Point Papers

 

2011

POINT PAPERS


Lifespan Respite Care and Funding

The Issue

Paralyzed Veterans of America’s (PVA) members are honorably discharged veterans with spinal cord injury and/or dysfunction. Virtually all use wheelchairs and many need assistance with activities of daily living – generally provided by family members.

Family caregivers in the U.S. provide almost $375 billion in uncompensated services. They are the backbone of the nation’s long term care system, and cite respite care as one of their most pressing needs. Though the Department of Veterans Affairs provides respite services to eligible veterans in DVA medical facilities, only 15% of family caregivers take advantage of the program. Many more would likely take advantage of respite services were they provided in the home. Pub. L. 111-163, the Caregivers and Veterans Omnibus Health Services Act of 2010, will improve the situation for caregivers of eligible veterans (those with service-connected injuries incurred post September 11, 2011) but the majority of PVA members will not be eligible for these increased services.

The Lifespan Respite Care Act (LRCA) was signed into law in 2006, and is to be reauthorized in 2012. Under LRCA, the U.S. Administration on Aging offers competitive grants to state agencies to make quality respite available and accessible to caregivers regardless of age or disability through the establishment of State Lifespan Respite Systems.

LRCA has been severely under-funded and few states have received grants sufficient to set up a substantive respite program. Though authorized for $30 million for fiscal year 2007 rising to $71 million for fiscal year 2010, appropriations for LRCA have been limited to a total of $2.5 million for each of FY 2009/2010. The authorization level for FY 11 for the LCRP is $94.8 million. It is unlikely that the program will receive any increase this year and may be funded at $2.5 million again.

This pattern of gross under-appropriation severely limits the ability of the Lifespan Respite program to achieve its stated goal to “assist family caregivers in accessing affordable and high-quality respite care.”

PVA’s Position

  • PVA asks Congress to appropriate $50 million to fund the Lifespan Respite Care program and support its reauthorization in 2012. With adequate funding, states can establish programs to recruit and train respite providers and provide planned and emergency respite for family caregivers. This is the most urgent need of personal caregivers.

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Protection of The Department of Veterans Affairs Health Care System

The Issue

The Department of Veterans Affairs (VA) is the best health care provider for veterans. Providing primary care and specialized health services is an integral component of VA’s core mission and responsibility to veterans. Across the nation, VA is a model health care provider that has led the way in various areas of medical research, specialized services, and health care technology.

Over the years, VA has earned a reputation as a leader in the medical field for its quality of care and innovation in both the health care and medical research fields. However, even with VA’s advances as a health care provider, political leaders and policy makers continue to advocate for VA enrollment restrictions, use of vouchers, or increased fee basis care. Such changes to the Veterans Health Administration (VHA) would result in moving veterans from “veteran-specific” care within VA and into the private health care industry. Ultimately, these proposals would lead to diminution of VA health care services, and increased health care costs in the federal budget. Despite these recent calls for providing veterans with vouchers for private care or the expansion of fee basis care, PVA strongly believes that VA remains the best option available for veterans seeking health care services.

The VA’s unique system of care is one of the nation’s only health care systems that provide developed expertise in a broad continuum of care. Currently, VHA serves more than 8 million veterans, and provides specialized health care services that include program specific centers for care in the areas of spinal cord injury/disease, blind rehabilitation, traumatic brain injury, prosthetic services, mental health, and war-related polytraumatic injuries. Such quality and expertise on veterans’ health care cannot be adequately duplicated in the private sector.

As VA services are catered to the needs of veterans, VHA has received excellent ratings from patient satisfaction surveys, and garnered much recognition for its national safety program. The VA’s system of patient-centered and coordinated care helps to ensure safe and consistent delivery of services. Additionally, independent research organizations have also found VA to be the lowest cost provider when compared to private industry.

For decades, VA has provided services and benefits to ensure that the unique health care needs of veterans are adequately provided for and that the quality of those services is of the highest caliber possible. Providing primary care and specialized health services is an integral component of the Department of Veterans Affairs’ core mission and responsibility to veterans.

PVA’s Position

  • The Department of Veterans Affairs is the best provider for veterans seeking health care services because it provides a broad continuum of quality specialized services unique to the needs of veterans.
  • The Department of Veterans Affairs and Congress must reject any proposals advocating vouchers for private care or the expansion of fee basis care as such actions will increase the costs of veterans’ health care, weaken VA health care services, and dilute the quality of “veteran-specific” care.

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Defend Social Security

The Issue

In December of 2010, the National Commission on Fiscal Responsibility and Reform issued a set of recommendations for addressing the nation’s massive federal budget deficit. Among those recommendations were changes to Social Security, including increases in the early and full retirement ages, modifications to lower cost-of-living-adjustments [COLAs] and revisions in the benefit formula that would gradually erode the link between a worker’s wages and benefits received. As the deficit debate takes on greater urgency, many in Congress are pointing to cuts in Social Security such as those outlined by this commission and other deficit reduction plans as a necessary component of fiscal reform.

Often ignored in these discussions of Social Security reform is the harmful effect many suggested changes would have on people with disabilities who rely on its disability insurance program. Because retirement, disability and survivor benefits are all based on the same formula, changes to that formula or to measures used to set COLAs will directly affect those receiving Social Security disability insurance [SSDI]. Additionally, increasing the retirement age will put pressure on the SSDI program. Many individuals with chronic health conditions often opt for early retirement benefits because they cannot work any longer. If the early retirement age is raised, they may seek help from the disability program. Any hardship exemption for those unable to reach a higher retirement age will add administrative complexity to the system, thereby increasing costs to Social Security’s operational budget.

While it is critical that order be restored to this country’s financial circumstances, Social Security should not be part of that process. Social Security did not contribute to the deficit. It has been self-financed since its creation and the reforms of 1983 have created a surplus in the Social Security trust fund of $2.6 trillion. Because Congress and administrations over several decades have borrowed that money for other purposes is no reason to penalize current and future beneficiaries. While modest steps should be taken to ensure the long-term strength of Social Security beyond 2037, this should be done outside the current federal deficit debate.

PVA’s Position

  • Because Social Security benefits are a vital source of support for almost all our members, Paralyzed Veterans of America urges Congress to protect Social Security against rash actions that will result in long-term damage to the millions of elderly, survivors and people with disabilities who depend on this social insurance program. PVA calls on Congress to reject calls to include Social Security in discussions of deficit reduction and asks members of the Senate to join the Defend Social Security Caucus and support the Social Security Protection Act.

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Protect The Clas Program

The Issue

Public Law 111-148, the Affordable Care Act (ACA,) established a national, voluntary insurance program for purchasing Community Living Services and Supports (CLASS). CLASS is designed to expand options for working adults who become functionally disabled and require long-term services and supports. Adults who meet eligibility criteria will receive a cash benefit that can be used to purchase non-medical services and supports necessary to remain in the home or community. The Program is voluntary and financed by individual payroll deductions that vest in 5 years.

Section 3208(b) of the ACA states: “No taxpayer funds shall be used for payment of benefits under a CLASS Independent Benefit Plan. For purposes of this subsection, the term ‘taxpayer funds’ means any Federal funds from a source other than premiums deposited by CLASS program participants in the CLASS Independence Fund and any associated interested earnings.” The Secretary of Health and Human Services has the authority to adjust premiums if needed to support the benefits program.

Despite the legal requirement that the CLASS program be self-sustaining, in December of 2010, the National Commission on Fiscal Responsibility and Reform recommended repealing or reforming the CLASS Program to decrease any effect on the national deficit.

The non-partisan Congressional Budget Office estimates federal Medicaid savings of about $2 billion in the initial years the CLASS Program will pay benefits. The CBO acknowledges the difficulty of projecting long term financial effects with the flexibility in the law, but in a recent letter to the Speaker of the House CBO stated: “Repeal of the CLASS provisions would increase federal deficits by $86 billion over the 2012-2021 periods. ... In particular, the program will pay out far less in benefits than it will receive in premiums over the 2012-2021 periods. Consequently, repealing the CLASS provisions would increase federal deficits over that period.”

PVA’s Position

  • PVA calls on Congress to support the CLASS Program and work with the Secretary to ensure its implementation. By law, CLASS cannot use federal funds to pay benefits, and will not affect the deficit except to decrease payouts through Medicaid. The CLASS Program will allow working Americans to prepare for their future needs / independence in a responsible way.

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Special Monthly Compensation (SMC)


The Issue

It is often overlooked that veterans with significant catastrophic disabilities are likely to be compensated from the impact on loss of quality of life. Special Monthly Compensation (SMC) represents payments for “quality of life” issues, such as the loss of an eye or limb, the inability to naturally control bowel and bladder function, the inability to achieve sexual satisfaction or the need to rely on others for the activities of daily life like bathing, or eating. Many severely injured veterans do not have the means to function in an independent setting and need intensive care on a daily basis. Many veterans spend more on daily attendant care than they are receiving in SMC benefits. The impact on quality of life of the extreme nature of disabilities incurred by most veterans in receipt of SMC cannot be totally compensated for; however, SMC does at least offset some of the loss of quality of life.

One of the most important SMC benefits to PVA is Aid and Attendance (A&A). PVA would like to recommend that Aid and Attendance benefits be appropriately increased. Attendant care is very expensive and often the Aid and Attendance benefits provided to eligible veterans do not cover this cost. In fact, many PVA members who pay for full-time attendant care incur costs that far exceed the amount they receive as SMC-Aid and Attendant beneficiaries at the R2 compensation level (the highest rate available). We encourage the Committee to consider the provisions of legislation introduced during the 111th Congress, H.R. 3407, the “Severely Injured Veterans Benefits Improvement Act of 2009,” that specifically addresses increases to the R1 and R2 rates for SMC.

This legislation would ensure that severely injured veterans receive all the support they are owed without forcing them and their loved ones to endure financial strains or hardship. Due to the high importance this issue carries and the catastrophically disabled veterans it affects, legislation needs to be drafted and enacted during the the 112th Congress.

PVA’s Position  

  • Paralyzed Veterans of America (PVA) calls on Congress to enact legislation to increase SMC benefits that are essential for our veterans with severe disabilities.

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Inappropriate Billing

The Issue

In recent years, PVA has seen significant increases in medical care collections estimates as well as the actual dollars collected by the Department of Veterans Affairs (VA). We have received an increasing number of reports from veterans who are being inappropriately billed by the Veterans Health Administration (VHA) for their care. Moreover, this is not a problem being experienced by just service-connected disabled veterans, but non-service connected disabled veterans as well.

Inappropriate charges for VA medical services places unnecessary financial stress on individual veterans and their families. These inaccurate charges are not easily remedied and their occurrence places the burden for correction directly on the veteran, their families or caregivers. PVA believes that many veterans are not aware of these mistakes and simply submit full payment to VA when a billing statement arrives at their home. Veterans who identify erroneous charges face a cumbersome process to correct the problem and receive a credit for the error on a subsequent billing statement. This is not an easy task for veterans as VA billing statements are often received months after actual medical care is provided.

To understand inappropriate billing, it is important to emphasize that service-connected and non-service connected veterans have experienced this problem; however, the problems they have are uniquely different. Service-connected veterans face a scenario where they, or their insurance company, may be billed for treatment of a service-connected condition.

The vast majority of PVA members who are service-connected are rated as 100 percent PERMANENT and TOTAL, suggesting that any condition a veteran experiences is related to his or her service-connected condition. This should mean that 100 percent PERMANENT and TOTAL service-connected disabled veterans should not be billed, nor should their insurance company be billed, for any treatment they receive.

Meanwhile, non-service connected disabled veterans are usually billed multiple times for the same treatment episode or have difficulty getting their insurance companies to pay for treatment provided by the VA. While P.L. 111-163, the “Caregivers and Veterans Omnibus Health Services Act” which became law on May 5, 2010, prohibits VA from collecting co-payments from catastrophically disabled non-service connected veterans for medical services, this may not remove all the problems non-service connected veterans face.

PVA’s Position

  • The VA Under Secretary for Health should establish policies and monitor compliance to prevent veterans from being billed for service-connected conditions and secondary symptoms or conditions that are related to a service-connected disability.
  • Congress should enact legislation that exempts veterans who are service-connected with permanent and total disability ratings from being subjected to first- or third-party billing from treatment of any condition.

 

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Increase in ChamPVA Beneficiary Age

The Issue

P.L. 111-148, the “Patient Protection and Affordable Care Act,” extended the eligibility age for dependent children being carried on their parents’ health insurance policies to 26 years old. Unfortunately, this benefit was not initially provided to TRICARE and CHAMPVA beneficiaries. The extension was subsequently provided to dependent children of military personnel (those on TRICARE) by P.L. 111-383, the “National Defense Authorization Act (NDAA) for FY 2011.”

Unfortunately, CHAMPVA beneficiaries were omitted from the NDAA when it became law. At this time, the only qualified dependents that are not covered under a parent’s health insurance policy are those of 100 percent service-connected disabled veterans covered under CHAMPVA. To address this issue, legislation was introduced in the House of Representatives—H.R. 115, the “CHAMPVA Children’s Protection Act of 2011.” At this time, similar legislation has not been introduced in the Senate; however, we have been assured by the Senate Committee on Veterans’ Affairs that companion legislation will soon follow.

PVA’s Position

  • PVA urges the Senate to introduce companion legislation to H.R. 115, the “CHAMPVA Children’s Protection Act of 2011.”
  • PVA urges Congress to enact H.R.115, the ”CHAMPVA Children’s Protection Act of 2011,” to ensure that the dependent children of 100 percent service-connected disabled veterans are afforded the same health care protections as all other children.

 

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FY 2012 VA Health Care Budget

The Issue

Last year the Administration recommended an advance appropriation for FY 2012 of approximately $50.6 billion in discretionary funding for VA medical care. The House of Representatives recently supported this recommendation in H.R. 1, the “Continuing Resolution for FY 2011.” When combined with the $3.7 billion Administration projection for medical care collections, the total available operating budget recommended for FY 2012 is approximately $54.3 billion. However, included in the President’s Budget Request for FY 2012, the Administration revised the estimates for Medical Care down by $713 million due to the proposed federal pay freeze (a factor not included in H.R.1).

Of particular concern to The Independent Budget is an ill-defined contingency fund that would provide $953 million more for Medical Services for FY 2012. Moreover, we are especially concerned that the VA presumes “management improvements” of approximately $1.1 billion to be directed towards FY 2012 and FY 2013. The use of management improvements or efficiencies was a gimmick commonly used in the past to reduce the requested level of discretionary funding; and yet, rarely did the VA realize any actual savings from those gimmicks. Additionally, we are concerned about the revised estimate in Medical Care Collections from the originally projected $3.7 billion to now only $3.1 billion. Given this revision in estimates, the VA budget request may arguably be short $600 million in budget authority for next year.

For FY 2012, the Administration recommends $53.9 billion for total Medical Care spending. The Independent Budget recommends approximately $55.0 billion for total medical care. This includes approximately $43.8 billion for Medical Services.

We are also concerned about the steep reduction in spending for Medical and Prosthetic Research. The Independent Budget recommends $620 million, approximately $111 million more than the Administration’s request. Research is a vital part of veterans’ health care, and an essential mission for our national health care system. At a time of war, the government should be investing more, not less, in veterans’ biomedical research programs.

We are pleased to see that the Administration has proposed an increase in the Medical Care accounts for FY 2013. The Administration recommends $55.8 billion for total medical care budget authority for FY 2013. We urge Congress to remain vigilant to ensure that the proposed funding levels for FY 2013 are in fact sufficient to meet the continued growth in demand on the health care system.

PVA’s Position

  • Congress must ensure that sufficient funding is provided to the Department of Veterans Affairs health care system for FY 2012.
  • Congress must support advance appropriations funding recommendations that will ensure sufficient, timely, and predictable funding for FY 2013.
  • Congress must appropriate $620 million for medical and prosthetic research, $111 million more than the Administration’s request.

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