Test test. Test. We want it to work like medicare. Help us do that. The choice law has eight different eligibility criteria. We have to determine if theyre Service Connected or not. We have to determine if they have another Health Insurance or not. We want to be able to get to the point where it is actually i only have 30 seconds left. We promise to work with you on that. Could you tell me when Eastern Maine will get 13 million and when maine medical will get 9 million . I dont think its 13 maryland but were meeting with them this week. They think its 134 maryla m we dont. Whatever we agree on we will cut a check and make his day. Is it going to be in three weeks . Three weeks. The weather is clearing up. Its a good time to be in maine. Thank you, member chair. And thanks for organizing this committee hearing. Secretary shulkin, congratulations. I live in california, a lot of new americans where english is their second language. First question to you, the number of latino veterans is rapidly rising. Over the next decade theyll make 15 of all of the veterans. With that many mind, maybe language challenges. How are latino veterans finding and fairing under the Veterans Choice Program . I have not seen a specific study on that issue. Its probably a good thing for our office of minority and diversity to take a look at to make sure that theyre not fairing any worse. Our workforce tends to reflect the makeup of our veterans since more than 40 of our workforce are veterans. We do have a large contingent of Latino Workforce as well. And i hope that we are certainly meeting the needs of all of our veterans. But thats something that i think we would like to work with you on. Mr. Chair, i would like to see, you know, some goals or maybe some data on that area. Yes. A lot of them, again, their families are spanish speaking. Possibly english is their second language as well. I want to make sure that language is not a barrier to them receiving the proper benefits, Veterans Services that theyre entitled to. Second question is an important one. Under existing immigration laws if a legal permanent resident veteran is convicted of a crime, even nonviolent offense or minor infraction, some of them face deportation. These men and women have defended our country with honor, yet their lives continue to be disproportionately affected. So are we doing anything to ensure that these veterans, resident veterans who fall into these categories have access to Health Care Without fearing deportation . That is, that is something that i think that were going to have to work with our general counsel on. I understand the concern. Im not aware of any particular circumstances right now, but we certainly we have a Veterans Court program, we have a veterans justice outreach program. We work very closely with veterans who do get into trouble with the law and we work with judges in particular on those issues. So i would hope that we could work in a way that would i would love to work with you on this issue. Orange county, our district was the first in california to have a Veterans Court. This is a unique issue in the sense that legal permanent residents who violate the law or convicted luose their residency and are being deported. I know a lot of them are concerned about where do they go, what do they access and do they face deportation. Theres a growing group of these veterans south of the border who are now living there because theyve lost their legal permanent residency. I would like to explore this issue with you a bit further. Thank you. Thank you, sir. Thank you, gentleman. Dr. Done, youre recognized for five minutes thank you, mr. Chairman and thank you secretary shulkin and all of you gentlemen for spending your evening with us. Im sure its exciting for you to be here. I thank secretary shulkin for mentioning dr. Tom starzal who passed away this weekend. He was a champion for the veterans and a pioneer in the transplant surgery realm. I was fortunate to study under him many years ago. Just yesterday a veteran i represent provided to my office an account of his experience receiving Specialty Care through the Choice Program and it underscored a number of challenges that weve discussed here, particularly the veteran encountered poor communication between the va and Third Party Administrator and also the va and his choice provider. And it severely delayed his access to care. Automobile though he ultimately did get an appointment with a podiatrist through the Choice Program, the nearest provider was hours away from his home. And he had some difficulty getting his prescribed custom prosthesis and orthotics. Ultimately he did the math on the multiple round trips and the prosthesis was cheaper and the medical care was cheaper out of his pocket. And thats what he did. This letter is amazingly lucid and articulate, polite letter. Ill make it available to the committee. It reads like a Marx Brothers skit. What should this committee keep in mind in regard to the particular needs of the Specialty Care patients like this and how is that different from the primary care referrals. This is sort of a special situation. Yeah. Well, what we are doing to make sure that we get this right is we are doing community by Community Assessments because theres you know, just like real estate, all health care is local. And so there are some areas that have oversupply specialists and some under supply. And it sounds like your constituent lives in an area where there might be a shortage of specialists. On your panel clearly. I know there with specialists near him but for whatever reason theyre not on the panel. Were continuing to grow orb network so if there are available specialists in the area and we have a shortage of them, we are continuing to grow that area. We actually have a slide of this where you can see the progress that were making in provider growth right now. It might not pop up. Oh, there it is. 133 growth. But we need to continue to build out the network and stories like that are impactful. Im glad youre going to make it part of the record and we can look at that. Im also my practice, we were on your Choice Network and i will say that a lot of times the problem was not that the i mean the veterans are there in town, were there in town, we have slot thr them, we can see them. But the problems were authorizations. This system in a number of ways is dysfunctional. The Payment System is also pretty dysfunctional. More basically its important to get them in and get themm taken care of. They had to go back for authorizations again and again. What are we going to do to make the system work a little better . When we started our authorizations were only good for 60 days. We did a contract modification and made it for a year. So as we learn the problems in the program, much like the way that youre describing, we are doing these modifications. Weve had 70 of them since the contract started. So they would come to see me and they wouldnt be able to get xrays. I would see them, prescribe them medicine which they would have to get at the va, they couldnt get the xrays. I couldnt see the xrays. The delays were just atrocious. In addition to lengthening the care, what were doing now is doing bundles. If youre getting your hip replaced, the pt comes with it, the mri comes with it. Were trying to tackle that problem as an episode together so we dont split up and we maintain continuity of care. Thank you. We look forward to working with you. Were excited about the possibility. Mr. Chairman, i yield back. Youre recognized. Thank you everyone. Good morning. From where im from its 11 00 in the morning. I know i have been nodding off a bit but when it takes you 25 hours to get here, you get tired. And because its so far away, mr. Secretary, congratulations, sir, on your appointment, on your confirmation. I truly wish you all of the success in your term in office. You were successful in your previous job running a huge hospital. But the veterans believe that our country has forgotten them. I dont stop anywhere in the country going home or coming back. But i stopped over in hawaii, i met dr. Hastings, i urged him to complete the contract that he was negotiating with one doctor who actually now provides service to a certain number of veterans, the only doctor on the island providing service to veterans. And then we now have one vha employee. But the country, the veterans feel that the department that is tasked with administering Veterans Benefits and services have done little to change their feelings about their being forgotten. Over the years in the last nine month my office has seen increasing complaints from va receives members, their family members that no use of va resources have brought in people who helped with teach iing methods. For people with ptsd i brought in a documentary and tom, who walked the country to learn how to handle his demons. I just had a resource fair a couple of weeks ago and i have never had a more successful fair. We put together all potential resource providers and brought our veterans in. And were very successful. And then all of the sudden comes senior administrator from hawaii and his deputy and they couldnt make it to the fair but now theyre having a one and a half hour town hall, after stopping in guam for the night. So my question is, will you pledge to work with me, please, to improve the quality and access to va services if our veterans . Im from the Northern Islands. Somehow we truly are we truly need your service, sir. Yeah. Id like to come and see you and lets try to figure this out together. Thank you very much. Thank you. That committee is important. Mr. Missal, thats you, sir, right . Yes it is. Inspector general . Yes, sir. In your evaluation of the Choice Program implementation, what have you found to be the experience of veteran patients in the outlying areas or insular areas or territories, some people say in the colonies such as the northern accessing health care in a timely manner under the Choice Program . Well, sir, weve looked at it in a number of different ways. We havent just isolated it in those particular areas you mentioned. But the same issues we found, whether its with vision 6, whether when we looked at it more nationally are going to be the same issues that impact people in those more rural areas, which are the complexity of the programs make it very difficult to administer which increases the time involved. And then one of the other issues that i know weve talked about already is the care coordination, to make sure that when a veteran leaves the va system one of the strengths of the va system, its an integrated system where they can watch very closely the care for the patients. When they leave that system, you have to make sure that the records go out with the patient and you have to make sure they come back in. And weve seen challenges to both of those situations where theyre not going out as quickly and coming back as quickly as they should. Well my question was, so thats the experience you have found in veterans accessing health care in a timely manner or is that an answer that says really that you dont know what youre talking about . I would hold that answer and well come back a little later. Mr. Rutherford, youre recognized for five minute. My time is up. Mr. Secretary. Thank you for your long testimony here tonight. Youve probably heard the old saying that vision without action is just daydreaming and action without vision is chaos. And sometimes i hear from veterans in my district im from florida 4, which is the Northeast Corner of florida. We have a very large veteran population. Sometimes they talk about the chaos of the system. But ive heard a couple of things here tonight that really struck me. One was that your number one concern, and it happens to be mine as well, is veteran suicide. Yes, sir. Im very pleased to hear that. In addition to that, i heard that another vision you have is that the va is going to get out of developing i. T. Software and those kind of things and look for those off the shelf type packages. Those are significant cultural shifts i think within the va. Yes. Could you just give me one or two more yeah. That you have you know, visions that you have about the va and how to yes. What will change the culture . Yeah. The three biggest areas that im focused on are number one, giving veterans additional choice. And you know, i think that ive already explained tonight, this means keeping the va system strong. I happen to believe the way you keep the va system strong is by allowing veterans to decide where they want to get care. Right. And giving them more choice. And i believe thats going to make us a stronger system. I think it goes along with, secondly, what dr. Roe has introduced, which is accountability. For me, account aboability w had that discussion as well. Accountability is not only making sure that if you lose your way and lose your value you shouldnt working in the va but also that the secretary has the tools to recruit and retain the very best in health care. And i do believe we have among the very best Health Care Professionals in the country working at the va today. I want to keep them there. And third is i want the system to be modernized. I believe that veterans deserve the very best this country can offer, modern i. T. Facilities, modern programs and proof professionals and technology. Those three things are what are driving the transformation of the va. Thank you, mr. Secretary. I believe the entire committee looks forward in working with you and making that happen. In light of the hour, mr. Chairman, ill yield back. Thank the gentleman for yielding. Thank you, mr. Chairman, thank you mr. Secretary and all of those staying in the late hours. I this were all extremely ha l heartened to hear about the i. T. This issue about coordinated care, i had one of my round tables yesterday, someone came forward and said a friend of theirs had just gotten a 36,000 hospital bill that went straight to the veteran despite medicare. Medicare extension at that or Bluecross Blueshield and va and the hospital sent him a 36,000 bill. This is someone recovering from surgery, is already qualified, has served this country and is over 65. And that is just shameful and wrong and we absolutely need to have a system where that cant happen. They cannot as a first course of resource send that bill. I heard the same with the er care. The veterans get the er bills. They dont know what to do. Theyre told they have a bill to pay, they panic, they dont pay other bills, they pay the er bill and thats wrong. We need clarification of what the rules are. It should not take 150page manual. It just should not be that hard. On military suicide, were heartened to hear your commitment around that. I found for a lot its people who have not come into the system at all. So you may have the best care available, but if nobody is coming into the system, like my friend beto, i know our Veterans Centers are providing that care for our Vietnam Veterans right now. We need to figure out how to reach out over the last 20 years. Theyre not in the system whatsoever. Were getting those calls in our office. Weve had suicide calls come into the office and had to patch people through and track down their provider. Shouldnt be having to call your member of congress to get help. So we need to Work Together to figure out how to actually bring people in so that theyre not saying, hey, weve got great care but youre never going to see it. One of the issues you did not flag which i would like you to is on women veterans. That needs to be a priority. We are integrating our forces. There have been some unwelcomed news out of the marines in the last couple of days. If you want to talk about the damage that does to our system and ability to attract and retain and attain the brightest, that does real damage. And that underscores the need to have that kind of care. Its a little specialized. And as we look at care outside of the system, those distances become an issue. Mine is one of those districts, im in connecticut but it is rural. Northwest corner of my state looks a lot like vermont or maine. To actually get to a va facility might be 50 or 60 miles but theres a cboc thats 20 miles away. We need to deal with the issue where you may have outpatient thats really close but actually what you need is going to be further. So i would like your feedback on whether we can have choice recognize the difference between a facility thats within the 40 miles and actually what you need. And it may not be that specialized. If youre talking women veterans, it may be more specialized. Well, congresswoman, you have identified so many important issues, i dont even know how to begin to address them all. Let me try to make one point about each one. Putting the veteran in the middle with the bills, absolutely horrible. I am going to tell you what to do. Call 18778778817618. That is a special hotline for veterans who are in the situation where theyll being billed inappropriately and were going to get them out of the credit situation. On the issue of veteran suicide, thank you for your recognition on that. We know va cant do this alone. It has to work with the Community Providers and we are strongly looking for Community Groups and other partnerships who are willing to go into the community and reach people that youre talking about. On the issue of womens veterans, absolutely. Its an oversight not to mention it as one of our key areas, Fastest Growing group of veterans. We have done a lot but we need to do a lot more and its not uniform across all of our facilities, our specialized womens care but were getting there. On the Choice Program, as ive said, if i were designing a program, i would not have picked mileage and wait times as my criteria. I tend to think more clinically about how you meet Health Care Needs of veterans and patients. So thats what we look forward to working with you. If i