Saturday, May 27, 2017

Department of Veterans Affairs - 2018 proposed budget


 

VAntage Point
Official Blog of the U.S. Department of Veterans Affairs

Care and benefits for Veterans
strengthened by $186 billion VA budget
bonus question: How many times did the author forget to capitalize the word “President”?
1) This is a proposal for a budget request. This not the actual budget, yet.
2) The entire article misleads in that the VA has already stated a 30% reduction in their Facilities, a 15% reduction, across the board, in Staffing, and further expansion of their “Choice Program” above the current 30% enrollment.
3) They are proposing 82 pieces of Legislation to accomplish all this. Tell me what the odds are of getting all that past a do-nothing Congress.
4) Under “Highlights....” you can ignore items 3, 4 & 5. They are total B.S.
5) Be aware that when the VA uses the phrase “other stakeholders” they are not talking about you, their customer base. They are talking about highly paid outside Consultants like “Plaintree”.
6) Under “Improving....” they claim to be knocking 14 days off the current six year process of Appeals. Now that’s going to make a huge difference in the “Veteran Experience”. Once again, they are promoting the use of their famous “DENIED” rubber stamp.
7) TBI (Traumatic Brain Injury) is the largest increase in both Medical and Mental Health Care demand, yet it is receiving the absolute least funding of any category in this budget.
8) Under “Expanding Access”, Cemetery expansions will need $855 million in some very specific locations. Those locations have seen a recent spike in Veteran deaths due to VA mismanagement and abusive care, so those cemeteries are running out of space to burry Veterans. They propose $862 million for new construction when they are in the process of closing 30% of their Facilities, and they can afford to build only one new Clinic in California. (N.B. - The entire Denver Hospital complex cost $691 million.)
9) Under “Disability...” they are borrowing $107.7 billion from a 2019 budget that doesn’t exist, yet.
10) Under “Health Care”, they admit to kicking another 8 million Veterans out of the VA system into the “Choice Program”. They can’t even pay for the Veterans in that Program now, and they want to blow the lid off the enrollment numbers. They are padding the 2018 budget with $700 million from 2017 that they never spent paying for Private Sector (“Choice”) care. Two-thirds of the budget for the “Choice Program” is for administrative costs: $9.7 billion.
11) Under “Other key...” there is $306 million to administer the National Cemeteries. That figure is contradicted by the $855 million under “Expanding Access”. Voodoo economics at its best!
12) Last, but not least, under “Enhanced oversight...” they want to throw $160 million at the VA/OIG, so the “fox” can better guard the “henhouse”.
In his FY 2018 Budget, President Trump is proposing $186.5 billion for VA. The budget request will ensure the nation’s Veterans receive high-quality health care and timely access to benefits and services. The budget also supports the continued transformation of VA to rebuild the full trust of Veterans as a premier provider of choice for their services and benefits.
“The 2018 budget request reflects the strong commitment of the president to provide the services and benefits that our nation’s Veterans have earned.” said VA Secretary David Shulkin. “VA has made significant progress in improving its service to Veterans and their family members. We are fully committed to continuing the transformation across the department so we can deliver the standards of performance our Veterans expect and deserve.”
This year’s budget request includes 82 legislative proposals that will help enable the department to better serve Veterans.

Highlights from the President’s 2018 Budget request for VA
The FY 2018 budget includes $82.1 billion in discretionary funding, largely for health care, and $104.3 billion in mandatory funding for benefit programs, such as disability compensation and pensions, and for continuation of the Veterans Choice Program (Choice Program). The discretionary budget request is $4.3 billion (5.5 percent) above the 2017 enacted level, including nearly $3.3 billion in medical care collections from health insurers and Veteran copayments. The budget also requests $74 billion, including collections, for the 2019 advance appropriations for medical care, an increase of $1.7 billion and 2.4 percent above the 2018 medical care budget request. The request includes $107.7 billion in 2019 mandatory advance appropriations for Compensation and Pensions, Readjustment Benefits, and Veterans Insurance and Indemnities benefits programs in the Veterans Benefits Administration.
Health Care
With a total medical care budget of $75.2 billion, including collections and new mandatory funding for the Choice Program, VA is positioned to continue expanding health care services to over 7 million patients. Health care is being provided to more than 858,000 Veterans who served in Operation Enduring Freedom/Operation Iraqi Freedom/Operation New Dawn/Operation Inherent Resolve and Operation Freedom’s Sentinel. Major categories funded within the health care budget are:
  • $13.2 billion for community care;
  • $8.8 billion for long-term care;
  • $8.4 billion for mental health care;
  • $1.7 billion for programs for homeless and at-risk Veterans;
  • $751 million for Hepatitis-C treatment;
  • $604 million for caregivers’ benefits; and
  • $316 million for treatment of traumatic brain injuries.
Expanding Access
The president’s budget ensures that care and other benefits are available to Veterans when and where they need them. Among the programs that will expand access under the proposed budget are:
  • $13.2 billion for community care compared to $11.2 billion in 2017, a 13 percent increase;
  • $505 million for gender-specific health care services for women, an increase of 7 percent over the 2017 level;
  • $862 million for the activation of new and enhanced health care facilities;
  • $855 million for major and minor construction projects, including a new outpatient clinic at Livermore, California, and expansion of cemeteries at Calverton, New York; Sacramento, California; Bushnell, Florida; Phoenix, Arizona; Bridgeville, Pennsylvania; and Elwood, Illinois.
Disability Compensation Claims Backlog and Appeals Reform
VBA has continued aggressive efforts aimed at bringing down the disability compensation claims backlog, completing a record-breaking 1.3 million claims in 2016 and reducing the claims backlog by 88 percent, cumulatively, from a peak of 611,000 claims in March 2013 to 71,690 on September 30, 2016. In 2016, Veterans waited, on average, 203 fewer days for a decision than four years ago. In 2018, VBA is projected to complete 1.4 million claims, and the number of claims pending longer than 125 days is anticipated to remain at about 70 thousand claims. This pending claims status may change as the volume of claims receipts increases or decreases, and as claims processing becomes more efficient. VBA’s success in reducing the rating claims backlog has also resulted in a growing appeals inventory.
From 2010 through 2016, VBA completed more than one million disability compensation rating claims annually. Approximately 11 to 12 percent of VBA decisions are appealed, with nearly half of those being formally appealed to the Board of Veterans’ Appeals (the Board). While the appeal rate has remained steady over the last two decades, the appeals volume has increased proportionately to the increase in claims decisions. The average processing time for resolving appeals in 2016 was three years. For those appeals that reached the Board, average processing time was six years with thousands of Veterans waiting much longer.
VA has worked with Congress, Veterans Service Organizations (VSOs), and other stakeholders to develop a legislative proposal to reform the appeals process. The appeals process under current law is ineffective and confusing, and Veterans wait much too long for a decision on appeal. The new process will: 1) establish options for Veterans, 2) provide early resolution and improved notifications as to best options, 3) eliminate the perpetual churn of appeals inherent to the existing process, 4) provide Veterans feedback loops to VBA, and 5) improve transparency of the process by clearly defining the roles of VBA and the Board throughout the appeals process.
Appeals reform is one of VA’s top legislative priorities, and the Department will continue to work with Congress and the VSOs to ensure Veterans receive the best possible service.
Improving the Veteran Experience
National Call Centers (NCCs): In 2018, VA expects the NCCs to sustain the average speed of answering in 30 seconds or less, while maintaining exceptional customer satisfaction.
National Work Queue (NWQ): In 2017, disability compensation claims are moving through the process faster than before implementation of the NWQ process – on average, claims are ready for decision 14 days faster. In 2018, NWQ will be expanded to other key VBA priorities such as the non-rating and appeals workload distribution.
Veterans Claim Intake Program (VCIP) / Centralized Mail: By the end of 2018, VCIP will relocate the entire file banks of remaining Regional Offices and convert the documents electronically, an integral element of VBA’s comprehensive transformation and modernization strategy. In 2018, Centralized Mail will build upon on sustained progress in disability compensation and expand to additional stakeholders, to include the Board of Veteran Appeals, Vocational Rehabilitation and Employment, Fiduciary Service, Support Services Division, Debt Management Center (DMC), and Loan Guaranty.
Veterans Homelessness
The budget requests $1.7 billion for programs to prevent or reduce Veteran homelessness, including:
  • $320 million for Supportive Services for Veteran Families to promote housing stability;
  • $543 million for the HUD-VASH program, wherein VA provides case management services for at-risk Veterans and their families and the Department of Housing and Urban Development (HUD) provides permanent housing through its Housing Choice Voucher program; and
  • $257 million in grant and per diem payments that support transitional housing provided by community-based organizations.
Veterans Choice Program—Community Care
VA is requesting a total of $13.2 billion in 2018 for Veterans Community Care. This consists of a request for $9.7 billion in discretionary funding for the Medical Community Care account, plus an additional $2.9 billion in new mandatory budget authority for the Choice Program. When combined with $626 million in estimated start-of-year unobligated balances from the original Choice Program appropriation, the total Community Care funding level is $13.2 billion in 2018. The budget also requests $3.5 billion in mandatory budget authority in 2019 for the Choice Program. This additional funding will allow VA to continue increasing Veterans’ access to health care services by allowing them to choose VA direct care or community care.
Other Key Services for Veterans
  • $306 million to administer VA’s system of 136 national cemeteries, including funding for the activation of three new cemeteries that will open in 2018 and 2019. Funds are also included to raise, realign, and clean headstones to ensure VA national cemeteries are maintained as shrines.
  • $4.1 billion for information technology (IT), including investments to strengthen cybersecurity, modernize Veterans’ electronic health records, improve Veterans’ access to benefits, and enhance the IT infrastructure; and
  • $135 million for state cemetery grants and state extended care grants.
  Enhanced Oversight of VA’s programs
  • The 2018 budget requests $159.6 million for the Office of Inspector General (OIG) to enhance oversight and assist the OIG in fulfilling its statutory mission of making recommendations that will help VA improve the care and services it provides.



Monday, May 22, 2017

The Veterans Health Administration

The Veterans Health Administration
(We love our Vets!)
vs.
My Thyroid Gland

Let me say right up front that I understand by Law the VHA must buy their medications from the lowest bidder. I also know that I have been taking a certain medication for almost twenty years.

I started getting it from a private insurance health plan in 1998 and, in 2009, began getting the “same” medication from the Veterans Health Administration. Upon making that switch of provider, I was continued on the same dosage as before. A subsequent blood test showed a remarkable change in my Thyroid number.

I had been taking the “Synthroid” brand-name drug, but when I hit the VA it was changed over to the generic “Levothyroxine”. This change precipitated a change in dosage amount to accomplish the same result I had gotten in the private sector with the “Synthroid”. It sounded like the problem was solved, and I have received “Levothyroxine” from what appears to be the same generic supplier for six years. Much to my surprise, I noticed a change in the color and shape six months ago. I was due for a routine blood test at the VA Medical Center I frequent, and, wouldn’t you know it, my Thyroid number was out of whack again.

So, my Primary Care Doctor readjusted the dosage, and off I went with another new color and shape pill from a different generic supplier.

Well just last week I had my blood tested again; specifically for my Thyroid level, and this time the number came back drastically different from before. No, I didn’t change the mode I have used for nineteen plus years for taking this particular medication. The only change has been the supplier of origin for this medication. Apparently the Veterans Health Administration has absolutely no control mechanism over the suppliers of this drug. For all I know, I could be taking placebo sugar pills. Seems like someone is not minding the Store. Seems someone else is making a lot of money and not delivering the goods. Seems like they are both getting away with it!

And, you wonder what we talk about when we say the VA has been killing Veterans for decades? Not having control over what medications they are purchasing is just one of the many ways the VA has found to legally allow Veterans to die, so they keep their costs down. Believe me, there are a myriad of other mechanisms built into this system designed to produce the exact same result.

This is just one example of why I will keep calling the VA out for its insulting care of our Nation’s Military Veterans. Changes will be made. They will be made by Veterans and a supportive Public; not by the Government, and, certainly, not by the VA.