[inaudible conversations] the committee will come to order. Good evening and thank you all for being here and joining us. Its a somewhat unusual for the committee to meet in the evening hours. Tonights topic is one worth staying up late for. I want to keep our work this evening laser focused on the future on how we can all Work Together to create a better, brighter, healthier one for our veterans and for the Health Care System that weve built to serve. Rather than rehashing the mistakes we made long ago. As we begin to move forward this evening we mustnt lose sight of where we started. Three years ago next month in this very room, the Committee Heard testimony from a veteran who spoke about waiting almost a year for care from the department of Veterans Affairs medical facility in south carolina. When he was finally seen long after he should have been, he was diagnosed with stage four colon cancer that had spread to his liver and his lungs. He passed away in january last year. It was his story and accompanying allegations that for the veteran patients died while waiting to receive care from the Va Medical Center in arizona that kicked off a nationwide access and accountability scandal the likes of which the va had never seen. Ever seen. It also led directly to the creation of a Choice Program and the allocation of billions more taxpayer dollars to increase access to care for veteran patients. In the three years since then, more than 2 million authorizations for care has been approved in over 1 million veterans have been able to get the care that otherwise might not have been readily available. However all of us continue to hear from veterans day after day experiencing lengthy and frustrating delays when attempting to schedule appointments using choice. In fact i was contacted by a veteran with a story much like this. The veteran was diagnosed with cancer last fall and referred to choice for treatment. While im relieved to say he is receiving the care that he needs from the provider of his choice he suffered three weeks of doubt due to mishaps and miscommunications between the va, the thirdparty administrator managing choice in this particular region and the Community Provider who had agreed to treat him. It appears three years after his testimony, a lot has changed but too much has stayed the same. Whats more, recent work performed in the Government Accountability office illustrate very clearly the choice isnt set up to succeed at its primary mission providing timely care to veterans who cannot access the care put in the va because it isnt offered or available in a reasonable amount of time or it would entail a veteran traveling a great distance. For example, they are going to testify this evening that veterans could potentially lead up to 81 calendar days before receiving care due to the bureaucratic process the va and post on choice. That is unacceptable to me and im sure everyone in this room. Ive been a practice for over 30 years and i assure you it doesnt have to be this complicated and should not and should most certainly not take this long. Luckily the choices in the same program today as it was when it was reviewed in the last year and certainly it is in the program that it was on when it s first created. Through the legislative changes in the contract modifications and counting its been continuously improved on and made stronger but it remains far from perfect and in far too many cases it fails the veterans was created to serve. Im working to wichit double geh the Ranking Member and secretary and Senior Leaders and our Senate Colleagues and with our Veterans ServiceOrganization Partners to chart a path forward for choice and all Community Care programs in short order. I hope to have language to share in the coming weeks and have a Health Care Reform bill on the president s desk this year. However the first step to reforming the choice is making sure there is a smooth transition to lead the way. This is why it is critical the Committee Act tomorrow to mark up 369 though i introduced earlier to remove current threeyear sunset dates from the Choice Program. Absent legislation choice will begin shutting down in just a matter of the end will the and y in five short months from today. Cutting off the access at a time when veterans are seeking care more than ever before and critically at a time when the non Choice Community care account is not able to observe additional demand of care the va is already facing a 3. 4 billion deficit in the Community Care account next fiscal year that the leaders have told the Committee Staff would require additional appropriations to address. By removing the sunset date we are not endorsing the program in its current state but we are ensuring that emergency Funds Congress made available for the veterans care are used for that purpose until they are extended. Community care appointments increased by 61 overall in the choice was created in the last year 30 of all appointments were held in the community rather than medical facilities. The future relies on not only a strong Healthcare System but one that is inextricably linked with Community Resources to fill the gaps and meet the need of the veterans when and where they are. We must get this right and learn from the mistakes, miscommunication, undue bureaucratic process since its inception. Not only for those that depend on the system today but also for generations of american heroes to come. That is what i am committing to once again this evening. With that i will yield to the Ranking Member for any Opening Statement he may have. Thank you for holding the hearing and to senator mccain. It is a pleasure to have you over here in a special thank you to the secretary again that sounds very good and we appreciate you being here and also the Inspector General as well as the Committee Members are here all have the same mission and goal and in the most timely manner for our veterans so im grateful to each and everyone of you last congress we heard from policy experts including veteran service organizations, independent Assessment Panel about how we should shape the va in the future. Now it is time to get to Work Together to make positions and pass legislation to ensure they receive the health care they deserve. One of the highest priorities is to ensure they receive the highest quality healthcare in a timely manner and a safe environment that includes care aof the medical facilities and through Community Health care providers. From listening to the constituents are waiting too long to see care, we need to make changes in the program. The witnesses, Inspector General and the gao will testify to survey data to back up constituents have been telling all of us, the veterans are waiting too long for Community Care and in many cases theyve been forced to manage care on their own. It should never take 80 days to get an appointment in the community. Veterans in need of Mental Health care shouldnt be struggling to make their own appointments and coordinate complex care. The decisions should be made between the doctor and the veteran and the va should be there to make sure they get a timely appointment and make sure the doctor has a record to treat the veteran and the veteran isnt stuck with a huge medical bill after seeing the doctor. As they move forward in the consolidation plan, i hope we can take some of the lessons we learned from choice. We need strong leaders at the hospital to those committed to putting the plan in place. The facilities were responsible for filling in inadequate Community Care networks and providing the staff to support this new program. They should be involved in this new Community Plan every step of the way. We need technology to support our providers and Community Providers. This requires them to have Electronic Health records and an id system to reduce the time it takes to coordinate care and process claims. The Current System or the lack of to support care coordination are contributing to th the delas an increasing workload for staff were manually processing them. To get the plan right it will cost a significant amount of money. The president said hes committed to increasing funding for the veterans but this doesnt mean they get a blank check to continue programs that are not working or that it should go to Community Care when veterans need the care and coordination that only the va can and should provide. It also means they must be able to forecast the resources and staff it to provide the care and facilities through the network of Community Providers. Tomorrotomorrow well be marking legislation that will allow the remaining Program Funds to be spent in along with this weve come to a bipartisan agreement that the va should be build first before a veteran is built for receiving care and the Community Providers should be able to have access to the medical records. This was a bipartisan agreement working with the experts and i applaud them for making this happen. I hope he can continue working together to make decisions that move forward and improve healthcare. Thank you and i yield back. It is my pleasure to welcome a fellow veteran and our colleague from across the capital, the honorable john mccain the senator from the sene great state of arizona. On behalf of our service members, veterans and their families i appreciate your willingness to be with us this evening to talk about a topic i know its a personal and passionate one for you and all of us. You are recognized for five minutes. Thank you for your kind words mr. Chairman. I am one of those whose members of landings dont match the number of takeoffs. Thank you for allowing me to be here. I would like to set up my full statement for the record and i wont try to be brief since it is past my bedtime. [laughter] i would also like to comment on my strong support for doctor shulkin as the head of the va and we all have Great Respect for his work. Yesterday the front page of the republic reported there was a 2. 5 million settlement to an individual and army veteran of 18 years. He waited almost two years before seeing a doctor at the phoenix va and by the time he received care from his routine appointment turned into a diagnosis of terminal cancer. Everyone in this room has heard a similar story. Its not acceptable, it needs to be stopped. I want to thank every member of the committee for their dedication to our veterans and to make sure that never again is there another steve cooper served his country with honor and then because of the failure to get an appointment, hes terminally ill. In 2014 the country was shocked to learn he was one of 15,000 veterans standing in line for care, 3,300 of whom were urology patients and this served as a catalyst for the access choice accountability act and created a program that is an enabled program to receive their program needs. More than 7 million appointments for the providers with everything from diagnostic urology screenings to lifesaving heart and Cancer Treatment has been a result. Theres been significant progress in improving healthcare and we have a long way to go to change the status quo and thats why i know none of us will bend on our efforts to provide choice and flexibility and why we must continue the hard work of refining and improving the veterans care Choice Program. As you mentioned, we authorize the veterans Choice Program which is set to expire in a few short months. We let the Program Lapse hundreds of thousands of veterans lose their ability to visit a provider and apple once again become overwhelmed. I come from a rural state. I dont want to have to have a veteran drive for 50 miles or 40 miles when he can go to a local healthcare provider. It isnt more complicated than that. Can i say the choice authorization operation is approaching end of the va has already begun limiting care under the veterans Trace Program whose treatments extend beyond august 7, 2017. I think that lends urgency to your action. I am concerned veterans nationwide may encounter significant lapses in care if we dont act quickly. The outcome is not only unavoidable but it is unacceptable and in congress we must ask on the place for snobs reside to take a critical step forward by joining the senate veterans, johnny isakson, the Ranking Member john tester and others to introduce the Choice Program improvement act . You and the members of the committee, let me be clear no one is advocating if we privatize many veterans are satisfied knowing for providing specialized treatment in areas of Mental Health, post Traumatic Stress disorder and traumatic brain injury and at the same time we cant afford to go back to the days when a bureaucrat had the final say on when and where a veteran received care so that is what resulted in nearly 15,000 veterans standing in line for care. I know this committee agrees as does the secretary and i look forward to working with all of you and my colleagues in the senate to extend the program and continue to keep faith with our nations veterans. My dear friends, the world is in turmoil, and i believe that we will be sending our young men and women into harms way in a lot of places in the world for years to come and they will be veterans and they will come home someday and i believe the work you are doing is the lords work and because you are committed as all americans are giving the veterans t the care that they nd and deserve i thank you for allowing me to appear before you. God bless. [applause] [applause] i was going to thank senator mccain that he got two quick. Veterans affairs will be testifying for the first time. We certainly enjoyed the Ranking Member being at the white house for the swearing in with your lovely family. Thank you for being here and congratulations once again on your confirmation. 100zip, i might add. I look forward to working with you. The secretary is accompanied tonight by the deputy undersecretary for health communicator. Thank you for being here. Also, we are joined by the honorable va Inspector General and Randy Williams and health care directohealthcare directore Government Accountability office. Thank you for joining us tonight. We begin with you and you are recognized for five minutes. Good evening, chairman, Ranking Member, members of the committee it for the opportunity to discuss Community Care. I also did want to thank senator mccain that he ran out so quick for his leadership. I couldnt agree more we have to act now to ensure veterans have timely access to the care they need and i want to offer my condolences to the family of a World War Ii Navy veteran and father of modern transplantation who worked in the va and with veterans for over 50 years and conducted the first liver transplant at the va in 1963. As you know the va provided Community Care to veterans for over 70 years. Since august, 2014 we also provided care through the veterans Choice Program and we appreciate your support and providing the legislation and funding to better serve our veterans. As directed in the law o for pa implemented the program and in 90 days nationwide that is unprecedented for a program of this scope and complexity. Because of the design and the law and this implementation we did run into challenges many of which will be identified in the evaluations by the gao and the Inspector General. But since then, the Choice Program has evolved. We worked with members of congress on different amendments and with contractors on 70 different modifications to improve access and efficiency and as a result of these shortcomings identified in both be ig report are now outdated. Choice isnt a program it once was that these are valuations were released. I call it a living and growing program. Since the start of the program over 1. 2 million have received some Community Care. A million appointments in fiscal year 2015 now have increased to 5. 5 million in 2016. Even with these increases we have much more work to do. We are not satisfied with it. Our overarching concern is veterans have access when they needed regardless whether it is in the va facility where their communities. The goal is to deliver a program that is easy to understand, simple to administer and meets needs. We know we are not there right no