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No delay for new Veterans community care rules, despite concerns from advocates

Community Care Rules


Veterans “choice” is happening in 10 weeks, unless critics can find a way to stop it.

Veterans Affairs Secretary Robert Wilkie this week expressed his confidence that new community care standards expanding Veterans access to private-sector physicians will be in place on schedule this June, regardless of ongoing concerns over the changes.

“The statute is very clear, the timelines are very clear,” he told reporters after a Senate Veterans’ Affairs Committee hearing on Tuesday. “The regulations are in place. I can’t see them changing unless Congress steps in between now and June 6.”

But Congress may try that. Democratic lawmakers have expressed numerous concerns about the outside care expansion they say are still unanswered: how much it will cost; how it will affect other VA health care reforms; what standards private-sector physicians will have to meet; and whether it all amounts to a stealth privatization of the department.

House Veterans’ Affairs Committee Chairman Mark Takano, D-Calif., said he’ll find ways to halt those changes if his questions aren’t answered soon.

“I’d rather make sure we get the VA to do the right thing rather than meet this time deadline,” he said Thursday.

The VA Mission Act changes — often labeled as “choice” by President Donald Trump, even though a separate VA program with that name already exists — amount to a significant expansion in the number of Veterans who can receive private-sector health care with taxpayers’ funds.

Published in the federal register last month, the moves could triple the number of Veterans eligible for the care, expanding it to almost a third of the former military population.

Veterans who live more than 30 minutes from a Veterans Affairs medical clinic or face a wait of more than 20 days for most health care appointments would be eligible for expanded community care programs. Wilkie and VA officials argue those standards fall in line with military health care and private sector benchmarks

The updated standards would replace the 40-mile, 30-day guidelines currently in place for most Veterans. For specialty care, Veterans would have a 60-minute-drive or 28-day wait standard.

About one-third of all VA medical appointments are currently handled outside the department’s health care system now, a figure that has held steady in recent years.

And VA officials have insisted that they do not expect a significant increase in the number of Veterans who seek care outside the traditional VA health care system. They argue the new rules give Veterans the flexibility to pick the best health care options for their situation, but assume many will still stick with the VA care they’re already using.

“The care in the private sector, nine times out of 10, is probably not as good as care in VA,” Wilkie told the committee.

But opponents say the department’s projections are flawed, and question their estimates that the moves won’t ultimately draw funding from other VA priorities. When Wilkie noted this week that the department needs $60 billion in facility improvements nationwide in coming years, Senate Democrats asked why that money isn’t included in the president’s budget plans.

“You have said no privatization, and your staff has also said that,” Sen. Jon Tester, D-Mont., told Wilkie at a Senate Veterans’ Affairs Committee hearing on Tuesday. “Everything that I'm hearing and everything I'm seeing says something different.”

This week, 55 lawmakers (no Republicans) sent a seven-page letter to VA officials detailing concerns over how the new rules were crafted and their potential impact.

“We are very concerned that his proposal will ultimately degrade the Veterans Health Administration for those Veterans who prefer and rely on its health care services to lead more meaningful, healthy lives,” they wrote. “We fear this proposed rule will be the first step towards dismantling the system.”

Wilkie has pushed back on that criticism, noting that the president’s VA budget proposal calls for another big jump in spending next year. “It’s not borne out by our budget.”

Veterans groups have expressed concerns about the specifics, as well, and urged VA officials not to move ahead too quickly with the changes.

Officials from the Veterans of Foreign Wars said the department still needs to refine its standards for outside care quality and communicating advantages of VA care to Veterans. Disabled American Veterans this week called for “withdrawing the current proposed rule and swiftly replacing it with a new proposed regulation based on more realistic, feasible and sustainable access and quality standards.”

In addition, Sen. Tammy Duckworth, D-Ill., and a combat-wounded Iraq war Veteran, asked the VA inspector general this week to look into whether administration allies manipulated the public comment process of the new rulemaking, further complicating the process.

Duckworth said Veterans advocates found “an unusually high volume of identical public comments” designed to create a false sense of public support for the controversial rule changes.

“If automated entities are spamming the public comment process, this not only wastes taxpayer dollars in the form of hours spent sifting through bot-generated messages, but it also threatens to drown out the voices of real Veterans, Veterans service organizations and other advocates,” she wrote.

Even with those concerns, it’s unclear whether those opponents have leverage to stop the new rules.

Both the House and Senate Veterans’ Affairs Committees have hearings scheduled early next month to review the issue, but under current law the new regulations are mandated to be in place in June. Republican lawmakers have offered questions and potential improvements, but thus far have appeared uninterested in wholesale delays to the process.

“From some comments from some of my colleagues, it's almost like we're giving some of our Veterans too much choice,” Sen. Thom Tillis, R-N.C., said in response to Democratic concerns about the Mission Act changes.

ilkie said failing to move ahead with the new rules “would no longer be a Veteran-centric, patient-centric approach to health care.” He said he’ll work in coming weeks to explain more specifics of the changes, but isn’t looking for any reason to slow them down.


The VA is ‘close’ to piloting tele-hearing capability

Tele Hearing


If the Department of Veterans Affairs can provide Veterans with doctor’s visits virtually through its popular telehealth system, can the Board of Veterans Appeals hold benefits appeals hearings in the same manner?

The answer, the board believes, is yes. And it is currently “close” to piloting a tele-hearing capability, Chairman of the Board Cheryl Mason told FedScoop in a recent interview.

“We’re working closely with IT, and others in the department, to use the telehealth foundation to do tele-hearings, which will be much like the telehealth process,” she said. The similarity between the two goes to their technological roots — the emergent tele-hearing platform, which has apparently been under development for the past few months, is built on “almost the same” foundation as the telehealth system, Mason said.

The board currently hears a lot of its cases through a video teleconferencing system. Per a BVA report to Congress, a full 71 percent of the over 16,000 hearings held in 2018 were done via video. But this system has some limitations — the Veterans law judge who presides over a given hearing must do so from inside the BVA building in Washington D.C., and the Veteran must travel to a VA regional office or local Veterans Health Administration facility to join the video conference. The Veteran’s representative must be with the Veteran in person, or at a similar facility.

Once the new tele-hearing system launches, Veterans will be able to enter a “virtual hearing room” from a computer at home and meet with both their representative and the judge in that virtual environment.

This capability will present benefits to both the board and the Veteran. From the Veteran’s perspective, Mason said, it “opens up opportunities” and is more “convenient” than traveling to a regional office, especially in rural areas where the regional office may be quite far away.

And on the board’s side, tele-hearings could mean fewer days “lost” when inclement weather strikes the D.C. area. Things like snow days, Mason said, are “very frustrating for our Veterans because they’re like, ‘it’s sunny and clear here in Arizona.'” But now, judges, like Veterans, will be able to conduct hearings anywhere with internet connectivity, precluding disruptions like a snow closure.

Mason said that some of the board’s roughly 80 Veterans law judges are cleared for telework — once the tele-hearing platform is up and running these judges will be able to hold their hearings as scheduled, even on days when the BVA building is closed.

“It’s a modernization opportunity to provide service to our Veterans where they are,” she added.

The coming tele-hearing capability isn’t BVA’s only recent modernization — the agency implemented a new appeals case management system in February. Caseflow, as the system is known, will replace the legacy Veterans Appeals Control and Location System (VACOLS), which was created in 1979 and currently being phased out. Mason described the upgrade as “much needed.”

FedScoop reached out to the VA for further information from the IT office on how the tele-hearing platform is being developed. A spokesperson said the agency has “nothing else to offer at this time.”


Veterans harmed at VA nursing homes in 25 states, inspections find

Harmed at VA nursing homes


At the Veterans Affairs nursing home in Brockton, Massachusetts, a severely impaired Veteran with dementia sat trapped in his wheelchair for hours, his right foot stuck between the foot rests. Inspectors watched as staff walked past the struggling man without helping.

Veterans moaned in pain without adequate medication at VA nursing homes in Dayton, Ohio, and Augusta, Maine. A unit at the VA nursing home in Lyons, New Jersey, had no functional call system for residents to summon caregivers.

Nine months after USA TODAY and The Boston Globe reported Veterans received substandard care at many Department of Veterans Affairs nursing homes, newly released inspection reports paint a discouraging picture of the care that Veterans have received.

From April through December 2018, inspectors from a private contractor cited 52 out of 99 VA nursing homes for deficiencies that caused “actual harm” to Veterans. In three facilities, they found Veterans’ health and safety in “immediate jeopardy,” and in eight, inspectors found both Veteran "harm" and "jeopardy."

The facilities cited for shortfalls that caused harm are in 25 states, the District of Columbia and Puerto Rico. Harm and jeopardy are standard categories of severity in the industry, but non-VA nursing homes are rarely cited for them.

“That is really bad. It’s really bad,” said Richard Mollot, executive director of the Long Term Care Community Coalition, a New York City-based nonprofit advocate of nursing home care improvement.

“It should be very rare when there is harm (or) when someone is ... in immediate jeopardy,” he said in an interview, adding it’s difficult to compare VA findings with inspections of non-VA nursing homes because those inspections may not be as rigorous.

Inspectors found that staff at more than two dozen VA nursing homes failed to take steps to ensure bedsores healed or new ones didn’t develop. They can occur when frail people are left in the same position for too long. In Cincinnati, one resident had five bedsores in six months, yet when inspectors visited, they found no one moved the man or put cushions under him for hours.

“It’s heartbreaking, and you think these are our Vets, how can we not be taking care of them?” Mollot said.

Bedsores are “almost always preventable and quickly treatable,” he said. “So there’s just no excuse.”

In a statement issued with the inspection reports this month, VA officials said residents in their nursing homes are more difficult to care for than residents in private facilities. They said 42 percent of residents last year had conditions related to military service that have left them 50 percent or more disabled.

“Overall, VA’s nursing home system compares closely with private-sector nursing homes, though the department on average cares for sicker and more complex patients in its nursing homes than do private facilities,” VA Secretary Robert Wilkie said.

VA spokesman Curt Cashour said Wednesday that non-VA nursing homes also have problems. He said that by posting the VA reports for the first time, "we hope to drive improvements throughout the system."

The inspection results – made public nearly a year after USA TODAY and the Globe disclosed the existence of the reports – reveal for the first time the deficiencies identified during surprise visits by the outside inspectors.

Data reveal: VA homes have more residents with bedsores, pain, than private facilities

Inspections can provide Veterans and their families important background information on the homes. More than 40,000 elderly and infirm Veterans stay in the agency's nursing homes each year.

Widespread deficiencies

Many VA nursing homes failed in one of the most fundamental responsibilities – taking steps to prevent and control infection.

At two out of three VA nursing homes, inspectors found the staffs often didn’t follow simple protocols, such as wearing sterile gowns and gloves when treating residents.

In Des Moines, Iowa, they found managers didn’t make sure staff adequately cleaned a Veteran, who contracted six urinary tract infections in seven months – the last three from E. coli bacteria.

Residents weren’t properly monitored or were exposed to hazardous conditions at more than 50 VA nursing homes, inspectors concluded.

Water used for washing hands and bathing was so dangerously hot at nursing homes in Carrollton, Georgia; Martinsburg, West Virginia; and St Cloud, Minnesota, that it could scald residents, particularly those with dementia or other conditions that make them less sensitive to pain or heat.

Temperatures at the facilities – up to 128 degrees in two cases – were intended to kill Legionella bacteria but were too high to be safe, inspectors said.

In Bedford, Massachusetts, inspectors concluded Veterans were in “immediate jeopardy” because a resident with dementia who was physically unable to hold, light or extinguish a cigarette was allowed to go outside to smoke by himself.

And it wasn’t the first time – he previously had returned with burn holes in his clothing and on the seat cushion of his wheelchair.

In Chillicothe, Ohio, the VA allowed a family to hire a private aide to take care of a resident and didn't provide adequate supervision. Inspectors said the aide nearly allowed the man with Parkinson's disease to fall. The aide was lying on the man's bed looking at a cellphone as the man leaned dangerously forward. He had fallen four times in less than two months, once sustaining a head injury that the aide said required stitches.

The same aide was supposed to feed the man a semi-liquid diet because he had trouble swallowing, but the aide often fed him fast food. In one instance, the Veteran was found eating Styrofoam from fast-food packaging.

When confronted by inspectors, facility management agreed to immediately stop allowing untrained aides to feed residents.

Inspectors cited a handful of VA nursing homes, including in Washington, for failing to meet standards of care in as many as 10 key categories, such as treating residents with dignity.

The VA nursing home in Jackson, Mississippi, performed the worst of all the facilities on that count, with failures cited in 12 areas. Residents suffered in serious pain. A Veteran didn’t have a bowel movement for days, but staff didn’t tell doctors until his temperature spiked to more than 100 degrees. Veterans languished without staff-assisted exercise to help them gain or maintain muscle tone.

In just seven cases, VA nursing homes passed inspections with no identified problems. Those facilities are in Topeka and Wichita, Kansas; Orlando; Houston; Miles City, Montana; Fargo, North Dakota; and New Orleans.

Uneven record on transparency

When Veterans need nursing home care, the VA can place them in agency nursing homes or in other facilities at VA expense.

Taxpayers pay $1,125 each night to house a Veteran in VA nursing homes. That's far higher than the average $296 each night in private facilities or $174 in state-run nursing homes where the VA pays a portion of the cost, according to agency budget documents.

VA officials said the rates are not directly comparable because VA nursing home costs include hospital care and "more expensive medical services that just aren't available in most non-VA facilities."

The agency told the Government Accountability Office in 2013 that about 40 percent of VA nursing home costs account for "core" services and would be comparable. At that percentage, the current VA core cost would be $450 a night, still 52 percent more than the agency's cost for private placement.

Despite the sizable public spending on VA nursing homes – more than $3.6 billion in 2018 – the agency until recently had kept the findings of inspections of its nursing homes confidential.

USA TODAY and the Globe revealed in June that the VA had long tracked the quality of care at its nursing homes through inspections as well as quality indicators and star ratings.

Under pressure from the news outlets, the VA pledged to release the inspection reports. That did not happen until this month, when the agency posted the reports for 99 of its nursing homes on its website. The VA said it planned to post the remaining 35 reports by October.

USA TODAY and the Globe obtained previously confidential quality data and reported in June that more than 100 VA nursing homes scored worse than other nursing homes in 2017 on a majority of key quality indicators. At more than two-thirds of VA nursing homes, residents were more likely to have serious bedsores, as well as suffer serious pain.

VA nursing homes: Secret ratings hide poor quality care from the public

The newly released inspection results add depth to those findings and chronicle cases in which individual Veterans suffered from poor care.

'The resident moaned throughout’

One severely impaired Veteran with Parkinson’s disease went without adequate pain medication day after day at the VA nursing home in Augusta, Maine, as nursing staff treated a sore at the base of his spine that had penetrated to the bone.

“The resident moaned throughout the wound care and the moaning increased during wound cleansing and measuring,” noted an inspector who witnessed the episodes in July.

Inspectors cited the Augusta facility and 28 other VA nursing homes for failing to ensure Veterans didn’t suffer from serious pain.

The issue has been a long-standing problem at VA nursing homes – flagged more than seven years ago by the GAO, which found a high percentage of Veterans were in pain.

Specialists said caregivers should assess and adjust medications or try other methods to make sure residents get relief.

“There’s very little quality of life”when you're in constant pain, said Robyn Grant, director of public policy and advocacy at the National Consumer Voice for Quality Long-Term Care. “Veterans have gone through so much, the last thing that they should be facing is relentless pain, especially if it could be mitigated.”


VA partners with Objective Zero Foundation

DVA Logo 33


The U.S. Department of Veterans Affairs (VA) recently partnered with the nonprofit Objective Zero Foundation to aid in connecting Veterans with suicide prevention support and resources.

The partnership, formalized on Dec. 3, 2018 provides a shared goal of preventing suicide among service members and Veterans, with a special focus on service members transitioning out of the military.

Objective Zero offers a free mobile app that instantly and anonymously connects Veterans, service members, their families and caregivers to suicide prevention resources and a nationwide community of peer supporters via text, voice, and video chat. The foundation, enhances social connectedness among Veterans and improves access to mental health and wellness resources.

“At VA, we are working to prevent Veteran suicide by using an approach that looks beyond our traditional health care settings,” said VA Secretary Robert Wilkie. “Our partnership with Objective Zero is an integral part of reaching Veterans where they live, work and thrive, and we are looking forward to working more closely with them.”

Objective Zero Co-founder and Executive Director Betsey Mercado said her foundation was proud to partner with VA to improve the well-being and mental health of Veterans.

“Joining efforts with this community provides better access to resources and highly needed support for the men and women that have served and sacrificed so much for our country,” Mercado said.

VA has a suite of mobile mental health apps that offer information about mental health issues, tools to help develop and practice coping skills, and assessments that allow users to track progress over time. Learn more at The Objective Zero app can be downloaded at

Veterans who are in crisis or having thoughts of suicide, and those who know a Veteran in crisis, can call the Veterans Crisis Line for confidential support 24 hours a day, seven days a week, 365 days a year. Call 800-273-8255 and press 1, send a text message to 838255 or chat online at


New study finds rising VA employee engagement key to increased success at nearly 150 medical centers

DVA Logo 32


The U.S. Department of Veterans Affairs’ (VA) received high marks from an independent March 25 study showing a significant relationship between employee engagement and work performance by VA medical center staff.

The rankings reveal engaged employees perform better, resulting in higher patient satisfaction and increased retention of nurses and mission-critical staff.

The Partnership for Public Service and the Boston Consulting Group analyzed nearly 150 medical centers along with data from the 2016, 2017 and 2018 “Best Places to Work in the Federal Government” engagement scores and Veterans Health Administration’s Strategic Analytics for Improvement and Learning (SAIL) scorecards.

“These findings are representative of our commitment to creating positive work environments for employees, which I believe develops a more holistic experience for our Veterans,” said VA Secretary Robert Wilkie. “I am extremely pleased with our medical center leadership teams as they are integral to our continued mission of improving and transforming VA health care.”

The findings also highlight the successful implementation of employee engagement strategies at the James E. Van Zandt VA Medical Center and the St. Louis Health Care System, which lead to lower staff turnover and higher performance. Examples of employee engagement strategies may include expanding existing training opportunities and recognizing and rewarding staff members.

This continued progress represents another reason Veterans Choose VA for their health care, following a recent Dartmouth study that found VA medical centers ‘outperform private hospitals in most health care markets throughout the country,’ and the Partnership for Public Service ranking VA as one of the top 6 Best Places to Work in the federal government.

These independent analyses further underscore VA’s efforts transform the nation’s largest integrated health care system into a high reliability organization (HRO). VA recently selected 18 medical centers that will lead the way. Lessons learned from these 18 sites will guide a more impactful rollout across every Veterans Health Administration medical facility in 2020.

To learn more about the March 2019 Partnership for Public Service and the Boston Consulting Group study visit


Lack of leadership to blame for the VA's botched 'Forever GI Bill' rollout, report says

Botched GI Bill


The U.S. Department of Veterans Affairs failed to modify its electronic systems and lacked an accountable official to oversee implementation of the "Forever GI Bill," resulting in a bungled rollout last year that affected thousands of college students, a new report from the agency's Inspector General says.

The Forever GI Bill, officially called the Harry W. Colmery Veterans Educational Assistance Act of 2017, was approved unanimously in both chambers of Congress and signed into law by President Donald Trump in the summer of 2017.

The law changed how education benefits are to be applied for Veterans, revising the formula that determines students' stipend amounts and removing a 15-year expiration date included in the previous version of the law.

However, beginning in August, the VA's system could not handle the intricacies of those changes across more than 400,000 claims, the report said. The result was that some students were underpaid and, in some cases, not paid at all.

In November, the VA decided to delay full implementation until Dec. 1, 2019.

According to the Inspector General's report, the VA's failure to appoint an accountable official to lead implementation of the program resulted in "unclear communication of implementation progress and inadequately defined expectations, roles and responsibilities of the various VA business lines and contractors involved."

Additionally, investigators found that the VA's Office of Information and Technology and the Veterans Benefits Administration Education Service did not agree on how to solve problems once they arose.

Investigators found a 10-month gap from the time the Forever GI Bill became law and when the VA received the computer software to implement it. During those months, the VA worked with contractor Booz Allen Hamilton to develop the program.

But without a single accountable manager in charge, people involved were unclear about their roles, the report said.

In November, the VA Secretary Robert Wilkie gave Paul Lawrence, the VA benefits undersecretary, the task of implementing the Forever GI Bill. Members of Congress, unhappy with how Wilkie was handling the issues, called on the Inspector General to dig into what was happening at the agency.

In January, the Forever GI Bill Housing Payment Fulfillment Act was signed by Trump, codifying into law that the agency would repay students who were affected by the troubles.

In February, Wilkie appeared before the House Committee on Veterans Affairs and talked about a new timeline for the Forever GI BIll.

"My first full day in office was Aug. 1 of last year, and it was clear to me we were reinforcing a broken system," Wilkie said. "I expect everything to be on schedule and back to the norms set by the GI Bill either at the end of this year or at the beginning of next year."

Derek Abbey, the director of the Joan and Art Barron Veterans Center at San Diego State, said the majority of the university's roughly 1500 GI Bill recipients were not affected by the VA's trouble with the new version of the law. For those who were, he said, the Veterans Center tried to minimize the impact.

The university didn't charge late fees, Abbey said, adding that his office ensures paperwork is submitted to the VA in a "timely fashion."

Rep. Mike Levin, D-San Juan Capistrano, who serves on the House Veterans Affairs Committee and whose district includes Marine Corps Base Camp Pendleton, said in a statement he was closely monitoring the VA's efforts to fix its problems.

"I am deeply concerned about any undue financial burden placed on our Veterans by these missed and underpaid housing stipends," Levin said.

The IG's office said it would continue to monitor VA's progress in implementing the law.


VA MISSION Act: What is the latest on community care?

VA Mission Act


How VA is transforming Veteran community care under the VA MISSION Act of 2018 and what to expect.

Last June, President Trump signed landmark legislation, known as the VA MISSION Act of 2018, that makes dramatic improvements to how Veterans receive community care—health care provided outside of VA. VA’s goal is to give Veterans greater choice over their health care, allowing VA to deliver world-class, seamless customer service either through a VA facility or community provider.

While the law affects many other VA programs, the changes to community care are among the most complex and far-reaching in recent history. After the legislation was enacted, VA immediately began taking the steps needed to implement the vast changes required.

Current Activities

Understanding the enormous scale of VA health care operations and VA’s responsibility for America’s Veterans, VA has been working hard on many large, interrelated tasks to implement the new Veteran community care program by June 2019. These tasks include the following:

  • Design and launch a new internal operating structure for community care, including the new urgent care/walk-in care benefit
  • Propose access standards as one of the six eligibility criteria for community care
  • VA’s proposed rules for the new Veterans community care program, including access standards, are currently open for public comment until March 25, 2019
  • Award contracts to Third Party Administrators (TPAs) to manage regions of VA’s new Community Care Network (CCN)
  • Plan to implement Veterans Care Agreements to allow VA to purchase hospital care, medical services, or extended care services in certain situations
  • Define competency standards for certain conditions applicable to community providers to make sure Veterans are getting high-quality care when they receive care outside of VA
  • Set up new requirements for prompt payments to community providers
  • Draft regulations to implement the law

What to Expect

So what can Veterans expect when the new program starts this summer? Given the magnitude of the changes, VA is working hard to make sure the rollout goes smoothly. If you are a Veteran enrolled in VA health care, or a Veteran who can receive care without needing to enroll, you can expect:

  • To continue to have access to community care under current programs and then transition to the new program when regulations are final and published
  • To follow an improved process to receive community care under the new program, with better access to community providers and improvements to customer service, such as more streamlined eligibility requirements
  • A new benefit that provides eligible Veterans with access to urgent, non-emergency care for non-life-threatening conditions in VA’s network of community providers
  • Improved care coordination as VA transitions to a single information technology system that better links together VA and community providers
  • Your provider to receive timely payments for bills as VA transitions to better claims processing systems

Going Forward

VA will be providing regular updates on community care as part of this series of articles. Community care will continue to supplement VA health care as part of VA’s broad commitment to modernize and strengthen the VA health care system, expand access, and ensure timely delivery of care to America’s Veterans. VA health care regularly outperforms the private sector, and VA staff are experienced and devoted to meeting Veterans’ specific needs. VA believes Veterans will continue to choose VA when they need timely, high-quality care.


  • Fact Sheet – Veteran Community Care – General Information (VA MISSION Act of 2018)
  • VA’s proposed rules for Veteran community care now open for public comment


Should Veterans have to pay for VA’s benefits errors?

VAs Benefits Errors


A group of Senate lawmakers is again arguing that if Veterans are overpaid on benefits because of accounting errors, they shouldn’t be punished for the federal government’s mistakes.

Legislation introduced Wednesday would require changes to how the Department of Veterans Affairs handles benefit corrections, including limiting the amount they can withhold from Veterans’ future payouts to cover the debt.

“It’s wrong to put the debt from the VA’s accounting mistakes on the shoulders of men and women who have served their country,” Sen. Jon Tester, ranking member of the Senate Veterans’ Affairs Committee, said in a statement. “For some Veterans, these benefits make the difference between paying monthly rent or missing payments.

“We’ve got to stop the VA from pulling the rug out from under Veterans and their families.”

Under current law, VA officials can withhold 100 percent of a Veteran’s monthly benefits to cover past overpayments, even if those mistakes are the fault of federal officials.

The new legislation would limit that withholding to no more than 25 percent of a monthly benefits check and put a five-year limit on the time where VA officials can recover overpayments. The measure would not wipe out all debts related to VA mistakes.

The senators said up to 200,000 overpayment notifications are sent out to Veterans and their families each year.

Bill co-sponsor Sen. John Boozman, R-Ark., called the moves a common-sense step in providing better customer service to Veterans.

“Supporting Veterans and their families by eliminating the potential for hardships caused by the VA’s errors is important to honoring our commitment to their service and sacrifice,” he said in a statement.

Lawmakers proposed similar reforms last session but saw only parts of that legislation become law. Those changes included rewriting VA policy to allow Veterans to update personal information in department systems, in an effort to cut down on potential mistakes in benefits payouts.

This measure goes further, requiring VA to update its computer systems to ease that process and mandating electronic notification of debt notices, including information on how to request hardship waivers.

The legislation, called the Veterans Debt Fairness Act, has not yet been scheduled for a committee hearing.


VA Receives $25 Million Donation to Provide Genetic Testing for Veterans

25 Million Donation


A billionaire philanthropist has donated $25 million to the Department of Veterans Affairs to provide genetic tests for Veterans to help tailor their medical treatments and medications.

The VA and Denny Sanford, a South Dakota banker and Air Force Reserve Veteran, announced the gift March 12. The money is expected to help up to 250,000 Veterans through 2022, starting with those who have received a cancer diagnosis.

According to Sanford Health, the hospital system named for Sanford after he donated $400 million in 2007, the gift will fund the testing program, called Pharmacogenomics Action for Cancer Survivorship, or PHASeR. It aims to use a Veteran's DNA to determine personalized treatment and reduce costly adverse drug reactions.

During the announcement of the donation at the National Press Club in Washington, D.C., VA Secretary Robert Wilkie said the gift will help shape future treatment for all Veterans who receive care at VA.

"The pharmacogenetic testing that we are going to be using as a result of Mr. Sanford's generosity is critical for our nation's Veterans," Wilkie said. "We are all committed to active engagement with medicine and science ... to bring our Veterans the very best care."

Dr. Deepak Voora, with the Duke University School of Medicine's Center for Applied Genomics and Precision Medicine, will oversee the program; a pilot is expected to launch at the Durham, N.C. VA Health System later this year.

"As a physician, it's hard to predict exactly how a patient will respond to a medicine," Voora said at the announcement event. "But this pharmacogenetic testing program can change that by indicating how patients might respond to medications before they even take them."

He added that specialized pharmacogenetic testing largely has been out of reach for VA patients due to cost.

The program is expected to be available at 125 sites by 2022. Test will be taken at local VA facilities and processed at a Sanford Health facility in South Dakota. The tests will examine genetic markers to determine how patients tolerate and metabolize different types of drugs, including antidepressants, blood thinners and pain medications.

Sanford Health plans to supplement Sanford's gift with a matching fundraising effort.

"We recognize that our patients who are Veterans are coming to us with something special on their mind and in their experiences," Sanford Health CEO Kelby Krabbenhoft said. "This is a natural way for all of us at Sanford Health to give back."

Denny Sanford, 83, made his fortune, estimated by Forbes to be at $2.2 billion, in banking and credit card companies. He said on Fox News Sunday on March 17 that he plans to die broke, having given away his fortune. To date, he has donated $1.6 billion to causes that include health care research and services, neglected children, the University of Minnesota, education, the San Diego Children's Zoo, stem cell and breast cancer research.

"It's a joy to help other people," he told Chris Wallace. "I will die broke. Everything is committed to different organizations."


VA releases health care inspection reports and staffing data for more than 100 Community Living Centers

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Today, the U.S. Department of Veterans Affairs (VA) began publicly posting, for the first time, health care inspection reports and staffing data for its nursing home system.

To date, VA has posted 101 health inspection reports of its 134 Community Living Centers (CLCs) with the remainder scheduled to be posted by October 2019.

The health care inspection reports, which cover April 2018 to present, are available here. In the future, VA will post the reports annually.

The health care inspection reports show that, in comparison with non-VA facilities rated by the Centers for Medicare and Medicaid Services (CMS), VA has a lower number of low-performing facilities (VA: 17.2 percent, non-VA: 19.7 percent) and a higher number of higher-performing facilities (VA: 17.2 percent, non-VA: 10.8 percent).

“Overall, VA’s nursing home system compares closely with private sector nursing homes, though the department on average cares for sicker and more complex patients in its nursing homes than do private facilities,” said VA Secretary Robert Wilkie.

Many VA nursing home residents are being treated for conditions such as prostate obstruction, spinal cord injury, mental illness, homelessness, post-traumatic stress disorder, combat injury, terminal illness and other conditions rarely seen in private nursing homes. In fact, 42 percent of 41,076 VA CLC residents in fiscal 2018 had a service-connected disability rating of 50 percent or higher.

When comparing VA CLCs with private sector nursing homes, the VA CLCs care for more complex Veterans with Veteran-specific conditions such as post-traumatic stress disorder (11.6 percent vs. 0.5 percent) and traumatic brain injury (1.7 percent vs. 0.8 percent) in addition to the VA CLCs providing more hospice-related care to include hospice care (10.3 percent vs. 3.7 percent), chemotherapy (1.2 percent vs. 0.4 percent) and radiation therapy (1.4 percent vs. 0.1 percent).

Further, the overall star rating for VA’s nursing homes compared with the 15,487 private sector nursing homes rated by the CMS shows that VA has a significantly lower percentage of one-star, or lowest rated, facilities than the rest of the nation. VA’s latest ratings show that only eight, roughly 6 percent, of VA’s nursing homes received an overall one-star rating.

For more information about VA nursing homes, see here and here. About the reports

The inspection reports are based on yearly, unannounced inspections conducted by an outside contracted agency. As part of the reports, survey teams look at many aspects of life at VA nursing homes, including:

  • The care of residents and the processes used to give that care.
  • How the staff and residents interact.
  • The nursing home environment.

Surveyors also review residents’ clinical records, interview residents and family members, as well as caregivers and administrative staff.


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