Im getting over it. Administration needs no introduction, so mine will be brief. In addition to Vital Services they mean something deeply special to our veterans. It is the fulfillment of a sacred promise our country made to them. To protect and defend the country and the time of need some of the folks return relatively unscathed from their service. Others carry physical and psychic wounds which will flag them for the rest of their lives. Now they are in need they need vocational rehabilitation, Education Assistance home loans, and even burial rights. How they provide the services for them the country is holding its end of the contracted made. That contract it made. The contract it made. To thank you and acknowledge the norms response ability you have undertaken to employeese 377,000 are providing the services that are 18. 5 million veterans expect believe they have earned, they have earned, and believe they deserve. Fiscal year 18 is described as a year of transition for the department of Veterans Affairs. We drafted a new Strategic Plan that reimagines our relationship with veterans and how we serve them. The metrics we track on this and the targets we strive to achieve will that statement leaves much to the imagination. My minnesota Veterans Organization leaders what i should ask the secretary, my number one responses are you going to privatize the v. A. Echo so i hope you will use this opportunity to provide a clear picture to what the v. A. Will transition into. The daytoday interface each veteran will have their organization and how it will improve the quality of services they will receive. Welcome to everyone. We appreciate you joining us here for this very important discussion about veterans in america and how we can better serve and make sure they get the care and services they deserve. Men and women who serve in the military put their lives on the line, they give up their holidays, birthdays, anniversaries, amidst all kinds of important events in their lives. Every time they put on that uniform and going to harms way, they put their lives at stake. Them as a nation, we owe them as governors and citizens of our state to take care of our veterans when they are finished with their service to our nation. Now their service doesnt just stop and their harms way doesnt just stop, once the person leaves the battlefield. It also carries on when they are home. Times the different issues that are veterans face, that they need our help with, we are looking forward to hearing the secretary and his discussion about the administrations plans and certainly his plans about how we can better care of our veterans and service their needs. We look for to hearing your comments about how we can improve the delivery of health that the delivery of cost affects our states and our nations, how we can improve our infrastructure with our Veterans Homes and the quality of care they receive. We are certainly facing problems of homelessness among our veterans and suicide prevention, which we cared deeply about. Education and training is also important to our veterans to be a will to work and to find a job to support themselves and their families. And of course getting through the system and being able to way through all the paperwork and all the different agencies that deal with. It certainly critical to the care and treatment and issues they may need some extra help with. We cant forget the families of military spouses. Being able to find the right types of jobs and getting the licenses they need. I have a opportunity to talk with the secretary a few months ago about these subsidy issues. We just finished a panel about prescription drugs and Substance Abuse. Im very encouraged they are focused on Substance Abuse and veterans courts and how we can help keep our veterans out of the criminal Justice System by being able to diverge them away from Substance Abuse and treatment, or some issues they may have. I know our governors are willing and excited to be able to engage with you and to work with you. Give them the type of respect and care they deserve in the service to our nation. We appreciate you taking the time away from your busy schedule. And we welcome you to the National Governors association. Please welcome secretary dr. David lton good afternoon everybody, thank you for those comments. I appreciate it and i want to have a chance to update you as both our governors said, we are going to have a chance to hear from you and some questions and some interaction, which i really look forward to. Just this past month i had a chance to meet with the directors of your state homes. To have a chance to me with your state directors of veteran affairs. The more interaction i can hear and we have a chance to share what is happening in your state and how we can better support you, its really important. I was like to start with why we do this, its really our mission as you remember from history, right before the second inaugural address president lincoln gave the country this mission, that is really our responsibility to care for him or her who has borne the battle and be able to be there for them when they come home to their families. This past year we have had some important accomplishments 11 bills that passed through congress that the president has signed are all done in a bipartisan way we have the best committees in congress because they work on the issues, they dont let politics get in the way. We found some pretty important things for veterans. We have a new Family Caregiver advisory group. We launched the tidy 47 veterans hotline that goes into the white important gets the information directly to get the support of the white house. We have expanded our g. I. Bill now to provide more education benefits happening in your states. Law toged the appeals modernize it. Last time it was update it was 1933. And we are making important progress that im talking about. We are continue to get our Choice Program working better. Already we have extended and expanded the amount of support to get veterans in our community. Ive expanded Mental Health care to an those that are honorably discharged. Service leavehe with others and Honorable Discharge and they dont have access to Mental Health care. The president just signed an executive order that 100 of servicemembers who leave will have Mental Health coverage for 12 months at a time. Only 40 have access to v. A. Health services. Thats going to be 100 . And we just released a national id card for veterans. We are here to talk about how we can Work Together better and that so important to be a better partner to you. We understand your role in caring for veterans is essential. 50 of all veterans across the nation are in your facilities in longterm care. We also know we can work with you using Technology Like telehealth to reach into those facilities and we are beginning to do that. We want to expand that to give all of you that care. Homes are working with the government in important areas to improve safety like false initiatives that Falls Initiative to prevent falls. Some states, and i cant name them all, we are putting a clinic right on the state Veterans Home ground so we can provide Mental Health services. And this type of Partnership Works really well. Texas and california, but many others working with us to get that backlog now. About our workw with you in the veteran cemetery programs. Every single state in the country has a v. A. Cemetery. States therefore states that have five veterans cemeteries. We have six more currently under construction throughout the country and to states this year open up cemeteries. Mississippi if you provide us the land we will be able to provide support to develop it and work with you. You can see where your state is. Very Successful Program in collaboration we have with you. We are looking to end veteran homelessness. Nationally we have had close to a 50 of reduction in the number of Homeless Veterans over the last five years. Still he had 45,000 veterans in this country. We know the only way we can tackle this is working closely to local communities and states to Work Together in a collaborative way. We are putting more money into this project we are refocusing our efforts on what we know works and what we know doesnt dont need to tell you that our veterans are getting older. The population is getting older. That means its pretty predictable. Weve modeled this out that the growth and longterm care and working with you in the states is one to be even higher in the next tech to come, so we have to do this next decade to come. So we have to do this in a smarter way. I want to briefly touch on these so you know we are focused on these efforts and it is hitting on things that you think are important to you. We may need to make some adjustments. Prioritiesf the five is to get our veterans greater choice. And that means we believe they should be involved in where they get their care decisions on how they get their care and how they get their services. And we are trying to change our current systems from being very rulesbased and administratively based. You need to be 30 miles away or need 30 days before getting access to the ability to get to more clinically driven system. Where we focus on what is the right thing to do for our patients and veterans. So we are working with congress right now we work with members of congress in a bipartisan way to give them greater choice. The second of the five parties is to modernize our system. I was talking with the governor and she said our facilities are pretty old. More than 50 of our facilities are 60 years old or more. One of the decisions i recently made was to scrap our old Home Grown Health record and select a modern offtheshelf electronic record. It happens to be the same one the department of defense uses. We have spent over 1 billion getting to systems to talk. Thats an example of what we are doing, we are trying to modernize our facilities, trying to do something in tulsa like this. This is a facility in palo alto. Pleasant, we want this for all of our facilities and for the first time in over three Years Congress works with us to get 28 new leases in our communities, we are looking at business differently by working with the private sector to build , not have federal construction be the only way of building new facilities. We think we can do it faster and cheaper by working with the private sector. No sense paying for maintenance of the vacant building so i announced i have 1100 or 1200 vacant buildings. We are going to continue to do that the infrastructure built wall doesnt have money for v. A. , it allows us to take the proceeds from what we get rid of and reinvested in your facility that we know veterans need. The third of the fifth priorities is to improve the timeline of our services. 90 are all completed within 30 days 86 within seven days. 20 are done on a same day basis. We have established same day services for primary and Mental Health and every one of our medical facilities now. ,f you have an urgent issue Sameday Services are available. We are also the only Health System in the country and no ones proven me wrong yet if you go to our website you can see the wait time in your facilities and your states updated every two weeks in real time so you can see what the wait times are, whether its good, bad, needs a lot of work to develop, we are sharing information to give them choices about their decision, and so we can focus on improvements. We do know that while v. A. Still has access problems in particular locations, overall wait times are much shorter than the private sector area im sure you get calls saying a friend and family is sick, can you help them get an appointment at a place. We know that is a challenge in the private sector but wait times tend to be up to 40 better than in many parts of the country that struggle with shortages of primary care. We are also doubling down on technology. Nobody is doing more in this country than the v. A. 730,000 vector veterans in their care. Im talking to one of my patients there on the screen. Yet using been there our federal supremacy licensing we are able to use v. A. Physicians from new york city and chicago to any part of the country that doesnt have access to super specialists or some primary care doctor. We are using this to be able to address the wait time at access this issue. The fourth of the priorities is to make sure we focus on the thing that is most important for veterans. The v. A. S they need not only to be good at that world class act. Blind rehabilitation. Spinal cord injury. Environmental hazards. We are focusing our resources to make sure that is what we are good at. If you go to our website you can see where the v. A. Is on standardize quality measures and compare it to your local community to see if we really are better. And thats where we need to focus our efforts. This is to make sure every veteran has the opportunity to stay in their home as long as they want to. Using technology, using homebased services, using caregivers, the v. A. Supports caregivers. We want to expand our support for that. The home is in an environment where many people want to remain. We are doing things like focusing on our resource focusing our resources to things that matter like that matter to veterans. About 18 months ago there were close to 160,000 veterans with hepatitis c. Atare are soon going to be 20,000 or less. We are going to be the first system in the country that has targeted this disease and going to eliminated from the entire population of veterans. You focus your resources, to make sure we are doing right things by veterans. We are again the only system in iountry who publishes want you guys to get your hospitals and your doctor groups to publish your prescribing rates. You can click on any one of your sites and you can see the opioid prescription rates. I know who the highest in the country is, i know who the lowest in the country is. You should know where youre v. A. Hospitals are and other facilities, because this is important that we get this right for veterans but also for all americans. The fifth and final priority is to prevent suicide. 20 veterans a day take their life through suicide. A number that is unacceptable to you, unacceptable to me. If veterans get their care in the v. A. System, it saves lives. Take a look at the bottom line, female veterans. If you are a female veteran getting care in the v. A. System your rate of suicide went down by 2. 6 . If you are not getting care in the v. A. But out in the community, maybe not getting care at all, your rates went up 81. 6 . We can save lives by working together to get people to help they need. People are dying every day. If this for cancer and we knew there was a treatment that would help them save a help them stay alive we would be doing that. We have a campaign called be there for veterans. Tom hanks is our national spokesperson. We are working with local communities to prevent suicide. Im starting to permit test starting to present im starting to present the president s budget to congress. 198 billion. Is investing in both improving the infrastructure of the v. A. But giving veterans greater choice in the community. I think it is that balance that is going to be meaningful to veterans. Since we dont have a stock price as a company i cannot track that the way the Corporate Organization would. Our stock price is the trust that veterans have in the v. A. It was a low of 46 . It showing we are moving in the right direction like posting our accountability actions, talking about the problems that are significant and real, that we have to work on together, thats a formula for regaining some of that trust. I should mention your feedback to me really does matter. Governor scott came to me that a year ago and said you guys dont make our lives easier. Comes with all these rules and regulations, we have to build the greenhouse model, it costs us a fortune, quite frankly let us do what we think is right and ill them and ate it all the federal regulations and your state regulations. You can build a greenhouse model if you want. If you think its better to use your money in a different way we will provide you with the money to do what you think is right. That was very helpful feedback to me. I dont know all these things that your state directors know. I hope you understand i am committed to working with you so that together we can to the right thing for the people that have defended us. Glad to take any questions. [applause] start, you talk about the Financial Assistance and folks in nursing homes. We are looking to increase the number of seniors as well as keep them in their homes. If your Financial Assistance has kept pace with that trend. In talking to some of the states Veterans Homes that i did earlier this month, they told me there is things they can do like make it easier for you to establish an adult day care program. Our regulations prevent you from doing that. We can keep people out of institutions and support them in ways that we want to take the lead from what you want to do. Looking to support you, because there are certain people that arent going to be able to remain in their homes. So youre going to have a valuable role there. And we are looking at the bureaucracy to function in way you wanted to function. You and i were talking earlier about Substance Abuse, opioid addiction, and some who may enter into our criminal Justice System. You are talking about a unique system with the veterans courts and being able help those that are incarcerated. Could you talk some that you see across the nation . We have 342 veteran treatment courts all located in your communities. Is they try to find where thees to prison crime that has been committed his nonviolent and related to either persons, psychiatric or mental condition or substance or them inse, and why put the prison when what they need is treatment . The judges allow them to get right into intensive treatments. This Program Shows the recidivism rate one year after at an 80 reduction. I think that is not only the right thing to do for veterans, it is the right thing to do for taxpayers and the states that are shouldering that burden. We think its a very successful model that can be applied outside of veterans, of course. We are working to expand that. Even as governor fallin was seem toabout, they decrease the number of problems in the prison in a cohort it group of people that are used to understanding each other. I think there are a lot of lessons as we look forward getting people the right treatment. And we are certain learning from all of you. A couple of quick questions. 1200 facilities. Between any correlation the shutdown in the state or as event on the bus type of approach . Omnibus type of approach . What the president is hoping to do under the infrastructure law is allow it to be targeted to help veterans. The bill is an idea, not a reality. Outstanding. I wanted to talk to you about the efforts to eradicate hep c and the population you are referring to. Its a fairly audacious undertaking yet you seem confidence confident that you are close to doing so. Can you talk about the methodology . Specifically what drugs or Drug Companies are you working with . First of all, what we have done is we are proactively out. Ing the drugs now have a 90 cure rate. Out. We have team of pharmacists that we have trained. That are reaching out to veterans, calling the men, explaining what the options are. And overseeing the compliance program. Drugs,re not one time you have to use them over the course of a couple months. I think thats whats different. I have run hospitals and some of your states hospitals in some of your states. The v. A. Is reaching out. When we started the program there was one drug company, gilead. When others enter the market with a similar type crisis it dropped. We now work with and use multiple Drug Companies. The prices are less than half of when we started this program. It allows us to be able to reach out more. And get this done even faster. Interesting thing that we are finding is there is a population of veterans that while they could be cured are choosing not to take the drug. We can offer some Veterans Homes. A small number but it is not insignificant. We are trying to understand how we can do better with that with the General Community. I think its going to be a problem with the General Community as well. Thank you very much for being with us. Talked about the appeal process and reviewing files. I absolutely urge that be engaged on an ongoing basis. Clearly separated people from the military service primarily due to Mental Health challenges. And leads to suicide and other behaviors. We very much appreciate the assistance. One to three to end homelessness among veterans. Of course that is to find these folks who will access this. I will also tight we do ongoing outreach to people who refuse to take the help. And we had a pretty good rate of folks changing their mind. Want to talk about the issue of incarcerated veterans. And you may are to be aware of it. We have opened a series of reintegration want to talk aboue issue of incarcerated veterans. Centers, one of which is devoted entirely to veterans really calling upon the best days of their life as they prepare to reenter society. Most of our veterans in the Reintegration Centers spend between the last six months, the last six to 18 months of their period of incarceration. What we are seeing are folks who are substantially prepared to reenter a broader society. Frankly calling upon their experiences that got them to a level of accomplishment that perhaps they have not seen in a long period of time. In regard to that extent, they you all could reach out on a bigger basis, to a corrections officials in the country, i think that would pay big dividends. We see it in connecticut and i think it would be helpful. One of the things we have also done is try to make sure that no one veteran or otherwise leaves prison who has had a heroine problem without access medically assisted support. We have seen that demonstrated great results. With respect to staying out of prison. Do everything we can to keep them out of prison. I urge you to reach out to that group of missioners across the United States that are doing some of these things. I was going to say that the the same thing to you. These types of gains you made in your state is theres no way the deep the v. A. Can do this alone, theres no way the states can do this alone. These are efforts that have been able to achieve what you have been able to do with homelessness. Just to share one thought, we made it a priority with our local housing authorities to add or amongas a preferred the First Service groups to gain housing when it was available. It was like a light switch being thrown. When people realize they thought they should do it and you could we built a good part of additional housing. O housing has helped just highlighting how important was to the individual communities and organizations. We have 10 minutes left. I will ask you to keep your comments brief. I want to say congratulations and my comp limits to you and your choice of the team. We need to do our best to honor our veterans. I think its a partnership that the state and federal governments need to work on. One of the things governor fallin pointed out is the need to Work Together to make sure that especially spouses of , we havefolks have some coronation of a license or certification. Is that something you can help us with . I think youre absolutely right. You all know this, so dont want to Say Something you already its not just them, its their entire family. And the stress the families are under when their spouses are deployed is incredible. We are looking at ways to be able to help that. Effortsour employment are better than the general population and is now helping spouses achieve that meaningful employment as well. Thank you, governor. I appreciate your visit to the Medical Center not that long ago and your great work. I was in congress when we created the Choice Program and there was a similar delay in getting folks to go through the Choice Program to get access to those appointments. They had to go through some kind of intermediary. Could you comment on that . I consider what you did in congress in response to the crisis for the Choice Program pretty room pretty miraculous. We started from zero to national in 90 days. Even with as well thought out as it was we learned a lot of problems with the program. There are seven different ways of paying for veterans in the community. Expensive, complex, no one understands it, especially veterans. With new piece of legislation combining into one program, secondly we designed this we put a thirdparty administrator, there are two in the country right in the middle of the veteran and the v. A. And not too many businesses that stay in business outsource customer service. It just doesnt work. So we are bringing that back in our least this is our proposal in congress. They know and trust their staff. We want to use a third party for things we dont do well, hang bills. Keep in the network up with providers all over the country. Keeping the network up with providers all over the country. Taken the lessons over the last three years and a lot of problems. And we are working with congress to launch a new program. Our committees are working through their proper processes. Thank you, Governor Walker . Thank you very much with your secretary for your presentation. A picture of your slides. I like to get a copy if i could. Ive narrowed my five questions down into one. We are trying to develop a Veterans Cemetery and one of the requirements is we have the land , we have to build it to your specifications, a road in alaska is a little different than a any in i wont pick out urban areas, but its just different. Is there anyway or potential to e an alaskan road put in senator sullivan made me come to alaska, which i was glad to do to make this point. Once youre up there and understand how different it is, its easy to sit in washington and say everyone should be the same. Im very open to considering waivers. I does need you to tell me what you need me to do. Not going to recommend something if its not the right thing. We are not here to secondguess you. We are here to support you. And we will do that. Thank you and thank you mr. Secretary for being here. If you could expand quickly on the opportunities for sister living, particularly with aging veterans of it can stay at their anes and extending invitation, we are opening a Veterans Home in reno nevada. It would be a clerk a privilege and an honor if you could join. Thank you. To tryonshot of helping veterans, and frankly all americans be able to remain in , i dont have to many patients who say help me find a nursing home. We are at a breaking point that we can do this. Sometimes more often on their mobile phones or their ipads with homecare visits, we have home directed primary care teams that go into homes, homes specialty care. And caregivers. The v. A. Supports 27,000 caregivers right now even animals, dogs are super important for mobility. And now emotional support issues. There are ways we can build a system around our veterans and let them remain in the settings they want. I think its cheaper, i think its better and were going to take it as a moonshot. We are not there right now. Why been talking to your directors and your state captains about doing this together. Thats where they said, look, help us clean up the daycare. The adult day care, thats part of the solution. I think we will be leading the way for the rest of americans. Much. Nk you very im going to ask governor fallin to make any closing remarks. I think we heard great information about what the Veterans Affairs missions are. Hopefully we heard some great comments from our governor on how we can Work Together. Many of us have had the privilege of knowing the general who passed away unexpectedly last summer. He was one of the Founding Fathers of the council of governors, which governor fallin and myself have had the privilege of heading. He was instrumental in the creation of the dual status commander and establishing the National Guard as a cyber workforce. He was also an active voice in defending the guard against to structural and operational capabilities. Anybody who had the privilege of working with him can attest to the impact he had in ensuring its continued strategic and operational importance in our nations defense. During our counselor governors meeting on friday we approved a resolution honoring the life of the general. And i bring it before this body and ask for your consideration. He continues to be widely praised by governors, their staff, the National Guard community. A home and security adviser for 14 years, helped to establish the council of governors and support the National Governors consultant from his retirement from the military. I would now offer that as a motion and asked that we approve the resolution. favor. Anything else before the committee . We are adjourned. You. Nk