Transcripts For CSPAN Veterans Affairs Budget 20180216

A congressman who called for the secretary to resign spoke with reporters after the hearing. [inaudible] the committee will come to order. Thank you all for being here to discuss the president s fiscal year 2019 budget submission for the department of Veterans Affairs. Holds 19. 8 6equest million billion. That is a huge number. It is even more striking when you compare the growth in the be a budget to the overall federal spending and the economy. It illustrates his point. Since 2006, the v. A. Budget is up 175 . Overall federal spending increased by 54 and gdp grew only 40 . Given the aggressive expansion of the a resources, i appreciate the secretarys testimony. The Department Must stay focused on the core mission to ensure resources are properly utilized and veterans care prioritize. The able take action on many important items in 2019. Some examples include the implementation of the forever the start of will be a costly and lengthy replacement of the v. A. s Electronic Health record. Because we cannot possibly cover these important issues in length in todays hearing, in the coming weeks our subcommittees will hold hearings on specific aspects of the Budget Proposal within their jurisdictions. We will discuss the proposed budget to help ensure department providing better quality and more Timely Services to our nations veterans. We want to consolidate and improve the a Community Care. Fromcommittee has heard veterans, v. A. Employees, and Industry Leaders about the many from effectively partnering and providing inhouse healthcare services. [captions Copyright National cable satellite corp. 2016] [captioning performed by the national captioning institute, which is responsible for its caption content and accuracy. Visit ncicap. Org] consolidating this into a program that will help veterans, dollare every all spent count. Another priority is an assets andnt of va infrastructure review process to help the department repurpose or billings, 11 to be spent where they make the most impact. As is crucial to ensure success. I was glad to see this in president trumps plan. Folio is for pot challenging. Every v. A. Bill is approaching 68 years old i know something about that number and was designed for model patient model care. Out of the real estate, nearly 6 million square feet are vacant, many more underutilized. We need a methodical and datadriven review to figure out how to adapt this physical footprint to meet the needs of the future. The implementation of a modern commercial health record. While this effort is necessary, it is very expensive. A contract has a price tag of 10 billion. That doesnt include the cost of updating infrastructure to accommodate, support and sustaining the vista until it can be turned off. After visiting a spokane, Washington Air base, im not sure if can ever turn this off. We have to resolve the question interoperability capabilities. Its unthinkable that va could potentially spend billions of dollars on a project that doesnt increase the departments ability to share information or to share information. If the v. A. Appen fails to proceed in a careful, deliberate matter. It was a relief when secretary schultz paused the awards look forward to discussing and i look forward to discussing any updates. The department of Veterans Affairs has a Sacred Mission to serve those who have served our country. Is entrusted with significant resources, outpacing those of nearly every other agency. With substantial resources, substantial responsibilities to spend dollars wisely. Before i yield to Ranking Member walls, i would like to discuss the general psych the yesterday. Eneral like many members, i was disappointed in the allegations raised. Alongside Ranking Member walls and senator isakson, i was briefed yesterday and have instructed my staff to request additional documentation from the ig. Ive gotten to know you well over the last two years, and i believe your intentions to serve in care for our nations veterans are well clear. , as public officials, we are all expected to be held to a higher standard, and be good stewards of tax dollars. Ice hope you will i hope you will take any changes necessary. We cannot allow distractions like these to keep us from doing our work. I look forward to seeing your response. Two members today, i incurred you to remember the importance of the topic at hand. Many of you will ask about the igs findings. Keep in mind that we are reviewing a budget request of nearly 200 billion. That should inspire discussion today. We have a responsibility to taxpayers for a third review as well. Me and the secretary will testify that this is not business as usual, the a budget. Budget. Orward va i look forward to seeing how this will transform the v. A. All eager tore receive the secretarys testimony, so i will leave it at that. I will turn it over to Ranking Member walls. Well, thank you chairman. I we get chart started, want to say, heartfelt thoughts and prayers. Our actions go out to our fellow citizens in florida, the tragedy that once again has befallen them. I appreciate the chairman on this. Mr. Secretary, i have gotten the opportunity to know you. Your intention to help veterans is clear. The trust you have on this committee is strong, but we do need to address these allegations. Report, ite an ig would be appropriate, and i appreciate that the chairman is moving forward. You had 3. 5 days to respond, a little unusual. Usually, longer time is given to address these. I will just say, before moving onto the budget, the allegations of a potential hacking of a v. A. Computer system is a serious matter. I would ask you come mr. Secretary we are prepared to ask the distrust the department of justice to look into that. We will follow up to see that the appropriate action to go on. Budget reflects the president s priorities. Many of these we are going to agree upon. Some of them are going to be contentious, rounding down. We know those are there. I would address, and i have been here for much of that increase from 2006. I would note several things have happened. 12 years of war. In 2003, the budget was so underfunded, they came back on in 2009. This committee had the courage and moral clarity to tackle the lemur claims and the Blue Water Navy issue. The our responsibility, and chairman is right, to account for every penny of that. In the snapshot of things, that baseline where we started in 2006 was grossly inadequate from where it was. There were things that needed to be correct. Its not the end money dollar. Its what we are getting for those dollars, and improvement of care for our veterans. Several issues last week, Congress Passed a bipartisan budget act, included a the a budget cap 4 billion. V. A. Budget cap 4 billion. Needs andignificant backlogs and will be provided resources. Morefocus is on spending on other things instead of hospitals, after 2. 4 in supplemental funding emergency. Between fiscal year 1719 request, communities benching will have increased spending will have increased 49 . Time and again, members of this committee, keystone stakeholders, have raised concerns about privatization of the v. A. You yourself mr. Secretary said your intent is not to privatize the v. A. You are seeking to merge congressionally mandated counts provided to provide greater accountability and transparency, and issue you have championed. How much care was being spent outside the v. A. . We will be delivering care to our nations veterans. I hope you can understand our concerns with that proposal. Year thereof last were over 31,000 provider vacancies and others for Human Resources and contracting positions that had not been filled because of an unofficial hiring freeze. The hiringnow if freeze will continue. Additionally, president trumps budget proposed is a paid freeze of fiscal year 2019. I want to know how the department will retain the best employees when our president does not appear to value their work trade last week, he testified in front of this committee that your commitment would be reflected in this budget. I didnt see it. While you are willing to make astronomical request, here are not willing to do the same for caregiver community. The chairman has been a champion on this. Im doing the best from our side to do the same. Caregivers deserve no less than our commitment to expand all eras. The cost of this expansion is small compared to what veterans and their families and caregivers have been forced to pay. Im pleased to see a request for the Electronic Health record. Want to make sure we are updated. Here is what i wanted to touch you on. The budget for the ice ig would be scaled back during 2019, leaving the oig for start far short of their staffing level. The optics of cutting the ig today are bad. Havesomething that i championed with the chairman together. Our common goals are absolutely clear. Our commitment to our nation, veterans are clear, getting the budget right is our job. I think this committee is up to the task, and i yield back. I think the gentleman for yielding. We are joined by the honorable david shulkin. Welcome. The secretary is joined by the honorable John Rachelle ski, assistant secretary management chief Financial Officer for Veterans Affairs, the cheek site the chief Financial Officer of the health administration, acting deputy undersecretary for the Veterans Benefits administration, the deputy forrsecretary for finance the National Cemetery administration, and richard chandler, Deputy Assistant secretary for v. A. V. A. Research management for the office of information technology. You are now recognized. Mr. Chairman, i want to thank you. I want to thank all the members of the committee. Many of you had a chance to come over to my office, spent some time talking about the issues. I know all of you are committed to the work we are doing. Thats why i think we have the best committee, the veterans committees in the house and senate. We work well together in a bipartisan way. Mr. Chairman, Ranking Member, thank you for keeping the focus on the work we have. This is a big deal getting the resources right for our veterans. I do regret the decisions that have been made, that have taken the focus off of that important work. Of you ares why all here. We care deeply about this subject. Its the reason why, to keep the attention on the important things, that ive made this decision to reimburse the treasury, to follow ig recommendations, doing what we have to do to focus on veterans and make this better. Today is about president trumps 2019 budget, and the two dozen 20 appropriations budget. Its very strong. It reflects the president s commitment to veterans and their families. It provides the resources to continue v. A. Modernization and respond to changing needs, with increasing investments in our foundational services, greater access to care, better management practices, and modernizing infrastructure and our legacy systems. In the written statement ive willred, i detail how we target certain areas for innovation and improvement. The president s 2019 the president s 2019 budget request billion, and. 6 includes medical care inlections, 109. 7 billion mandatory benefits. The discretionary budget represents an increase of 6. 8 billion dollars, 8. 3 over the 2018 request. This request has two point 4 billion more, now available due to legislation to raise Discretionary Spending caps. The recent addendum to the budget request are important to fully fund the Community Care and Choice Program. Although we are talking about fiscal 2019 today, i would ask for your support in securing a full appropriation for the v. A. In 2018. V. A. Relies on the funding for a total requirements. The budget also seizes the opportunity to expand access to benefits and services, which are focused on the priorities ive outlined. Providing veterans with greater choice, modernizing our systems, focusing on resources and what is most important to veterans, improving timeliness and services, and preventing veteran suicide. Suicide is my top clinical priority. The budget includes 8. 6 billion for v. A. s at health services, an increase, 5. 8 above the 2018 current estimate. The increase enables 1062000 more outpatients in 2019 for Mental Health, and directs 299 million more for suicide 299 million more for suicide outreach. To budget also enables us effectively implement the president s executive order that supports transitioning military members with Mental Health services to Mental Health services during the first critical year as veterans. We are also targeting womens health, one of our growing populations of the v. A. , by over 2018. Nearly 6 the budget provides 1. 1 billion in Major Construction spun funding as well. That this is the largest in the last five years, that will allow us to address s aging infrastructure concerns that you mentioned, mr. Chairman. This allows us to innovate operationally, and includes an increase of 129 million above the budget of last year to enhance access to the veteran to improve the veteran experience. Another project made possible is the Financial Management business transformation, replacing the old financial systems, and providing us with a modern innovative Financial Management solution. It supports our Electronic Health record, as you mentioned, so we can coordinate care for veterans who have perceived care not only from v. A. , but the parmer of defense and argument the partner of defense and our community partners. This includes 1. 2 billion to advance the limitation of this Electronic Health record. The two dozen 19 budget estimates important the 2019 budget also will hire more variousl for the offices, and hire an additional 225 field examiners to ensure protection of our vote most vulnerable population. This budget reflects our efforts practices business and do what is right for veterans, and allow the transformation. Our response ability doesnt end when we ask for more money our responsibility doesnt end when we ask for more money. We will focus on the wellbeing of veterans, conducting administrative reviews of compensation payment rates, and extending the broad waste and Abuse Initiative in benefit payments. We will make benefits more equitable for veterans and widely used wisely use taxpayer resources. We will significantly reduce the impact of certain disabilities on the lives of veterans. The needis to decrease for compensation. We have modernized the rating system. More importantly, veterans and their families deserve access, choice, and control of health care. V. A. s working to improve build an improved integrated network. We call this the coordinated experienceswarding and veteran care. It will allow us to semper fi eligibility requirements, streamline administrative processes, and build a highperforming network to implement new care coordination for veterans. As secretary, my job is to build a sustainable v. A. For a changing world. More importantly, my job is to ensure that v. A. s benefits, care, and policies are stronger in the future. This supports us. Our will help maintain commitment to our nations veterans. I look forward to working with you and the committee on doing what is right, and i look forward to your questions. Thank you doctor. I will start by saying that, to the Ranking Member, that we have started a great discussion on caregivers and will continue that with around table. Id like to make that bicameral, so we get both the senators and us in a room together. I thought it was a great start the other day. I see a path forward where we can do this right and get this done, hopefully this year. That would be my goal. Theres a great article, i still read my medical journals. February 6 medical association journal, a great article on ensuring timely access to quality care. I would encourage i will send them to your office. Send them to your offices. I encourage you to read them. Mr. Secretary, you mentioned mosty the v. A. People in the country dont realize how extensive the v. A. Is. We work in all the facets of medical care, the benefits process, which we know has gotten slow down. We talked about that yesterday, concerned people, im that hiring people who dont have the skills to do it will actually slow the process down. You get someone whos a good claims adjudicated, they may be able to look at that claim and get it off their desk in a timely fashion, where someone is brandnew will kick it into the appeals process, where it gets really slow down. I would encourage you slowed down. I would encourage you to ensure 605e 6005 people a people are trained. These records are an end of the these are all huge projects, under one umbrella of the v. A. I want to get in my short period of time a look at the cemeteries. One thing the cemetery demonstration does is, i have a National Cemetery within one mile and a half of where i live. Its a park like setting, an irreverent setting. I want to thank you all, every v. A. Cemetery i have visited has been immaculate and well cared for and honored area want to thank you for that. Honored. I want to thank you for that. Theyre looking at modernizing 106,000 plus holding, you are the largest villa stakeholders in the world, probably. Getting that footprint, its a huge project. \ i want to start out i want to start out because you asked us, this program will be put together sooner than we have. Assuming legislation is added next month, how much more funding for the existing Choice Program, existing nonv. A. Care program, and the process itself will be necessary before implementing consolidation . My something is all of this is under the bipartisan budget act. Is that correct . Know, thes, as you president s budget as proposed funds Community Care, by putting this all into discretionary. That would be a 9 increase in funding above the 2018 levels. The situation we have right now is that without new legislation, we have funded the Choice Program through the end of this may. What this president s budget does is it, it essentially puts more money into the two dozen 13 budget so we can get through the 2013 budgetear so we can get through the end of the year. We will make this a single program, a better use of the money. I think you explained to us, its about a year process to do this, correct . Yes. To transition to a new system, integrate all programs together, to change eligibility requirements. Mr. Secretary, you announced your Electronic Health record last june. Recently, the contest that was paused to conduct an assessment that was paused to conduct an assessment. My time is about expired. I think, this is a huge decision. Ever implemented an Electronic Health record change this big. We are taking it seriously. Given the track record of implementing big i. T. Projects, we have to really make sure we got this one right. We will clearly, first of all, theres four stages of interoperability. Everyone at the v. A. Thinks we have Electronic Health record, but we dont. We have 130 different parts of vista. This will bring us to a single Electronic Health record within v. A. Secondly, since this is proposed to be the same system that dod uses, we will have an interoperable system within dod. The reason i paused is because of want to make sure this 36 getting care, we can actually understand what care they got and make sure we are doing the right job for veterans. So, we have to make sure that we can be interoperable with dozens of Different Health systems, documentation systems or records up Health Medication systems and other records, and thats something the American Health system hasnt figured out. We think they can the v. A. Can help lead this for the whole country. My time is expired. Thank you, mr. Secretary. Theres lots of issues. We will dig down into deep ones, many members will ask. The big question, is striking that balance between the care and research in the v. A. Vs the Community Care. We know in this room, thats always been there, trying to respond to some of the issues that arose several years ago. Do we have enough money to make it till may in the Choice Program . We do, till the end of may. How do we know that . Because we are tracking this on a weekly basis. We are on a spend rate, the Choice Program between 350 million 400 million. You authorized 2. 1 billion back in december. When we do the math, we are ok until the end of may. Are we providing care based on the amount of money, or providing care that the money will follow . The latter. We are putting the veterans the veterans needs first. We gave 4 billion for infrastructure. Usedpears that wont be for the structure, and will go to Community Care. Am i reading that correctly . I dont think thats exactly right. I will turn to john to explain the 4 billion. There has been confusion about tracking that money. Theou are talking about 2019. Correct. We are asking for the money where it is not most needed. I would point to the major and minor construction requests, one of the largest in five years. We looked to nonrecurring maintenance for the last two years. It is substantial, 1. 9 billion and 1. 4 billion. Im not discounting the aging facilities. Available, weunds could better use that funding, frankly, in Community Care. Rep. Walz we are talking about the 20 billion in backlogs, have we have attempted to handle that. Like many of you, i turned on my morning news and saw the president had an executive order on Mental Health, and issue i have been somewhat engaged in over the last 12 years. Thats 500 million. Wheres that coming from . Dr. Shulkin we were able to get that once a deal was reached. We were given an additional 500 million to support that executive order. We had originally made the as you know Ranking Member, because we thought it was the right thing to do. Worry about the money, but we are fortunate that the 500 million was given to us to make sure that was done thoroughly and appropriately. Rep. Walz our phone number is down here. We were under the assumption that that money was going inside the v. A. , which all the research in the Rand Corporation shows is far more successful than until health care. That will be a discussion for this committee to have. Based on the baseline, and reflects close to a 50 increase in Community Care. Is that the normal increase, 50 in the community . Uhh, i dont think so. I think we have seen a significant increase as we have addressed the axis crisis. This was a significant crisis in 2014. We still have some axis issues. Out, inetting veterans a way we agree upon. We have reached essentially a much Slower Growth rate. We are doing what you said, which is making sure veterans are being cared for appropriately, then letting the money follow. We will see the same continued rate of growth. I think this was a Choice Program implemented that was complex, that people werent able to use. Three years later, they are understanding how to use it. That could lead to growth. Rep. Walz choice is good, ive always supported. The choice not being given is a those 30,000ith positions. We are making the choice that they will not get in the v. A. , wasse in the v. A. Appointeds are open. The alternative is going to the community. Instead of spending money for 30,000, we will shift. We have never been against trying to strike this balance, but when we appropriate for billion dollars and say its for infrastructure and a big 4 billion and say its for the structure but then going up, if we went through the regular order passed and signed into law but instead we have an executive order that none of us know about. My frustration is its becoming more and more difficult, mr. Secretary, to say im not supporting privatization of the v. A. , say that not pejoratively because thats the best way to get veterans care. In many cases it is, but not in the bulk of it. Thatll have deep concerns this buzz it this budget is going to continue that trend without the knowledge. I think thats the wrong approach, because veterans themselves have made it clear they want that fully funded v. A. I yield back. For thank the gentleman yielding. Our care will be march 6. Mr. Secretary, in looking at iur construction budget, think its 1. 1 billion in major , smaller amounts for a different amount for cemetery spending. The last four hospitals the v. A. At leastere each hundreds of millions of dollars over budget, years behind schedule, the worst example being in my congressional district, which was 1 billion over budget and four years behind schedule. One of the efforts i letting congress was to strip the v. A. Of their Construction Management authority for building Major Construction projects, hospitals, 100 million and above. I think that number is way too high. I think it needs to go way down. The same people that had have their think prince on these for Construction Projects that were years behind these four Construction Projects that were years behind schedule and over inget, are the same people charge of construction in the department of Veterans Affairs. It is unchanged. The people that have their fingerprints on this stuff are the same people there. I want to encourage you without legislation, in a way that requires that we need to move it forward, that, that you need to, to find these people another job hopefully somewhere outside of the federal government. You need to shift responsibility, as we did in my hospital, my district to the army corps of engineers, some third Party Outside the v. A. Its a waste and abuse. Its just incredible. Could you respond to that . Dr. Shulkin congressman, you have been very vocal of that. Shulkin congress meant, you have been very vocal on that. We cannot continue to do business as usual. The army corps is involved in all of our Construction Projects above 100 billion. 100 million. We need to do that in a different way in the future, private part privatePublic Partnerships. Thats why we are excited about this project in omaha, nebraska, a groundbreaking model of constructing v. A. Facilities. 400 million of the Major Construction will be seismic improvements. We record those for a long time. In terms of reorganizing and different personnel, we are committed to doing that. We cannot continue to do it the same way. We are going to be reorganizing our whole internal route for construction and facilities and thattics, and the people job is being recruited for, we are going to look for people with outside expertise. We think you are pushing us in the right direction. Rep. Coffman for your comment, for quickly on your idea introducing mandatory spending in terms of disability. Sec. Shulkin yes. Ou growth in this budgetr ,ur growth in this budget 20062020 is increasing. The federal budget has increased by 52 during that same timeframe. We cannot continue to do is to assess usual and think to do business as usual and think the v. A. Is a sustainable structure, which it used to be. We want our veterans to focus on getting veterans back to andpendence and wellbeing, all of our efforts should be to help restore the quality of life of our veterans. We want to change the focus of our program to make sure we are doing that. We believe this is good for veterans, and that will decrease the rate of spending of our mandatory program. Rep. Coffman on the last point, and i know this is not about the investigation, but you issued a memorandum prior to your trip to europe last summer, travel. L employee i will quote from the report. Beforewill be a request approving any travel, a manager must determine if it is essential to generate savings within the v. A. Do you think your trip last summer met that criteria . Sec. Shulkin i do. I believe this was essential travel. This was a conference, our allies who fight alongside us in every war, canada, new zealand, australia, the United States. We have had this coverage for 43 straight years. It has been attended by every v. A. Secretary. If united if the United States, the largest of those thisoes not go conference was on veterans Mental Health. If the United States does not participate, that conference ends. I planned on going to it for a year and a half, because we plan these things ahead of time, but i do recognize the object of this the objects of this are not good. I accept responsibility for that, but i do believe its important the United States continue its work with allied countries. Rep. Coffman its not the optics that are not good. Its the facts that are not good. I yield back. Chairman thank you. To echoecretary, i want the sentiments of my colleagues. Misuse of tax money is a significant breach of the trust we play place on those responsible for serving nations veterans. Im profoundly frustrated that mismanagement has interfered with our mission of building a stronger and sustainable v. A. Its vitally restore the trust of the American People and veterans so we can get back to the critical work for those who serve. I have gotten to know you and your dedication to the mission of this department. To ask quickly a few questions. How does this budget address over 30,000 provider vacancies, and 4000 additional vacancies in administrative staff, specifically but just six, procurement, contracting for Human Services . Is the official hiring freeze so affect . Sec. Shulkin there is no hiring freeze. Rep. Takano do support of fy19 . On employee pay in sec. Shulkin im going to take a leadership from the president. Essential for us to ,et the right people in v. A. That we have competitive salaries. I would be concerned if we fall behind. Ability to dor that, particularly using title 30 to make sure that we are competitive. Rep. Takano i gather there would be concern over a hiring freeze. How would a federal employee fate pay freeze affect the department . Sec. Shulkin we are competing, particularly in health care, but in all aspects of v. A. To get the best employees. We know we dont have competitive salaries, thinner vacancies stay open or we get the wrong people. Its essential that we remain competitive. Rep. Takano with a hiring freeze, would you be willing to ask the president for a waiver if you felt that the needs of the v. A. Sec. Shulkin i would. I want to make sure we are maximizing our authorities under title 38 and title five. If it got to the point where i was not able to recruit the people that are veterans served, to have caring for them, i would ask for a waiver. I am pleased to hear that. Rep. Takano i am pleased to hear that. The Medical Center near me was having difficulty recruiting, because pay was low. Housekeeping staff is vital to keep facilities clean and safe. In many cases, the cleaning staff has to be especially trained on bio hazards. Wouldnt a pay freeze exacerbate this problem, and improve and hurt danger safety . Sec. Shulkin there are a number of occupational hazards in the vap. This is one, where it when you clean a hospital this is not the same, i think you are saying this this is not the same as cleaning an office building. Making people understand the type of organisms that live in hospitals, and the reasons you have to clean these environments, is lifesaving. We are working to change the job specifications so that we can be competitive, but we have a big problem hiring enough environment to workers right now, so we have to change that. Rep. Takano when to pay freeze exacerbate this problem and in danger Patient Safety . Sec. Shulkin if we didnt change the grade of that position, that would. Rep. Takano what resources do you need to ensure these are filled . Sec. Shulkin we need to get more new ball about how we grade these positions and how the outside world changes. We need to make hiring practices easier to get the right people on board. Work is underway right now. T we have heard reports that rep. Takano weve heard reports that the v. A. Central offices improvingoceeded on pay on jobs. Is this true . Sec. Shulkin if that is true, that should not be followed. We want our facilities to do the market surveys. They need to be competitive. We have to fill these vacancies. There is no hiring freeze. Our people who work in our valuables are our most assets, and we have to make sure we have the right people serving veterans. Rep. Takano my time is up. Can i ask one questions . In many cases , one more question . Cases, vacancies are directly contributed to the postponement of procedures ineffective patient care. How does this budget address vacancies . Sec. Shulkin this fully funds our needs. People should be filling those positions. I think you are right. Theye case of the dcva, were understaffed. We had to bring in a large number of people in procurement. Human resources should not be under resource without that. Without that, the rest of the organization doesnt work. Rep. Takano thank you. Chairman thank you for yielding. Part of the problem is not the v. A. , its countrywide. At home, our hospital is having a terrible time filling positions. Its not just hospital. Jobs are out there. You are recognized for five minutes. Thank you, mr. Chairman. As the new appeals process goes into place, the v. A. Will prioritize and fill, go after the new system, those newly filed appeals, then walk away from the old legacy appeals. I know the president s budget, a request for initial 605 fulltime equivalents, dedicated to appeals. How many of those will the v. A. Dedicated processing legacy appeals . Sec. Shulkin thats a great question. Jamie, the want to take that . Jimmy is from the v. A. Jamie the first thing we are s giving a pellets the opportunity to opt in to the new appeal process as we speak. We have gone to the pellets who have had the lungs to peel and said you have the first opportunity to opt in. We are sending letters to the people, telling them they can opt in. Thats not my question. Of those 605, how many are going to be dedicated to clearing up the old backlog . Are they specifically going to be that or is it going to be across the board . Jamie all of our appeals personnel will be working. The number hes talking about the legacy. Progress. Aking i dont think any of those, well, i guess the claims. What they have done is implemented something called a drc claimclaim, a that gets this done in 30 days, instead of the usual seven hut several hundred days. And so concerned about this. I am still concerned about this. Morere asking for 605 employees. Weve got to speed the process up. Is that going to speed the process up to answer these appeals and get them taken care of . Jamie absolutely. We have more, if you will, more f. T. E. To work appeals. We will do a blended approach with working with legacy and the new appeals. Its a concern of our committee, its one thing to handle the new ones, but these people have been there for a long time. Their families, trying to get an answer. The reason to change it was to straighten it up. Amie absolutely. As i indicated earlier, we are giving them the opportunity to opt into this process. Those have been waiting longest in the appeal line, if you will. Mr. Secretary, you didnt think any of them would go to basic hundred 5 605 are goingthe to be focused on addressing the appeals, not on claims. Rep. Bost ok. I want to go to another quick question. You know the problems i have had in my district. The budget is requesting millions for the for accountability. I have two questions. One, was this level of funding sufficient to properly inspect and keep up with problems in the v. A. . Second, you need new authority to establish do you need new authority to establish qualifications for positions like h. R. . Sec. Shulkin on the inspector general, my understanding, and john i will ask you to confirm this, they increase the levels increased the levels last year. This allows them to continue what they raised last year. They had some carryover funding, so they hired people above their baseline funding level last year. The funding for that was less than what they had hired above, so they requested an increase, didnt receive an increase. I think that we need to look at what the requirement is. You cant just have selfdetermined needs. If you look at the line on that, it has decreased. Why i fte, thats described how that occurred. It would carryover funds. They hired more thanon they had they for ine year hired more than they had money for in one year. They needed to be validated. It could be more, less. Rep. Bost thank you. Thank you, mr. Chairman. Mr. Secretary, i wanted to focus a little on the open nominations. I think theres clearly a lack of consistent leadership within think as ahat i barrier to many of the challenges that the v. A. Faces. The last i heard, eight out of 22 leadership positions in the v. A. Today are being filled by individuals in an interim or acting role. I know we dont have an undersecretary for health,. Ndersecretary of benefits int progress are we making, terms of finding candidates to fill leadership in the v. A. . Sec. Shulkin i push it that. I share that same concern. Its taking us too long. The under secretary for health, we had our third round of commissions. Its the third time weve had a Commission Interview candidates. That was on tuesday this week. Yesterday, i was given three names from the commission, so they completed the work. If they are vetted through, we will take those names to the president for nomination. The under secretary for benefits, we did submit three names to the president. They are in the process of vetting those. Weve done the cio process in a similar way. Rep. Brownley are you waiting to get these filled for those folks who are then in the position to hire to fill other important positions . Sec. Shulkin no. No. Rep. Brownley thank you. I share the concerns and line of questioning that my colleague, mr. Takano asked. To me, these many vacancies theughout the v. A. , i think heart of the issue is predominantly around lack of Human Resource personnel. I need to hear a commitment from you that you have a laser sharp focus to fill these positions so they can roll down their sleeves and work to fill these other critical positions across country. Sec. Shulkin i agree. I would be concerned if anybody out there is pleased that there is a freeze or any desire not to completely staff your Human Resources office. This is a critical area to be sure we are fully staffed in. Rep. Brownley i know in my business in Southern California and beyond, that the primary issue. When i ask the questions, its because Human Resources isnt able to fulfill their responsibilities on a timely basis. I wanted to ask, in terms of the president s executive order on Mental Health in the community, what is your, what is the embalming tatian of that look like . Sec. Shulkin we are planning on presenting a detailed plan back to the president march 9. What that looks like is preenrolling Service Members before they leave on the last day of service, so they dont have to wonder how they get access to benefits that they arty have right there. Offering an initial, what we would call an introduction to the benefits and services that every Service Member would have, so that they understand that asking for help, getting the Services Offered through the v. A. Is available to them. We feel like using peer counselors, because that is the strongest way to help people identify how they might get help , and what they are going through. We are providing expedited access to those who need help at the right time. Rep. Brownley when the plane is complete, you will present to the president. Will you when the plan is will presented to the president. Will you also presented to the committee . Sec. Shulkin yes. Chairman my friend, he can have as much time as he wants. [laughter] we will stick with the five minutes. Chairman thank you. Flex abilitya of and making decisions, it makes sense that we take a look at our resources. Ed there is one vacant or mostly vacant buildings that have been repurposed of or disposed of. Im wondering how much revenue we have gained from that, or did it cost us more to get rid of them in the short term, but helped in the longterm . Sec. Shulkin i think you are correct. Part of the reason why these buildings remain standing and vacant, become problems is because it sometimes takes capital to knock them down and clear the scott clear the site. The savings from those 131 buildings is about 7 million per year. We had to invest some money to remove those facilities, or get rid of them. Its overall savings. The infrastructure bill introduced by the president will allow us to reinvest in v. A. And the structure. We are grateful for the present provision, which has not existed before. Washington journal that leads to minutes question. Rep. Wenstrup that leads to my next question. This goes from infrastructure to modernization. What is the plan . Sec. Shulkin currently today, if we exit a property, that money gets returned to the u. S. Treasury. We are not able to reinvest that. The instructor bill would change that. Thats what we are supportive of that. We save the maintenance. We keep the buildings. ,hat remains in our general what we call our nrm budgets, recurring maintenance budgets. Rep. Wenstrup will you be able to get an idea of how it is converted directly or indirectly to care or veteran services . Sec. Shulkin yes, yes. What we would plan on doing is. Einvesting we contract that. Rep. Wenstrup one of the things the budget talks about his financial foundational services. The list includes geriatrics and other things. Im trying to understand what we considered foundational services. Someu could give me clarity on that. Sec. Shulkin we spent a lot of time on this. This is theres a list of things that the v. A. Needs to do well, and ensure we are doing it in a worldclass way. There is no doubt that things like spinal cord injury and postTraumatic Stress, focusing on the suicide issue, other things, clearly are foundational services. Its part of the v. A. s definition of health, how we do things. We believe a system of strong, primary, geriatrics care for older people, womens health, as well as Mental Health, is the foundation of what a strong integrated system needs to have. We dont need to be doing everything. We cant do everything well. We have learned that in the past. These services, every v. A. Facility needs to be focused on to do in a worldclass way. Rep. Wenstrup things for that clarity. I would tend to agree. Something that can be connected cant be treated as efficiently if you dont have proper primary care. I yield back. Thank the gentleman for yielding chairman thank the gentleman for yielding. I want to thank you, mr. Chairman, for your focus on reducing veterans you mentioned this is your number one clinical priority, the first being secretary to my knowledge, to make this in the highprofile issue. Im convinced that as we acknowledge the problem, we know that for those veterans who have another discharge, hundreds of thousands of u. S. Veterans have an honorable discharge. Tens of thousands were diagnosed with post dramatic stress disorder or a dramatic brain injury, or other conditions caused by their service, who are effectively denied access to the a health care. You worked with myself and others to save lives in el paso, expand access. Theres a correlation between the number of Health Care Providers and access to Mental Health care health, reducing veterans suicide. We went from 68 fulltime Mental Health care staff to 122. More veterans are getting care, seeing psychiatrist and therapists. I know you have personally taken an interest in this, and i want to thank you. To that point, if there are appropriatedized for, unfilled clinical positions, how many of those 30,000 positions are psychiatrists and psychologists, therapists, neurologists, others to help with unique conditions connected to service . Year, 763in last psychiatrists and psychologists. Unfortunately, it was only a matter of 250 because of retirement, sometimes people chose other places to work. We have a need right now for at least 1000 Mental Health professionals in this fiscal year. The budget allows us with an million in 500 Mental Health building coming. How many of the 30,000 unfilled clinical positions are primary care providers . I dont have an exact number. When you saythis primary care providers, i am going to talk about family doctors, too. Shulkin i am to hang out until the end of the hearing. I want to make sure this is a priority. Lets understand what we are going to do to bridge that gap, to Hire Resources and prioritize those hires. Do you think that a veterans primary care provider should be in the Veterans Administration . My preference would be, since pa uses a different model of vimary care, since the model ofa different primary care, patients are usually seen about every 15 or 20 minutes. There is a more comprehensive evaluation. Includes Health Integration in a broader way. Primary care providers need to have military confidence. Yes . Shulkin is that a the need to be trained well. Shulkin we made understand we may understand they need to be referred out. But if we make the Veterans Administration central to that care, they have taken care of other veterans and Service Members. That they are going to have a and a greaterency level of experience taking care of those veterans. I think the veterans are going to get Better Outcomes as a result. Be v. A. That needs to policy. For those treatments that are unique to service in combat, most are Traumatic Stress disorder and traumatic brain injury, amputation, spinal cord injuries. I would ask you to prioritize your hiring for those carealists to ensure that for the veteran is anchored and shares some of the concerns others have raised, including veterans who have come to the town halls, that there is a move to privatize care. I want that care centered in the Veterans Administration. I am going to await the answers to these specific questions i asked on hiring. I agree, it is better to have good numbers. Is exactlyescribed our strategy around services. On the thingsd that veterans need is to be good at. I absolutely agree with your description. Time has expired. Primary physician who has never served would be as wellprepared as a veteran like myself, a doctor who retired from the military. There are people on the outside who can provide those services. Others who served in the military certainly understand those means. Higgins, you are recognized for five minutes. Mr. Higgins thank you, mr. Chairman. Thank you to the secretary for appearing today. I thank you for your dedicated leadership. Remind those present, including the media and my nation of, that the American Veterans has fought to establish and maintain a nation of laws, where man is considered innocent until proven guilty. Ir i would hope were not sliding toward a nation of allegation and accusation. Regarding extended care facilities, i have seen the a 66 pointre is seven increase request for grants for state facilities. Request for veterans cemeteries. There seems to be a disconnect there. Especially with the aging veteran population, as we attempt to provide for these veterans who in some cases certainly are Vietnam Veterans, and did not return to open arms from a nation they served. Veterans thatsame are not cure for in the caregiver program. Cared for in their caregiver program. They are approaching the last years on this earth. Facility, irm care would think we would at least seek to provide for the aging dignity, endoflife, where they can be revered and visited by family in their community where they live, i just see a disparity in budget. Would you please address that . Sec. Shulkin we did significantly increase the amount of Funds Available to the where 50 of the country of the veterans are being cared for right now in the state. I met with all of the directors this week and they are extremely grateful for the support we are providing, to be able to do that work. Number of veterans that are aging is increasing. These cemeteries, we have 334 million increases in the fiscal year. Increase in the fiscal year 2019 to address major and minor construction for national cemeteries. The grants program is a flat request,st, a flat is grants have matching funds and assurances necessary to provide the grants awarded for the fiscal year. Rep. Higgins you think this is sufficient for states to perform at that level, the aging veteran the next stop from extended and longterm care is a cemetery. As a nationthe goal to provide veterans with endoflife dignity. That would include appropriate services, military services, and to be buried amongst veterans. Mr. Sullivan that is the mission. We work with our state partners to operate the network of our 130 five national cemeteries, as well as 107 grant funded state cemeteries, providing National Transport final resting places. Rep. Higgins that is encouraging. Secretary, your witness testified previously that noninstitutional care settings are more costeffective than institutional care settings. This budget allocates 556 million as a continued investment in noninstitutional settings. How does this budget invest in noninstitutional care settings . Sec. Shulkin we believe it is better to allow people to remain in their home. Care,hings like adult day we want veterans to get access to that. With the advances in technology, we have a package of services that is now a priority focus for us to make sure we implement that. We are supportive, isaiah know i know you are, about expanding caregivers to older veterans. We think that is an important piece as well. Sec. Shulkin rep. Higgins my time has expired. Welcome, mr. Secretary. I appreciate your comments at the top. I think it is important to restore confidence in our executive officials. I hope in the coming days you will be forthcoming with the American People. I want to turn to the issue of coordination of care and collaboration. Will be introducing a bipartisan bill today that is a Pilot Project for integrating veteran character in our federally qualified health. Enters ural, northern parts of , peoplee, in the fqac can get access to care without traveling long distances. Can you comment on that venture or other or other collaborations the Veterans Administration is getting into . Sec. Shulkin i am not sure people realize how important the qualified Health Care Centers are. They do amazing work for a vulnerable population. As a large provider of federal health care services, i believe these organizations should look for the chance to collaborate more and to integrate in ways that we really havent in the past. I think the Pilot Program in that aria area would be productive. Rep. Kuster we look forward to working with your team as we go forward. Focus on the Leadership Structure in the v. A. We have hadhat issues around manchester, the veterans hospital. Concernse been serious in the v. A. Hospital in massachusetts. Inont see anyone stepping effectively, where there are problems in the v. A. Hospitals. Do you think we might have come to a time where we need to change this business organizational structure, and particularly with regards to hospital leadership and their reporting directly to your team as compared to not being sufficiently responsive . I appreciate you sharing these concerns as you have. You have been a very strong advocate for getting this issue right. The concept was introduced over 15 years ago. At howime to take a look the modern Healthcare System operates. That is what we are doing in our modernization work. We have looked at trinity, kaiser, that have multiple hospitals throughout large regions. We are looking at those best practices and seeing what we need to do. We have totrategy is give people running the facilities, the Medical Center directors, more authority and accountability to be responsible for the decisions. Look at what the role of this is and how it modernizes. To. Kuster we look forward working with your team on reviewing that structure, particularly focusing in on hospitals where this has not been an effective oversight. A half, i minute and would love to here your thoughts newou have created a account for the Veterans Administration, modernizing vela Electronic Health records system. Will this new account included funds to support and maintain the current the stuff Electronic Health record during the modernization process, or well these funds only be used in the adoption and augmentation of the department of defense Electronic Health records . If you could walk us through . Sec. Shulkin it has to be both. In order to implement the new Electronic Medical record, we are going to have to invest in the infrastructure of our connectivity, servers, to get ready to do that. We will have to undergo significant change management. Implementing this, about technology, it is only a little bit. This is about business. We are to take 130 different systems and really be creating a single instance. That is a major change. Inshould create improvements quality as well. Focused ong to be maintaining vista. Transitions to happen. That is why over a 10year time, you will be running vista up until that last instance. My time is up. I hope you will keep the Committee Informed of your timeline and progress. Thank you. And i thinkomment, we will get into this more as we when i was at fairchild, i am not sure you were ever going to be as long as you are in the new system as you are in the old one. Until the last of us die better in that system, there is so much information that are in that system. There is so much information. They can download everything, so you have to look back. It is a major undertakings to do what they are doing. You are recognized. First and foremost, i am a enormously proud of what we have accomplished with this event in partnership with this administration. We have done a lot of great work for veterans we should be proud of over the past 14 months. I appreciate the seriousness that you have taken in addressing this report. I look forward to continuing to see you do that. I know that you agree that veterans deserve a scheduling care, shorter to wait times, the ability to track and manage information around the care continuum. We appropriate money and pass budgets, i want to ensure the money we provide is effectively utilize to the v. A. That is why you are here. We have seen the Electronic Health record run into some trouble. We have seen the delay of implementation even further. Cuts,he readily available solution, and appointments scheduling system or mast program that can be deployed in a twoyear time frame, what are your plans or timelines to be more specific and utilize the funds you received for i. T. Improvements to pay for a full deployment is not dependent on the stalled h. R. Rollout . Specifically on scheduling . Yeah. Specifically on sec. Shulkin there are plenty of good commercial systems that are out there. System ischeduling being unlimited right now in columbus, ohio. We very much look forward to seeing out how to seeing how that is working. The pilot is on track. It should be in march . Itin the next few months goes live. We have other products that are being tested on three other sites. That ford is one of them. We are very much looking forward to seeing how that is working. To 35,000 it has gone different veteran transactions, an internal system called veteran scheduling enhancements. The plan is to go towards and off the shelf product. Rep. Banks i was disconcerted when the v. A. Considered taking funds from a Homeless Program, Homeless Program case managers, and converting them to generalpurpose funds. You and i and others on your team have talked about this. I appreciate to wanting to provide flexibility to the directors, but that should not come at a cost of assisting veterans that are most in need. If less veterans find their footing, we will be spending more money and not saving money. It appears the v. A. Revisits the possibility by submitting Stakeholder Input first, a healthy part of the process. If it remains opposed to this change, as it was overwhelmingly can youal year 18, guarantee they wont execute this change for Homeless Programs in fiscal year 2019 . Sec. Shulkin the mistake we made was letting anyone think we are taking before off the paddle as to aiding federal homelessness. Pedal as to aiding federal homelessness. Homelessness went in the wrong direction last year. There were five specific cities that led to that increase. Seattle and los angeles where the overwhelming increase. We wanted to find a way to use this one point 8 billion to focus on where the veterans were having the most problems. We need Stakeholder Input. Thoughtfully it before we make any changes. We do not want to have unintended consequences of anything we are doing. Will not do anything until we have a chance to sit down and review with stakeholders, making sure that decisions made will be good ones. We are not going to do anything until it is a thoughtful plan, but we do want to get the resources to where the veterans arent homeless. I yelled back. Chairman i recognize bill raucus. Raucus the fiscal year 29 budget request is 8. 6 billion for veterans Mental Health services. This follows uniform Service Transition to civilian life. My colleagues and i on the committees have had multiple hearings, when just the other day, on the transition assistance process. Can you tell me what the harm is what you arest doing to assist the transition in the upcoming year . Sec. Shulkin we recognized we could be doing it a lot better. The Veterans Experience Office has looked at this and made a number of recommendations that we are working through to make that a better program. Places already have taken that have made it a better program. Preenroll veterans in benefits so they know they have them when they leave, instead of wondering and going to a likely process, after they wonder how to get access to benefits. The big issue is to make sure people know these services are there and make it easy for them, and auto enrollment process so there is no work to be done. The nextrakis question has to do with the Blue Water Navy veterans. 2. 9 Million Dollars is being sought for Veterans Benefits. For 4. 5 million veterans and 600,000 survivors. Blue water Navy Veterans are excluded from these benefits. You have said in the past these veterans shouldnt be waiting any longer. Know if the v. A. Has any plans to reexamine this in the upcoming year. If not, why . Sec. Shulkin the problem is there is not much to reexamine. There is nothing much that we can do to go back. Have tried every which way to do microscopic analysis or new studies. There is not going to be new studies. This is about the obligation to those who have served. Simply keep on passing the buck and not honoring this countrys obligations to our veterans, i dont think is morally the right thing. I am committed to working with you. I know the chairman feels the , to try and find a way to honor obligations to these veterans. To haveorking discussions with the administration to work with congress. Offsets, ifind those believe it is morally and ethically the right thing to do. There is not going to be scientific data. Later, there is not going to be signed to the data to rely upon. Rep. Bilirakis you would consider this the top priority . Sec. Shulkin we have to do this and find the offsets to be able to go ahead and resolve this issue. Theyve waited too long. The chairman has found the offsets. I know he wants to proceed. They cant wait any longer. Sec. Shulkin thank you. Three,lirakis question the fiscal year 2019 v. A. Budget request, 700 27 million for direct research. Year increase over fiscal 2018. What about the efforts to improve research and treatment for veterans who may be experiencing negative Health Effects due to toxic exposure, inhalationt pi during military service . It is a priority for a bite of members on the committee. Doing . The v. A. Sec. Shulkin i dont know the answer to that question. Can we get back to you on that . Rep. Bilirakis please do. I have 20 seconds. Back and submit the rest of the questions. Mr. Chairman you are recognized for five minutes. Thank you mr. Chairman and secretary. Thank you for taking the time to meet with us yesterday. It is important we keep open lines of communication. We are here to talk about how we can better deliver care for veterans and their families. I know we have a shared goal around that. Congress has a responsibility to make sure those taxpayer funds are wisely spent. I do appreciate your willingness to speak with us on this report. We will deal with that another time. I want to associate myself with pits andks of burn blue water veterans. They are very big issues in my district. I have legislation on both of those and i am looking forward to them. The other issue is what we discussed at breakfast yesterday, rethinking the disabilityability issue. For morewe do temporary disability status in order to able our veterans. In order to able our veterans to get back and fully participate in the economy. That is something i want to pursue. I want to focus with our time here, and i am reserving 30 for my friend from minnesota in my former district. I want to turn to the modernization efforts and what we talked about over the last several months. As the appeal to modernization expands intod ramp new offices, do you feel the proposed fiscal year 2019 budget will appropriately handle the pending legacy appeals . I do. Hulkin t. sink we are adding 605 f. To the appeals process. We are hoping we have as much as 25 better going into this process in 2019. Of the 680 veterans that have chosen this process, they have gotten an answer in 38 days, versus over 1000 days in the traditional process. Bsosg with the bos and outreach efforts, we hope to get this resolved quickly. Rep. Etsy we are encouraged by the drive to reduce redundancy of self reporting. This is an issue for pension benefits. Income information will be provided by the Social Security administration and irs. What systems will take place to ensure recording errors will not . Reporting errors will not . I will have to get back to you. I will turn to a follow up on the caregivers hearing from last week. An proposed limiting expansion of the v. A. Program of comprehensive assistance for family caregivers to all me those who have fallen into the most severely ill or injured veterans. Can you clarify . Inre was some disagreement the room, understanding what you meant by that limitation, whether your recommendation is to maintain the current Eligibility Criteria for post9 11 veterans and expand only to pre9 11 veterans in in tieree, or the three . This is your decision. I am giving you my advice on this in terms of our resources. Has the who currently program should be grandfathered under the current rues. Current roles. I dont think it is fair to change them after you have started the process. For the 27,000 currently in the program, i would not recommend changing that. If there is a decision to expand eligibility, i believe you should pick a standard used by other professionals, which would be equivalent to a tier three. Rep. Etsy thank you. Mr. Chairman time has expired. Five minutes. Thank you all for being here. I had to step out to a Different Event for a while. I know my colleagues asked questions about the v. A. Facilities. In the reinvestment of the dollars you are getting from closing or shutting down unused track on ayou shortterm basis and a longterm as to exactly how you are going to reinvest the dollars you save from not maintaining a space opened that is not being used . When we dispose of a property, sometimes large properties, like in pittsburgh, we dispose of the whole site we lost in katrina in new orleans. For thethat back to gsa general treasury. Under the president s Infrastructure Program he announced monday, there would be a proposal that v. A. Could proceeds if we were to give back property. Would track that very specifically and they would be reinvested in infrastructure in v. A. Spend in the v. A. Rep. Bergman you know they are being phased out. Could we do a multiple listing in real estate . Here is what we have in our inventory across the country . Sec. Shulkin yeah. That is a great way to do it. We have been handling them individually. Rep. Bergman i have been i haved for decades been on both sides of the equation, whether it be arguments for staying open or having something be repurposed. We have had extending outstanding examples as to how to do it. It takes an important tnership between trying to between those trying to dispose of the facilities and those in the local community or whoever might want to use that. I look forward to you continuing to develop that and providing that availability for those of us who want to see what the market looks like. Subject, a more pamphlets, you talk a little bit about this, the addition of a fulltime equivalents to handle new tasks, bringing people up and online. Alternative, rather than just adding fulltime people, can you be specific to that appeals process . There is probably a ramp with a peak. If you do it right, it will drop off. To add they need thetime equivalents to point where they will be up to speed in what they are doing in time for that peak . Or do we have things synced up . Multiprongedng a approach to get things available for processing claims when the laws are fully enacted. We are using a program to recruit military members as they are transitioning from service to civilian life and teaching them to be claims processors and appeals processors. Rep. Bergman what is their job after the peak . We have a certain number of veterans applying, and there will be a spike. What do we do with that fulltime equivalent after the peak . A great question. We experience about 55 ftes per paid pay period in attrition. This will take care of any additional fte in the books. Rep. Bergman as a committee, we have no easy decisions. As a committee, to work thether, with all of you, question we have is how do we Work Together . Mr. Chairman you are recognized for five minutes. You mr. Gman thank chairman and ricky member for holding this hearing. Thank you secretary and your team for coming in to answer our questions. It is a pleasure to see you. Thank you for yesterdays meeting. It was very useful. Americans consistently boast one of the highest rates of approved may improvement in the nation. I never get tired of emphasizing this fact. I am thankful for the veterans of the islands. Increased enlistment means a amount of ourl community suffers from ptsd and other Health Issues associated with service. Friends and neighbors bear these invisible wounds. It would be a dishonor to characterize the soldiers are victims, and an even greater one to not provide the care for their complex and often misunderstood Health Issues. Andral different charts figures have come across my desk. I hope you could help me interpret some contradicting figures. Would you please clarify whether or not the Budget Proposal request more or less funding for medical research, compared to the 2018 request . And how Much Research funding do you hope to dedicate to Mental Health research . Our Research Request in the 2019 budget is 727 million. Small increase, but an increase from the fiscal year 2018, and in addition to that, we have about 1. 1 billion of external grants, some of them government and some of them commercial. It is about a 2 billion budget for research. Mental health is one of our key areas of focus. This is critical. I dont have the exact number, mark. Do you have it . The increase in appropriation 727 Million Dollars in 2019 from 640 million in 2018. Del. Radewagen my staff and i have had meetings with companies and groups who are interested in working with the v. A. To do ptsd and Mental Health research. What role do private or Public Partnerships play in maximizing the v. A. Budget, especially with regarding research and developing Mental Health care . To behulkin we need doing more. The advances in science and technology are incredible. Million we are27 proposing for research and match it with the 1. 1 billion of federal and commercial grants. Very substantial amount of research dedicated to the health of veterans. Of thatto be doing more and working with the private sector and reaching out more to what could help, particularly with ptsd and Mental Health issues. Thank you, mr. Chairman. I yield. Man five minutes. I want to focus on the of resources,pect the 12 billion in additional funding to deliver for veterans on behalf of the taxpayers. As someone who has helped run a government agency, i know the challenges you face. It is imperative you are able to manage your assets. The most important of your assets are your people, for any position. People will this 12 billion translate into new people . Sec. Shulkin i believe the budget, prior to the budget cuts 6200 was an incremental people. It may be more, not a care has been have been additional funds. Rep rutherford 6200 additional employees at the v. A. , bringing the total number in the enterprise to 373,000. Rep rutherford that is your biggest budget expense . Sec. Shulkin yes. Rep rutherford we have to get this right. Thenitial introduction to Veterans Administration was frustrating with respect to performance ins achieving the desired outcomes. Accountability would be the core of that. A challenge, especially in bureaucracy, government, civil service, unions, you do this under the leadership of the chairman, the Ranking Member, the bipartisan efforts. We gave you at least some accountability, authority, and flexibility. How are you exercising it . Do you need more . Thank you for giving us that authority. Since we have opened up the office of accountability and whistleblower protection, 1300 employees have been removed in the last eight months. We dont have a target for that. It is not the objective to reach that. We objective is to make sure are doing the job we are doing and everyone understands that they serve veterans. We are focused on that. Rep rutherford can you tell the difference . Do you feel a shift in the culture with this new set of tools . Sec. Shulkin one of the things you learn when you run your organization as big as the v. A. , there is a different culture at each v. A. There is a lot of work to do at v. A. s v. A. Of the and other that has used this to improve. It is noticeable but not over all of the facilities. Rep rutherford i am so grateful to work with the Ranking Member and our subcommittee. Have been ablewe to achieve a lot of bipartisan , probably the most productive committee in congress. 35 bills passing the house. 12 will become law. Great team, including the president. He is fighting for veterans, as are my colleagues. This is the biggest point of frustration for me, with respect to managing people and getting that right. My first hearing, we got a report from the gao that there were hundreds of that Bank Employees that were Union Members who spent 100 of their time on Union Hundreds of va employees that were Union Members who spent 100 of their time on Union Activity. Texas,ple back in west 49 thousand rural counties, they find it outrageous that somebody would spend 100 of their time on something other than the job they were hired to do. Can you tell me how you feel about that . And what can we do to help you . After this answer, i yield back. Sec. Shulkin i have come from the private sector. I have run institutions with large unions. I have not seen that before. On union time is usually supported by union dues. Do believe the unions are productive partners with us. I do really appreciate the collaboration we have. I believe we care about getting the right services to veterans. Believe the time spent at the government pays for should be to serve veterans in direct veterans services. This is not an antiunion position. I believe strongly we need to work with them. I believe we should be looking at alternative ways to make sure Union Activity and direct veteran care are separated. Chairman, thank you. You have created asked for an increase, the largest of which is a 400 million seismic corrections fund. Language and stimulates the fund be available, regardless, of the estimated cost of the project. What does that mean, exactly . Sec. Shulkin you are right in asking that question. I am not sure what that means. 400 Million Dollars should be 400 million. Rep. Dunn i am thinking fund. Slush fund. Lets revisit that. O has raised the ga concerns about the Capital Projects linking system, skipped by improperly coding projects as seismic corrections. Thesed like to be sure requested seismic Fund Projects are truly too hard in buildings in earthquakes owns. And you give me that assurance can you give me that assurance . Sec. Shulkin are you familiar with skip ratings . The samecerned about thing, how highly prioritized the seismic issues were. I was afraid if you werent in that part of the country, you wouldnt get any of that funding. We did change the prioritization of the seismic. Haveis the first time we been able to substantially deal with some of the seismic issues that are decades old inefficiencies. Deficiencies. I know the specific projects the 400 million are going for we have the appendix that lists some of these projects, in arkansas, illinois, south carolina, earthquake zones. In thees are involved seismic correction projects, plus washington dc in puerto rico. And puerto rico. I would like to be sure these requested projects, along with 7. 6 billion worth of seismic that these are truly for seismic projects. I am concerned about that. Sec. Shulkin you have raised several good issues about the language, and the criteria. If it is ok, we will get back to you and sit down with you. I am reading from the budget. Even though some facilitylevel planning officials told us they didnt think these demolition projects would score high enough to get funding, officials who oversee this process told us that if the projects narratives ed to seismic link corrections, they might get priority that they otherwise wouldnt. With that, i yield back. Chairman on the seismic issues, a little over 200 years ago, there was an earthquake in the west tennessee ariella. Area. Church bells rang in philadelphia. There are needs along the mississippi you might not be aware of, one of the largest earthquake faults in the country. I recognize for five minutes. I appreciate it. I know the chairman put the scrap appear earlier. Here earlier. Up where would the business of caring for veterans we are in the business of caring for our veterans. When we have the world war ii folks and the korea folks moving the population of our veterans responsible we are responsible for caring for is dropping. Women young men and coming back from the middle east are greatly injured a lot of men and women coming back from the middle east are greatly injured. Looking at is a budget that has grown dramatically over the last five or 10 years. It greatly outpaces growth of the total federal government and our economy. The point i am trying to make, you have an economy growing at x sixa department growing at that, it is not sustainable. You, theike to remind federal government is horribly in debt. Or almost. N, with Interest Rates rising into the economy picking up, there is going to be more pressure on Interest Rates, the debt Service Economy interest on that debt is going to continue to go up. Back to us asking for another 12 billion in a budget that has gone up , greatly outpacing the growth of the rest of the federal government and the economy. It is clearly not sustainable. Will you please in a nutshell two or what are the three top drivers that is and whythis to happen, you have to come back to us every year asking for, in this case, another 12 billion . Sec. Shulkin i share your exact concerns. I think you said this correctly. Docannot continue to business as usual. This will eventually lead to us not being able to support the veterans of our country, which will be a great error and lapse of our responsibilities. We have to do things differently. We are dealing with problems that have been essentially neglected in the v. A. For putting in a Financial Management system that still programming,t running versions of an Electronic Health record that is 35 years old and we are putting in all our money to maintain it. Dealing with old hiring practices and not having the right accountability. We are doing everything we can bring us that, to modernized systems, to decrease the rate of increase, and my team knows that is our goal. Drivers are Vietnam Veterans , getting older and requiring more services. Talked about people that continue to return with significant needs. The mandatory benefits are rising at huge growth rates. Thosens have earned benefits, but we have to make sure Veterans Benefits are designed to help people return to wellbeing. Rep. Poliquin correct me if i am mistaken. The goal is when a veteran comes them better. To have them become independent. Would you site for us what you talked about at breakfast, someone coming in who is an amputee with sleep apnea . Sec. Shulkin we started to process six or seven years ago, to read look at all of our body relook at all of our body systems. Sleep apnea has a 50 year Service Connection with it. Ofare spending billions dollars on that. Medical advancements have helped us to treat this condition. We need to diagnose it properly, treat it, management, manage it, and people can go on with their lights. With their lives. Once we get people to function in the way that they should with adequate treatment, there should be a recognition of that and the benefits program. We are going through this the bs, to work with sos. System like this needs to evolve and change as science changes. Rep. Poliquin may i have a few more seconds to ask a question imperative to staff . That was a lean yes, thank you. To reimburse the Judgment Funds for claims and settlements. Is the v. A. Liable to the Judgment Fund . We have to get back to you. I have no further members. I will yield for closing statements. I yield to the gentleman from texas. I ask you for outstanding total Mental Health hires or vacancies. I also asked for all outstanding primary care hires. They gave us a number in the hundreds. I didnt ask the question the right way. I want to know how many outstanding primary care providers there are. Goneimary care provider is. I havent been reassigned another one to go to. Would you give that to me and the members of the committee . Sec. Shulkin primary care, 270. I was handed what you were. It seems small. rourke inadvertently, my colleague conflated two distinct terms. Initial time and inactivity. Official time and inactivity. If someone is pointing 100 of their job on official time, that is one thing. That is not Union Activity. To say official time, not union time. No one intends to spend 100 of their day on union time. Sec. Shulkin thank you for clarifying. What distinguishes this committee from any other, it has been noted, is the ability to focus together on the issues that matter. I am hoping the press were here for the budget, today. All of us know what that is. One isto be clear, no not taking those things seriously. It appears there have been allegations of criminal contact on those on both sides. Those things need to be found out. The decision for to reimburse the federal government and move on. The reason this Committee Works is because we have chosen collectively not to allow partisan politics here. Your predecessor was a democratic presence that was there. Of have the unique position someone who spans both sides of the aisle. I hope everyone understands that. To clarify one thing. I have set on this committee longer than anyone. The Blue Water Navy has been a passion of mine. My disagreement is not about getting this done. Bedisagreement is we should not asking for a group of Wounded Warriors to pay for another. Take 1 10 of 1 up off of the tax bracket. Toyou got a deferment vietnam, maybe you should pay for the ones who were there. Chairmans commitment to fixing the Blue Water Navy is second to no one in this country. I simplyting that, disagree with how we are doing it. He brings up a valid point. Where you are at, we are all committed to getting this right. I understand that there is valid arguments. But they are not coming from a position that we do not care about getting it done. I want to make that clear. Act, 30 ofbility the people come from food service and laundry. Perhaps we are quick to move people before we get them in. I believe strongly in accountability. I was there to craft this. My intention was not to get rid of housekeepers if these are things that can be corrected with training, Human Resources, and management. I think the gentleman thank the gentleman for clarifying positions on official time. Now we are back to the work of the budget. I am grateful the president sent out a budget. The constitution is very clear on this. Is not supposed to write the budgets. Congress is supposed to find out from trusted folks, those who have to deliver that. We need to have that conversation on budget growth. I dont disagree. We do have to ignore it, i would argue, the v. A. , especially the clinical folks, are doing fantastic. Who come toveterans the the a want to get their care there who come to the v. A. Want to get their care there. If you go to where there is a cost that does not end with the last bullet, we have been at war for 16 years, we have asked people to go. We are going to have to budget. It may not be sustainable, but i do not see that this is discretion of funding. This is an absolute mandatory requirement for our veterans. I think the chairman for his leadership. Thank the gentleman and i thank the panel for being here today and certainly the start of the discussion of the 2019 budget. And i was sitting here thinking, as we close, about, for our folks that are watching this, just what are the services that va actually provides . And ive been here now nine, going on ten years. And basically, it provides Quality Health care for over 9 million veterans. And whether its inside the va or outside the va, their commitment is to provide quality care wherever the veteran gets that care. It provides memorial benefits. We talked about that earlier to over 140,000 veterans a year who have now passed and those benefits to their families. Pension benefits. Hundreds of thousands of veterans get pension benefits. Group life insurance. We dont think about that. 6 million. Home loans. Veterans now over 3 million get a home loan from the v. A. Compensation benefits over, what, four to five million of our benefits get the educational benefits. Huge benefits, both the montgomery g. I. Bill, the post 9 11 and now the forever g. I. Bill and half, i think, of the young men and women who separate from the military use that g. I. Benefit. One is sitting in this chair. And i want to thank the president for his focus on the va. I remember sitting up at night and late in the evening when he gave his acceptance speech and one of the first things out of his mouth was his commitment to the nations veterans, and i very much appreciate that, and i dont think its stopped. Every time he talks about gives a speech, he mentions our nations heroes. And i thank him for that. We have a huge this committee in a bipartisan way, as the Ranking Member mentioned, has got a huge amount of work to do this year. We have transition of the Choice Program. Weve got to get that done, so you can move on with that. Weve got the asset review to get the va right sized, to begin to go down the pathway of more efficient care in the neighborhoods, in the communities where our veterans live. Weve got ehr modernization. Thats starting. Weve got appeals reform that were just now weve talked about that just a little this morning as mr. Walz brought up. One of my passions i want to get off the table is our Blue Water Navy friends. I want to get that solved. Weve got caregivers. Were moving forward with that. The 7th of march, we have our first round table on that. Statement veteran homes were mentioned. I think those are tremendous. Everywhere ive been, ive looked at estate veteran homes. Those are really quality places that our older veterans can go. You mentioned at as your Number One Health priority, suicide prevention. Weve got enormous work to do on that and theres a Huge Investment in this budget for reducing the amount of suicide we have in this country. And lastly, i know we always privatization comes up, its hard to do that with a straight face. In the nine years ive been here, there were 250,000 employees at the va when i started on this committee, 2009. I think you just said there are now 373,000 and the budgets gone from 93 billion to 198 billion. That doesnt look like privatizing to me. That looks like a commitment this nation is making to its veterans and im proud of that. I think this is something, when i go home, and i live in a very conservative area of the country, i will never apologize for helping earn money we spend on our nations veterans, and i dont think a person on this dais does. I think we can go home proudly and say that we have supported, in this entire congress, both republicans and democrats have done this. Just lastly, as we close, we have a number of questions for the record and one of those i want to get out before is transition to choice, and you dont have to answer it right now. But we have money that will last until the end of may, and then further money was appropriated. Yes. And then thats until the end of the fiscal year, which is 1 october, 30 september. Then how do we get from 30 september to march of 19 because that appears to be when were going to have this youll have the time, your team will have the time to get this new Choice Program fully implemented. You dont have to answer that right now but i need that. And will it be under the budget caps . With that being said, i ask unanimous consent that all members have five legislative days to revise and extend the remarks and include extraneous material. Without objection, so ordered. Hearings adjourned. I mean, i think theres always been a question in my mind about him. I think what the president wanted and the president really campaigned on cleaning up the va, and what the president wanted was somebody from outside the va to come in. He couldnt get the i think he went through, like, three different picks who all backed away. And so, i think he just kind of gave up and went for somebody within the va, and i think ultimately, thats been a mistake. How do you think shulkins resignation would affect the choice overhaul, though . I wonder if thats a major factor in the treatment of this report by this committee today. Im not at all why . I think were on that path. I think well continue on that path. We got to get the system to work and obviously we have to pass good authorizing legislation. I dont think it would. I dont think it would. I mean, thats a congressional issue thats going to be debated between members of congress. But i mean, ive seen over years now that the va spending of mandatory funds through choice has a huge impact on how you guys have to move in response to make sure the veterans still have access to care. So, i wonder if a vacancy at that high of a level could really threaten your ability to manage it depends on how long the vacancy is there. I would hope that the vacancy wouldnt be there for long at all. Yeah. Okay. Thanks so much for your time. Record, do you have anybody youd rather see as secretary . Well, i think i mean, i know who i certainly rather see somebody from the outside that has experience that, number one, has a military background, number two, has a background in preferably managing a Major Hospital system. But that brings an executive experience, executive experience into the va and thats not thats not going to be to morph into becoming part of the system. Part of the culture of the va. Which weve had in the past. This one and the two predecessors. It seems like when they get in there, they just become part of the system. Part of the culture. Thank you, senator