Statement of Christopher Neiweem
Legislative Associate
at
Iraq and Afghanistan Veterans of America
before the
House Committee on Veterans’ Affairs
for the
Hearing: “Assessing the Promise and Progress of the Choice Program”

May 13, 2015

Chairman Miller, Ranking Member Brown and Distinguished Members of the Committee.

On behalf of Iraq and Afghanistan Veterans of America (IAVA) and our nearly 400,000 members and supporters, thank you for the opportunity to share our views with you at today’s hearing Assessing the Promise and Progress of the Choice Program.

IAVA was one of the leading veterans organizations involved in the early negotiations on the Veterans Access to Choice and Accountability Act (VACAA), as it was being drafted and the breadth of its final language was debated. This is a highly complex law that the Department is continuing to work to effectively implement in order to ensure veterans are not left waiting for unacceptable lengths of time to receive health care services.

My remarks will focus on the experiences of utilizing the VA Choice Program IAVA members have recently reported by way of survey research. Additionally, I will provide recommendations Congress and the Secretary must consider in order to get this program operating at the height of its potential. These recommendations include: legislative clarification of the eligibility criteria for accessing the choice program, strengthening training guidelines for VA schedulers charged to explain the eligibility criteria to veterans, and active engagement with veteran organizations to more broadly identify a comprehensive strategy and plan for delivering Non-VA care in the future.

In examining the current criteria for determining which veterans are eligible to use the Choice Program, those who must wait longer than 30 days for an appointment and those who live more than 40 miles from a VA medical facility, more statutory clarity is required. Veterans are all too frequently reporting they are unsure if they are eligible for choice and VA has, in some cases, been inconsistent in communicating whether or not a veteran can access it in individual cases.

Over 1/3rd of IAVA members have reported they do not know how to access the program. This is compounded by reports that in some cases VA scheduling personnel are not explaining eligibility for choice to veterans and are then offering appointments “off the grid” of the 30 day standard–sometimes much later.

The Secretary must continue to engage VA front-facing scheduling personnel with ongoing and evolving training standards, so when veterans call the VA, they hang up the phone with the correct or best answer that explains their choice eligibility. The VA has improved in this area but with so many veterans still confused about choice eligibility–nearly 7 months after the program’s birth–training criteria must be strengthened and maintained.

Congress should aid in the Department’s implementation efforts by clarifying in law that the 40-mile criteria must relate specifically to the VA facility in which the needed medical care will be provided. The frustrating example that has surfaced is one of a veteran that requires specialized care in a VA facility outside of 40 miles, but through strict interpretation of the current VACAA law, is ineligible for participation because a local CBOC may be geographically near the veteran’s address, notwithstanding that facility cannot provide the required care. One of our members illustrated one of these cases with the following statement: “Because there is a CBOC in my area I was denied. The clinic doesn’t provide any service or treatment I need for my primary service connected disability. [The] nearest medical center in my network is 153 miles away.” Congress must provide much-needed clarity and work with VA to eliminate cases like those just described.

However, VA’s action to step up to fix the initial ineffectiveness of the 40-mile rule calculations under regulation, as it related to geodesic distance vs. driving distance is encouraging. That regulatory correction was much needed and we applaud the Secretary for leading to make that change happen.

VHA’s statistics on choice utilization among the veteran population as of this month state there have been nearly 58,863 authorizations for care and nearly 47,000 appointments. This data verifies that veterans out there are using the program and the VA has been making progress to implement what is clearly a complex and historic mandate relating to the furnishment of veteran health care now and in years to come.

IAVA is committed to remaining actively engaged with the veterans making use of choice care so we can keep current on the veteran experience. We are mindful that with thousands of appointments for care being concluded, there will inevitably be thousands of unique experiences we want to know about to gauge the satisfaction with this program.The satisfaction of the veteran utilizing choice, the cost of the care purchased outside of VA facilities and understanding issues that come up along the way will allow us to better identify the scope and role the concept of choice plays in the future.

We appreciate the hard work of Congress, the VA, and the veteran community and recognize we have to stay focused on improving veteran healthcare delivery in the short and long-term. Robust discussion on the scope and cost of maintaining healthcare networks is complicated and multi-layered, which is why our last recommendation is simple: we must continue to work together and keep communication active between all relevant stakeholders.

Mr. Chairman, we sincerely appreciate your Committee’s hard work in this area, your invitation to allow us to participate in this important hearing, and we stand ready to assist Congress and Secretary Bob McDonald to achieve the best results for the choice program now and in the future.

I am happy to answer any questions you may have.