency room use all of which endanger patients while being costs the VA has a challenge to hire full-time psychiatrists nurse practitioners and physician assistants they're competing with the private market and Hospital Systems when needed Contracting
▶ 0:28:05with practices like mine would allow the VA to save on hiring training long-term benefit costs infrastructure costs it will enable the VA to scale staff based on need and have access to specialized expertise very quickly and they could do all of this while enhancing patient access and care there are numerous ways that the VA can do this there are models that I have outlined in my written testimony I believe that allowing increased public private Partnerships to address chronic care needs is a common sense
▶ 0:28:35First Step particularly as this is an area where the current Community Network falls short under this model for example private Partners would contract with the VA for services as needed when there are staffing issues lag in patient wait times or lack of va resources private Partners would be required to integrate with the vs electronic medical records to ensure seamless information sharing and collaboration with va8 teams this allows for continuity of care greater provide availability and reduced weight times especially for veterans in Rural and underserved
▶ 0:29:05areas Private Practice such as mine have more flexibility to work with local clinics and provide greater tele medicine options therefore we can eliminate typical access barriers and deliver the cost deliver most appropriate cost effective care in emergencies we can quickly get get the veteran to the best level of care in a very short time in closing the VA needs support in closing access gaps and reducing weight times for mental health care our model at RP and Ally Psychiatry demonstrates that a partnership with private providers can expand
▶ 0:29:36capacity improve patient outcomes to reduce costs this permanent public private partnership model is a win-win for taxpayers and our nation our success so far is based on collaborative model to improve outcomes and we ask for the same thank you thank you Dr Yaman Chile um in accordance with committee Rule 5 e I asked unanimous consent that representative Carter from Georgia be permitted to participate in today's subcommittee hearing without objection so ordered as
▶ 0:30:06is my typical practice I'll reserve my time until all other members have had a chance to ask your their questions I now recognize ranking member brownley for 5 minutes for any question she may have thank you madam chair Mr Urban since you mentioned having been employed uh by a national provider of substance of Sub sub excuse me substance use disorder treatment starting in February 2021 the majority of my questions I think are going to be towards you um so first I believe the company
▶ 0:30:36you worked for starting in February of 2021 was uh bany treatment recovery LLC is that correct yes ma'am pardon me yes ma'am thank you um in your written testimony you mentioned VA having cut reimbursement rates to this Provider by 90% for virtual care and by 60% for residential treatment and detox what rates was banan charging VA daily ma'am I couldn't answer
▶ 0:31:06that because I wasn't in Billing you weren't in the building billing I'm not I don't take part in Billing I just build the programs and operate them so so you have no idea how the va's rates compared to other uh other payers rates I do there initial rates were I don't know who set them but they weren't educated they were not what they were not educated the rate fee that I did see was far beyond what anybody should have been reimbursed but that was va's schedule we had nothing to do with that
▶ 0:31:37well VA doesn't have a schedule They just they do ma'am I forward it to you there there's no established fee schedule for Community providers in this kind of treatment ma'am there is one in Alaska because that's why we ask for a fee waiver that you that the VA just put out in 202 that might be the the VA hospital in Alaska that does that but not VA Central but anyway so I I guess you don't know if if your rates were lower
▶ 0:32:07about the same no ma'am I said originally when I first saw the rates they were beyond what anybody should have been paying so you're saying you're paying a lot less or excuse me charging a lot less now they're more in l no what VA was reimbursing based on their fee schedule was beyond what any Commercial Insurance pay days the rates are now in line due to most of the rate Cuts but now they have went so far that rural veterans and veterans in Alaska you can't
▶ 0:32:38sustain operations because they just cut them you seem to know a lot about the rates but you don't know what Bion was charging I I'm not in that department I have seen I know but you know seem to know a lot about you know where the rates were where they are now but yet don't have any idea what the number is I don't ma'am because what I'm told is these rates are getting cut and if we don't figure this out you won't sustain treating veterans my job is to build programs and operate them I get told the budget and whatever it is they set
▶ 0:33:08for that facility I I'm not in the billing okay I I just for the record disagree the VA does not have a fee schedule for Community providers period full stop but in your bio it says in your current role as a consultant that you develop business strategies and train teams on Outreach to the veteran and Military populations can you elaborate
▶ 0:33:38on exactly what that means yes ma'am I train organizations who would like to work with veterans on on veteran language uh how the VA operates how it functions how to collaborate we've created systems to collaborate effectively with the VA develop business strategies what does that look like that means teaching them how they can reach veterans in the community who need resources so in Alaska right The Villages where none of the VA employees will go I trained a company to go to The Villages
▶ 0:34:08and find veterans and bring them back okay it just honestly it sounds like to me that um it says you're helping treatment facilities like the one you used to work for more effectively um targeting veterans to receive Care at the facilities you worked with which also brings along a dedicated Revenue stream in the form of of va reimbursements a does a financial incentive to treat veterans exist in the facilities like Banyon I mean it's a
▶ 0:34:38a job it would be the same as you worked at the VA you have an interest in keeping veterans in the VA so wouldn't you in the private sector I'm talking about incentives about how many people you can bring into the facility Etc not where I have work no ma'am okay I will just say um I I I think uh you know the providers in this industry seem to have to me a profit motive to serve veterans Ba's mission is to honor
▶ 0:35:09the promises we have made to our veterans and ethically care for their Whole Health after they serve our country their motivation is to provide worldclass care to Veterans it's clear to me that through the actions of your past employers and your own actions as a consultant that your motives are very different and with that I will yield back thank you ranking member brownley the chair now recognizes Dr Dexter for five minutes for any questions she may have thank you madam chair
▶ 0:35:39um first thank you to our panel for coming and Miss Jared I am so sorry for the loss of your son um and thank you for your courage coming to share his story with us it it means a great deal um having taken care of many patients unfortunately like your son is a critical care doctor um what I can say for certain is he's not unfortunately alone and we are failing not just our veterans but everyone in our community across this country
▶ 0:36:09this is a tragic um reality that we are all facing I also know having been both a VA and a community provider that Community standard as Mr Urban talked about is actually not Superior in many areas um to the veterans administration care I know we're failing um everyone broadly but to be clear what we don't know with these policies and this is just for the record um
▶ 0:36:39we don't have any ability to compare when we refer someone whether or not they will get Community Care faster than they will get in the VA or if it's better quality and on that quality note I Mr Urban wanted to first thank you for your service to our country and and for sharing your story as well um with substance use disorder and and your desire which is clear to help our veterans deal with that um I trust your intentions are good and that you share in this committee's commitment to ensuring our veterans receive the highest quality of care um but
▶ 0:37:09what I read in preparing for today's hearing similar to what I think um my ranking member we're trying to get to is that we are concerned about the reimbursement that does not have a fee schedule and and I know that different areas may have different policies um but that we are paying as much as $6,000 a day for in patient care for some of this treatment Mr Urban does that seem consistent with Community levels of reimbursement in experience currently or when they started
▶ 0:37:40when $6,000 a day reur it's absolutely insane I said that in my last statement no one should be paying that amount of money I agree and so I think what foundationally I would assert is that before we pass any such policy as this we should have a fee schedule we need to have control over what we are paying to the community because there is waste Fraud and Abuse that is potentially going to be a risk with if with this without better control we also should know how long it should take um for someone to be
▶ 0:38:10ex expecting treatment if they're sent to the community and whether it's sooner than in the VA um so those things I wanted to establish I also understand that you weren't the manager you weren't in charge of running these facilities necessarily is that correct Mr B correct okay um there clearly were many issues at both banion treatment and Recovery as well as is it correct that you worked at the living Gren foundation in 2019 through 2021 yes ma'am
▶ 0:38:41okay and also at sobriety solutions from June of 2018 to May of 2020 yes they weren't Community providers though so none of those were providing living just just living Gren okay thank you for that clarification the thing I wanted to offer is that there could be Community Care in different areas of the community that that may be a reflective experience that um these facilities each had improper safety well I'll say to Banyan um there were
▶ 0:39:11improper safety measures at one of their facilities that led to a permanent paralysis of a patient who fell from the fourth floor roof that there were um nurses who had wages that were revoked um that the New Jersey Commission of Investigation found that ban was engaged in patient brokering and the practice of paying for referrals so I'm not asserting that this is your practice by any means but what I do want to suggest is that there is incentive for Waste Fraud and Abuse
▶ 0:39:41when we don't have clear um expectations for Community Care and and the quality of that care and even when providers have the best interest that you may not have control of that is that a fair assertion Mr Urban yes ma'am thank you um so for the committee what I wanted to establish is that even for someone who clearly cares for our Wellness of our veteran is a veteran has suffered with substance use disorder and wants to serve it's challenging to maintain high levels of care and our veterans deserve to have the highest
▶ 0:40:11quality most effective care and we know that that is provided within the Veterans Administration and until we have a fee schedule that is established and disincentivizes waste fronted abuse I would assert that we should not um be considering further um exploration of expansion of this thank you the gentoman yields the chair now recognizes uh representative Carter for five minutes thank you madam chair and thank you for holding this hearing I appreciate this very much and thank you for allowing
▶ 0:40:42me to wave on um also want to thank the witnesses particularly my constituent Missy Jarett Missy thank you for being here your courage is a is an inspiration to all of us and I want you to know how much we appreciate this I know this is not easy for you and you've been up here the second time you've been up here in I think less than a month and we appreciate that very much and I know that um I say I know I can
▶ 0:41:12only imagine what it's like to lose a son I can't even go there but I I want you to know that that you've made a purpose of of making sure that you're advocating for necessary changes that and reforms to the VA that would raise awareness about the dangers of elicit fentel poisoning as you know I'm a pharmacist and I'm very familiar with fentel and I'm very familiar with the illicit use of it
▶ 0:41:42but um I want to tell you Madame chair members of the committee first class as you heard I'm sure first class Landon hul exemplified what it meant to be and to serve his country he was born in Savannah Georgia on April 22nd 1985 and he was a proud veteran and he was a patriot of this great nation he serves as an air traffic controller in Florida he was a father to two children they're now teenagers
▶ 0:42:12and he passed away on May 2nd 2024 due to fentel poisoning poisoning not fenil addiction fentel poisoning he was a veteran who was experiencing mental health issues like many of our veterans do once they get out of the service and like many of our veterans he reached out to the VA but unfortunately the va's response was not adequate and and it was unsuccessful
▶ 0:42:43at preventing the tragedy from occurring under the previous administration the VA Council multiple visits and denied Mr hul the chance to see a healthc care provider during a time of need Mr Jarett do you believe had your son been able to receive care from qualified providers in the community without delay do you believe it would have changed the outcome yes he he would be with us today the um the what we
▶ 0:43:13experienced with him in the emotions um to the point where I let uh the committee hear his voicemail which was Monday prior to um passing away on Thursday went to work Tuesday went to Wednesday um called Thursday morning to talk to his brother and myself
▶ 0:43:44and uh who was vacationing from Colorado in Savannah we all had plans so after it was around 5:22 p.m. he walked into uh a restaurant as I said on the island they found him 45 minutes later they worked on him 20 minutes and um of course uh the telephone call received a call and um
▶ 0:44:14it it's you know it's I will never forget it you know grieving it's always going to be there and I questioned as to whether I was going to come back up here um thanks to congresswoman Miller Meeks I received an invitation to come back so giving back I guess I could call this is a way for me to give back maybe in Landon's memory
▶ 0:44:45veterans me veterans out there like I said are waiting and I sit here and I listen I sat through your you know your previous meeting and I sit here here listening go back and forth about what should be covered in benefits under the VA and I'm thinking why is this even an issue in the Private health sector under private plans we cover buiatrics
▶ 0:45:16we cover the therapy you're talking about and you're still talking about it preventive care has been there 100% down the line we even covered vitamins in our plan preventive care is all about providing those tools and resources to keep people healthy and that includes veterans and their dependence as well so I'm I'm like therapy
▶ 0:45:46and then in 2019 under the Trump Administration he passed the right to try yet you're sitting here talking about are we going to cover this or that well a veteran has the same right as we do to try psychedelics to try Cancer Treatments to try therapy programs if I'm wrong let me know but in my mind I was thinking right to
▶ 0:46:16try out there why is it a question why can't they do it if they want to do it and they make that decision as to whether they want to have it or not based on whatever they know so under under the VA I can't imagine I just realized you're talking about there's not a fee schedule how do you operate without a fee schedule I mean networks operate doctors operate
▶ 0:46:47with fee schedules and when you're in a network the whole reason you have a network is because doctors are looking for you to steer patients to them which reduces fees also so a network okay there's networks out you had the Community Care Group and by the way when I went to our ZIP code in Savannah
▶ 0:47:17here's your VA website va.gov and you can go across and you can review Benefits Resources tool school's mental health I went to the mental health site and I typed in you can search a provider by ZIP code or city so I typed in our ZIP code in Savanah Georgia the facility type which is required it comes
▶ 0:47:48up Community providers n va's network service type required so you can type in Chiropractic or optometrist I typed in psychiatrist it pulled up we couldn't find that please try another service M Jared we I'm sorry we've already gone over and the chair has been very indulgent but again I want to thank you for being here and I want to thank you for your courage and for your advocacy you've made
▶ 0:48:18it your purpose to bring this to attention to all of us and we appreciate that very much and God bless you thank you Congressman I appreciate absolutely thank you back thank you for your Indulgence all the committee the gentleman y thank you very much uh representative Carter Miss Jarrett thank you for your bravery and being here um I I guess I just have a very simple question did your son was uh denied and delayed numerous appointments uh the initial appointments
▶ 0:48:48were months apart when he received one visit did anyone at the VA ever explain your family's right to access Community Care or offer you alternative treatment options when VA programs were unavailable uh to my knowledge um no and you know we've heard today uh that you know veterans should have the highest quality most effective care do you think that your son through the VA had the highest quality most effective
▶ 0:49:23congresswoman Landon lived in color colado so he accessed the VA Colorado there was not a problem there he said Mom it stay there he lived in Nashville North Carolina he was pleased with the facility there okay the VA there as a matter of fact he made a comment he said Mom if I were back in Asheville you know I would have gotten in
▶ 0:49:55sooner okay he mve moved South to be near family his daughter Etc so what what I'm saying is what he saw there in consistencies between the siners and and there are not there's not coordination of care y precisely which is why we have community care because of the inconsistencies and lack of care do you believe that no care is better than care in the community
▶ 0:50:25Mr Urban is no care better than care in the community absolutely not dror Chile is no care better than care in the community no ma'am yeah and how cost effective is it if people die waiting for Care at the VA Dr Chile you noted that practices like yours achieve significant cost savings up to 30% while expanding patient capacity it doesn't sound like you're driven by a profit motive to me can you provide more detail on how these savings are realized without compromising
▶ 0:50:55Care Quality particularly within the VA systems uh VA systems regulatory framework one of our philosophies is that you know we went to school we've the community at large actually families and universities have given us a unique skill to treat patients with that we kind of in the group anyway we think that how many people can we reach how many people can we touch how many people can we can we help so in that model we set up our schedules in such a way that there is gradients and schedule where
▶ 0:51:26new patients require more time patients in crisis require more time uh patients that are Midway to treatment may require a little bit less patients that are stable they quite less we collaborate between the providers and the therapists to see if how things are flowing and getting getting better or worse if patients need to come back sooner we bring them back in sooner we need to see them more more frequently we see them more frequently so with this kind of a matrix of how we see patients I think we're able to see more patients in a given day but at
▶ 0:51:56the end of day it's the same cost right so then when you look at how much is let's say if we're spending you know whatever amount of money but then we're seeing more patients then your pration cost comes down thank you and Mr Urban given your story and your both your written and your verbal testimony it seems to me like your experience at the VA or lack of care inconsistent care difficulty accessing care is really what propelled you into the uh profession you now hold
▶ 0:52:26and based upon your experience what's the single most consequential policy failure that prevents veterans from receiving timely residential substance use disorder treatment through the VA I think the time it gets access to care if you read VHA directive 10 10601 it says you know you have seven days to complete a screening from when someone asked for help seven days good luck I I you know how long it took me to get to those seven days before I finally was offered a bed two months away I mean I think
▶ 0:52:56that the access to care and how long it takes to get care and the different scheme I shouldn't say schemes the different ways V have set up the process delays care like and every VA is different in the way they want you to get a mental health referral to treatment that people just give up they just say I don't care I'll go to Medicaid or I'll I'll use a community Resource as opposed to getting timely access I'm not opposed to getting Care at the VA but like it shouldn't take a month two months
▶ 0:53:27uh and as far as standards we can't compare apples to apples when VA makes its own standard and Asam is what the industry follows let me let me address that what clinical standards such as uh Asam criteria do you believe the VA should be required to adopt nationally to ensure consistent levels of care for substance use disorder treatment and if Dr Chile you have input please uh provide that as well I I think uh it should be utilizing Asam because it dictates the level of care someone
▶ 0:53:57should get at it it dictates the intensity of care it dictates the services the Staffing ratios it lays everything out and places someone appropriately as opposed to this well we have a bed in the acute psych word we'll put you there till an rrt like that's the the difference and if I can allow you to redeem yourself and I know I'm going over time so Mr Urban is what drives you to do what you do uh profit no m' it's I don't want someone waiting two to three months for a bed
▶ 0:54:28and Dr Chile um in given what you've do and the model you've created is profit the reason why you do what you do no ma' uh thank you very much on behalf of the subcommittee I want to thank you all for your testimony and for joining us today you now excused we'll wait for a moment while the second finel comes to the table e
▶ 0:55:43I would now like to introduce the panel two witnesses testifying before us today Dr Maria D lorenti acting assistant under secretary for health for integrated veterans care at the veterans Health Administration who is accompanied by Dr Ela wers deputy director office of mental health at the veterans Health Administration if I mispronounced your name please feel free to correct me uh Dr Len you're now recognized for five minutes to deliver your opening statement before I start my oral testimony I just want to acknowledge and thank the first panel
▶ 0:56:14for sharing their very personal stories particularly one of such devastating loss it it really does take a lot of courage and and I want to thank them for advocating for other veterans chair when when Miller Meeks ranking member brownley and other members of the subcommittee my name is Maria lorente and I was recently appointed as the acting assistant under secretary for health for integrated veteran care it's been my privilege to work as a VA psychiatrist being board certified in adult and geriatric
▶ 0:56:44Psychiatry and addiction medicine for the past 30 years I take care of veterans with mental health and substance use disorders and it's an honor to serve veterans who've made such significant sacrifices for our our country thank you for the opportunity today to discuss the provision of residential substance use disorder or sud treatment through va's mental health residential Rehabilitation treatment programs or mhr RTP and Community Care Residential Treatment programs joining me here today
▶ 0:57:14is Dr Elsa weers deputy director office of mental health uh veterans Health Administration and also a geriatric psychiatrist and provider prior to the mission act in one of my prior roles as the associate chief of staff for mental health at a VA Medical Center I experienced firsthand the challenges our veterans faced related to access for residential treatment programs the facility where I worked didn't have its own residential treatment program so we had to refer veterans to other facilities that did
▶ 0:57:44the demand for this life-saving care often exceeded the supply of available beds and this delay in care increased the risk of relapse and worse Health outcomes offering our veterans access to residential treatment through Community Care address this concern this allowed us to seamlessly transition the veteran into residential care when indicated timely access to Residential Treatment programs enhances overall outcomes so the veteran was more likely to engage in mental health services and treatment and maintain
▶ 0:58:15sobriety mhr rtps provide care within specialized sud programs referred to as domiciliary Su programs as well as across the full and MH rrtp Continuum which includes programs for the treatment of post-traumatic stress disorder General mental health concerns and services for homeless veterans these programs have evolved over time to better meet the needs of Veterans for example in 2012 as part of the first culture of safety standown VA introduced Noone
▶ 0:58:45as a critical tool to prevent overdose deaths the passage of the VA Mission Act of 2018 expanded access to Community Care furthering transforming veteran care this law expanded access to eligible veterans who can elect to receive care in the community in certain situations in October 2020 VA developed the mhr RTP standardized episode of care which made it easier for VA to order residential treatment in the community this has led to significant
▶ 0:59:15growth in the nor in the number of community programs providing residential treatment and the number of veterans receiving this care to help maintain highquality care for veterans VI requires that residential Community Care Providers maintain appropriate credentials such as by the commission on accreditation of Rehabilitation Facilities or by The Joint Commission as of March 2025 there are over 260 mhr rtps across 125 locations providing
▶ 0:59:46more than 6600 operational beds in f24 approximately 32,000 veterans used mhr RTP care with 97 % diagnosed with sud and over 92% with co-occurring sud and mental health diagnoses and during the first quarter of the current fiscal year 70% of veterans were admitted to VA domiciliary care within 20 days increasing access to Community Care is a significant component of va's strategy
▶ 1:00:16to ensure that veterans have access to the care they need and on average veterans must travel 150 minutes or more to receive the specialized care whether through VA or through community care for VA to continue to meet the growing need for mhr RTP care we acknowledge that changes are needed to va's current access standards as a result VA was proud to support the veterans access Act of 2025 before the Full House committee on Veterans Affairs on February 25th 2025
▶ 1:00:47while ensuring the offsets or additional Appropriations are provided we're committed to working with Congress and other stakeholders to reduce barriers and improve access to the care veterans have earned we want to thank the committee for its continued oversight and we would be happy to answer any questions you or other members of the subcommittee may have thank you thank you Dr Len as my typical practice I'll reserve my time until all the other members have had a chance to ask their questions I now recognize ranking member brownley for five minutes
▶ 1:01:17for any question she may have thank you madam chair uh Dr weers can you tell me how many Mental Health Providers have resigned or retired earlier than expected since January 20th 2025 I don't have those numbers in front of me for the national set of numbers no I don't so so you know how many you just don't have those that information with you I do not I do not have that number it's not under the purview of my office um and who's under whose perview is it it would be um
▶ 1:01:48some an information that we would have at a facility and a vision level so I would have to dig in to get those numbers for you I don't have those and I I I I presume by your answer that um mental health providers who accepted the so-called fork in the road uh offer you have the same answer for that as well you don't know the numbers and it's not under your purview correct okay um Dr lorenta as you um probably gathered from my questioning in the first panel
▶ 1:02:18um you know I am very concerned that VA has not developed a a fee schedule for residential uh treatment facil uh facilities and you are currently reimbursing these providers at much higher rates than industry Norms on average VA has been paying $3,000 per day for this type of care some providers are getting paid as much as $6,000 a day far more than the average cost of care per day in an ICU um I understand that
▶ 1:02:48the VA has been working for some time to establish this fee schedule and and bring its payment rates uh more in line line with industry Norms I also understand that VA will have to modify its contracts both with tri West and opum uh in order to implement a new fee schedule so can you tell me what the status of this effort is and when you'll have a fee schedule in place yes ma'am I'm very appreciative actually that you asked those questions um it's my understanding that
▶ 1:03:18in December this past December Tri West did establish a policy with with respect to reimbursements um for uh r rtps that are within their Network I believe that that was um in part what the first panelist referencing um because those um payments um are now a perum rather than multiple line items it did make
▶ 1:03:49differences with respect to the providers in that Network um in addition to that with respect to iops and phps um those fees are now in keeping with CMS standards with respect to optim um I would have to take that question back in order to provide you with a more accurate status update so if I understand you correctly you're saying that the schedule that the previous witness was referring to was possibly a schedule that was a my
▶ 1:04:19understanding is that it might be a percentage of uh of a cost that is is is charged or you know a a percentage of of what the rate would be um rather than here's a here's the rate for this specific uh you know for for an hour of care or for this specific care it's not explicit and sort of complete for everything that possibly these uh residential providers would provide
▶ 1:04:49my understanding is it's a per deum okay as opposed to multiple Billings but I can get you the detail ma'am so um so are residential uh treatment providers qualified to provide emergency stabilization care for veterans experiencing an acute suicidal crisis under the authority provided by the compact act it would have to depend upon the residential facility itself so Standalone
▶ 1:05:19Residential Treatment programs no if the residential treatment program is part of uh a Health Care system that includes an emergency department with 247 coverage then it could so for the for Standalone providers that don't have um hospitals or Emergency Care the answer is no correct that's my understanding yes so uh is it true that VA has detected a a pattern of certain Community providers admitting Veterans for residential rehabilit Rehabilitation treatment without VA authorization
▶ 1:05:50and then attempting to build VA for this care under the compact Act I personally don't have detailed information of what you're referencing but I'm more than happy to inquire and get the information back to you I will just say that your predecessor told both the House and Senate committee staff that that was occurring and that that's entirely possible ma'am I I I just don't have firsthand knowledge so um the office of Inspector General uh also issued this
▶ 1:06:21fraud alert um in December of 2024 requesting the Public's help in stopping scams invol involving substance use disorder treatments specifically the oig warned quote certain drug and alcohol rehabilitation facilities or treatment centers are attempting to exploit veterans with substance substance use disorders for profit through various unethical and illegal practices so do you
▶ 1:06:51know um what the VA is doing to remove Bad actors like these from the Community Care Program yes ma'am um several different things the first is when we do identify concerns with respect to those types of practices um we often will reach out to the IG reques an investigation describe the nature of the concerns that we've identified and at the same time we will also notify the TPA um if the
▶ 1:07:21that particular provider is in one of our networks um based Bas on my understanding of how the contracts work the TPA then will conduct an investigation um based on the results of those investigations then there's typically a back and forth with the VA um when um findings are substantiated then um those types of providers could be removed from our Network it's my understanding that the oig is still investigating some of these some of these issues so you might get some
▶ 1:07:51results in the near future a yield back and thank you you member brownley the chair and I recognizes Dr Dexter for five minutes thank you so much Madam chair and thank you again to our panel for for being here um I share my Republican colleagues concerns about uh the veterans access to weight or access to care and the weight times they are facing for mental health care substance use disorder treatment and residential Rehabilitation treatment programs but as I showed previously this is not
▶ 1:08:21a specific problem to our veterans administration facilities this is a CommunityWide problem in fact in my district we continue to have far too care provide far too few care providers and far too long of delays and that's not improving it's getting worse so I think it feels like magical thinking when we offer proposals to codify additional Community Care access standards when it's abundantly clear that there is not the capacity in the community to accept our veterans and get them the Urgent Care that they
▶ 1:08:51need so I'll just state that I believe in controlling the controllable we can't control outside of the VA but we can control what we are doing within the VA and as ranking member brownley pointed out earlier the VA does not have a set fee schedule so that needs to be changed um clearly paying $6,000 a day is egregious and a waste of taxpayer dollars but I also think it's not exactly shocking that while referrals to impatient care including Residential Treatment made about made up about 13%
▶ 1:09:22of the va's total Behavioral Health referrals to Community Care Prov providers in fiscal year 2021 through 2023 those referrals that 13% made up nearly 34 of the total expenditures for Behavioral Community Care referrals so we have a problem I think we can agree on that and I'll just State for the record that Dr Lauren is um yes ma'am yesing her head so I'll just um ask you do you also agree that we should be seeking to ensure that veterans are getting proven high quality Care
▶ 1:09:52in all instances as much as possible yes ma'am there there's no question about that veterans deserve the very best care um and we're very proud that we are able to demonstrate with studies research that VA delivers that care but unfortunately not every VA has that care available and that's where Community Care can fill a gap exactly and I absolutely agree that we need to make sure that they have that care I think accreditation
▶ 1:10:22requirements into Community Care contracts is for instance there's this mindblowing case in South Florida of a community care provider that employed patient recruiters to give illegal drugs prior to admission to ensure that um patients were admitted for Detox Services which were the most expensive um obviously none of us want our taxpayer dollars used um at the har doing harm to our veterans um so Community Care standards
▶ 1:10:52a fee schedule um and I also just wanted to ask Dr Lauren do you can you confirm that in late January president Trump fired the va's Inspector General Michael Mell that's what I read in the news yes ma'am yeah and we've been talking about the inspector General's office and the importance that they play in investigating some of these things would you agree that not having an inspector General impedes our ability to do that so I I I don't know that I can fully agree with that
▶ 1:11:22because we continue to engage with the inspector General's office we continue to participate um in investigation inquiries in audits we receive reports um and findings and um really engage very very collaboratively with the inspector General's office that that work has continued I am so happy to hear that it's continuing and I think it's probably a short-term reality that until there's some
▶ 1:11:53upper level director in my experience when there's no Captain things kind of derail over time so that's not a question I don't need you you don't have to make a position on that but I just want to bring us back to acknowledging that the larger context that we are all here to do is make sure our veterans are getting the best care possible um our Administration has fired um veteran staff it has removed the Inspector General um we are here talking about spending
▶ 1:12:23less money in our budget for the veterans um and we are wasting a lot of that on um unnecessary um expenditures that we have the ability to control so I just hope before this committee sends anything to the floor that my colleagues and I can work to together to address this headon and ensure the administration is um allowing us to inspect things but also that we are making sure that our veterans have access to the best possible care and that our policies reflect that thank you madam chair I yield back
▶ 1:12:54uh thank you Dr Dexter the chair now recognizes Dr Morrison for 5 minutes for any questions she may have thank you madam chair I appreciate the discussion brought forward in this hearing about the importance of access to treatment for substance use disorders it's imperative that we care uh that the care we offer our veterans comes from providers with a demonstrated ability to deliver highquality evidence-based care my experience as one of the millions of Physicians who that has trained in a VA facility gave me a firsthand introduction to the uniquely Specialized
▶ 1:13:24Care that the VA is able to offer our veterans achieving the goal of quality while preserving the Specialized Care VA offers requires intentional investment in VHA facilities that provide substance disorder care and continual reflection on how providers are meeting veteran needs for over 1 years VA has been committed to providing residential care for veterans in need of additional structure and support in 2022 VHA served over 300,000 veterans uh with substance use disorder diagnosis um thank you doctors
▶ 1:13:54both of you for for being here today in the spirit of understanding the progress VA is made in substance Ed disorder treatment I I have a couple of pretty straightforward questions for you and they they really are just yes or no questions um the first one is has utilization of residential substance used disorder treatment programs increased over time and just to clarify um in Direct Care Community Care both both uh short answer is yes
▶ 1:14:25would you agree doctor absolutely yes okay thank you um next question is has increased capacity in VA substance Ed disorder treatment programs led to improvements in your ability to provide the Intensive medical treatment veterans especially under served groups increasingly need I'd like to ask Dr weers to answer that question sure yes or no yes okay thank you and then last question uh would you characterize the educational training and Staffing level requirements
▶ 1:14:55within va's substance use disorder treatment programs to be consistent across your program sites yes okay thank you very much va's commitment to developing a cohesive Continuum of Care is indispensable to achieving successful outcomes for veterans that find themselves at various stages of treatment for substance use disorders I urge my colleagues to recognize the importance of supporting the residential substitutes disorder treatment infrastructure within VHA investing in expanded program
▶ 1:15:25capacity and standing against tactics that would undercut treating our veterans with the dignity they so rightfully deserve thank you madam chair I yield back thank you the chair and I'll recognize yourself for five minutes and uh I would also urge my colleagues uh to uh recognize the care that comes in the community the reason why a mission act exists is because patients weren't getting care veterans weren't getting care they weren't getting access they were waiting they were dying they were committing suicide they're overdosing
▶ 1:15:55they're dying of fil poisoning as a matter of fact in this very hearing room when we had a hearing on residential care and substance use disorder prior VA admitted that they did not think that residential care or substance you disorder Residential Care fell under the mission act so it didn't matter if the patient waited 30 days or a 100 days or a year they still weren't going to refer them Comm commun to Community
▶ 1:16:26Care because they didn't feel it was under uh that fell under the mission act this is the va's own words Dr rente um and I'm an opthalmologist and not only have I worked at VA facilities Not only was my uncle uh you know six of the eight kids of my family are veterans my father is my husband is uh my grandfathers are uh my uncle was in a residential uh facility at the VA for his entire life when a ship went down the Pacific and world wari too
▶ 1:16:56and I've done substance use disorder and help to change policies at the state level but when a veteran is assessed as needing urgent residential care how long do you think they should wait and are you confident that every VA facility applies the same timeline and criteria to get that veteran placed or referred to the community without delay thank you very much for that question um so first let me say that the national Poli policy is very
▶ 1:17:26clear and is applicable across the country the fact that there is variability and a lack of standardization is a problem there there there is no question so if if the if the standard is present then that means the culture is not permitting the standard to be met so because the committee continues to hear that policies governing residential treatment and Community Care referrals are interpreted differently depending on where a veteran seeks
▶ 1:17:57care how is a VA going to ensure that policies are followed uniformally thank you very much um the secretary has initiated a review this would be secretary Collins yes ma'am um has initiated a review of policies directives Staffing organization structure of multiple aspects of the direct care system as well as multiple aspects of the community care system in order to be able to
▶ 1:18:27begin to answer the questions that you're asking um in general and these are generalities when you have policy and it's just not being carried out there are common reasons for that some common reasons is that the policy may not be clearly written the policy may have broad subject to interpretation features it may be that we've simply not adequately trained the Frontline staff and there are a host
▶ 1:18:57of other reasons in between those things those are the things that we need to address because those are interfering with our ability to provide the access that veterans need to have it's inter it's creating barriers and in some cases it it may be creating additional administrative steps and and uh Dr Ry as I mentioned um we have programs like the Gordon Fox uh Parker Suicide Prevention grant program we we have buddy systems within our veteran service organizations
▶ 1:19:28that help veterans to navigate some of these things and and I realize that you're a recent addition although you've cared and done mental health and substance use for a long time but um how do programs like the Gordon Parker Fox Suicide Prevention Grant Program help veterans access Mental Health Care Services um is that a question you might be able to take Dr weers sure so the the fox grants uh program U provides uh grants to community organizations that are
▶ 1:19:58helping to engage veterans that don't engage directly with our VA Health System um so it really helps to fill that Gap um in providing access out in the community there are Partners out in the community and helping engage veterans to reduce their risk for suicide they can also um grantee um participants can also access care through VA um when they've become a part of one of the uh programs with a grantee so let me just say that you know I think um that our VA Health Care System
▶ 1:20:28although I don't utilize it as a veteran nor does my husband I want to save that for the veterans who have most in need and need that access to care but nonetheless I think our uh you know Veterans Administration our hospitals uh our programs do a very good job but they're not always there and it is those gaps that we're trying to feel and these Partnerships whether they be in the private sector in other avenues that we're trying to make sure veterans have access to care I think we all want the same
▶ 1:20:58thing but I think to continually um digigrade a pro provider that's outside the VA just like to continually denigrate the VA itself both of those uh attitudes are are inappropriate and wrong because as we've already said we want the highest quality most effective care and sometimes that's at the VA hospital and sometimes that's in the community because if you can't get access to care it doesn't matter how high the quality is it doesn't matter how matter how
▶ 1:21:28effective the program is if you can't get access to care you have no care uh and given that I'm in a rural area uh our veterans like to have access to care when and where they can get it so uh with that ranking member brownley would you like to make any closing remarks would you like to make any closing remarks I would I would indeed thank you very much so I i' just like to say um that I agree with my
▶ 1:21:58colleagues across the aisle that we must ensure that any veteran who is ready to seek assistance can be treated unequivocally I'm worried that treatment will not be available with the clinicians who have been either fired or can't be recruited we're already underst staffed we need a fee schedule so so that commun so that Community providers will conform to industry norms and we need to weed out Bad actors and not
▶ 1:22:29fire very capable employees within the VA uh and for the record one more time I will say I support Community Care and Community Care is a critical partner to VA but we've got to get it right and I will yield back uh thank you very much uh I'm going to again uh remind this committee as we did several weeks ago that over the uh four years of the previous admin Administration there was an increase of $126 billion to the VA
▶ 1:22:59an increase of 80,000 employees 57 of those full-time 23,000 part-time uh and that as we've heard from secretary Collins uh healthcare workers uh uh were exempt with that I'd like to thank everyone for their participation in today's hearing and for the great discussions we've had on this important topic I'd especially like to thank our Witnesses and Miss Jared for her very moving testimony to today and for having the come uh the courage to come forward I want to thank both of our Witnesses from the
▶ 1:23:29VA some of who may be new uh to this process for being here today as well today's hearing reinforced what we've heard time and time again while there may be very good care to excellent care at the VA veterans don't struggle because the VA lacks funding or resources they struggle because they continue to fall through the traps the tracks of a cracks of a bureaucratic system that's bogged down in inefficient processes and inconsistent standard standards veterans in crisis cannot afford to wait I know this firsthand and personally
▶ 1:24:00and I look forward to working with secretary Collins and the VA to break down barriers preventing our veterans from accessing the life-saving care that they so desperately need in their moments of Crisis be it at a VA or be it in a community the complete written statements of today's witnesses will be entered into the hearing record I ask unanimous consent that all members have five legislative days to revise and extend their remarks and include extraneous materium hearing no objection so ordered I thank the members and the witnesses for their attendance and participation today this hearing is
▶ 1:24:53adjourned e