health association. >> members are responsible for muting and on muting themselves -- and unmuting yourselves. i remind members that the five minute rule applies. if there are tech issues, we will move to the next and you will remain the balance of your time. your clock will show you how much time you have remaining. the clock will turn red when time expires. in terms of the speaking order, we will follow the order. we alternate between majority and minority. members not present at the time the hearing is not called order. house rules require me to remind you we have set up an email dress where you wish to submit in writing. that email was provided to you in advance. today we welcome back to the sub committee the assistant undersecretary of the utterance health administration. she is accompanied by the director of mental health and suicide prevention at the health administration. dr. patricia hayes, chief officer at the veterans health administration. and the chief financial officer at the veterans health administration. today's hearing will cover some areas of care at the v.a. that are essential for veterans. women's health, mental health, suicide invention are some areas this many has ir test. i know we are all proud of the work we have done to achieve that. this will give us an opportunity to update those efforts and what we look to do in the coming year. once the budget is released, we will have the opportunity to dive further into this. in addition to investing resources to help programs succeed, this committee is focused on oversight. there is too much work to be done to ensure veterans are receiving services. these programs come together to help the v.a. provide care and services in the cap brands of fashion required in order for veterans to achieve the best possible health outcome. all four programs received increases in the appropriations act. it was enacted in december and provided nearly $661 million per gender specific care for women. it reflects the need for this growing number of veterans. it should not be considered specialty care or a bonus, it should be built into the system at a fundamental level and put into practice across the v.a. health care system. if you want to encourage veterans to get care, we need them to be properly staffed with women's health care providers and support teams and offer events and services that address health care challenges facing women. women need access to programs but they have unique needs. areas like maternity care, from a lot -- gynecological care. we want to make sure we keep making process and move forward. we need to make greater progress. veterans died by suicide is still deeply troubling and remains stagnant when it should be decreasing. data used in the annual study is two years old. we are getting a full picture of the current state. in v.a. has been applying proactive approaches to reduce these numbers seeking to keep veterans connected during their transition from active duty, identifying those at risk for suicide and reaching out. i look forward to hearing about these efforts to prevent suicide as well as to make sure every veteran who needs health care getting it. no one should be turned away from care and we need to make sure care is of the highest quality. we are committee -- committed to strengthen mental health programs and reach every veteran in need. in fy 21, we provided $10 billion from and health programs and specifically directed funds for suicide prevention. these funds will help us determine what is working. this is why i am excited about the health care program which supports going on treating physical conditions and works personalize health care plans for veterans that considers physical, mental, emotional, spiritual, and environmental needs. i am optimistic this will help with mental health care challenges and i am glad the v.a. is seeing the potential in this program. and one of the challenges facing the v.a. is that of homelessness. the v.a. has made notable progress and it has declined by nearly half. but there is still more work to do, especially in light of the pandemic and the latest challenges. cares act will give $971 million to help homeless veterans impacted by the pandemic and also to adapt homelessness programs. the american rescue plan that passed into law includes funding to ensure the v.a. has the resources needed to continue the efforts moving forward. >> pandemic or not, we must continue working to reduce veteran homelessness and prevent them from sliding back into homelessness. all four of these are at critical junctures. it will continue to be among our top priority to ensure veterans health and i look forward to hearing from witnesses about the work being done in these areas. i am pleased to yield to judge carter for opening statements. judge carter: thank you. the v.a. specialty programs are very important. this delves into issues. i think we all appreciate the opportunity for the oversight on veterans health care issues. oversight is missing in many instances and we hope to do a good job on oversight. the testimonies presented today will highlight notable accomplishments. and tell, over the past year, it is the goal during the pandemic. i would like to express my appreciation to dr. matthew as well as others. we thank them for the hard work and dedication. before i go, i received a new. i don't know if everyone sees my --, but over the last 20 years a very good friend of mine and visits me. he passed away yesterday. roger was a guy who had issues but he always brightened your day. if anybody knows him, we lost a really good man to virginia. thank you for allowing -- a lost a great man to --. thank you for letting me say that. >> we are appreciative of his commitment and support for the state of israel the u.s. relationships between i don't believe -- are here. dr. matthews, you are the only one who will be completing testimony. their written testimony will be included and you are not recognized. >> good morning, madam chair, ranking member carter and sting wished members of the subcommittee. we appreciate the opportunity to discuss how the v.a. gives a roach by leveraging capabilities, including women's health, -- gives an approach by leveraging capabilities in women's health. patricia hayes and the rector of the health and suicide prevention. we promote, protect, and restore veterans health and well-being to empower and equip them to achieve goals and provide state-of-the-art treatment as needed. the v.a. provides a continuum of forward-looking residential inpatient services. services are integrated to ensure the veteran is at the center of their care and that she or he receives those services when and where they are needed. both physical and mental health issues included -- including opioid health disorders and others need to include veteran centric treatments and associated social needs in order to prevent poor outcomes. with your guidance and support, the v.a. has worked diligently to work on the pressing social needs including homelessness. the cares act provisions were used to help those with housing insecurity. the veterans family program received $716 million to provide emergency housing and homelessness prevention assistance to prevent the potential homelessness that would have resulted from unemployment during the pandemic. it included over 24,000 hotel or motel placements that occurred since april last year through january 2021, reducing the risk of covid-19 for those one horrible veterans. it does not end there. covid testing tested 7000 veterans and has vaccinated many overall. the program received $170 million to support increases for transit services and reduce risk of exposure and congregate settings. we used cares act funding for over 28,000 smart homes for homeless veterans to facilitate virtual access to providers, prospective employers, and landlords. it has not only addressed emergency housing needs but broader social, physical, mental health needs. the v.a. is leading the nation in a transverse -- transition focused on disease management to one that is based on a partnership between the veterans and the bha to focus on -- the v ha to focus on health. it was mandated and demonstrated rapid decreases in mobile utilization and improved quality of life as well as an increased meaning and purpose in life. based on this effort and building on the experience, the systemwide rollout of whole health is underway with an emphasis on integration into all primary care and medical health settings, a seamless transition into all v.a. services. if includes 37 dimensions. -- it includes 37 dimensions. more women are using the v.a. for their care in the last five years. the number of women veterans using vha care has tripled since 2001. the v.a. strategically enhanced services and access for women veterans by investing $75 million in an equipment and hiring initiative. the v.a. vied services for women veterans, including women specific areas of gynecology, mental health services and to deal with my -- deal with mental sexual trauma. the providers offer general primary care and gender specific primary care in the context of a longitudinal relationship. v.a. satisfaction and quality data indicates women who are assigned to pcps have higher satisfaction and higher gender specific care than others. women assigned to these care providers are twice as likely to stay in v.a. care over time. the goal is to meet all veterans where they are in life and walk with them to achieve their goals hearing our objective is to give veterans quality care have earned and deserved in a seamless manner. this includes my statement paid we are eager to take your questions. >> then cute so much, madam secretary. i appreciate your work -- thank you so much, madam secretary. i appreciate your work and look forward to talking to you and your colleagues. we have to be staffed in unique and different ways. i was interrupted by my daughter who brought me a pen, so excuse the interruption. i understand there has been a reorganization within vha to report directly to the undersecretary for help. can you talk about the impact of that change? when did that happen and what does it allow them to do more effectively? that is a huge move from when i gave -- i became the ranking member because it felt like the women's health program was a stepchild at the v.a. in this is really a significant move. >> i will let you take that directly. >> good morning. thank you very much for having us and allowing me to be a part of this hearing. it is very important that the v-8 was able through modernization and encouragement -- the v.a. was able through modernization and encouragement to -- this gives me direct lines of communication to be able to discuss the needs and impact and gaps in services. i do have direct contact with the undersecretary and regular meetings come emails, and conversations. we have been able to move -- and i should note that happen in january of 2020 and was formerly made effective when we got our complete budget at the beginning of this fiscal year. all the other pieces were transferred over with more seamless this year. i have more access to direct members and have performance evaluation of how we are doing in filling the gaps for women veterans. >> have you been able to see the impact of that change? what did it enable to you to do more effectively? >> we were able to rollout initiatives and number of the millions into hiring and equipment. we were able to start out getting approval to get funds out october 1. i think those kinds of things that normally would have to go through more change in signatures have been expedited. >> back in 2015, the v.a. published a study about accessing v.a. care for women veterans. i know the study has informed a lot of the planning for gender specific health care. has the study been updated since? how are you ensuring you are keeping your finger on the pulse of what women veterans want to see? >> the study is set to be updated for a number of reasons, but particularly because of the 2020 improvement act that requires us to redo the study. we are in the process of getting that ready to go. there are a number of ways we can pay attention to feedback from women veterans, regular focus groups are underway. also what we call signals, which goes out to 150,000 veterans on a regular basis. we are able to look at that by gender and location and drill down better concerns and feedback at a local level and we regularly do that with the regular women's grandma managers. >> -- women's gender managers. >> we talked about access to services at the v.a. for veterans. the b is currently on the committee a decade ago -- the v.a. is currently from a committee a decade ago, how is this allowed you to get them better services? >> this is a critical issue for us. the current policy has some restrictions which are antiquated and simply unfair. we want to be able to work with you so the v.a. can through legislation establish its own policies to open up the eligibility for veterans who would like to build families. i personally have talked to 60 veterans for whom the ivf current regulations closed them out and most heart wrenching conversations because of the ways regulations had been formulated. i want to work closely with you and other members of congress so we can fix this and invite veterans into full ivf and other care. >> thank you so much good we want to work with you -- thank you so much. we want to work with you as well. my time has expired. i will yield to judge carter. judge carter: thank you, madam chairman. in texas i hear a lot of concerns about toxic exposures. can you tell us about the services of a veteran that has been exposed to toxic chemicals? what treatments are available? >> thank you for the question. this is definitely an area is of great concern because unfortunately it is a great range of symptoms. sometimes being quite subjective, eating they can't exercise as well or get the air in, all the way up to coughing, wheezing, and shortness of breath, which is a lot like asthma. there is a lot of confusion there. treatments very -- vary. if it is looking a lot like asthma, we have difficult courses there. for those more subjective symptoms, we don't have a lot currently that the evidence shows. it doesn't mean we wouldn't necessarily attempt other options that may help the patient feel more comfortable. there is a great deal of rich church cup -- research coming out to look just at this and it is equally concerning for us. judge carter: are they trying to spot this issue? >> they are trained and expected to question a wide range of symptoms. they then make referrals over to the environmental health feeds. everyone has a clinician or program coordinator that is actually responsible for doing the full registry exam. once the veteran is on the registry, there are regular, even annual involvement. we created an act to help even if the primary care or the there are questions about the referral and community providers can use that as well. while the formal training is long modules online, that is taken by the environmental health doctors doing the more formal exams. the information is available and >> thank you very much. does the v.a. help them with that? dr. matthews: we of course perform a proportion of those exams through the exam work we assist the v.a. with, but we are not the doctors making the decisions about percentage, connection, in which they declared we assist with the physical exams and hand that over. >> one more time i'm going to ask you, over the last couple of years -- [indiscernible] how is the v.a. using these technologies? >> do you have information on that? dr. carroll: we appreciate your support. the first thing we would talk about is our reach that program. -- reach vet program. it identifies those who from a statistical point of view may be at the highest rate of predicted suicide risk, and then our teams share that information with the providers at the local facilities, who then review the record and reach out to veterans, and ask, what more can we be doing? this gives a signal to the provider to make sure they are examining the care provided, and step up that care in any way that is important for the veterans. we have seen increased engagement in care following these kinds of contacts, and there has been a reduction in mortality for those we have engaged in this process. >> are you working with the vs so and organizations? dr. carroll: yes, we work with the vso's on many fronts to make sure there is messaging going out about the resources that are available to v.a.. we are working with partners across the federal government and in the private sector on a dancing all of our work in social media -- advancing all our work in social media and technology platforms. >> it seems at least that in this modern day, suicide is becoming almost epidemic, not just among the servicemen, but also across the v.a. i am not sure whether -- [indiscernible] epidemic it seems to be. now the army is -- i think you for what you do. -- thank you for what you do. this is a very complicated area for people considering suicide. it seems to be right now epidemic across the board, even around schools. so you are very important to this country. thank you for what you do. i yield back. dr. carroll: thank you. >> thank you, judge. i would like to call upon -- for five minutes. >> thank you, madam chair. dr. matthews, or whoever you want to refer this to, can i talk to you a little bit about veterans homelessness? yes, there have been great strides made. still, way too many veterans and as you know better than me, disproportionate veteran populations are affected by homelessness, particularly true in my home state of hawaii where it is a very difficult homeless issue to try to solve all the way around. ethnic disparities and disparities on many fronts. i guess the question is, we have had to suspend the point in time counts, but are a comfortable with the fact that we are doing -- i agree there are increased pressure on the homeless population and to maintain this momentum during covid-19. what are we doing to try to stay on top of it and maintain this progress? the cares act funded a great deal of money to various homeless programs for exactly this purpose, whether allocated to emergency homeless programs or to keep people housed out of homelessness. can you just update in the covid-19 world on where you think the progress of going after veterans homelessness is? dr. matthews: thank you for the question, sir. you are right. without the pit count, we have a risk there, a sense of unknown. i am very proud of the work that we've done during the pandemic. i think we approached it as holistically as possible. there was obviously the need to truly focus on emergency housing. and some more than 24,000 hotel and motel placements to really make sure that we were decreasing risk of exposure. this isn't just about getting veterans off the street. it was about making sure they were getting out of congregate settings, so their immediate safety was quite critical. we even established of course increased rates through the grant per diem program. we provided additional funding through ssvf to make sure we had navigators for the grantees, they could fund navigators to make sure the veterans were connected back to the v.a., connected to health services. again, quite critical that we are looking at more than just our housing needs. a lot of the outreach we did unfortunately has to be restricted because we did not have a recent pit count like you highlighted, but it was focused on targeting the homeless that we at least have some record of, and assuring homelessness prevention assistance where possible, through our grantees, facility partners, reaching out to those veterans, making sure if there are any concerns regarding fam