Next, the Senate VeteranAffairs Committee examines caregiving provisions under the Va Mission Act signed into law on june 2018. Almost two and a half hours. Good morning, everyone. The committee will come to order. I welcome our witnesses appearing in person and those appearing distantly. We look forward to their testimony to get a better idea of where the department of Veterans Affairs are in administering the missions act. We are also interested in learning more about the caregivers implementation as well. Member of our participating. Be hearing isf todays the implementation of title i under the mission act by the department of Veterans Affairs relating to Veterans Community care programs and the program of comprehensive assistance to family caregivers. I scheduled this hearing because my dissatisfying dissatisfaction with the implementation of the mission. Department chose to decline the invitation. This committee and the be a share a common goal to pass the mission in 2018 to better serve veterans and their families and we continue to Work Together to address important issues for our nations veterans. I would expect them to be here for this conversation to share all they have accomplished since the the a was transformed with to discussation and what needs to be done to make improvements. The v. A. Is an integral part of this dialogue which is why i plan to hold subsequent discussions with officials to discuss title i implementation. Mentionbe remiss to not the challenges presented by the pandemic. Officials deserve our thanks. However, at a time when accessing health care is of utmost importance, the the a has struggled to uphold the requirements. My staff and i continue to hear complaints from veterans and providers elated to poor communications, lapses in continuity of care and network inadequacies. Try west and octomom are valued and essential partners in the delivery of care to veterans through the network. In play an Important Role building a robust and resilient Community Care network able to provide veterans timely access to care to make sure that Community Providers receive prompt payment. When the v. A. Released stringent access standards for community see was encouraged to to think more veterans would be able to access timely and quality care but my staff and i have since learned that the v. A. s contracts with third ies use different standards. Toerans are often forced drive up to three hours for care. I have discussed this clearing inconsistency with the a officials for months but despite their assurances public land privately, it is uncertain if they have modify the terms of the contract. It appears to me that it is possible now for veterans to have a different access for care , certainly then the law, the mission act requires different than the regulations of the va and perhaps based on the contract terms of the third thirdparty administrators. We hope to learn more about this today. To network is central into arming the care 21st Century Health care system capable of addressing the challenges. As such, i want to ensure that the mission act succeeds and utilization of Community Care networks are accurately accounted for. Much has changed in our country since the Committee Held a hearing on the implementation. The intent and goal of the mission act has not changed. We remain committed to making certain that veterans that qualify for care are able to get that care without unnecessary scheduling delays through a geographically dispersed community of providers. And that the providers are cared in a paid for in a timely manner. I believe that some of the v. A. s Senior Leaders might agree with me that progress must move faster to serve veterans as we all envisioned. I want to know how the v. A. Is making progress in working with thirdparty administrators to transform the v. A. And offer veterans access to the health care that they deserve. Another essential component of the mission act is the expansion and eligibility of program for comprehensive assistance to caregivers. Many have been providing support providing care without support for years or decades. Depression,erience anxiety, or other Mental Health conditions. The stress associated with caregiving for a Family Member with a set of complex Health Care Needs is a real concern for caregivers. It is essential that the v. A. Support for caregivers these Mental Health challenges be addressed effectively. Process tolined a expand resources with an anticipated start date of october 1, 2018 for phase one. Phase one implementation only just began october 1 of this year, two years behind schedule. This delayed rollout will result in caregivers needing to wait longer to be part of the vital support program. I look forward to hearing testimony from everybody who part will be taking part in todays hearing. I apologize my Opening Statement is longer than my usual practice, but i had sufficient desire to say a few things this morning as we begin this hearing. I now want to yield to the Ranking Member and author, sender tester senator tester. Thank you, mr. Chairman. I want to have you for holding this and look forward to the panel of witnesses. I, like you, am very disappointed they have not chosen to be in this dialog. I dont know why something as important as implementation of the mission act doesnt rise to that importance in the va. Hopefully its not because theyre out campaigning across the country. The fact is, is this committee has serious issues with the administration on the implementation of the Va Mission Act and its important, its unfortunate the va couldnt be here to finding solutions for those programs. When congress creates programs to benefit their veterans and families, and its important to implementation and congress intended. Were not here as a nuisance, we do things and have expectations. So the executive branch sent folks here with the creation of the Va Mission Act, congress sought to provide better and greater options for Community Care when the department could not provide care in a timely manner or when veterans were forced to travel long distances to the va facilities. The latest data from the va, made 4. 1 referrals in the beginning of fiscal year 020 to june. Nationally, it took va nearly 22 days to Schedule HealthCare Services after a request was made. Thats not acceptable. Thats a problem. Veterans should have shouldnt have to wait for the va to navigate a bureaucratic process before their appointments are scheduled. Then veterans wait an average of 20 days for their appointments after theyre scheduled. That doesnt work. That dog doesnt hunt. If the va was here find a way to reduce the red tape. They need to explain how to get down the number of days veterans get scheduled for care in the community and the last year, theres not been much improvement in this timeline. Rather than speaking with this broken process, the Administration Needs to find out a better path forward. I have a bill, the accountability and department of Veterans Affair scheduling consult Management Act passed out of Committee Last august. It would help the va to do just that. It would require the va to take a hard look at scheduling process and then report how long it takes to get through that process. It would also require scheduling honest and review of rating of physicians involved in scheduling because too often personnel leave these for better communities elsewhere. My bill would also help veterans make better informed decisions where they can get care because they would have the information they need to make those decisions. It would also help congress exercise oversight of va scheduling to make sure its working the way we intend. Another is the newly looked program. And caregivers many of whom waited for years for the same stipends for post 9 11 veterans and caregivers, im concerned the administration too narrowly wrote the rules. And tightened eligibility for the Current Program are not mission act driven and were undertaken solely by the administration in an effort to limit eligibility for the program and the veteran it impacts. Im concerned that the administration was in rush to meet a new selfimposed deadline after missing the mark for a while and prepared little time preparing stakeholders for when the program would go live causing confusion when it actually did. I do want to thank the Elizabeth Dole foundation for being here today to shed light on issues to make sure this program a functioning well for veterans and caregivers. With that, mr. Chairman, i want to thank you again for calling this important hearing. Senator tester, thank you. Now let me introduce our witnesses. Dave macintyre is the ceo. Trisha, the ceo of optimum. And steve is of the liz both Dole Foundation. And molly from the Elizabeth Dole foundation. And jenny, caregiver and liz bo both Elizabeth Dole foundation. Thank you for being here so we can understand your goals of meeting the needs of veterans of our country. Well now begin the hearing with our first witness, lieutenant general, youre now recognized for five minutes to deliver your testimony. Thank you for being here and thank you for the conversation we had nor nearly an hour on sunday evening. [inaudible] on behalf of the [inaudible] can you hear it now . Im sorry. Would you like me to start over . Do you want me to start over . Okay. Good. I had to dig deep into my military voice there, sorry. After 33 years of Uniformed Service the mission is personal to me and our entire organization, were veterans. My Leadership Team has a total of 350 years of service in uniform. Many of us or our Family Members received care from the Va Health System or the community. Since i last appeared before the committee across regions one two and three, our responsibility is to build and manage a high quality Provider Network. Were managing a network of 830,000 providers across 1. 6 million sites of care. We intentionally built a Large Network so veterans could have their choice from a wide variety of timely care options. To date the va has issued more than 1. 5 million referrals for care to our network connecting individual veterans with a high quality provider, one veteran at a time. 100 of our network is fully accredited and credentialed. In addition, as compared to the 15 benchmark set by the va, 54 of providers assessed are designated as high performing providers. The success of our Provider Network goes beyond the data. Underlying the data are hundreds of thousands of individual connections made between care providers and veterans. We understand that health care is local and the choice of a provider is personal. Our network is dynamic, highly reliable, and responds quickly to the needs on the ground. Recently, the leadership at the Lexington Va Medical Center expressed gratitude for our assistance in ensuring a veteran who is battling cancer could be treated by the same provider as his wife. We know that caring for our nations heroes is more than a contractor providing a claim. It means caring about the women and men who have worn the cloth of our nation and doing whatever it takes to help them heal. Every day we work side by side, to advance veterans care and review successes and address challenges and share best practices. These relationships are critical when the unexpected happens. This occurred in august when hurricane laura left 200,000 without water and a million without power in louisiana. Many hospitals were forced to close and my team jumped into action leveraging relationships with the louisiana hospital association. We ensured they had uptodate information on hospitals where they could safely serve veterans. Our network is not a national entity. Its a collection of regional care eco systems designed to be responsive and convenient to veterans. Working with each we have prioritized the credentialing of high quality providers with a history of serving veterans in the community. As a result, weve partnered with 92 of priority providers identified by the va. And 93 of academic affiliates including duke and the university of kansas and for the first time in the vas history, a provider care in the community, partnered with the va to bring the mayo clinic into the care network. While its a dynamic, our restlessness keeps our veterans at the center of everything we do. This year we learned that a veteran was matched with a lifesaving heart more quickly than expected this evoked our warrior ethos of never leaving a fallen comrade behind. Within 24 hours this West Virginia veteran received a new heart. Over the last few weeks, we began fill facilitating dozens of life saving transplants. This is a power of one, one organization working oneonone with va staff, congress, caregivers, vsos and many others to advance the health and wellbeing of one veteran at a time. Mr. Chairman, Ranking Member tester and members of the committee thank you for the ability to appear for you today. As a veteran, Army Sergeant general, wife of a veteran, daughter of a veteran, the proud mother after airborne infantry lieutenant, ensuring veterans have a high quality Credentials Network that meets their needs is important to me and our entire organization. I look forward to your questions. Thank you. General, thank you for your testimony and thank you to you and your family for your service to our nation. Mr. Mcintyre, welcome. Mr. Chairman, Ranking Member tester and the members of the Senate Committee on Veterans Affairs its an honor to appear before you today and pleased to do so with patty and those from the bob and Elizabeth Dole foundation. Weve been serving the military and veterans population for nearly 25 years now. We are privileged helping them respond to the Health Care Needs veterans from pc3 to replacing the health net, its been quite a journey. Weve tried to remain nimble and one objective to support with not compete with the v hamilton for providing timely care for veterans. Through the use of capacity process and leveraging the footprint of our nonprofit owners weve tailored highly, high Quality Networks in collaboration with va to patch the unique demands of each and veterans. Our network will soon contain all academic affiliates for region four has now delivered more than 32 million medical appointments in support of va to give them needed elasticity. This has included everything from merging care within 30 minutes of a Veterans Home to eye appointments, to we in va have collaborated in administering the ibf benefit for hundreds of couples who could otherwise not have children because of battle wounds. Weve a network for each one of the couples, unique circumstances and lots of babies and proud and grateful parents as a result. Im pleased to result that due to the team effort between us and va, we are now processing and paying claims and professional and institutional alike within two weeks to a level of accuracy in excess of 98 percent. It will please you, im sure, mr. Chairman. That the va is reimbursing us on a timely basis as well. Along with successes have come some challenges, especially in the delivery of timely appointments. As you know, early in the year, our nation was hit with covid, a challenge unprecedented in our lifetimes. Community providers and va alike reduced the Available Services as they made changes to keep their staffs and patients safe and preserved capacity for those fighting the virus. It was a daunting situation. But soon and since the live this year, weve been scheduling appointments within five days for 90 of all veterans needing primary care appointments and theyre seen within 26 days from the receipt of the referral. Mental health within 27 and specialty until 28th. Theres all who are urgent and emergent in their needs are seen within the mission act standards. Theres still a bit of work to do, but were close and only one percent of the care requests that weve been given have been returned for no network provider. Getting here has been challenging. But we are close and we will not rest until we in va and four are delivering on our collective commitment to timely and convenient care. With the implementation of ccn, va takes over care coordination and appointing, but vas request, we have begun supporting within region four and services and expect that elasticity soon to be spread to other va medical centers. With the recent award of the ccn contract for region five. We look forward to doing the same in alaska. Not to replace va, but to enhance it and to provide the elasticity needed so they can serve veterans as you and they believe should be served. Veterans deserve no less. We applaud your continued leadership, mr. Chairman and members of the committee, and direction as we w