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Mr. Chairman, I again commend Mr. Stearns for
conducting a subcommittee oversight hearing in 1998 to determine
if VA was maintaining its capacity to provide specialized rehabilitative
services to disabled veterans. BVA is convinced that a follow-up
hearing is necessary given the negative testimony suggesting that
VA is falling far short of its legislative mandate. The final
GAO report on this issue released last year, further documenting
VA’s failure to maintain capacity, should be the focus of
the hearing. How these specialized services are being integrated
into the new managed primary model of health care delivery must
be thoroughly examined. Additionally, the VERA model must be reviewed
in terms of its applicability to the special programs. The major
question concerns the appropriateness of a capitated model of
resource allocation for these programs. Furthermore, we have maintained
that the issue of centralized management and funding should be
explored in greater debate. We believe other questions need answers
such as the role of the program officials at VAHQ. If the special
disability programs are national in scope, who is responsible
for developing and disseminating national guidelines and performance
standards for these programs? In the same context, do the special
program managers at VAHQ have any real authority or responsibility
for the conduct of the programs in the field?
BVA appreciates the enormous task VHA has
taken on in the transition to the new model of service delivery.
We understand the need for sufficient time to fully implement
the new changes. We do not want to appear to be alarmists regarding
the problems we have identified above but feel the new system
is far enough along to reveal at least somewhat, how the special
disability programs are to be treated in the new VHA. Our concern
does not lie so much with what Dr. Kizer and Dr. Garthwaite have
prescribed as their vision for the VA health care system, as it
does with the manner in which implementation has taken place in
the field. Ongoing oversight hearings could shed light on these
important issues and assist in protecting these programs as intended
by the Eligibility Reform Act. We also believe the status of the
recommendations adopted by the Gold Ribbon Panel appointed by
Dr. Garthwaite, should be carefully reviewed by the Subcommittee.
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