Statement of Bill Rausch
Political Director
at
Iraq and Afghanistan Veterans of America
before the
Senate Committee on Veterans’ Affairs
for the
Hearing: “Exploring the Implementation and Future of the Veterans Choice Program”

May 12, 2014

Chairman Isakson, Ranking Member Blumenthal, 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 working hard 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 continued active engagement with veteran organizations to more broadly identify a comprehensive strategy and plan for delivering Non-VA care in the community moving forward.

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.

Based on our most recent survey, over 1/3rd of IAVA members have reported they do not know how to access the choice program. This is compounded by reports that in some cases VA scheduling personnel are not explaining eligibility for choice while offering appointments outside the 30-day window.

The Secretary and VA Senior Leadership must continue to engage VA front-facing scheduling personnel with ongoing and evolving training standards, so when veterans call the VA, they receive consistent and clear understanding of their eligibility for the choice program. 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 continues to surface 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 or other facility 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.

There have been encouraging developments related to the implementation of the Choice Program, specifically, the VA’s action to step up and fix the initial ineffectiveness of the 40-mile rule calculations under regulation, as it related to geodesic distance vs. driving distance. That regulatory correction was much needed and as a result there are hundreds of thousands of new veterans eligible for the choice program. On behalf of our members we applaud Secretary Bob McDonald and Deputy Secretary Sloan Gibson for their leadership in listening to their customers, our veterans, 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 yet important program.

IAVA is committed to remaining actively engaged with the veterans making use of the choice program so we can keep current on the veteran experience. We are mindful that with thousands of appointments for care being conducted, there will inevitably be thousands of unique experiences that 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 realize a veteran-focus strategy and plan for non-VA care in the community moving forward.

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 me to testify before you again, and we want you to know 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.