Live here on cspan three in the Senate VeteranAffairs Meeting testifying on the president s 2024 request for his department. May join this meeting live in progress. I visited there, as you have, as your staff had, you do the right thing. We want to keep working with you. I want to talk about the pact act a little bit. Do you have numbers, up to date numbers of how many veterans are taking advantage of it . I like to say when i do these round tables that this is government and right. This bill passed if, i remember, of august 2022. By january you had it up and running. Hundreds of thousands of veterans were getting care. That is exactly the way governments should run. All of us are proud to be part of that. Do you have an eye to the number of how many people have been served . Yes. Thank you very much. As of may 6th, 251,584 total veterans or survivors have had completed pact act relating claims. We are granting at about 80 . That is the beauty of the presumption we are able to grant at a much higher rate 79. 7 . The average, this is a troubling number, averaged 80s for completing a pact act relating claim right now is 155 days. I think there is a series of reasons for that. The biggest is some claims are filed either really did to our initial presumptive claims are filed shortly after the president signed that law. We did not begin to process the pact act claims until january. We should see that average number of days go down. As i said earlier we have about 77, 000, a little over 77,000 new enrollees as a result of that. We have many more existing enrollees who qualified for greater access to care thank you. I participated as an observer at the toledo event of the screening in march. It was illuminating to see what veterans go through. I know you have been more handson than any va secretary than ive ever seen in regards to going out seeing it in action. Some veterans who need additional screenings. Many of Poorer Health they need to have invasive lung biopsies in order to finish these steps. What steps are being taken to lower the invasiveness of the screenings . The toxic exposure screenings that you talked about, that are enabled by the law, we have now had about 3. 3 million complete those screenings. Very interesting because in somewhere between 35 and 40 , i dont have the most recent numbers. It fluctuates in their, cases of those screenings we have veterans about whom we learned some new exposure that that veteran may have experienced. So, that is allowing us to get to know the veterans already in our care better. There are technological challenges. One of the things that we think most veteran suffer from, just bronchiolitis, which the test for which are so invasive as to make them actually not useful. Potentially harmful, to the veteran. So, that is why we stood up to the pact act enabled us to stand up a special organization focused just on the science of the exposures. As well as new techniques to verify the existence of the technician. That team meets on a regular basis. We just met with them last week on this. Not only did you set up the presumptive process for us, but youve also given us Additional Authority to make sure we are testing new technologies to make the confirmation of these conditions, including bronchiolitis, less invasive. Thank you. Mister chairman, thank you. Mister secretary, you have helped especially since you took office. In cincinnati, in columbus, your help for the National Va Center has been appreciated. Thank you for all of that. [inaudible] thank you mister chairman. Secretary mcdonough. Thank you for your opening statement. Congratulations on your upcoming graduation. That is a fine institution. 15 minutes from my home, davidson college. I want to thank you for their brave thing you gave me back in my office. Probably known to most pokes who voted against the pact act and, in spite of the fact that i worked a lot on, it didnt have anything to do with the numbers. It had to do with operational challenges. I thought we would be able to clear up. You gave me a reason to be optimistic based on the briefing that you gave me in the room. Can you give me a 62nd cliff notes, or give their committee a 62nd clip Snow Committee on some of the rest . I did hear the 104 today. You have to bend that down. Do you have a plan to doing that . Sure. Thank you very much. What we know now after years of watching the benefits process, in particular, the claims filing process is that overwhelmingly is the main tour that that first enter at va. It is a very human intensive process. We need to make assessments about how many events we anticipate filing claims. We need to make sure that we have trained people ready to handle those claims. Starting at the end of the fiscal year 2021, we began hiring. We now have 28,000 professionals. Importantly, they are not only hired, but a good chunk of them are now through the training process, such that they can begin to add to our ability to reduce the backlog of claims that get filed. A good example of this is that, yesterday, we had the single biggest claims of claim completion in the history of of the va. We completed 9245 claims yesterday. We are still getting more claims in any given day than that. But we are able, now, to move many more claims through the process. We can see through the expected surge of claims right now we have a strategy for how to then manage the size of that workforce on the other side. Managing to a peak. Getting down to what you think the future run race is going to be, thats good news. County and to help me go forward. With respect to the discussion about the house bill, the house bill we know that the negotiation is going to come from the president and Speaker Mccarthy is going to produce something different. I think it will be fair to veterans. I wanted to talk about one of the thing. You mentioned 77,000 new people. The pact act was much publicized. We got more people to contacts of ei even of 20 of them are not getting the presumption. Hopefully its positive for people who dont get the news on the presumption. At least they are engaged. We know that the suicide rate among veterans who have no relationship to the va is higher than those who do. There are a lot of reasons we need to get people to the va. Theres also a lot of reasons why im absolutely sick of the camp lajune toxic ads on tv. However, i think that there is a great opportunity there to connect with more veterans. I heard, i think it was in a prior committee, an exchange between senator sullivan and thunder renault are capping fees. Which will be very difficult to get any consensus on. I asked my staff to take a look at drafting a bill that we call the patriots bill of rights. One of the things that i would like to do is to get support in congress for an informed veteran before they sign a retainer for these attorneys that are spending millions of dollars in ads. I think it represents a great opportunity for the va. I know that they contacted the department of the navy. I wasnt being as something as simple as the document, without a retainer agreement, that said that you need understand what your rights are independently without representation of an attorney. Number one, contact the va. Number two, contact a local congressional representative. We do thousands of va cases every year. Im sure that the other members do the same. Make them aware of the fact that congress members, state offices, help veterans every day. Their case may or may not rise to a level where they need legal representation. But make them aware of the recognized vsos that also have experience in this case let them go through that process before they find out what is wrong with that idea . We talked about this in your office. We, especially our camp lajune, meteorologist eddie publicized week where a veteran had camp lajune as more likely to suffer from parkinsons then nantes. Then one not deployed there. We have a lot of presumptions already about kaplan june. We want to make sure that is understood. You do not have to hire a lawyer to uva benefits we are aggressively using all of our communication tools to do that and we are having some success anything that will allow us to get more of what we call the untethered thats. Those vets not yet in that is a net positive things for as im concerned. Thank you very much, mister chairman. Secretary, good to see you. Welcome. As you know and you told us yesterday the va announce that in agreement with a new hr contract being made with oracle it is really important to see that the va is prioritizing reliability and the patient to Patient Safety across the contract. I appreciate that last week the g. A. O. Released a report indicating the video had not established target goals to a User Satisfaction and the va lack to basis for determining when satisfaction has improved enough for the system to be deployed at any other site. I support the recent period as you know i support the efforts move for but only if you are confident about the safety and effectiveness of the system and have a clear establish satisfaction marker. What matters is the providers on the ground on what they think veteran the nighted to serve as the best health care we can offer. It is our job to make sure the va in oracle really get this right. Have a couple of questions around this. When do you expect to have a revised request for the ehr account in fiscal year 24 . As well as estimates of whether you need the funds requested to support the rollout in the i. T. In medical facilities . First of all, i think i want to make sure that we are absolutely clear that roughly a little bit over 400 million set aside for this year we have communicated with you in the Appropriation Committee that we do not anticipate needing that money this year. I want to be very clear about that. One. Two, the updated request, both for the rest of this year and into next, i think that we need a little bit of time but not much. I do not have a specific timeline for you here. We recognize that one year options that we have just exercise is a great opportunity for us to test whether we can get those five sites working. Not only that, but we have providers on each of those five sites that you have brought to our attention. We have big expectations on those sites and they are tired of waiting. We are not asking for a lot of extra time. But we want to get this right, rather than get it fast. Rather than give your from commitment i can tell you this is a number one issue for us the department to come to the department with a revised request. You have plans to establish target to assess User Satisfaction . You dissatisfaction in a critical part of this. Whether we have these pacific target set, i will get back to you on that one of the principal ways we are going to be able to figure out whether we are working in the five sides is going to be User Satisfaction. That will be part of the evaluation . Correct. Whether we have the specific targets that are laid out in a different timeline is what im not sure about. Are there any changes you made or plan to make . A big part of it is the enhanced Accountability Measures around up time and system reliability which comes directly from the user experience. Thank you as you know we are following this very closely. I really appreciate the vas diligence on that and i want to keep your agreement thank you. Senator boozman . Thank you. Mister secretary, again, thank you for being here today. We enjoy adhering here priorities regarding the budget last week we do appreciate all that youre doing all the homework aiding the men and women who have served. In regard to an hr end. One of the things i hear from the authorizing committee or on the Appropriations Committee is d. O. D. Has successfully gotten a bunch of things going in various installations we are struggling i support the move to back off. I think that was wise of you to do. I think you have really good support for doing that. Can you explain why d. O. D. Is having success . What is the difference . Why are we struggling while they didnt . Another reasons, can you expound on them . I think the number one reason is we have health the storms that are built for different populations and different outcomes. As a general matter our patients wait time is longer. Our veterans have more complicated Health Care System as a result our system is that much more complicated. I think that is the main issue. The other question is, when weve struggled with reliability, oftentimes, in fact, in the last three weeks we have had these two outages. For the first time in 70 plus days. Those outages impacts the entire system. It is not just the va, they also impact dod. My point is because of a pressure on us, we, i think, or making the entire system more reliable, including for d. O. D. I think notwithstanding the fact that a patients are more demanding i think the work to put it through is going to make the whole system, including d. O. D. For quicker that much more effective. When you came and talked about your budget he recognized the growth of the number of Women Veterans seeking care in the va. Which is more than tripled over the last 20 years. The fiscal year 2020 requests includes gender specific requests for Womens Health care. Supporting the Health Program office. Last congress we had legislation that dr. Kay henry thomas saying the service act was signed into law. The eligibility micro screenings to veterans who are exposed to toxic substances. That is really good story in what everyone was able to do. Can you touch on how the implementation for the service act is going . Are there any challenges that youre facing that we can be helpful with you . Let me start by saying that youve been tireless in giving us Additional Authority and additional funding to do the things that you just went through. We are not only very proud of that, but we are very grateful for. That the implementation is well underway. We began providing Breast Cancer assessments in march of this year including the incident with the toxic exposure risk assessment. We can follow along with the implementation of that. We project that in this fiscal year as a result of the service act there will be an additional 52,000 breath cancer incidents across all sites. As we learned last week the new guidance that Breast Cancer screening should start at 40. Pretty clear that here advocacy for the service act was well ahead of even this more cutting edge assessment last week. There is going to be challenges and some facilities where Women Veteran are coming to us on and roll because they have heard about this screening. That is going to create some administrative burden. There is not anything we need from you for that. That will be a challenge. That means more direct in our care. That is absolutely good news. Thank you mister secretary. Senator king . Thank you, senator. Mister secretary, welcome to the committee. One of the issues, i serve on both Armed Services in this committee is the transition. It seems to me, even that we have made great progress, we are still not there. What i would like to get from you is some thoughts about how we can make this a warmer handoff, if you will. The data suggest that that transition, that 2 to 3year transition after the reactive duties a moment of danger. So i wondered if you had thoughts on how we might be able to make this a more effective process in order to protect our veterans. I think your instinct is exactly correct. In my view, a talked about this we are looking at this a lot. I worry sometimes that we think the answer is to overload the transition. The cat program. Handing a veteran a 300page form is not the answer. Right. As you know im not of that but i have found jobs, leaving the white house, i had to sign a lot of different things. I was not gonna go to any extra thing that i didnt want to go to. So, we think very strongly is we need to set our programming and our opportunity into veterans lives to a Customer Experience journey rather than make them fit our stuff on our schedule. That means we are talking to veterans outside of the Program Using that time, as you say, year to three years after the transition in order to establish a tradition with them. One condition of and looking at is an active Duty Service Member has to opt in to have their day to day officer of the state. If we made that an opt out i would probably increase the amount of contact. My vision is, frankly, someone meeting veteran at the airport. Saying, welcome home. Here are some resources. Here is the vas number. We have to be able to contact them. Now if they dont want to be contacted thats fine. We have vsos and people out there that are very willing to help. We have to make that connection easier. We are in conversations with the National Association of the state and veteran affairs. We have not been a first rate partner into our state partners on this. We give them down to. It is not readable. It is not usable. We are trying to make that better. Heres a suggestion, as governor i would call the states 800 number just to see what you would get as a consumer. Think of yourself as the customer, that is a good way to put Something Like that. The state directors of veteran affairs in each state working with each of them and each of your states they are not shrinking violets we are hearing from them that they have not been a good partner we do think that that ready handoff is really important. In a limited time just a couple of points. Im still concerned about on boarding time and the cumbersome notes of the hiring process. It strikes me that decentralizing it to some extent would be good, number one. If you need to hide and a Administrative Assistant he shouldnt have to go through boston and washington. Number two, reciprocity. If you have someone who is in customs and border patrol, they dont have to go through a whole new process of background checks. Reciprocity would speed up the process. I hope that, again, this is one of those things where if we were going to design a hiring process from scratch on a blank sheet of paper what with the look like. I appreciate that very much. We feel like weve ha