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Fox Grant Reauthorization, Access for Rural Veterans, Service Dogs, & More

Posted on September 13, 2024 Posted By: Danielle Forand Categories: The Nimitz Report 
Several draft bills were considered by the HVAC Health Subcommittee today; witnesses expressed support and areas of improvement…

⚡NIMITZ NEWS FLASH⚡

Review of Draft Legislation

House Veterans Affairs Committee, Health Subcommittee Hearing

September 11, 2024 (recording here)

HEARING INFORMATION

Witnesses & Written Testimony (linked) (Panel One):

  • Dr. Carolyn Clancy: Assistant Undersecretary for Health, Discovery, Education, and Affiliate Networks, U.S. Department of Veterans Affairs, on behalf of Veterans Health Administration
  • Dr. Matthew Miller: Executive Director, Office of Suicide Prevention, U.S. Department of Veterans Affairs, on behalf of Veterans Health Administration
  • Dr. Ajit Pai: Executive Director, Office of Rehabilitation and Prosthetic Services, U.S. Department of Veterans Affairs, on behalf of Veterans Health Administration
  • Dr. Ryan Heiman: Acting Director, Member Services, U.S. Department of Veterans Affairs, on behalf of Veterans Health Administration

Witnesses & Written Testimony (linked) (Panel Two):

Keywords mentioned:

  • Mental health, suicide prevention, community care, rural veterans, adaptive prosthetics, telemedicine, outreach, accountability, coordination of care

IN THEIR WORDS

“If we're going to ask the question, we need to have a plan for the answer.”
-Ms. Missy Meyers
“We remain hopeful that the [Staff Sergeant Parker Gordon Fox Suicide Prevention Grant Program] becomes a permanent fixture in VA’s public health strategy.” 
-Mr. Brian Dempsey
Chairwoman Miller-Meeks was one of several members of Congress with bills under consideration at today’s hearing.

OPENING STATEMENTS FROM THE SUBCOMMITTEE & OTHER MEMBERS

  • Chairwoman Miller-Meeks welcomed the Subcommittee and witnesses, mentioning the potential impact of the legislation under consideration. She introduced two bills, the No Wrong Door for Veterans Act (H.R. 9438) and the Veterans SPORT Act (H.R. 9478). H.R. 9438 aims to reauthorize the Staff Sergeant Parker Gordon Fox Suicide Prevention Grant Program (SSG Fox SPGP) for an additional three years and make administrative changes to the program, including improvements to the coordination of care between VA providers and grantees and the standardization of the veteran intake process. H.R. 9478 seeks to provide amputee veterans access to adaptive prosthetic limbs for sports and recreation.
  • Rep. Cherfilus-McCormick acknowledged the absence of Ranking Member Brownley, commending her for the Have You Served Act (H.R. 6291) and stressing the importance of recognizing veteran status to enhance outreach and support. She also discussed Democratic bills aimed at increasing healthcare access for rural veterans, including the Rural Veterans Transportation to Care Act (H.R. 7504) and the New Mexico Rural Veterans Healthcare Access Act (H.R. 9301).
  • Rep. Luttrell introduced the Service Dogs Assisting Veterans (SAVES) Act, which would establish a five-year program to provide service dogs to veterans through nonprofit organizations. The bill ensures that veterans receive service dogs free of charge and are provided with veterinary insurance. The legislation also seeks to address long wait times and limited availability of service dogs, expanding eligibility for veterans with various disabilities including PTSD and traumatic brain injuries.
  • Rep. Franklin expressed concern over the VA pushing veterans back into VA facilities from community care providers, disrupting continuity of care. His bill, the Ensuring Continuity in Veterans Health Act (H.R. 9146), aims to protect veterans’ choice to receive care from community providers and ensure continuity and convenience in their healthcare.
  • Rep. Vasquez advocated for H.R. 9301, sharing the difficulties veterans in his district face in accessing VA care due to travel distances. His bill would adjust VA service lines, allowing veterans to receive care and travel reimbursement from the nearest VA facility, such as in El Paso, rather than Albuquerque. He underscored that rural veterans should not be disadvantaged in accessing the care they deserve.
  • Rep. Self introduced the Enhancing Faith-Based Support for Veterans Act of 2024 (H.R. 9485), which would allow veterans to share their contact information with non-VA faith-based organizations of their choice. This bill ensures veterans can receive the spiritual care they seek without bureaucratic barriers. Rep. Self cited the example of a Catholic minister who was previously denied access to VA patients due to policy changes and emphasized that veterans should have full control over their spiritual support options.
  • Rep. Gluesenkamp-Perez discussed H.R. 7504, which aims to address the sudden loss of transportation funding for veterans in rural counties due to a change in eligibility definitions. Her bill would expand the definition of rural areas and restore funding for critical transportation services, allowing rural veterans to access VA healthcare. She noted the importance of reliable transportation in ensuring veterans receive timely, life-saving care.
  • Rep. Womack introduced the Protecting Veteran Access to Telemedicine Services Act of 2024 (H.R. 9324), which seeks to extend telemedicine access for veterans beyond the temporary provisions of the Ryan Haight Act. His bill would allow VA healthcare providers to continue prescribing controlled substances via telemedicine, ensuring that veterans, especially in rural areas, have uninterrupted access to necessary treatments. He argued that without this exemption, veterans could face longer wait times and travel burdens for in-person appointments.
  • Rep. Tokuda presented the Parity for Native Hawaiian Veterans Act of 2024 (H.R. 8562), which seeks to ensure Native Hawaiian veterans have the same healthcare access and benefits as American Indian and Alaska Native veterans. The bill would update the definition of Native Hawaiians in veteran-related statutes, eliminate co-pays for Native Hawaiian veterans, and allow the VA to reimburse the Native Hawaiian Health System for care provided to these veterans. Rep. Tokuda stressed that Native Hawaiian veterans deserve equal access to healthcare services as part of the federal government’s trust responsibility.
  • Rep. Chavez-DeRemer introduced the VA Geriatrics and Gerontology Advisory Committee Expansion Act, which would add a representative from the National Association of State Veterans Homes (NASVH) to the VA’s advisory committee on geriatrics. This addition would enhance the VA’s understanding of long-term care needs and strengthen care options for aging veterans. Rep. Chavez-DeRemer emphasized that state veterans’ homes offer valuable expertise and that their inclusion would help address the growing demand for geriatric care.

SUMMARY OF KEY POINTS (PANEL ONE)

OPENING STATEMENTS FROM THE SUBCOMMITTEE & OTHER MEMBERS

  • Chairwoman Miller-Meeks welcomed the Subcommittee and witnesses, mentioning the potential impact of the legislation under consideration. She introduced two bills, the No Wrong Door for Veterans Act (H.R. 9438) and the Veterans SPORT Act (H.R. 9478). H.R. 9438 aims to reauthorize the Staff Sergeant Parker Gordon Fox Suicide Prevention Grant Program (SSG Fox SPGP) for an additional three years and make administrative changes to the program, including improvements to the coordination of care between VA providers and grantees and the standardization of the veteran intake process. H.R. 9478 seeks to provide amputee veterans access to adaptive prosthetic limbs for sports and recreation.
  • Rep. Cherfilus-McCormick acknowledged the absence of Ranking Member Brownley, commending her for the Have You Served Act (H.R. 6291) and stressing the importance of recognizing veteran status to enhance outreach and support. She also discussed Democratic bills aimed at increasing healthcare access for rural veterans, including the Rural Veterans Transportation to Care Act (H.R. 7504) and the New Mexico Rural Veterans Healthcare Access Act (H.R. 9301).
  • Rep. Luttrell introduced the Service Dogs Assisting Veterans (SAVES) Act, which would establish a five-year program to provide service dogs to veterans through nonprofit organizations. The bill ensures that veterans receive service dogs free of charge and are provided with veterinary insurance. The legislation also seeks to address long wait times and limited availability of service dogs, expanding eligibility for veterans with various disabilities including PTSD and traumatic brain injuries.
  • Rep. Franklin expressed concern over the VA pushing veterans back into VA facilities from community care providers, disrupting continuity of care. His bill, the Ensuring Continuity in Veterans Health Act (H.R. 9146), aims to protect veterans’ choice to receive care from community providers and ensure continuity and convenience in their healthcare.
  • Rep. Vasquez advocated for H.R. 9301, sharing the difficulties veterans in his district face in accessing VA care due to travel distances. His bill would adjust VA service lines, allowing veterans to receive care and travel reimbursement from the nearest VA facility, such as in El Paso, rather than Albuquerque. He underscored that rural veterans should not be disadvantaged in accessing the care they deserve.
  • Rep. Self introduced the Enhancing Faith-Based Support for Veterans Act of 2024 (H.R. 9485), which would allow veterans to share their contact information with non-VA faith-based organizations of their choice. This bill ensures veterans can receive the spiritual care they seek without bureaucratic barriers. Rep. Self cited the example of a Catholic minister who was previously denied access to VA patients due to policy changes and emphasized that veterans should have full control over their spiritual support options.
  • Rep. Gluesenkamp-Perez discussed H.R. 7504, which aims to address the sudden loss of transportation funding for veterans in rural counties due to a change in eligibility definitions. Her bill would expand the definition of rural areas and restore funding for critical transportation services, allowing rural veterans to access VA healthcare. She noted the importance of reliable transportation in ensuring veterans receive timely, life-saving care.
  • Rep. Womack introduced the Protecting Veteran Access to Telemedicine Services Act of 2024 (H.R. 9324), which seeks to extend telemedicine access for veterans beyond the temporary provisions of the Ryan Haight Act. His bill would allow VA healthcare providers to continue prescribing controlled substances via telemedicine, ensuring that veterans, especially in rural areas, have uninterrupted access to necessary treatments. He argued that without this exemption, veterans could face longer wait times and travel burdens for in-person appointments.
  • Rep. Tokuda presented the Parity for Native Hawaiian Veterans Act of 2024 (H.R. 8562), which seeks to ensure Native Hawaiian veterans have the same healthcare access and benefits as American Indian and Alaska Native veterans. The bill would update the definition of Native Hawaiians in veteran-related statutes, eliminate co-pays for Native Hawaiian veterans, and allow the VA to reimburse the Native Hawaiian Health System for care provided to these veterans. Rep. Tokuda stressed that Native Hawaiian veterans deserve equal access to healthcare services as part of the federal government’s trust responsibility.
  • Rep. Chavez-DeRemer introduced the VA Geriatrics and Gerontology Advisory Committee Expansion Act, which would add a representative from the National Association of State Veterans Homes (NASVH) to the VA’s advisory committee on geriatrics. This addition would enhance the VA’s understanding of long-term care needs and strengthen care options for aging veterans. Rep. Chavez-DeRemer emphasized that state veterans’ homes offer valuable expertise and that their inclusion would help address the growing demand for geriatric care.

SUMMARY OF KEY POINTS (PANEL ONE)

  • Dr. Clancy thanked Chairwoman Miller-Meeks and the Subcommittee for the opportunity to present views on several bills affecting VA programs. She mentioned the significance of 9/11, acknowledging the unique challenges and healthcare needs of veterans from two decades of conflict. Dr. Clancy supported the intent of the H.R. 9438, but recommended against codifying the Columbia Suicide Severity Rating. She suggested that the pilot program be extended with increased appropriations. She also expressed support for H.R. 6291 and H.R. 6330, proposing clarifying amendments, and endorsed H.R. 7504 and H.R. 9324. Dr. Clancy recommended technical edits for all bills to improve implementation.
  • Rep. Cherfilus-McCormick asked Dr. Clancy to elaborate on the specific applicant requirements needed for the grant program in H.R. 6291 to ensure appropriate entities receive grants. Dr. Clancy emphasized that the VA supports the intent of the bill and requested greater clarity around the application process and requirements for applicants. She mentioned that these details could be worked out during the markup process, and her team was ready to provide suggestions.
  • Rep. Cherfilus-McCormick asked for specifics on how the array of VA services and benefits should be identified for grantees in H.R. 6291. Dr. Miller noted that the goal was to strike a balance between broad and overly prescriptive language in the bill. He suggested that the VA’s subject matter experts could collaborate to fine-tune the language to fully support the bill’s intent.
  • Rep. Cherfilus-McCormick inquired how H.R. 6291 could support the VA’s community partnership efforts and the Veteran Resource Community Network. Dr. Miller responded that the bill aligns with the “Governor’s Challenge” and offers the opportunity to expand existing efforts beyond those partnerships. He suggested that it could draw in other partnerships and initiatives to benefit veterans.
  • Rep. Cherfilus-McCormick then asked about improvements from the VA’s interagency working group regarding suicides on VA campuses, tying it to the Veterans Sentinel Act (H.R. 6330). Dr. Miller outlined three key improvements: standardizing informational briefings, creating checkpoints for peer reviews and root cause analyses, and implementing parking lot signs with the Veterans Crisis Line (VCL) and 988 numbers across all VA facilities.
  • Chairwoman Miller-Meeks questioned the VA’s request to remove the statutory cap on the SSG Fox SPGP amounts, given oversight issues in the program. Dr. Clancy explained that the request to adjust the cap was due to inflation, to ensure the grant awards reflect current costs. She acknowledged the oversight concerns but believed adjusting the cap would help address those issues.
  • Chairwoman Miller-Meeks asked why the VA does not support including adaptive prosthetic devices in the definition of medical services under Title 38. Dr. Pai responded that the VA already includes adaptive sports devices in its regulations, but these devices are highly complex and require extended rehabilitation. He argued that codifying them into law would be redundant as the VA is already addressing the need.
  • Chairwoman Miller-Meeks asked why the grants in H.R. 6291 could not be directed to existing veteran service organizations. Dr. Clancy agreed that grants could go to veteran service organizations but also noted that some areas are beyond the reach of those organizations. She suggested working with the Chairwoman’s staff on this issue.
  • Rep. Cherfilus-McCormick inquired whether the VA could apply the same investigation methods from H.R. 6330 to suicides at community care facilities. Dr. Miller agreed that including information from non-VA sites would be valuable for the VA’s awareness and surveillance process. He stated that the VA would look into engaging community partners to expand this effort.
  • Rep. Cherfilus-McCormick then asked about the VA’s actions to address transportation reimbursement issues for veterans in New Mexico who receive care from El Paso instead of Albuquerque. Dr. Heiman explained that the VA is examining referral patterns and transportation reimbursement, and it does not believe a law is needed to address the issue. He indicated that the VA plans to brief the committee and local delegations by the end of the year.
  • Ranking Member Takano (Full Committee) asked whether limiting grantees to the Columbia Suicide Severity Rating Scale would impair data collection and the assessment of the SSG Fox SPGP’s effectiveness. Dr. Miller agreed that restricting the program to the Columbia Scale could impact the evaluation of outcomes. He underlined that other measures, such as broader assessments of mental health and financial status, are also necessary for a comprehensive evaluation.

SUMMARY OF KEY POINTS (PANEL TWO)

  • Mr. Dempsey emphasized that Wounded Warrior Project’s mission has been to honor and empower post-9/11 veterans and their families. He supported several bills, including H.R. 9438 and H.R. 9427, which provides grants for outpatient mental health treatment. He also endorsed H.R. 9478 and advocated for increased transportation access for rural veterans through H.R. 7504. Mr. Dempsey underscored the importance of ensuring these legislative efforts cater to the unique needs of wounded veterans, especially those with traumatic brain injuries.
  • Ms. Meyer also focused on H.R. 9427 and H.R. 9438, supporting the expansion of mental health care for veterans through outpatient facilities while advocating for a holistic approach. She highlighted the success of the SSG Fox SPGP, noting that America’s Warrior Partnership has used it to screen over 1,900 veterans and identify many at risk for suicide. Ms. Meyer suggested improvements to the program, including adding more flexibility in assessments, streamlining VA intake for grant participants, and implementing clearer accountability metrics. She called for reforms to enhance outreach and ensure veterans can quickly access the care they need.
  • Mr. Pennington spoke in favor of H.R. 9478, which would include adaptive prosthetics for sports and recreational activities as part of VA medical services, arguing that current VA regulations limit access to these devices outside of rehabilitative treatment plans. He stated that adaptive equipment is vital for veterans’ long-term physical and mental health. He also supported H.R. 9438, emphasizing the importance of offering immediate support to those at risk of suicide. Mr. Pennington urged swift passage of these bills to better serve the needs of wounded veterans.
  • Mr. Retzer expressed DAV’s support for several bills, including H.R. 6291 and H.R. 6330. He also supported H.R. 9324 and H.R. 9438, but he raised concerns about the 72-hour care provision disconnecting veterans from necessary VA services. Mr. Retzer also backed H.R. 9478, reiterating the importance of adaptive prosthetics for veterans’ well-being, and the SAVES Act.
  • Rep. Bergman asked Ms. Meyer to describe bureaucratic barriers at the VA that prevent veterans from receiving mental health or suicide prevention care. Ms. Meyer explained that one significant barrier is the requirement for veterans to participate in multiple baseline mental health assessments, which can be redundant and deter them from enrolling in the SSG Fox SPGP. She noted that while the Columbia protocol may qualify veterans for the program, the additional required assessments often cause them to become ineligible.
  • Rep. Bergman followed up on how the SSG Fox SPGP has improved veteran access to suicide prevention care. Mr. Pennington stated that the SSG Fox SPGP has provided organizations with essential funding to expand their suicide prevention programs. He mentioned that the program has also enabled collaboration with law enforcement, allowing them to train first responders who often encounter veterans in crisis.
  • Chairwoman Miller-Meeks asked Mr. Dempsey about the benefits of using the Columbia protocol for baseline screenings in the SSG Fox SPGP. Mr. Dempsey explained that the Columbia protocol has been highly effective in streamlining the screening process for veterans at risk of suicide, helping Wounded Warrior Project assign veterans to the appropriate level of care quickly. He stated that the efficiency of the protocol has been beneficial in addressing veterans’ mental health needs.
  • Chairwoman Miller-Meeks asked how quarterly briefings regarding the SSG Fox SPGP could build partnerships between the VA and the community and improve care coordination for veterans. Ms. Meyer stated that quarterly briefings would help VA staff become more familiar with the program, as there is currently a gap in awareness, particularly among frontline staff. She believed that this increased understanding would improve the intake process and care coordination for veterans receiving services from SSG Fox SPGP grantees.
  • Chairwoman Miller-Meeks asked how H.R. 9324, which expands telemedicine services, would benefit rural veterans. Mr. Retzer explained that rural veterans face geographic and weather-related barriers to accessing VA services, which can interrupt the continuity of their care, especially for life-saving medications. He emphasized that expanding telemedicine would fill this gap by ensuring veterans can receive care and prescriptions without needing to travel long distances.
  • Chairwoman Miller-Meeks inquired about how the VA’s policy on adaptive prosthetics for recreational use has affected veterans and asked for examples of those denied equipment due to this policy. Mr. Pennington cited two specific cases where veterans were denied swimming blades due to the VA’s restrictive policy on providing adaptive prosthetics for recreational use. He argued that this limitation has negatively impacted the veterans’ mental health, as they are unable to participate in activities they enjoyed prior to their injuries.

SPECIAL TOPICS

🖤 Mental health and suicide:

  • Chairwoman Miller-Meeks introduced the No Wrong Door for Veterans Act (H.R. 9438) to reauthorize the VA’s Staff Sergeant Parker Gordon Fox Suicide Prevention Grant Program until 2028. This program aims to fund community-based organizations to expand mental health support for veterans and improve coordination between VA providers and grantees. This bill and grant program were discussed at length during the hearing.
  • Rep. Cherfilus-McCormick underscored the importance of identifying veterans and connecting them with mental health resources. She discussed the Veterans Sentinel Act (H.R. 6330), which addresses suicides on VA campuses by creating a task force to investigate the causes and prevent future occurrences.
  • Rep. Luttrell introduced the SAVES Act, which would provide service dogs to veterans with mental health conditions, such as PTSD. The bill is designed to help address the wide range of mental health issues veterans face.

👨‍💻 IT issues:

  • Ms. Meyer mentioned that the data collection tool implemented by the VA for the SSG Fox SPGP has caused issues because it now requires veterans’ Social Security numbers and dates of birth, which has led to reduced data reporting. She suggested returning to the original system that used anonymous identification numbers to preserve privacy.

🧠 TBI:

  • The No Wrong Door for Veterans Act (H.R. 9438) was referenced as supporting mental health services, including addressing the needs of veterans with brain health challenges.
  • Rep. Luttrell discussed the SAVES Act, which would expand the provision of service dogs to veterans with TBI, offering them an additional avenue of support.
  • Mr. Dempsey spoke on the many post-9/11 veterans who suffer from traumatic brain injuries and neurocognitive impairments. These injuries make it difficult for veterans to travel to VA medical appointments, and he supported the Rural Veterans Transportation to Care Act (H.R. 7504).

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