NAVAPD’s Concerns With Proposed Legislation
NAVAPD has been informed of multiple bills that are up for discussion at the House Committee on Veterans Affairs hearing on December 17, 2024. The bills were provided to NAVAPD for review and comment ahead of the scheduled hearing. The bills have been summarized below and can also be found using the search feature on the Congress.gov website. NAVAPD has concerns about the proposed legislation, and our comments submitted to the House committee are below.
HR214 – “Veterans True Choice Act of 2023” – Provides eligibility for Tricare Select to Veterans with Service-Connected disabilities. Veterans may elect to enroll in Tricare Select during the annual open enrollment period. The cost sharing for Tricare Select will be calculated regardless of the date of original enlistment or appointment of the beneficiary in the uniformed services. Dependents of covered veterans may not enroll in Tricare solely by reason of the covered veteran enrolling in Tricare. The veteran is prohibited from receiving VA healthcare while the veteran is enrolled in Tricare.
NAVAPD’s Feedback:
NAVAPD is concerned because the VA may be the best provider of certain types of care the veteran needs given its unique understanding, training and experience in treating military conditions, as well as research into advances in treatment options for those unique healthcare conditions. Prohibiting the veteran from receiving VA healthcare because they are enrolled in Tricare does not put the veteran’s healthcare first and we are concerned this will compromise the health of veterans since community providers are not as well versed as VA physicians in treating these unique conditions.
HR3176 – “Veterans Health Care Freedom Act” – This bill allows veterans to choose their health care providers. This will be a pilot program for trialed for a period of 3 years in at least 4 distinct VISN’s. Under this pilot program, veterans can elect to receive hospital care, medical services, and extended care services at any provider in the covered care system. The veteran can elect any specialty care and mental health provider in the covered system to receive specialty care.
NAVAPD’s Feedback:
This bill effectively removes VA physicians from caring for veterans simply based on the veteran's preference. The veteran can simply say they do not want to be treated within VA and will then be offered community care. There are no funds allocated for this program. This means that the medical center will have to bear the cost from their allocated budget, NAVAPD is concerned because if the medical center must bear the cost, this will lead to a hemorrhage of funds from the budget. To maintain their budget and continue operations, the medical center will eliminate physicians, dentists, and other direct care providers and they will not approve funds for advances in care, new equipment, infrastructure and the like. These medical centers will lose the ability to recruit and retain LIP's. NAVAPD sees this as a waste of resources since VA can provide better, higher quality, and more timely care than the private sector, but VA must invest in recruiting, hiring and retaining physicians and dentists.
HR5287 – “Veteran Access to Direct Primary Care Act” – This is a second pilot program that Congress is debating. This bill will provide health savings accounts to veterans. This bill establishes a 5-year pilot program. Under the bill, veterans have the option to choose to receive primary care services furnished by non-Department health care providers under a direct primary care service arrangement using a health savings account. The health savings account can be used to: purchase primary care services at non-Departmental PCP’s, pay for periodic fees paid to a physician for a defined set of medical services, provide fees for paid or prepaid for services to diagnose, cure, mitigate, treat or prevent disease, and promote wellness, pay for prescription or nonprescription medications and drugs. The bill states that the amount given to the health savings account will be determined in consultation with an actuarial service. There are no additional funds authorized to be appropriated to carry out this program.
NAVAPD’s Feedback:
NAVAPD has the same concerns noted above. See comments under HR3176
HR8347 – “Improving Menopause Care for Veterans Act of 2024” – This bill directs the Comptroller General of the United States to conduct a study on the medical services furnished by the VA for veterans experiencing perimenopause, Genitourinary Syndrome of Menopause, and the stages of menopause. The Comptroller General’s report will describe menopause care in VA, guidelines and protocols for menopause care, training given to providers giving menopause care, diagnosis and treatment of those conditions in women veterans, an evaluation of the adequacy of access to interdisciplinary care for those conditions, an evaluation of the initiatives by VA to make veterans aware of this care, an evaluation of the quality and efficacy of menopause care in VA, and research into development of new treatments and protocols for care, as well as recommendations to improve menopause care in VA.
NAVAPD’s Feedback:
NAVAPD is in support of this bill. As it is currently written, this bill sounds like it will benefit woman veterans and improve the care they receive from the VA, It will monitor menopause care ensuring there are treatment advances made in this field allowing the VA to be a world leader in this treatment
HR6333 – “Veterans Emergency Care Reimbursement Act” – This bill will modify the limitation on reimbursement for emergency treatment of amounts owed to a third party for which the veteran is responsible under a health plan contract. This is a retroactive bill and will applies to any reimbursement claim for emergency treatment furnished after February 1, 2010.
NAVAPD’s Feedback:
NAVAPD will support this bill. As it is currently written, this sounds like it may be of benefit to the veterans so that they are not responsible for any out-of-pocket costs associated with emergency care provided at a non-Departmental hospital not covered by the third-party health plan. Our concern is the retroactive date (going back almost 15 years and the costs to the VA for these retroactive payments. The bill does not specify if funds have been allocated for the retroactive payments.
HR9924 – “What Works for Preventing Veteran Suicide Act” – In this bill, the VA is directed to prescribe regulations that establish standard practices that, unless prohibited by law, shall apply to grant or pilot programs relating to suicide prevention or mental health. Practices include establishing clear and measurable objectives, defining a plan to evaluate those programs, determination of how information will be analyzed to evaluate the programs, and identification of standards for decisions whether to expand, extend or make the program permanent.
NAVAPD’s Feedback:
NAVAPD supports activities to reduce veteran suicide and improve veteran mental health. However, this bill is so ambiguous it does not seem like it will do anything to improve either of those two conditions. If the bill is re-written to have practical outcomes and measures that demonstratively reduce veteran suicide while keeping mental health care under the auspices of the VA, then this bill seems to have merit.
HR10012 – This bill is written to allow eyeglasses in the category of medical services authorized to be furnished to veterans under community care.
NAVAPD’s Feedback:
NAVAPD is concerned about this bill because the cost for eyeglasses in community care will far exceed the costs of providing eyeglasses in house. Community Care Optical shops will be incentivized to upsell glasses by providing expensive designer frames, adding all sorts of unnecessary coatings and protections to the lenses to increase the cost of the glasses and hence their reimbursement from VA. NAVAPD would like to see these services offered in house to keep costs reasonable or if Congress insists on eyeglasses being added to the community care benefit to codify what will be covered by VA.
HR8481 – “Emergency Community Care Notification Time Adjustment Act of 2024” – This bill provides a modification in the time required to notify VA in the case of an emergency where a veteran has been admitted to a non-VA health care provider. The bill states that any care or services received by the veteran during the period beginning at time of admission and ending at time of discharge from the facility at which such care or services were furnished will be authorized if the veteran, or agent acting on behalf of the veteran, submits an application for authorization by the deadline the VA deems appropriate, and the deadline cannot be any earlier than 72 hours following discharge.
NAVAPD’s Feedback:
NAVAPD believes that in nearly every case, emergency care needs to provided at a facility that is closest to where the veteran is in crisis, regardless of whether or not that facility is a non-VA hospital. NAVAPD supports this bill so that in the case of emergency health or mental health care the veteran is not responsible for any out-of-pocket costs.
HR Unnumbered Bill – “Complete the Mission Act of 2024” – This bill is written to improve the provision of care and services under the Community Care program. This bill has multiple parts including the following:
1. Eligibility Standards for Access to Community Care – This section states a veteran will be eligible to elect to receive non-Department hospital care, medical services, extended care services (excluding nursing home care) through Community care with the following eligibility access standards: (Telehealth appointments will be considered in determining eligibility)
a. Primary Care, mental health, extended care – if VA cannot schedule an in-person appointment within 30 minutes average driving time and within 20 days of the date of request for the appointment.
b. Specialty Care – if VA cannot schedule an in-person appointment within 60 minutes average driving time and within 28 days of the date of the request for the appointment.
c. If the veteran has had an appointment in VA canceled by VA for any reason other than the request of the veteran the wait time shall be calculated from the date of the request for the original appointment.
d. If the veteran agrees to a longer drive time or later date the VA will be required to electronically document that agreement AND provide the veteran a copy of the documentation of the agreement.
2. VA must notify all veterans they are eligible for this new community care initially and annually.
3. VA must notify veterans in writing if they are denied community care including the reason for denial, and how to appeal the decision.
4. VA must notify veterans if they are eligible for telehealth if appropriate.
5. VA must develop a plan to establish an interactive, online self-service module to allow veterans to schedule appointments, track referrals for health care, receive appointment reminders, and to allow veterans to appeal and track decisions on appeals if denied for community care services.
6. VA will be required to publish monthly on a commercially available website, average wait time for a veteran to schedule an appointment at each medical center for primary care, specialty care, mental health care measured from the date of request for the appointment to the date on which the care was provided.
7. This bill also allows a three-year pilot program in not fewer than five locations to allow veterans enrolled to access outpatient mental health and substance use services through outside health care providers without referral or pre-authorization. This section allows this program to be extended across all VA medical centers.
NAVAPD’s Feedback:
NAVAPD opposes this bill because the bill seems designed to divest VA from providing healthcare instead allowing all healthcare to be referred to community care. This will leave VA in the position of a third-party administrator akin to an insurance company. It is unreasonable to have the measure of whether a veteran is offered community care simply based on the date the veteran desires the appointment. The "date of the veteran desires the appointment" can be any date the veteran chooses, including dates in the past. Cutting the drive time is unreasonable in large metropolitan areas where a veteran may live only a few miles from the medical center but due to traffic may take more than 30 minutes to get to the VA location. Allowing the veteran to go online to request and schedule appointments will not work in procedure-based clinics such as dentistry, surgical clinics or podiatry clinics. Those clinic schedules need to be managed by the clinical staff. NAVAPD sees many problems with this bill not the least of which is a slippery slope allowing veterans to access community care for anything they want simply based on their request. Congress needs to realize this will bloat the VA budget and make it impossible to provide high quality care to all veterans. Instead of wasting resources sending all veterans out to community care, the VA needs to invest in care by hiring and retaining physicians, dentists, and other LIP's.
HR Unnumbered Draft Bill - Senator Takano introduced a bill cited as the “Supporting Medical Students and VA Workforce Act” [of 2024]. The Act, as proposed in the draft legislation, would authorize a scholarship program enacted jointly by the Department of Veterans Affairs, The Department of Health and Human Services and Department of Defense. This scholarship program would allow the VA to pay for the medical education of commissioned Public Health Officers to be trained at the Uniformed Services University. In exchange for the tuition being covered by the VA, the Public Health Officer would be obligated to complete a term of service at VA after their graduation and completion of a residency program for a period of not to exceed 10 years.
NAVAPD’s Feedback:
NAVAPD supports this legislation as long as the Public Health Officer serves a term long enough to ensure high quality continuity of care for veterans as well as vesting the physician in to the VA system so that once their contract is satisfied, they will stay with VA.
These bills as well as the House Hearing can be followed on www.congress.gov . NAVAPD will continue to follow the progress of the bills, and any other legislation proposed affecting VA Physicians and Dentists. You can make your concerns heard by writing to your Congress Person and Senators.