| |
Mr. Chairman, significant disincentives exist
within the VERA model as currently constructed. BRS, through its
Blind Rehabilitation Outpatient Specialist (BROS) program, is
making a substantial effort to provide blind rehab services when
appropriate on an outpatient basis and seek opportunities to contract
for services in a veteran's local area. VERA, however, does not
currently have an intermediate reimbursement rate that will compensate
the local facility as this system objective is accomplished. For
example, if a BROS completes a comprehensive needs assessment
for a blinded veteran, the BROS then determines that the veteran
could have his needs met through the provision of local services.
The local facility is required to pay for these services. In some
cases, it may be appropriate to contract locally for such services.
The basic reimbursement rate, however, is not likely to cover
the costs of these contracted services. Therefore, it is in the
interest of the local facility manager to refer this veteran to
a BRC for training in order to receive the high reimbursement
rate.
Clearly, it is much more cost effective as a
whole to provide services locally, when appropriate, rather than
referring a veteran to a residential program some distance from
his or her home. Unfortunately, local facility managers do not
view this option as cost-effective. Indeed, it is more costly
than the resources provided under VERA. BVA is not advocating
for wholesale contracting of services as this certainly is not
in the best interest of blinded veterans. We do recognize however
that there may be certain blinded veterans who, for whatever reason,
cannot, or will not attend a residential program though they still
have needs that must be addressed. The BROS program provides an
excellent opportunity to test, refine, and validate the effectiveness
of outpatient service delivery. It assists in determining which
veterans can receive maximum benefit from this rehabilitation
model. Even if providing services locally on an outpatient basis
is the right thing to do, there are sufficient disincentives in
VERA that discourage this approach. We have conveyed this concern
to VHA officials. It does not appear, however, that the model
will be modified to remove this disincentive. Access and timeliness
of service delivery are important issues related to VA's statutory
responsibility to maintain its capacity to provide rehabilitative
services to disabled veterans.
|
|
