bob goodlatte. he once ran a sales and marketing firm in addition to being a public prosecutor and attorney in private practice. he's also served in the virginia house of delegates since 2002. democrat abigail will represent virginia's seventh district. she is a former postal inspector and cia officer. she later worked for a company now called eab and enrollment which helps colleges and universities develop more diverse student bodies. democrat jennifer laxton was elected to virginia's tenth congressional district. she has served as a public prosecutor and attorney in private practice. she was elected to the virginia senate in 2013. new congress new leaders, watch it all on c-span. >> veterans affairs secretary robert wilkie testified before a joint hearing of the house and senate veterans affairs

committee last week. he answered questions about medical care for veterans, the backlog of veterans claims and improving facilities for veterans. this is two hours 45 minutes. >> the committee will come to order. before it began i would ask unanimous consent to cox with someone beloved to sit on the diet is that in today's proceedings. during no objections so order. wow, thank you for joining us today for the joint hearing of the house and senate committees on veterans affairs. this morning we will discuss the implementation of the john s. mccain, daniel k. akaka, and samuel r. johnson department of veterans affairs maintaining internal systems and strengthening integrated outside networks act of 2018, better known as the mission act. the mission act is a truly transformative piece of legislation that will impact virtually every aspect of the care that va provides. developing it took many months of intense negotiation and close collaboration between our

committees, the trump administration, the department, and numerous veterans service organizations, stakeholders, and advocates. we should all be proud of our work on the mission act and of the benefits that our nation's veterans will derive from it in the years ahead. however, in many ways, the real work has just begun. almost six months ago, the mission act was signed into law. almost six months from now, one of the act's most noteworthy requirements, the creation of a consolidated community care program, will go into effect. today, at the midpoint between enactment and execution, we are here on a bicameral and bipartisan basis to evaluate both the progress that va has made thus far with regard to the implementation of the mission act and the barriers that may exist to full, on-time, and on-budget implementation in the coming months. seeing the mission act signed into law took the collective effort of all of us, working closely together with one another, with va senior leaders,

with the white house, and with our veteran service organization partners. seeing the mission act implemented appropriately will require no less than that same teamwork. in 24 to ask the choice act in response to a correctly categorized as the crisis in access. axis. a recent news article has criticized the execution of the program namely the high cost of administering these. while i didn't dispute the cost of this medicare expansion were-typical government insurance coverage, the choice program represented a transformational first step and have the eight provides care where and when it is needed. these contracts were stood up in record time and changes that were made both legislatively and contractually over the past three years as a programmer toward. and i will say this, as a physician, as the va at that point in time to do something no one could do which it stands up

a nationwide network in 90 days. no one could have accomplished that on time. the choice program is not perfect but it did allow for an undeniable expansion of access of care both integral to the va and in the community. this is what it is so important the mission act which will guide the future coronation of care to execute efficiently and thoughtfully. mr. secretary, thank you for being here today to provide concrete answers to our many questions about the work that the agency has been doing these last six months and the work that lies before you in the next six months and beyond. the importance and the enormity of the task ahead cannot be overstated, but i have faith in you and your team and i know that the considerable support of this administration and this congress is behind you. we want you to succeed. i implore you to be as up-front as possible today and every day about the challenges you are facing and the help that you need from us to ensure success for our veterans.

i look forward to working together to overcome any barrier that may be in your way. i will not yield to chairman isakson for any opening statement that he may have. >> thank you very much with abduction and thanks for spearheading calling this meeting today the first six months of the mission act. glad were doing. before i make my comments i want to say this. your service when working with you has been a privilege. you have done a phenomenally job as chairman in the house, have helped us in the senate immensely. your goal setting and what you focus on has been unbelievable, and with the exception of a few minor things mainly wormy whene might've dropped the ball, we have carried the ball and made significant changes in the veterans administration that are known for lasting a long period of time. i just want to publicly thank you for your cooperativeness, your desire to work. it's a great to have a physician at the top of the leadership in the house or the senate for that

matter, because we make better decisions when the people have actually done it, talking aboutt easy for some whose may was a professional patient if we need a professional doctor and to denigrate up and appreciate your friendship, what you've done and the leadership. and john deserves a lot of credit. he does a great job. let me say this. we are prepared in the next two years to do everything we can do to continue the cooperative spirit between republicans and democrats that we had on the senate side, and to work on fine tuning the action we passed and implementing things that need to be done to help you and the va, those who were here from the va, get your job done. we understand what's ahead of us is tough but we have no choice but to see to it that the ace functioning at the highest possible level picks up those of wrist that like for a nation and pledge their service to the soldiers, have the same treatment back to them when we are entering their healthcare and those benefits, they are promised under the laws of the united states of america. i look forward to serving with you and working with you and want to tell you how much i

appreciate the great job you've done. i want to tell my senate membership, and our committee members that here, we have had the greatest cooperative spirit. without the mission act fast in committee with only one negative vote, sailed through the floor. we realized we dropped the ball with you on one thing. y'all got the blue water navy through on a voice vote on the floor or suspension vote i think on the floor. we failed in the senate on two, wanted in one last week and i still have difficulty for her to objections. we will come right back and hit the ground running. secretary wilkie is denigrate jeff indicating who wants to work with us and help us where he can. i'm not going to let that bone, take that bone out of my mouth. a lot of people in the house committee have worked on the blue water navy issue. we have innocent as well and we want to the same teamwork as possible. i primarily want to thank you and thank secretary wilkie for bring a breath of fresh air to

the leadership to the va. he sent a great job. he took over after a problematic and tumultuous time but he's got a good bedside manner which most physicians, good position to pick he's doing a great job. we welcome you and all your va membership here today. thank you very much, chairman roe and merry christmas to everyone and the awesome audience today. >> thank you, mr. chairman. i wish the bulldog of georgia could've done something to the folks in alabama. i wish they could it happen. >> i can talk about what we want to do to the alabama people in public. i have to slip out and i apologize, not that i'm walking out on you that if one more thing to do on our side. thank you, mr. chairman. >> thank you mr. chairman. it's been a privilege to work with the senate this year, too. this term i should say, the last two years. and i was going to reserve a remarks until the end for you and i realize you had to leave but what incredible you and senator tester been to work with

us you. we never passed 80 bills now since had so many hurt in the senate, and our stats staff asu point out work hand-in-hand behind us to make this possible. it wouldn't have happened otherwise. either 29 for 30 pieces of legislation, just very briefly, a small thing like like a cont, the cable contract you might decide or a contract on an apartment, and your spouse loses the life in service to the country, you ought to be able to get out of the country for you, now gently will be able to do that. little things like that that don't seem like big things but if you're the person on the end of that, they are big things. i have seen and witnessed it with my friends who have had to deal with this. these ideas ib is a capable sif doubt want to thank all my colleagues in the senate and house post ideas. i will now you'll to mr. takano.

>> thank you, chairman. i look for to working with you in the next congress to serve our nation veterans. thank you ranking member tester for also being here. good afternoon mr. secretary. thank you for taking the time to testify before us today. we will always welcome the opportunity to speak with you about the progress you've made regarding the implementation of the mission act. it has been a little over six months since the mission act was passed, and seven months since you were confirmed as secretary of veterans affairs. i commend you on your hard work so far and assure you that as we move into the next congress you will continue to find a willing partner on this committee, meaning me, and as most, as the most bipartisan committee in this congress i intend to work with my colleagues on both sides of the aisle with you, mr. secretary, and with our vso

partners to ensure veterans get the benefits that they have earned. transparency and open communication between the department and congress is key to our oversight efforts and to ensure that our work here is effective. we asked for and need information from the department so that we have an understanding of the steps he a mistake to achieve the objectives mandated under the mission act over the next six months. we also need to know more about the reported outsized influence, a group of advisors may have had on your decisions, as va should not be subject to outside influence or the whims of individuals or interest who cannot be held accountable, and who do not have veterans interests best, veterans best interests in mind. however, va should ensure that the voice of veterans expressed

to our veterans service organizations are adequately considered when important decisions such as the adoption of the designated access standards are made. the term designated access standard seems a bit wonky. so what i would like to hear from you today is a simple explanation of what those different scenarios look like in practice. and i think to unpack designated access data, for the public we can simply understand them as the criteria by which the va refers veterans out to private sector doctors, outside, , non-a providers. what are the criteria? of course we know we began with an arbitrary criterion, criteria of 40 miles, living 40 miles

outside of aba radius, the radius of the va, of a health center, and somebody who has been waiting for more than 30 days. without those arbitrary standards initially, we would've spent large sums of money, diverted large sums of money to va health care dollars. support we get these standards right. the truth is we always, always at the va, the va has always embraced outside non-va medical providers as part of the solution. and so this is nothing new in terms of how we take care of our veterans, but we can't do that at the expense of making, of maintaining and adequately growing the interim capacity of the va. so these access standard outline when and where and how veterans will be referred to private

sector and how much budget we need to pay for the private sector we know is often more expensive than dea's internal services. and we know it is a multiple by the likes of the rand corporation and dartmouth university, vha care is often, is frequently of high-quality than the private sector. so standards that are too liberal for access to private care could easily jeopardize that high-quality va care that are most vulnerable veterans rely on as the dollars to support this care will be diverted into private sector care. so we need that right balance. so we need answers to these questions, and i remain concerned with the departments lack of transparency. for instance, yesterday we discovered via the media not the va that yet another veteran has

taken his life at the bay pines medical the epistle to pick this is the fifth suicide since 2013. we should not the first learning about this in the press but we should be notified immediately with facts will help us act so we can prevent of the veterans from taking their lives. the gao report requested by ranking member walz demonstrates a lack of leadership and commitment by the department to prevent veteran suicide. this is the departments top political priority. when veterans between the ages of 18-34 are committing suicide at the highest rate, the department still to communicate services and attempt to reach veterans in this age group via social media is shameful. va offers actual mental health service but the quote disabled american veterans, they are useless and actually preventing suicide, if the veterans and family members don't know they exist or are unable to access

them. now, it is simply wrong, simply wrong that only the 2000, $57,000 in funds congress prioritize to address preventing veteran suicide has been spent, and $6.2 million has been left on the table. now, i'm to her to achieving progress over the next two years and i hope that you will, in fact, make suicide prevention of priority that the department claims it to be so that we, as congress, can support, not criticize, your efforts. the same offer applies to the implementation of the mission act. the implementation thus far has been rocky, and all too often members, their staff and veterans who misled, or misinformed. in the next congress lets work towards having a productive relationship, and open dialogue so we can work together on behalf of the veterans we serve. i look forward to our discussion

today and hope that it is the beginning of a strong partnership between the department and congress. i yield back, mr. >> now you'll do ranking member tester for any opening comments. >> thank you, chairman roe, chairman isakson. if tim walsh were her i would be thanking him, , too. and congressman takano, thank you very much. before i get into my reinstatement i just want to say it's been a pleasure this last congress working with all the other three corners, and to think what make a relationship work is communication. we have tried not to surprise one another. we try to keep one another form, who want to go gigabyte example. i was walking over here to the string just out my staff member said dr. roe wants to say something about confirmations. he's concerned it might embarrass you. that's damn nice of you. i did want to tell you that. and give them hell in the confirmation because it's

ridiculous that the folks are not confirmed. the lesson want to say is bluewater. we just did live -- and of the ds those have been providing information after information at information on this issue. i'm going to tell you, if we are not willing to take up our veterans, we shouldn't be making them, , and upon what is, is wee got to get this done. the site is clear and i would say that i think maybe the folks in the legislative branch don't realize it, but we're different than the executive branch and we need to make the call. if you want to veto the danville, then let the executive branch feet away. in the meantime we need to take care of our veterans. secretary wilkie, thank you for being here. implementation of the mission act was going to finally transform the delivery help system for our nation's veterans. for more than you would all work carefully with the white house

energy to negotiate the text of that bill. we were in regular communications the on how it intrepid and implement the bill. passing back and forth, tech to process its insurance were all on the same page. since that time i have grown increasingly concerned with the departments plan implementation of the new veterans community care program created in the bill. secretary wilkie, the va is moving away from the russians had just six months ago. make no mistake about that. the most dramatic example as to do with the va designated certain types of care as nearly automatic eligibility for community give it six months ago we agreed it veterans face excessive wait times are driving times distance to access certain services at a va facility they should be offered referral to the community. specifically we discussed designate access standard for services like routine lab work and x-rays. we agreed to give the va the authority to decide exactly

which services are categories of care should make veterans automatically eligible to receive care within the command. now that we passed the va mission act, va has decided to head in what i believe is a completely different direction. the eight now indicates the plans to visit texas dems that apply to each and every type of care of veteran might need. this would essentially outsource all segments of va healthcare to the community based on arbitrary wait times are geographic standards which were supposed to be moving away from by ending the choice broken. that is despite the fact that several studies, one is recently as last week, have indicated the quality of care at the va is good or better than the private sector. let me say that one more time. because it's not safe enough, as recently as last week we received yet another study that indicated that va care is as good or better than the private sector. to make matters worse va

officials have offered only vague verbal descriptions of the various sets of potential access standards under consideration by you, mr. wilkie. it also can certainly each that we discussed this issue in the last two months va officials that give as one of the tube investments of budgetary resources needed to implement these sets of access standards you are considering. for example, if the department uses go with the same axis confused by tricare prime we've been told could cost anywhere from 1 billion for the first year, to more than 20 billion over five years. some of the v.a. estimates indicate the cost will be less than what we spent on choice but would make a greater percentage of veterans eligible for community care referrals. that doesn't make sense. we need to know what you're doing, mr. secretary and how much it is going to cost. no conflicting or they vacatedo fuzzy math, no games because the stakes are simply too high. mr. secretary, 96 months ago you came before the the senate vets

for committee and you said you would oppose attempts to privatize. if you move further down this path gutting for the health-care system for those veterans who want and need to use it come you'll end up bringing down the whole boat. you will spend whole of the time and money sending veterans in the committee for care that is less timely and not as high in quality. that's a bad deal for taxpayers, a bad deal for our veterans who would ultimately bear the brunt of cuts to other services or benefits to cover the increased cost of community care. that will lead to a bad deal for veterans because at some point you will burn through the funds quicker than expected and come to us because vha is running out of money again. veterans will be in limbo when seeking community care as congress sorts at the va's fiscal issues. i'm frosted because this thing would have a great opportunity to talk with the great work being done by the employees across this country every single day and, indeed, they are. and another critical work will

be bolstered by additional healthcare professionals. and about a stream on the very va community care program in the new community care network will make care more efficient, more time with them seamless for veterans. instead we are here left can't figure why the v.a. decide to take things in a different direction than what i put congress intended and certainly what veterans have advocated for. my suspicion is that it is politics. i hope i'm wrong because at the end of the day i really hope that meaningful consultation will take place before final decisions are made. we've got this far by working together and by taking our cues from veterans and it would be shame undermined the efforts and relationships because they political agenda. i said it before and i'll say it again. i have tremendous faith in you, secretary wilkie, to make sure that the is run in a way that our veterans deserve. we need to really step up and do it. thank you for being here.

>> thank the gentleman for yielding to we are joined on our first and only panel today by the honorable robert wilkie, sector of the department of veterans affairs. welcome. thank you for being here this afternoon. the secretary is a company by dr. melissa glynn, assistant secretary of the of enterprise integration, and dr. steven lieberman, the executive in charge of veterans health administration. thank you all for being here. secretary wilkie, you're not recognized. >> thank you, mr. chairman, and thank you, chairman isakson, chairman elect takano and senator tester. distinguished members of both committees, i i want to thank u for the opportunity to address the efforts underway to open the v.a. mission act as well as share with you the governance and management approach institute over the last 130 days. as you have said we are on the cusp of the greatest transformative. in the history of va, and your leadership led to the passage of that historic legislation.

as i testified in front of the senate veterans affairs committee earlier in the year i am happy to report the state of the department of veterans affairs is better and it is better because of the work of these committees and the attention paid to our department i the president. as secretary i visited 17 states in 130 days, 23 hospitals from anchorage to orlando, four lens processing centers and the veterans treatment court in maryland. and as senator tester said am astounded by the commitment of the v.a. workforce. it is dedicated and it is in my opinion the finest workforce in the federal government. today am honored to have with me to make senior leaders, dr. lieberman and doctor melissa glynn, the assistant secretary for enterprise integration. we are committed to implementing the mission act by june 2019, and describe how that commitment

is being fulfilled. we have established a task force representing key offices across the v.a., and guided by experienced program leaders. we now have a battle group of progress reviews to align resources, identify and mitigate risks, and deliver on the promise to transform va healthcare that puts veterans at the center of everything that we do. this effort is emblematic of a new government in management structure we established that the department. that is how we were able to identify that the technology supporting g.i. bill implantation was untenable. i made the decision to define a new approach to deliver education and housing benefits to our veterans and their family members. i want to emphasize will execute the law as written at every post-9/11 g.i. bill beneficiary will be made whole other housing benefits based on both sections 107 and 51 of the forever g.i.

bill. i made the decisions that only destabilize the delivery of services but to improve the current choice programs, expansion and extension of the triwest contract ensures access to community care for our veterans. decision allows for smooth the transition to the community care network contracts when awarded. after multiple delays prior to my arrival at v.a., the acquisition process and subsequent awards are back on track. community care region 123 will be awarded before the end of february 2019 and region four is expected to be awarded in march. once active, these contracts will support a key pillar of the mission act by giving veterans expanded choice in their healthcare. as part of our new community care program we are addressing the timeliness and accuracy of payments to providers. we are moving away from paper claims and requiring provider to submit electronic claims to our

new electronic claims administration and management system that will be deployed next year. through the mission act we we'e established a center for innovation, care, and payment to develop new approaches to testing payment and service delivery methods. the center has developed a charter and is developing criteria for pilot projects to drive healthcare quality and efficiency. another pillar of the mission act is groundbreaking support for caregivers. there are 5.5 million veteran caregivers across the country. i had the privilege several weeks ago to address the third annual national convening of military and veteran caregivers jointly sponsored by the elizabeth woodall foundation and veterans affairs. the work of senator dole to invest in caregivers and their experiences strengthen our ability to successfully execute and expanded program comprehensive assistance to family caregivers under the mission act. i would be remiss if i did not

think the foundation of vsos for the efforts to making sure that this benefit was incorporated into the legislation, and i will take the opportunity also to thank in person someone who is familiar to all of you and who was instrumental not only in the development of the mission act, if the caregiver program, but someone who's been on point for veterans for many years, and he is retiring, and that's gary augustine, a disabled american veterans and i thank you for being here as well. the other most meaningful aspect of this legislation is a series of related products that ultimately support the work of the asset infrastructure review commission. these include outputs of national market assessments and our strategic plan, and a data driven assets and infrastructure assessment and recommendation, with input from our veterans, employees, vsos, local

communities and other key stakeholders. v.a. is embracing the opportunity to assess our footprint and develop recommendations for modernization and realignment of facility. mr. chairman, i would like to beg your indulgence for a minute, and going to go off script. it is partially in response to a series of stories that i read this morning, stories that have particular meaning to so many members of these committees, and it is on the issue of suicide prevention. when i was acting secretary of the department for eight weeks, i declared that suicide prevention is the number one clinical priority of the department. in addition to that i named a permanent head of our office that suicide prevention, dr. franklin, who was head of our efforts at the department of defense when i was the

undersecretary. in addition to that we have developed with the department of defense a streamlined and comprehensive program to begin addressing the issues that impact our veterans and the issue of suicide, beginning from the time that they list. our transition assistance program is done in conjunction with secretary mattis, and now thinks to the work of this committee we are including other than honorable discharge ease in our education and outreach efforts when it comes to suicide. the tragic and expect that aspect of this is up for the 20 american warriors who take their lives on a daily basis, 14 of those warriors are outside of the department of veterans affairs. when i i've gone across the country i've asked governors, mayors, vsos to help us find those veterans. when i was in alaska recently i

spoke to the alaska federation of natives. 50% of the veterans in the state of alaska are outside the v.a. system, and i've asked them to help us find those who might be in danger. suicide prevention is the number one priority of this department when it comes to our clinical efforts to keep our veterans healthy and well. in addition to that i do want to say that i echo what senator tester said. last week dartmouth and "the annals of internal medicine" indicated that the department of veterans affairs healthcare, medical care is as good or better as any in the private sector. that is the story i wish to tell. the other part of that story is, and it will come as a confounding statement for some in the press, that a conservative republican is here saying this. i am incredibly proud to be part of the workforce that i consider

to be the finest in the federal government. in my travels i have seen the dedication of our men and women, 370,000 strong, thousand strong, and it is my pledge to tell the good news stories that they have created on the behalf of our veterans. in addition to that, another story that i am proud of is that the partnership for public service, for the first time in memory, has now included the department of veterans affairs in the top third of all federal departments when it comes to workplace satisfaction, and the pride our workers have in being part of the v.a. that is a great step forward. without that pride we will not be able to deliver the kind of customer service that our veterans expect. in addition to that i'm also happy to say that the department of veterans affairs, when time issued its a list of the 50 most

influential healthcare minds and providers in this country, the department of veterans affairs had researchers on that list your it is a good news story to tell. it is one that i'm proud to tell, and i'm very happy and humbled to be part of that outstanding workforce that on a daily basis helps veterans remind all of us why we sleep soundly at night. mr. chairman, i thank you for the indulgence and look forward to your questions. >> thank you very much. and just very quickly since we have a large number of people here, i will be dropping the gavel at five minutes, including myself. appreciate you being here but ii would like to focus today on this hearing, on the implementation of the v.a. mission act, specifically the community care part because that is, that's coming up in six months.

and really it's literally, if we can do three things, i think, mr. secretary, if you can lay out and give me some ease about how i feel about this, one come to have, but we have networks in place? number two, can you schedule an apartment to the doctor in those networks? and number three, will you pay the bills once the veterans that seems so they don't get the bills. if we can do those three things my concern, we have the four regions of the country, the various regions have year according to the law to put these networks together. i know you sign the contracts three helped by february and region four by march. that's less than 90 days in the time this thing goes live, the last contract. because i remember april 2014 the fiasco that occurred there. some of those three things, when we go live, are you going to

need more time? quite frankly, if you say it isn't happening i would rather keep doing exactly what we're doing, and implement a month later than have this thing on his face every full of all the community care program slip into one and it not work. >> yes, sir. obviously the goal is to fulfill those commitments. i'm going to take a step back and answer the third part of your question first. and that is the timely payment to our community caregivers and particularly are small-town doctors across the country. without that the entire choice system contained in the mission act fails. we have learned valuable lessons from the experience of the choice. i do believe that we have the beginnings of a comprehensive set of standards whereby we will take to the country, to bring this community care providers

into the networks, the contracts are ready to go. we do have the lessons learned from, as i said, the problems that we had with the choice. right now, and i will go ahead and address an issue that was raised in a meeting this morning, triwest is the bridge to the expansion of our program to the community care networks. and i am confident that given the governance structure that we have in place that we will be able to reach those goals. i will also say that if at any time i don't think we can, i will be up here posthaste to make sure that we inform the congress of that contingency. dr. lieberman what to say anything about where we are in terms of the contract. >> so we're really pleased with how our contact has been going. we've been meeting weekly on

this and as a secretary said we expect it to be completed on schedule, as he told you. and then we're ready to go with all the topics you brought up. we certainly are implementing a number of things to help with the timelines -- hymen hymenaes included timings of the payments. we are going to be requiring something rare circumstances the payments be electronic which speeds up the claims process. we also are going to have an off the shelf product that will auto adjudicate the claims and pay them timely. >> and i would note, that's. the department of veterans affairs, as these, these committees have noted on more than one occasions, has an i.t. problem. when it comes to claims processing, hands have to touch each claim. what we've done is look to the market for off-the-shelf technology that will allow us to automate the claims process so

that individuals are not having to touch each claim, and this will put the department of veterans affairs in line with the most modern healthcare administrations in the country. >> my time is about expired but this is why want to have happen. if i'm a patient at a come to see the doctor and i need to go see a neurologist or whomever, i sing to the doctor that day, i walk up front, the v.a. does have specials in the hospital, i get my appointment schedule. i get it made. i go see the doctor, that information is transmitted back in the doctor gets paid. that's how the system works. i had surgery 18 months ago, two weeks after surgery the bills have been paid by the third party administrator, and that's how i know it will not be that quick but that's the kind of efficiency we want and hope we have. i'm not expecting it on june 7 but am expecting it sometime very soon. mr. takata, you are recognized. >> thank you, mr. chairman. mr. secretary, over the last few

months committee staff answered from various stakeholders including v.a., conflicting information regarding the v.a.'s development and/or adoption of, i talked to my opening statement of designated access standards. we've also from the asap, the president is likely to announce the adoption of a designated access standard model during his state of the union address. however, congress has not yet been made aware of which models are being considered, and the reasoning behind in the imminent decisions. would you commit to us today that you are willing to offer each of the four corners, and i would say members of the committee, but i mean it should be made available to all of us, a briefing by milliman who is the actuary, tried to the state of the union? and reasonably before the state of the union. >> what i will promise is that as soon as the president is

briefed, i owe him that courtesy and certainly he is responsible for the final decision, and once he makes that decision i will be up here with our team to brief this committee, these committees, or any comments and advice you have and any corrective actions that you might have. it's absolutely vital. i think i mentioned in my confirmation hearing, i grew up in this institution. i know what article one is the first article, and i will commit to coming up here when the president does make his decision. it is still not clear if he's going to announce anything at the state of the union, but i hope to have him briefed and have those decisions made. >> mr. secretary, i'm a a litte concerned that this decision could be made the night before he delivers his speech, and makes a grand speech about how every veteran is going to be able to any doctor they want to

see. that's one model, the veteran can see any doctor. of course that sounds good but there's lots of downsides to that kind of a model. all the more reason why come toe vsos, many of them are complaining that there's a lack of participation, as per what we said in the mission act that they should be participating in the development of these access standards. i'm really not set us up with the answer. i wish we are able to get better insight as to what models you are considering, what the costs are associated with each of those models. because that has a lot to do with how much money might be diverted from regular central v.a. care. >> mr. takata, let me answer the second part of the question first. in terms of engagement with the vsos. i can say that they are a vital part of what we do at the department. in my time as secretary we have

doubled the number of views of engagement that the department had prior to my arrival. the majority of our vso engagements are handled at the under secretary level, or above. over the last nine weeks, our vsos have experienced briefings from senior leadership in the department that lasts well over four hours a week. i will also tell you that in my travels across the country, i've made it a point to reach out to veterans organizations in the rest of the united states. in alaska i spoke to the largest vfw post i think west of the mississippi. i was just in your area of california, spent two hours with veterans leadership in southern california. if the same thing with the indian nations, the native nations in oklahoma, and also in

hawaii, on the big island and also in a wahoo. so that is important to me. if the veteran is not at the center of decisions, it won't work. but but i will see what comes to access standards, i have in mind that only senator tester state of montana when it comes to the building of our veterans to get to services but also have in mind some of the most heavily congested metropolitan areas of this country. we have to make it easier for our veterans to get the care that they need. but i will also say, and i repeat what i said when i testified in the senate in september, my observation, my experience, and senator tester said it earlier today, veterans are happy with the service ticket at the department of veterans affairs. i have not seen any indication that the majority of our

veterans are chomping at the bit to find alternative ways to take care of themselves. the most important part of this is the one that is not quantifiable, and that is the communal nature of veterans care. veterans want to go places where people speak the language and understand the culture. that is what i've experienced in my lifetime around the military, and that has certainly been validated in the travels that i've undertaken in the very short time that i have been the secretary. veterans will always be at the center of any decision that i make. >> senator tester can you recognize. >> thank you, mr. chairman. i want to thank mr. secretary, you and dr. lieberman, dr. glynn for being a country aware of an article published yesterday outlining the cost of the choice program. it was reported 1.9 billion, the court of funds spent on choice were for admin fees. i have a huge problem with that.

do you have a problem with that? >> absolutely. okay. so moving forward what are you going to do, are what are you doing, when it comes to admin costs for the private providers? >> in order to move forward, senator, may i please take a step back? >> quick step. >> this committee addressed the problems with choice with the mission act. the article in question addressed the problems with the system before mission was passed, before i became the secretary. i am cognizant of what went on with choice. you mentioned it. hastily put together in response to a tragedy in arizona. so it is my direction, and i believe because of negotiations that we've been having with potential community care

providers, that those administrative costs you will not see at the level that we experienced during choice because the department, i will admit, was taken advantage of because of the hasty nature that took place when the program was put in place. >> i will kind of except that. but a lot of the folks who were delivering the carried out under your thumb are close to one quarter in admin cost. close to one quarter. i asked my staff to find it with the v.a. was before choice, for admin, , but as i recall it was one at is not the cheapest delivery care system in the nation what comes to an admin cost. i would say that because i think i would say is this, and congressman takano talked about this. access standard models are expanded to the point, added don't think it was congressional intent for this. in fact, i know it wasn't for unfettered choice, we've got a big problem because it's going to cost more money.

the care isn't going to be good. i i talked to my opening statemt about blue water that is. june why we can't get bluewater folks covered? money. extrapolate this out levit. if it cost more to be in the private sector, if admin costs are high, benefits are going to be cut. so why use its the presidency decision, and it is, he's the boss, there better be some good, good information coming from you and the people that know better that this axis standard needs to controls about it. would you agree? >> i agree with you. i just want to mention that the administration costs are not as high as was quoted in that article. the number is less and it's actually been over years, so it is a much lower percentage. we have learned since choice was first implemented in a hurry, what we now move towards is itemization of the administrative charges. so there's now a range of what the charges are, and too close

to the amount those in the article per individual can but then with the community care network we have learned more and we're going to go to a new model which will further decrease the administrative costs. >> okay. so are you planning on putting over handicaps in those contracts? >> we are moving towards a standard that is similar to what the community does. >> so that is a no? you are not going to put caps and the? >> we certainly can't speak as i'm not advocating for what i'm saying is some has to have the think on this costs because we're talking billions of dollars. after the fact we can get it back. those of dollars that should be spent taking care of veterans. is that, so do we have a plan? because the truth is, with the mission act we passed it with the best of intentions but it could be a train wreck, too. i hate to tell you this but it is kind of in your lap. it is in your lab. so when we're talking about two

hi commissioner koskinen talking asses to standard models that were basically unfettered choice, we could end up with the problem where were actually cutting benefits where veterans moving forward, my guess is if you ask any of the vsos, that would not be could think such as one make sure that it on your radar screen. i got to have one more. you talk about getting information to the vsos. you talked about briefings. are you gathering information back from them? this isn't an information dump on the vsos. you're actually listening to them and find out what their concerns are. because i'm telling you it's critical. it's critical for us. it's critical for you. did you want and to that, dr. glynn? >> i can do it. absolutely. in fact, many of the people in the audience will be with me tomorrow morning in my office discussing what was discussed here, and they will be telling me their input. >> so not telling anybody under the bus here but i'm going to get a lot of vsos have talked to me about taking medication

within the va it's not where it needs to be. >> senator, let me add one thing to get. >> okay. >> add that quickly. >> i'll do it real fast. something is happening in the makeup of our veterans population. for the first time since the fall of saigon, half of her veterans now under the age of 65, which means they have different cares, different interests. what i've done in my short time is actually open the aperture to the table at the department of veterans affairs to bring it veterans were not traditionally heart of the system, purple heart, blinded veterans, student veterans. in fact, we have more veterans at the table discussing the issues with us that we've ever had, and that mirrors the change in active duty reserve and retiree population that we've seen. so yet my commitment that every

veteran who wants to talk will be heard and input will be given. >> thank the gentleman for usin using. >> mr. secretary, thank you for you and your teams presence today. i asked my staff to give me the statutory requirements of your consultation with congress, and it turned out to be pages. in the mission act you are directed to consult with us as you develop regulations. and the goal of that language was to make certain that congress was informed before the regulations were determined, , t a consultation this is this of what the regulations will be. my understanding is that those consultations that have occurred a progressively gotten better. we still want more specificity and you seem beheaded in that direction but i would encourage you and your team as we get those briefings to give us the details so that we can

encourage, comment, suggest an event a decision made at the department of veterans affairs. that was a very intentional aspect of the language included in the bill. let me see if i can get a couple of things in the four minutes i now have left that are specific. first of all, how you define can have the department of veterans affairs to find episodic care is officially important issue in regard to the mission act will be in permitted and what of care our veterans will receive. can you, mr. secretary, any specific way, tell me how you would find episodic care? >> i will let the doctor described that. >> doctor, thank you. >> so depending on what -- thank you. so it would depend on what the issue is. certainly we have six different criteria that go into it. if it is something where you require orthopedic surgery, require physical therapy, we

will bundle the care for that. where as if we can't but will provided outside. >> obviously informers there's not a way to be terribly specific but that it will be something will continue to ask you if i would tell you that might interest in these topics is generated by our case were, what veterans bring to our office and what problems they have had under choice. the idea to you have to go back to the va every time to get the laboratory work, the x-ray, that is not an efficient system and one that is designed to fail and not be beneficial to the veteran. would you commit that will be, will be a real review definition, mr. secretary, episodic care before the regular process? >> absolute. let me turn to access and which has been a topic of conversation by most of my colleagues have spoken already this morning. here is what i would look for in

today's setting. i'd like to have assurance that access standards will be applied to wear a veteran actually lives, not his post office, his or her p.o. box as a been the case in the past. >> absolutely. and i said on many occasions and most of my focus has been on the western united states. that is absolutely necessary evil going to make choice work. it's striking to me that still in 2018 we don't understand the skill of the american west. what you said is absolutely essential. if we're going to make access standards were. >> another piece of casework that has become a challenge for us is the definition of in the v.a., and that is that in circumstances in which our veterans are trying to access care, the fda's response is the care is available within the v.a., broadly. in my view the question is, is the care in the v.a. available

at the facility, the hospital where the veteran lives? and our veterans are being asked to travel long distances because the care is available in the v.a. but not geographically available. >> and that is one of the things that we will fix as a result of the mission act, and we will get a system in place that allows the veteran the opportunity to get that care that is most convenient to him and to his family. senator tester is gone. example i i use is the 700-mile round-trip in montana, kansas, the distances are almost as great. so absolutely. >> thank you, mr. secretary. thank you, mr. chairman. >> thank the gentleman for yielding. senator murray come here recognize. >> thank you, mr. chairman. mr. secretary, before i i get n the main focus of this hearing and megginson but the caregiver bill, i do want want to mention the current chaos with the g.i.

bill. it is unacceptable to we veterans technically veterans without a stipend or if incorrect statement or delayed stipend especially when they rely on that you pay for rent or food and it is unacceptable to put veterans in rome at to give tuition payment to the universities as well on time. .. especially in light of the recent collapse of aca, to explain why the department of education has stopped sharing information with the va. i'd like a written response back to those and we're all

very concerned about it, but i want to ask about the care givers program. according to briefings from the va, the department has ruled out narrowing the eligibility criteria for the caregiver programs, changing to the stipend, restricting veterans based on type of injury or disability rating. this seems to be va still focused on keeping people out of the program instead of making it work better for our vetera veterans. and npr talked about veterans were out inappropriately. this is a continuing program in the managing of this program.

when the va previously downgraded caregivers, va assured me that it had resolved the problems that led to this type of action. it's very clear that that's not true and i would like you to reinstate a ban on down grades and terminations until va can demonstrate that the serious management problems have been corrected and these outrageous errors will not occur again. >> senator, i would say caregivers is important to me. i'm the son of a greatly wounded warrior and i've seen my mother and family tack care of my father who passed-- >> will you reinstate the ban? >> i will-- i'm not familiar with all the rules, but i will tell you that the national public radio story, that problem was corrected within 24 to 48 hours. >> those are not isolated cases. we're hearing many of them.

>> and those cases, is my understanding, have been corrected because of directives from this department that people were not reading the regulations properly. so, my promise to you is that i am going to do everything i can to make sure everybody stays in the program. it's that important to me personally. >> can i have your assurance that no one else will be downgraded or kicked out of the program until you look and make sure that the regulations are being implemented at every level correctly? >> absolutely. i will make that commitment and will brief these committees. >> okay. and also, i won't have enough time, but i'd like you to get me what your guidance to the program 0 office issen guidance to the field on how this is being implemented so we can see what you're telling your staff. >> yes. >> okay. and i'm also very concerned about the implementation of the changes to the caregiver program that were passed as part of the mission act. before the expansion can begin,

you have to certify that a new i.t. system is in place and the law required you to have that system in place by october 1st, that was a month and a half ago. this was not a new requirement. gao's initial recommendation was made in 2014 and the va has assured us that it's working on that issue. i want to know when you will have that i.t. system in place and make the certification as the law requires? >> the goal is october 1st. i would not be telling you the truth if i told you that i was absolutely certain that given the state of va's i.t. system that that date will be met. >> that was a national correspondent and a half ago. >> yeah. >> the date's passed. >> i was talking about-- no, it's october of 2019. >> no. >> to certify that the i.t. works. are we confusing two dates?

>> that's your new goal. that's not the goal you were given by congress. >> the timeline to certify the new system is october 19. >> okay. >> we did miss the october 18 date. >> you gave yourself another year. >> there are two dates associated with the requirement. the first date october of this year was for validating and doe employing a new system. we have not deployed the new system, but the certification of that system which required prior to expansion. >> you totally defined all the requirements for that system? >> we have worked on-- we have totally defined requirements. we're working, as the secretary mentioned, on either acceptance testing of the system and we are working through that. we do not want to deploy a system until it's been thoroughly tested and we feel

is capable of serving caregivers and veterans need. >> that has been the problem i've talked and discussed with members of this committee. g.i. bill was a classic case, senator, of a program being imposed on a system that was incapable of handling it. that's why i had to make the decision to go back to the old system on the g.i. bill. the same applies here. the system was not capable of addressing it. i give you my commitment. i'm doing everything i can and so is the department to bring the i.t. system up to modern standards. the g.i. bill we're talking about a 50-year-old system. it's not acceptable, but you have my commitment that we're working with the best minds we can find to make va a modern health care administration and benefits--

>> mr. chairman, i know my time is up. and i've been on this committee 20 years and always heard we are into the going to get an i.t. system because there's a problems. every time it changes, and every time there are problems. we've got to get it right. >> i appreciate the gentle lady on that, and i've heard it 10 years. a lot of people are here, you're recognized for five minutes. >> i could yield back right now, but i won't. folks, we'll get to the heart of the matter very quickly. you're designing a system that you're going to implement for the benefit of the outcome of the veterans. in my district first district of michigan, if any system would work in that district, it will work anywhere largely a

rural district with some small cities. i'm hoping you'll factor in that whatever system you're designing to get the veterans caregivers in this case into a functional status, that you consider the tyranny of distance, the tyranny of weather, all of that. in setting up your network, i'm guessing although i don't see it in the slides, there are certain assumptions that you have made and certain risk assessment involved with those assumptions and i'd like to ask you just to take this for record. we don't need to talk about it here, but if you would give us that list of assumptions and the risks that you have, you know, put together, that would be greatly helpful. and i notice in the slides here, great slides. i would guess at these meetings that are, whether they be weekly, daily, bimonthly.

when you find a course correction as a result of a meeting or update that needs to be made? what do you do? i don't see that in the slides. i'm a pilot. you see a need to change your heading, change your heading, don't wait. >> thank you, congressman. right now our team actually is engaged in 180-day reviews back at the va on all of the provisions of the mission act. we are, as you say identifying risk and identifying as senator murray highlighted, concerns with things be like i.t. how do we take different parallel paths towards getting to that october date. we're bringing that through our executive committee and then issuing guidance to the teams, working through resource requirements, working through changes in project plans, understanding what our state

engagement protocol to make sure we can update this program-- >> i know on oversight investigation one of the questions was asked at every hearing. is there a sense of urgency? within your folks trying to implement and good people trying to do the right thing. this might sound like an oxymoron, bureaucratic urgency? >> yes, sir. and that's one of the reasons why a battle rhythm was implemented. as you know, i have a military background, not as extensive as yours. the department has never had governance for anything this complicated and we do now and we have time lines to meet as we would on the flight line in my air force flight. so, yes, and i'll also point back to what i said earlier about the attitude of those in the department, it's been my

experience that we have incredible support from those in the career leadership because they understand that va can't fail on this one. and, but i'm very happy with that attitude. >> well, number one, thank you for your service and all honorable service should be respected by all and i could just say personally the biggest is led by marines and that's what drives us. in the interest of time i'm going to yield back 50 seconds. >> i thank the gentleman for yielding. >> and one thing that they could do is confirm his assistant secretary for i.t. i now yield to miss brownlee. >> thank you mr. chairman and thank you, for being here today.

i wanted to follow up with senator murray's question with regards to the caregiver program. if i could, i heard you make a commitment, but i want to be abundantly clear that you are committing to us today to not modify any of the current eligibility requirements within the caregiver program as it expands? >> i am committing to review every case involving a caregiver who is in distress. i'm also committed to making sure that before any decision is made on the future of the program, that this committee is involved in it. and as i told senator murray, i will be reporting to her on the path forward. it's important to me personally because of my own experiences and we're going to get this right for the 5.5 million family care givers out there.

>> you mentioned earlier in response to some other questions with regards to the importance of the input of the vso's and veterans in general. you responded, i think, by saying even expanded that audience from younger veterans and trying to get a broader representation, which i think is good. on the other hand, the leadership of the vso's really lead by concensus within their organization and representing that broad sense. and so, i too have heard from many vso's, that don't feel particularly in the care giver expansion that they have or have not been involved to the degree that i believe, and i think that we all believe that they should be in terms of

properly making right decisions as you move through this process. >> well, you have my commitment and so do they, that they will be involved. they are involved in making sure that we make the right decisions. but i will fall back on what i said earlier, it's important for us, as you pointed out, to make sure that we hear from the entire across section of the nation's veterans. i have he a said in my statement and the caregiver effort. that would not have been able to come to the finish line without the work of what i call the foundational vsa and -- vso ap the majority of veterans in that family care at home come

from vietnam. some left from the korean era, the foundational vso's are the ones who represent the community most impacted by the care giver. >> can you commit to providing our committee progress reports in terms of i.t. system for the care giver so we can feel as confident as you do meeting the october, 2019 deadline. >> absolutely. >> in terms of broadly, the governance structure that you've set up for assistance in the implementation of the mission program, i think, you know, one of my frustrations on the committee, i've served on the committee now for six years, is that we have va representatives come to testify. they're updating, in this case, we're going to want obviously,

with the admission to program. many times they come, they avod answering the tough questions. response is usually we'll take it for the record, we'll get back to you. i have found i don't get responses. if i do, it's months and months later. so i just, you know, would like to get your commitment in it's you or others representing you, that you will provide us with the best information possible to be informed and prepared for our questions. and at the end of the day, you've set up a governance structure that's-- i want to hear from you that at the end of the day, the buck stops with you and that you alone are accountable for the

succe successful hopfully completion of the mission act. >> congress, i will say that having grown up in this institution, the time i've been the secretary and acting secretary we've seen a 20% increase in terms of the number of round table briefings that we've given to committee since the committee and staff and we have seen a 50% increase in terms of the actual engagemen engagements. that's part of the commitment i made to senator isaac and senator testtor. having grown up in that i'm aware of article 1.

>> thank you. . >> mr. secretary in my mind the mission act is making sure that the community care dollars that congress appropriates actually makes it and reaches a veteran. our committees have a spirited debate every year about the funding levels, but the reality, you could pick your analogy here, it seems like we've been pouring money into a leaky bucket or through a clogged up pipe. the when they're lost. they're not received in a timely fashion. when providers don't get paid, think drop out of the network and the veteran often ends up in collection. and for all the programs for community care, the mission gives the va the first chance in years to actually make the system work. now, my question to you though is this: do you agree that the mission

act merely makes it possible and laws is implementation of stronger audits, improved customer service, clear consideration to veterans. >> absolutely, absolutely, it is the greatest first step, but it can't stop. >> i appreciate that sentiment, but i do want to explore one aspect of that hard work. achieving interoperability with the community providers and ehr's is one of my top priorities. and i know when speaking with you personally it's one of your top priorities as well. the va is going to advance interoperatorability with providers that already run serner. what is the ehr's?

what's the electronic health monitor specifically attacking that problem? >> right now i will confess i'm not an i.t. expert. but right now we're testing those, those standards, those operations in the pac northwest and alaska, so that these systems talk to each other. our first goal is to make sure that dod and va talk to one another, we are pretty far on the road with that. the next is to make sure that we communicate with doctors in the private sector, community care hospitals. as well as private pharmacy. and to talk about those who are not a part of the serner. i'll say you're right about the interoperatorability pt and i will say to the issue of

privatization. i have argued that the success of the electronic health records system ensures that va will stay at the op -- at the center of health care and nonator what that veteran decides to do and that that is one of the answers when it comes to the issue of privatization. i see that as a veteran myself. i see that when i look at the experiences of people in my family as well. >> i appreciate that. one of the other processes is cla claim processing. working on contractors, whoever wins the contract, to bring to the stable a new and improved claims processing system. va is still going to have to pay the company somehow though, but the idea seems to be to

outsource the i.t. system along most-- along most of the claims paying function. can you please comment on the thinking here and how that will improve the situation? >> thank you. overall, we are making, as you have mentioned, as well there are many changes. it's not just the consolidation. and right now we're implementing an electronic's payment system. we are changing the way we will pay the third party administrators as well and they have the funding to pay the providers so all of that has to happen in tandem and as part of the implementation to get to june 6th. as you mentioned there are many aspects of this and it's certainly not just consolidation, the programs and new regulations. it's building up the technical structure communicating with

the community care program. and there will be changes in how the t.p.a. are paid as well. we have looking into fraud, waste and abuse. >> thank you, my time has expired. thank you for joining us today. are you aware that the congress heal budget office estimated that the mission act would cost around 46 and a half billion over four years from 2019-2023. >> yes. >> that number is familiar to you? >> yes. >> as far as i'm aware there's no pay for that specifically for that 46 1/2 billion dollars, right? >> correct. and those would be discretionary funds? >> yes. >> so they would count against the budget cap on va under the

current arrangement? >> yes. >> and if we went over this because of the billions or any other, that could sequestration. for that 46 1/2 billion in order to avoid sequestration we'll have to find the money in va's current budget. >> correct. >> have you aware that the president has asked each of their agency cut their total budget by 5%? >> yes. >> do you have a plan to do that? >> i've discussed the plan with o and b. >> and what is it. >> i will wait for his decision. >> will the money for community care be cut by 5%? i am-- well, first of all, love to say

for the choice program we're fully funded. er woo' -- we're funded until next year. i would say in the submissions i made there were no cuts in the community care. >> so the 5% would come from the rest of the budget that does not contain community care. >> absolutely. and as a steward of the taxpayers' money i'm going to do my best to make sure we're as efficient and lean as possible. >> so actually the noncommunity care part of the va's budget is going to be cut twice. it's going to be cut by the 5% requirement and cut by whatever needs to be spent on community care. >> well, we don't know where it's going to be cut. >> i have made proposals. >> you have made a proposal. >> i have made with a pap sal. >> and you're not going to scare that--

>> does it make cuts to paern? >> it's efficiencies. >> are there fewer than today? >> no, can't say that. i can say we've hired 11,000 more employees the at va. >> so we have been hiring at a very steady rate. >> will you committee to providing us before the end of this year an itemization of the things that you propose to be cut with that 5% requirement? >> i commit to discussing with the committee at the earliest possible date the decisions that are made by the people who are responsible for those decisions. again, i owe the president the courtesy of having him make the digs and then come to the nent

and you are the ultimate arbiter. i can tell you from my experience what usually happens in democratic and republican budget comes to congress, i can't think of the way one passed as it came over to the white house. that's just the practical nurture of the base. >> do you think when you'll find out? >> i certainly hope in the next few weeks. >> we have your commitment once you receive word from that on the proposed cuts. >> once the president has given the all-clear and you know the dance that goes on with the budget process, usually coming in to the finish line sometime in february. i will be as transparent as i can be as the system as it

exited all the way back to 1974. >> we'd like to see an itemized proposal you have given to the white house and we'd like to see that at the absolutely earliest day. >> okay. >> thank you. >> just to clarify, the fact that you would cut 5% doesn't necessarily mean it would come out of the va's budget and i would refer to this graph here. these are the number of employees here, mr. lamb, that have been hired and i've been here ten years and looked at this and the va has had an average of employees to the left, from 2013 to 2017. >> about 25,000 a year and averaged hiring 31,000 during that time. we we go back, we've gone from 97 billion when i showed up in 2009, to i think the last

budget was 106 billion. so it's over doubled in the last ten years and we found that money elsewhere in the caps. it didn't necessarily come from the va. the va benefitted under the caps. >> mr. chairman, may i make a comment from mr. lamb's questioning? >> yes. >> i may be ahead of my skis, i come from the department of defense, i'm in the other department in the federal government whose needs and mission is unique. you've served in one of the two defendants and as the chairman has said. our budget has been going up, it is at record levels. i do expect the president, is to continue his robust support for this department, as he has for the department of defense. we are different and as the

chairman has said that's reflected in the increase of our budget and priority in which this administration has placed on both department of veterans affairs and the department of defense. >> thank you, yeah, for yielding. your recognized. >> i want to thank chairman isaacson and chairman roe and ranking members tessa and walter who is not here. and chairman elect o'connell and thank secretary wilkie. and i want to thank you for keeping with my staff on the status of the community network care contract in the u.s. territories. the territory including my home, differ from the united states of the -- special care

must be taken to ensure that the unique health care needs are considered and to that end, i'm glad they're looking at the uniqueness of the care tris and handling the contracts separately. secretary wilkie, the va staff briefed my office on contracts last month and i'd like this opportunity to touch on the topic once again? >> could you go over by the uniq uniq uniq unique challenges will affect the contracts and requirements and could i get your commitment to work with congress so that implementation of the mission act, the contracts and any future related legislation is in line with the needs of the territory. to put it another way, will you help us help you provide for

our xik veterans. we want to make sure. >> i just returned from hawaii and i made a commitment to one of the governors, american samoa and guam and martin may mariann mariannas. and the same applies to the americans in the pacific. no group serves in the military at a greater rate than the men and women of the pacific islands or the native peoples of the continental united states. the unique nature of the

challenge is 4.5 million square miles that we have to take care of in the pacific. my commitment is that special c categorization of the islands in the pacific will address the unique needs. we'll make sure, particularly through the implementation of additional telehealth services, more robust visits from our major medical center in hawaii to the pacific islands, that we always take care that the islands are recognized for the special needs that they have. and i just wanted to add and you were probably briefed on this, that we want to look how tri-care has succeeded in these areas. lessons learned from them, also. and yes, we have to get this right so we'll continue to work

until we get this right. >> thank you, mr. chairman. i yield back. >> thank you gentle lady for yielding. you're recognized for five minutes. >> i want to thank chairman roe and these are incredibly important issues and served decades ago and it's relevant to today's hearing. we owe is to them. if we're not managing these appropriate will i they will not be able to get the care they deserve. they said when you bought it broke it you bought it. and it's to not just the will, but the means to do right by them and i thank the senate for enduring efforts to get this passed. and i want to say something on the care givers. several of us worked on this area and it's an area where

we've made commitments and we know it's the preference of our veterans and we need to find a way to honor the commitments and that brings you me to today a he is hearings. we've made promises to people that we're going to get them care where they want it, how they want it and in order to do that we have to manage those budgets. i see i have not lost all of my time here, but we will continue on. it is 12 seconds already. will you have sufficient funds in the 802 account given what we have now, in the community care networks in the 802 accounts, given closeout and authorization and contested claims that you need to finish? i want to make sure that you make that transition to mission, but we can't let go of what we currently have. >> let me assure that overall

we are monitoring on a very close basis the expenditures of related to 802 and the current choice and p c3 programs and we do believe in forecasts that we will have funding available through the end of this fiscal year and have taken account all closeout costs in these projections. >> doctor, if it's not correct, please let us know. we should not be hanging in that transition. >> you are correct, this is the wave of the future for medicine, for va care, particularly for-- even though the majority are from the vietnam era, for the new veterans. they demand service at home. they expect service at home and the trends in medical care in this country, as you've rightly pointed to, are that people get

better when they're at home. and you have my commitment to do everything i can to make sure that this is fully funded and it reaches every veteran that we can touch. >> thank you again, secretary for being with us today. i wanted to just review from the very beginning what the time line we are to expect right now with the awarding of the contracts for regions one, two, three and four? could you go over those again? because they're a little different than what we had in breaching and i want to make sure we're all on the same page, please? >> for the one to three is by the end of february and 4 is by the end of march. >> all right. well, we will want to be, you know, looking at that time frame again. and i'd like to return for a moment to the discussion we had on the number one clinical priority, and that is on military suicide prevention and it is, secretary wilkie, in

part that connection between the handoff from dod, to the va. that's something that we need to do a much better job of. i would suggest most of you working with us on the committee really believe that a check back in six months after returning would be a very helpful time to make sure that people are in the system. that's number one, but number two, i do have to push back, as my colleagues have, if we know for younger veterans that they are using social media and they are not already involved in the system with va. why in the world have we barically touched the money that this congress has allocated for you to do that outreach? it's just astounding to me, knowing this is a group who is not in the system and they need different ways of being connected and we are baffled as to what this epidemic of military suicide how we've done so little to use the funds that we've allocated. >> so, we actually used one and a half million of that, not

as-- as the year end up that we used the 1.5 million, but overall we've used 12.2 million we spent last year in outreach and done a number of different efforts. we in nielsen top ten for the public service announcements. we did 22,000 outreach events. last year our suicide coordinators reached 2.2 million individuals. we also had the be there campaign. i don't know if you saw the advertisements with tom hanks and had over 100,000 hits to that site. so it's actually been very active and this year i'm making sure that we have spending the funding 100% and so i'm reviewing budget monthly and making sure that this moves forward. we have certainly obligated all the dollars and we have plans to reach out, including social media this year. we have to get it right. >> and i will also say i was

responsible as the undersecretary for personal readiness for instituting the training and the awareness on the part of pentagon commands on the challenges and the threats to our servicemen and women regarding suicide. we instituted the transition assistance program to include those markers indicating that there's a potential for a very tragic event. secretary mattis is committed to that. i am committed to being part of that. we also, thanks to this, these committees, are treating those who are-- who have, other than honorable discharges, and making sure that they have that transition assistance and that we join with the department to try to catch this before it becomes tragic. >> thank you. and i yield back. >> thanks for yielding.

senator, you're recognized. >> secretary wilkie, thank you for being with us. we appreciate your service very, very much. i've had the pleasure of serving on the committee over the years and i've seen the va go through pains of implementing many new programs. this congress we passed significant legislation that will bring, quote, fundamental transformation to the va. as you know, when the va fails to properly implement programs, these committees become the back stop to ensure resources are to mitigate impact to the greatest degree possible. during a staff briefing about how the va is going to fix implementation of the housing--

they were unprepared to answer basic questions on how much funding spent on reaction to the problem and what lessons the va learned from the situation that it can take forward to other implementation efforts in the future and underway at the current time. these aren't hard-hitting questions, these are just the basics. more to the topic of this hearing, va staffer had a meeting with your staff to get an update on where the department is with determining access standards. a key factor that will have an impact on our va funding levels. when i hear that one set of information is provided authorizing staff and another set of information is provided to appropriating staff and a different set of information is provided in briefing to all committee staffers, that's a problem. and i agree with you totally, the va is filled with truly wonderful people, but when your

staff comes over without their act together with no semblance of transparency, that reflects on va leadership which you have direct control over. you know that it just works better when we can trust each other and work together. we simply don't have any other choice. for fiscal year 19, the congress appropriated 5.2 billion for the veterans choice fund and 9.4 billion for community care. can you tell us what the current burn rate and care is in the programs? >> it's-- i don't remember the exact number, we can get it for you, but it's-- >> it's in two different ones, 460 or 340. >> it's my understanding it's around 460, but we'll get back to you with the exact number. >> and you're saying under

current estimates, funding is sufficient. i guess the next question would be, if it's not and times have come up in the past where it wasn't. how does va intend to address any possible shortfall? >> well, i would certainly come to the congress with that. let me talk about the burn rate for a second. one of the things that we saw with the choice act is that many viewer veterans decided to take advantage of it than was originally projected after what happened in phoenix. of those veterans eligible for 100% care outside of the va, less than 1% took advantage of that. that number of veterans is in the 3 or 4,000. so, every trend that i have seen indicates that we are well positioned to take care of choice funding for the rest of this year.

>> as the va, develops regulations of things like rates, access standards to the admission act implementation, many decisions will have significant budget implicatio implications, certainly those do. we understand the va looks at multiple options tri-care, choice and-- what is the budget for the range of option? when will you let the committee act care to cost annually? >> i expect to be here as soon as the president approves the recommendations that i give him. in terms of the excess standards, i perceive them to be a hybrid of several of those trams that you just discussed, cms, tri-care and and that we will come to a conclusion based

on the combination of those standards and what is best for veterans, but i will be up here as soon as the president approves of the access standards. >> thank you. and thank you, mr. chairman. >> thank you for yielding back. senator, you're recognized for five minutes. >> thank you, mr. chairman. let me get unanimous consent to place into the record a recent article that appeared in pro publ publica and political act. >> without objection. >> thank you. it talks about the fact that several private companies have been paid nearly $2 billion for overhead, including profit to provide health care to veterans and that's about 24% of the

company's total program expenses. so we have enormous administrative costs in private care for veterans at a time when i hope we could agree. but the function of the va is to provide the highest quality care to all veterans in a cost effective way and mr. chairman, my ongoing concern in this article kind of demonstrates that, is that we are in the process of dismembering the va, taking resources away from the va and putting it in the private sector and the result will be many of our veterans will not get the quality care that they deserve. mr. secretary, it is no secret, and by the way, thank you so much for being here. it is no secret that i opposed the mission act. there are parts of the law that i obviously export like expanding the caregivers program and loan debt

reduction, houwever,ry remain concerned this law forces us to be in a situation where the va pays for private sector care at t the-- i remain concerned about the level of understaffing at the va that continues to exist. i fear this is nothing short of a steady march toward the privatization of the va and i think sometimes when people talk about the privatization. va they think that one day the secretary is going to come forward and he's going to announce the va is now privatized. that's not the way it's going to happen. it's going to happen piece by piece by piece until over a period of time there's not much in the va to provide the caught quality care that our veterans deserve. no one disagrees, we've

discussed this a million times, that veterans should be able to seek private care in cases where the va cannot provide or when wait times are too long or veterans might have to travel long distances for that care. there's no disagreement. the va has done that. but the way to reduce time is not to direct sources outside of the va as the mission act does, but to strengthen the va. va should be focused on recruiting and retaining the best health care professionals in our country to care for those who put their lives on the line to defend us. va should be focused on investing into its aging infrastructure so veterans can benefit from the best health care facilities and va focused on significa figuring out the b needs for our veteran patients. mr. secretary, let me start off

by asking you a simple question and that is the veterans organizations, to my mind, do a very good job in understanding where the veterans are at. the problems that the veterans of our country see when they interface with the va. to my mind what the law says is that you are to consult with t the-- that's what we have in law, but that does not mean a one-way discussion. it doesn't mean you telling them what's going on. it means you are listening to them. so let me just ask you this, mr. secretary. can you tell me exactly in as precise a way that you can, how you have solicited feedback from the vso's and how that feedback has been incorporated

into the regulations currently written on quality and access standards. mr. secretary. >> senator, in the little lease than four months that i haven about the secretary, i have doubled the number of vso engagemen engagements by including groups that represent the new breed of veterans and even some that represent veterans going back to vietnam that have not been included, the blinded veterans, the purple heart veterans. i'm meeting tomorrow with many of the people in the audience today. it's absolutely essential. i have served. i have a long line of family service. without talking to the veterans, and i say talking to the veterans, when i'm out in the country in the great nations of the plains, when i was out in--

>> i'm sorry to interrupt you. >> i do meet with them. it's not-- >> here is the point, and i appreciate that and i appreciate you do that, meeting and talking with them is different from listening to them. did i have your commitment you'll incorporate the ideas and their concerns in the work you do. >> absolutely. >> mr. chairman, may i answer-- >> go ahead. >> a comment by what senator sanders said. >> i agree with him about privatization. and i agree with him about understaffing the va. but i do need to make it clear that we do not-- we do not exist in a vacuum. the united states, as you have pointed out in many floor debates when i worked in this institution, is suffering from a shortage of mental health professionals, it's suffering from a shortage of women's

health professionals, suffering from a shortage of private care and internists. we're competing for those. what has happened with the mission act and one of the benefits that i have now is that i have the opportunity to offer more impressive packages to bring those health care providers into the va. we're doing our level best because you are absolutely right. we are short on those. and i will also say that when it comes to privatization, you and i discussed this in your office several months ago prior to my confirmation. i believe this strongly. i've said it all across the country. i don't believe that veterans will allow va to be privatized and i tell you why. it is-- it's not anecdotal, but it is emotional. veterans want to be where

people understand their culture and speak their language. i'm from that world, i understand it and i agree with you that my job right now is to ensure that those veterans who need that care outside of the va and we don't have it, get it. >> thank you, let's continue this discussion. >> i think the gentleman, i would asks encourage support from the va and from the senate and house on a bill that i have on-- on an immigration bill that allow doctors trained here to stay in the country and it's ridiculous that we're doing that since we have such a need her. i recognize you for five minutes. >> thank you mr. chairman. thank you, mr. secretary, for your service. if a veteran doesn't get good care at vha, do the doctors till get paid there? >> they get paid because they're on a federal scale, however-- >> so the federal government will pay them whether they

serve the veterans or not. will the administrators get a paycheck whether or not the veterans are receiving good quality care and service? >> i can give you an example of how i acted on that. >> just historically, that they get paid regardless of the outcome for the patient? >> historically before the accountability act was passed, historically before the mission act was passed, the head of the department of veterans affairs was under the same strictures that every cabinet member, there was a laborious process removing those federal employees who did not perform. that does not exist now. the one year that i have been in and out of va we've removed 5,000 employees, including the contract of one of our largest va medical centers. i did that because the would, was not getting done and veterans were not getting

treated and i felt that the powers that the congress had given us needed to be exercised and i intend to exercise that, those powers whenever i see a problem because the veterans are first, the institution is not first. >> and i hope you continue to do that. that's the only way you'll stay relevant and prevent the veterans voting with their feet and what it looks like. let's not be so arrogant that we think we can build a mouse trap from the federal government, from washington that satisfies the country. either you deliver good service or not. and they'll make the decision for whether it's a hybrid or not and good for you in the private sector, if they don't provide a service they don't build-- that's what you're competing

about and that's why i'm for choice, why i'm giving veterans to choose to opt out after system that may not be working for them. maybe it's not the best way to provide service to our heroes, i don't know, where it's working, good, great. continue to do good. where it's not, i get why it's not because it's a very different animal altogether. so, okay. it was good to meet you the other night by the way, and your wife. >> good to meet you. >> i'm really not an angry guy, but i get fired up about it. i know you're passionate about it, too. let me ask you this. are people choosing to go to community care at a greater rate today than a year ago? >> they're not choosing to go to can community care at a greater rate when they did when omar bradley ran va 1945-1947. it's been about the same level.

which is 30 to 35% historically. i think we're even seeing dr. lieberman, a slight dip in-- >> fewer veterans are choosing to go outside of the va than two years ago-- >> a little bit. it's a small number. >> i'll take your word for it. i assume you measured the quality and overall service that veterans get at the vha. do you measure the quality and overall care at your various facilities in the vha, yes or no, doctor? >> within the vha, yes, sir. >> and do you all compare the quality metrics and the service metrics in community care with the quality care and service at vha? >> absolutely, but we also compare it to--

. >> how do they compare, mr. secretary? are they comparable, are they better at-- >> i will tell you that the dartmouth released its most recent study a week or so ago in the annals of internal medicine and their conclusion was that care at the department of veterans affairs is as good or better than any care in the rest of the country. and of course, that includes community care, so we are being judged by comparison to the biggest health care networks. >> that's good to hear. last question. i represent a big swath of rural west texas, how are the access standards going to affect their access to va care? >> i've talked a lot-- >> i field back. ...

giving them the option to seek care that is closer to home, if they have to embark on a 300, 400, 500-mile round-trip journey to get to a v.a. center. as i've said many times, it is incredible that in 2018, and i i saw was in hawaii last week, we do not understand the scale of the west and we don't understand the scale of the pacific. >> thank the gentleman for yielding. i was in greg walden subdistrict in oregon at your ago, and his congressional district has more square miles and the state of tennessee.

our challenge in this committee was to devise a mission act, a program that was good for world america and for urban america, and that's hard to do when you're trying to do both. if you're on the 405 in los angeles you may be quicker to someone else if you're stuck on there to get an appointment if you don't live ten miles from somewhere. so it's a real challenge to do this and get it right where you provide the care and point of service for the veterans. i think the v.a. is moving in the right direction, taking care of veterans, i believe that. mr. o'rourke, you're recognized. >> thank you, mr. chairman here mr. secretary, in answer to senator tester about administrative costs totaling around 24%, and that number was disputed, but in response you said we were taken advantage of. could you clarify by whom the

v.a. was taken advantage of? >> i meant in a generic way that the choice act, and i think there is agreement from the leadership of both committees that the choice act was rushed and we were given such unreal, unnatural timelines to implement a program and a 370,000 -- >> so there was no actor or third-party, administer or outside contractor who took advantage -- >> we were forced to take what we could get to implement a law based on the timeline that was created by that act, which has now been rectified by the mission act. so when i sit taken advantage of, and i wasn't there, i was happily in the department of defense. i understand, my understanding was v.a. had to move as rapidly

as possible, and there was not that time for reflection that you usually have in an issue like this. >> the articles about the recent release gl report about unspent suicide prevention outreach dollars, 6.2 million allocated as of september, 57,000 spent and doctor gamgee suggested there was perhaps one, 1.59 spin on top of that out of the 6.2. you say you will exhaust that throughout the interview. you got 100,000 hundred thousand hits on the website. another thing that's perhaps more alarming than the unspent money is you have not established targets for the efficacy of this outreach effort. hits to the website, don't know what it means and don't know if it matters. how do you know how you are doing what you have established as your number one clinical

priority, suicide reduction? which am grateful for that's a priority. how do you know how you're doing against that priority? what are your goals? >> lippy talk about the national situation that we face. first of all, i was responsible for the department of defense -- >> i have limited time at a don't want your anecdote. i want to hear a goalspirit and not been given anecdote. 14 of the 20 veterans who died either own hands every day or outside of v.a. >> correct. we have known that years. we spent $12.2 million on the outreach just in the time i believe that i've been in charge, which is just a few months, but i had to go beyond what that gao report says. talked with governor brown, talk with other governors. i am busy. >> if it is your priority what is your goal and how are you doing against your goal? i'm not blaming you for world we

are. >> the goal, the goal is to do our best to make sure that we've done everything possible speed is never be able to judge you. >> that's right. the majority, the majority of those warriors who take their own lives come from my fathers wore your generation. that means is these are probles that are 50 years in the making. i'm not going to tell you that i can wave a magic wand and correct problems that began -- i'm doing my best with the outreach that we have and the resources that start with the department of defense we never had a transition program or an awareness program on suicide until the last year or so at the department of defense. that's what has to start. so that we make sure that mistakes of begin in 1968, 69

and 1970 are not replicated now. that's not anecdote. that's just historical. >> i agree but if you don't measure it you will never be able to prove it. do not agree with the finding your of not established targets, the majority of metrics used to gauge the effectiveness of your suicide prevention outreach campaign? if you agree, what are you doing to correct the finding? >> we do not have a robust enough metrics at the time of the gao evaluation. we are in the process as we responded to the board come in the process of developing more robust want. >> when will you have been? >> later this year. >> this year. >> sorry, 2019. >> thank you. >> so that is, i put in place, that is the number one clinical priority. and i can promise you that we will expand everything that we can to try to correct this and address this great national

tragedy. >> thank the gentleman for yielding. i think the question was if you don't know we are going you might end up someplace else, if you don't have your goals set, you don't meet those goals i think that's what you're asking. mr. coffman is recognized. >> thank you, mr. chairman. mr. secretary, i think the v.a. has was had the authority to reach out to community providers prior to the choice act, i think and specifically shall. remember the name of -- is it the p3 program? one of the complaints i've heard about the program, still exist today, is that every separate agreement is negotiated independently. and so in colorado we've had some potential providers under the p3 program drop out because of the length of the

negotiations and the complexity of the negotiations. where i think one question that they always raised to me was why don't we simply use medicare rates as reimbursement on the p3 program so we're not renegotiating every new agreement from scratch? >> well, we actually are moving away right now with the triwest and in the future with the agreements with the mission act. right now we have come tri-west have stood up and actually in colorado, and in the first week, and derogating medicare rates, and in the first week actually have entered 2700 consult and overscheduled 500 patients, and so they have been able to create the network that the facility seven struggling to do on their own so they are creating it. that's what's going to be part of the community care networks as we pulled up. >> how are we doing in terms of if you cheesy on telemedicine? i think was raised about rural

america, certainly rural colorado it's a struggle. we've got people in grand junction, colorado, there's a c bok there, but for oftentimes for care they have to go to the v.a. medical center regional medical center which is now in aurora. it's a four hour drive. i know they are reimbursed for the mileage of that, but are we doing better in terms of telemedicine. so we are investing through support of the congress. we are investing in increasing bandwidth at many of our c bok locations which is important that we doing the anywhere anywhere system which is in and access their own home. we can provide telehealth into the home. we are in partnerships with different private entities, they

were give us a private room in a more rural area and a veteran can go there and have their appointment in that location that is close to home. >> there is legislation passed that i authored, i think was included in a larger bill that requires an independent study as to those veterans who died, who committed suicide who were under v.a. care. and i think the objective of it is to go to look into what prescriptions that they had at the time of the death because i do have a concern that we are overprescribing some of our veterans in mental health. >> let me talk about the opioid issue, which is part of that continuum. and also to congressman overlooks well-founded

observations about the suicide program, i do want to say that we are not divorced from national problems. we are one part of that which is why in the answer to your question i will say in this case v.a. has taken the lead in creating alternative therapies, alternative prescriptions for those with great pain. the one factor about v.a. care that is not shared in the private sector is that we help people who come from a dangerous profession. people like my father, after 30 years of jumping out of airplanes, needed to make new knees, to make new hips and had led and his body from vietnam. we have been able to reduce the amount of opioid prescriptions by 41% 41% just in the last two

years. in addition we are on the cutting edge of alternative therapies, occupational therapies, tai chi, acupuncture, things of would have been unimaginable ten, 15, 20 years ago. and that is part of the answer to those veterans who are suffering from pain and subsequent issues like mental health. >> mr. chairman, i yield back. >> thank the gentleman for yielding. ms. kuster, you are recognized. >> thank you. thank you very much. i very much appreciate the progress that is being made by the v.a. on the opioid epidemic and the help that we can spread those new alternative pain management strategies, not only within the v.a., but frankly within the private sector as well. i just want to revisit briefly this issue because i think

certainly my constituents but i think constituents across this country are so shocked and concerned to read today about this issue that your department had only spent 1% of the 6 million for suicide prevention. we've had a little bit more testing on that today. you say that you doing your best, but what i'm concerned about is that, that can't be true when we have so many leadership vacancies at key posts in the v.a. related to these programs. what are you going to do about getting the right people in the right place? and i just want to give you one chance to revisit trantor caution because we can't respond here in our oversight function of doing your best if we don't know what your goals are. and you talk about the majority

of the suicides committed by people outside the system that's true. that is our frustration, how it would bring them into the system? >> as was said, we began to move when i became active. the vacancy talked about at the head of the suicide prevention office was immediately filled by me by making permanent -- >> and does that person have the staff that they need on board? >> yes. and also the expertise as having been the leader of the department of defense in the suicide prevention office. >> is that program -- >> just for the record speed i'm sorry, there are other vacancies and are in the process of hiring -- >> we're building a large office underneath this individual so we are hiring most people to supporter. >> and does that program have functional capacity at all the

visitor and coaches will? >> they certainly work with all the visits. they have a responsibility to roll and work with her and what i did to come out. i also just want to let you know that we really are focusing in a new way on the high risk veteran populations both within vha and once outside, and so number one there is an executive order took on transitioning veterans so we been working with dod on that. the other than honorable, we been working that since 2017 but this month, this week in surrey, and the rest of the month we're mailing out letters to over 500,000 other than honorable encouraging them to come to us to see whether their eligible for care in mental health aware also looking at the reserve and the guard that have never served. the been identified recent as our data gets mitchard, we can identify at-risk populations, and they are at risk. we do mobile vet center at

reaches to the on the weekends when they're doing their drills, and where reaching out to leadership in those areas. finally, another risk went in a fight recently was that if a veteran came to the emergency room in the prior three months and had just a little bit of suicidal ideation, not enough to have to admit them, that if we did research and we found that if we made a suicide safety plan with them where if they're having suicidal thoughts, what is he going to do? are they going to call a loved one? by the card to call the therapist? are they going to listen to music? it's been shown to reduce suicide rates by 50%. what we've done is implement this rapidly at all our centers all across the country so we're trying new novel thinks as a come along. >> the research is important. my time is running short. i had another question about the whole issue under the v.a. mission act and the designated

access standards but i but i gi will leave it at this. new hampshire is one of the rare states without a full-service v.a. hospital. think we're all trying to find this balance of care at the v.a. and if that's not possible, then care within the community. but i would just use new hampshire as a cautionary tale and the problems that we had recently at manchester when the level of care drops below what is necessary for a robust va going forward. i think that was the point that senator sanders was making, and to think it's instructive as we move forward, but with that i will yield back. >> and i would just add, i agree with you completely about suicide. i mentioned that i was in and out of the v.a. as acting and then had to go back to dod and await confirmation. in my first week i laid down the

first half on the suicide issue. i will tell you, that is nothing more important, and there's nothing more tragic and you have my commitment that as long as i am privileged to be part of the v.a. team that will continue to be the case. >> if i could, one quick second. i've been in congress for six years. you are our fifth v.a. secretary in those six years. so i appreciate your personal commitment. i have literally heard that five times, and veterans are dying every single day. so we will hold you to the commitment. we will want to know the metrics. i appreciate the innovative solutions, and will look for to continue to discussion. thank you. >> senator hirono, you are recognized for five minutes. [inaudible]

okay. this one is working. can you add to my time? okay. are you listening? >> we froze the clock. >> okay, i get very much. i'm glad you in hawaii and obviously you spoke with the governor, but did you let the congressional delegation know that you're going to be in hawaii? >> yeah, i think i mentioned it to you the last time we spoke that i would be in hawaii in december. >> i don't think we got the date, but not to bejewel but had with the but i think that it would be good for you, your team, to alert the congressional delegation when you come to our state to maximize your ability

to support and work with the. >> and i will go back back of t you and i discussed last time. i made two commitments, one to go to hawaii and one to go, if you're not there, i've got to go back because i'm going to go to samoa and guam, go with you, go there with you when you are there. >> thank you very much. the v.a. over the years the course that'll have had so many sectors over the last five years as mentioned, there are ongoing challenges whether it be i.t., homelessness, suicides, construction delays, course access to care. youth have been asked whether there is a sense of urgency at the v.a. but ask you whether you have a sense of urgency? >> absolutely. >> if you have a sense of urgency what are your top priorities for the v.a.? >> i top priorities for the v.a., and an agent the first critical priority which is suicide prevention. my top priority is to create

with the assistance of these committees, a modern 21st century healthcare administration that keeps veterans at the center of their healthcare. this committee has already laid down the template for that and it is my duty to carry that out. >> i think i'm looking for something a lot more measurable. so, for example, you are asked how can we verify whether you're reaching your goal regarding suicide prevention. a former v.a. secretary said that his goal would be to end homelessness. so those are the kinds of specific kinds of priorities that i'm asking you to articulate, if you have them. >> i will tell you i am not going to come to this committee and tells you that i will end homelessness. and i'm not going to come to this committee to tell you that i can eliminate suicide amongst

-- >> pass that one of asking you. what i'm asking you, out of a sense of urgency what are your top priorities for the v.a.? so whether it be decreasing suicides, decreasing homelessness. do you have those kinds of priorities? >> i just mention modern point for century healthcare administration v.a., which means modern i.t., meaning the best medical care possible -- >> when you say something like best medical care possible, how do you come up with a verifiable matrix? >> i can tell you that our healthcare is, we have the standards. we have the metrics which we share with this committee. we compare what we provide with healthcare across the country. i have referenced the latest comparison that dartmouth, ivy league has done that was in "the annals of internal medicine"

last week that says -- >> i am running out of time. >> that says archer is as good or better than any in the country. >> if you have those priorities for you because i think would be good for us to hold people accountable and that the fee transparency and accountability and i would certainly want to apply that to you. so if you have those priorities and they are listed and how you're going to come was he a verifiable metrics to enable us to realize whether you have attained of those primaries, would be great. i have a question about the family caregiver comprehensive assistance for family caregivers. that is a a very important prom for a lot of veterans, and i am glad we expanded it. i have received, for example, aa note from a caregiver in hawaii just this week and she wrote, quote, i just received the density news that we are no longer eligible for the caregiver program. i did not even received a a phe call follow-up from a

coordinator or even an expiration other than the fact that her husband is simply no longer eligible. so how are you communicating with the 5500 family caregivers as to what is happening with this program, what the requirements are, et cetera? >> so first of all, if your office could share with us that individual so we can follow up on. >> certainly. >> the mission act is giving us the tools to do this right moving forward and making sure that we have objective ways so make sure if many the same thing no matter what state you're in across the country. part of what we are proposing is to move away from these reassessments and more towards wellness checks to make sure that the caregiver has what they need to succeed and the veteran is receiving the services that may need. we have regular ways of the community with the caregivers.

we have phone calls with them around the country. we have a phone line what they can call in, but we have not yet made our decision on how we're rolling out. we're still getting input. right now it is in the federal register, some of the ideas of how to improve upon the services available in the program. >> thank you. >> and your absolute right, it is i .5 million family caregivers out there. we have to support. >> yes. that's a lot of people to stay in touch with. >> absolutely, but it's the wave of the future. >> thank you, mr. chairman. >> thank you senator kirk senator blumenthal, your recognize. >> thanks, mr. chairman. thanks for having the strength. thank you to the secretary and your colleagues for being here today. i want to thank my house colleagues for passing the blue water navy bill unanimously. i want to say how disappointed

come in fact, a a shame i am tt the senate failed to do the same, even though as recently as a couple of hours ago i was on the floor of the senate asking for unanimous consent from my colleagues to move ahead so that that it would become law. if the v.a. the v.a. were doinb and supporting this bill, it would have to overcome the opposition of a small number, a handful of my colleagues who are blocking it now. i'm going to ask you to commit, as i have before inhering, that you will help us pass that blue water navy bill. >> i committed to the chairman and to senator tester that i would everything i could to help that, your committee. >> you have done that before, but, unfortunately, that support

has not been translated into active advocacy with my colleagues and hope you will do better during the next session. i want to follow up on a number of questions asked by congressman o'rourke about metrics. you can't do better and less you measure what you are doing. and insofar as i can see one of the chief criticism of the gao report has been the lack of metrics and measurements. and i would suggest to you respectively that two goodwins would be whether the rate of suicide is coming down -- good ones -- which it is not and whether the gao using using all the resources at its disposal to bring it down, which it is not. would you agree? >> i agree with the state of affairs at the age that gao laid out. >> you agree with the gao report. >> which is why --

>> so you would agree the reason you failed at the v.a. just been more than a fraction of the money given to you by the united states conquers is, i'm quoting, the reason they did not spin the remaining funds on suicide prevention paid media industry or 2018 was that the approval of this paid media plan was delayed due to changes in leadership and organizational realignment of the suicide prevention program. and they go on more specifically to say, on pages 15 and 17, that it was a lack of leadership available to make decisions about the suicide prevention campaign. and then on page 17, by not signing key leadership responsibilities and clear lines of reporting, the v.a. chase the ability to oversee the suicide

prevention media outreach activities was hindered and his outreach activities decrease. that's a failure of leadership. >> i going to agree with you, and you and i i think discussed in your office when i was the acting secretary that the first thing i did when i became acting, which is sort of being in limbo, but i did anyway, was to start moving on the suicide prevention issue. identified leadership and i made this the number one clinical priority. i agree that the department had not done what this congress and what veterans demand of it. >> let me ask you because my time is limited and i apologize for interrupting, can you commit that the v.a. will spend every dime devoted by the congress, allocated by others, to suicide prevention drink the coming fiscal year? >> absolutely. and i will probably ask for more

allocate more because of this national tragedy. >> , how much more you think is necessary. >> was i don't know. i don't know, that is why, and i mentioned it and you were not here, in the last few weeks i have been on the phone or in person with jerry brown, with the governor from why, with governor inslee discussing the way ahead. we have not had a comprehensive nationwide response to veterans suicide. i need the cooperation of our governors and that's why i put in train the development of the metrics that senator hirono talks about, that you talk about, , so that we have in plae a program to go and attack this problem. that's the best answer i can give you, that i've moved on it, as soon as i moved into v.a. >> i know that you've moved on it, but you have to forgive me and maybe us that we've seen

this movie before. as one of my colleagues remarked. we have seen slew of secretaries who have made commitments and promises, and i think we are, at least speaking for myself, expressing the frustration and inpatients that is well-founded in fact, because of the turnover in leadership from the top through the middle ranks, and with all due respect, dr. lieberman is an example, he follows others who've been in that position for small links of time. we can't demand accountability if there is this constant churn and turnover in leadership which then becomes a failure to spend the money that allocated to suicide prevention and maybe other programs. >> i agree with your observation about suicide. the program, at best it was in kuwait in 2017, and that is why

i primly appointed the dod leader in suicide prevention, the person with the most expertise in this matter that available to the government and were increasing the size of that operation. i agree with you. >> my time as a spy. i apologize, mr. chairman,. >> thank you, senator blumenthal. thank your for being here. i would like to use my colleague mr. takano, next years chairman if yes any closing comments. >> thank you, mr. chairman. [inaudible conversations] look forward to hearing as soon as possible your, more about the doesn't ask a standard i know you told me in your response to me that you still need to await the president choices. but hope that you will consider speaking to us before that time

because i see no reason why the vsos and congress can cannot participate with you i think is the spirit of the mission act does stipulate, that these ask instead were not to be developed alone between you, mr. secretary, and the president. and i certainly don't want to see expectations unnecessarily raise at the state of the union speech, and congress being in the position to have to try and pull those expectations back. so i would like to, and the time between now and the third week of january, like to see your department work more closely with the vsos and congress in developing these access standards because so much is at stake. and we need to do some trust building among the stakeholders,

congress, and your department. with regard to, i want to reiterate what senator blumenthal has said, the frustration of congress be able to hold the v.a. accountable when we have seen such change over or acting secretaries, and some of it is on, i hate to say, the senate in not confirming people in a timely manner, but nevertheless,, it's been very disappointing to see in the last two years and administration that is not been able to put in place stable leadership at the v.a., and i see the i.t. failure with regard to the payments, the issue with the social media and adequate marketing being done to inform veterans about suicide

prevention hotlines. all leading back to the same on the middle problem, which is the unstable leadership at the very top. this has got to change, and so mr. secretary, i'd like nothing more than to see you succeed and for you to serve out a tenure which allows you to implement changes. i certainly do appreciate the sentiment you expressed when you quote the dartmouth study recently, and for the back of the rand study, and that you have an understanding about how well our v.a. does deliver healthcare. and you recall that the rand corporation study indicated that the main problem is access. and we are still 41,000 vacancies. i want to work with you, mr. secretary, on not slow walking those vacancies but doing all

that we can to improve the personal function of the v.a. so applications are acknowledged, people are quickly made offers, and that we also take a look at what we need to do to develop the healthcare workforce of this country. because i think that's part of the problem. it's not just doctors. it's the technicians, the alice health professions of a need to pay attention to. not everything is resolved by medical degrees and for your degrees. some of this could be putting a lot of americans who work in the service of our country. so mr. secretary, in the spirit of that i hope, 19 to work with you and i intend that we change and turned around the situation. >> i thank you, sir, and i intend to work closely with both committees. i mentioned earlier this is what i was trained. my respect for this institution knows no bounds, and the beauty, as you said at the beginning, is that this is a bipartisan effort. i like to think of the

department is being nonpartisan, like the department of defense. and you have my commitment to do everything that we can to make sure that the lives of our veterans are better. >> thanked the job for yielding, and i'm first of all thank you, mr. secretary, and her team for being here today. i want to thank our staffs. we passed a major piece of legislation, the v.a. mission act, the would not have happened without the staffs john and ray, thank you for leadership. the senate, we work very close with a senate colleagues on both sides of the aisle so thank you for the work that you wanted. you are very, very helpful in this. i personally just as a point of personal privilege one of the great authors of my life served as chairman of this committee and i will continue to serve as ranking member, just as passionate as i did before. i also want to thank, look around this room fantasy a lot of our veteran service folks, veterans organizations, and the river and similar. i remember sitting on the table in my office for hours on end

hammock at the details of this. you had committed into it and it would not be the bill it is today without your input so thank you for that. they v.a. mission act, the idea was to take a bill, a piece of legislation, and as i said before, make it applicable to rural america and make it applicable to urban america, and make sure the number one thing that happened was that the veteran got the absolute very best care this nation is offer, whether it was at the v.a., whether it was outside the v.a. i was one of those physicians who provided care outside the behavior of also worked in with some of medical training. i've also been a doctor in the army. i think i understand the system fairly well. i want to get three things out before release. number one, on june 6 when ready to go. if we're not and would you be willing to come by, mr. secretary, lets the at the end of march 1 more, they can be

combined meeting or have we want to do, informal, but the members of we're ready to go live on the sixth of june or thereabouts? number two, that we can make appointments at the v.a. for our veterans in a timely fashion? number three, can we can we pay our providers so they will stay in? i have lots of french want to stay in but won't because he can get pay. these are good doctors that want to serve soft like to see those three things happen. there will be other things on the caregiver bill and asset review. i would encourage my senate colleagues, we have a couple people, i.t. position and accountability whistleblower protection. the young woman who's a a staff member on our committee now, tami, an incredible young woman, immigrant to this country, who came in without any education, served in the u.s. navy, has got an rn degree, now a doctorate degree and is that investigations of the is all

over this country. she could be in the position right now doing her job, and i don't go to a speech that the president is that it doesn't talk about accountability and whistleblower protection bill. we need to get that done and she needs to be confirmed sooner rather than later. it's a point of frustration for me to hold her up. on the mental health side, and we started, we held a hearing and a look at this 20 20 numbe. that's a veterans and active duty military, that number is i said if we are doing, spending eight, $9 billion a year year and we have moved the needle at all, why don't we through thoroy evaluate that and change what we are doing? there are plans out there, when in my state, guard your body. the command of the guard, he took over 2011, at four suicide the first days he was command of

the tennessee state court. the institute a plan called guard your body. i will go into the details of the ideas lowered the suicide rate among our guardsmen in tennessee by 70%. that's scalable and it is an expensive. we should do that across the country, a fight with what works and what actually went in. mr. made a great point. we had this great call center, one in atlanta and understand that i said are we change anything? we're spending all this money and talking to people but if the number is still the same, we need to do something different. that's what the metrics are so important. i think working with mr. to,, we'll continue work on that. it is a tragedy be on calculable. the suicide rates are because i have said many times. i spent hours in operating room operating on a cancer and then treated the patient after, save one life. if you've lowered the rate by as much as 55% by doing a simple

thing in the emergency room, why are we not doing that in every emergency room and the united states whether you're a veteran or not? that should be done. two senator hirono, your question about, it's fairly simple in medicine, now if you're looking at quality metrics, they are fairly standard and if you just look at it, you look at what medicare uses. basically v.a. does the same thing. if you come in, a certain age, you could screen for hemoglobin a1c, you have had a mammogram if you're female. blood pressure check, if you exercise. it always irritates woman doctor asked me if i can stand up? but asking those questions and those are scalable, vision screening, hearing screening,, all those things are measurable and i think david is an outstanding job. i want to finish by saying this. what i hear about my v.a. at home, this is mountain home v.a. in johnson city, tennessee, and i've traveled from long island

to los angeles from puerto rico last two years. is that not 100% but the vast majority of people like the care they get at the v.a. almost never anything negative. i do occasionally as you would in a big organization like that, and it's very customer friendly. that veterans believe and i think they're getting great care. i want to see every veteran get that kind of care and i'm committed to that. the men and women in the show and mr. secretary, apsley know in your heart that you are committed for that. i thank you all for being here today and i thank you for the point of personal privilege, and if there are no further questions i ask unanimous consent of all members -- mr. to? >> i just want to say mr. sablan of could not be with us for washing but that he will be soy questions. >> satisfied. if there are no for the question i asked nevins consent all members have high blood is the

days to revise and extend the remarks. and could extraneous material without objection, so ordered. the hearing was adjourned. [inaudible conversations] [inaudible conversations] [inaudible conversations] [inaudible conversations]

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[inaudible conversations] [inaudible conversations] >> today is day five of a government shutdown. funding ran up friday at midnight. negotiations continue on a bill that can pass both chambers of congress and get the approval of the president. watch live coverage live covere on c-span and the senate here on c-span2. >> sunday on q&a -- >> so we are on the floor of the united states senate and this is unprecedented, and no else has ever gotten an opportunity to do this.

it's for a production of the document of the u.s. senate on the floor before they begin. we will get shots during the session and that afterwards were going back down to the floor. >> c-span executive producer mark farkas talks about his work on c-span's upcoming original production the senate, conflict and compromise. >> if mitch mcconnell suggested this, how much control did he have over the content? >> zero. when we met with them for the first time we had a couple conditions. one was that hey, you've got to grease the skids with the democrats because the blood access to republicans, we got to get access to the democrats. and number two, you didn't have any editorial control over this. and they said well, that's fine, but we don't want you to focus on the acrimony. and so we sort of said well, no, you can ask us to get because we will not concentrate on it but again we can't shy away from it.

with that, with a product that we feel both people on the journalism site and the people watch watched the city can okay, they didn't get it a quick kiss from senate but you can watch it and say we did do a a hatchet job either. >> mark farkas executive producer on c-span2 original production, the senate, conflict and compromise sunday night at eight eastern on c-span's q&a. >> c-span, where history unfolds daily. in 1979 c-span was created as a public service by america's cable-television companies, and today we continue to bring to unfiltered coverage of congress, the white house, the supreme court, and public policy events in washington, d.c. and around the country. c-span is brought to you by your cable or satellite provider.