Letter to the Honorable Robert McDonald, Secretary of the Department of Veterans Affairs - Press for Changes to the Veterans Choice Program Payment System

Letter

Dear Secretary McDonald:

I write to convey my continuing frustrations with the Department of Veterans Affairs' (VA's) administration and oversight of the Veterans Choice Program (VCP). As I discussed in my January 14, 2016, letter to you, revising payments processing conditions in the VCP to achieve prompt payment is essential to protect New Hampshire veterans' access-to-care needs. While I appreciate the reforms VA is pursuing to rectify this issue-as well as the ongoing engagement of your staff in coordination with myself and my office-there are numerous shortcomings in the administration of the VCP that demand your immediate attention.

Prompt payments and medical documentation reforms

As you are aware, healthcare providers across our state continue to encounter substantial problems participating in the VCP due to the failure to receive payments for services rendered in a timely manner due in large part to payments processing conditions imposed by VA. The stakes are high. Providers participating in the program are being put in the position of either caring for veterans and not being paid, or leaving the Choice program.

Both alternatives are unacceptable. As such, in my January letter to you I requested that you revise the payments processing requirements to accomplish prompt payment as required by the creating statute, the Veterans Access, Choice, and Accountability Act of 2014. In that letter and in subsequent conversations my staff and I have had with VA officials, it is clear that this law does not require the payments process VA chose to pursue. As such, you have the authority to make these necessary modifications.

I have been encouraged by your subordinates' discussion of steps being taken to achieve this outcome as expeditiously as possible. Recognizing that administrative action is both proper and likely to be timelier than a legislative solution, I reiterate my concern that VCP payment processes and requirements be modified to effectuate providers' participation without undue burden and delay.

Other issues with the implementation and administration of the VCP

Fixing the payment processing and medical documentation shortcomings are necessary, yet they are far from the only issues with VA's administration and oversight of the VCP. As the originator of the contract for service, VA is ultimately responsible for the administration of services by its contractors, which for New Hampshire is Health Net Federal Services. My office has received many complaints related to the VCP, many of which can be summarized as follows:

* 15 months into the implementation of this program there is still a significant gap in the number of authorizations accepted by Health Net that are ready for appointing, and the total number of authorizations with a scheduled appointment date. Even if this gap is in part caused by veterans' decision to not utilize a VCP authorization, those decisions are too often driven by VA or Health Net's failures to get veterans appointment options in a timely manner.

* There are repeated problems with veterans getting prompt responses from Health Net. Health Net has acknowledged backlogs and keeps reporting that they are ramping up hiring at the call centers to deal with the issues. However, we've been hearing that message for months while at the same time also hearing from veterans stating that service has not substantially improved.

* My office currently has 46 formal inquiries open with Health Net. 41 concern individual veterans with problems utilizing the VCP, and five are for medical care providers who have accepted veterans from the Choice Program and are not being paid for services rendered to eligible veterans. My office also has a number of informal inquiries outstanding.

* As with the individual veterans, when medical care providers reach out directly by phone to Health Net, they too often report not being able to get through to Health Net staff, or when they do, they are on the phone for inordinate amounts of time trying to reconcile claims. For smaller health care offices, this is an extraordinary burden that directly impacts the ability to deliver care to veterans. Providers have said they want to care for veterans, but they are unable to commit the time and energy required by these bureaucratic barriers as well as having to bear the risk of thousands of dollars of unpaid claims on their books.

* Claims and the related medical records for billing submissions are required to be faxed to Health Net. Nearly all providers with whom my office has spoken have stated that they have repeatedly faxed claims and records to Health Net only to be told by Health Net that the paperwork has not been received. Health care providers are frustrated with having to work with legacy systems that failure to function as needed. Fax machines as operated by the VCP appear to be a subpar mechanism for transmitting data given currently available technologies that are utilized in the health care sector.

As evidenced by the volume and enduring nature of these shortcomings in the administration of the VCP, VA must aggressively act to improve the operation of the program.

VA leadership commitment to the VCP

VA leadership must be committed to implementing and administering the VCP as required by law. Unfortunately, a recent comment by a regional VA official responsible for New Hampshire VA facilities call into question that commitment, stating that the program is "going away in a year and a half." While this may have been an offhand remark, it is deeply troubling. While it is true that Congress authorized the VCP for a period of three years, as evidenced by my attention to this program, my cosponsorship of legislation to make it permanent in New Hampshire, as well as the active engagement of so many of my colleagues in Congress, this is a service that cannot be ignored, lest our veterans be denied important access-to-care options.

Congress expects VA to implement and administer the VCP as required by law fully and faithfully. Failure to do so by attempting to run out the clock is a dereliction of duty to our veterans. I hope that VA leadership is deeply committed to furthering the VCP and its goals as it is an important mechanism-particularly in New Hampshire, which lacks a full-service VA hospital-for giving veterans options in how and where to receive health care.

I continue to urge your immediate attention to these issues. The VCP is too important an access-to-care alternative for New Hampshire veterans to let it be degraded by the forced abandonments of the program by healthcare providers, or neglect by the agency responsible for running it.

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