New Bill: VA Must Provide for Veterans Seeking Outside Mental Health Services

by U.S. Medicine

November 6, 2013

By Sandra Basu

WASHINGTON — Amid controversy about treatment backlogs at some medical centers, VA recently announced a new initiative to ensure timely healthcare, including mental healthcare, to its veteran patients.

The program also supplements care in a new area for VA: childbirth.

Through the new Patient-Centered Community Care initiative, medical centers will be able to purchase non-VA care for veterans through local contracted medical providers when there is limited capacity at the facility or geographical distance poses a problem to the veteran.

According to VA, “eligible veterans will have access to inpatient specialty care, outpatient specialty care, mental health care, limited emergency care, and limited newborn care for enrolled female veterans following the birth of a child.”

“PCCC provides a regional contracting vehicle for VA to work with local community providers to give veterans access to high quality care,” said Robert Petzel, MD, VA’s Under Secretary for Health in a written statement. “It will also help VA in our continued efforts to ensure timely and accessible services are provided to veterans for non-VA medical care.”

The new initiative comes as the chairman of a key House committee has been calling for VA to do more to ensure timely mental healthcare for veterans.

While VA announced this year it had met its goal to hire 1,600 new mental health specialists and that it has hired more than 2,005 mental health clinical providers to fill existing vacancies, House Committee on Veterans’ Affairs Chairman Rep. Jeff Miller (R-FL) has promoted his draft legislation that would require VA to contract with non-VA facilities to coordinate care for veterans who elect to receive mental health care outside VA.

“The status quo, with an overburdened VA failing to adequately deliver mental health care to veterans who need it most, is what is truly undermining the integrity of the VA system. Allowing VA to offer care through qualified private-sector providers will help relieve the backlog of veterans waiting for mental health appointments, thereby enabling the department to provide better treatment for those they do see, and better access for all veterans,” he wrote in an opinion piece in September for the Huffington Post.

House Committee on Veterans’ Affairs Chairman Rep. Jeff Miller (R-FL) after a joint hearing with the House Armed Services.

Care Coordination

Miller’s draft bill requires that mental healthcare be provided to an eligible veteran who elects to receive care at a non-VA facility through a care-coordination contract with a “qualified entity.” The bill would require that entity to meet specific performance metrics “regarding quality and timeliness of care and exchange relevant clinical information with VA.”

He said these provisions would ensure that mental healthcare provided to veteran patients is timely and coordinated from the initial point of contact throughout the recovery process.

“Last year, the IG found that more than half of the veterans who go to VA seeking mental healthcare services wait 50 days on average to receive even an initial evaluation,” he said during a hearing on the draft legislation earlier this year. “This year, the IG found that thousands of Georgia veterans had fallen through giant cracks in VA’s mental healthcare system and may or may not have received the care they so desperately needed. We cannot wait to see what next year brings.”

Miller was referring to problems at the Atlanta VAMC, where four deaths were attributed to inadequate VA mental health services and/or oversight of outside providers.

The reaction to the bill from organizations representing troops and veterans was mixed, however.

Alex Nicholson, legislative director for the Iraq and Afghanistan Veterans of America, told the committee earlier this year that his organization supports the legislation.

“IAVA’s 2013 membership survey revealed that 80% of our respondents don’t think service members and veterans are getting the mental health care they need. IAVA believes that one way to help address the mental healthcare needs of veterans is through building the type of community partnerships that are advocated in and facilitated by this bill,” he said.

Other organizations, including the Paralyzed Veterans of America, said at that time they do not support the bill.

PVA Associate Director of Health Legislation Alethea Predeoux told lawmakers her organization believes that “current VA initiatives should be further developed before additional resources are put into another program for non-VA care-coordination.” “The VA is currently working on multiple initiatives to improve care-coordination with private providers and increase timely access to mental health services,” she explained.

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