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Statements on Introduced Bills and Joint Resolutions

Location: Washington, DC




S. 1182. A bill to amend title 38, United States Code, to improve health care for veterans, and for other purposes; to the Committee on Veterans' Affairs.

Mr. CRAIG. Mr. President, I seek recognition today to introduce legislation that will expand the services available to our Nation's veterans and their dependents, and improve the ability of the Department of Veterans Affairs (VA) to provide health care services to this same group of deserving Americans. I take a few moments now to explain the provisions of this legislation.

First, the bill would, in section 2, exempt veterans enrolled for VA care from all copayments for hospice care services provided by VA. Over the past several years, VA has greatly expanded its efforts to provide compassionate end-of-life care for our Nation's heroes. Last year, Congress made efforts to ensure that the surviving spouses and children would not receive bills for such services following the deaths of such veterans who were in the hospice program. Unfortunately, last year's legislation did not go far enough, and today some veterans' families are still paying for this care. This provision would end that practice in all hospice care settings.

Section 3 of the bill would exempt former Prisoners of War from copayments that are applicable to care in a VA extended care facility. Congress has already exempted this deserving group of veterans from other VA medical copayments, and this provision would complete the range of services available to these veterans free of charge. In addition, this section bill would remove the requirement that VA maintain the exact number of nursing home care beds in VA facilities as it had during fiscal year 1998. Now before some suggest that I am advocating the reduction in services available to veterans, I'd like to explain how the current requirement came about and why I believe it should be reconsidered.

The requirement that VA maintain a specified level of nursing home beds was inserted into the law in 1999 when Congress enacted legislation to expand options for non-institutional, long-term care services available to veterans. At that time, some felt that by growing the non-institutional care program, VA would seek simply to shut all of its institutional care capacity. So in a compromise, Congress decided that fiscal year 1998 would be the year against which changes in the institutional care program would be measured. And then it required that VA maintain all of the beds it had in 1998.

Since 1998, VA has increased the number of veterans it treats by nearly 2 million. Yet, year after year, VA reports to Congress that it does not need to maintain the number of nursing home beds required by law. Does that mean VA is closing beds unnecessarily? No. It means VA has followed the progress of medicine and is offering tens-of-thousands of veterans non-institutional care services while keeping them at home rather than in VA nursing home beds. I do not believe that Congress should continue to mandate the maintenance of an arbitrarily-determined number of beds in a system that is trying to effectively use every dollar it can to provide real and needed services to our veterans. This provision reflects that belief.

The fourth section of the legislation, if enacted, would ensure that veterans who seek emergency medical services at the nearby community medical facilities are treated no differently financially than if the care had been provided at a VA medical facility. This is an important issue in the provision of quality health care for our veterans. VA has some evidence that veterans who need emergency services are bypassing local medical facilities, and are attempting to ``make it'' to a VA facility even in the face of an emergency, because of concerns that VA's reimbursement policies for non-VA provided emergency care will result in the veteran paying more out-of-pocket costs. Clearly, that is not the kind of behavior Congress wants to encourage in our veterans. Nor is it good medicine. This provision would clarify once and for all that veterans will be treated equally regardless of where emergency care treatment is sought.

Section 5 of the bill would authorize VA to provide or pay for up to the first fourteen days of care for a newborn child of an enrolled female veteran who delivers her baby under VA provided, or VA financed, care. As most of my colleagues know, VA provides what it calls a ``comprehensive package of health benefits for eligible veterans.'' Unfortunately, for the increasing number of female veterans enrolling for VA care, the word ``comprehensive'' does not include coverage for a newborn's first few days of needed care. This type of arrangement is common in the private sector. In my judgment, this is an issue we must address to assure our female service members that, as more and more of them join the service and change the face of the American military, we will make certain that the face of VA changes right along with it.

Section 6 would allow private health care providers to recoup costs for care provided to children afflicted with spina bifida of Vietnam veterans--children who are, by law, entitled to VA-provided care--when the costs are not fully covered by VA reimbursements. This so-called ``balance billing'' authority would prohibit charging individual patients or veterans themselves. Only a beneficiary with private insurance could have his or her insurance cover charges not covered by VA. This provision is important because it will provide a financial incentive to many providers who, unfortunately in some cases today, are not willing to provide the very specialized services needed by these children because some costs are not reimbursed by VA at a sufficient rate.

Section 7 of this bill would increase the authorized level of funding for the Homeless Grant and Per Diem Program at the Department of Veterans Affairs. I know all of my colleagues would agree that any man or woman who served this country in uniform should not be among the unfortunate Americans who find themselves on the street without shelter. VA has made tremendous strides in this area by providing grant programs, health care services, mental health treatment, and other assistance to those veterans who do find themselves on the street. This provision would ensure that good programs remain on track for the foreseeable future.

The eighth section of this bill would authorize VA medical centers to employ Marriage and Family Therapists. I realize that to some of my colleagues this may sound as though VA is beginning to become a family health care system and not a veterans' health care system. I want to assure any who harbor such concerns that this is not the intention or the purpose of this proposed authority. Rather, this proposal seeks to recognize that for some veterans, the trauma and experiences of war may lead to troubles at home. Often in these situations, treatment as a family is more effective for the betterment of the veteran. Of course, preservation of the family is an extremely important byproduct of this treatment approach as well. I do not believe it is incompatible with the mission of treating our veterans to focus on their family well-being when it is appropriate. The military is offering many of these services already to those who are returning from overseas. These programs are receiving good reviews from those in the mental health and counseling professions. It seems only logical that we extend successful ideas from the military experience to our veterans.

Section 9 would provide pay equity for the national Director of VA's Nursing Service. Currently, this position is paid at a rate that is less than all of the other service chiefs at VA's Central Office. I believe correcting this inequity is not only a matter of fairness, but a long overdue recognition that VA's nursing service is just as important to the provision of health services for our veterans as the pharmacy service, the dental service, and other such services within VA.

Section 10 of this bill would allow VA to conduct cost-comparison studies within its health care system. Mr. President, such studies are invaluable tools for government to measure whether its current workforce has identified the most efficient and effective means of delivering services to our veterans, and value to the taxpayers. In my opinion, any organization that fails to measure its performance against others in the same field will quickly cease to be an effective organization. VA is--and it must continue to be--an effective and efficient health care provider. This small change in the law will provide one additional tool to ensure that is the case far into the future.

Section 11 of my legislation would focus on an area of great importance to many members of the Senate: The treatment of mental health issues for those returning from service in Operations Iraqi Freedom and Enduring Freedom. I know many of us have read reports that estimate that as many as 20 percent of those serving overseas will need some mental health care services to cope with the stress of serving in a war zone. First, I want to say to my colleagues that the Department of Veterans Affairs already has in place numerous programs and services to respond to the needs of those veterans seeking care for mental health issues. Still, as Chairman of the Veterans' Affairs Committee, I believe it is important that we assure our brave servicemen and women, and the American people, that we are not satisfied with merely maintaining VA's ability to provide mental health services. Rather, we must assure that VA continues to improve and expand the treatment options available.

This section of the bill would authorize $95 million in both fiscal years 2006 and 2007 to improve and expand the mental health services available to our Nation's veterans. The Secretary of Veterans Affairs would be required to devote specific resources to certain important areas of treatment including, but not limited to $5 million to expand the number of clinical teams devoted to the treatment of Post-Traumatic Stress Disorder; $50 million to expand the services available to diagnose and treat veterans with substance abuse problems; $10 million to expand tele-health capabilities in areas of the country where access to basic mental health services is nearly impossible; $1 million to improve educational programs available for primary care providers to learn more about diagnosing and treating veterans with mental illness; $20 million to expand the number of community-based outpatient clinics with mental health services; and $5 million to expand VA's Mental Health Intensive Case Management Teams.

I want to make it clear to my colleagues that I am taking this approach because I am concerned about the availability of these services as much as anyone in the Senate. But, I am also concerned about recent moves to ``micro-manage'' the VA health care system by requiring, for example, that certain percentages of VA's budget be spent on one service or another, or that every VA facility have some certain clinical service available. These approaches, while well-intentioned, run the risk of diverting important resources away from services that are extremely important to our veterans. My approach is to put Congress on record as expecting improvements and expansion in certain important programs, attaching a reasonable amount of money to those efforts, and then monitoring the progress closely from the Veterans' Committee.

Section 12 addresses a point of legal contention that has restricted the sharing of medical information between the Department of Defense and VA. As a result, record transfers for patients who would be VA patients are not arriving in VA hands as quickly and as seamlessly as they should. This provision would make clear that DoD and VA may exchange health records information for the purpose of providing health care to beneficiaries of one system who seek to quickly move to the other for services.

Section 13 of the bill would direct VA to expand the number VA employees dedicated to serving the Veterans Readjustment Counseling Service's Global War on Terrorism (GWOT) Outreach Program. The Committee on Veterans' Affairs held a hearing earlier this year at which two GWOT counselors testified on the numerous services their program provides to returning service members, specifically Guardsmen and Reservists coming back from Iraq and Afghanistan. In many cases, these GWOT counselors are the first VA officials to welcome home our troops at the airport, provide them with their first briefing on VA benefits and services, and steer those in need to counseling services and health care centers. This is a creative, vibrant program with only 50 employees that is just now beginning to reach its peak effect on returning combat veterans. I believe VA should expand its efforts in this area to ensure we are reaching everyone we can.

Section 14 of this bill would require VA to expand the number of Vet Centers capable of providing tele-health services and counseling to veterans returning from combat. Currently there are 21 Vet Center facilities that maintain this capability. And while that is a laudable effort, I believe we can do better. Tele-medicine offers a tremendous opportunity to bring many health services, particularly mental health services, to veterans who reside in areas of the country where those services would not otherwise be available. Practitioners are showing great results with tele-health services for mental health treatment, and our veterans are getting the services they need, closer to home, in a more timely fashion. Expansion of such success only seems logical.

Finally, section 15 of this bill would require the Secretary of Veterans Affairs to submit a report on all of the mental health data maintained by VA, including the actual geographic locations of collection and whether all of these points of data should continue to be collected.

Over the next several weeks, the Committee on Veterans' Affairs will be taking testimony on this bill and other legislation introduced by Senators to improve the range of services and benefits available to our Nation's veterans. I look forward to working with my colleagues throughout the rest of this session of Congress on these and other important efforts.

I ask unanimous consent that the text of the bill be printed in the RECORD.

There being no objection, the bill was ordered to be printed in the RECORD, as follows:

S. 1182


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