Chairman isakson call this meet of the Senate VeteransAffairs Committee together. I apologize again for being a little bit late i want to make sure were on the right track. I didnt mess anything up. I want to welcome secretary shulkin, who has had a great start. I dont think anybody in this administration started out with a better unanimous vote than he. Doing better than unanimous when you are confirmed. I think the vote last week on accountability was extraordinary. And the way we got to the decision working together was extraordinary and i commend the Ranking Member on his help in doing the same. We have some other things to do today to Start Talking about. Well have some other decisions made. We can keep the same tempo, same discipline, and same commitment to making sure we all know what each other knows before they happen rather than find out after the fact well all be better off. I welcome dr. Shulkin and the other members of the staff that are here today. And appreciate all that they are doing in our meeting the other day to explain where were going in the Veterans Administration which is upward and outward and further ahead. Ill make a long statement at all except to say a long statement. One thing i have to brag about, the decision in getting our Electronic Medical records issues solved after years of unwillingness to address it is extraordinary. And i think from what i have heard, people are coming together in the past hadnt been together to make sure this happens and works sufficiently for our veterans and for the department of defense and the department of Veterans Affairs at the same time. It was silly to have an agency, two different agencies in the same government serving the same soldiers fighting for the same country and same constitution that two medical systems that were not interoperable. One to the other. And our veterans who fought for us would literally fall in a hole leaving from active duty to department of defense to Veterans Affairs. I think this move will prove to be a tremendous move. Economically for the v. A. And benefit wise for our veterans. And there is no possible way to do any better than that. I commend you on that decision as well. With that instead of getting into details i turn for an Opening Statement to the Ranking Member, john tester. Senator tester thank you, mr. Chairman. Thanks for having this hearing. I think its important to say that our thoughts are with the colleagues who were the victims this morning. We wish a speedy recovery for congressman scalise and everybody else who was injured. And a big, big thank you to the Capitol Police officers who work every day to make sure this place is a safe place. Our thoughts with them. Secretary shulkin, i want to thank you for being here. I want to thank you for being here with your v. A. Team. We spoke last week are about the future Choice Program and i hope i made my perspective clear. It was intended to supplement care. Provided directly by the v. A. Not replace it. Not now, not in the future. I worry the budget proposed by this Administration Starts us down a path of unfettered choice that will hollow out the v. A. N doing so it proposes to increase funding for Community Care by a third while proposing the v. A. s only hospitals receive an increase that is less than half of the medical inflation rate, not much. Further, the budget does absolutely nothing to address v. A. s aging infrastructure. V. A. s hospital for fund used to hire staff and provide care for veterans while also denying them money to address the environment care concerns, we know what that outcome will be. Soon enough there wont be any quality v. A. Hospital staff by quality providers. And the v. A. Care will become nothing more than a voucher plan to send veterans into the private sector to hunt for a doctor who has the time and the capacity and the knowledge to treat them. That is not what our veterans need. Its not what the veterans want to happen. For a state like mine, montana, it would be a disaster. We need to be honest. Each year more and more rural hospitals are at the risk of closing. If their rollbacks to recent medicaid expansions its likely these closures will accelerate. We cant assume rural care will work where there are not providers in the first place. We know the vast majority of veterans using choice are eligible due to long wait lines not because they live too far from a v. A. Facility. Data shows that rural veterans arent just using choice but they do defend on v. A. Care. But now based on your quest yesterday, we may have to shift additional funds around to get the Choice Program through the fiscal year. For months we have been asking about the choice suspend rate and the amount of funds remaining funds. We were never provided with those answers we needed to make informed decisions, and now were in a difficult spot. Mr. Secretary, no one wants to lay the delay the care for veterans. Will act appropriately in a timely manner to solve this problem. For that to happen this late in the game is a bit frustrating to me. And my frustrations compounded by a budget that cuts Services Veterans rely on. Makes cuts to education oversight. And cuts to i. T. Which affects every business line. Im most concerned it appears these cuts are being made to pay for certain veterans to get private care. The new policies proposed in this budget to pay for private care are simply untenable. To put forward a proposal that would without warning stop earned benefits payments to the most severely disabled vets is unacceptable n this case were not talking about folks milking the system for Government Fund and compensation that they dont need or dont deserve. To get the individual on plan ben fete payment, it must be determined he must be engage in work as a direct result of service to their contry. President trumps budget proposes we stop paying these veterans at a time when more americans are having to work longer to make longer in their lives to make ends meet. All in the name of finding more money for choice. Thats a nonstarter and i hope we can get your commitment today to keep this important benefit in place. I look forward to working with my colleagues, both sides of the aisle, to address these concerns and look forward to hearing from you and how you intend to prioritize funding for veterans who get care and benefits directly from the v. A. Finally i would like to wish the u. S. Army a happy birthday. With that, thank you, mr. Chairman. I look forward to your testimony, secretary shulkin. Chairman isakson welcome. Let me introduce those you brought with you to back you up. We appreciate them. Edward murray, thank you for being here acting assistant secretary for management and chief financial officer. Richard chandler, deputy assist ant secretary, resource management. Mark yow, chief financial officer, Veterans Health administration. James manker, acting Principal Deputy under secretary for benefits. And mr. Matthew sullivan, deputy under secretary for finance and planning. Secretary shulkin, floort is yours. Secretary shulkin thank you, chairman isakson, Ranking Member tester, and other members of the committee. As you can see i brought a big team with me because i know you are going to have lots of questions and in particular with the Opening Statements i really do look forward to having a meaningful discussion and getting to some solutions and some closure on some of these issues. I also did want to echo the Ranking Members concern that the is a sad day for nation where Public Servants who work as hard as i know all of you do have to worry about their personal safety and our thoughts and prayers are with t nation where the congressman and the staff and the Capitol Police as well. Thank you again for allowing us to be here today. What we want to talk about today is the 2018 president s budget and the 2019 advanced appropriations. And all of this is in way of showing support for veterans. We appreciate the legislation that recently been passed. As you know, you passed just within the past week the accountability bill and that went through the house yesterday. Were looking forward to actually next tuesday bringing it for a signature for the president. And thats good news. We also appreciate your support for the veterans choice improvement act that you supported. And for providing us for the first time in a long time the full 2017 budget. This is really allowed us to make Real Progress for veterans. Were again grateful for that support. I have submitted the full written statement for the record. Let me just start by thanking you again for allowing us to participate in the hearing last week. Seems like we were just here with you. I thought it was an excellent hearing. Good discussion on choice. And that type of discussion, dialogue, will allow us to help get it right for veterans. When i testified before the house Veterans Affairs committee on march 7, we had 2. 0 billion in the choice account. Less than a month and a half later when the president signed the choice extension act into law, our choice account was at 1. 5 billion. Today that account is at 821 million. As we know more veterans than ever are using choice. We have authorized 8. 2 million Community Care appointments since january of this year. Thats 2. 6 million more than last year, or a 46 increase. In fact, march, april, and may were the largest months ever for choice. And frankly that happened because we fixed so many of the problems that we have all been working to fix with choice. And we have been increasing our use of choice. One of the reasons why is the 17 budget as you may remember actually had 2 billion less in Community Care, so we have been putting more through choice. Two years ago, im sure youre going to remember, in july of 2015, we had two little too little money in our Community Care accounts within the v. A. Which we solved with your help by accessing unused funds in the choice account. So we transferred money from choice into Community Care. We now have too little money in the choice account which were working to solve again working with you with legislative authority to replenish funds into the choice account. So this is the situation that have described before where for a single purpose of providing care in the community we have two Checking Accounts. Will i tell you i wish it were easier than it is. We have to figure for a single purpose of providing care in the Community Balance these two Checking Accounts at all times. Obviously its not a sigh epidemics, its an heart. Were having difficulty with that once again. Thats why we need to work with you to solve it. The Veterans Care Program that we outlined for you last week will solve this recurring problem permanently by modernizing and consolidating all the Community Care accounts, including choice. The president s budget in 2018 and 2019 provides additional funds for choice and the resources necessary to continue the ongoing modernization of v. A. It requests 186. 5 billion for v. A. 104. 3 billion in mandatory funding, and 82. 1 billion in discretionary funding. For a total increase of 6. 4 billion, or 3. Of over 2017. It provides 2. 9 billion in mandatory funding to tint Choice Program in 2018 plus a 7. 1 increase in discretionary funding for v. H. A. To improve Patient Access and timeliness of care. It supports the strengthening, Foundational Services, as well as modernization and consolidating v. A. Community care through the veteran care Program Announced last week. So veterans can make the right decision abouts their care together with their physician or provider, giving them yet another reason to choose v. A. This budget reflects the president s strong personal commitment to the nations veterans. Its also a budget we need to achieve. My priority as secretary providing greater choice for veterans, modernizing our systems, focusing our resources towards whats most important for veterans, improving the timeliness of our services, and suicide prevention. Were already taking steps to meet the challenges that we face. At the president s direction, we have established a v. A. Accountability office. The resent decisions made by the senate and house will help us with that. We have recently removed two Medical Center directors and three other senior executives. We simply will not tolerate employees who act counter to our values or put veterans at risk. I recently announce add new waste, fraud, and abuse prevention Advisery Committee which will be set up and running later this summer. I also directed the v. A. Central office remain under a hiring freeze, those are for administrative position, as we consolidate program offices, implement shared service, and realign overhead to get more money back to the field. We now have same day services for primary Care Mental Health at all of our medical septemberers. Veterans can access wait time data for their local v. A. Use n an online easy to use tool to understand access and quality. No other Health System in the country has this type of transparency. We have made it easier for veterans to fill Online Health care applications. So much easier that since last summer we received eight times as many online applications than the year before. Last month we were able to process a disability claim in just three days. I said that right. A disability claim processed in three days. Using a new process called decision ready claims. Well be introducing decision ready claims nationally september 1. At our regional offices, well be completely paperless for claims by mid 2018. A few months ago the Veterans Crisis line had a call rollover rate of more than 30 . Today that rate is less than 13ers. We have launched a new predicted modeling reach investigate allowing v. A. To provide proactive support for veterans who are at higher risk for suicide. Were also launch agnew initiative this summer getting to zero to help end veteran suicide. This is my top clinical priority. To keep moving forward we need your help. We have identified over 1,000 facilities either vacant or undertheutilized and working now to move forward with 142 of those facilities and with your help we could do more of the same. We need congress to fund our i. T. Modernization to keep our legacy systems from failing and to replace vista with the system already in use by the department of defense. This will ultimately put all patient data in one shared system enabling seamless care between the v. A. And d. O. D. Without manual and Electronic Exchange reconciliation of data between except brat systems. We also need congress to authorize and overhaul our broken and failing claims appeals process. We have worked closely with v. S. O. s and other stakeholders to draft a proposal to modernize the system and were pleased to see the house unite behind the bill last month. Now we just need the senate to act. Most of all, we need congress to ensure the continued success of choice for veterans. Veterans are responding to our modernization efforts by choosing v. A. More than before. To keep up with those choices, we need to fully fund choice and help us modernize and consolidate v. A. Community care through the Veterans Care Program. The Veterans Care Program will coordinate care so veterans get the right care at the right time with the right provider, whether in a v. A. Facility or from a high performing v. A. Community care provider. We just need your help to make it happen, including funding to keep up with veterans as they choose v. A. Thank you and we look forward to your questions today. Chairman isakson thank you, dr. Shulkin. We appreciate your attendance today. I want to start off with my questions on the appeals process. I have consistently said that any change in the process to improve it must include an acceleration of and dealing with 70,000 veterans whose claims are pending today. Would you agree . Secretary shulkin i would like to see that happen. Chairman isakson im going to give you a chance to make an amendment on that. If both appeal reform and budget requests are adopted in this budget, would v. A. Be able to begin accelerating decisions for those 470,000 appeals pending . Secretary shulkin the appeals that are in the board of appeals are the one that is were most were most concerned about. If the senate votes to move the appeals modernization forward, as i think youre saying, mr. Chairman, we will have a process to expedite those from the time that the law passes moving forward. Youre asking about the legacy claims and appeals. We do not have a plan to make signature progress on those. Significant progress on those. The budget this year will add 142 more staff to the board. That will allow us to make incremental progress. I think to deal with the backlog we would be looking at 2026 before we dealt with the backlog. The one hope i have, mr. Chairman, rather than adding a large number of staff to deal with the backlog, is that well give current veterans who are in the appeals process the option of opting into the new process. And if they choose to opt in, but its going to have to be their choice, they would