Vet Healthcare

From: "Bruce K. Melson" <>

Hello All:

Just caught C-Span and the House of Representatives.

They admitted that when the Millennium Healthcare Act was passed, they
passed the bill without funding the "Emergency Care" provisions of the
Act.  This partially explains why the VA is refusing to implement this
provision at the present time.  But, also, it appears that Congress had
the full intent not to fund the MB.  Because, their intent was to
further define what the bill would actually provide.

In other words - passing the MB to gather veterans support for the
elections this year.  That they were doing something for veterans, when
in fact they hadn't done a damn thing.  I hope I am wrong!

This discussion occurred during the passage of H.R. 5109. A bill that is
titled (a) SHORT TITLE- This Act may be cited as the `Department of
Veterans Affairs Health Care Personnel Act of 2000'.  The purpose of the
bill to provide pay raises for nurses, pharmacists and dentists.

Two sections, later added to the bill, that in my opinion directly
affect the Millennium Bill, being added to Title 38.

Sect 301 - a provision that requires a veteran to relate his military
experiences and exposures during service.  In other words, in the
discussion, the vet will be required to relate essentially a medical
history that will become a permanent part of his VA Healthcare records.
Part of this discussion I see as having a direct impact on any claim for
disability.  That if the recorded health history does not include
information in regards to the claim, the claim will be denied up front,
as "no record exists to support that the condition was caused by or
incurred in service, etc."

Such as a knee injury in service, with the Vet involved in in-service
sports activity after the injury.  Stated by the Vet when the VA gathers
this health history.  Then the Vet hurting the knee again after service,
likely because the knee was already weak.  I can see the VA saying -
there is no record that the in-service injury contributed to the after
service injury - then denying the claim.


     (a) MILITARY HISTORIES- The Secretary of Veterans Affairs, in
carrying out the responsibilities of the Secretary
     under chapter 17 of title 38, United States Code, shall ensure

          (1) during at least one clinical evaluation of a patient in a
facility of the Department, a protocol is used to
          identify pertinent military experiences and exposures of the
patient that may contribute to the health status
          of the patient; and

          (2) pertinent information relating to the military history of
the patient is included in the Department's
          medical records of the patient.

     (b) REPORT- Not later than nine months after the date of the
enactment of this Act, the Secretary shall submit to
     the Committees on Veterans' Affairs of the Senate and House of
Representatives a report on the feasibility and
     desirability of using a computer-based system in conducting
clinical evaluations referred to in subsection (a)(1)."
How many veterans can relate their military healthcare history, let
alone correlate it to medical conditions - diagnosis - etc.?

Part of the discussion included the comment, "The veteran expects to
receive healthcare, so the veteran should be expected to provide their
health history."

I can see this causing even more problems than already exist in getting
medical documentation that a current condition is related to an
in-service injury/disease.  Particularly since a VA doctor is not
allowed to give any such opinion.

Also, I think this goes along with the VA now doing pre-separation
claims actions.  Allowing the VA to pre-determine that military records
don't support a disability claim.  In other words - setting up a
continued denial on a condition that was mis-diagnosed in-service, or
was determined as acute and healed in service and that no residual
injury/disease existed after.

Sect 401, amending sect 1725 (the MB Emergency Care provision):

It specifically deals with "in-patient" care of a veteran in a non-VA
facility. It sets up a pilot program (for 2 to 3 years) in 4 areas of
the country (not named) for Vets to receive in-patient care (surgery and
such) at the expense of the VA.  Then comparing this cost to providing
the same care in a VA facility.  This has already been done in Fla.
(Rep. Weldon) and showed a 15% plus savings to the VA, by doing care
this way.

     (a) IN GENERAL- Chapter 17 is amended by inserting after section
1725 the following new section:

`Sec. 1725A. Coordination of hospital benefits: pilot program

     `(a) The Secretary may carry out a pilot program in not more than
four geographic areas of the United States to
     improve access to, and coordination of, inpatient care of eligible
veterans. Under the pilot program, the
     Secretary, subject to subsection (b), may pay certain costs
described in subsection (b) for which an eligible
     veteran would otherwise be personally liable. The authority to
carry out the pilot program shall expire on
     September 30, 2005.

     `(b) In carrying out the program described in subsection (a), the
Secretary may pay the costs authorized under
     this section for hospital care and medical services furnished on an
inpatient basis in a non-Department hospital
     to an eligible veteran participating in the program. Such payment
may cover the costs for applicable plan
     deductibles and coinsurance and the reasonable costs of such
inpatient care and medical services not covered by
     any applicable health-care plan of the veteran, but only to the
extent such care and services are of the kind
     authorized under this chapter. The Secretary shall limit the care
and services for which payment may be made
     under the program to general medical and surgical services and
shall require that such services may be provided
     only upon pre authorization by the Secretary.

     `(c)(1) A veteran described in paragraph (1) or (2) of section
1710(a) of this title is eligible to participate in the
     pilot program if the veteran--

          `(A) is enrolled to receive medical services from an
outpatient clinic operated by the Secretary which is (i)
          within reasonable proximity to the principal residence of the
veteran, and (ii) located within the
          geographic area in which the Secretary is carrying out the
program described in subsection (a);

          `(B) has received care under this chapter within the 24-month
period preceding the veteran's application
          for enrollment in the pilot program;

          `(C) as determined by the Secretary before the hospitalization
of the veteran (i) requires such hospital care
          and services for a non-service-connected condition, and (ii)
could not receive such services from a clinic
          operated by the Secretary; and

          `(D) elects to receive such care under a health-care plan
(other than under this title) under which the
          veteran is entitled to receive such care.

     `(2) Nothing in this section shall be construed to reduce the
authority of the Secretary to contract with
     non-Department facilities for care of a service-connected
disability of a veteran.

     `(3) Notwithstanding subparagraph (D) of paragraph (1), the
Secretary shall ensure that not less than 15 percent
     of the veterans participating in the program are veterans who do
not have a health-care plan.

     `(d) As part of the program under this section, the Secretary
shall, through provision of case-management,
     coordinate the care being furnished directly by the Secretary and
care furnished under the program in
     non-Department hospitals to veterans participating in the program.

     `(e)(1) In designating geographic areas in which to establish the
program under subsection (a), the Secretary
     shall ensure that--

          `(A) the areas designated are geographically dispersed;

          `(B) at least 70 percent of the veterans who reside in a
designated area reside at least two hours driving
          distance from the closest medical center operated by the
Secretary which provides medical and surgical
          hospital care; and

          `(C) the establishment of the program in any such area would
not result in jeopardizing the critical mass of
          patients needed to maintain a Department medical center that
serves that area.

     `(2) Notwithstanding paragraph (1)(B), the Secretary may designate
for participation in the program at least one
     area which is in proximity to a Department medical center which, as
a result of a change in mission of that
     center, does not provide hospital care.

     `(f)(1) Not later than September 30, 2002, the Secretary shall
submit to the Committees on Veterans' Affairs of
     the Senate and House of Representatives a report on the experience
in implementing the pilot program under
     subsection (a).

     `(2) Not later than September 30, 2004, the Secretary shall submit
to those committees a report on the
     experience in operating the pilot program during the first two full
fiscal years during which the pilot program is
     conducted. That report shall include--

          `(A) a comparison of the costs incurred by the Secretary under
the program and the cost experience for the
          calendar year preceding establishment of the program at each
site at which the program is operated;

          `(B) an assessment of the satisfaction of the participants in
the program; and

          `(C) an analysis of the effect of the program on access and
quality of care for veterans.

     `(g) The total amount expended for the pilot program in any fiscal
year (including amounts for administrative
     costs) may not exceed $50,000,000.

     `(h) For purposes of this section, the term `health-care plan' has
the meaning given that term in section
     1725(f)(3) of this title.'.

     (b) CLERICAL AMENDMENT- The table of sections at the beginning of
such chapter is amended by inserting
     after the item relating to section 1725 the following new item:

          `1725A. Coordination of hospital benefits: pilot program.'.
However, in my opinion this partially guts the ER provision of the
Millennium Bill, by specifically separating emergency care from
in-patient care.  Directly making this new provision a part of Sect 1725
of Title 38, the ER care portion of the MB Act.

I can see this being used to provide a separation of what the VA will
pay on medical bills.  In other words - paying for the ER care, but then
denying payment for in-patient care if the Vet was admitted as a result
of the emergency.

Because, it deals specifically with general medical and surgical care,
but this care having to be pre-authorized by the VA.

How many times have Vets went to the ER, been admitted, stabilized, and
not transferred to VA, because the VA has no bed space.  The Vet then
having to receive what could be considered general medical and surgical
care, while awaiting transfer.  To me this opens the door for the VA to
determine specific care was not authorized and refuse to pay for that
care.  Even though the Vet should be in the hospital and not at home
awaiting further care.

Such as a heart attack:  Many hospitals due a cardiac cath to determine
how bad off a Vets heart has been damaged and if they need surgery.
But, this being done after the patient has been stabilized and able to
undergo the procedure.  I can see the VA denying payment for this, as
not authorized.  Further, putting the Vet into the situation of having
to determine if what the non-VA facility is providing is authorized by
the VA.  Since part of the discussion was implying that the VA will be
acting as an insurance provider.  In other words - setting the VA up and
authorizing the VA to act in the manner of an HMO, etc.  In short - the
VA will be determining what care a non-VA facility can perform on a
Vet.  Just like the horror stories of folks who can't get their
insurance company to pay for procedures or care recommended by their

Over all - what I see the Congress doing is assisting the VA in writing
the regulations for the implementation of the Millennium Bill.  Further,
limiting the care below what was the supposed original (?) intent under
the bill.

Further, it fuels my fear that the VA is slowly but assuredly becoming
an HMO and all that goes with it.  In short - turning the VA into
something like Tri-Care (No-Care).

Essentially the same crap that has occurred on the Retiree's Healthcare
that was gutted and won't go into effect until sometime in 2001, then
only funded for two years at that.