Rep. Marionette Miller-Meeks (R-IA)
WASHINGTON, DC — Congress is considering several pieces of legislation that would create new funding opportunities for non-VA providers to provide care to veterans outside the community care system. While the bills’ sponsors say they believe this would fill existing gaps in research and treatment, other committee members, as well as VA leaders and physician associations, argue that it syphons money from existing veterans’ healthcare services while providing less oversight.
The Recover Act, crafted by House VA Committee Chair Mike Bost (R-IL), targets provider shortages and capacity constraints in rural areas. It would require VA to carry out a 3-year pilot program under which nonprofit outpatient mental health providers who are already serving veterans but are likely to discontinue care would be eligible for grant awards.
The Beacon Act establishes two grant programs, one to accelerate research into mild TBI with a focus on nonpharmacological and community-based approaches and another to support clinician training, clinical studies and veteran and family outreach. The bill’s crafters, as well as several of the larger veterans’ service organizations, say they believe that the grants will fold civilian and academic expertise into VA treatment strategies and strengthen existing VA programs.
“Too often, we have asked veterans to navigate a system that treats symptoms instead of people. A system that relies on pills instead of purpose. A system that, despite good intentions, has left too many veterans feeling unseen, unheard, and alone,” said Cole Lyle, director of Veterans Affairs & Rehabilitation at The American Legion. “This bill reflects a concerted effort by lawmakers and advocates to listen to veterans’ needs and act on their expertise.”
The Health Desert Reform Act would direct VA to create pilot partnerships with non-VA hospitals in healthcare deserts—areas lacking a VA facility within a reasonable driving distance. According to the bill’s sponsor, Rep. Marionette Miller-Meeks (R-IA), the goal would be to provide veterans with the same level of care they would receive through community care.
“In a health desert, basic care is difficult to maintain, and even the most routine care presents a significant burden for the veteran,” she said at a House VA Health Subcommittee hearing to discuss this and the other proposed legislation.
At the hearing, Rep. Julia Brownley (D-CA) pointed out a common theme between the proposed bills.
“They all siphon money from existing VA programs and redirect it to outside providers to do the very thing VA is already doing, but with fewer guardrails and fewer requirements to ensure quality of care,” Brownley said. “Taken together these bills represent a concerted effort to circumvent VA’s direct care programs and research enterprise and create no strings attached handouts of VA funding to private companies.”
If providers want to provide care to veterans, they should do so by meeting the requirements of the community care network and enrolling that way, she argued.
“I don’t believe we should be creating carve-outs for grant programs that would allow private providers to avoid the requirements of the MISSION Act and still financially benefit from VA funding,” she declared.
Brownley also pointed out that a single non-VA provider could receive funding through one of these grants, while also being part of the community care network, and simultaneously billing veteran’s third-party insurer.
“I can’t see how this makes sense,” she said. “It gives three opportunities to perhaps triple dip.”
VA leaders agree that the grant programs are problematic and possibly not the best way to meet the goals the bills’ sponsors have in mind.
“Grants are one way but not the only way, for providing financial assistance to non-governmental agencies,” said Dr. Mark Koeniger, VA’s acting assistant underecretary for patient-care services. “VA would welcome the opportunity to discuss these bills further with the committee to determine if a different structure would be appropriate.”
Maria Llorente, MD, VA acting assistant undersecretary for integrated care, added, “The community care program does have a series of requirements to make sure the providers who are delivering services to veterans have the needed credentials, have the privileges and offer the quality of care we expect they will deliver. … A community provider could potentially get one of these grants and offer services through these grants that may not meet the requirements under the community care program.”
Conwell Smith, deputy chief for military and veterans policy at the American Psychological Association, said the APA is concerned that building parallel systems risks further fragmenting care, separating veterans from coordinating treatment teams and weakening benefits to VA’s coordinated care model.
“The Recover Act provides $60 million in grants to mental health facilities … but doesn’t require clinicians to meet the training standards expected of VA providers,” she said. “Notably, suicide prevention training is not mandated, even though the bill targets areas with high veteran suicide risk.”