Good morning, everyone. The committee will come to order. I welcome our witnesses in person and those that are appearing distancely. We look forward to their testimony and getting a better understanding of where the department of Veterans Affairs and the Third Party Administrators are in administering the mission act. Im also very interested in hearing more today about the caregivers implementation, as well. Almost every member of our committee, though not physically present at the moment, some are joining us in person and others will be joining us, almost every member of our committee will be participating and is expected in todays hearing. The focus of todays hearing is the implementation of title 1 under the mission act by the department of Veterans Affairs related to Veterans Community care programs and the program of comprehensive assistance to family caregivers. I scheduled this hearing because of my dissatisfaction with the pace of mission implementation. While va officials were invited to participate in todays hearing to discuss the critical programs they oversee, the department chose to decline that invitation. This committee and the va shared a common goal to pass the mission act in 2018 to better serve veterans and their families and we continue to Work Together to address important issues for our nations veterans. I would expect them to be here for this conversation to share all theyve accomplished since the va was transformed with this legislation and to discuss what needs to be done to meet improvements. The va is an integral part of this dialogue, which is why i discuss title one implementation. I would be remiss not to discuss it during the covid19 pandemic. The va staff require our recognition for fulfilling the vas mission. The va has struggled to uphold the mig acts requimissions acts requirements. My staff and i continue to hear complaints from veterans and providers regarding poor communication and lapses to inadequacies. Third pf party, are valued in essential partners in the care through the Community Care network. You play and they play an Important Role in a robust and resilient care network which provide veterans timely access to care and make search they receive prompt payment for the care ask services they provide. When the va released stringent access standards for Community Care, i was encouraged to see more veterans would finally be able to access timely, quality care closer to home. However, once again, my staff and i have since learned that the vas contracts with Third Party Administrators use a completely different set of standards to determine how veterans access care. Under contract terms, rural and highly rural veterans can be forced to drive up to three hours for care which is completely, totally unacceptable and contradicts the spirit of mission. Ive discussed this glaring inconsistency with the va officials with months and despite vas assurances privately and publicly it is uncertain whether the va has modified the terms of the contract. It appears to me that its possible now for veterans to have a different access for care certainly than the law and the mission act requires different than the regulations of the va and perhaps different from vision to vision based upon the contract terms based upon third pf party administrates and we hope to learn more about it today and it is central to the transform the va into an innovative and responsive 21st century system capable of addressing what veterans face today under the law. As such i want to make sure that vision act succeeds and the Communications Network is accurately accounted for because there are a sufficient of number of local providers for veterans to utilize. Much has changed in our country since the Committee Held a hearing on implementation and the Community CareNetwork Earlier this year and the intent and goal of the mission act has not changed and theyre able to get that care without unnecessarily scheduling delays for Community Providers and that those providers are pait paid in a timely manner. Congress has the responsibility to execute the laws to serve veterans and i take and this Committee Takes its responsibilities seriously. I believe some of the vas most Senior Leaders agree with me that while progress may be under way it must move fast tore enable Community Care networks to serve veterans as we all envisioned. I want to know how the va is make being progress to working with thirdparty administrators to offer veterans access to the health care they deserve. Another essential component of the mission act is the family caregivers to all generations of veterans, many caregivers have been providing essential services for their loved ones without support for years and in some cases, decades. As veteran caregivers are often the main care takers for their loved ones, many can experience depression, anxiety and other Mental Health decisions in part or solely to the stress of care giving. The stress associated with caring for a spouse or Family Member with the set of complex healthcare needs is a real and present concern for veteran caregivers. It is essential that the va support for caregivers these Mental Health challenges be addressed effectively. Mission outlined a twofaced process to expand the resources with the anticipated start date of october 1, 2018. For phase one. Phase one implementation only just began october 1 of this year, two years behind schedule. This delayed rollout will result in caregivers needing to wait longer to be a part of the vital support program. Forward to hea testimony from everyone about the issues that you face in your work to help care for and serve veterans and steps that the va can take to make certain both of these programs are functional and able to deliver good results and outcomes for veteran caregivers. My Opening Statement is longer than my usual practice, but i had sufficient desire to say a few things this morning as we begin this hearing and i want to yield to the Ranking Member and author, senator tester. Thank you, mr. Chairman. I want to thank you for holding todays hearing. And im looking forward to the discussion among our panelist witnesses. But i, like you, am disappointed the administration chose not to participate in this dialogue. I do not know why something as important as implementation of the mission act doesnt rise to that importance in the va. Hopefully its not because theyre out campaigning across the country. This committee has serious issues with the administration on the imp indicatilication of mission act and its unfortunate they couldnt be here to participate to finding solutions for those problems. When congress creates programs to benefit veterans and their families, the expectation the administration will implement those programs as congress intended. The legislative branch isnt here just as a nuance. We actually do things and have expectations. So the executive branch ought to be sending folks here. With the creation of the va missions act, congress sought to provide veterans with greater options for Community Care when the department could not provide care in a timely manner. The latest data we have from the va shows that it made more than 4. 1 million referrals into the community from the beginning of fiscal year 2020 to june. Nationally, they took va nearly 22 days to Schedule HealthCare Services in the community after a request is made. Thats not acceptable. Its a problem. Veterans should have shouldnt have to wait for the va to navigate a bureaucratic process before their appointments are scheduled. Veterans wait an average of 20 days for their appointments after theyve been scheduled. Thats that doesnt work, man. That dog doesnt hunt. If the va was here, i would tell them to find a way to reduce the red tape. The Administration Needs to explain how it plans to bring down the number of days it takes to get veterans to the point where they get scheduled for care in the community. And the last year, theres not been much improvement in this timeline. Rather than sticking with this broken process, the Administration Needs to figure out a better path forward. I have a bill, the accountability and department of Veterans Affair scheduling and consult managing act which passed last august. It would help the va do just that, it would require the va to take a hard look at its scheduling process and then report how long it takes to get through that process. It would also require scheduling audits and review of scheduling because too often personnel leave these jobs for better opportunities. My bill would help veterans make better informed decisions on where they can get care because they would have the information they need to make those decisions. It would also help congress exercise oversight of va scheduling to make sure the program is working as we intended. Another area of scrutiny is the Caregivers Program. While it has the potential to vastly improve the lives of veterans and their caregivers, many of whom have waited years to receive the same stipends, straining and Mental Health services that have been available to post9 11 veterans, im concerned that the administration wrote the rules on eligibility. Modifications that tighten eligibility for the current and expanded program are not mission act driven and were undertaken by the administration in an effort to limit eligibility for this program and for the veterans that it impacts. Im also concerned that the administration is in a rush to meet a new selfimposed deadline after missing the mark by a year causing on fusion when causing confusion when it actually did. I want to thank the Elizabeth Dole foundation for being here today so we can make sure this program is functioning well for veterans and their caregivers. Thank you, mr. Chairman, for calling this very important hearing. Let me introduce our witnesses. Dave mcentire is the ceo of triwest, steve that wschwab fro elizabeth both foundation. Thank you for providing testimony so we can understand the circumstances by which we may help you accomplish your goals of meeting the needs of veterans of yoour country. Were begin with Lieutenant General horoho. Thank you for being here and thank you for the conversation that we had for nearly an hour on sunday evening. On behalf of the 25,000 health care employees, were honored to support the commission to ensure our nations heroes live the healthiest lives. Can you hear now . Im sorry. Would you like me to start over . Do you want me to start over . Okay, good. I had to dig deep into my military voice there. After 33 years of uniformed service, the mission is personal to me and our entire organization. Were veterans. My Leadership Team has a total of 350 years of service in uniform. Many of us or our Family Members receive care from the Va Health System or the community. Since i last appeared before the committee, optum serve completed our implementation across regions. Our responsibility is to build and manage a highquality provider network. Were managing a network of 830,000 providers across 1. 6 million sites of care. We intentionally built a Large Network so veterans could have their choice from a wide variety of timely care options. To date, the va has issued more than 1. 5 million referrals for care to our Network Connected individual veterans with a highquality provider, one veteran at a time. 100 of our network is fully accredited and credentialed. In addition, as compared to the 15 benchmarks set by the va, 54 of providers assessed are designated as highperforming providers. The success of our network goes beyond the data. Underlying the data are hundreds of thousands of individual connections made between care providers and veterans. We understand that health care is local and the choice of a provider is personal. Our network is dynamic, highly reliable, and responds quickly to the needs on the ground. Recently the leadership at the Lexington Va Medical Center expressed gratitude for our assistance in ensuring a veteran who was battling cancer could be treated by the same provider as his wife. We know that caring for our nations heroes is more than signing a provider contract or paying a claim. It means caring about the women and the men who have worn the cloth of our nation and doing whatever it takes to help them heal. Every day we work side by side to advance veteran care, review successes, develop action plans, address challenges, and share best practices. These relationships are critical when the unexpected happens. This occurred in august when hurricane laura left 200,000 without water and a million without power in louisiana. Many hospitals were forced to close and my team jumped into action, leveraging relationships with the louisiana hospital association. We ensured they had uptodate information on hospitals where they could safely serve veterans. Our network is not a national entity. Its a collection of regional care, ecosystems, designed to be responsive and convenient to veterans. Working with each group, we have prioritized the credentialing of highquality providers with a history of serving verpts in te the community. Weve partnered with providers and 93 of academic affiliates including duke and the university of kansas. And for the first time in the vas history, a providing care in the community, optum partnered with the va to bring the mayo clinic into the network. While managing our network is a dynamic process, our restlessness keeps the veteran at the center of everything we do. This month we learned that a veteran was matched with a lifesaving heart. More quickly than expected. This evoked our warrior ethos of never leaving a fallen comrade behind. Within 24 hours, this West Virginia veteran received a new heart. Over the last few weeks, we began facilitating dozens of lifesaving organ transplants. This is the power of one, one organization working one on one with va staff, vsos, congress, caregivers and many others to advance the health and wellbeing of one veteran at the time. Mr. Chairman, Ranking Member tester and members of the committee, thank you for the opportunity to appear before you today as a veteran, former army surgeon general, wife of a veteran, daughter of a veteran, and the proud mother of an airborne infantry lieutenant, ensuring veterans has a network that meets their needs is important to me and our entire organization. Thank you for your testimony and thank you to you and your family for your service to our nation. Mr. Mcentire, welcome. Mr. Chairman, Ranking Member tester and distinguished members of the Senate Committee on Veterans Affairs, on behalf of all those associated with triwest, its an honor to appear before you today. Weve been serving the military and veterans population for nearly 25 years now. Were privileged to have partnered with va for the past seven years and helping them respond to the Health Care Needs of veterans from pc3 to the choice act to expansion and replacing of health net its been quite a journey. Weve tried to remain nimble and focused on one objective, to support, not compete with, the va in providing timely, quality care for veterans. Through the use of our proven demand capacity process and leveraging the footprint of our nonprofit owners, weve tailored highquality networks in collaboration with va to match the unique demands of each of their enrolled veterans. It will contain all academics for region 4 and delivered more than 42 million medical appointments. This included everything from urgent care within 30 minutes of a Veterans Home to eye appointments, to primary care, to urology, to womens services, to Behavioral Health and just this past weekend, a triple organ transplant to safe the life of a hero. We have collaborated in administering the benefit for hundreds of couples who cannot otherwise have children because of their combatrelated wounds. We have customized a network for each one of the couples, their unique circumstances, and lots of babies and proud and grateful parents are the result. Im pleased to report that due to the team effort between us and va, were processing and paying clean claims, professional institutional alike within two weeks to a level of accuracy and access of 98 . And it will please you, im sure, mr. Chairman, to know that the va is reimbursing us on a timely basis as well. Along with these successes have come some challenges. Especially in the delivery of timely appointments. As you know, early in the year, our nation was hit with covid, a challenge unprecedented in our lifetime they reduced the Available Services as they made changes to keep their staffs and patients safe and preserve capacity for those fighting the virus. It was a daunting situation. But soon and since july of this year, weve been scheduling appointments within five days for 90 of all veterans needing primary care appointments and theyre seen within 26 days from the receipt of the referral. Mental health within 27, and specialty until 28. Theres still a bit of work to do, but were close. And only 1 of the care requests that weve been given have returned been returned for no network provided. Getting here has been challenging, but were